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Sample records for thoracic fusion surgery

  1. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    PubMed Central

    Minato, Tsuyoki; Miyagi, Masayuki; Saito, Wataru; Shoji, Shintaro; Nakazawa, Toshiyuki; Inoue, Gen; Imura, Takayuki; Minehara, Hiroaki; Matsuura, Terumasa; Kawamura, Tadashi; Namba, Takanori; Takahira, Naonobu; Takaso, Masashi

    2016-01-01

    We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case. PMID:26989542

  2. [Surgery for thoracic tuberculosis].

    PubMed

    Kilani, T; Boudaya, M S; Zribi, H; Ouerghi, S; Marghli, A; Mestiri, T; Mezni, F

    2015-01-01

    Tuberculosis is mainly a medical disease. Surgery has been the unique therapeutic tool for a long time before the advent of specific antituberculous drugs, and the role of surgery was then confined to the treatment of the sequelae of tuberculosis and their complications. The resurgence of tuberculosis and the emergence of multidrug-resistant TB combined to immunosuppressed patients represent a new challenge for tuberculosis surgery. Surgery may be indicated for a diagnostic purpose in patients with pulmonary, pleural, mediastinal or thoracic wall involvement, or with a therapeutic purpose (drainage, resection, residual cavity obliteration). Modern imaging techniques and the advent of video-assisted thoracic surgery allowed a new approach of this pathology; the majority of diagnostic interventions and selected cases requiring lung resection can be performed through a mini-invasive approach. Patients proposed for aggressive surgery may be treated with the best results thanks to a good evaluation of the thoracic lesions, of the patients' nutritional, infectious and general status combined with a good coordination between the specialized medical team for an optimal preparation to surgery. PMID:24894967

  3. European perspectives in thoracic surgery

    PubMed Central

    2014-01-01

    Europe, the old Continent, has been the cradle of thoracic surgery from the beginning of the last century. The structure and the activities of the European Society of Thoracic Surgeons (ESTS) activities are directed to enlighten the path, provide the tools and set the standards for a quality inspired practice in thoracic surgery. PMID:24868436

  4. Robotic Surgery for Thoracic Disease.

    PubMed

    Yamashita, Shin-Ichi; Yoshida, Yasuhiro; Iwasaki, Akinori

    2016-02-20

    Robotic surgeries have developed in the general thoracic field over the past decade, and publications on robotic surgery outcomes have accumulated. However, controversy remains about the application of robotic surgery, with a lack of well-established evidence. Robotic surgery has several advantages such as natural movement of the surgeon's hands when manipulating the robotic arms and instruments controlled by computer-assisted systems. Most studies have reported the feasibility and safety of robotic surgery based on acceptable morbidity and mortality compared to open or video-assisted thoracic surgery (VATS). Furthermore, there are accumulated data to indicate longer operation times and shorter hospital stay in robotic surgery. However, randomized controlled trials between robotic and open or VATS procedures are needed to clarify the advantage of robotic surgery. In this review, we focused the literature about robotic surgery used to treat lung cancer and mediastinal tumor. PMID:26822625

  5. Evolution of thoracic surgery in Canada

    PubMed Central

    Deslauriers, Jean; Griffith Pearson, F; Nelems, Bill

    2015-01-01

    BACKGROUND: Canada’s contributions toward the 21st century’s practice of thoracic surgery have been both unique and multilayered. Scattered throughout are tales of pioneers where none had gone before, where opportunities were greeted by creativity and where iconic figures followed one another. OBJECTIVE: To describe the numerous and important achievements of Canadian thoracic surgeons in the areas of surgery for pulmonary tuberculosis, thoracic oncology, airway surgery and lung transplantation. METHOD: Information was collected through reading of the numerous publications written by Canadian thoracic surgeons over the past 100 years, interviews with interested people from all thoracic surgery divisions across Canada and review of pertinent material form the archives of several Canadian hospitals and universities. RESULTS: Many of the developments occurred by chance. It was the early and specific focus on thoracic surgery, to the exclusion of cardiac and general surgery, that distinguishes the Canadian experience, a model that is now emerging everywhere. From lung transplantation in chimera twin calves to ex vivo organ preservation, from the removal of airways to tissue regeneration, and from intensive care research to complex science, Canadians have excelled in their commitment to research. Over the years, the influence of Canadian thoracic surgery on international practice has been significant. CONCLUSIONS: Canada spearheaded the development of thoracic surgery over the past 100 years to a greater degree than any other country. From research to education, from national infrastructures to the regionalization of local practices, it happened in Canada.

  6. Analgesia in thoracic surgery: review.

    PubMed

    De Cosmo, G; Aceto, P; Gualtieri, E; Congedo, E

    2009-06-01

    Post-thoracotomy pain is one of the most severe types of postoperative pain. It can last up to 2 months and can become chronic in 30% of patients. Pain relief after thoracic surgery is of particular significance, not only for ethical considerations but also for reduction of postoperative pulmonary and cardiac complications. Because of the difficulty in pain control, many approaches have been suggested, but a multimodal therapeutic strategy that provides a central or peripheral block associated with nonsteroidal anti-inflammatory (NSAID) and adjuvant drugs is now the cornerstone of treatment, offering the possibility of reducing opioid requirements and side effects. Thoracic epidural analgesia with local anesthetics and opioids is regarded as the gold standard treatment for post-thoracotomy pain management because it results in early extubation, better ventilatory mechanisms and gas exchange, decreased incidence of atelectasis, pneumonia and chronic postoperative pain. When epidural analgesia is contraindicated or cannot be performed, other regional techniques of analgesia can be used. An alternative method of providing adequate pain relief is a thoracic paravertebral block: continuous paravertebral infusion of local anesthetic via a catheter placed percutaneously or under direct vision during thoracotomy. This is effective in controlling postoperative pain and in preserving pulmonary function. Other techniques, such as intercostal and interpleural blocks, are rarely utilized, whereas a single shot of intrathecal injection of a hydrophilic opioid, such as morphine, appears to be effective. Cryoanalgesia, which is successful in the immediate postoperative period, has been abandoned for its brief duration and increased incidence of chronic pain. PMID:18953284

  7. Nonintubated anesthesia in thoracic surgery: general issues

    PubMed Central

    Castillo, Maria

    2015-01-01

    Anesthetic management for awake thoracic surgery (ATS) is more difficult than under general anesthesia (GA), being technically extremely challenging for the anesthesiologist. Therefore, thorough preparation and vigilance are paramount for successful patient management. In this review, important considerations of nonintubated anesthesia for thoracic surgery are discussed in view of careful patient selection, anesthetic preparation, potential perioperative difficulties and the management of its complications. PMID:26046051

  8. [Gastrontestinal hemorrhage following thoracic surgery].

    PubMed

    Durić, O; Tvrtković, R; Budalica, M

    1976-01-01

    The authors discuss eight cases who suffered hemorrhaging stress ulcers out of 200 cases on whom Thoracotomies were performed. Presented is the common factor of the onset of this complication, it's diagnosis, and therapy. Listed below are the diagnoses and operative procedures used on these eight patients. Cysta Aerea Permagna Lobi Inf. Pulm. Dexter/operation: Mytomis Longitudinalis Ooesophagi. Caverna Bronchiectatica Permagna Lobi Inferior Pulmo Dexter/operation: Lobestomia Typica. Echinococcus Heaptis Complicatus, Empyema Pleurae Dexter/opetation: Decorticatio. Haemathorax Spontaneous Lobus Sinister/operation: Decorticatio Pleurae Sinister. Echi Comp. Cupolae Hepatis Permagnus/operation: Thoracotomia Phrenotomia, evacuatio, Triplex Drainage. Bronchiectasiae Lobi Medius et Inferior Pulmo Dexter/operation: Biblobectomia Typica. Carcinoma Bronchi Lobi Inferior Pulmo Dexter/operation: Lobectomia Typica. Gastric problems had troubled four of these eight patients in their past history. Bleeding in three patients occurred three days postoperatively, and in the remaining five, thirty days following their operation. Six patients had to be treated conservatively because of serious contraindications to reoperation. Four of them expired. Autopsy revealed: Pyothorax, Dehiscention Bronchi, Empyema, and Gastritis Errosiva with multiulcerations, hemoragia, and dilatation of the right heart. Two patients with recent stress ulcers were reoperated on, and were cured. The authors estimate that the occurrence of hemorrhaging stress ulcer following thoracic surgery are basically due to Hypoxia. The chain of events whic brought about the stress ulcer, however, began even before the operation, continued throughout the operation, and appeared postoperatively due to postoperative complications. The authors point out that these complications can be foreseen (early and late), but firstly, an attempt should be made to treat the patient with conservative therapy. Inasmuch as the hemorrhaging does not respond to conservative measures, conservative surgery is indicated; Suture and Vagotomy, and eventually pyloroplasty. PMID:1085089

  9. The History of Duke Thoracic Surgery.

    PubMed

    Smith, Peter K; Mulvihill, Michael S; D'Amico, Thomas A

    2015-01-01

    Since 1931, Duke Thoracic Surgery has been defined by excellence in patient care, research, and the education of leaders in surgery. In this work, the history, contributions, historic figures, and current structure of the program are reviewed. The program has cultivated a commitment to surgical investigation and training that persists to the present day. This commitment is manifest by the program's contributions to the field of cardiothoracic surgery, from the fundamental investigation of the coronary circulation and the development of the heat exchanger for myocardial preservation, to large-scale clinical trials in cardiac and thoracic surgery. PMID:26811042

  10. Modern impact of video assisted thoracic surgery

    PubMed Central

    D’Amico, Thomas A.

    2014-01-01

    With advancement in technology, experience and training over the last two decades, video assisted thoracic surgery (VATS) has become widely accepted and utilized all over the world. VATS started as a diagnostic tool in the early 1990s, technique of VATS lobectomy evolved and became safer over the next 10-15 years and now it is being used for more advanced and hybrid operations. VATS has contributed to the development of minimally invasive surgical interventions for other thoracic disorders like mediastinal tumors and esophageal cancer as well. This article looks at the advantages of VATS, technique advancements and its applications in other thoracic operations and its influence on the present and future of thoracic surgery. PMID:25379201

  11. [Video-assisted thoracic surgery, lung transplantation and mediastinitis: major issues in thoracic surgery in 2010].

    PubMed

    Borro, José M; Moreno, Ramón; Gómez, Ana; Duque, José Luis

    2011-01-01

    We reviewed the major issues in thoracic surgery relating to the advances made in our specialty in 2010. To do this, the 43(rd) Congress of the Spanish Society of Pneumology and Thoracic Surgery held in La Coruña and the articles published in the Society's journal, Archivos de Bronconeumología, were reviewed. The main areas of interest were related to the development of video-assisted thoracic surgery, lung transplantation and descending mediastinitis. The new tumor-node-metastasis (TNM) classification (7(th) edition), presented last year, was still a topical issue this year. The First Forum of Thoracic Surgeons and the Update in Thoracic Surgery together with the Nurses' Area have constituted an excellent teaching program. PMID:21300211

  12. Thoracic hyperkyphosis: assessment of the distal fusion level.

    PubMed

    Lundine, Kristopher; Turner, Peter; Johnson, Michael

    2012-06-01

    Study Design This is a retrospective study. Objective The objective of this study was to assess the sagittal stable vertebra (SSV) versus the first lordotic vertebra (FLV) as the inferior fusion level in patients undergoing spinal surgery for thoracic hyperkyphosis. The main outcome of interest was the development of distal junctional kyphosis (DJK). Summary of Background Data Prior research has pointed to selection of the FLV for the distal instrumentation level in fusion for thoracic hyperkyphosis. In 2009, Cho et al introduced the concept of the SSV after recognizing the development of DJK despite fusion to the FLV. Methods Patients were reviewed who had undergone spinal fusion for thoracic hyperkyphosis. Preoperative radiographs were reviewed to assess thoracic kyphosis, lumbar lordosis, SSV, and FLV. Postoperative radiographs were reviewed to assess curve correction and whether patients developed DJK or implant failure. Results We reviewed 22 patients with a mean age at surgery of 18 (range 14 to 22). Mean preoperative kyphosis was 85 ± 14 degrees, and mean postoperative kyphosis at final follow-up was 59 ± 12 degrees for a mean correction of 26 ± 12 degrees. Eleven patients developed DJK and four patients experienced hardware failure. In 12 patients, the SSV was inferior to the FLV. Rates of DJK when the instrumentation included the SSV or FLV were 13 and 38%, respectively. Conclusions Fusion to the SSV is superior at preventing DJK when compared with fusion to the FLV. PMID:24353949

  13. [Precise thoracic surgery: new era of minimally invasive surgery].

    PubMed

    Li, Hui

    2015-10-01

    Precise surgery is based on the integrated application of modern science and technology and integrated innovation of surgical technology revolution features. It is built in high-end digital medical bases. The purpose of precise surgery is to achieve accurate lesion resection, minimize injury, improve the quality of life and reduce the risk of surgery. In this paper we forward new concept of precise thoracic surgery. An overview was made on the development of precise surgery with great support of virtual reality technology, augmented reality technology and image acquisition technology. Finally the paper illustrated the prospect of precise of thoracic surgery from the following aspects: preoperative planning, the choice of surgical approach, precise tumor localization, postoperative immediate 3-dimension multi modality imaging evaluation. PMID:26654300

  14. [Efficacy of soft coagulation in thoracic surgery].

    PubMed

    Sato, Yukio

    2014-07-01

    The soft coagulation is a novel mode of electrosurgical device which automatically regulates its output voltage to stay below 190 Volts, causing pure coagulation without carbonization. The soft coagulation is available with bipolar and monopolar devices in thoracic surgery. Bipolar scissors can be applied for dissection of pulmonary vessels safely and efficiently without the damage to vessel wall. Monopolar soft coagulation can be applied to shrink bullous change of lung, cease air leakage from lung parenchyme or bleeding from pulmonary vessels. PMID:25138947

  15. Is incentive spirometry effective following thoracic surgery?

    PubMed

    Agostini, Paula; Calvert, Rachel; Subramanian, Hariharan; Naidu, Babu

    2008-04-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether incentive spirometry is a useful intervention for patients after thoracic surgery. Altogether 255 papers were found using the reported search, of which seven represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that incentive spirometry is a relatively good measure of lung function and may be used to assess respiratory recovery in the days after thoracic surgery. Physiotherapy either with or without incentive spirometry reduces the incidence of postoperative complications and improves lung function but there is currently no evidence that incentive spirometry in itself could either replace or significantly augment the work of the physiotherapists. Clinicians should be aware that while incentive spirometry can provide an assessment of lung recovery, well-organised and regular physiotherapy remains the most effective mechanism to augment their patient's recovery and avoid postoperative complications. PMID:18039692

  16. The European educational platform on thoracic surgery

    PubMed Central

    Rocco, Gaetano; Venuta, Federico

    2014-01-01

    As the largest scientific organisation world-wide exclusively dedicated to general thoracic surgery (GTS), the European Society of Thoracic Surgeons (ESTS) recognized that one of its priorities is education. The educational platform designed ESTS addresses not only trainees, but also confirmed thoracic surgeons. The two main aims are (I) to prepare trainees to graduation and to the certification by the European Board of Thoracic Surgery and (II) to offer opportunities for continuous medical education in the perspective of life-long learning and continuous professional development to certified thoracic surgeons. It is likely that recertification will become an obligation during the coming decade. At its inception, the platform differentiated two different events. A 6-day course emphasizing on theoretic knowledge was created in Antalya in 2007. The same year, a 2-day school oriented to practical issues with hands-on in the animal lab was launched in Antalya. These two teaching tracks need further development. In the knowledge track, we intend to organize highly specialized 2-day courses to deepen insight into theoretical questions. The skill track will be implemented by specialized courses for high technology such as tracheal surgery, ECMO, robotics or chest wall reconstruction. In order to promote tomorrows’ leadership, we created an academic competence track giving an insight into medical communication, methodology and management. We also had to respond to an increasing demand from the Russian speaking countries, where colleagues may face problems to attend western meetings, and where the language bareer may be a major impediment. We initiated a Russian school with three events yearly in 2012. Contemporary teaching must be completed with an e-learning platform, which is currently under development. The school activities are organized by the educational committee, which is headed by the ESTS Director of Education, assisted by coordinators of the teaching tracks and e-learning platform. Ongoing discussions concern development of contemporary teaching techniques and measure of outcome. The major challenge for the coming years is harmonisation of training and certification in thoracic surgery in the European space. PMID:24868446

  17. Developing the academic thoracic surgeon: teaching surgery.

    PubMed

    Baumgartner, W A; Greene, P S

    2000-04-01

    Teaching surgery can be a very gratifying experience for those of us involved in academic thoracic surgery. Fundamentals of a good residency program require that patients should always be placed in the highest priority. However, the residency program should also be committed to teaching as a priority. Creating the proper operating room environment is essential for optimal conduct of the operation. This environment is similar to that of the airline industry, which is known as crew or cockpit resource management. The design of a teaching program needs to have evaluation as one of its key elements. In addition to resident evaluation, it is also important to have faculty evaluation by the residents. The goal of any residency program should be to foster the development of the future leaders in our specialty. The information contained within this article represents the art and science of teaching thoracic surgery as applied by the faculty in the Division of Cardiac Surgery at The Johns Hopkins Hospital. PMID:10727957

  18. Management of a Left Internal Thoracic Artery Graft Injury during Left Thoracotomy for Thoracic Surgery.

    PubMed

    Oates, Matthew; Yadav, Sumit; Saxena, Pankaj

    2016-07-01

    There have been some recent reports on the surgical treatment of lung cancer in patients following previous coronary artery bypass graft surgery. Use of internal thoracic artery graft is a gold standard in cardiac surgery with superior long-term patency. Left internal thoracic artery graft is usually patent during left lung resection in patients who present to the surgeon with an operable lung cancer. We have presented our institutional experience with left-sided thoracic surgery in patients who have had previous coronary artery surgery with a patent internal thoracic artery graft. PMID:26907619

  19. Robotic thoracic surgery: from the perspectives of European chest surgeons

    PubMed Central

    2014-01-01

    Although thoracic surgery is one of the fastest growing programs, the results of robotic thoracic surgery reports are presented very rarely. In this manuscript, the development of robotic thoracic surgery programs in Europe and the initial results are discussed. Several European countries lead the development of robotic surgery in the world, especially for lung cancer surgery and for thymus—thymoma surgery. Yet, we may not recognize any major advantage in the outcome when compared to video-assisted thoracic surgery (VATS). But, certainly, the superior capabilities of the intraoperative instrumentation of robotic surgery will be beneficial. More experience in robotic surgery may provide superior results in oncological, physiological and life quality measurements. PMID:24868438

  20. The Society of Thoracic Surgeons General Thoracic Surgery Database Update on Outcomes and Quality.

    PubMed

    Seder, Christopher W; Wright, Cameron D; Chang, Andrew C; Han, Jane M; McDonald, Donna; Kozower, Benjamin D

    2016-05-01

    The Society of Thoracic Surgeons General Thoracic Surgery Database (STS GTSD) is a voluntary effort that provides participants with semiannual, risk-adjusted performance reports that facilitate quality improvement and comparison of institutional outcomes with national benchmarks. With improved participation in the STS GTSD, increasingly meaningful analyses are available. This year, risk models for lobectomy and esophagectomy for cancer were updated. In addition, we developed the first composite quality measure for general thoracic surgery, a composite measure for lobectomy for lung cancer. Furthermore, international collaboration with the European Society of Thoracic Surgery has facilitated our understanding of variation between American and European treatment patterns, providing a foundation for future quality improvement initiatives. This article summarizes current aggregate national outcomes in general thoracic surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency from the STS GTSD over the past 12 months. PMID:27041451

  1. [Flexible endoscope in thoracic surgery: CITES or cVATS?].

    PubMed

    Assouad, J; Fénane, H; Masmoudi, H; Giol, M; Karsenti, A; Gounant, V; Grunenwald, D

    2013-10-01

    Early pain and persistent parietal disorders remains a major unresolved problem in thoracic surgery. Thoracotomy and the use of multiple ports in most Video Assisted Thoracic Surgery (VATS) procedures are the major cause of this persistent pain. For the last decade, a few publications describing the use of either single incision VATS and cervical thoracic approaches have been reported without significant results in comparison with current used techniques. Intercostals compression during surgery and early after by intercostals chest tube placement, are probably the major cause of postoperative pain. Flexible endoscope is currently used in several surgeries and will take more and more importance in our daily use in thoracic surgery. Instrument flexibility allows its use through minimally invasive approaches and offers a very interesting intra-thoracic navigation. We describe here the first use in France of a flexible endoscope in thoracic surgery through a single cervical incision to perform simultaneous exploration and biopsies of the mediastinum and right pleura using the original approach of Cervical Incision Thoracic Endoscopic Surgery (CITES). PMID:24041974

  2. Minimally invasive thoracic surgery: new trends in Italy

    PubMed Central

    2015-01-01

    In Italy there exists quite a long and rich history in minimally invasive thoracic surgery. Pioneer Italian surgeons have been amongst those who first adopted video-assisted thoracic surgery (VATS) to perform procedures such as lobectomy and esophagectomy, respectively and quite many others have provided important contributions related to minimally invasive thoracic surgery and have proposed innovative ideas and creative technical refinements. According to a web search on recent studies published in Italy on minimally invasive thoracic surgery along the last 3 years, uniportal, nonintubated, and robotic VATS as well as VATS lobectomy have been found to represent the most frequently investigated issues. An ongoing active investigation in each of these sub-topics is contributing to a better definition of indications advantages and disadvantages of the various surgical strategies. In addition it is likely that combination strategies including adoption of uniportal and nonintubated approaches will lead to define novel ultra-minimally invasive treatment options. PMID:26605315

  3. Video-Assisted Thoracic Surgery for Tubercular Spondylitis

    PubMed Central

    Singh, Roop; Gogna, Paritosh; Parshad, Sanjeev; Karwasra, Rajender Kumar; Karwasra, Parmod Kumar; Kaur, Kiranpreet

    2014-01-01

    The present study evaluated the outcome of video-assisted thoracic surgery (VATS) in 9 patients (males = 6, females = 3) with clinico-radiological diagnosis of tubercular spondylitis of the dorsal spine. The mean duration of surgery was 140.88 ± 20.09 minutes, mean blood was 417.77 ± 190.90 mL, and mean duration of postoperative hospital stay was 5.77 ± 0.97 days, Seven patients had a preoperative Grade A neurological involvement, while at the time of final followup the only deficit was Grade D power in 2 patients. In patients without bone graft placement (n = 6), average increase in Kyphosis angle was 16°, while in patients with bone graft placement (n = 3) the deformity remained stationary. At the time of final follow up, fusion was achieved in all patients, the VAS score for back pain improved from a pretreatment score of 8.3 to 2, and the function assessment yielded excellent (n = 4) to good (n = 5) results. In two patients minithoracotomy had to be resorted due to extensive pleural adhesions (n = 1) or difficulty in placement of graft (n = 1). Videoassisted thoracoscopic surgery provides a safe and effective approach in the management of spinal tuberculosis. It has the advantages of decreased blood loss and post operative morbidity with minimal complications. PMID:24804092

  4. Video-assisted thoracic surgery for tubercular spondylitis.

    PubMed

    Singh, Roop; Gogna, Paritosh; Parshad, Sanjeev; Karwasra, Rajender Kumar; Karwasra, Parmod Kumar; Kaur, Kiranpreet

    2014-01-01

    The present study evaluated the outcome of video-assisted thoracic surgery (VATS) in 9 patients (males = 6, females = 3) with clinico-radiological diagnosis of tubercular spondylitis of the dorsal spine. The mean duration of surgery was 140.88 ± 20.09 minutes, mean blood was 417.77 ± 190.90 mL, and mean duration of postoperative hospital stay was 5.77 ± 0.97 days, Seven patients had a preoperative Grade A neurological involvement, while at the time of final followup the only deficit was Grade D power in 2 patients. In patients without bone graft placement (n = 6), average increase in Kyphosis angle was 16°, while in patients with bone graft placement (n = 3) the deformity remained stationary. At the time of final follow up, fusion was achieved in all patients, the VAS score for back pain improved from a pretreatment score of 8.3 to 2, and the function assessment yielded excellent (n = 4) to good (n = 5) results. In two patients minithoracotomy had to be resorted due to extensive pleural adhesions (n = 1) or difficulty in placement of graft (n = 1). Videoassisted thoracoscopic surgery provides a safe and effective approach in the management of spinal tuberculosis. It has the advantages of decreased blood loss and post operative morbidity with minimal complications. PMID:24804092

  5. Clinical pathway for thoracic surgery in the United States

    PubMed Central

    Wei, Benjamin

    2016-01-01

    The paradigm for postoperative care for thoracic surgical patients in the United States has shifted with efforts to reduce hospital length of stay and improve quality of life. The increasing usage of minimally invasive techniques in thoracic surgery has been an important part of this. In this review we will examine our standard practices as well as the evidence behind both general contemporary postoperative care principles and those specific to certain operations. PMID:26941967

  6. Effects of fusion and conservative treatment on disc degeneration and rates of subsequent surgery after thoracolumbar fracture.

    PubMed

    D'Oro, Anthony; Spoonamore, Mark J; Cohen, Jeremiah R; Acosta, Frank L; Hsieh, Patrick C; Liu, John C; Chen, Thomas C; Buser, Zorica; Wang, Jeffrey C

    2016-03-01

    OBJECT The objective of this study was to compare the incidence of degeneration and need for subsequent fusion surgery between patients who were treated nonsurgically and patients treated with fusion after a diagnosis of thoracic-or lumbar-level fracture without degenerative disease. METHODS The authors performed a retrospective study of Orthopedic United Healthcare patients diagnosed with thoracic or lumbar fracture. Patients were filtered into thoracic and lumbar fracture groups using diagnostic codes and then assigned to one of 2 treatment subgroups (fusion surgery or no surgery) on the basis of procedural codes. Disc degeneration and follow-up surgery were recorded. Chi-square statistical analysis was used. RESULTS Of 3699 patients diagnosed with a thoracic fracture, 117 (3.2%) underwent thoracic fusion and 3215 (86.9%) were treated nonsurgically. Within 3 years, 147 (4.6%) patients from the nonsurgical subgroup and fewer than 11 (0.9%-8.5%) from the fusion subgroup were diagnosed with thoracic disc degeneration. From the nonsurgical subgroup, 11 (0.3%) patients underwent a thoracic surgery related to disc degeneration compared with zero from the fusion group (p > 0.05). Of 5016 patients diagnosed with lumbar fracture, 150 (3.0%) underwent fusion and 4371 (87.1%) had no surgery. Within 3 years, 503 patients (11.5%) from the nonsurgical subgroup and 35 (23.3%) from the fusion subgroup were diagnosed with lumbar disc degeneration (p < 0.05). From the nonsurgical subgroup, 42 (1.0%) went on to have surgery related to disc degeneration, compared with fewer than 11 (0.7%-6.7%) from the fusion subgroup (values not precise due to privacy limitations). CONCLUSIONS Fusion surgery for thoracic fracture does not appear to increase the likelihood of undergoing future surgery. In the lumbar region, initial fusion surgery appears to increase the incidence of disc degeneration and could potentially necessitate future surgeries. PMID:26637065

  7. [The system problems related to thoracic surgery practices in japan; message from the Japanese association for thoracic surgery].

    PubMed

    Matsuda, Hikaru

    2007-05-01

    The thoracic surgery practice in Japan has characteristics such as strong burden to surgeons and young trainees for high-risk procedures under poor health care manpower system and less qualification for their high-level practices. The presence of too many numbers of certified surgeons and teaching hospitals for cardiac, general thoracic and esophageal surgeries has been well recognized providing low quality maintenance and poor training system. The Japanese Association for Thoracic Surgery has recently made a step towards to open the data of hospital quality promoting the discussion to reunify the hospitals and surgeons into reasonable numbers to respond to the social demand. The new 2-year postgraduate clinical training and also a new specialty medical board approval for advertisement have provided various problems and controversies, and we must make efforts to overcome these problems by providing new strategies to make our practices more qualified. PMID:17515081

  8. Accreditation Council for Graduate Medical Education Case Log: General Surgery Resident Thoracic Surgery Experience

    PubMed Central

    Kansier, Nicole; Varghese, Thomas K.; Verrier, Edward D.; Drake, F. Thurston; Gow, Kenneth W.

    2014-01-01

    Background General surgery resident training has changed dramatically over the past 2 decades, with likely impact on specialty exposure. We sought to assess trends in general surgery resident exposure to thoracic surgery using the Accreditation Council for Graduate Medical Education (ACGME) case logs over time. Methods The ACGME case logs for graduating general surgery residents were reviewed from academic year (AY) 1989–1990 to 2011–2012 for defined thoracic surgery cases. Data were divided into 5 eras of training for comparison: I, AY89 to 93; II, AY93 to 98; III, AY98 to 03; IV, AY03 to 08; V, AY08 to 12. We analyzed quantity and types of cases per time period. Student t tests compared averages among the time periods with significance at a p values less than 0.05. Results A total of 21,803,843 general surgery cases were reviewed over the 23-year period. Residents averaged 33.6 thoracic cases each in period I and 39.7 in period V. Thoracic cases accounted for nearly 4% of total cases performed annually (period I 3.7% [134,550 of 3,598,574]; period V 4.1% [167,957 of 4,077,939]). For the 3 most frequently performed procedures there was a statistically significant increase in thoracoscopic approach from period II to period V. Conclusions General surgery trainees today have the same volume of thoracic surgery exposure as their counterparts over the last 2 decades. This maintenance in caseload has occurred in spite of work-hour restrictions. However, general surgery graduates have a different thoracic surgery skill set at the end of their training, due to the predominance of minimally invasive techniques. Thoracic surgery educators should take into account these differences when training future cardiothoracic surgeons. PMID:24968766

  9. The Society of Thoracic Surgeons and the European Society of Thoracic Surgeons general thoracic surgery databases: joint standardization of variable definitions and terminology.

    PubMed

    Fernandez, Felix G; Falcoz, Pierre E; Kozower, Benjamin D; Salati, Michele; Wright, Cameron D; Brunelli, Alessandro

    2015-01-01

    The European Society of Thoracic Surgery (ESTS) and the Society of Thoracic Surgeons (STS) general thoracic surgery databases collect thoracic surgical data from Europe and North America, respectively. Their objectives are similar: to measure processes and outcomes so as to improve the quality of thoracic surgical care. Future collaboration between the two databases and their integration could generate significant new knowledge. However, important discrepancies exist in terminology and definitions between the two databases. The objective of this collaboration between the ESTS and STS is to identify important differences between databases and harmonize terminology and definitions to facilitate future endeavors. PMID:25555970

  10. Muscle and myocutaneous flaps in reconstructive surgery of thoracic defects.

    PubMed

    Tosson, R; Peter, F-W; Steinau, H U; Vogt, P

    2004-12-01

    Reconstructive surgery of thoracic defects presents a challenge for the surgeon. With defects of different aetiology and the need for precise localisation of the area to be treated, a broad range of experience is required. We present our interdisciplinary experience in dealing with full thickness thoracic wall defects and intrathoracic cavities. The latissimus dorsi muscle as well as the pectoralis major muscle and their covering skin are the most commonly used flaps in covering an intrathoracic or extrathoracic defect. They have the advantage of being easily and safely dissected. Other flaps such as the greater omentum, serratus anterior, the transverse rectus abodominal muscle (TRAM), and the filet of the arm are less frequently used. Indications and applications of these flaps are reviewed. Our interdisciplinary surgical treatment of thoracic wall defects allows optimal operative excision and reconstruction as well as giving best functional and aesthetic results for the patients. PMID:16352225

  11. Self-perceived video-assisted thoracic surgery lobectomy proficiency by recent graduates of North American thoracic residencies.

    PubMed

    Boffa, Daniel J; Gangadharan, Sidharta; Kent, Michael; Kerendi, Faraz; Onaitis, Mark; Verrier, Edward; Roselli, Eric

    2012-06-01

    Minimally invasive surgical techniques offer several advantages over traditional open procedures, yet the pathway to minimally invasive proficiency can be difficult to navigate. As a part of an effort of the Joint Council of Thoracic Surgical Education to increase access to this skill set in the general thoracic community, recent graduates of thoracic residencies were surveyed to determine the self-reported achievement of video-assisted thoracic surgery (VATS) lobectomy proficiency and the merits of various educational opportunities. The objective of this study was to estimate the comfort level of recent graduates with the minimally invasive approach, as this demographic not only reflects the current status of training, but represents the future of the specialty. Surgeons graduating North American thoracic residencies between 2006 and 2008 identifying themselves as practitioners of general thoracic surgery were surveyed. A total of 271 surgeons completed training between 2006 and 2008 and indicated general thoracic to be a part of their practice (84 dedicated thoracic and 187 mixed). One hundred and forty-six surgeons completed the survey (54%) including 74 of 84 (88%) dedicated thoracic surgeons. Overall, 58% of recent graduates who perform general thoracic procedures consider themselves proficient in VATS lobectomies (86% of dedicated thoracic surgeons and 28% of surgeons with a mixed practice, P < 0.0001). Of surgeons considering themselves to be proficient at VATS lobectomies, 66% felt thoracic residency was critical or very important to achieving proficiency. Fellowships after completing board residency, animal labs, and follow-up VATS courses put on by experts were much less consistently beneficial. The vast majority of the 25 dedicated general thoracic surgeons who graduate each year consider themselves proficient in VATS lobectomies, largely due to training in their thoracic residencies. On the other hand, the minority of surgeons performing general thoracic procedures as a part of a mixed practice consider themselves proficient in VATS lobectomies. Further study is warranted to enhance the VATS lobectomy experience of mixed practice surgeons particularly during their thoracic residencies. PMID:22381653

  12. Surgical Management for Thoracic Spinal Tuberculosis Posterior Only versus Anterior Video-Assisted Thoracoscopic Surgery

    PubMed Central

    Zhong, Weiye; Xiong, Guangzhong; Wang, Bing; Dai, Zhihui

    2015-01-01

    Study Design A comparable retrospective study. Object To compare the clinical outcomes of surgical treatment by posterior only and anterior video-assisted thoracoscopic surgery for thoracic spinal tuberculosis (TSTB). Method 145 patients with TSTB treated by two different surgical procedures in our institution from June 2001 to June 2014 were studied. All cases were retrospectively analyzed and divided into two groups according to the given treatments: 75 cases (32F/43M) in group A performed single-stage posterior debridement, transforaminal thoracic interbody fusion and instrumentation, and 70 cases (30F/40M) in group B underwent anterior video-assisted thoracoscopic surgery (VATS). Clinical and radiographic results in the two groups were analyzed and compared. Results Patients in group A and B were followed up for an average of 4.6±1.8, 4.4±1.2 years, respectively. There was no statistically significant difference between groups in terms of the operation time, blood loss, bony fusion, neurological recovery and the correction angle of kyphotic deformity (P>0.05). Fewer pulmonary complications were observed in group A. Good clinical outcomes were achieved in both groups. Conclusions Both the anterior VATS and posterior approaches can effectively treat thoracic tuberculosis. Nevertheless, the posterior approach procedure obtained less morbidity and complications than the other. PMID:25781165

  13. Intraoperative neurophysiologic monitoring with Hoffmann reflex during thoracic spine surgery.

    PubMed

    Feyissa, Anteneh M; Tummala, Sudhakar

    2015-06-01

    The aim of this study was examine the role of Hoffmann reflex (H-reflex) monitoring in identifying intraoperative spinal cord injury and predicting postoperative neurological outcome in patients undergoing thoracic spine surgery. Despite the physiologic basis for the use of H-reflex to monitor spinal motor pathways, there are only a few reports highlighting its application as an intraoperative neuromonitoring tool. We retrospectively reviewed the electronic medical records of 19 consecutive patients who underwent thoracic spine surgery for metastatic thoracic spinal tumors between 2011 and 2013 at the MD Anderson Cancer Center. H-waves and somatosensory evoked potentials (SSEP) were simultaneously monitored in our series consisting of four female and 15 male patients aged 10-71 years. In 10 of 19 patients, bilateral H-waves and SSEP were stable throughout the monitoring. Five of 19 patients had a <50% transient reduction in H-wave amplitude that later returned to baseline. SSEP were absent from baseline throughout surgery in two of 19 patients. In our series, neither general anesthesia nor low dose muscle relaxants interfered with the H-waves. At 3 and 6 month follow-ups, none of the patients exhibited new postoperative neurological deficits. Stable intraoperative H-waves are suggestive of preserved postoperative neurologic outcomes. Intraoperative H-reflex monitoring could be a reasonable alternative especially when motor evoked potentials are unattainable. Given its greater sensitivity to spinal cord ischemia, relatively low cost and ease of acquisition, H-reflex monitoring could be a useful adjunct in during thoracic spine surgeries. PMID:25769258

  14. Effect of Massage on Pain Management for Thoracic Surgery Patients

    PubMed Central

    Dion, Liza; Rodgers, Nancy; Cutshall, Susanne M.; Cordes, Mary Ellen; Bauer, Brent; Cassivi, Stephen D.; Cha, Stephen

    2011-01-01

    Background: Integrative therapies such as massage have gained support as interventions that improve the overall patient experience during hospitalization. Thoracic surgery patients undergo long procedures and commonly have postoperative back, neck, and shoulder pain. Purpose: Given the promising effects of massage therapy for alleviation of pain, we studied the effectiveness and feasibility of massage therapy delivered in the postoperative thoracic surgery setting. Methods: Patients who received massage in the postoperative setting had pain scores evaluated pre and post massage on a rating scale of 0 to 10 (0 = no pain, 10 = worst possible pain). Results: In total, 160 patients completed the pilot study and received massage therapy that was individualized. Patients receiving massage therapy had significantly decreased pain scores after massage (p ≤ .001), and patients’ comments were very favorable. Patients and staff were highly satisfied with having massage therapy available, and no major barriers to implementing massage therapy were identified. Conclusions: Massage therapy may be an important additional pain management component of the healing experience for patients after thoracic surgery. PMID:21847428

  15. Selective thoracic fusion of King II scoliosis with segmental spinal instrumentation.

    PubMed

    Lim, H H; Choon, D S

    2000-09-01

    Segmental spinal instrumentation with Harrington rod secured to the spine by sublaminar wires was a popular method of scoliosis correction in 1980's. It was gradually replaced by newer rod-hook systems due to concern about neurological complications. However, correction of type II and III curves by selectively fusing the thoracic curves with these new instruments has resulted in poor results in some cases. The aim of this study is to review the result of selective thoracic fusion treated by segmental spinal instrumentation. Between January 1989 to October 1994, 31 patients with King II scoliosis were treated operatively in our unit. These consisted of 29 girls and 2 boys. The mean age of these patients were 11.3 years. The study population consisted of 21 Chinese, 5 Malays and 5 Indians. In one patient, the thoracic curve was convex to the left whilst the thoracic curves in the majority were to the right. The surgery was performed by three surgeons using harrington rods and posterior fusion with autograft. Anterior releases were also required in eight patients to increase flexibility. The curve correction obtained was an improvement from a average preoperative cobb's angle of 71.5 degrees to 39.5 degrees postoperatively. After an average follow-up period of 77.9 months, the correction deteriorated by 22% in the thoracic curve and 59% in the lumbar spine without disturbance to truncal balance. Only one sublaminar wire broke. However, no implant failure or removal has to be performed as yet. This technique appears useful in our institution with minimal morbidity. PMID:11200041

  16. Mid- to long-term outcomes of posterior decompression with instrumented fusion for thoracic ossification of the posterior longitudinal ligament.

    PubMed

    Koda, Masao; Furuya, Takeo; Okawa, Akihiko; Inada, Taigo; Kamiya, Koshiro; Ota, Mitsutoshi; Maki, Satoshi; Takahashi, Kazuhisa; Yamazaki, Masashi; Aramomi, Masaaki; Ikeda, Osamu; Mannoji, Chikato

    2016-05-01

    Posterior decompression with instrumented fusion (PDF) surgery has been previously reported as a relatively safe surgical procedure for any type of thoracic ossification of the longitudinal ligament (OPLL). However, mid- to long-term outcomes are still unclear. The aim of the present study was to elucidate the mid- to long-term clinical outcome of PDF surgery for thoracic OPLL patients. The present study included 20 patients who had undergone PDF for thoracic OPLL and were followed for at least 5years. Increment change and recovery rate of the Japanese Orthopaedic Association (JOA) score were assessed. Revision surgery during the follow-up period was also recorded. Average JOA scores were 3.5 preoperatively and 7.1 at final follow-up. The average improvement in JOA score was 3.8 points and the average recovery rate was 47.0%. The JOA score showed gradual increase after surgery, and took 9months to reach peak recovery. As for neurological complications, two patients suffered postoperative paralysis, but both recovered without intervention. Six revision surgeries in four patients were related to OPLL. Additional anterior thoracic decompression for remaining ossification at the same level of PDF surgery was performed in one patient. Decompression surgery for deterioration of symptoms of pre-existing cervical OPLL was performed in three patients. One patient had undergone lumbar and cervical PDF surgery for de novo ossification foci of the lumbar and cervical spine. PDF surgery for thoracic OPLL is thus considered a relatively safe and stable surgical procedure considering the mid- to long-term outcomes. PMID:26794690

  17. Pulmonary Complications following Thoracic Spinal Surgery: A Systematic Review.

    PubMed

    Gabel, Brandon C; Schnell, Eric C; Dettori, Joseph R; Jeyamohan, Shiveindra; Oskouian, Rod

    2016-05-01

    Study Design Systematic review. Objective To determine the frequency of pulmonary effusion, pneumothorax, and hemothorax in adult patients undergoing thoracic corpectomy or osteotomy for any condition and to determine if these frequencies vary by surgical approach (i.e., anterior, posterior, or lateral). Methods Electronic databases and reference lists of key articles were searched through September 21, 2015, to identify studies specifically evaluating the frequency of pulmonary effusion, pneumothorax, and hemothorax in patients undergoing thoracic spine surgery. Results Fourteen studies, 13 retrospective and 1 prospective, met inclusion criteria. The frequency across studies of pulmonary effusion ranged from 0 to 77%; for hemothorax, 0 to 77%; and for pneumothorax, 0 to 50%. There was no clear pattern of pulmonary complications with respect to surgical approach. Conclusions There is insufficient data to determine the risk of pulmonary complications following anterior, posterior, or lateral approaches to the thoracic spine. Methods for assessing pulmonary complications were not well reported, and data is sparse. PMID:27099821

  18. Pulmonary Complications following Thoracic Spinal Surgery: A Systematic Review

    PubMed Central

    Gabel, Brandon C.; Schnell, Eric C.; Dettori, Joseph R.; Jeyamohan, Shiveindra; Oskouian, Rod

    2016-01-01

    Study Design Systematic review. Objective To determine the frequency of pulmonary effusion, pneumothorax, and hemothorax in adult patients undergoing thoracic corpectomy or osteotomy for any condition and to determine if these frequencies vary by surgical approach (i.e., anterior, posterior, or lateral). Methods Electronic databases and reference lists of key articles were searched through September 21, 2015, to identify studies specifically evaluating the frequency of pulmonary effusion, pneumothorax, and hemothorax in patients undergoing thoracic spine surgery. Results Fourteen studies, 13 retrospective and 1 prospective, met inclusion criteria. The frequency across studies of pulmonary effusion ranged from 0 to 77%; for hemothorax, 0 to 77%; and for pneumothorax, 0 to 50%. There was no clear pattern of pulmonary complications with respect to surgical approach. Conclusions There is insufficient data to determine the risk of pulmonary complications following anterior, posterior, or lateral approaches to the thoracic spine. Methods for assessing pulmonary complications were not well reported, and data is sparse. PMID:27099821

  19. Enhanced recovery pathway for thoracic surgery in the UK

    PubMed Central

    Solli, Piergiorgio

    2016-01-01

    Background Enhanced recovery (ER) refers to a combination of perioperative interventions designed to minimise the impact of surgery on patients’ recovery in order to reduce postoperative complications and to allow an early discharge reducing hospital costs. Methods An ER protocol was established at our institution following a review of the best evidence available. We introduced a multi-disciplinary integrated perioperative pathway by engaging with every person involved, including the patients themselves. The programme was monitored using specifically-designed patients related outcome measures (PROMs). Results One-hundred and fifty-four ER patients were compared with 171 controls from the year before ER was introduced. There was an 80% increase in same-day admissions, with a net gain of more than 300 patient bed-days. The ER group had a significantly higher number of procedures performed by video assisted thoracoscopic surgery (VATS) (ER, 32.9% vs. 9.4%, P=0.0001) and a lower rate of admission to the intensive care unit (ER, 5.8% versus 12.9%, P=0.04). Patients on the ER programme had a significantly reduced postoperative length of stay (mean ER, 5.2 vs. 11.7 days, P<0.0001). Patient satisfaction was higher in the ER group after a patient survey. The project resulted in a net saving of £214,000 for the Trust for the 2013/2014 financial year. We were also able to increase the number of patients who underwent thoracic surgery in 2013/2014 by 30% (159 patients) compared with 2012/2013. Conclusions The ER pathway has proven to be a safe perioperative management strategy to improve patient satisfaction and to reduce the length of hospital stay and cost after major thoracic surgery, without increasing morbidity or mortality. PMID:26941974

  20. Posterior fusion only for thoracic adolescent idiopathic scoliosis of more than 80°: pedicle screws versus hybrid instrumentation

    PubMed Central

    Bakaloudis, Georgios; Lolli, Francesco; Vommaro, Francesco; Martikos, Konstantinos; Parisini, Patrizio

    2008-01-01

    The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80° traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5–8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic (>80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80° (Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF–H group; n = 27 patients), or with pedicle screw-only construct (PSF–S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser’s sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF–H: 92° vs. PSF–S: 88°), or flexibility on bending films (PSF–H: 27% vs. PSF–S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for non-parametric paired analysis, and the Mann–Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF–S group, when compared to the PSF–H group had a final MT correction rate of 52.4 versus 44.52% (P = 0.001), with a loss of −1.9° versus −11.3° (P = 0.0005), a TL/L correction of 50 versus 43% (ns), a greater correction of the lowest instrumented vertebra translation (−1.00 vs. −0.54 cm; P = 0.04), and tilt (−19° vs. −10°; P = 0.005) on the coronal plane. There were no statistically significant differences in sagittal and global coronal alignment between the two groups (C7-S1 offset: PSF–H = 0.5 cm vs. PSF–S = 0 cm). In the hybrid series (27 patients) surgery-related complications necessitated three revision surgeries, whereas in the screw group (25 patients) one revision surgery was performed. No neurological complications or deep wound infection occurred in this series. In conclusion, posterior spinal fusion for severe thoracic AIS with pedicle screws only, when compared to hybrid construct, allowed a greater coronal correction of both main thoracic and secondary lumbar curves, less loss of the postoperative correction achieved, and fewer revision surgeries. Posterior-only fusion with pedicle screws enabled a good and stable correction of severe scoliosis. However, severe curves may be amenable to hybrid instrumentation that produced analogous results to the screws-only constructs concerning patient satisfaction; at the latest follow-up, SRS-30 and SF-36 scores did not show any statistical differences between the two groups. PMID:18696126

  1. Robot-assisted thoracic surgery versus open thoracic surgery for lung cancer: a system review and meta-analysis

    PubMed Central

    Zhang, Liangze; Gao, Shugeng

    2015-01-01

    The aim of this meta-analysis is to compare the perioperative morbidity and mortality outcomes of robotic-assisted thoracic surgery (RATS) with open thoracic surgery (OTS) for patients with lung cancer. We searched articles indexed in the Pubmed and Sciencedirect published as of July 2015 that met our predefined criteria. A meta-analysis was performed by combining the results of reported incidences of perioperative morbidity and mortality. The relative risk (RR) was used as a summary statistic. Five eligible articles with 2433 subjects were considered in the analysis (5 articles for morbidity, while 3 articles for mortality). Overall, pooled analysis indicated that perioperative morbidity and mortality rate was significantly lower among patients who underwent RATS than patients who underwent OTS (for morbidity: RR, 0.83; 95% CI, 0.75 to 0.92; P<0.01; for mortality: RR, 0.14; 95% CI, 0.03 to 0.59; P=0.007). No evidence of publication bias was observed. In conclusion, this meta-analysis showed that RATS resulted in significantly lower perioperative morbidity and mortality rate compared with OTS cases. Thus, we suggest RATS be an appropriate alternative to OTS for lung cancer resection. RATS should be studied further in selected centers and compared with OTS in a randomized fashion to better define its potential advantages and disadvantages. PMID:26770372

  2. [Early discharge following major thoracic surgery: identification of related factors].

    PubMed

    de Lima, Nuno Fevereiro Ferreira; Carvalho, André Luís de Aquino

    2003-01-01

    There is a direct relation between hospital costs and hospital length of stay after the operation. In the other hand, reduced stay increases the productivity of the public hospitals with high service demanding. The objective of this study was to identify factors determining the decrease in hospital stay after major thoracic surgery. A two-phase retrospective study was conducted on analysis of medical records. In the first phase, data on length of hospital stay and related factors were collected from a consecutive series of 169 patients divided into group I (n=81)--patients operated on between June 1990 and 1995, and group II (n=88)--1996 through May 2000. In the second phase, data were collected from a consecutive series of 20 patients (group III) starting backwards from March 2002, for analysis and comparison with a internet survey sent to 21 thoracic surgeons. Intensive care unit was avoided for most patients in the immediate post operative period. The mean hospital stay decreased from 7.6 days (median 7) in group I to 5.1 days (median 4) in group II (p<0.001). The more frequent utilization of epidural analgesia and less traumatic thoracotomy in group II reached statistic significance (p<0.001). In group III, the mean hospital stay was 4.2 days (median 4), and there was a more effective use of epidural analgesia (75%) and muscle-sparing thoracotomy (90%). Eight thoracic surgeons answered the survey: the mean hospital stay varied from 5 to 9 days and all patients were sent to intensive care or similar units. Only two surgeons utilize muscle-sparing thoracotomy. This study confirms that pain control and less traumatic surgical approach are important for faster functional recovery of the patients. It suggests that the IC units may be used only for selected patients. PMID:14685631

  3. Systematic survey of opinion regarding the thoracic surgery residency.

    PubMed

    Wilcox, B R; Stritter, F T; Anderson, R P; Gay, W A; Kaiser, G C; Orringer, M B; Rainer, W G; Replogle, R L

    1993-05-01

    To summarize this rather wide-ranging study, let us review the high points. The future practice of thoracic surgery will be increasingly affected by governmental factors and will have even greater technological dimensions. To do this work, we must continue to attract high-caliber individuals, and this is best accomplished by the early and continuing involvement in the educational process of strong role models from our field. These future surgeons must be motivated to do good work and should have high ethical standards as well as maturity and high intelligence. Experienced, involved faculty leading the residents through a broad program that offers graduated assumption of clinical and leadership responsibilities will facilitate the development of mature clinical judgment. Residents must be taught the clinical skills necessary to do all thoracic operations, leaving subspecialization to postresidency fellowships. The educational program should be humane in its demands and collegial in its application. It should incorporate experiences beyond the operating room, including the opportunity to read, think, and interact with local mentors and colleagues from around the country. The requirements of certification should not be so rigid as to preclude the development of different pathways to the same end. Likewise, although the accreditation process must protect the resident from exploitation, it must not be so restrictive that it does not allow for educational innovation and justifiable differences among programs. These are the thoughtful opinions of our colleagues. They deserve serious consideration. PMID:8494460

  4. Assessment of spontaneous correction of lumbar curve after fusion of the main thoracic in Lenke 1 adolescent idiopathic scoliosis☆

    PubMed Central

    Mizusaki, Danilo; Gotfryd, Alberto Ofenhejm

    2016-01-01

    Objective To evaluate the clinical and radiographic response of the lumbar curve after fusion of the main thoracic, in patients with adolescent idiopathic scoliosis of Lenke type 1. Methods Forty-two patients with Lenke 1 adolescent idiopathic scoliosis who underwent operations via the posterior route with pedicle screws were prospectively evaluated. Clinical measurements (size of the hump and translation of the trunk in the coronal plane, by means of a plumb line) and radiographic measurements (Cobb angle, distal level of arthrodesis, translation of the lumbar apical vertebral and Risser) were made. The evaluations were performed preoperatively, immediately postoperatively and two years after surgery. Results The mean Cobb angle of the main thoracic curve was found to have been corrected by 68.9% and the lumbar curve by 57.1%. Eighty percent of the patients presented improved coronal trunk balance two years after surgery. In four patients, worsening of the plumb line measurements was observed, but there was no need for surgical intervention. Less satisfactory results were observed in patients with lumbar modifier B. Conclusions In Lenke 1 patients, fusion of the thoracic curve alone provided spontaneous correction of the lumbar curve and led to trunk balance. Less satisfactory results were observed in curves with lumbar modifier B, and this may be related to overcorrection of the main thoracic curve. PMID:26962505

  5. Tuberculosis a disease that created and shaped thoracic surgery.

    PubMed

    Inzirillo, Francesco; Giorgetta, Casimiro; Robustellini, Mario; Ravalli, Eugenio; Tiberi, Simon; Della Pona, Claudio

    2014-01-01

    Today it is incredible to think that an infectious disease, Tuberculosis (TB) as the disease that shaped Thoracic Surgery. The history of TB has so far evolved similarities with that of the mythological Phoenix, where the resurgence of this never completely eradicated "Insidious Disease" has now re-emerged and brought new challenges to modern medicine that of multi drug resistance. The probability of success, in treating complicated multi-drug resistant (MDR) TB pushing us back to the pre-antibiotic era, now depends on several factors: (I) optimal antibiotic management; (II) patient compliance; (III) multi-disciplinary teamwork; (IV) experience in carrying out "not-routine" surgical procedures; and finally (V) ability to offer long term patient hospitalization, frequently months, without bureaucratic and economical problems. The probability of good patient outcome is higher when all of these criteria are satisfied. PMID:25332981

  6. Advances in Video-Assisted Thoracic Surgery, Thoracoscopy.

    PubMed

    Case, Joseph Brad

    2016-01-01

    Video-assisted thoracic surgery (VATS) is an evolving modality in the treatment and management of a variety of pathologies affecting dogs and cats. Representative disease processes include pericardial effusion, pericardial neoplasia, cranial mediastinal neoplasia, vascular ring anomaly, pulmonary neoplasia, pulmonary blebs and bullae, spontaneous pneumothorax, and chylothorax. Several descriptive and small case reports have been published on the use of VATS in veterinary medicine. More recently, larger case series and experimental studies have revealed potential benefits and limitations not documented previously. Significant technological advances over the past 5 years have made possible a host of new applications in VATS. This article focuses on updates and cutting-edge applications in VATS. PMID:26410560

  7. A comparison of thoracic or lumbar patient-controlled epidural analgesia methods after thoracic surgery

    PubMed Central

    2014-01-01

    Background We aimed to compare patient-controlled thoracic or lumbar epidural analgesia methods after thoracotomy operations. Methods One hundred and twenty patients were prospectively randomized to receive either thoracic epidural analgesia (TEA group) or lumbar epidural analgesia (LEA group). In both groups, epidural catheters were administered. Hemodynamic measurements, visual analog scale scores at rest (VAS-R) and after coughing (VAS-C), analgesic consumption, and side effects were compared at 0, 2, 4, 8, 16, and 24 hours postoperatively. Results The VAS-R and VAS-C values were lower in the TEA group in comparison to the LEA group at 2, 4, 8, and 16 hours after surgery (for VAS-R, P = 0.001, P = 0.01, P = 0.008, and P = 0.029, respectively; and for VAS-C, P = 0.035, P = 0.023, P = 0.002, and P = 0.037, respectively). Total 24-hour analgesic consumption was different between groups (175 +/- 20 mL versus 185 +/- 31 mL; P = 0.034). The comparison of postoperative complications revealed that the incidence of hypotension (21/57, 36.8% versus 8/63, 12.7%; P = 0.002), bradycardia (9/57, 15.8% versus 2/63, 3.2%; P = 0.017), atelectasis (1/57, 1.8% versus 7/63, 11.1%; P = 0.04), and the need for intensive care unit (ICU) treatment (0/57, 0% versus 5/63, 7.9%; P = 0.03) were lower in the TEA group in comparison to the LEA group. Conclusions TEA has beneficial hemostatic effects in comparison to LEA after thoracotomies along with more satisfactory pain relief profile. PMID:24885545

  8. Combined Video-Assisted Thoracic Surgery and Posterior Spinal Surgery for the Treatment of Dumbbell Tumor of the First Thoracic Nerve Root

    PubMed Central

    Miyoshi, Kota; Kitagawa, Tomoaki; Sato, Yusuke; Maehara, Takamitsu; Mikami, Yoji

    2015-01-01

    Although several cases of a dumbbell tumor of thoracic nerve roots have been reported, reports on the surgical procedures for a dumbbell tumor of the first thoracic (T1) nerve root are rare. Surgeons should be cautious, especially when performing a surgical procedure for a dumbbell tumor of the T1 nerve root because the tumor is anatomically located adjacent to important organs and because the T1 nerve root composes the lower trunk of the brachial plexus with the eighth cervical nerve root. We present cases with dumbbell tumors of the T1 nerve root that were treated with combined surgical treatment to remove the tumor. We first performed video-assisted thoracic surgery (VATS) to release the organs anteriorly and then performed posterior spinal surgery in the prone position. The combined VATS and posterior spinal surgery may become a standard surgical procedure for the treatment of dumbbell tumors of the T1 nerve root. PMID:26240720

  9. Wound prophylaxis in thoracic surgery: a new approach.

    PubMed Central

    Walker, W S; Faichney, A; Raychaudhury, T; Prescott, R J; Calder, M A; Sang, C T; Cameron, E W; Walbaum, P R

    1984-01-01

    A prospective double blind, randomised study was performed in 100 patients undergoing major elective thoracic surgery to assess a new method of prophylaxis of wound infection using one preincisional intraparietal infiltration of cefuroxime sodium along the line of proposed incision as the sole protection against wound infection. A significant (p less than 0.01) reduction in the incidence of wound infection occurred in the antibiotic treated group (2%) compared with the control group (20%), who received by the same route the same volume of saline only. The groups were comparable with respect to age, sex, pathological condition, and operative variables. The use of additional antibiotics was significantly greater in the control group (p less than 0.01), largely owing to a much greater incidence of postoperative pulmonary infection in the control group (60%) than in the antibiotic treated group (40%). No morbidity was associated with this technique. The organisms found in oesophageal and bronchial operative luminal specimens did not correlate with postoperative wound or pulmonary infection or with organisms causing these infections. Reductions in wound and pulmonary infection rates equivalent to those produced by conventional multiple dose parenteral regimens were achieved by this technique. PMID:6367129

  10. Video-assisted thoracic surgery for pulmonary sequestration: a safe alternative procedure

    PubMed Central

    Wang, Lu-Ming; Cao, Jin-Lin

    2016-01-01

    Background Pulmonary sequestration (PS), a rare congenital anatomic anomaly of the lung, is usually treated through resection by a conventional thoracotomy procedure. The efficacy and safety of video-assisted thoracic surgery (VATS) in PS treatment has seldom been evaluated. To address this research gap, we assessed the efficacy and safety of VATS in the treatment of PS in a large Chinese cohort. Methods We retrospectively reviewed 58 patients with PS who had undergone surgical resection in our department between January 2003 and April 2014. Of these patients, 42 (72.4%) underwent thoracotomy, and 16 (27.6%) underwent attempted VATS resection. Clinical and demographic data, including patients’ age, sex, complaints, sequestration characteristics, approach and procedures, operative time, resection range, blood loss, drainage volume, chest tube duration, hospital stay, and complications were collected, in addition to short-term follow-up data. Results Of the 58 participating patients, 55 accepted anatomic lobectomy, 2 accepted wedge resection, and 1 accepted left lower lobectomy combined with lingular segmentectomy. All lesions were located in the lower lobe, with 1–4 aberrant arteries, except one right upper lobe sequestration. Three cases (18.8%) in the VATS group were converted to thoracotomy because of dense adhesion (n=1), hilar fusion (n=1), or bleeding (n=1). No significant differences in operative time, postoperative hospital stay, or perioperative complications were observed between the VATS and thoracotomy groups, although the VATS patients had less blood loss (P=0.032), a greater drainage volume (P=0.001), and a longer chest tube duration (P=0.001) than their thoracotomy counterparts. Conclusions VATS is a viable alternative procedure for PS in some patients. Simple sequestration without a thoracic cavity or hilum adhesion is a good indication for VATS resection, particularly for VATS anatomic lobectomy. Thoracic cavity and hilum adhesion remain a challenge for VATS. PMID:26904209

  11. Patient safety in thoracic surgery and European Society of Thoracic Surgeons checklist.

    PubMed

    Novoa, Nuria M

    2015-04-01

    Improving patient safety seems to be a new interesting clinical subject but, in fact, it is no new. It has to do with one of the oldest ethical principles of our profession: curing and not harming. The important research that has been done in a short period of time has brought in new insight to this complex area that is fast developing. The creation of safety managing systems will allow coordinating efforts from very different, although complementary, areas to create real safety culture and safety climate in every organization. In the surgical settings, teamwork is basic to provide good quality of care. Safety leaders in every team have an important role in establishing priorities, summarizing proposals, coordinating efforts, launching new initiatives and transmitting that safety efforts are worth taken. Preparedness and anticipation are key points for avoiding most of the diverse types of patient harm that can occur. As has been published, a great number of errors can be avoided simply using crosscheck based on specialized checklist that reviews every important detail of the procedure. This strategy has been demonstrated very useful at other high risk industries such as aviation, nuclear or food management. The Safe Surgery Saves Lives program launched in 2002 by the WHO has taught us that improvement is possible using a simple checklist. More complex and detail checklist can be more adequate for more complex procedures and settings. The proposed ESTS checklist reviews different areas of possible error in deeper detail allowing the finest adjustment of the patient before the skin incision. It has been recently released to the general thoracic community and monitors its use and usefulness has to be warrantied. PMID:25984360

  12. From “awake” to “monitored anesthesia care” thoracic surgery: A 15 year evolution

    PubMed Central

    Mineo, Tommaso C; Tacconi, Federico

    2014-01-01

    Although general anesthesia still represents the standard when performing thoracic surgery, the interest toward alternative methods is increasing. These have evolved from the employ of just local or regional analgesia techniques in completely alert patients (awake thoracic surgery), to more complex protocols entailing conscious sedation and spontaneous ventilation. The main rationale of these methods is to prevent serious complications related to general anesthesia and selective ventilation, such as tracheobronchial injury, acute lung injury, and cardiovascular events. Trends toward shorter hospitalization and reduced overall costs have also been indicated in preliminary reports. Monitored anesthesia care in thoracic surgery can be successfully employed to manage diverse oncologic conditions, such as malignant pleural effusion, peripheral lung nodules, and mediastinal tumors. Main non-oncologic indications include pneumothorax, emphysema, pleural infections, and interstitial lung disease. Furthermore, as the familiarity with this surgical practice has increased, major operations are now being performed this way. Despite the absence of randomized controlled trials, there is preliminary evidence that monitored anesthesia care protocols in thoracic surgery may be beneficial in high-risk patients, with non-inferior efficacy when compared to standard operations under general anesthesia. Monitored anesthesia care in thoracic surgery should enter the armamentarium of modern thoracic surgeons, and adequate training should be scheduled in accredited residency programs. PMID:26766966

  13. Design and implementation of an enhanced recovery program in thoracic surgery

    PubMed Central

    Giménez-Milà, Marc; Klein, Andrew A.

    2016-01-01

    Despite significant improvements in perioperative care, major surgery is still associated with major complications. Enhanced recovery after surgery was introduced by the National Health Service in the UK with the aim of improving patient outcomes and reducing length of stay in hospital. The degree of applicability differs between surgical specialties, and in thoracic surgery it has not been developed until recently. We have therefore reviewed recent literature specific to thoracic surgery, and will discuss key elements of the design, implementation and monitoring of an enhanced recovery (ER) program based on our recent experience. The program is divided into several high impact intervention measures that involve the preoperative, intraoperative and postoperative periods. Physical activity promotion and educational programs that provide information about the surgery and the surgical pathway are an essential part of the preoperative strategies. During surgery, an optimal pain control strategy, antibiotic prophylaxis and protective ventilation are important. Minimally invasive surgery and well-planned postoperative care including early drain removal and planned discharge are also important. Overall, we have shown that ER in thoracic surgery can facilitate early discharge from hospital and possibly reduce postoperative complications. Further studies are required to understand the extent of ER benefits when applied to thoracic surgery, and to test individual components in a prospective manner. PMID:26941969

  14. Video-assisted thoracic surgery right sleeve lobectomy

    PubMed Central

    Wang, Sheng; Kai, Jindan

    2014-01-01

    A 50-year-old active male with a smoking history of 30 years (20 cigarettes per day) was admitted to hospital because of more than one month’s cough without sputum. No comorbidity was present. The preoperative examination showed: blood test normal, ECG normal, cardio-pulmonary function normal, chest computed tomography (CT) display right upper lobe (RUL) mass of 5 cm diameter. Bronchoscopy examination and biopsy indicated large cell neuroendocrine carcinoma (LCNEC) in the take-off of RUL bronchus. No metastatic focus was found after emission computed tomography (ECT) scan of whole body bone, abdominal US scanning and brain MR. After initial evaluation, the clinical stage before operation was cT2bN0M0 (IIA stage). A selective video-assisted thoracic surgery (VATS) operation was arranged after 9 days of smoking cessation. Lateral position, one 10 mm trocar for camera in the 7th intercostals space in the mid-auxiliary line, 4 cm trocar for operation in the 4th intercostal space in the anterior axillary line, 15 mm trocar for auxiliary operation in the 8th intercostal space in the scapula line, the patient received VATS RUL lobectomy, plus systemic mediastinal lymph nodes dissection. The procedure of 200 minutes operation was smooth with blood loss of about 150 mL. Chest tube was removed 6 days after operation, and the patient discharged 11 days after the operation; The post-operation pathological examination showed RUL LCNEC, and the pathological stage was pT2bN0M0R0 (IIA stage). The patient has received four cycles of EP adjuvant chemotherapy per 21 days and is still alive without disease recurrence and metastasis after re-examination. PMID:25589983

  15. Video-assisted thoracic surgery right sleeve lobectomy.

    PubMed

    Xiong, Fei; Wang, Sheng; Kai, Jindan

    2014-12-01

    A 50-year-old active male with a smoking history of 30 years (20 cigarettes per day) was admitted to hospital because of more than one month's cough without sputum. No comorbidity was present. The preoperative examination showed: blood test normal, ECG normal, cardio-pulmonary function normal, chest computed tomography (CT) display right upper lobe (RUL) mass of 5 cm diameter. Bronchoscopy examination and biopsy indicated large cell neuroendocrine carcinoma (LCNEC) in the take-off of RUL bronchus. No metastatic focus was found after emission computed tomography (ECT) scan of whole body bone, abdominal US scanning and brain MR. After initial evaluation, the clinical stage before operation was cT2bN0M0 (IIA stage). A selective video-assisted thoracic surgery (VATS) operation was arranged after 9 days of smoking cessation. Lateral position, one 10 mm trocar for camera in the 7th intercostals space in the mid-auxiliary line, 4 cm trocar for operation in the 4th intercostal space in the anterior axillary line, 15 mm trocar for auxiliary operation in the 8th intercostal space in the scapula line, the patient received VATS RUL lobectomy, plus systemic mediastinal lymph nodes dissection. The procedure of 200 minutes operation was smooth with blood loss of about 150 mL. Chest tube was removed 6 days after operation, and the patient discharged 11 days after the operation; The post-operation pathological examination showed RUL LCNEC, and the pathological stage was pT2bN0M0R0 (IIA stage). The patient has received four cycles of EP adjuvant chemotherapy per 21 days and is still alive without disease recurrence and metastasis after re-examination. PMID:25589983

  16. Spontaneous Thoracic Curve Correction After Selective Posterior Fusion of Thoracolumbar/Lumbar Curves in Lenke 5C Adolescent Idiopathic Scoliosis.

    PubMed

    Wang, Fei; Xu, Xi-ming; Wei, Xian-zhao; Zhu, Xiao-dong; Li, Ming

    2015-07-01

    Selective fusion of the thoracolumbar/lumbar (TL/L) curve is an effective method for the treatment of Lenke type 5C curves. Several studies have demonstrated that spontaneous correction of the thoracic curve does indeed occur. However, how this correction occurs after isolated posterior segmental instrumentation of the structural lumbar curve has not been well described. The aim of this study was to evaluate the response of the thoracic curve to selective TL/L curve fusion in patients with Lenke type 5C adolescent idiopathic scoliosis (AIS) and assess the correlative clinical outcomes. Thirty-four consecutive patients with Lenke type 5C AIS were included in this study. All patients underwent selective TL/L curve instrumentation and fusion via the posterior approach. Coronal and sagittal radiographs were analyzed before surgery, at 1 week after surgery and at least 2 years after surgery. The preoperative coronal Cobb angle of the major TL/L curve was 45.4° ± 7.0°, and that of the minor thoracic curve was 25.4° ± 8.8°. The major TL/L and minor thoracic curves were corrected to postoperative angles of 9.5° ± 5.0° and 11.2° ± 5.2°, respectively, and measured 10.5° ± 6.0° and 13.4° ± 7.5° at the follow-up, respectively. The supine side-bending average Cobb angle of the thoracic curve was 9.9°. These results demonstrate satisfactory improvements because of coronal and sagittal restoration. Significant correlations were found between the preoperative and early postoperative conditions and the Cobb angle changes of the minor thoracic curve and the major TL/L curves (r = 0.42, P = 0.01). Significant correlations were also observed between the early and final follow-up postoperative conditions and the Cobb angle changes of the minor thoracic curve and the major TL/L curves (r = 0.57, P < 0.001). Significant correlations were observed between increased thoracic kyphosis (TK) and increased lumbar lordosis (LL) in the preoperative and early postoperative conditions (r = 0.36, P = 0.035) and between increased TK and increased LL in the preoperative and final follow-up postoperative conditions (r = 0.51, P = 0.002). Spontaneous correction of the thoracic curve is a reflection of the TL/L curve correction in Lenke 5C AIS patients. Supine side-bending radiographs are an effective method of predicting the spontaneous correction of thoracic curves. The correction of LL is important for maintaining spinal sagittal alignment. PMID:26200615

  17. Use of video-assisted thoracic surgery in the treatment of chylothorax.

    PubMed

    Graham, D D; McGahren, E D; Tribble, C G; Daniel, T M; Rodgers, B M

    1994-06-01

    Chylothorax, a potentially lethal disorder that may cause profound respiratory, nutritional, and immunologic complications, has become increasingly common in recent years. Medical therapy has been found to have a significant failure rate. Therefore, surgical treatment of complicated chylothorax has become a mainstay of care. Between 1987 and 1993, ten patients at the University of Virginia Hospital were treated with video-assisted thoracic surgery for complicated chylothorax. Twelve thoracoscopic procedures were performed. Patients ranged in age from 7 months to 82 years. Causes included iatrogenic (2), congenital (2), caval thrombosis (2), amyloid (2), blunt trauma (1), and metastatic carcinoid tumor (1). In 10 cases, video-assisted thoracic surgery was employed as the principal mode of therapy: 8 using talc pleurodesis alone, 1 using talc pleurodesis and clipping of the thoracic duct with application of fibrin glue, and 1 requiring clipping of a pleural defect with application of fibrin glue. In 2 cases, a video-assisted thoracic operation was used in conjunction with pleuroperitoneal shunting: a previously placed pleuroperitoneal shunt that was malfunctioning was repositioned thoracoscopically after a pleural adhesiolysis, and a pleural adhesiolysis was performed thoracoscopically before placement of a pleuroperitoneal shunt. In all cases the effusion resolved after the video-assisted thoracic operation without further intervention. Video-assisted thoracic surgery offers an effective means of treating chylothorax, regardless of cause, allowing the advantage of access to thoracic structures without the morbidity of more extensive procedures. PMID:8010794

  18. Update on three-dimensional image reconstruction for preoperative simulation in thoracic surgery

    PubMed Central

    Chen-Yoshikawa, Toyofumi F.

    2016-01-01

    Background Three-dimensional computed tomography (3D-CT) technologies have been developed and refined over time. Recently, high-speed and high-quality 3D-CT technologies have also been introduced to the field of thoracic surgery. The purpose of this manuscript is to demonstrate several examples of these 3D-CT technologies in various scenarios in thoracic surgery. Methods A newly-developed high-speed and high-quality 3D image analysis software system was used in Kyoto University Hospital. Simulation and/or navigation were performed using this 3D-CT technology in various thoracic surgeries. Results Preoperative 3D-CT simulation was performed in most patients undergoing video-assisted thoracoscopic surgery (VATS). Anatomical variation was frequently detected preoperatively, which was useful in performing VATS procedures when using only a monitor for vision. In sublobar resection, 3D-CT simulation was more helpful. In small lung lesions, which were supposedly neither visible nor palpable, preoperative marking of the lesions was performed using 3D-CT simulation, and wedge resection or segmentectomy was successfully performed with confidence. This technique also enabled virtual-reality endobronchial ultrasonography (EBUS), which made the procedure more safe and reliable. Furthermore, in living-donor lobar lung transplantation (LDLLT), surgical procedures for donor lobectomy were simulated preoperatively by 3D-CT angiography, which also affected surgical procedures for recipient surgery. New surgical techniques such as right and left inverted LDLLT were also established using 3D models created with this technique. Conclusions After the introduction of 3D-CT technology to the field of thoracic surgery, preoperative simulation has been developed for various thoracic procedures. In the near future, this technique will become more common in thoracic surgery, and frequent use by thoracic surgeons will be seen in worldwide daily practice. PMID:27014477

  19. Overview of uniportal video-assisted thoracic surgery (VATS): past and present

    PubMed Central

    Reinersman, J. Matthew; Passera, Eliseo

    2016-01-01

    Single incision video-assisted thoracic surgery (VATS), better known as uniportal VATS, has taken the world of thoracic surgery by storm over the previous few years. Through advances in techniques and technology, surgeons have been able to perform increasingly complex thoracic procedures utilizing a single small incision, hence avoiding the inherent morbidity of the standard open thoracotomy. This was a natural extension of what most recognize as the standard of care for early stage lung cancer, the VATS lobectomy, generally performed through a three- or four-incision technique. Improved camera optics have allowed the use of smaller cameras, making the uniportal approach technically easier. Improvement in articulating staplers and the development of other roticulator instruments have also aided working through a small single access point. The uniportal technique further brings the operative fulcrum inside the chest cavity, enabling better visualization, and creates working conditions similar to the open thoracotomy. Currently, uniportal VATS is being used for minor thoracic procedures and lung resections up to complex thoracic procedures typically requiring open approaches, such as chest wall resections, pneumonectomy, and bronchoplastic and pulmonary artery sleeve resections. Uniportal VATS is a clear advance in the field of general thoracic surgery and provides but a glimpse into the untold future. PMID:27134837

  20. Redundancy and variability in quality and outcome reporting for cardiac and thoracic surgery

    PubMed Central

    Dixon, Jennifer L.; Papaconstantinou, Harry T.; Hodges, Bonnie; Korsmo, Robyn S.; Jupiter, Dan; Shake, Jay; Sareyyupoglu, Basar; Rascoe, Philip A.

    2015-01-01

    Health care is evolving into a value-based reimbursement system focused on quality and outcomes. Reported outcomes from national databases are used for quality improvement projects and public reporting. This study compared reported outcomes in cardiac and thoracic surgery from two validated reporting databases—the Society of Thoracic Surgeons (STS) database and the National Surgical Quality Improvement Program (NSQIP)—from January 2011 to June 2012. Quality metrics and outcomes included mortality, wound infection, prolonged ventilation, pneumonia, renal failure, stroke, and cardiac arrest. Comparison was made by chi-square analysis. A total of 737 and 177 cardiac surgery cases and 451 and 105 thoracic surgery cases were captured by the STS database and NSQIP, respectively. Within cardiac surgery, there was a statistically significant difference in the reported rates of prolonged ventilation, renal failure, and mortality. No significant differences were found for the thoracic surgery data. In conclusion, our data indicated a significant discordance in quality reporting for cardiac surgery between the NSQIP and the STS databases. The disparity between databases and duplicate participation strongly indicates that a unified national quality reporting program is required. Consolidation of reporting databases and standardization of morbidity definitions across all databases may improve participation and reduce hospital cost. PMID:25552787

  1. High thoracic epidural anesthesia in cardiac surgery: risk factors for arterial hypotension.

    PubMed

    Casalino, Stefano; Mangia, Fabio; Stelian, Edmond; Novelli, Eugenio; Diena, Marco; Tesler, Ugo F

    2006-01-01

    There is an interest in the use of high thoracic epidural anesthesia in cardiac surgery, because experimental and clinical studies have suggested that central neuroaxial blockade attenuates the response to surgical stress and improves myocardial metabolism and perioperative analgesia-thus enabling earlier extubation and a smoother postoperative course. Matters of major concern in the adoption of high thoracic epidural anesthesia in cardiac surgery are neurologic injury secondary to neuroaxial hematoma and hypotension secondary to sympatholysis. The risk associated with possible neuraxial hematoma caused by high thoracic epidural anesthesia has been thoroughly investigated and largely discounted, but scant attention has been devoted to the onset of hypotensive episodes in the same setting. We analyzed the hypotensive episodes that occurred in a series of 144 patients who underwent on-pump cardiac surgery procedures. Among the patient variables that we tested in a multivariate logistic-regression model, only female sex was found to be significantly correlated with hypotension. In order to decrease the incidence and severity of hypotensive episodes resulting from anesthetic blockade, anesthesiologists need to monitor, with special care, women patients who are under high thoracic epidural anesthesia. Further studies are needed in order to determine why women undergoing open heart surgery under high thoracic epidural anesthesia are at a relatively greater risk of hypotension. PMID:16878616

  2. Statistical and data reporting guidelines for the European Journal of Cardio-Thoracic Surgery and the Interactive CardioVascular and Thoracic Surgery.

    PubMed

    Hickey, Graeme L; Dunning, Joel; Seifert, Burkhardt; Sodeck, Gottfried; Carr, Matthew J; Burger, Hans Ulrich; Beyersdorf, Friedhelm

    2015-08-01

    As part of the peer review process for the European Journal of Cardio-Thoracic Surgery (EJCTS) and the Interactive CardioVascular and Thoracic Surgery (ICVTS), a statistician reviews any manuscript that includes a statistical analysis. To facilitate authors considering submitting a manuscript and to make it clearer about the expectations of the statistical reviewers, we present up-to-date guidelines for authors on statistical and data reporting specifically in these journals. The number of statistical methods used in the cardiothoracic literature is vast, as are the ways in which data are presented. Therefore, we narrow the scope of these guidelines to cover the most common applications submitted to the EJCTS and ICVTS, focusing in particular on those that the statistical reviewers most frequently comment on. PMID:25971435

  3. Electroacupuncture Reduces Postoperative Pain and Analgesic Consumption in Patients Undergoing Thoracic Surgery: A Randomized Study

    PubMed Central

    Chen, Tongyu; Xu, Jianjun; Ma, Wen; Zhou, Jia

    2016-01-01

    The aim of this study was to evaluate the effect of electroacupuncture (EA) on postoperative pain management in patients undergoing thoracic surgery. A randomized study was conducted. Ninety-two thoracic surgical patients were randomly divided into an EA group and a sham group. Postoperative intravenous analgesia was applied with a half dose of the conventional drug concentration in both groups. In the EA group, EA treatment was administered for three consecutive days after the surgery with 6 sessions of 30 min each. Compared with the sham group, patients in the EA group had a lower visual analogue scale (VAS) score at 2, 24, 48, and 72 hours and consumed less analgesic after surgery. The incidence of opioid-related adverse effects of nausea was lower in the EA group. The time to first flatus and defecation was also shorter in the EA group. Furthermore, the plasma β-endorphin (β-EP) level was higher by radioimmunoassay and the plasma 5-hydroxytryptamine (5-HT) level was lower in the EA group by enzyme-linked immunosorbent assay during the first 72 hr after thoracic surgery. Therefore, EA is suitable as an adjunct treatment for postoperative pain management after thoracic surgery. PMID:27073400

  4. The history of surgery of the thoracic aorta.

    PubMed

    Cooley, D A

    1999-11-01

    Until the late 19th century, treatment of thoracic aortic aneurysms relied on ligation of the parent vessel or introduction of foreign materials to promote coagulation or fibrosis. A major breakthrough occurred in 1888, when Rudolph Matas reported an internal repair technique known as endoaneurysmorrhaphy. In this approach, the clot was excised from the aneurysmal sac, and the orifices of the arteries that entered the sac were sutured from within, reestablishing continuous blood flow. At the beginning of the 20th century, Alexis Carrel and Charles Guthrie began to lay the foundation for modern vascular anastomotic techniques. Although isolated successes were reported, optimal treatment of thoracic aortic disease awaited the development of reliable synthetic grafts in the 1950s and 1960s. During the past 15 years, the treatment goal has reverted to endoaneurysmorrhaphy, involving the use of a suitable graft to restore aortic continuity. PMID:10589335

  5. [Bronchopleural fistula: a serious complication after thoracic surgery].

    PubMed

    Purek, L; Licker, M; Frey, J G; Spiliopoulos, A; Tschopp, J M

    2009-05-13

    Postsurgical bronchopleural fistula (BPF) is a serious complication accompanied with a high mortality, requiring early and correct diagnosis. The acute form of BPF is usually a technical failure of the surgical stump requiring an immediate surgical reoperation. The subacute or chronic BPF is more difficult to diagnose because of non specific symptoms. It requires well targeted antibiotics depending on microbiology, an adequate drainage of the thoracic cavity and very often repeated surgical or endoscopic procedures. PMID:19526974

  6. Complications corner: Anterior thoracic disc surgery with dural tear/CSF fistula and low-pressure pleural drain led to severe intracranial hypotension

    PubMed Central

    Oudeman, Eline A.; Tewarie, Rishi D. S. Nandoe; Jbsis, G. Joost; Arts, Mark P.; Kruyt, Nyika D.

    2015-01-01

    Background: Thoracic disc surgery can lead to a life-threatening complication: intracranial hypotension due to a subarachnoid-pleural fistula. Case Description: We report a 63-year-old male with paraparesis due to multiple herniated thoracic discs, with compressive myelopathy. The patient required a circumferential procedure including a laminectomy/fusion followed by an anterior thoracic decompression to address both diffuse idiopathic skeletal hyperostosis (DISH) anteriorly and posterior stenosis. The postoperative course was complicated by severe intracranial hypotension attributed to the erroneous placement of a low-pressure drain placed in the pleural cavity instead of a lumbar drain; this resulted in subdural hematoma's necessitating subsequent surgery. Conclusion: Severe neurological deterioration occurring after thoracic decompressive surgery may rarely be attributed to intracranial hypotension due to a subarachnoid-pleural fistula. Patients should be treated with external lumbar drainage of cerebrospinal fluid for 35 days rather than a low-pressure pleural drain to avoid the onset of intracranial hypotension leading to symptomatic subdural hematomas. PMID:26005575

  7. [Actual respiratory technologies in thoracic surgery: traditional problems and innovative solutions].

    PubMed

    Vyzhigina, M A; Parshin, V D; Titov, V A; Alekseev, A V

    2015-01-01

    The problem of efficient gas exchange maintenance is always actual in anesthetic management of thoracic surgery and determines the selection of appropriate method of anesthesia. The article presents an experience of anesthesia during operations on lungs, trachea, bronchi and mediastinal structures performed from 1963 to 2015. Current concept of safety and efficacy of anesthetic management in thoracic surgery is presented. The role of actual current respiratory technologies and methods of anesthesia per se to maximize the efficiency of gas exchange in all stages of thoracicsurgery is emphasized. Absolute coherence of anesthesiologist and surgeon based on correct interaction is the most important condition of successful surgery. Effectiveness of special respiratory technologies for thoracic surgery associated with one-lung ventilation and prolonged wide dissection of airways is described. The research results and pathophysiological rationale for the use of special respiratory technologies including different variants of differentiated independent lung ventilation especially important for patients with concomitant cardiorespiratory pathology are presented. We reported experience of effective gas exchange maintenance in reconstructive surgery of trachea and main bronchi including traditional mechanical ventilation with "shunt-breath" system, use of jet high-frequency ventilation and relatively new respiratory technology such as flow apnoeic oxygenation. PMID:26753198

  8. Aiming at One-Stage Corrective Surgery for Extended Thoracic Aortic Dilatation

    PubMed Central

    Niinimaki, Eetu; Kajander, Henri; Paavonen, Timo; Sioris, Thanos; Mennander, Ari

    2014-01-01

    Definitive treatment of extended thoracic aortic dilatation is a major surgical challenge. Histopathology of resected thoracic aortic wall may reveal undiagnosed aortitis affecting outcome. We sought to investigate the benefit of thorough histopathology after one-stage corrective surgery for the treatment of extended thoracic aortic dilatation. Five patients underwent one-stage corrective surgery using the hybrid open arch repair by the frozen elephant trunk together with endovascular aortic grafting. A representative sample of the resected aortic arch was procured for histology. T- and B-lymphocytes, plasma cells, macrophages, and immunoglobulin G4 (IgG4) positivity were evaluated by immunohistochemistry. The mean preoperative maximum aortic diameter was 54 mm (range, 41–79 mm). The mean follow-up was 18 months (range, 1–24 months). As confirmed by computed tomography (CT) upon follow-up, complete thrombosis of the false lumen at the level of the frozen elephant trunk was achieved in all patients with dissection. One patient was operated due to atherosclerotic dilatation of the thoracic aorta, and postoperative CT showed successful exclusion of the atherosclerotic dilatation; this 75-year-old man was diagnosed with IgG4-positive aortitis and experienced unexpected blindness after surgery without evidence of emboli or long-term neurological impairment upon repeated brain CT. The hybrid open arch repair by the frozen elephant trunk and simultaneous endovascular repair is a feasible choice for one-stage surgery through sternotomy aiming at definitive treatment of extended thoracic aortic pathology. However, systematic evaluation of inflammation may reveal concealed aortitis affecting postoperative outcome and need for long-term surveillance. PMID:25075162

  9. Segmental thoracic spinal has advantages over general anesthesia for breast cancer surgery

    PubMed Central

    Elakany, Mohamed Hamdy; Abdelhamid, Sherif Ahmed

    2013-01-01

    Background: Thoracic spinal anesthesia has been used for laparoscopic cholecystectomy and abdominal surgeries, but not in breast surgery. The present study compared this technique with general anesthesia in breast cancer surgeries. Materials and Methods: Forty patients were enrolled in this comparative study with inclusion criteria of ASA physical status I-III, primary breast cancer without known extension beyond the breast and axillary nodes, scheduled for unilateral mastectomy with axillary dissection. They were randomly divided into two groups. The thoracic spinal group (S) (n = 20) underwent segmental thoracic spinal anesthesia with bupivacaine and fentanyl at T5-T6 interspace, while the other group (n = 20) underwent general anesthesia (G). Intraoperative hemodynamic parameters, intraoperative complications, postoperative discharge time from post-anesthesia care unit (PACU), postoperative pain and analgesic consumption, postoperative adverse effects, and patient satisfaction with the anesthetic techniques were recorded. Results: Intraoperative hypertension (20%) was more frequent in group (G), while hypotension and bradycardia (15%) were more frequent in the segmental thoracic spinal (S) group. Postoperative nausea (30%) and vomiting (40%) during PACU stay were more frequent in the (G) group. Postoperative discharge time from PACU was shorter in the (S) group (124 38 min) than in the (G) group (212 46 min). The quality of postoperative analgesia and analgesic consumption was better in the (S) group. Patient satisfaction was similar in both groups. Conclusions: Segmental thoracic spinal anesthesia has some advantages when compared with general anesthesia and can be considered as a sole anesthetic in breast cancer surgery with axillary lymph node clearance. PMID:25885990

  10. Current Trend of Robotic Thoracic and Cardiovascular Surgeries in Korea: Analysis of Seven-Year National Data

    PubMed Central

    Kang, Chang Hyun; Bok, Jin San; Lee, Na Rae; Kim, Young Tae; Lee, Seon Heui; Lim, Cheong

    2015-01-01

    Background Robotic surgery is an alternative to minimally invasive surgery. The aim of this study was to report on current trends in robotic thoracic and cardiovascular surgical techniques in Korea. Methods Data from the National Evidence-based Healthcare Collaborating Agency (NECA) between January 2006 and June 2012 were used in this study, including a total of 932 cases of robotic surgeries reported to NECA. The annual trends in the case volume, indications for robotic surgery, and distribution by hospitals and surgeons were analyzed in this study. Results Of the 932 cases, 591 (63%) were thoracic operations and 340 (37%) were cardiac operations. The case number increased explosively in 2007 and 2008. However, the rate of increase regained a steady state after 2011. The main indications for robotic thoracic surgery were pulmonary disease (n=271, 46%), esophageal disease (n=199, 34%), and mediastinal disease (n=117, 20%). The main indications for robotic cardiac surgery were valvular heart disease (n=228, 67%), atrial septal defect (n=79, 23%), and cardiac myxoma (n=27, 8%). Robotic thoracic and cardiovascular surgeries were performed in 19 hospitals. Three large volume hospitals performed 94% of the case volume of robotic cardiac surgery and 74% of robotic thoracic surgery. Centralization of robotic operation was significantly (p<0.0001) more common in cardiac surgery than in thoracic surgery. A total of 39 surgeons performed robotic surgeries. However, only 27% of cardiac surgeons and 23% of thoracic surgeons performed more than 10 cases of robotic surgery. Conclusion Trend analysis of robotic and cardiovascular operations demonstrated a gradual increase in the surgical volume in Korea. Meanwhile, centralization of surgical cases toward specific surgeons in specific hospitals was observed. PMID:26509124

  11. Electromagnetic navigational bronchoscopy and robotic-assisted thoracic surgery.

    PubMed

    Christie, Sara

    2014-06-01

    With the use of electromagnetic navigational bronchoscopy and robotics, lung lesions can be diagnosed and resected during one surgical procedure. Global positioning system technology allows surgeons to identify and mark a thoracic tumor, and then robotics technology allows them to perform minimally invasive resection and cancer staging procedures. Nurses on the perioperative robotics team must consider the logistics of providing safe and competent care when performing combined procedures during one surgical encounter. Instrumentation, OR organization and room setup, and patient positioning are important factors to consider to complete the procedure systematically and efficiently. This revolutionary concept of combining navigational bronchoscopy with robotics requires a team of dedicated nurses to facilitate the sequence of events essential for providing optimal patient outcomes in highly advanced surgical procedures. PMID:24875210

  12. Minimally Invasive Thoracic Surgery in Pediatric Patients: The Taiwan Experience

    PubMed Central

    Huang, Yu-Kai; Chou, Chieh; Li, Chung-Liang; Chiu, Hui-Gin; Chang, Yu-Tang

    2013-01-01

    Minimally invasive technology or laparoscopic surgery underwent a major breakthrough over the past two decades. The first experience of thoracoscopy in children was reported around 1980 for diagnosis of intrathoracic pathology and neoplasia. Up until the middle of the 1990s, the surgical community in Taiwan was still not well prepared to accept the coming era of minimally invasive surgery. In the beginning, laparoscopy was performed in only a few specialties and only relatively short or simple surgeries were considered. But now, the Taiwan's experiences over the several different clinical scenarios were dramatically increased. Therefore, we elaborated on the experience about pectus excavatum: Nuss procedure, primary spontaneous hemopneumothorax, thoracoscopic thymectomy, and empyema in Taiwan. PMID:23819123

  13. Office-Based Intracordal Hyaluronate Injections Improve Quality of Life in Thoracic-Surgery-Related Unilateral Vocal Fold Paralysis

    PubMed Central

    Fang, Tuan-Jen; Hsin, Li-Jen; Chung, Hsiu-Feng; Chiang, Hui-Chen; Li, Hsueh-Yu; Wong, Alice M.K.; Pei, Yu-Chen

    2015-01-01

    Abstract Thoracic-surgery-related unilateral vocal fold paralysis (UVFP) may cause severe morbidity and can cause profound functional impairment and psychosocial stress in patients with pre-existing thoracic diseases. In-office intracordal hyaluronate (HA) injections have recently been applied to improve voice and quality of life in patients with vocal incompetence, but their effect on thoracic-surgery-related UVFP remains inconclusive. We therefore conducted a prospective study to clarify the effect of early HA injection on voice and quality of life in patients with thoracic-surgery-related UVFP. Patients with UVFP within 3 months after thoracic surgery who received office-based HA injection were recruited. Quantitative laryngeal electromyography, videolaryngostroboscopy, voice-related life quality (voice outcome survey), laboratory voice analysis, and health-related quality of life (SF-36) were evaluated at baseline, and at 1 month postinjection. A total of 104 consecutive patients accepted office-based HA intracordal injection during the study period, 34 of whom were treated in relation to thoracic surgery and were eligible for inclusion. Voice-related life quality, voice laboratory analysis, and most generic quality of life domains were significantly improved at 1 month after in-office HA intracordal injection. No HA-related complications were reported. Single office-based HA intracordal injection is a safe and effective treatment for thoracic-surgery-related UVFP, resulting in immediate improvements in patient quality of life, voice quality, and swallowing ability. PMID:26448034

  14. Arthroscopic discectomy and interbody fusion of the thoracic spine: A report of ipsilateral 2-portal approach

    PubMed Central

    Osman, Said G.; Schwartz, Jeremy A.; Marsolais, E. B.

    2012-01-01

    Background The standard approach to the thoracic disc is through thoracotomy. The video-assisted thoracoscopic approach has been used as an alternative to the open approach for nearly 20 years, and more recently, extracavitary, posterolateral approaches have been introduced. Both the transthoracic procedures involve deflating the lung for access to the spine, and postoperative thoracic drainage is necessary; postoperative morbidity can be significant. The retropleural procedures are in their infancy, but the published results are promising. The purpose of this study is to introduce the posterolateral arthroscopic thoracic decompression and fusion procedure, which is extrapleural, less disruptive to normal anatomy, and cost-effective. Methods Fifteen consecutive patients who underwent arthroscopic decompression and interbody fusion of the thoracic spine were prospectively studied according to the hospital's institutional review board protocol. The Short Form 36 and visual analog scale questionnaires were completed preoperatively and postoperatively. Paired t tests were used for statistical analysis. The patient was placed in the prone position on a radiolucent table, and instrumentation was performed under fluoroscopic control. Two portals were developed ipsilaterally (one for the arthroscope and the other for instruments) on the side of disc herniation, and a single portal was used on the contralateral side. Various instruments were used for disc excision and exploration of the spinal canal. Fusion was accomplished with bilateral corticocancellous dowels obtained from the iliac crests. Infiltration of the access channel and facet injections of the contiguous joints were performed with bupivacaine, for immediate postoperative pain control. Results Fifteen patients with a mean age of 54 years were followed up for 28 months postoperatively. The overall back pain score decreased from 7.2 (SD, 1.5) to 3 (SD, 2) after the procedure (P < .005). Eleven patients were satisfied with their current lifestyle postoperatively as opposed to one preoperatively. Two patients had reoccurrences. Hospital stay averaged 18.5 hours. The operating room cost and the cost of hospital stay was 51.9% of the cost of anterior open discectomy. Conclusions The extrapleural, biportal, ipsilateral arthroscopic approach for the decompression and interbody fusion of the thoracic spine is feasible, cost-effective, less traumatic, and associated with minimal complications. The best results were obtained in patients with single-level thoracic disc herniation. The technique is applicable for most thoracic disc herniations. PMID:25694878

  15. Hormonal response in thoracic surgery. Effects of high-dose fentanyl anesthesia, compared to halothane anesthesia.

    PubMed

    Sofianos, E; Alevizou, F; Zissis, N; Kostaki, P; Balamoutsos, N

    1985-06-01

    Thirty two patients undergoing cardiac thoracic surgery were randomly assigned into two groups: Patients of the first group received high dose fentanyl (50 micrograms/kg) at the induction and patients of the second group received halothane for the maintenance of anesthesia. All patients received N2O:O2 and pancuronium for muscle relaxation. Surgical stress, as evaluated by changes in blood pressure, heart rate, plasma cortisol and glucose levels, appeared in the halothane group but not in the fentanyl group. Postoperative respiratory depression was expressed usually by mild elevation of pCO2 in the fentanyl group. Nevertheless two of these patients presented hypoventilation requiring intubation and naloxone administration. High dose fentanyl anesthesia may prove to be very useful in non cardiac thoracic surgery as it protects the patient from the stress of the operation and assures prolonged postoperative analgesia. When this technique is used one must always anticipate postoperative mechanical ventilation. PMID:3929553

  16. Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery

    PubMed Central

    Ellakany, Mohamed Hamdy

    2014-01-01

    Aim: A double-blinded randomized controlled study to compare discharge time and patient satisfaction between two groups of patients submitted to open surgeries for abdominal malignancies using segmental thoracic spinal or general anesthesia. Background: Open surgeries for abdominal malignancy are usually done under general anesthesia, but many patients with major medical problems sometimes can’t tolerate such anesthesia. Regional anesthesia namely segmental thoracic spinal anesthesia may be beneficial in such patients. Materials and Methods: A total of 60 patients classified according to American Society of Anesthesiology (ASA) as class II or III undergoing surgeries for abdominal malignancy, like colonic or gastric carcinoma, divided into two groups, 30 patients each. Group G, received general anesthesia, Group S received a segmental (T9-T10 injection) thoracic spinal anesthesia with intrathecal injection of 2 ml of hyperbaric bupivacaine 0.5% (10 mg) and 20 ug fentanyl citrate. Intraoperative monitoring, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two groups. Results: Spinal anesthesia was performed easily in all 30 patients, although two patients complained of paraesthesiae, which responded to slight needle withdrawal. No patient required conversion to general anesthesia, six patients required midazolam for anxiety and six patients required phenylephrine and atropine for hypotension and bradycardia, recovery was uneventful and without sequelae. The two groups were comparable with respect to gender, age, weight, height, body mass index, ASA classification, preoperative oxygen saturation and preoperative respiratory rate and operative time. Conclusion: This preliminary study has shown that segmental thoracic spinal anesthesia can be used successfully and effectively for open surgeries for abdominal malignancies by experienced anesthetists. It showed shorter postanesthesia care unit stay, better postoperative pain relief and patient satisfaction than general anesthesia. PMID:25886230

  17. Pneumocephalus Following Thoracic Surgery with Posterior Chest Wall Resection.

    PubMed

    Müller, Ina; Tönnies, Mario; Pfannschmidt, Joachim; Kaiser, Dirk

    2015-12-01

    Pneumocephalus can be seen after head injury with fracture of the skull-base or in cerebral neoplasm, infection, or after intracranial or spinal surgery. We report on a 69-year-old male patient with pneumocephalus after right-sided lobectomy and en bloc resection of the chest wall for non-small-cell lung cancer. Postoperatively, the patient showed a reduced vigilance level with no response to pain stimuli and anisocoria. The CCT scan revealed an extensive pneumocephalus; following which, the patient underwent neurosurgery with laminectomy and ligature of the transected nerve roots. After operation the patient returned to his baseline mental status. PMID:26693117

  18. The History of Deep Hypothermic Circulatory Arrest in Thoracic Aortic Surgery.

    PubMed

    Rimmer, Lara; Fok, Matthew; Bashir, Mohamad

    2014-08-01

    Depending on the extent of aortic disease and surgical repair required, thoracic aortic surgery often involves periods of reduced cerebral perfusion. Historically, this resulted in detrimental neurological dysfunction, and high risk of mortality and morbidity. Over the last half century, rapid improvements have revolutionized aortic surgery. Among these, deep hypothermic circulatory arrest (DHCA) has drastically reduced the risk of mortality and morbidity following surgery on the thoracic aorta. This progress was facilitated by experimental pioneers such as Bigelow, who studied reduced oxygen expenditure consequent on induction of hypothermia in dogs. These encouraging findings led to trials in human cardiac surgery by Lewis in 1952 and further made possible the first successful aortic arch replacement by Denton Cooley and Michael De Bakey. Modern day surgery has come a long way from the use of immersion of the patient in ice baths and other primitive techniques previously described. This paper explores the development of deep hypothermic circulatory arrest from its origins to the present. PMID:26798730

  19. Infant lumbar and thoracic epidurals for abdominal surgeries: cases in a paediatric tertiary institution

    PubMed Central

    Thong, Sze Ying; Sin, Eliza I-Lin; Chan, Diana Xin Hui; Shahani, Jagdish M

    2015-01-01

    INTRODUCTION There is strong evidence that epidural analgesia provides good postoperative pain relief in adults, but its use in infants is less established. In this retrospective study, we present our experience with managing infant epidural analgesia for abdominal surgeries in a tertiary paediatric institution. METHODS The records of 54 infants who had received a thoracic or lumbar epidural as perioperative analgesia for abdominal surgeries were included. The mean age of the infants was 6.1 (standard deviation [SD] 3.8) months and their mean weight was 6.8 kg (SD 1.8). Most (63%) had an ASA (American Society of Anesthesiologists) status of 2 and all underwent elective gastrointestinal, urogenital, hepatobiliary or retroperitoneal surgeries. 20 catheters (37.0%) were inserted in the thoracic region and 33 (61.1%) in the lumbar region. RESULTS A total of 52 (96.3%) catheters provided adequate intraoperative analgesia and 36 (66.7%) provided effective analgesia for the postoperative period. Active management of epidural analgesia, such as through epidural top-ups and infusion rate adjustment, was necessary to optimise analgesia in 22 (44%) of the 50 patients postoperatively. Reasons for premature catheter removal were mainly technical issues such as catheter disconnection, leakage and blockage. CONCLUSION Our data suggests that in experienced hands, specialised settings and active management, the success rate of epidural analgesia in infants undergoing major abdominal surgeries is high and without major incident. PMID:26311911

  20. [Cross-sectoral Approach of a Perioperative Management Center for General Thoracic Surgery].

    PubMed

    Shimoda, Atsushi; Soh, Junichi; Ashiba, Takako; Murata, Naomichi; Fukuda, Tomomi; Kobayashi, Motomu; Torigoe, Hidejiro; Maki, Yuho; Sugimoto, Seiichiro; Yamane, Masaomi; Toyooka, Shinichi; Oto, Takahiro; Miyoshi, Shinichiro

    2016-01-01

    Perioperative assessment and care, such as enhanced recovery after surgery (ERAS), is very important for improving the clinical outcomes of patients who have undergone surgery. However, professional assessments and care cannot be achieved through the actions of only 1 surgical department. We established a perioperative management center(PERIO) comprised of surgeons, dedicated nurses, anesthesiologists, dentists, physiotherapists, pharmacists, and nutritionists to perform intensive cross-sectoral perioperative management. In this manuscript, we investigated the impact of PERIO on the clinical outcomes of 127 elderly patients who underwent thoracic surgery for the resection of non-small cell lung cancer (NSCLC). We categorized these 127 patients into 3 groups:① those treated before the introduction of PERIO (between January 2006 to August 2008), ② those treated during the early phase after PERIO introduction (September 2008 to December 2011), and ③ those treated during the late phase after PERIO introduction( January 2012 to December 2014). Radical operations were performed significantly more frequently after PERIO introduction than before PERIO introduction, while the postoperative complication rates were similar among the 3 groups. The duration of postoperative hospitalization was reduced after the introduction of PERIO, and the hospital surplus increased after the introduction of PERIO. In conclusion, PERIO may play an important role in improving the clinical outcomes of thoracic surgery, especially for elderly patients with NSCLC. PMID:26975638

  1. Opportunities and challenges for thoracic surgery collaborations in China: a commentary

    PubMed Central

    2016-01-01

    Through a unique combination of factors—including a huge population, rapid social development, and concentration of resources in its mega-cities—China is witnessing phenomenal developments in the field of thoracic surgery. Ultra-high-volume centers are emerging that provide fantastic new opportunities for surgical training and clinical research to surgeons in China and partners from other countries. However, there are also particular shortcomings that are limiting clinical and academic developments. To realize the potential and reap the rewards, the challenges posed by these limitations must be overcome. Thoracic surgeons from Europe may be particularly well-placed to achieve this through multi-dimensional exchanges with their Chinese counterparts. PMID:27195139

  2. Transumbilical scarless surgery with thoracic trocar: easy and low-cost

    PubMed Central

    Okur, Mehmet Hanifi; Aydogdu, Bahattin; Arslan, Mehmet Serif; Cimen, Hasan; Otcu, Selcuk

    2013-01-01

    Purpose Single-site laparoscopic surgery has become increasingly common. We herein report an easy and low-cost thoracic trocar technique (TTT) for these types of procedures and recommend the simpler name "transumbilical scarless surgery" (TUSS) to minimize confusion in nomenclature. Methods We retrospectively reviewed patients who underwent TUSS by TTT using a thoracic trocar and surgical glove in our hospital between November 2011 and November 2012. Operating time, postoperative stay, and complications were detailed. Results A total of 101 TUSS by TTT were successfully performed, comprising appendectomy (n = 63), ovarian cyst excision (n = 7), splenectomy (n = 5), nephroureterectomy (n = 5), orchidopexy (n = 4), pyeloplasty (n = 3), nephrolithotomy (n = 2), orchiectomy (n = 2), varicocelectomy (n = 2), lymphangioma excision (n = 2), ureterectomy (n = 1), Morgagni diaphragmatic hernia repair (n = 1), ovarian detorsion (n = 1), antegrade continence enema (n = 1), intestinal resection anastomosis (n = 1), and intestinal duplication excision (n = 1). Kirschner wires were used for some organ traction. Nine patients required an additional port, but no major complications occurred. The postoperative stay (mean ± standard deviation) was 3.2 ± 1.4 days, and operating time was 58.9 ± 38.3 minutes. Conclusion We recommend the simpler name of TUSS to minimize confusion in nomenclature for all transumbilical single-incision laparoendoscopic surgeries. TTT is an easy and low-cost TUSS technique. PMID:23741694

  3. Gene expression profile in the diaphragm following contractile inactivity during thoracic surgery

    PubMed Central

    Welvaart, Willem N; Paul, Marinus A; Kuster, Diederik WD; van Wieringen, WesselN; Rustenburg, Francois; Stienen, Ger JM; Vonk-Noordegraaf, Anton; Ottenheijm, Coen AC

    2011-01-01

    Introduction. Recent work revealed the development of marked muscle fiber weakness in the diaphragm, but not in the non-respiratory latissimus dorsi, during thoracic surgery. To disentangle the molecular processes that underlie the development of diaphragm muscle fiber weakness during thoracic surgery, we studied changes in the gene expression profile. Methods. Serial biopsies from the diaphragm and the latissimus dorsi muscle were obtained from four patients during thoracotomy for resection of a tumor in the right lung. Biopsies were taken as soon as the diaphragm had been exposed (t0) and again after two hours (t2). Gobal differences in gene expression in diaphragm biopsies were assessed by microarray analysis. Results. 346 differentially expressed gene transcripts were found in the diaphragm at t2 vs. t0. Pathway analysis revealed that genes associated with inflammation (83 genes; p<0.0001) and cell death (118 genes, p<0.0001) pathways were significantly overexpressed at t2. Of the 346 differentially expressed genes in the diaphragm at t2, 258 were also differential in the latissimus dorsi muscle, with the direction of change being identical for all differentially expressed genes. In addition, latissimus dorsi showed exclusive upregula-ton of negative regulators of cell death. Conclusions. Two hours of thoracic surgery result in rapid and profound changes in expression of inflammatory response and apoptotic genes in the diaphragm. The apoptotic response was stronger in the diaphragm than in the latissiums dorsi. These findings suggest that the development of selective diaphragm muscle fiber weakness in these patients might be related to an exaggerated apoptotic response. PMID:21941608

  4. Compact light-emitting diode lighting ring for video-assisted thoracic surgery

    NASA Astrophysics Data System (ADS)

    Lu, Ming-Kuan; Chang, Feng-Chen; Wang, Wen-Zhe; Hsieh, Chih-Cheng; Kao, Fu-Jen

    2014-10-01

    In this work, a foldable ring-shaped light-emitting diode (LED) lighting assembly, designed to attach to a rubber wound retractor, is realized and tested through porcine animal experiments. Enabled by the small size and the high efficiency of LED chips, the lighting assembly is compact, flexible, and disposable while providing direct and high brightness lighting for more uniform background illumination in video-assisted thoracic surgery (VATS). When compared with a conventional fiber bundle coupled light source that is usually used in laparoscopy and endoscopy, the much broader solid angle of illumination enabled by the LED assembly allows greatly improved background lighting and imaging quality in VATS.

  5. The Use of Oxidized Regenerated Cellulose for Video-Assisted Thoracic Surgery.

    PubMed

    Tanaka, Yugo; Tane, Shinya; Hokka, Daisuke; Ogawa, Hiroyuki; Maniwa, Yoshimasa

    2016-02-01

    Disturbance of the surgical view during video-assisted thoracic surgery (VATS) as a result of blood oozing from the wound surface of the access port may lead to additional stress on surgeons and is difficult to prevent. We used a wound edge protector with oxidized regenerated cellulose (ORC) rings for the wound surfaces of the access ports and eliminated the problem. Furthermore, no hemostatic procedure was required for the wound surface before wound closure because the ORC rings completely stopped wound surface bleeding during the operation. ORC rings enhanced protection of the thoracoscopic port and the quality of VATS. PMID:26777946

  6. Patients' satisfaction: customer relationship management as a new opportunity for quality improvement in thoracic surgery.

    PubMed

    Rocco, Gaetano; Brunelli, Alessandro

    2012-11-01

    Clinical and nonclinical indicators of performance are meant to provide the surgeon with tools to identify weaknesses to be improved. The World Health Organization's Performance Evaluation Systems represent a multidimensional approach to quality measurement based on several categories made of different indicators. Indicators for patient satisfaction may include overall perceived quality, accessibility, humanization and patient involvement, communication, and trust in health care providers. Patient satisfaction is included among nonclinical indicators of performance in thoracic surgery and is increasingly recognized as one of the outcome measures for delivered quality of care. PMID:23084619

  7. Pulmonary arterioplasty using video-assisted thoracic surgery mechanical suture technique

    PubMed Central

    Xu, Xin; Huang, Jun; Yin, Weiqiang; Zhang, Xin; Chen, Hanzhang; Mo, Lili

    2016-01-01

    Lung cancer invading pulmonary trunk is a locally advanced condition, which may indicate poor prognosis. Surgical resection of the lesion can significantly improve survival for some patients. Lobectomy/Pneumonectomy with pulmonary arterioplasty via thoracotomy were generally accepted and used in the past. As the rapid development of minimally invasive techniques and devices, pulmonary arterioplasty is feasible via video-assisted thoracic surgery (VATS). However, few studies have reported the VATS surgical techniques. In this study, we reported the techniques of pulmonary arterioplasty via VATS. PMID:27076961

  8. Comparative In-Hospital Morbidity and Mortality after Revision versus Primary Thoracic and Lumbar Spine Fusion

    PubMed Central

    Ma, Yan; Passias, Peter; Gaber-Baylis, Licia K.; Girardi, Federico P.; Memtsoudis, Stavros G.

    2010-01-01

    Background Context Despite increasing utilization of surgical spine fusions, a paucity of literature addressing perioperative complications after revision (RPSF) versus primary posterior spine fusions (PPSF) of the thoracic and lumbar spine exists. Purpose To examine demographics of patients undergoing PPSF and RPSF of the thoracic and lumbar spine, assess the incidence of perioperative morbidity and mortality, and determine independent risk factors for in-hospital death. Study Design/Setting Analysis of nationally representative data collected for the National Inpatient Sample (NIS). Patient Sample All discharges included in the NIS with a procedure code for posterior thoracic and lumbar spine fusion from 1998 to 2006. Outcome Measures In-hospital mortality and morbidity. Methods Data collected for each year between 1998 and 2006 for the National Inpatient Sample were analyzed. Discharges with a procedure code for thoracic and lumbar spine fusion were included in the sample. The prevalence of patient as well as health care system related demographics were evaluated by procedure type (primary vs. revision). Frequencies of procedure-related complications and in-hospital mortality were analyzed. Independent predictors for in-hospital mortality were determined. Results We identified 222,549 PPSF and 12,474 RPSF discharges between 1998 and 2006. Patients undergoing PPSF were significantly younger (51.23 (CI= [51.16, 51.31]) years) and had lower average comorbidity indices (0.40 (CI= [0.39, 0.41]) than those undergoing RPSF (52.69 (CI= [52.43, 52.97]) years and 0.44 (CI=[0.43, 0.45]), P<0.0001). The incidence of procedure related complications was 16.02% among RPSF compared to 13.44% in PPSF patients (P<0.0001). In- hospital mortality rates after PPSF were approximately twice those of RPSF (0.28% vs. 0.15%, P=0.006). Adjusted risk factors for increased in-hospital mortality included PPSF compared to RPSF, male gender, and increasing age. A number of comorbidities, complications, and specific surgical indications increased the risk for perioperative death. Conclusion Despite being performed in generally younger and healthier patients, and having lower perioperative morbidity, PPSF procedures are associated with increased mortality compared with RPSF procedures. The findings of this study can be used for risk stratification, accurate patient consultation, and hypothesis formation for future research. PMID:20869002

  9. Single-port video-assisted thoracic surgery for early lung cancer: initial experience in Japan

    PubMed Central

    Takeuchi, Shingo; Usuda, Jitsuo

    2016-01-01

    Background Single-port video-assisted thoracic surgery (SPVATS) emerged several years ago as a new, minimally invasive surgery for diseases in the field of respiratory surgery, and is increasingly becoming a subject of interest for some thoracic surgeons in Europe and Asia. However, the adoption rate of this procedure in the United States and Japan remains low. We herein reviewed our experience of SPVATS for early lung cancer in our center, and evaluated the safety and minimal invasiveness of this technique. Methods We retrospectively analyzed patients who had undergone SPVATS for pathological stage I lung cancer in Nippon Medical School Chiba Hokusoh Hospital between September 2012 and October 2015. In SPVATS, an approximately 4-cm incision was made at the 4th or 5th intercostal space between the anterior and posterior axillary lines. A rib spreader was not used at the incision site, and surgical manipulation was performed very carefully in order to avoid contact between surgical instruments and the intercostal nerves. The same surgeon performed surgery on all patients, and analyzed laboratory data before and after surgery. Results Eighty-four patients underwent anatomical lung resection for postoperative pathological stage I lung cancer. The mean wound length was 4.2 cm. Eighty-four patients underwent lobectomy and segmentectomy, respectively. The mean preoperative forced expiratory volume in 1 second (FEV1%) was 1.85%±0.36%. Our patients consisted of 49 men (58.3%) and 35 women (41.7%), with 64, 18, 1, and 1 having adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, and small-cell lung cancer, respectively. The mean operative time was 175±21 min, operative blood loss 92±18 mL, and duration of drain placement 1.9±0.6 days. The duration of the postoperative hospital stay was 7.1±1.7 days, numeric rating scale (NRS) 1 week after surgery 2.8±0.6, and occurrence rate of allodynia 1 month after surgery 10.7%. No patient developed serious complications, and no deaths occurred within 30 days of surgery. Two patients (2.4%) were converted to open thoracotomy. Conclusions SPVATS is a safe and feasible technique, and is promising for next-generation thoracoscopic surgery. It may also reduce postoperative wound pain and contribute to improvements in the activities of daily living of patients. PMID:27014483

  10. Video-assisted thoracoscopic surgery in the management of penetrating and blunt thoracic trauma

    PubMed Central

    Milanchi, S; Makey, I; McKenna, R; Margulies, D R

    2009-01-01

    BACKGROUND: The role of video-assisted Thoracoscopic Surgery (VATS) is still being defined in the management of thoracic trauma. We report our trauma cases managed by VATS and review the role of VATS in the management of thoracic trauma. MATERIALS AND METHODS: All the trauma patients who underwent VATS from 2000 to 2007 at Cedars-Sinai Medical Center were retrospectively studied. RESULTS: Twenty-three trauma patients underwent 25 cases of VATS. The most common indication for VATS was retained haemothorax. Thoracotomy was avoided in 21 patients. VATS failed in two cases. On an average VATS was performed on trauma day seven (range 1-26) and the length of hospital stay was 20 days (range 3-58). There was no mortality. VATS was performed in an emergency (day 1-2), or in the early (day 2-7) or late (after day 7) phases of trauma. CONCLUSION: VATS can be performed safely for the management of thoracic traumas. VATS can be performed before or after thoracotomy and at any stage of trauma. The use of VATS in trauma has a trimodal distribution (emergent, early, late), each with different indications. PMID:20040799

  11. Clinical Experiences of Non-fusion Dynamic Stabilization Surgery for Adjacent Segmental Pathology after Lumbar Fusion

    PubMed Central

    Lee, Soo Eon; Kim, Hyun-Jib

    2016-01-01

    Background As an alternative to spinal fusion, non-fusion dynamic stabilization surgery has been developed, showing good clinical outcomes. In the present study, we introduce our surgical series, which involves non-fusion dynamic stabilization surgery for adjacent segment pathology (ASP) after lumbar fusion surgery. Methods Fifteen patients (13 female and 2 male, mean age of 62.1 years) who underwent dynamic stabilization surgery for symptomatic ASP were included and medical records, magnetic resonance images (MRI), and plain radiographs were retrospectively evaluated. Results Twelve of the 15 patients had the fusion segment at L4-5, and the most common segment affected by ASP was L3-4. The time interval between prior fusion and later non-fusion surgery was mean 67.0 months. The Visual Analog Scale and Oswestry Disability Index showed values of 7.4 and 58.5% before the non-fusion surgery and these values respectively declined to 4.2 and 41.3% postoperatively at 36 months (p=0.027 and p=0.018, respectively). During the mean 44.8 months of follow-up, medication of analgesics was also significantly reduced. The MRI grade for disc and central stenosis identified significant degeneration at L3-4, and similar disc degeneration from lateral radiographs was determined at L3-4 between before the prior fusion surgery and the later non-fusion surgery. After the non-fusion surgery, the L3-4 segment and the proximal segment of L2-3 were preserved in the disc, stenosis and facet joint whereas L1-2 showed disc degeneration on the last MRI (p=0.032). Five instances of radiologic ASP were identified, showing characteristic disc-space narrowing at the proximal segments of L1-2 and L2-3. However, no patient underwent additional surgery for ASP after non-fusion dynamic stabilization surgery. Conclusion The proposed non-fusion dynamic stabilization system could be an effective surgical treatment for elderly patients with symptomatic ASP after lumbar fusion. PMID:27162710

  12. A Retrospective Study of Chronic Post-Surgical Pain following Thoracic Surgery: Prevalence, Risk Factors, Incidence of Neuropathic Component, and Impact on Qualify of Life

    PubMed Central

    Peng, Zhiyou; Li, Huiling; Zhang, Chong; Qian, Xiang; Feng, Zhiying; Zhu, Shengmei

    2014-01-01

    Background Thoracic surgeries including thoracotomy and VATS are some of the highest risk procedures that often lead to CPSP, with or without a neuropathic component. This retrospective study aims to determine retrospectively the prevalence of CPSP following thoracic surgery, its predicting risk factors, the incidence of neuropathic component, and its impact on quality of life. Methods Patients who underwent thoracic surgeries including thoracotomy and VATS between 01/2010 and 12/2011 at the First Affiliated Hospital, School of Medicine, Zhejiang University were first contacted and screened for CPSP following thoracic surgery via phone interview. Patients who developed CPSP were then mailed with a battery of questionnaires, including a questionnaire referenced to Maguire's research, a validated Chinese version of the ID pain questionnaire, and a SF-36 Health Survey. Logistic regression analyses were subsequently performed to identify risk factors for CPSP following thoracic surgery and its neuropathic component. Results The point prevalence of CPSP following thoracic surgery was 24.9% (320/1284 patients), and the point prevalence of neuropathic component of CPSP was 32.5% (86/265 patients). CPSP following thoracic surgery did not improve significantly with time. Multiple predictive factors were identified for CPSP following thoracic surgery, including age<60 years old, female gender, prolonged duration of post-operative chest tube drainage (≥4 days), options of post-operative pain management, and pre-existing hypertension. Furthermore, patients who experienced CPSP following thoracic surgery were found to have significantly decreased physical function and worse quality of life, especially those with neuropathic component. Conclusions Our study demonstrated that nearly 1 out of 4 patients underwent thoracic surgery might develop CPSP, and one third of them accompanied with a neuropathic component. Early prevention as well as aggressive treatment is important for patients with CPSP following thoracic surgery to achieve a high quality of life. PMID:24587187

  13. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2016 Update on Outcomes and Quality.

    PubMed

    Jacobs, Jeffrey P; Mayer, John E; Mavroudis, Constantine; O'Brien, Sean M; Austin, Erle H; Pasquali, Sara K; Hill, Kevin D; He, Xia; Overman, David M; St Louis, James D; Karamlou, Tara; Pizarro, Christian; Hirsch-Romano, Jennifer C; McDonald, Donna; Han, Jane M; Dokholyan, Rachel S; Tchervenkov, Christo I; Lacour-Gayet, Francois; Backer, Carl L; Fraser, Charles D; Tweddell, James S; Elliott, Martin J; Walters, Hal; Jonas, Richard A; Prager, Richard L; Shahian, David M; Jacobs, Marshall L

    2016-03-01

    The Society of Thoracic Surgeons Congenital Heart Surgery Database is the largest congenital and pediatric cardiac surgical clinical data registry in the world. It is the platform for all activities of The Society of Thoracic Surgeons related to the analysis of outcomes and the improvement of quality in this subspecialty. This article summarizes current aggregate national outcomes in congenital and pediatric cardiac surgery and reviews related activities in the areas of quality measurement, performance improvement, and transparency. The reported data about aggregate national outcomes are exemplified by an analysis of 10 benchmark operations performed from January 2011 to December 2014 and documenting overall discharge mortality (interquartile range among programs with more than 9 cases): off-bypass coarctation, 1.0% (0.0% to 0.9%); ventricular septal defect repair, 0.7% (0.0% to 1.1%); tetralogy of Fallot repair, 1.0% (0.0% to 1.7%); complete atrioventricular canal repair, 3.2% (0.0% to 6.5%); arterial switch operation, 2.7% (0.0% to 5.6%); arterial switch operation plus ventricular septal defect, 5.3% (0.0% to 6.7%); Glenn/hemiFontan, 2.1% (0.0% to 3.8%); Fontan operation, 1.4% (0.0% to 2.4%); truncus arteriosus repair, 9.6% (0.0 % to 11.8%); and Norwood procedure, 15.6% (10.0% to 21.4%). PMID:26897186

  14. Complications of Minimally Invasive, Tubular Access Surgery for Cervical, Thoracic, and Lumbar Surgery

    PubMed Central

    Ross, Donald A.

    2014-01-01

    The object of the study was to review the author's large series of minimally invasive spine surgeries for complication rates. The author reviewed a personal operative database for minimally access spine surgeries done through nonexpandable tubular retractors for extradural, nonfusion procedures. Consecutive cases (n = 1231) were reviewed for complications. There were no wound infections. Durotomy occurred in 33 cases (2.7% overall or 3.4% of lumbar cases). There were no external or symptomatic internal cerebrospinal fluid leaks or pseudomeningoceles requiring additional treatment. The only motor injuries were 3 C5 root palsies, 2 of which resolved. Minimally invasive spine surgery performed through tubular retractors can result in a low wound infection rate when compared to open surgery. Durotomy is no more common than open procedures and does not often result in the need for secondary procedures. New neurologic deficits are uncommon, with most observed at the C5 root. Minimally invasive spine surgery, even without benefits such as less pain or shorter hospital stays, can result in considerably lower complication rates than open surgery. PMID:25097785

  15. Minimally invasive (robotic assisted thoracic surgery and video-assisted thoracic surgery) lobectomy for the treatment of locally advanced non-small cell lung cancer

    PubMed Central

    Yang, Hao-Xian; Woo, Kaitlin M.; Sima, Camelia S.

    2016-01-01

    Background Insufficient data exist on the results of minimally invasive surgery (MIS) for locally advanced non-small cell lung cancer (NSCLC) traditionally approached by thoracotomy. The use of telerobotic surgical systems may allow for greater utilization of MIS approaches to locally advanced disease. We will review the existing literature on MIS for locally advanced disease and briefly report on the results of a recent study conducted at our institution. Methods We performed a retrospective review of a prospective single institution database to identify patients with clinical stage II and IIIA NSCLC who underwent lobectomy following induction chemotherapy. The patients were classified into two groups (MIS and thoracotomy) and were compared for differences in outcomes and survival. Results From January 2002 to December 2013, 428 patients {397 thoracotomy, 31 MIS [17 robotic and 14 video-assisted thoracic surgery (VATS)]} underwent induction chemotherapy followed by lobectomy. The conversion rate in the MIS group was 26% (8/31) The R0 resection rate was similar between the groups (97% for MIS vs. 94% for thoracotomy; P=0.71), as was postoperative morbidity (32% for MIS vs. 33% for thoracotomy; P=0.99). The median length of hospital stay was shorter in the MIS group (4 vs. 5 days; P<0.001). The 3-year overall survival (OS) was 48.3% in the MIS group and 56.6% in the thoracotomy group (P=0.84); the corresponding 3-year DFS were 49.0% and 42.1% (P=0.19). Conclusions In appropriately selected patients with NSCLC, MIS approaches to lobectomy following induction therapy are feasible and associated with similar disease-free and OS to those following thoracotomy. PMID:27195138

  16. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: The Driving Force for Improvement in Cardiac Surgery.

    PubMed

    Winkley Shroyer, Annie Laurie; Bakaeen, Faisal; Shahian, David M; Carr, Brendan M; Prager, Richard L; Jacobs, Jeffrey P; Ferraris, Victor; Edwards, Fred; Grover, Frederick L

    2015-01-01

    Initiated in 1989, the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database (ACSD) includes more than 1085 participating centers, representing 90%-95% of current US-based adult cardiac surgery hospitals. Since its inception, the primary goal of the STS ACSD has been to use clinical data to track and improve cardiac surgical outcomes. Patients' preoperative risk characteristics, procedure-related processes of care, and clinical outcomes data have been captured and analyzed, with timely risk-adjusted feedback reports to participating providers. In 2006, STS initiated an external audit process to evaluate STS ACSD completeness and accuracy. Given the extremely high inter-rater reliability and completeness rates of STS ACSD, it is widely regarded as the "gold standard" for benchmarking cardiac surgery risk-adjusted outcomes. Over time, STS ACSD has expanded its quality horizons beyond the traditional focus on isolated, risk-adjusted short-term outcomes such as perioperative morbidity and mortality. New quality indicators have evolved including composite measures of key processes of care and outcomes (risk-adjusted morbidity and risk-adjusted mortality), longer-term outcomes, and readmissions. Resource use and patient-reported outcomes would be added in the future. These additional metrics provide a more comprehensive perspective on quality as well as additional end points. Widespread acceptance and use of STS ACSD has led to a cultural transformation within cardiac surgery by providing nationally benchmarked data for internal quality assessment, aiding data-driven quality improvement activities, serving as the basis for a voluntary public reporting program, advancing cardiac surgery care through STS ACSD-based research, and facilitating data-driven informed consent dialogues and alternative treatment-related discussions. PMID:26686440

  17. Is video-assisted thoracic surgery lobectomy in benign disease practical and effective?

    PubMed Central

    Kim, Dohun; Kim, Hong Kwan; Choi, Yong Soo; Kim, Jhingook; Shim, Young Mog

    2014-01-01

    Background The aim of this study was to analyze the surgical outcomes of video-assisted thoracic surgery (VATS) lobectomy for benign pulmonary disease and to propose surgical guidelines based on the retrospective cohort study. Methods From January 2004 to December 2009, all lobectomies performed in a university-based tertiary care hospital were analyzed. The inclusion criteria were as follows: (I) VATS lobectomy for benign disease; (II) thoracotomy conversion cases initially approached by VATS lobectomy. All malignant cases were excluded. Electronic medical records were retrospectively analyzed and patients were divided into two groups: with infection and without infection. The primary outcomes were the thoracotomy conversion rate, length of hospital stay, period of thoracic drainage and complications. Results VATS was performed in 163 (42%) of 385 patients who underwent lobectomy for benign disease. There were 68 in the infection group and 95 in the group without infection. VATS lobectomy was successful in 157 (96%) patients while 6 were converted into thoracotomy. The mean operation time and blood loss were 160 minutes and 326 mL. Comparing two groups, operation time and blood loss were not statistically different (P value =0.92, 0.63). Moreover conversion rate, length of hospital stay, period of thoracic drainage and complications (P value =0.67, 0.18, 0.25, and 0.50) were not different. Conclusions VATS lobectomy for benign disease is practical and effective in selected cases regardless of the presence of infection. However, because various technical obstacles may be encountered during the procedure, therefore, careful patient selection is needed. PMID:25276364

  18. Complications after video-assisted thoracic surgery in patients with pulmonary nontuberculous mycobacterial lung disease who underwent preoperative pulmonary rehabilitation

    PubMed Central

    Morino, Akira; Murase, Kazuma; Yamada, Katsuo

    2015-01-01

    [Purpose] Video-assisted thoracic surgery and preoperative pulmonary rehabilitation are effective in preventing postoperative complications in patients with cardiopulmonary disease. The present study aims to elucidate the presence of postoperative pneumonia and atelectasis in patients with nontuberculous mycobacterial lung disease who underwent lung resection with video-assisted thoracic surgery and preoperative pulmonary rehabilitation. [Subjects and Methods] Nineteen patients with nontuberculous mycobacterial lung disease who had undergone lung resection with video-assisted thoracic surgery and preoperative pulmonary rehabilitation were enrolled in this study. The presence of postoperative pneumonia and atelectasis was evaluated, and preoperative and postoperative pulmonary functions were compared. [Results] Postoperative pneumonia and postoperative atelectasis were not observed. Decreases of pulmonary function were 5.9% (standard deviation, 8.5) in forced vital capacity (percent predicted) and 9.6% (standard deviation, 11.1) in forced expiratory volume in 1 s (percent predicted). [Conclusion] The present study indicates that the combination of lung resection with video-assisted thoracic surgery and preoperative pulmonary rehabilitation in patients with nontuberculous mycobacterial lung disease may be effective in preventing postoperative complications. PMID:26357436

  19. Management of an ingested fish bone in the lung using video-assist thoracic surgery: a case report.

    PubMed

    Tan, Sichuang; Tan, Sipin; Peng, Muyun; Yu, Fenglei

    2015-06-01

    We report a case of lung abscess caused by an ingested fish bone that was successfully treated by minimally invasive surgery. Although cases of ingested foreign body abscess are well reported, lung abscess caused by ingested fish bone is extremely rare. To date, less than 10 similar cases have been reported in the literature. To the best of our knowledge, the case presented in this case report is the first report of this kind that was successfully treated by video-assist thoracic surgery (VATS). A 47-year-old man was admitted to department of thoracic surgery with the complaint of continues dry cough and fever. The patient accidentally swallowed a long sharp-blade-shaped fish bone 20 days before, which perforated the upper thoracic esophagus on the right and embedded in the right upper lobe.The diagnosis was verified by computed tomography scan and a video-assist thoracic surgery procedure was successfully performed to treat the patient. The patient survived the esophageal perforation fortunately without involvement of great vessel injury and probable mediastinitis. This report may provide additional experience on lung abscess caused by ingested fish bones. However, it is also important to educate the public of the risks of trying to force an ingested object down into the stomach. PMID:26039134

  20. Clinical pathway for video-assisted thoracic surgery: the Hong Kong story.

    PubMed

    Sihoe, Alan D L

    2016-02-01

    A clinical pathway provides a scheduled, objective protocol for the multi-disciplinary, evidence-based management of patients with a specific condition or undergoing a specific procedure. In implementing a clinical pathway for the care of patients receiving video-assisted thoracic surgery (VATS) in Hong Kong, many insights were gained into what makes a clinical pathway work: meticulous preparation and team-building are keys to success; the pathway must be constantly reviewed and revisions made in response to evolving clinical need; and data collection is a key element to allow auditing and clinical research. If these can be achieved, a clinical pathway delivers not only measurable improvements in patient outcomes, but also fundamentally complements clinical advances such as VATS. This article narrates the story of how the clinical pathway for VATS in Hong Kong was created and evolved, highlighting how the above lessons were learned. PMID:26941965

  1. The American Association for Thoracic Surgery Consensus Guidelines: Reasons and purpose.

    PubMed

    Svensson, Lars G; Gillinov, A Marc; Weisel, Richard D; Keshavjee, Shaf; Bacha, Emile A; Moon, Marc R; Cameron, Duke E; Sugarbaker, David J; Adams, David H; Gaynor, J William; Coselli, Joseph S; Del Nido, Pedro J; Jones, David; Sundt, Thoralf M; Cohn, Lawrence H; Pomar, Jose L; Lytle, Bruce W; Schaff, Hartzell V

    2016-04-01

    The time interval for the doubling of medical knowledge continues to decline. Physicians, patients, administrators, government officials, and payors are struggling to keep up to date with the waves of new information and to integrate the knowledge into new patient treatment protocols, processes, and metrics. Guidelines, Consensus Guidelines, and Consensus Statements, moderated by seasoned content experts, offer one method to rapidly distribute new information in a timely manner and also guide minimal standards of treatment of clinical care pathways as they are developed as part of bundled care programs. These proposed Consensus Guidelines advance The American Association for Thoracic Surgery's mission of leading in cardiothoracic health care, education, innovation, and modeling excellence. PMID:26892077

  2. Clinical pathway for video-assisted thoracic surgery: the Hong Kong story

    PubMed Central

    2016-01-01

    A clinical pathway provides a scheduled, objective protocol for the multi-disciplinary, evidence-based management of patients with a specific condition or undergoing a specific procedure. In implementing a clinical pathway for the care of patients receiving video-assisted thoracic surgery (VATS) in Hong Kong, many insights were gained into what makes a clinical pathway work: meticulous preparation and team-building are keys to success; the pathway must be constantly reviewed and revisions made in response to evolving clinical need; and data collection is a key element to allow auditing and clinical research. If these can be achieved, a clinical pathway delivers not only measurable improvements in patient outcomes, but also fundamentally complements clinical advances such as VATS. This article narrates the story of how the clinical pathway for VATS in Hong Kong was created and evolved, highlighting how the above lessons were learned. PMID:26941965

  3. Methodology manual for European Association for Cardio-Thoracic Surgery (EACTS) clinical guidelines.

    PubMed

    Sousa-Uva, Miguel; Head, Stuart J; Thielmann, Matthias; Cardillo, Giuseppe; Benedetto, Umberto; Czerny, Martin; Dunning, Joel; Castella, Manuel; Gudbjartsson, Tomas; Howell, Neil; Hazekamp, Mark; Kolh, Philippe; Beyersdorf, Friedhelm; Pagano, Domenico; Kappetein, A Pieter

    2015-12-01

    The goal of all clinical guidelines is to assist patients and practitioners in making healthcare decisions. However, clinical guidelines have been questioned about their quality, transparency and independence. Based on the revision of manuals by other scientific cardiothoracic organizations, this document provides instructions for the development of European Association for Cardio-Thoracic Surgery (EACTS) clinical guidelines and other types of evidence-based documents. Four key areas have been addressed: (i) selection of taskforce members and transparency of relations with the industry, (ii) methods for critical appraisal of medical evidence, (iii) rules for writing recommendations and (iv) review process. It is hoped that, by adopting this methodology, clinical guidelines produced by the EACTS will be well balanced, objective and, importantly, trusted by physicians and patients who benefit from their implementation. PMID:26362426

  4. Selective thoracic surgery in the Lenke type 1A: King III and King IV type curves

    PubMed Central

    Parisini, P.; Lolli, F.; Bakaloudis, G.

    2009-01-01

    Pedicle screw fixation enables enhanced three-dimensional correction of spinal deformities and effectively shortens the distal fusion level. However, the choice of distal fusion level is still controversial in single thoracic idiopathic scoliosis with the lumbar compensatory curve not crossing the middle line (Lenke type 1 with modifier A or King type III and IV curves).The authors retrospectively analyzed 31 patients treated by segmental pedicular instrumentation alone, affected by a single thoracic adolescent idiopathic scoliosis with a compensatory lumbar curve not crossing the midline (Lenke 1A), with an average age of 16.3 years (range 10–22 years). The patients with regard to the King classification were also assessed. A statistical analysis was performed to determine whether the two groups (King III, King IV) presented differences concerning the level of the stable vertebra (SV), end vertebra (EV), and neutral vertebra (NV) and were also analyzed the results at follow-up regarding the relationships between the SV, EV, and lowest instrumented vertebra (LIV). The statistical analysis showed a significant difference between the two curve types. In the King III type curve the SV, EV, and NV appeared to be more proximal than those of the King IV type curve and the segments between the SV, EV, and NV appeared to be reduced in King III curves compared with King IV curves. At a follow-up of 3.2 years (range 2.2–5) the thoracic curve showed a correction of 58.4% (from 62.3° to 26.6°) and compensatory lumbar curve an average spontaneous correction of 52.4% (from 38.1° to 18.1°).The position of the LIV was shorter than the position of the SV in 30 patients (97%) with an average “salvage” of 2.1 (from 1 to 4) distal fusion levels. Four cases (13%), all affected by a King IV type curve, presented at follow-up an unsatisfactory results due to an “adding on” phenomenon. The statistical analysis confirmed that this phenomenon was correlated with The King IV curve (P = 0.043; Chi-square test) and that the only predictive parameter for its onset was the LIV–SV difference (odds ratio = 0.093; with a confidence interval of 0.008–1): every time that in King IV curve type the LIV was three or more levels shorter than the stable vertebra at follow-up the “adding on” phenomenon was present. The authors conclude that Lenke’s type 1 with modifier A includes two kinds of curves, King III and King IV and that the Lenke’s type 2 curves and King V with the lumbar curve not crossing the middle line have a similar behavior. Therefore, it is of authors’ opinion that “the adding on phenomenon” could be prevented by more rigidly defining K. IV versus K. III curves. In Lenke’s 1/2 A-K. IV/V type with the rotation of the first vertebra just below the thoracic lower EV in the same direction as the thoracic curve, and when SV and EV show more than two levels of difference, it is necessary to extend the lower fusion down to L2 or L3 (not more than two levels shorter than the SV). Whereas in Lenke’s 1/2 A-K. III/V with the rotation of the first proximal vertebra of lumbar curve in the opposite direction to the thoracic apex and when SV and EV show not more than two level gap differences, the position of the lowest instrumented vertebra can be two or three levels shorter than the stable vertebra with satisfactory postoperative spinal balance. Therefore, the stable vertebra and the rotation of lumbar curve are considered to be a reliable guide for selecting the lower level of fusion. PMID:19399532

  5. Outcomes of Acute Type A Dissection Repair Before and After Implementation of a Multidisciplinary Thoracic Aortic Surgery Program

    PubMed Central

    Andersen, Nicholas D.; Ganapathi, Asvin M.; Hanna, Jennifer M.; Williams, Judson B.; Gaca, Jeffrey G.; Hughes, G. Chad

    2014-01-01

    Objectives The purpose of this study was to compare the results of acute type A aortic dissection (ATAAD) repair before and after implementation of a multidisciplinary thoracic aortic surgery program (TASP) at our institution, with dedicated high-volume thoracic aortic surgeons, a multidisciplinary approach to thoracic aortic disease management, and a standardized protocol for ATAAD repair. Background Outcomes of ATAAD repair may be improved when operations are performed at specialized high-volume thoracic aortic surgical centers. Methods Between 1999 and 2011, 128 patients underwent ATAAD repair at our institution. Records of patients who underwent ATAAD repair 6 years before (n = 56) and 6 years after (n = 72) implementation of the TASP were retrospectively compared. Expected operative mortality rates were calculated using the International Registry of Acute Aortic Dissection pre-operative prediction model. Results Baseline risk profiles and expected operative mortality rates were comparable between patients who underwent surgery before and after implementation of the TASP. Operative mortality before TASP implementation was 33.9% and was statistically equivalent to the expected operative mortality rate of 26.0% (observed-to-expected mortality ratio 1.30; p = 0.54). Operative mortality after TASP implementation fell to 2.8% and was statistically improved compared with the expected operative mortality rate of 18.2% (observed-to-expected mortality ratio 0.15; p = 0.005). Differences in survival persisted over long-term follow-up, with 5-year survival rates of 85% observed for TASP patients compared with 55% for pre-TASP patients (p = 0.002). Conclusions ATAAD repair can be performed with results approximating those of elective proximal aortic surgery when operations are performed by a high-volume multidisciplinary thoracic aortic surgery team. Efforts to standardize or centralize care of patients undergoing ATAAD are warranted. PMID:24412454

  6. Has Microsoft® Left Behind Risk Modeling in Cardiac and Thoracic Surgery?

    PubMed Central

    Poullis, Mike

    2011-01-01

    Abstract: This concept paper examines a number of key areas central to quality and risk assessment in cardiac surgery. The effect of surgeon and institutional factors with regard to outcomes in cardiac surgery is utilized to demonstrate the need to sub analyze cardiac surgeons performance in a more sophisticated manner than just operation type and patient risk factors, as in current risk models. By utilizing the mathematical/engineering concept of Fourier analysis in the breakdown of cardiac surgical results the effects of each of the core components that makes up the care package of a patient’s experiences are examined. The core components examined include: institutional, regional, patient, and surgeon effects. The limitations of current additive (Parsonnet, Euroscore) and logistic (Euroscore, Southern Thoracic Society) regression risk analysis techniques are discussed. The inadequacy of current modeling techniques is demonstrated via the use of known medical formula for calculating flow in the internal mammary artery and the calculation of blood pressure. By examining the fundamental limitations of current risk analysis techniques a new technique is proposed that embraces modern software computer technology via the use of structured query language. PMID:21449233

  7. Single-stage bilateral pulmonary resections by video-assisted thoracic surgery for multiple small nodules

    PubMed Central

    Yao, Feng; Yang, Haitang

    2016-01-01

    Background Surgical treatment is thought to be the most effective strategy for multiple small nodules. However, in general, one-stage bilateral resection is not recommended due to its highly invasive nature. Methods Clinical records of patients undergoing one-stage bilateral resections of multiple pulmonary nodules between January 2009 and September 2014 in a single institution were retrospectively reviewed. Results Simultaneous bilateral pulmonary resection by conventional video-assisted thoracic surgery (VATS) was undertaken in 29 patients. Ground glass opacity (GGO) accounted for 71.9% (46/64) of total lesions, including 26 pure GGO and 20 mixed GGO lesions. One case underwent bilateral lobectomy that was complicated by postoperative dyspnea. Lobar-sublobar (L/SL) resection and bilateral sublobar resection (SL-SL) were conducted in 16 and 12 cases, respectively, and most of these cases had uneventful postoperative courses. There was no significant difference with regard to postoperative complications (P=0.703), duration of use of chest drains (P=0.485), between one- and two-stage groups. Mean postoperative follow-up in cases of primary lung cancer was 31.4 (range, 10–51) months. There was neither recurrence nor deaths at final follow-up. Conclusions Single-stage bilateral surgery in selected cases with synchronous bilateral multiple nodules (SBMNs) is feasible and associated with satisfactory outcomes. PMID:27076942

  8. Pain prevalence and trajectories following pediatric spinal fusion surgery

    PubMed Central

    Sieberg, Christine B.; Simons, Laura E.; Edelstein, Mark R.; DeAngelis, Maria R.; Pielech, Melissa; Sethna, Navil; Hresko, M. Timothy

    2013-01-01

    Factors contributing to pain following surgery are poorly understood with previous research largely focused on adults. With approximately 6 million children undergoing surgery each year8, there is a need to study pediatric persistent postsurgical pain. The present study includes patients with adolescent idiopathic scoliosis undergoing spinal fusion surgery enrolled in a prospective, multi-centered registry examining post-surgical outcomes. The Scoliosis Research Society Questionnaire- Version 30, which includes pain, activity, mental health, and self-image subscales, was administered to 190 patients prior to surgery and at 1 and 2 years post-surgery. A subset (n=77) completed 5-year post-surgery data. Pain prevalence at each time point and longitudinal trajectories of pain outcomes derived from SAS PROC TRAJ were examined using ANOVAs and post-hoc pairwise analyses across groups. Thirty-five percent of patients reported pain in the moderate-severe range prior to surgery. One year postoperative, 11% reported pain in this range while 15% reported pain at two years post-surgery. At five years post-surgery, 15% of patients reported pain in the moderate to severe range. Among the five empirically-derived pain trajectories, there were significant differences on self-image, mental health, and age. Identifying predictors of poor long-term outcomes in children with postsurgical pain may prevent the development of chronic pain into adulthood. PMID:24290449

  9. [Modified lateral approach for surgery of thoracic disk herniation. Technical note].

    PubMed

    Rossitti, S

    1994-06-01

    The thoracic spine may be approached by different ways: posterior, posterolateral, anterolateral and anteriorly, with associated removal of diverse osseous structures as facet joints, costal processes, pedicles and ribs, subsequently imposing the use of diverse fusion procedures in some cases. The extreme lateral approach to the thoracic disc space produces minimum disruption of the normal spinal musculoskeletal anatomy, avoids retraction of the spinal cord and preserves the intercostal neurovascular bundle and the segmental radicular arteries. The operation is carried out with the patient in the prone position, and the patient is rotated away from the surgeon as necessary when the deeper levels are accessed. Radioscopy is used to identify the correct level after positioning of the patient. A straight transversal paravertebral incision is recommended in single-level operations. Alternatively an elliptical incision, concave medially and centered at the marked rib, is done and the skin flap is refleted medially. The muscles are partially divided at right angles over the rib to be excised and refleted cranial and caudally, exposing the rib and transverse process. The target disc is approached by removal of about 5 cm of the rib which has its insertion at the disc level, if necessary associated with partial removal of the transverse process, followed by partial pediculotomy (exclusively at the base of the pedicle) and a little lateral rachotomy (vertebral body ressection), which permits opening of the spinal canal exclusively ventral to the intervertebral foramen. In this way any kind of hemilaminectomy or facectomy is avoided. The discectomy is then carried out. This is a minimally invasive approach in comparison to the current ones.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7826252

  10. [Spinal instrumentation and spinal fusion surgery].

    PubMed

    Futatsuki, Takahiro; Kakihana, Yasuyuki; Nakamura, Kentaro; Hirakawa, Ai; Yamaguchi, Keiji; Yasuda, Tomotsugu

    2014-05-01

    In this article, we review the potential complications of spinal instrumentation discussing various types of postoperative complications. Surgical implants in spinal surgeries are used to stabilize the spine, replace the defective parts and maintain anatomic reduction. Internal spinal instrumentation has undergone considerable advances during the last century. However, the spinal instrumentation is an invasive surgery, and postoperative complications occur frequently after the spinal deformity surgery. Elderly patients, who may have many histories of medical complications and osteoporosis, have a higher complication rate. Pulmonary complications are the most common life-threatening postoperative complications. The acute onset of neurologic symptoms in the immediate postoperative period should arouse clinical suspicion about the possible formation of a hematoma. Such occurrences require urgent surgical decompression. Better recognition of postoperative risk factors and early detection of urgent signs may lead to decrease complication rates and may improve outcomes. Although the latest monitoring system is very useful we should recognize that the observation of the patients by the five senses is the most important way to detect the postoperative medical complications early. PMID:24864573

  11. Video-assisted thoracic surgery reduces early postoperative stress. A single-institutional prospective randomized study

    PubMed Central

    Asteriou, Christos; Lazopoulos, Achilleas; Rallis, Thomas; Gogakos, Apostolos S; Paliouras, Dimitrios; Tsakiridis, Kosmas; Zissimopoulos, Athanasios; Tsavlis, Drosos; Porpodis, Konstantinos; Hohenforst-Schmidt, Wolfgang; Kioumis, Ioannis; Organtzis, John; Zarogoulidis, Konstantinos; Zarogoulidis, Paul; Barbetakis, Nikolaos

    2016-01-01

    Background Video-assisted thoracic surgery (VATS) has been shown to effectively reduce postoperative pain, enhance mobilization of the patients, shorten in-hospital length of stay, and minimize postoperative morbidity rates. The aim of this prospective study is to evaluate neuroendocrine and respiratory parameters as stress markers in cancer patients who underwent lung wedge resections, using both mini muscle-sparing thoracotomy and VATS approach. Methods The patients were randomly allocated into two groups: Group A (n=30) involved patients who were operated on using the VATS approach, while in group B (n=30), the mini muscle-sparing thoracotomy approach was used. Neuroendocrine and biological variables assessed included blood glucose levels, C-reactive protein (CRP) levels, cortisol, epinephrine, and adrenocorticotropic hormone (ACTH) levels. Arterial oxygen (PaO2) and carbon dioxide (PaCO2) partial pressure were also evaluated. All parameters were measured at the following time points: 24 hours preoperatively (T1), 4 hours (T2), 24 hours (T3), 48 hours (T4), and 72 hours (T5), after the procedure. Results PaO2 levels were significantly higher 4 and 24 hours postoperatively in group A vs group B, respectively (T2: 94.3 vs 77.9 mmHg, P=0.015, T3: 96.4 vs 88.7 mmHg, P=0.034). Blood glucose (T2: 148 vs 163 mg/dL, P=0.045, T3: 133 vs 159 mg/dL, P=0.009) and CRP values (T2: 1.6 vs 2.5 mg/dL, P=0.024, T3: 1.5 vs 2.1 mg/dL, P=0.044) were found increased in both groups 4 and 24 hours after the procedure. However, their levels were significantly lower in the VATS group of patients. ACTH and cortisol values were elevated immediately after the operation and became normal after 48 hours in both groups, without significant difference. Postoperative epinephrine levels measured in group A vs group B, respectively, (T2: 78.9 vs 115.6 ng/L, P=0.007, T3: 83.4 vs 122.5 ng/L, P=0.012, T4: 67.4 vs 102.6 ng/L, P=0.021). The levels were significantly higher in group B. Conclusion This study confirmed that minimally invasive thoracic surgery, by means of VATS, significantly reduces the acute-phase response and surgical stress, while enables better postoperative oxygenation. PMID:26834478

  12. “High Frequency/Small Tidal Volume Differential Lung Ventilation”: A Technique of Ventilating the Nondependent Lung of One Lung Ventilation for Robotically Assisted Thoracic Surgery

    PubMed Central

    Shoman, Bassam M.; Ragab, Hany O.; Mustafa, Ammar; Mazhar, Rashid

    2015-01-01

    With the introduction of new techniques and advances in the thoracic surgery fields, challenges to the anesthesia techniques had became increasingly exponential. One of the great improvements that took place in the thoracic surgical field was the use of the robotically assisted thoracic surgical procedure and minimally invasive endoscopic thoracic surgery. One lung ventilation technique represents the core anesthetic management for the success of those surgical procedures. Even with the use of effective one lung ventilation, the patient hemodynamics and respiratory parameters could be deranged and could not be tolerating the procedure that could compromise the end result of surgery. We are presenting our experience in managing one patient who suffered persistent hypoxia and hemodynamic instability with one lung ventilation for robotically assisted thymectomy procedure and how it was managed till the completion of the surgery successfully. PMID:26347827

  13. Anterior thoracoscopic surgery followed by posterior instrumentation and fusion in spinal deformity.

    PubMed

    Niemeyer, T; Freeman, B J; Grevitt, M P; Webb, J K

    2000-12-01

    Many authors believe thoracoscopic surgery is associated with a lower level of morbidity compared to thoracotomy, for anterior release or growth arrest in spinal deformity. Others believe that anterior release achieved thoracoscopically is not as effective as that achieved with the open procedure. We evaluated the clinical results, radiological correction and morbidity following anterior thoracoscopic surgery followed by posterior instrumentation and fusion, to see whether there is any evidence for either of these beliefs. Twenty-nine patients undergoing thoracoscopic anterior release or growth arrest followed by posterior fusion and instrumentation were evaluated from a clinical and radiological viewpoint. The mean follow-up was 2 years (range 1-4 years). The average age was 16 years (range 5-26 years). The following diagnoses were present: idiopathic scoliosis (n = 17), neuromuscular scoliosis (n = 2), congenital scoliosis (n = 1), thoracic hyperkyphosis (n = 9). All patients were satisfied with cosmesis following surgery. Twenty scoliosis patients had a mean preoperative Cobb angle of 65.1 degrees (range 42 degrees-94 degrees) for the major curve, with an average flexibility of 34.5% (42.7 degrees). Post operative correction to 31.5 degrees (50.9%) and 34.4 degrees (47.1%) at maximal follow-up was noted. For nine patients with thoracic hyperkyphosis, the Cobb angle averaged 81 degrees (range 65 degrees-96 degrees), with hyperextension films showing an average correction to 65 degrees. Postoperative correction to an average of 58.6 degrees was maintained at 59.5 degrees at maximal follow-up. The average number of released levels was 5.1 (range 3-7) and the average duration of the thoracoscopic procedure was 188 min (range 120-280 min). There was a decrease in this length of time as the series progressed. No neurologic or vascular complications occurred. Postoperative complications included four recurrent pneumothoraces, one surgical emphysema, and one respiratory infection. Thoracoscopic anterior surgery appears a safe and effective technique for the treatment of paediatric and adolescent spinal deformity. A randomised controlled trial, comparing open with thoracoscopic methods, is required. PMID:11189918

  14. High-performance C-arm cone-beam CT guidance of thoracic surgery

    NASA Astrophysics Data System (ADS)

    Schafer, Sebastian; Otake, Yoshito; Uneri, Ali; Mirota, Daniel J.; Nithiananthan, Sajendra; Stayman, J. W.; Zbijewski, Wojciech; Kleinszig, Gerhard; Graumann, Rainer; Sussman, Marc; Siewerdsen, Jeffrey H.

    2012-02-01

    Localizing sub-palpable nodules in minimally invasive video-assisted thoracic surgery (VATS) presents a significant challenge. To overcome inherent problems of preoperative nodule tagging using CT fluoroscopic guidance, an intraoperative C-arm cone-beam CT (CBCT) image-guidance system has been developed for direct localization of subpalpable tumors in the OR, including real-time tracking of surgical tools (including thoracoscope), and video-CBCT registration for augmentation of the thoracoscopic scene. Acquisition protocols for nodule visibility in the inflated and deflated lung were delineated in phantom and animal/cadaver studies. Motion compensated reconstruction was implemented to account for motion induced by the ventilated contralateral lung. Experience in CBCT-guided targeting of simulated lung nodules included phantoms, porcine models, and cadavers. Phantom studies defined low-dose acquisition protocols providing contrast-to-noise ratio sufficient for lung nodule visualization, confirmed in porcine specimens with simulated nodules (3-6mm diameter PE spheres, ~100-150HU contrast, 2.1mGy). Nodule visibility in CBCT of the collapsed lung, with reduced contrast according to air volume retention, was more challenging, but initial studies confirmed visibility using scan protocols at slightly increased dose (~4.6-11.1mGy). Motion compensated reconstruction employing a 4D deformation map in the backprojection process reduced artifacts associated with motion blur. Augmentation of thoracoscopic video with renderings of the target and critical structures (e.g., pulmonary artery) showed geometric accuracy consistent with camera calibration and the tracking system (2.4mm registration error). Initial results suggest a potentially valuable role for CBCT guidance in VATS, improving precision in minimally invasive, lungconserving surgeries, avoid critical structures, obviate the burdens of preoperative localization, and improve patient safety.

  15. Real-time endoscopic guidance using near-infrared fluorescent light for thoracic surgery

    NASA Astrophysics Data System (ADS)

    Venugopal, Vivek; Stockdale, Alan; Neacsu, Florin; Kettenring, Frank; Frangioni, John V.; Gangadharan, Sidharta P.; Gioux, Sylvain

    2013-03-01

    Lung cancer is the leading cause of cancer death in the United States, accounting for 28% of all cancer deaths. Standard of care for potentially curable lung cancer involves preoperative radiographic or invasive staging, followed by surgical resection. With recent adjuvant chemotherapy and radiation studies showing a survival advantage in nodepositive patients, it is crucial to accurately stage these patients surgically in order to identify those who may benefit. However, lymphadenectomy in lung cancer is currently performed without guidance, mainly due to the lack of tools permitting real-time, intraoperative identification of lymph nodes. In this study we report the design and validation of a novel, clinically compatible near-infrared (NIR) fluorescence thoracoscope for real-time intraoperative guidance during lymphadenectomy. A novel, NIR-compatible, clinical rigid endoscope has been designed and fabricated, and coupled to a custom source and a dual channel camera to provide simultaneous color and NIR fluorescence information to the surgeon. The device has been successfully used in conjunction with a safe, FDA-approved fluorescent tracer to detect and resect mediastinal lymph nodes during thoracic surgery on Yorkshire pigs. Taken together, this study lays the foundation for the clinical translation of endoscopic NIR fluorescence intraoperative guidance and has the potential to profoundly impact the management of lung cancer patients.

  16. Non-intubated video-assisted thoracic surgery: where does evidence stand?

    PubMed Central

    Tacconi, Federico

    2016-01-01

    In recent years, non-intubated video-assisted thoracic surgery (NIVATS) strategies are gaining popularity worldwide. The main goal of this surgical practice is to achieve an overall improvement of patients’ management and outcome thanks to the avoidance of side-effects related to general anesthesia (GA) and one-lung ventilation. The spectrum of expected benefits is multifaceted and includes reduced postoperative morbidity, faster discharge, decreased hospital costs and a globally reduced perturbation of patients’ well-being status. We have conducted a literature search to evaluate the available evidence on this topic. Meta-analysis of collected results was also done where appropriate. Despite some fragmentation of data and potential biases, the available data suggest that NIVATS operations can reduce operative morbidity and hospital stay when compared to equipollent procedures performed under GA. Larger, well designed prospective studies are thus warranted to assess the effectiveness of NIVATS as far as to investigate comprehensively the various outcomes. Multi-institutional and multidisciplinary cooperation will be welcome to establish uniform study protocols and to help address the questions that are to be answered yet. PMID:27195134

  17. Effects of epidural analgesia with different concentrations of bupivacaine plus fentanyl on pain in patients undergoing thoracic surgery

    PubMed Central

    Li, Hao; Wang, Baosheng; Wang, Fumei; Xu, Zan; Zhou, Naibao; Wang, Xiuqin; Wang, Kaiguo

    2015-01-01

    Objective: To investigate and compared the efficacy and safety of epidural analgesia with different concentrations of bupivacaine plus fentanyl on pain in patients undergoing thoracic surgery. Methods: 120 cases undergoing elective thoracic surgery were randomly divided into A, B, C and D four groups each with 30 cases, and they were treated with 0.25% (A group), 0.375% (B group), 0.50% (C group) and 0.75% (D group) bupivacaine plus fentanyl 0.4 mg. The pain conditions postoperative 4 h, 8 h, 12 h, 24 h and 48 h were evaluated by visual analogue scale (VAS). The PCA pressing numbers and incidence of adverse reactions were compared between the four groups. Results: By postoperative 4 h, the VAS in D group were obviously lower than those in the other three groups (P all <0.05), and the other three groups showed no significances (P>0.05). However, the four groups showed no significant differences in VAS by postoperative 8 h, 12 h, 24 h and 48 h (P all >0.05). The incidences of respiratory depression in C and D groups were markedly higher than those in A and B groups (P all <0.05). Conclusions: 0.25%~0.375% bupivacaine plus fentanyl 0.4 mg using in epidural analgesia in patients undergoing thoracic surgery can lead to safe and effective analgesic effect. PMID:26550381

  18. Could CCI or FBCI Fully Eliminate the Impact of Curve Flexibility When Evaluating the Surgery Outcome for Thoracic Curve Idiopathic Scoliosis Patient? A Retrospective Study

    PubMed Central

    Ni, Haijian; Zhu, Xiaodong; Li, Ming

    2015-01-01

    Purpose To clarify if CCI or FBCI could fully eliminate the influence of curve flexibility on the coronal correction rate. Methods We reviewed medical record of all thoracic curve AIS cases undergoing posterior spinal fusion with all pedicle screw systems from June 2011 to July 2013. Radiographical data was collected and calculated. Student t test, Pearson correlation analysis and linear regression analysis were used to analyze the data. Results 60 were included in this study. The mean age was 14.7y (10-18y) with 10 males (17%) and 50 females (83%). The average Risser sign was 2.7. The mean thoracic Cobb angle before operation was 51.9°. The mean bending Cobb angle was 27.6° and the mean fulcrum bending Cobb angle was 17.4°. The mean Cobb angle at 2 week after surgery was 16.3°. The Pearson correlation coefficient r between CCI and BFR was -0.856(P<0.001), and between FBCI and FFR was -0.728 (P<0.001). A modified FBCI (M-FBCI) = (CR-0.513)/BFR or a modified CCI (M-CCI) = (CR-0.279)/FFR was generated by curve estimation has no significant correlation with FFR (r=-0.08, p=0.950) or with BFR (r=0.123, p=0.349). Conclusions Fulcrum-bending radiographs may better predict the outcome of AIS coronal correction than bending radiographs in thoracic curveAIS patients. Neither CCI nor FBCI can fully eliminate the impact of curve flexibility on the outcome of correction. A modified CCI or FBCI can better evaluating the corrective effects of different surgical techniques or instruments. PMID:25984945

  19. Optimizing postoperative care protocols in thoracic surgery: best evidence and new technology

    PubMed Central

    French, Daniel G.; Dilena, Michael; LaPlante, Simon; Shamji, Farid; Sundaresan, Sudhir; Villeneuve, James; Seely, Andrew; Maziak, Donna

    2016-01-01

    Postoperative clinical pathways have been shown to improve postoperative care and decrease length of stay in hospital. In thoracic surgery there is a need to develop chest tube management pathways. This paper considers four aspects of chest tube management: (I) appraising the role of chest X-rays in the management of lung resection patients with chest drains; (II) selecting of a fluid output threshold below which chest tubes can be removed safely; (III) deciding whether suction should be applied to chest tubes; (IV) and selecting the safest method for chest tube removal. There is evidence that routine use of chest X-rays does not influence the management of chest tubes. There is a lack of consensus on the highest fluid output threshold below which chest tubes can be safely removed. The optimal use of negative intra-pleural pressure has not yet been established despite multiple randomized controlled trials and meta-analyses. When attempting to improve efficiency in the management of chest tubes, evidence in support of drain removal without a trial of water seal should be considered. Inconsistencies in the interpretation of air leaks and in chest tube management are likely contributors to the conflicting results found in the literature. New digital pleural drainage systems, which provide a more objective air leak assessment and can record air leak trend over time, will likely contribute to the development of new evidence-based guidelines. Technology should be combined with continued efforts to standardize care, create clinical pathways, and analyze their impact on postoperative outcomes. PMID:26941968

  20. Non-intubated video-assisted thoracic surgery in patients aged 80 years and older

    PubMed Central

    Facktor, Matthew A.

    2015-01-01

    Background Video-assisted thoracic surgery (VATS) is routinely performed with general anesthesia and double-lumen endotracheal intubation, but this technique may stress an elderly patient’s functional reserve. We chose to study the safety and efficacy of non-intubated VATS, utilizing local anesthesia, sedation, and spontaneous ventilation in the elderly. Methods The medical records of all patients aged 80 years and older who underwent VATS under local anesthesia and sedation during the time period 6/1/2002 to 6/1/2010 at Geisinger Health System (Pennsylvania, USA) and 10/1/2011 to 12/31/2014 at Sinai Hospital (Maryland, USA) were retrospectively reviewed. Unsuccessful attempts at this technique were eligible for inclusion but there were none. No patient was excluded based on comorbidity. Results A total of 96 patients ranging in age from 80 to 104 years underwent 102 non-intubated VATS procedures: pleural biopsy/effusion drainage with or without talc 73, drainage of empyema 17, evacuate hemothorax 4, pericardial window 3, lung biopsy 2, treat chylothorax 2, treat pneumothorax 1. No patient required intubation or conversion to thoracotomy. No patient required a subsequent procedure or biopsy. Complications occurred in three patients (3.1% morbidity): cerebrovascular accident, pulmonary embolism, prolonged air leak. One 94-year-old patient died from overanticoagulation and two 84-year-old patients died of their advanced lung cancers (3.1% morbidity). Conclusions Non-intubated VATS utilizing local anesthesia and sedation in the elderly is well tolerated and safe for a number of indications. PMID:26046042

  1. Uniportal video-assisted thoracic surgery lobectomy in semiprone position: primary experience of 105 cases

    PubMed Central

    Lin, Zongwu; Xi, Junjie; Jiang, Wei; Wang, Lin; Wang, Qun

    2015-01-01

    Background Uniportal video-assisted thoracic surgery (VATS) is becoming popular, and uniportal lobectomy in semiprone position was reported in 2014. This study aimed to investigate the feasibility and safety of uniportal VATS in semiprone position. Methods From May 28, 2014 to October 19, 2015, we attempted uniportal VATS lobectomy in semiprone position in 105 cases. Forty-five patients were male, and 60 patients were female. Average age was 57.1±10.6 years (24–76 years). Perioperative parameters were documented. Results There were two conversions to three-port lobectomy, one conversion to double-port lobectomy, and three conversions to thoracotomy. Among the patients who received uniportal VATS in semiprone position, mean operation duration was 137.4±47.8 minutes. Mean estimated blood loss was 60.7±102.7 mL. Mean time of drainage was 3.0±2.1 days, and postoperative length of stay averaged 4.9±2.3 days. In the cases of primary lung cancer, the mean number of nodal stations explored was 7.2±1.3, with a mean of 20.8±6.3 lymph nodes resected. As to the mediastinal lymph node specifically, a mean of 4.4±1.0 nodal stations were explored, and the number of resected mediastinal lymph nodes averaged 12.8±5.1. No perioperative death or major complication occurred. Conclusions Uniportal VATS lobectomy in semiprone position is feasible and safe. PMID:26793366

  2. Procedure-Based Complications to Guide Informed Consent: Analysis of Society of Thoracic Surgeons-Congenital Heart Surgery Database

    PubMed Central

    Mavroudis, Constantine; Mavroudis, Constantine D.; Jacobs, Jeffrey P.; Siegel, Allison; Pasquali, Sara K.; Hill, Kevin D.; Jacobs, Marshall L.

    2014-01-01

    Background Informed consent refers to the process by which physicians and patients engage in a dialogue to explain and comprehend the nature, alternatives, and risks of a procedure or course of therapy. The goal of this study is to better “inform the process of informed consent” by offering empirically derived procedural complication lists that provide objective contemporary data that surgeons may share with patients and families. Methods The Society of Thoracic Surgeons Congenital Heart Surgery Database was queried for complications for 12 congenital heart operations (2010 to 2011) performed across all Society of Thoracic Surgeons-European Association of Cardio-Thoracic Surgery Congenital Heart Surgery (STAT) risk categories. Results The 12 index procedures reviewed for rates of complications were repair of atrial septal defect (ASD), ventricular septal defect (VSD), atrioventricular septal defect (AVSD), tetralogy of Fallot (TOF), coarctation, and truncus arteriosus, as well as arterial switch operation (ASO), ASO-VSD, BiGlenn, Fontan, Norwood procedure, and systemic to pulmonary artery (S-P) shunt. Arrhythmia was the most frequent complication for VSD (5.8%), TOF (8.9%), and AVSD (14.7%) repairs. There was a high rate of sternum left open (planned, unplanned) for ASO (26%, 7%), ASO-VSD (29%, 10%), truncus repair (41%, 11%), and Norwood (63%, 7%). The most frequent complications for other procedures include ASD (unplanned readmission, 1.9%), BiGlenn (chylothorax, 7%), Fontan (pleural effusion, 16%), S-P shunt (reintubation, 10.6%), and coarctation (reintubation, 5.2%). Conclusions The informed consent process for congenital heart surgery may be served by accurate contemporary data on occurrence of complications. While a threshold rate of occurrence of individual complications may guide the physician, rare but important debilitating complications should also be discussed irrespective of frequency. We propose to better inform the process of informed consent by providing objective complications data. PMID:24680033

  3. Comparison Between Phenylephrine and Dopamine in Maintaining Cerebral Oxygen Saturation in Thoracic Surgery: A Randomized Controlled Trial.

    PubMed

    Choi, Ji Won; JooAhn, Hyun; Yang, Mikyung; Kim, Jie Ae; Lee, Sangmin M; Ahn, Jin Hee

    2015-12-01

    Fluid is usually restricted during thoracic surgery, and vasoactive agents are often administered to maintain blood pressure. One-lung ventilation (OLV) decreases arterial oxygenation; thus oxygen delivery to the brain can be decreased. In this study, we compared phenylephrine and dopamine with respect to maintaining cerebral oxygenation during OLV in major thoracic surgery.Sixty-three patients undergoing lobectomies were randomly assigned to the dopamine (D) or phenylephrine (P) group. The patients' mean arterial pressure was maintained within 20% of baseline by a continuous infusion of dopamine or phenylephrine. Maintenance fluid was kept at 5 mL/kg/h. The depth of anesthesia was maintained with desflurane 1MAC and remifentanil infusion under bispectral index guidance. Regional cerebral oxygen saturation (rScO2) and hemodynamic variables were recorded using near-infrared spectroscopy and esophageal cardiac Doppler.The rScO2 was higher in the D group than the P group during OLV (OLV 60 min: 71 ± 6% vs 63 ± 12%; P = 0.03). The number of patients whose rScO2 dropped more than 20% from baseline was 0 and 6 in the D and P groups, respectively (P = 0.02). The D group showed higher cardiac output, but lower mean arterial pressure than the P group (4.7 ± 1.0 vs 3.9 ± 1.2 L/min; 76.7 ± 8.1 vs 84.5 ± 7.5 mm Hg; P = 0.02, P = 0.02). Among the variables, age, hemoglobin concentration, and cardiac output were associated with rScO2 by correlation analysis.Dopamine was superior to phenylephrine in maintaining cerebral oxygenation during OLV in thoracic surgery. PMID:26656357

  4. Resection of the sidewall of superior vena cava using video-assisted thoracic surgery mechanical suture technique

    PubMed Central

    Xu, Xin; Qiu, Yuan; Pan, Hui; Mo, Lili; Chen, Hanzhang

    2016-01-01

    Lung cancer invading the superior vena cava (SVC) is a locally advanced condition, for which poor prognosis is expected with conservative treatment alone. Surgical resection of the lesion can rapidly relieve the symptoms and significantly improve survival for some patients. Replacement, repair and partial resection of SVC via thoracotomy were generally accepted and used in the past. As the rapid development of minimally invasive techniques and devices, partial resection and repair of SVC are feasible via video-assisted thoracic surgery (VATS). However, few studies have reported the VATS surgical techniques. In this study, we reported the crucial techniques of partial resection of SVC via VATS. PMID:27076960

  5. Paravertebral Analgesia in Video-Assisted Thoracic Surgery: A New Hybrid Technique of Catheter Placement for Continuous Anesthetic Infusion.

    PubMed

    Cioffi, Ugo; Raveglia, Federico; Rizzi, Alessandro; Di Mauro, Piero; De Simone, Matilde; Baisi, Alessandro

    2015-09-01

    Advantages of paravertebral analgesia in thoracotomy include the absence of morphine side effects and the lack of contraindications. We introduce a new technique for paravertebral catheter placement during video-assisted thoracic surgery. The catheter is placed in the same intercostal space as the camera port. Anesthetic is injected to reach the parietal pleura. The catheter is inserted through the needle and pushed until the paravertebral space is reached. Postoperative analgesia is performed by a continuous infusion of local anesthetics. Our technique is safe and easy to perform and avoids opioid use. It works differently from intercostal analgesia and paravertebral blocks. PMID:25503817

  6. Thoracic Paravertebral Block, Multimodal Analgesia, and Monitored Anesthesia Care for Breast Cancer Surgery in Primary Lateral Sclerosis

    PubMed Central

    Fernandes, Anthony

    2016-01-01

    Objective. Primary lateral sclerosis (PLS) is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS). Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics. We present a case of a patient with PLS and recent diagnosis of breast cancer who underwent a simple mastectomy surgery uneventfully under an ultrasound guided thoracic paravertebral block, multimodal analgesia, and monitored anesthesia care. Patient reported minimal to no pain or discomfort in the postoperative period and received no opioids for pain management before being discharged home. In patients with PLS, thoracic paravertebral block and multimodal analgesia can provide reliable anesthesia and effective analgesia for breast surgery with avoidance of potential risks associated with general anesthesia, muscle paralysis, and opioid use. PMID:27200193

  7. Endovascular Surgery for Traumatic Thoracic Aortic Injury: Our Experience with Five Cases, Two of Whom were Young Patients

    PubMed Central

    Matsumoto, Takashi; Matsuyama, Sho; Fukumura, Fumio; Ando, Hiromi; Tanaka, Jiro; Uchida, Takayuki

    2014-01-01

    Objectives: We present our experience of endovascular surgery for traumatic aortic injury and the results of our procedures. Materials and Methods: From January 2009 to December 2013, we performed endovascular repairs of traumatic thoracic aortic injury on 5 male patients 16–75 years old (mean, 50.8), two of whom were young. Three of the patients had multiple organ injuries. The mean interval time to the operation is 22.0 hours (range, 10–36). All patients underwent endovascular repair with heparinization. The isthmus regions were seen in three cases and all of them were needed left subclavian artery (LSA) coverage. In the two young patients, the deployed stent graft was 22 mm (22.2% oversizing for diameter of aorta) and 26 mm (36.8% oversizing), respectively. Results: The procedures were successful in all patients, with no early mortality, paraplegia or stroke. During 3–63 months (mean, 30.8) follow-up period, no one experienced stent graft-related complications. One patient with LSA coverage experienced arm ischemia but the symptom improved with time. Conclusion: Endovascular surgery for traumatic thoracic aortic injury can be performed safely with low mortality or morbidity even in young small aorta. Accumulation of clinical experience and evaluation of long-term outcomes are necessary. PMID:25298833

  8. Tissue fusion, a new opportunity for sutureless bypass surgery.

    PubMed

    Bogni, Serge; Schöni, Daniel; Constantinescu, Mihai; Wirth, Amina; Vajtai, Istvan; Bregy, Amadé; Raabe, Andreas; Pieles, Uwe; Frenz, Martin; Reinert, Michael

    2011-01-01

    Microsurgical suturing is the standard for cerebral bypass surgery, a technique where temporary occlusion is usually necessary. Non-occlusive techniques such as excimer laser-assisted non-occlusive anastomosis (ELANA) have certainly widened the spectrum of treatment of complex cerebrovascular situations, such as giant cerebral aneurysms, that were otherwise non-treatable. Nevertheless, the reduction of surgical risks while widening the spectrum of indications, such as a prophylactic cerebral bypass, is still a main aim, that we would like to pursue with our sutureless tissue fusion research. The primary concern in sutureless tissue fusion- and especially in tissue fusion of cerebral vessels- is the lack of reproducibility, often caused by variations in the thermal damage of the vessel. This has prevented this novel fusion technique from being applicable in daily surgical use. In this overview, we present three ways to further improve the laser tissue soldering technique.In the first section entitled "Laser Tissue Soldering Using a Biodegradable Polymer," a porous polymer scaffold doped with albumin (BSA) and indocyanine green (ICG) is presented, leading to strong and reproducible tensile strengths in tissue soldering. Histologies and future developments are discussed.In the section "Numerical Simulation for Improvement of Laser Tissue Soldering," a powerful theoretical simulation model is used to calculate temperature distribution during soldering. The goal of this research is to have a tool in hand that allows us to determine laser irradiation parameters that guarantee strong vessel fusion without thermally damaging the inner structures such as the intima and endothelium.In a third section, "Nanoparticles in Laser Tissue Soldering," we demonstrate that nanoparticles can be used to produce a stable and well-defined spatial absorption profile in the scaffold, which is an important step towards increasing the reproducibility. The risks of implanting nanoparticles into a biodegradable scaffold are discussed.Step by step, these developments in sutureless tissue fusion have improved the tensile strength and the reproducibility, and are constantly evolving towards a clinically applicable anastomosis technique. PMID:21691987

  9. Endoscopic thoracic sympathectomy

    MedlinePlus

    Endoscopic thoracic sympathectomy (ETS) is surgery to treat sweating that is much heavier than normal. This condition ... hyperhidrosis . Usually the surgery is used to treat sweating in the palms or face. The sympathetic nerves ...

  10. Anterior Lumbar Interbody Fusion as a Salvage Technique for Pseudarthrosis following Posterior Lumbar Fusion Surgery

    PubMed Central

    Mobbs, Ralph J.; Phan, Kevin; Thayaparan, Ganesha K.; Rao, Prashanth J.

    2015-01-01

    Study Design Retrospective analysis of prospectively collected observational data. Objective To assess the safety and efficacy of anterior lumbar interbody fusion (ALIF) as a salvage option for lumbar pseudarthrosis following failed posterior lumbar fusion surgery. Methods From 2009 to 2013, patient outcome data was collected prospectively over 5 years from 327 patients undergoing ALIF performed by a single surgeon (R.J.M.) with 478 levels performed. Among these, there were 20 cases of failed prior posterior fusion that subsequently underwent ALIF. Visual analog score (VAS), Oswestry Disability Index (ODI), and Short Form 12-item health survey (SF-12) were measured pre- and postoperatively. The verification of fusion was determined by utilizing a fine-cut computed tomography scan at 12-month follow-up. Results There was a significant difference between the preoperative (7.25 ± 0.8) and postoperative (3.1 ± 2.1) VAS scores (p < 0.0001). The ODI scale also demonstrated a statistically significant reduction from preoperative (56.3 ± 16.5) and postoperative (30.4 ± 19.3) scores (p < 0.0001). The SF-12 scores were significantly improved after ALIF salvage surgery: Physical Health Composite Score (32.18 ± 5.5 versus 41.07 ± 9.67, p = 0.0003) and Mental Health Composite Score (36.62 ± 12.25 versus 50.89 ± 10.86, p = 0.0001). Overall, 19 patients (95%) achieved successful fusion. Conclusions Overall, our results suggest that the ALIF procedure results not only in radiographic improvements in bony fusion but in significant improvements in the patient's physical and mental experience of pain secondary to lumbar pseudarthrosis. Future multicenter registry studies and randomized controlled trials should be conducted to confirm the long-term benefit of ALIF as a salvage option for failed posterior lumbar fusion. PMID:26835197

  11. Miniature stereoscopic video system provides real-time 3D registration and image fusion for minimally invasive surgery

    NASA Astrophysics Data System (ADS)

    Yaron, Avi; Bar-Zohar, Meir; Horesh, Nadav

    2007-02-01

    Sophisticated surgeries require the integration of several medical imaging modalities, like MRI and CT, which are three-dimensional. Many efforts are invested in providing the surgeon with this information in an intuitive & easy to use manner. A notable development, made by Visionsense, enables the surgeon to visualize the scene in 3D using a miniature stereoscopic camera. It also provides real-time 3D measurements that allow registration of navigation systems as well as 3D imaging modalities, overlaying these images on the stereoscopic video image in real-time. The real-time MIS 'see through tissue' fusion solutions enable the development of new MIS procedures in various surgical segments, such as spine, abdomen, cardio-thoracic and brain. This paper describes 3D surface reconstruction and registration methods using Visionsense camera, as a step toward fully automated multi-modality 3D registration.

  12. Serial Peak Expiratory Flow Rates in Patients Undergoing Upper Abdominal Surgeries Under General Anaesthesia and Thoracic Epidural Analgesia

    PubMed Central

    Rao, Rammoorthi; Ribeiro, Karl SA

    2016-01-01

    Introduction Anaesthesia and upper abdominal surgeries alter lung compliance and functional residual capacity resulting from atelectasis. Upper abdominal surgeries also cause a decrease in peak expiratory flow rates, cough reflex due to pain limited inspiration. Aim This study aimed to study the effect of thoracic epidural analgesia (TEA) on the peak expiratory flow rates in patients undergoing upper abdominal surgeries. Materials and Methods A total of 44 patients posted for elective surgery were enrolled. Group 1 patients received GA + 0.125% bupivacaine infusion TEA and Group 2 received GA + Inj. Diclofenac sodium 50 mg slow i.v. TID for Postoperative analgesia. Haemodynamics, VAS pain score, PEFR measurements were done at 60 minutes, 24 hours, 48 hours and 4 days after surgery in both groups. ABG analysis was taken pre operatively and 24 hours after surgery. Results The SBP and DBP values obtained at 60 minutes (p<0.016) 24 and 48 hours (p<0.001) and day 4 (p<0.02) postoperative showed highly significant difference between the two groups which indicate better haemodynamic parameters in patients receiving epidural analgesia. Postoperatively the difference in PEFR values at 60 minutes, 24 hour, 48 hour and day 4 were very highly significant. (p<0.001). Group1 had a 10.739% deficit on day 4 from its pre operative baseline value while group 2 showed a 34.825 % deficit which was very highly significant (p<0.001). The difference in VAS scores recorded at 60 minutes, 24 hours, 48 hours and day 4 post op were very highly statistically significant (p < 0.001). The ABG taken at 24 hours shows statistically significant difference with patients in group 2 showing decreased values in pCO2 and pO2 reflecting poorer ventilation and oxygenation. Conclusion Thoracic epidural analgesia provides superior analgesia, better cough reflex as seen by better PEFR values, were haemodynamically more stable and their ABG values were better than the NSAID group. PMID:27042561

  13. Deformable registration of the inflated and deflated lung for cone-beam CT-guided thoracic surgery

    NASA Astrophysics Data System (ADS)

    Uneri, Ali; Nithiananthan, Sajendra; Schafer, Sebastian; Otake, Yoshito; Stayman, J. Webster; Kleinszig, Gerhard; Sussman, Marc S.; Taylor, Russell H.; Prince, Jerry L.; Siewerdsen, Jeffrey H.

    2012-02-01

    Intraoperative cone-beam CT (CBCT) could offer an important advance to thoracic surgeons in directly localizing subpalpable nodules during surgery. An image-guidance system is under development using mobile C-arm CBCT to directly localize tumors in the OR, potentially reducing the cost and logistical burden of conventional preoperative localization and facilitating safer surgery by visualizing critical structures surrounding the surgical target (e.g., pulmonary artery, airways, etc.). To utilize the wealth of preoperative image/planning data and to guide targeting under conditions in which the tumor may not be directly visualized, a deformable registration approach has been developed that geometrically resolves images of the inflated (i.e., inhale or exhale) and deflated states of the lung. This novel technique employs a coarse model-driven approach using lung surface and bronchial airways for fast registration, followed by an image-driven registration using a variant of the Demons algorithm to improve target localization to within ~1 mm. Two approaches to model-driven registration are presented and compared - the first involving point correspondences on the surface of the deflated and inflated lung and the second a mesh evolution approach. Intensity variations (i.e., higher image intensity in the deflated lung) due to expulsion of air from the lungs are accounted for using an a priori lung density modification, and its improvement on the performance of the intensity-driven Demons algorithm is demonstrated. Preliminary results of the combined model-driven and intensity-driven registration process demonstrate accuracy consistent with requirements in minimally invasive thoracic surgery in both target localization and critical structure avoidance.

  14. Probabilistic sparse matching for robust 3D/3D fusion in minimally invasive surgery.

    PubMed

    Neumann, Dominik; Grbic, Sasa; John, Matthias; Navab, Nassir; Hornegger, Joachim; Ionasec, Razvan

    2015-01-01

    Classical surgery is being overtaken by minimally invasive and transcatheter procedures. As there is no direct view or access to the affected anatomy, advanced imaging techniques such as 3D C-arm computed tomography (CT) and C-arm fluoroscopy are routinely used in clinical practice for intraoperative guidance. However, due to constraints regarding acquisition time and device configuration, intraoperative modalities have limited soft tissue image quality and reliable assessment of the cardiac anatomy typically requires contrast agent, which is harmful to the patient and requires complex acquisition protocols. We propose a probabilistic sparse matching approach to fuse high-quality preoperative CT images and nongated, noncontrast intraoperative C-arm CT images by utilizing robust machine learning and numerical optimization techniques. Thus, high-quality patient-specific models can be extracted from the preoperative CT and mapped to the intraoperative imaging environment to guide minimally invasive procedures. Extensive quantitative experiments on 95 clinical datasets demonstrate that our model-based fusion approach has an average execution time of 1.56 s, while the accuracy of 5.48 mm between the anchor anatomy in both images lies within expert user confidence intervals. In direct comparison with image-to-image registration based on an open-source state-of-the-art medical imaging library and a recently proposed quasi-global, knowledge-driven multi-modal fusion approach for thoracic-abdominal images, our model-based method exhibits superior performance in terms of registration accuracy and robustness with respect to both target anatomy and anchor anatomy alignment errors. PMID:25095250

  15. Endovascular retrieval of an irrigation cannula from the thoracic aorta following cardiac surgery: A case report

    PubMed Central

    Thomas, Biju K.; Elmore, James R.; Garvin, Robert P.; Ryer, Evan J.

    2015-01-01

    Introduction Endovascular techniques to retrieve intravascular foreign bodies are a necessary component of the Vascular surgeon's skill set. We report the successful retrieval of an embolized irrigation cannula from the thoracic aorta following aortic valve replacement. Presentation of case The patient is an 81 year old male who underwent coronary artery bypass grafting and aortic valve replacement. Prior to closure, the aortotomy was irrigated with heparinized saline using a syringe with an olive tip irrigation cannula. When the syringe was handed back to the nursing staff, the tip was noted to be missing but could not be found. Prior to closure of the sternum, the field was searched again for the tip and thus the chest was closed. The missing instrument then prompted an intraoperative chest radiograph that demonstrated a metal irrigation cannula superimposed on the cardiac silhouette. Additionally, a transesophageal echocardiogram was performed, which demonstrated the irrigation cannula within the descending thoracic aorta. Right common femoral artery was accessed and a thoracic aortogram was performed demonstrating the cannula to be lodged in the descending thoracic aorta. Intravascular ultrasound (IVUS) was performed to exclude an aortic abnormality preventing the caudad migration of the cannula. No aortic pathology was identified. A tri-lobed snare was used to grasp the cannula at its tip and withdrawn into the right external iliac artery. The cannula was successfully removed through a transverse arteriotomy in the distal right external iliac artery. The patient's postoperative course was uneventful. Conclusion Endovascular retrieval of intravascular foreign bodies is minimally invasive, relatively simple, and carries minimal morbidity compared to conventional open surgical techniques. This unusual case demonstrates the importance of a working knowledge of techniques and instruments requisite for retrieval of intravascular foreign bodies PMID:26521199

  16. Posterior Direct Decompression and Fusion of the Lower Thoracic and Lumbar Fractures with Neurological Deficit

    PubMed Central

    Jun, Deuk Soo; Ahn, Byoung Geun

    2011-01-01

    Study Design A retrospective study. Purpose To analyze the treatment outcome of patients with lower thoracic and lumbar fractures combined with neurological deficits. Overview of Literature Although various methods of the surgical treatment for lower thoracic and lumbar fractures are used, there has been no surgical treatment established as a superior option than others. Methods Between March 2001 and August 2009, this study enrolled 13 patients with lower thoracic and lumbar fractures who underwent spinal canal decompression by removing posteriorly displaced bony fragments via the posterior approach and who followed up for more than a year. We analyzed the difference between the preoperative and postoperative extents of canal encroachment, degrees of neurologic deficits and changes in the local kyphotic angle. Results The average age of the patients was 37 years. There were 10 patients with unstable burst factures and 3 patients with translational injuries. Canal encroachment improved from preoperative average of 84% to 9% postoperatively. Local kyphosis also improved from 20.5° to 1.5°. In 92% (12/13) of the patients, neurologic deficit improved more than Frankel grade 1 and an average improvement of 1.7 grade was observed. Deterioration of neurologic symptoms was not observed. Although some loss of reduction of kyphotic deformity was observed at the final follow-up, serious complications were not observed. Conclusions When posteriorly displaced bony fragments were removed by the posterior approach, neurological recovery could be facilitated by adequate decompression without serious complications. The posterior direct decompression could be used as one of treatments for lower thoracic and lumbar fractures combined with neurologic injuries. PMID:21892386

  17. Video-assisted thoracoscopic surgery resection and reconstruction of thoracic trachea in the management of a tracheal neoplasm

    PubMed Central

    Li, Shuben; Liu, Jun; He, Jiaxi; Dong, Qinglong; Liang, Lixia; Yin, Weiqiang; Pan, Hui

    2016-01-01

    Intratracheal tumor is a rare tumor, accounting for only 2% of upper respiratory tract neoplasms. Its symptoms are similar to those of head and neck cancers, including coughing up blood, sore throat, and airway obstruction. The diagnosis of this disease is often based on the findings of fibrobronchoscopy or computed tomography (CT). Surgery remains the treatment of choice for tracheal tumor. In patients with benign neoplasms or if the tumors have limited involvement, fibrobronchoscopic resection of the tumor can be performed. For malignant tumors, however, radical resection is required. In the past, open incision is used during the surgery for tumors located in thoracic trachea. Along with advances in video-assisted thoracoscopic surgery (VATS) minimally invasive techniques and devices, VATS resection and reconstruction of the trachea can achieve the radical resection of the tumor and meanwhile dramatically reduce the injury to the patients. In this article we describe the application of VATS resection and reconstruction of trachea in the management of a tracheal neoplasm. PMID:27076958

  18. Attitudes and access to lung volume reduction surgery for COPD: a survey by the British Thoracic Society

    PubMed Central

    McNulty, William; Jordan, Simon; Hopkinson, Nicholas S

    2014-01-01

    Objective Lung volume reduction surgery for emphysema leads to improved survival in appropriately selected individuals, and it is therefore recommended in national and international guidelines for this group of patients. Despite this, fewer than 100 patients undergo the procedure each year in the UK. Our objective was to establish whether this reflects concerns about morbidity and mortality or difficulties in the referral pathway. Design and setting We conducted a survey of members of the British Thoracic Society by email to investigate this in the second half of 2013. The survey included questions about access to investigations, the indications for lung volume reduction surgery (LVRS), whether a multidisciplinary meeting discussed eligibility of patients for LVRS and what the morbidity and mortality associated with the procedure was. Results There were 65 responses, 82% from respiratory physicians. Roughly half of the respondents were either unsure about the risks of death or prolonged (>30 days) hospital stay involved or significantly over-estimated them. In total, 70% did not have a specific multidisciplinary team to discuss the management of patients with advanced chronic obstructive pulmonary disease (COPD). There was no consensus as to which patients with COPD should undergo a CT scan to evaluate them for possible surgery. Conclusions Patients with COPD require a systematic and multidisciplinary approach to assessment for LVRS and these survey data suggest that work is needed to deliver this evidence-based therapy in a consistent and comprehensive way across the UK. PMID:25478175

  19. Radical resection of right upper lung cancer using uniportal video-assisted thoracic surgery with non-intubated anesthesia

    PubMed Central

    Wang, Wei; Peng, Guilin; Guo, Zhihua; Liang, Lixia; Dong, Qinglong

    2015-01-01

    Background Presently, the clinical effect of radical video-assisted thoracic surgery (VATS) is equal to that of traditional open chest surgery and has received worldwide recognition of its advantages: less trauma and faster recovery. In the attempt to further the advancement of minimally invasive surgery the operative techniques of uniportal VATS and non-intubated anesthesia have been developed. These techniques have been widely applied in hospitals around the world, however there are few reports on the combined use of these techniques: non-intubated uniportal VATS. Methods We report a case of peripheral lung cancer in the right-upper-lobe for which a non-intubated uniportal VATS resection was performed. This method was chosen as a result of the small size of the lesion and the placement in the right upper lobe. Results The postoperative course of this patient was good. Pathological results indicated infiltrating adenocarcinoma of the right upper lobe; there was no metastasis in hilar or mediastinal lymph nodes. Pathology results of the stump of the bronchus and vessels were also negative. Conclusions Uniportal VATS with non-intubated anesthesia was a feasible and safe option for this patient, and may be an alternative minimally invasive option for patients with peripheral lung cancer. PMID:26793360

  20. Video-assisted thoracoscopic surgery resection and reconstruction of thoracic trachea in the management of a tracheal neoplasm.

    PubMed

    Li, Shuben; Liu, Jun; He, Jiaxi; Dong, Qinglong; Liang, Lixia; Yin, Weiqiang; Pan, Hui; He, Jianxing

    2016-03-01

    Intratracheal tumor is a rare tumor, accounting for only 2% of upper respiratory tract neoplasms. Its symptoms are similar to those of head and neck cancers, including coughing up blood, sore throat, and airway obstruction. The diagnosis of this disease is often based on the findings of fibrobronchoscopy or computed tomography (CT). Surgery remains the treatment of choice for tracheal tumor. In patients with benign neoplasms or if the tumors have limited involvement, fibrobronchoscopic resection of the tumor can be performed. For malignant tumors, however, radical resection is required. In the past, open incision is used during the surgery for tumors located in thoracic trachea. Along with advances in video-assisted thoracoscopic surgery (VATS) minimally invasive techniques and devices, VATS resection and reconstruction of the trachea can achieve the radical resection of the tumor and meanwhile dramatically reduce the injury to the patients. In this article we describe the application of VATS resection and reconstruction of trachea in the management of a tracheal neoplasm. PMID:27076958

  1. Radiotherapy With or Without Concurrent Chemotherapy for Lymph Node Recurrence After Radical Surgery of Thoracic Esophageal Squamous Cell Carcinoma

    SciTech Connect

    Lu Jincheng; Kong Cheng; Tao Hua

    2010-11-01

    Purpose: To retrospectively compare the outcomes of patients with lymph node recurrence after radical surgery of esophageal cancer, when given radiotherapy with or without concurrent chemotherapy. Methods and Materials: Between January 1996 and December 2005, the data from 73 patients with lymph node recurrence after radical surgery of thoracic esophageal squamous cell carcinoma were retrospectively reviewed. The patients were separated into two groups: radiochemotherapy (RC, 31 patients) and radiotherapy alone (RA, 42 patients). Patients in the RC group received at least two cycles of 5-fluorouracil/cisplatin chemotherapy concurrently with radiotherapy. Results: The median duration of follow-up was 11 months (range, 2-48). The overall survival rate for all patients was 46.7% and 4.7% at 1 and 3 years, respectively. The median overall survival time was 9 months (95% confidence interval, 6.96-11.04) and 17 months (95% confidence interval, 13.61-20.39) for RA and RC groups, respectively. The survival rate at 1 and 3 years was 62.5% and 10.5% in the RC group and 33.8% and 0% in the RA group (p = .0049, log-rank test; hazard ratio for death, 0.52; 95% confidence interval, 0.30-0.92). Acute toxicities were more frequent in the RC group than in the RA group. No significant differences were found in the late toxicity profiles between the two groups. Conclusion: The results of the present retrospective analysis suggest that RC should be considered an effective and well-tolerated treatment of patients with thoracic esophageal squamous cell carcinoma and postoperative lymph node recurrence.

  2. Sternal and costochondral infections with gentamicin and methicillin resistant Staphylococcus aureus following thoracic surgery.

    PubMed

    Cafferkey, M T; Luke, D A; Keane, C T

    1983-01-01

    Six patients in a thoracic unit developed sternal osteomyelitis and costochondritis following median sternotomy. Five of the patients were operated on in another hospital. Gentamicin and methicillin resistant Staphylococcus aureus was isolated in pure culture in each case. The S. aureus isolate from 2 patients was of the same phage type suggesting cross-infection. Antibiotic prophylaxis administered in the perioperative period was ineffective. One patient, treated with amikacin (to which all of the strains were sensitive in vitro) and cefuroxime, died from overwhelming infection in spite of débridement and resuturing of the wound. The remaining 5 patients were cured with vancomycin therapy usually coupled with surgical intervention. PMID:6557667

  3. Perioperative Risk Factors Related to Lumbar Spine Fusion Surgery in Korean Geriatric Patients

    PubMed Central

    Lee, Jung-Hyun; Yi, Hyeong-Joong; Bak, Koang Hum; Ko, Yong; Lee, Yoon Kyoung

    2012-01-01

    Objective Life expectancy for humans has increased dramatically and with this there has been a considerable increase in the number of patients suffering from lumbar spine disease. Symptomatic lumbar spinal disease should be treated, even in the elderly, and surgical procedures such as fusion surgery are needed for moderate to severe lumbar spinal disease. However, various perioperative complications are associated with fusion surgery. The aim of this study was to examine perioperative complications and assess risk factors associated with lumbar spinal fusion, focusing on geriatric patients at least 70 years of age in the Republic of Korea. Methods We retrospectively investigated 489 patients with various lumbar spinal diseases who underwent lumbar spinal fusion surgery between 2003 and 2007 at our institution. Three fusion procedures and the number of fused segments were analyzed in this study. Chronic diseases were also evaluated. Risk factors for complications and their association with age were analyzed. Results In this study, 74 patients experienced complications (15%). The rate of perioperative complications was significantly higher in patients 70 years of age or older than in other age groups (univariate analysis, p=0.001; multivariate analysis, p=0.004). However, perioperative complications were not significantly associated with the other factors tested (sex, comorbidities, operation procedures, fusion segments involved). Conclusion Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery whereas other factors were not significant. We recommend good clinical judgment and careful selection of geriatric patients undergoing lumbar spinal fusion surgery. PMID:22949964

  4. Application of positive airway pressure in restoring pulmonary function and thoracic mobility in the postoperative period of bariatric surgery: a randomized clinical trial

    PubMed Central

    Brigatto, Patrícia; Carbinatto, Jéssica C.; Costa, Carolina M.; Montebelo, Maria I. L.; Rasera-Júnior, Irineu; Pazzianotto-Forti, Eli M.

    2014-01-01

    Objective: To evaluate whether the application of bilevel positive airway pressure in the postoperative period of bariatric surgery might be more effective in restoring lung volume and capacity and thoracic mobility than the separate application of expiratory and inspiratory positive pressure. Method: Sixty morbidly obese adult subjects who were hospitalized for bariatric surgery and met the predefined inclusion criteria were evaluated. The pulmonary function and thoracic mobility were preoperatively assessed by spirometry and cirtometry and reevaluated on the 1st postoperative day. After preoperative evaluation, the subjects were randomized and allocated into groups: EPAP Group (n=20), IPPB Group (n=20) and BIPAP Group (n=20), then received the corresponding intervention: positive expiratory pressure (EPAP), inspiratory positive pressure breathing (IPPB) or bilevel inspiratory positive airway pressure (BIPAP), in 6 sets of 15 breaths or 30 minutes twice a day in the immediate postoperative period and on the 1st postoperative day, in addition to conventional physical therapy. Results: There was a significant postoperative reduction in spirometric variables (p<0.05), regardless of the technique used, with no significant difference among the techniques (p>0.05). Thoracic mobility was preserved only in group BIPAP (p>0.05), but no significant difference was found in the comparison among groups (p>0.05). Conclusion: The application of positive pressure does not seem to be effective in restoring lung function after bariatric surgery, but the use of bilevel positive pressure can preserve thoracic mobility, although this technique was not superior to the other techniques. PMID:25590448

  5. Thoracic epidural analgesia for off-pump coronary artery bypass surgery in patients with chronic obstructive pulmonary disease.

    PubMed

    Mehta, Yatin; Vats, Mayank; Sharma, Munish; Arora, Reetesh; Trehan, Naresh

    2010-01-01

    The benefits of thoracic epidural analgesia in patients undergoing coronary artery bypass grafting are well documented. However, the literature available on the role of high thoracic epidural analgesia (HTEA) in patients with chronic obstructive pulmonary disease undergoing off-pump coronary artery bypass graft (OPCAB) surgery is scarce. We conducted a randomized clinical trial to establish whether HTEA is beneficial in patients with chronic obstructive pulmonary disease undergoing elective OPCAB surgery. After institutional ethics board approval and informed consent, 62 chronic obstructive pulmonary disease patients undergoing elective OPCAB were randomly grouped into two (n = 31 each). Both groups received general anesthesia (GA), but in the HTEA group patients, TEA was also administered. Standardized surgical and anesthetic techniques were used for both the groups. Pulmonary function tests were performed pre-operatively, 6 h and 24 h post-extubation and on days 2, 3, 4 and 5 along with arterial blood gas analysis (ABG) analysis. Time for extubation (h) and time for oxygen withdrawal (h) were recorded. Pain score was assessed by the 10-cm visual analogue scale. All hemodynamic/oxygenation parameters were noted. Any complications related to the TEA were also recorded. Patients in the HTEA group were extubated earlier (10.8 h vs. 13.5 h, P < 0.01) and their oxygen withdrawal time was also significantly lower (26.26 h vs. 29.87 h, P < 0.01). The VAS score, both at rest and on coughing, was significantly lower in the HTEA group at all times, post-operatively (P < 0.01). The forced vital capacity improved significantly at 6 h post-operatively in the HTEA group (P = 0.026) and remained significantly higher thereafter. A similar trend was observed in forced expiratory volume in the first second on day 2 in the HTEA group (P = 0.024). We did not observe any significant side-effects/mortality in either group. In chronic obstructive pulmonary disease patients undergoing elective OPCAB surgery, HTEA is a good adjunct to GA for early extubation, faster recovery of pulmonary function and better analgesia. PMID:20826963

  6. Successful surgery of massive thoracic injury in a girl following chest trauma.

    PubMed

    Bawany, Faizan Imran; Khan, Muhammad Shahzeb; Khan, Asadullah; Dar, Mudassir

    2013-12-01

    Patients with penetrating thoracic injuries should be managed appropriately and rapidly under the supervision of multi-disciplinary team. We present a case of a 9-year-old female student who survived a major road traffic accident (RTA), a leading contributor to accidental deaths in Pakistan. The girl was hit by a public transport bus impaled by a metallic rod through the right axilla, and subsequently dragged for a distance, resulting in avulsion of a broad front of the mid-anterior and left precordial part of the chest wall. Although both the lungs and heart were exposed, she did not suffer any myocardial injury. Despite massive hypovolaemic shock with bilateral open pneumothoraces, the girl made an uneventful recovery. She was discharged on the 7th post-operative day. The report highlights the value of proper management of hypovolaemic shock and optimally timed and executed surgical intervention. PMID:24397114

  7. Major thoracic surgery in Jehovah's witness: A multidisciplinary approach case report

    PubMed Central

    Rispoli, Marco; Bergaminelli, Carlo; Nespoli, Moana Rossella; Esposito, Mariana; Mattiacci, Dario Maria; Corcione, Antonio; Buono, Salvatore

    2016-01-01

    Introduction A bloodless surgery can be desirable also for non Jehovah’s witnesses patients, but requires a team approach from the very first assessment to ensure adequate planning. Presentation of the case Our patient, a Jehovah’s witnesses, was scheduled for right lower lobectomy due to pulmonary adenocarcinoma. Her firm denies to receive any kind of transfusions, forced clinicians to a bloodless management of the case. Discussion Before surgery a meticulous coagulopathy research and hemodynamic optimization are useful to prepare patient to operation. During surgery, controlled hypotension can help to obtain effective hemostasis. After surgery, clinicians monitored any possible active bleeding, using continuous noninvasive hemoglobin monitoring, limiting the blood loss due to serial in vitro testing. The optimization of cardiac index and delivery of oxygen were continued to grant a fast recovery. Conclusion Bloodless surgery is likely to gain popularity, and become standard practice for all patients. The need for transfusion should be targeted on individual case, avoiding strictly fixed limit often leading to unnecessary transfusion. PMID:27107502

  8. The Importance of Patient-Specific Preoperative Factors: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database

    PubMed Central

    Jacobs, Jeffrey Phillip; O'Brien, Sean M.; Pasquali, Sara K.; Kim, Sunghee; Gaynor, J. William; Tchervenkov, Christo Ivanov; Karamlou, Tara; Welke, Karl F.; Lacour-Gayet, Francois; Mavroudis, Constantine; Mayer, John E.; Jonas, Richard A.; Edwards, Fred H.; Grover, Frederick L.; Shahian, David M.; Jacobs, Marshall Lewis

    2014-01-01

    Background The most common fonns of risk adjustment for pediatric and congenital heart surgery used today are based mainly on the estimated risk of mortality of the primary procedure of the operation. The goals of this analysis were to assess the association of patient-specific preoperative factors with mortality and to determine which of these preoperative factors to include in future pediatric and congenital cardiac surgical risk models. Methods All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) during 2010 through 2012 were eligible for inclusion. Patients weighing less than 2.5 kg undergoing patent ductus arteriosus closure were excluded. Centers with more than 10% missing data and patients with missing data for discharge mortality or other key variables were excluded. Rates of discharge mortality for patients with or without specific preoperative factors were assessed across age groups and were compared using Fisher's exact test. Results In all, 25,476 operations were included (overall discharge mortality 3.7%, n = 943). The prevalence of common preoperative factors and their associations with discharge mortality were determined. Associations of the following preoperative factors with discharge mortality were all highly significant (p < 0.0001) for neonates, infants, and children: mechanical circulatory support, renal dysfunction, shock, and mechanical ventilation. Conclusions Current STS-CHSD risk adjustment is based on estimated risk of mortality of the primary procedure of the operation as well as age, weight, and prematurity. The inclusion of additional patient-specific preoperative factors in risk models for pediatric and congenital cardiac surgery could lead to increased precision in predicting risk of operative mortality and comparison of observed to expected outcomes. PMID:25262395

  9. Robotic-Assisted Thoracic Surgery for Early-Stage Lung Cancer: A Review.

    PubMed

    Brooks, Paula

    2015-07-01

    This review evaluates the benefits and disadvantages associated with the use of robotic-assisted technology in performing lobectomies in patients with early-stage lung cancer. The author conducted a literature search of Ovid®, MEDLINE®, PubMed®, and CINAHL® for articles published from 2005 to 2013. Search criteria included key terms such as robot, robotic, robotic-assisted lobectomy, and lung cancer. Of 922 articles, the author included a total of 12 research-based published studies in the analysis and incorporated the findings into an evidence table. Results showed that robotic-assisted lobectomies are feasible safe procedures for patients with stage 1A or 1B lung cancer; however, there is a steep learning curve and long-term randomized studies evaluating robotic-assisted lobectomy and conventional posterolateral thoracotomy or video-assisted thoracic lobectomy are needed. For patient safety, perioperative nurses should be aware of the length of time and experience required to perform these procedures, the costs, techniques, benefits, and disadvantages. PMID:26119608

  10. Symptomatic pericardial schwannoma treated with video-assisted thoracic surgery: a case report.

    PubMed

    Yun, Po-Jen; Huang, Tsai-Wang; Li, Yao-Feng; Chang, Hung; Lee, Shih-Chun; Kuo, Yen-Liang

    2016-05-01

    Intrathoracic schwannomas are neurogenic tumors derived from the Schwann cells of the nerve sheath, most often seen in the posterior mediastinum with anatomical correlations to nerves. Although they are typically benign, a malignant transformation can occur, and thoracotomy instead of video-assisted thoracoscopic surgery (VATS) is required to achieve a complete resection. Only a few cases of pericardial schwannoma have been reported so far. We present a rare case of pericardial schwannoma confirmed by video-assisted thoracoscopic resection. PMID:27162698

  11. Symptomatic pericardial schwannoma treated with video-assisted thoracic surgery: a case report

    PubMed Central

    Yun, Po-Jen; Huang, Tsai-Wang; Li, Yao-Feng; Chang, Hung; Lee, Shih-Chun

    2016-01-01

    Intrathoracic schwannomas are neurogenic tumors derived from the Schwann cells of the nerve sheath, most often seen in the posterior mediastinum with anatomical correlations to nerves. Although they are typically benign, a malignant transformation can occur, and thoracotomy instead of video-assisted thoracoscopic surgery (VATS) is required to achieve a complete resection. Only a few cases of pericardial schwannoma have been reported so far. We present a rare case of pericardial schwannoma confirmed by video-assisted thoracoscopic resection. PMID:27162698

  12. Postoperative complications and clinical outcomes among patients undergoing thoracic and gastrointestinal cancer surgery: A prospective cohort study

    PubMed Central

    Martos-Benítez, Frank Daniel; Gutiérrez-Noyola, Anarelys; Echevarría-Víctores, Adisbel

    2016-01-01

    Objective This study sought to determine the influence of postoperative complications on the clinical outcomes of patients who underwent thoracic and gastrointestinal cancer surgery. Methods A prospective cohort study was conducted regarding 179 consecutive patients who received thorax or digestive tract surgery due to cancer and were admitted to an oncological intensive care unit. The Postoperative Morbidity Survey was used to evaluate the incidence of postoperative complications. The influence of postoperative complications on both mortality and length of hospital stay were also assessed. Results Postoperative complications were found for 54 patients (30.2%); the most common complications were respiratory problems (14.5%), pain (12.9%), cardiovascular problems (11.7%), infectious disease (11.2%), and surgical wounds (10.1%). A multivariate logistic regression found that respiratory complications (OR = 18.68; 95%CI = 5.59 - 62.39; p < 0.0001), cardiovascular problems (OR = 5.06, 95%CI = 1.49 - 17.13; p = 0.009), gastrointestinal problems (OR = 26.09; 95%CI = 6.80 - 100.16; p < 0.0001), infectious diseases (OR = 20.55; 95%CI = 5.99 - 70.56; p < 0.0001) and renal complications (OR = 18.27; 95%CI = 3.88 - 83.35; p < 0.0001) were independently associated with hospital mortality. The occurrence of at least one complication increased the likelihood of remaining hospitalized (log-rank test, p = 0.002). Conclusions Postoperative complications are frequent disorders that are associated with poor clinical outcomes; thus, structural and procedural changes should be implemented to reduce postoperative morbidity and mortality.

  13. Ethical concerns of congresses and joint winter meetings of the Spanish Society of Pneumology and Thoracic Surgery.

    PubMed

    Chiner, Eusebi; Fernández-Fabrellas, Estrella; de Lucas, Pilar

    2013-05-01

    The pharmaceutical industry contributes to the development of new drugs, provides funding for research and collaborates in continuing medical education. Although this relationship with medical practice is beneficial and desirable, commercial interests could potentially eclipse patient benefits and compromise professional integrity. Congresses and meetings of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) agglutinate different spheres of knowledge, including aspects such as bioethics, management and communication, always centered on patient and their well-being. SEPAR congresses and meetings should provide sufficient economic benefits to be reinvested in research and other purposes which are reflected in SEPAR statutes in order to ensure the solvency, sustainability and economic independence of the Society. SEPAR has developed strict regulations governing the sponsorship and accreditation of training activities while striving for a balance between the interests of the industry and its own necessary independence, which results from the constant concern for maintaining good medical practice and complying with ethical aspects. This regulation is useful from an organizational and logistical standpoint, and it is necessary to prevent or resolve any possible conflicts of interest. Scientific societies should regulate common practices that could potentially result in conflicts of interest. PMID:23298823

  14. Mediastinal lymph node detection on thoracic CT scans using spatial prior from multi-atlas label fusion

    NASA Astrophysics Data System (ADS)

    Liu, Jiamin; Zhao, Jocelyn; Hoffman, Joanne; Yao, Jianhua; Zhang, Weidong; Turkbey, Evrim B.; Wang, Shijun; Kim, Christine; Summers, Ronald M.

    2014-03-01

    Lymph nodes play an important role in clinical practice but detection is challenging due to low contrast surrounding structures and variable size and shape. We propose a fully automatic method for mediastinal lymph node detection on thoracic CT scans. First, lungs are automatically segmented to locate the mediastinum region. Shape features by Hessian analysis, local scale, and circular transformation are computed at each voxel. Spatial prior distribution is determined based on the identification of multiple anatomical structures (esophagus, aortic arch, heart, etc.) by using multi-atlas label fusion. Shape features and spatial prior are then integrated for lymph node detection. The detected candidates are segmented by curve evolution. Characteristic features are calculated on the segmented lymph nodes and support vector machine is utilized for classification and false positive reduction. We applied our method to 20 patients with 62 enlarged mediastinal lymph nodes. The system achieved a significant improvement with 80% sensitivity at 8 false positives per patient with spatial prior compared to 45% sensitivity at 8 false positives per patient without a spatial prior.

  15. European perspective in Thoracic surgery-eso-coloplasty: when and how?

    PubMed

    Gust, Lucile; Ouattara, Moussa; Coosemans, Willy; Nafteux, Philippe; Thomas, Pascal Alexandre; D'Journo, Xavier Benoit

    2016-04-01

    Colon interposition has been used since the beginning of the 20(th) century as a substitute for esophageal replacement. Colon interposition is mainly chosen as a second line treatment when the stomach cannot be used, when the stomach has to be resected for oncological or technical reasons, or when the stomach is deliberately kept intact for benign diseases in young patients with long-life expectancy. During the surgery the vascularization of the colon must be carefully assessed, as well as the type of the graft (right or left colon), the length of the graft, the surgical approach and the route of the reconstruction. Early complications such as graft necrosis or anastomotic leaks, and late complications such as redundancy depend on the quality of the initial surgery. Despite a complex and time-consuming procedure requiring at least three or four digestive anastomoses, reported long term functional outcomes of colon interposition are good, with an acceptable operative risk. Thus, in very selected indications, colon interposition could be seen as a valuable alternative for esophageal replacement when stomach cannot be considered. This review aims at briefly defining "when" and "how" to perform a coloplasty through demonstrative videos. PMID:27195136

  16. Association of genetic and psychological factors with persistent pain after cosmetic thoracic surgery

    PubMed Central

    Dimova, Violeta; Lötsch, Jörn; Hühne, Kathrin; Winterpacht, Andreas; Heesen, Michael; Parthum, Andreas; Weber, Peter G; Carbon, Roman; Griessinger, Norbert; Sittl, Reinhard; Lautenbacher, Stefan

    2015-01-01

    The genetic control of pain has been repeatedly demonstrated in human association studies. In the present study, we assessed the relative contribution of 16 single nucleotide polymorphisms in pain-related genes, such as cathechol-O-methyl transferase gene (COMT), fatty acid amino hydrolase gene (FAAH), transient receptor potential cation channel, subfamily V, member 1 gene (TRPV1), and δ-opioid receptor gene (OPRD1), for postsurgical pain chronification. Ninety preoperatively pain-free male patients were assigned to good or poor outcome groups according to their intensity or disability score assessed at 1 week, 3 months, 6 months, and 1 year after funnel chest correction. The genetic effects were compared with those of two psychological predictors, the attentional bias toward positive words (dot-probe task) and the self-reported pain vigilance (Pain Vigilance and Awareness Questionnaire [PVAQ]), which were already shown to be the best predictors for pain intensity and disability at 6 months after surgery in the same sample, respectively. Cox regression analyses revealed no significant effects of any of the genetic predictors up to the end point of survival time at 1 year after surgery. Adding the genetics to the prediction by the attentional bias to positive words for pain intensity and the PVAQ for pain disability, again no significant additional explanation could be gained by the genetic predictors. In contrast, the preoperative PVAQ score was also, in the present enlarged sample, a meaningful predictor for lasting pain disability after surgery. Effect size measures suggested some genetic variables, for example, the polymorphism rs1800587G>A in the interleukin 1 alpha gene (IL1A) and the COMT haplotype rs4646312T>C/rs165722T>C/rs6269A>G/rs4633T>C/rs4818C>G/rs4680A>G, as possible relevant modulators of long-term postsurgical pain outcome. A comparison between pathophysiologically different predictor groups appears to be helpful in identifying clinically relevant predictors of chronic pain. PMID:26664154

  17. A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery.

    PubMed

    Richardson, J; Sabanathan, S; Mearns, A J; Shah, R D; Goulden, C

    1995-10-01

    We have undertaken a prospective, randomized comparison of the superficially similar techniques of interpleural and paravertebral (extrapleural) analgesia in 53 patients undergoing posterolateral thoracotomy. Local anaesthetic placed anterior to the superior costotransverse ligament and posterior to the parietal pleura produces a paravertebral block and instilled between the parietal and visceral pleurae produces an interpleural block. Patients received preoperative and postoperative continuous bupivacaine paravertebral blocks in group 1 and interpleural blocks in group 2. Premedication comprised diclofenac and morphine, and after operation all patients had regular diclofenac and patient-controlled morphine (PCM). Analgesia was assessed by visual analogue pain scores (VAS), PCM requirements, ratio of preoperative to postoperative spirometric values (PFT), rates of postoperative respiratory morbidity (PORM) and hospital stay, all recorded by blinded observers. Eight patients were withdrawn and data from 45 patients were analysed. Patient characteristics, surgery, VAS scores and PCM use were similar in both groups. PFT were significantly better (P = 0.03-0.0001) in group 1, and PORM was lower and hospital stay approximately 1 day less in this group. Five patients in group 2 became temporarily confused, probably because of bupivacaine toxicity (P = 0.02). We conclude that bupivacaine deposited paravertebrally produced greater preservation of lung function and fewer side effects than bupivacaine administered interpleurally. PMID:7488477

  18. A prospective, randomized comparison of interpleural and paravertebral analgesia in thoracic surgery.

    TOXLINE Toxicology Bibliographic Information

    Richardson J; Sabanathan S; Mearns AJ; Shah RD; Goulden C

    1995-10-01

    We have undertaken a prospective, randomized comparison of the superficially similar techniques of interpleural and paravertebral (extrapleural) analgesia in 53 patients undergoing posterolateral thoracotomy. Local anaesthetic placed anterior to the superior costotransverse ligament and posterior to the parietal pleura produces a paravertebral block and instilled between the parietal and visceral pleurae produces an interpleural block. Patients received preoperative and postoperative continuous bupivacaine paravertebral blocks in group 1 and interpleural blocks in group 2. Premedication comprised diclofenac and morphine, and after operation all patients had regular diclofenac and patient-controlled morphine (PCM). Analgesia was assessed by visual analogue pain scores (VAS), PCM requirements, ratio of preoperative to postoperative spirometric values (PFT), rates of postoperative respiratory morbidity (PORM) and hospital stay, all recorded by blinded observers. Eight patients were withdrawn and data from 45 patients were analysed. Patient characteristics, surgery, VAS scores and PCM use were similar in both groups. PFT were significantly better (P = 0.03-0.0001) in group 1, and PORM was lower and hospital stay approximately 1 day less in this group. Five patients in group 2 became temporarily confused, probably because of bupivacaine toxicity (P = 0.02). We conclude that bupivacaine deposited paravertebrally produced greater preservation of lung function and fewer side effects than bupivacaine administered interpleurally.

  19. Evidence regarding patient compliance with incentive spirometry interventions after cardiac, thoracic and abdominal surgeries: A systematic literature review

    PubMed Central

    Narayanan, Aqilah Leela T; Hamid, Syed Rasul G Syed; Supriyanto, Eko

    2016-01-01

    BACKGROUND: Evidence regarding the effectiveness of incentive spirometry (ISy) on postoperative pulmonary outcomes after thoracic, cardiac and abdominal surgery remains inconclusive. This is attributed to various methodological issues inherent in ISy trials. Patient compliance has also been highlighted as a possible confounding factor; however, the status of evidence regarding patient compliance in these trials is unknown. OBJECTIVE: To explore the status of evidence on patient compliance with ISy interventions in randomized controlled trials (RCTs) in the above contexts. METHOD: A systematic search using MEDLINE, EMBASE and CINAHL databases was conducted to obtain relevant RCTs from 1972 to 2015 using the inclusion criteria. These were examined for specific ISy parameters, methods used for determining compliance and reporting on compliance. Main outcome measures were comparison of ISy parameters prescribed and assessed, and reporting on compliance. RESULTS: Thirty-six relevant RCTs were obtained. Six ISy parameters were identified in ISy prescriptions from these trials. Almost all (97.2%) of the trials had ISy prescriptions with specific parameters. Wilcoxon signed-rank test revealed that the ISy parameters assessed were significantly lower (Z=−5.433; P<0.001) than those prescribed; 66.7% of the trials indicated use of various methods to assess these parameters. Only six (16.7%) trials included reports on compliance; however, these were also incomprehensive. CONCLUSIONS: There is a scarcity and inconsistency of evidence regarding ISy compliance. Compliance data should be obtained using reliable and standardized methods to facilitate comparisons between and among trials. These should be reported comprehensively to facilitate valid inferences regarding ISy intervention effectiveness. PMID:26909010

  20. Effects of high thoracic epidural anesthesia on mixed venous oxygen saturation in coronary artery bypass grafting surgery

    PubMed Central

    Gurses, Ercan; Berk, Dervi?; Sungurtekin, Hlya; Mete, Asli; Serin, Simay

    2013-01-01

    Background To investigate possible effects of high thoracic epidural anesthesia (HTEA) on mixed venous oxygen saturation (SvO2) in coronary artery bypass grafting surgery (CABGS). Material/Methods Sixty-four patients scheduled for CABGS were randomly assigned to either test (HTEA) or control group. Standard balanced general anesthesia was applied in both groups. Mean arterial blood pressure (MAP), heart rate (HR), oxygen saturation (SpO2), central venous pressure (CVP), cardiac output (CO), cardiac index (CI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), mean pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), pulmonary compliance (C), bispectral index (BIS), body temperature, SvO2, hematocrit values were recorded before induction. Postoperative hemodynamic changes, inotropic agent, need for vasodilatation, transfusion and additional analgesics, recovery score, extubation time, visual analogue scale (VAS) values, duration of stay in intensive care unit (ICU) and hospital were recorded. Results Study groups were similar in SpO2, CVP, PCWP, PAP, C, body temperature, BIS values, development of intraoperative bradycardia. In HTEA group, intraoperative MAP, SVR, PVR, need for transfusion were lower, whereas CO, CI, SvO2, hematocrit values were higher (p<0.05). Postoperative MAP, HR, hypertension development, need for vasodilatator, transfusion, analgesics, extubation time, recovery data, duration of stay in ICU, hospital were lower in HTEA group (p<0.05). VAS score decreased in 30 minutes and 12 hours following extubation in HTEA and control group, respectively. Conclusions HTEA may improve balance between oxygen presentation and usage by suppressing neuroendocrin stress response; provide efficient postoperative analgesia, more stabile hemodynamic, respiratory conditions, lower duration of stay in ICU, hospital. PMID:23531633

  1. The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 1—Statistical Methodology

    PubMed Central

    O’Brien, Sean M.; Jacobs, Jeffrey P.; Pasquali, Sara K.; Gaynor, J. William; Karamlou, Tara; Welke, Karl F.; Filardo, Giovanni; Han, Jane M.; Kim, Sunghee; Shahian, David M.; Jacobs, Marshall L.

    2016-01-01

    Background This study’s objective was to develop a risk model incorporating procedure type and patient factors to be used for case-mix adjustment in the analysis of hospital-specific operative mortality rates after congenital cardiac operations. Methods Included were patients of all ages undergoing cardiac operations, with or without cardiopulmonary bypass, at centers participating in The Society of Thoracic Surgeons Congenital Heart Surgery Database during January 1, 2010, to December 31, 2013. Excluded were isolated patent ductus arteriosus closures in patients weighing less than or equal to 2.5 kg, centers with more than 10% missing data, and patients with missing data for key variables. Data from the first 3.5 years were used for model development, and data from the last 0.5 year were used for assessing model discrimination and calibration. Potential risk factors were proposed based on expert consensus and selected after empirically comparing a variety of modeling options. Results The study cohort included 52,224 patients from 86 centers with 1,931 deaths (3.7%). Covariates included in the model were primary procedure, age, weight, and 11 additional patient factors reflecting acuity status and comorbidities. The C statistic in the validation sample was 0.858. Plots of observed-vs-expected mortality rates revealed good calibration overall and within subgroups, except for a slight overestimation of risk in the highest decile of predicted risk. Removing patient preoperative factors from the model reduced the C statistic to 0.831 and affected the performance classification for 12 of 86 hospitals. Conclusions The risk model is well suited to adjust for case mix in the analysis and reporting of hospital-specific mortality for congenital heart operations. Inclusion of patient factors added useful discriminatory power and reduced bias in the calculation of hospital-specific mortality metrics. PMID:26245502

  2. Effectiveness of brain natriuretic peptide in predicting postoperative atrial fibrillation in patients undergoing non-cardiac thoracic surgery.

    PubMed

    Toufektzian, Levon; Zisis, Charalambos; Balaka, Christina; Roussakis, Antonios

    2015-05-01

    A best evidence topic was written according to a structured protocol. The question addressed was whether plasma brain natriuretic peptide (BNP) levels could effectively predict the occurrence of postoperative atrial fibrillation (AF) in patients undergoing non-cardiac thoracic surgery. A total of 14 papers were identified using the reported search, of which 5 represented the best evidence to answer the clinical question. The authors, date, journal, country, study type, population, outcomes and key results are tabulated. All studies were prospective observational, and all reported a significant association between BNP and N-terminal (NT)-proBNP plasma levels measured in the immediate preoperative period and the incidence of postoperative AF in patients undergoing either anatomical lung resections or oesophagectomy. One study reported a cut-off value of 30 pg/ml above which significantly more patients suffered from postoperative AF (P < 0.0001), while another one reported that this value could predict postoperative AF with a sensitivity of 77% and a specificity of 93%. Another study reported that patients with NT-proBNP levels of 113 pg/ml or above had an 8-fold increased risk of developing postoperative AF. These findings support that BNP or NT-proBNP levels, especially when determined during the preoperative period, if increased, are able to identify patients at risk for the development of postoperative AF after anatomical major lung resection or oesophagectomy. The same does not seem to be true for lesser lung resections. These high-risk patients might have a particular benefit from the administration of prophylactic antiarrhythmic therapy. PMID:25630332

  3. [Scintigraphic comparison of graft patency between the left internal thoracic artery and saphenous vein graft after coronary bypass surgery].

    PubMed

    Nakano, H; Shimakura, T; Katsumata, T; Shimamura, Y; Hoshino, K; Harada, T; Maejima, F; Kohno, H; Asakawa, K; Shichikawa, H

    1993-07-01

    Graft patency after coronary bypass surgery (CABG) was evaluated with stress 201-thallium scintigraphy (stress 201Tl) in 26 cases, including 13 cases using the left internal thoracic artery (LITA group) in situ and 13 cases with saphenous vein graft (SVG group). All of them had effort or unstable angina caused by LAD lesion without apparent infarction. Stress 201Tl using a symptom-limited, graded bicycle exercise test was performed before CABG and 1 month, 6 months to 1 year, 1 year to 1.5 years after surgery. Five tomographic images including the apical side of the area fed by the bypass anastomosed to LAD in short axial sections were picked out and piled up. Fan-shaped ROI was made on this area and % Tl uptake was calculated using the following formula. 201Tl counts in ROI--Background counts/Maximum counts--Background counts x 100 (%) The normal % Tl uptake calculated in the control group (n = 11) in this ROI was 68.2 +/- 4.8%. Preoperative % Tl uptake showed 49.3 +/- 0.2% in the LITA group and 54.3 +/- 13.2% in the SVG group. % Tl uptake of the SVG group 1 month after CABG was slightly higher than that of the LITA group, (62.0 +/- 7.0% vs. 56.3 +/- 7.6%). However 6 months to 1 year after, % Tl uptake of the LITA group increased to 60.8 +/- 6.4%, inspite of a tendency on the decrease of that in the SVG group, (59.0 +/- 8.5%), and further more, 1 year to 1.5 years after CABG, increased to 62.3 +/- 5.1% near the normal % Tl uptake of the control group and the SVG group decreased to 58.8 +/- 6.8%. This result suggested that arterial in situ bypass graft might have an auto-regulation and "growing property" corresponding to flow demand, and this helps the excellent long-term patency of arterial bypass grafts. PMID:8336431

  4. [Nursing Care of Lumbar Spine Fusion Surgery Using a Semi-Rigid Device (ISOBAR)].

    PubMed

    Wu, Meng-Shan; Su, Shu-Fen

    2016-04-01

    Aging frequently induces degenerative changes in the spine. Patients who suffer from lumbar degenerative disease tend to have lower back pain, neurological claudication, and neuropathy. Furthermore, incontinence may be an increasing issue as symptoms become severe. Lumbar spine fusion surgery is necessary if clinical symptoms continue to worsen or if the patient fails to respond to medication, physical therapy, or alternative treatments. However, this surgical procedure frequently induces adjacent segment disease (ASD), which is evidenced by the appearance of pathological changes in the upper and lower sections of the spinal surgical sites. In 1997, ISOBAR TTL dynamic rod stabilization was developed for application in spinal fusion surgery to prevent ASD-related complications. The device has proven effective in reducing pain in the lower back and legs, decreasing functional disability, improving quality of life, and retarding disc degeneration. However, the effectiveness of this intervention in decreasing the incidence of ASD requires further research investigation, and relevant literature and research in Taiwan is still lacking. This article discusses lumbar degenerative disease, its indications, the contraindications of lumbar spine fusion surgery using ISOBAR, and related postoperative nursing care. We hope this article provides proper and new knowledge to clinical nurses for the care of patients undergoing lumbar spine fusion surgery with ISOBAR. PMID:27026564

  5. In-hospital airborne tuberculous infection from a lesion of calcified pleural thickening during thoracic surgery in a patient with lung cancer.

    PubMed

    Akata, Kentaro; Kawanami, Toshinori; Yatera, Kazuhiro; Tachiwada, Takashi; Takenaka, Masaru; Noguchi, Shingo; Yamasaki, Kei; Nishida, Chinatsu; Orihashi, Takeshi; Ishimoto, Hiroshi; Yoshii, Chiharu; Tanaka, Fumihiro; Mukae, Hiroshi

    2015-01-01

    A 75-year-old Japanese man underwent thoracic surgery to treat a large lung cancer lesion in the left upper lobe with calcified pleural thickening. Postoperatively, viable Mycobacterium tuberculosis was detected in the margin of the resected thickened calcified pleural lesion. Therefore, an infection control investigation of medical staff who had come in contact with the patient was conducted. Consequently, two of the 14 healthcare professionals who had been in the operating room were diagnosed with latent tuberculous infections. Therefore, strict precautions against airborne infections are required to prevent the in-hospital transmission of M. tuberculosis in such cases. PMID:26466714

  6. Contemporary patterns of surgery and outcomes for aortic coarctation: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database

    PubMed Central

    Ungerleider, Ross M.; Pasquali, Sara K.; Welke, Karl F.; Wallace, Amelia S.; Ootaki, Yoshio; Quartermain, Michael D.; Williams, Derek A.; Jacobs, Jeffrey P.

    2013-01-01

    Objective The objective of this study was to describe characteristics and early outcomes across a large multicenter cohort undergoing coarctation or hypoplastic aortic arch repair. Methods Patients undergoing coarctation or hypoplastic aortic arch repair (2006–2010) as their first cardiovascular operation in the Society of Thoracic Surgeons Congenital Heart Surgery Database were included. Group 1 patients consisted of those with coarctation or hypoplastic aortic arch without ventricular septal defect (coarctation or hypoplastic aortic arch, isolated); group 2, coarctation or hypoplastic aortic arch with ventricular septal defect (coarctation or hypoplastic aortic arch, ventricular septal defect); and group 3, coarctation or hypoplastic aortic arch with other major cardiac diagnoses (coarctation or hypoplastic aortic arch, other). Results The cohort included 5025 patients (95 centers): group 1, 2705 (54%); group 2, 840 (17%); and group 3, 1480 (29%). Group 1 underwent coarctation or hypoplastic aortic arch repair at an older age than groups 2 and 3 (groups 1, 2, and 3, 75%, 99%, and 88% < 1 year old, respectively; P<.0001). The most common operative techniques for coarctation or hypoplastic aortic arch repair (group 1) were end-to-end (33%) or extended end-to-end (56%) anastomosis. Overall mortality was 2.4%, and was 1%, 2.5%, and 4.8% for groups 1, 2, and 3 respectively (P < .0001). Ventricular septal defect management strategies for group 2 patients included ventricular septal defect closure (n = 211, 25%), pulmonary artery band (n = 89, 11%), or no intervention (n = 540, 64%) without significant difference in mortality (4%, 1%, 2%; P = .15). Postoperative complications occurred in 36% of patients overall and were more common in groups 2 and 3. There were no occurrences of spinal cord injury (0/973). Conclusions In the current era, primary coarctation or hypoplastic aortic arch repair is performed predominantly in neonates and infants. Overall mortality is low, although those with concomitant defects are at risk for higher morbidity and mortality. The risk of spinal cord injury is lower than previously reported. PMID:23098750

  7. Effect of Intraoperative and Postoperative Infusion of Dexmedetomidine on the Quality of Postoperative Analgesia in Highly Nicotine-Dependent Patients After Thoracic Surgery

    PubMed Central

    Ren, Chunguang; Zhang, Xuejun; Liu, Zhong; Li, Changying; Zhang, Zongwang; Qi, Feng

    2015-01-01

    Abstract Smoking is one of the most common addictions in the world. Nicotine inhalation could increase the risk of cardiorespiratory diseases. However, the solution that improved postoperative analgesia for highly nicotine-dependent patients undergoing thoracic surgery has not been specifically addressed. This CONSORT-prospective, randomized, double-blinded, controlled trial investigated the efficacy of combination of dexmedetomidine and sufentanil for highly nicotine (Fagerstrom test of nicotine dependence ≥6)-dependent patients after thoracic surgery. One hundred seventy-four male patients who underwent thoracic surgery were screened between February 2014 and November 2014, and a total of forty-nine were excluded. One hundred thirty-two highly nicotine-dependent male patients who underwent thoracic surgery and received postoperative patient-controlled intravenous analgesia were divided into 3 groups after surgery in this double-blind, randomized study: sufentanil (0.02 μg/kg/h, Group S), sufentanil plus dexmedetomidine (0.02 μg/kg/h each, Group D1), or sufentanil (0.02 μg/kg/h) plus dexmedetomidine (0.04 μg/kg/h) (Group D2). The patient-controlled analgesia (PCA) program was programmed to deliver a bolus dose of 2 ml, with background infusion of 2 ml/h and a lockout of 5 min, 4-hour limit of 40 ml, as our retrospective study. The primary outcome measure was the cumulative amount of self-administered sufentanil; the secondary outcome measures were pain intensity (numerical rating scale, NRS), level of sedation (LOS), Bruggrmann comfort scale (BCS), functional activity score (FAS), and concerning adverse effects. The amount of self-administered sufentanil were lower in group D2 compared with S and D1 groups during the 72 hours after surgery (P < 0.05), whereas the total dosage and dosage per body weight of sufentanil were significantly lower in D1 group than that of S group only at 4, 8, and 16 hours after surgery (P < 0.05). Compared with S group, the NRS scores at rest at 1, 4, and 8 hours after surgery and with coughing at 4, 8, 16, and 24 hours after surgery were significantly lower in D2 group (P < 0.05). However, compared with D1 group, the NRS scores both at rest and with coughing at 4 and 8 hours after surgery were significantly lower in D2 group (P < 0.05). The NRS scores both at rest and with coughing show that there were no significant differences between D1 group and S group at each time point after surgery (P > 0.05). LOS of group D2 was higher than S and D1 groups at 1 hour after surgery (P < 0.05), BCS of group D2 was higher than S and D1 groups at 4, 8, and 16 hours after surgery (P < 0.05), and FAS of group D2 was higher than S and D1 groups at 48 and 72 hours after surgery (P < 0.05). The number of rescue analgesia during 72 hours after surgery in D2 group was lower than S and D1 groups (P < 0.05). There were no significant differences among the 3 groups in terms of baseline clinical characteristics and postoperative adverse effects except for itching (P > 0.05). Among the tested patient-controlled analgesia options, the addition of dexmedetomidine (0.04 μg/kg/h) and sufentanil (0.02 μg/kg/h) showed better analgesic effect and greater patient satisfaction without other clinically relevant side effects for highly nicotine-dependent patients during the initial 72 hours after thoracic surgery. Trial Registration: chictr.org (ChiCTR-TRC-14004191). PMID:26266376

  8. Thoracic Insufficiency Syndrome

    MedlinePlus

    ... chest and straightening the spine indirectly without a spine fusion. VEPTR surgery is extensive. Devices are placed under the scapula ( ... are a limited number of institutions offering VEPTR surgery. Your child's spine surgeon can advise whether your child's condition is ...

  9. [Spontaneous Rupture of the Thoracic Aorta after Surgery of Rectal Cancer in an Elderly Patient;Report of a Case].

    PubMed

    Tokumo, Masaki; Okada, Koichiro; Kunisue, Hironori; Teruta, Shoma; Kakishita, Tomokazu; Naito, Minoru

    2016-03-01

    We reported a case of a 90-year-old man who underwent abdominoperineal resection of the rectum for advanced rectal cancer. On the 16th postoperative day, he suddenly lost consciousness during an exchange of the colostomy pouches. His heart arrested in a moment, and cardiopulmonary resuscitation was immediately performed, but in vain. The autopsy imaging revealed collapse of the heart and the thoracic aorta, as well as profuse blood-like effusion in the left pleural cavity. We considered that hemorrhagic shock due to spontaneous rupture of the thoracic aorta was the cause of his death. PMID:27075292

  10. Stratification of complexity in congenital heart surgery: comparative study of the Risk Adjustment for Congenital Heart Surgery (RACHS-1) method, Aristotle basic score and Society of Thoracic Surgeons-European Association for Cardio- Thoracic Surgery (STS-EACTS) mortality score

    PubMed Central

    Cavalcanti, Paulo Ernando Ferraz; Sá, Michel Pompeu Barros de Oliveira; dos Santos, Cecília Andrade; Esmeraldo, Isaac Melo; Chaves, Mariana Leal; Lins, Ricardo Felipe de Albuquerque; Lima, Ricardo de Carvalho

    2015-01-01

    Objective To determine whether stratification of complexity models in congenital heart surgery (RACHS-1, Aristotle basic score and STS-EACTS mortality score) fit to our center and determine the best method of discriminating hospital mortality. Methods Surgical procedures in congenital heart diseases in patients under 18 years of age were allocated to the categories proposed by the stratification of complexity methods currently available. The outcome hospital mortality was calculated for each category from the three models. Statistical analysis was performed to verify whether the categories presented different mortalities. The discriminatory ability of the models was determined by calculating the area under the ROC curve and a comparison between the curves of the three models was performed. Results 360 patients were allocated according to the three methods. There was a statistically significant difference between the mortality categories: RACHS-1 (1) - 1.3%, (2) - 11.4%, (3)-27.3%, (4) - 50 %, (P<0.001); Aristotle basic score (1) - 1.1%, (2) - 12.2%, (3) - 34%, (4) - 64.7%, (P<0.001); and STS-EACTS mortality score (1) - 5.5 %, (2) - 13.6%, (3) - 18.7%, (4) - 35.8%, (P<0.001). The three models had similar accuracy by calculating the area under the ROC curve: RACHS-1- 0.738; STS-EACTS-0.739; Aristotle- 0.766. Conclusion The three models of stratification of complexity currently available in the literature are useful with different mortalities between the proposed categories with similar discriminatory capacity for hospital mortality. PMID:26107445

  11. Osteoconductive hydroxyapatite coated PEEK for spinal fusion surgery

    NASA Astrophysics Data System (ADS)

    Hahn, Byung-Dong; Park, Dong-Soo; Choi, Jong-Jin; Ryu, Jungho; Yoon, Woon-Ha; Choi, Joon-Hwan; Kim, Jong-Woo; Ahn, Cheol-Woo; Kim, Hyoun-Ee; Yoon, Byung-Ho; Jung, In-Kwon

    2013-10-01

    Polyetheretherketone (PEEK) has attracted much interest as biomaterial for interbody fusion cages due to its similar stiffness to bone and good radio-transparency for post-op visualization. Hydroxyapatite (HA) coating stimulates bone growth to the medical implant. The objective of this work is to make an implant consisting of biocompatible PEEK with an osteoconductive HA surface for spinal or orthopedic applications. Highly dense and well-adhered HA coating was developed on medical-grade PEEK using aerosol deposition (AD) without thermal degradation of the PEEK. The HA coating had a dense microstructure with no cracks or pores, and showed good adhesion to PEEK at adhesion strengths above 14.3 MPa. The crystallinity of the HA coating was remarkably enhanced by hydrothermal annealing as post-deposition heat-treatment. In addition, in vitro and in vivo biocompatibility of PEEK, in terms of cell adhesion morphology, cell proliferation, differentiation, and bone-to-implant contact ratio, were remarkably enhanced by the HA coating through AD.

  12. Visualization of subdural electrodes with fusion CT scan/MRI during neuronavigation-guided epilepsy surgery.

    PubMed

    Kamida, Tohru; Anan, Mitsuo; Shimotaka, Kazunori; Abe, Tatsuya; Fujiki, Minoru; Kobayashi, Hidenori

    2010-04-01

    Neuronavigation in epilepsy surgery enables surgeons to accurately resect deep targets inside the brain, especially lesions that are unable to be visually differentiated from adjacent normal brain. The usefulness of visualizing subdural electrodes with postimplantation fusion CT/MRI was investigated. The use of platinum subdural electrodes made it possible to obtain postimplantation MRI. The postimplantation MRI and CT scans were fused on the surgical navigation system workstation to form three-dimensional (3D) images, and the epileptogenic regions were marked using the visualized electrodes. Immediately after a craniotomy was performed, the subdural electrodes were removed and the epileptogenic region was successfully resected using the neuronavigation guide. During neuronavigation-guided surgery to target deep brain epileptogenic lesions adjacent to eloquent areas, which are often invisible, we found visualization of the subdural electrodes with postimplantation fusion CT/MRI very useful. PMID:20122830

  13. Ultrasound-Assisted Thoracic Paravertebral Block Reduces Intraoperative Opioid Requirement and Improves Analgesia after Breast Cancer Surgery: A Randomized, Controlled, Single-Center Trial

    PubMed Central

    Tan, Gang; Mao, Feng; Yang, Dongsheng; Guan, Jinghong; Lin, Yan; Wang, Xuejing; Zhang, Yanna; Zhang, Xiaohui; Shen, Songjie; Xu, Zhonghuang; Sun, Qiang; Huang, Yuguang

    2015-01-01

    Objectives The contribution of ultrasound-assisted thoracic paravertebral block to postoperative analgesia remains unclear. We compared the effect of a combination of ultrasound assisted-thoracic paravertebral block and propofol general anesthesia with opioid and sevoflurane general anesthesia on volatile anesthetic, propofol and opioid consumption, and postoperative pain in patients having breast cancer surgery. Methods Patients undergoing breast cancer surgery were randomly assigned to ultrasound-assisted paravertebral block with propofol general anesthesia (PPA group, n = 121) or fentanyl with sevoflurane general anesthesia (GA group, n = 126). Volatile anesthetic, propofol and opioid consumption, and postoperative pain intensity were compared between the groups using noninferiority and superiority tests. Results Patients in the PPA group required less sevoflurane than those in the GA group (median [interquartile range] of 0 [0, 0] vs. 0.4 [0.3, 0.6] minimum alveolar concentration [MAC]-hours), less intraoperative fentanyl requirements (100 [50, 100] vs. 250 [200, 300]μg,), less intense postoperative pain (median visual analog scale score 2 [1, 3.5] vs. 3 [2, 4.5]), but more propofol (median 529 [424, 672] vs. 100 [100, 130] mg). Noninferiority was detected for all four outcomes; one-tailed superiority tests for each outcome were highly significant at P<0.001 in the expected directions. Conclusions The combination of propofol anesthesia with ultrasound-assisted paravertebral block reduces intraoperative volatile anesthetic and opioid requirements, and results in less post operative pain in patients undergoing breast cancer surgery. Trial Registration ClinicalTrial.gov NCT00418457 PMID:26588217

  14. Changes in postoperative night bispectral index of patients undergoing thoracic surgery with different types of anaesthesia management: a randomized controlled trial.

    PubMed

    Tan, Wen-Fei; Guo, Bing; Ma, Hong; Li, Xiao-Qian; Fang, Bo; Lv, Huang-Wei

    2016-03-01

    This study hypothesized that different types of anaesthesia management would result in similar postoperative sleep quality. In this prospective single-blind investigation, 219 patients undergoing elective thoracic surgery were randomized into three arms: general anaesthesia, as the control group (group C); general anaesthesia combined with thoracic epidural anaesthesia (TEA) (group E); and general anaesthesia combined with infusion of 1 μg/kg dexmedetomidine (group D). Plasma samples were obtained to measure the amine and inflammatory cytokine concentrations. All patients underwent assessment with the bispectral index (BIS) for sleep quality and the visual analogue scale (VAS) for pain. The primary outcomes were inflammatory cytokine [interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α)] secretion and postoperative sleep quality on the first and second postoperative nights. The secondary outcomes were amine (adrenaline and noradrenaline) secretion during the surgical period and haemodynamic stability. The postoperative BIS area under the curve was significantly lower in group E (75.7%) than in group C (87.3%) or group D (86.5%). Patients in group E had the highest BIS of sleep efficiency index (29.2%, P < 0.05) and the lowest VAS scores (3.5, P < 0.05). Group E had lower IL-6 levels than the other two groups 24 h after surgery (P < 0.05). Patients given TEA may show reduced sleep disturbances on the first night after surgery, perhaps due to better pain management and inhibition of IL-6 release. PMID:26699690

  15. [Metastatic tumor of thoracic and lumbar spine: prospective study comparing the surgery and radiotherapy vs external immobilization with radiotherapy].

    PubMed

    Falavigna, Asdrubal; Righesso Neto, Orlando; Ioppi, Ana Elisa Empinotti; Grasselli, Juliana

    2007-09-01

    Bone metastases at the thoracic and lumbar segment of the spine are usually presented with painful sensation and medullar compression. The treatment is based on the clinical and neurological conditions of the patient and the degree of tumor invasion. In the present study, 32 patients with spinal metastasis of thoracic and lumbar segment were prospectively analyzed. These patients were treated by decompression and internal stabilization followed by radiotherapy or irradiation with external immobilization. The election of the groups was in accordance with the tumor radiotherapy sensitivity, clinical conditions, spinal stability, medullar or nerve compression and patient's decision. The Frankel scale and pain visual test were applied at the moment of diagnosis and after 1 and 6 months. The surgical group had better results with preserving the ambulation longer and significant reduction of pain. PMID:17952304

  16. Effect of a single dose of pamidronate administered at the time of surgery in a rabbit posterolateral spinal fusion model

    PubMed Central

    Briceno, Jorge; Carmona, Maximiliano; Olavarria, Fernando; Hodgson, Felipe

    2010-01-01

    Spinal fusion is usually performed on patients who receive bisphosphonates (BP); however, limited data on their action on spinal fusion are available. Previous studies in animal models have shown that chronic administrations of BP reduced spinal fusion rates, and only one study has shown that a single dose administration of zolendronic acid increased fusion rate. The objective of the present study was to evaluate if pamidronate (PA), which was previously demonstrated to reduce spinal fusion rate when administered continuously for 8 weeks, would increase the spinal fusion rate if administered in a single dose at the time of surgery in a rabbit model. Thirty-two New Zealand rabbits underwent an L5–L6 posterolateral intertransverse fusion with iliac crest autograft. Animals were randomized to receive either PA 3 mg/kg in a single dose immediately after surgery, or normal saline. Animals were killed 8 weeks after surgery and fusion was determined by manual palpation and radiographic analysis. Fusion healing was obtained in eight rabbits (50%) in the PA group and in four animals (25%) in the control group, p = 0.137. In a rabbit model, a single dose of PA did not decrease lumbar spinal arthrodesis consolidation rates, but it obtained a nonsignificant higher spinal fusion rate. PMID:20127496

  17. The Efficacy and Perioperative Complications Associated with Lumbar Spinal Fusion Surgery, Focusing on Geriatric Patients in the Republic of Korea

    PubMed Central

    Kim, Il-Chun; Kwon, Ki-Young; Lee, Jong-Ju; Lee, Jong-Won; Lee, Hyun-Koo

    2013-01-01

    Objective The purpose of this study was to examine the efficacy and perioperative complications associated with lumbar spinal fusion surgery, focusing on geriatric patients in the Republic of Korea. Methods We retrospectively investigated 485 patients with degenerative spinal diseases who had lumbar spinal fusion surgeries between March 2006 and December 2010 at our institution. Age, sex, comorbidity, American Society of Anesthesiologists (ASA) class, fusion segments, perioperative complications, and outcomes were analyzed in this study. Risk factors for complications and their association with age were analyzed. Results In this study, 81 patients presented complications (16.7%). The rate of perioperative complications was significantly higher in patients 70 years or older than in other age groups (univariate analysis, p=0.015; multivariate analysis, p=0.024). The perioperative complications were not significantly associated with the other factors tested (sex, comorbidity, ASA class, and fusion segments). Post-operative outcomes of lumbar spinal fusion surgeries for the patients were determined on the basis of MacNab's criteria (average follow up period : 19.7 months), and 412 patients (85.0%) were classified as having "excellent" or "good" results. Conclusion Increasing age was an important risk factor for perioperative complications in patients undergoing lumbar spinal fusion surgery, whereas other factors were not significant. However, patients' satisfaction or return to daily activities when compared with younger patients did not show much difference. We recommend good clinical judgment as well as careful selection of geriatric patients for lumbar spinal fusion surgery. PMID:24294456

  18. Thoracic epidural analgesia in obese patients with body mass index of more than 30 kg/m2 for off pump coronary artery bypass surgery.

    PubMed

    Sharma, Munish; Mehta, Yatin; Sawhney, Ravinder; Vats, Mayank; Trehan, Naresh

    2010-01-01

    Perioperative Thoracic epidural analgesia (TEA) is an important part of a multimodal approach to improve analgesia and patient outcome after cardiac and thoracic surgery. This is particularly important for obese patients undergoing off pump coronary artery bypass surgery (OPCAB). We conducted a randomized clinical trial at tertiary care cardiac institute to compare the effect of TEA and conventional opioid based analgesia on perioperative lung functions and pain scores in obese patients undergoing OPCAB. Sixty obese patients with body mass index >30 kg/m2 for elective OPCAB were randomized into two groups (n=30 each). Patients in both the groups received general anesthesia but in group 1, TEA was also administered. We performed spirometry as preoperative assessment and at six hours, 24 hours, second, third, fourth and fifth day after extubation, along with arterial blood gases analysis. Visual analogue scale at rest and on coughing was recorded to assess the degree of analgesia. The other parameters observed were: time to endotracheal extubation, oxygen withdrawal time and intensive care unit length of stay. On statistical analysis there was a significant difference in Vital Capacity at six hours, 24 hours, second and third day postextubation. Forced vital capacity and forced expiratory volume in one second followed the same pattern for first four postoperative days and peak expiratory flow rate remained statistically high till second postoperative day. ABG values and PaO2/FiO2 ratio were statistically higher in the study group up to five days. Visual analogue scale at rest and on coughing was significantly lower till fourth and third postoperative day respectively. Tracheal extubation time, oxygen withdrawal time and ICU stay were significantly less in group 1. The use of TEA resulted in better analgesia, early tracheal extubation and shorter ICU stay and should be considered for obese patients undergoing OPCAB. PMID:20075532

  19. Perioperative complications of minimally invasive surgery (MIS): comparison of MIS and open interbody fusion techniques.

    PubMed

    Bagan, Bradley; Patel, Nimesh; Deutsch, Harel; Harrop, James; Sharan, Ashwini; Vaccaro, Alexander R; Ratliff, John K

    2008-01-01

    The risk of perioperative complications while adopting minimally invasive spine surgery techniques may slow the acceptance of this technology. We assess the perioperative complication rate with minimally invasive single- and two-level interbody fusions and compare this incidence with a contemporaneous cohort of open single- and two-level open interbody fusions, with all procedures completed by a single surgeon in a single practice group. We compiled all open and MIS interbody fusion cases completed during the study period. Sofamor-Danek X-Tube and Stryker Luxor minimally invasive systems were used on all patients. Medical records were reviewed to assess any adverse events occurring in the perioperative period. Care was taken to include all medical and surgical adverse events and complications occurring within 30 days of surgery. Over the study period, 28 minimally invasive lumbar fusions were identified: 24 single- and 4 two-level cases. Both TLIF and PLIF techniques were used. This cohort was compared with a group of 19 single- and two-level open interbody fusion cases completed over the same period. The complication rate for the MIS cohort was 18%, with 7 complications occurring in 5 patients. In the open group, 8 complications occurred in 7 patients, an incidence of 37%. A standard distribution of complications occurred, and the difference between the two groups was not statistically significant. Limiting our analysis to severe complications yielded rates of 7% and 21% for the two groups, also not significantly divergent. Perioperative complications are not more common in well-selected MIS patients. Allowing for proper patient selection, MIS techniques have a favorable complication profile. PMID:18802914

  20. Near-infrared optical monitoring of cardiac oxygen sufficiency through thoracic wall without open-chest surgery

    NASA Astrophysics Data System (ADS)

    Kakihana, Yasuyuki; Tamura, Mamoru

    1991-05-01

    The cardiac function is exquisitely sensitive to oxygen, because its energy production mainly depends on the oxidative phosphorylation at mitochondria. Thus, oxygenation state of the tissue is critical. Cytochrome a,a3, hemoglobin and myoglobin, which play indispensable role in the oxygen metabolism, have the broad absorption band in near infrared (NIR) region and the light in this region easily penetrates biological tissues. Using NIR spectrophotometry, we attempted to measure the redox state of the copper in cytochrome a,a3 in rat heart through thoracic wall without open chest. The result is given in this paper.

  1. [Minimum quantities from a thoracic surgical standpoint].

    PubMed

    Kaiser, D

    2007-11-01

    The dependence of operation lethality on hospital volume has been scientifically determined for thoracic surgery. Conclusions on the quality of the results are possible based on the structure and quality of the procedure. Minimum quantities for specialized centers in thoracic surgery have been established as 300 resectional operations on thoracic organs without mediastinoscopy, operations with the heart-lung machine, and thoracic drainage. Minimum quantities are necessary to uphold sufficient complication management by appropriate practice and experience and to keep operation lethality down. They are also needed for financing staff (at least two full-time active specialists in thoracic surgery). The concentration of thoracic surgical services at main hospitals (minimum 300 operations per year) and organ centers (minimum 500 resectional operations on thoracic organs per year) is reasonable for the 45,500 operations expected in Germany. PMID:17932631

  2. Thopaz Portable Suction Systems in Thoracic Surgery: An end user assessment and feedback in a tertiary unit

    PubMed Central

    2011-01-01

    Background Thoracic surgical patients have chest drains inserted to enable re-expansion of lungs, to clear contents from the pleural cavity which sometimes require negative suction. Suction impedes mobility, may have variable suction delivery and increases risk of infection. Assessment of air-leak in conventional drains is not scientific and is subjective. Thopaz chest drain system is a portable suction unit which allows mobilization of the patient, with scientific digital flow recordings and an in built alarm system. Methods We evaluated the utility, staff and patient feedback of this device in a pilot evaluation in a regional thoracic unit in a structured format over a period of two months. Staff responses were graded on a scale of 1 to 6 [1 Excellent to 6 Poor]. Results 120 patients who underwent elective bullectomy/pleurectomy, VATS lung biopsies, VATS metastectomy and lung resections were evaluated. The staff feedback forms were positive. The staff liked the system as it was more scientific and accurately recordable. It made nursing and physiotherapy easier as they could mobilise patients early. The patients liked the compact design, weightlessness and the silence. It enabled mobilisation of the patients and scientific removal of chest drain. Conclusions Thopaz digital suction units were found to be user friendly and were liked by the staff and patients. The staff feedback stated the devices to be objective and scientific in making decisions about removal and enabled mobilisation. PMID:21510897

  3. Use of Bone Morphogenetic Proteins in Spinal Fusion Surgery for Older Adults with Lumbar Stenosis: Trends, Complications, Repeat Surgery, and Charges

    PubMed Central

    Deyo, Richard A.; Ching, Alex; Matsen, Laura; Martin, Brook I.; Kreuter, William; Jarvik, Jeffrey G.; Angier, Heather; Mirza, Sohail K.

    2011-01-01

    Study Design Retrospective cohort study of Medicare claims. Objective Examine trends and patterns in the use of bone morphogenetic proteins (BMP) in surgery for lumbar stenosis; compare complications, reoperation rates, and charges for patients undergoing lumbar fusion with and without BMP. Summary of Background Data Small randomized trials have demonstrated higher rates of solid fusion with BMP than with allograft bone alone, with few complications, and in some studies, reduced rates of revision surgery. However, complication and reoperation rates from large population-based cohorts in routine care are unavailable. Methods We identified patients with a primary diagnosis of lumbar stenosis who had fusion surgery in 2003 or 2004 (n=16,822). We identified factors associated with BMP use; major medical complications during the index hospitalization, rates of rehospitalization within 30 days, and rates of reoperation within 4 years of follow-up (through 2008). Results Use of BMP increased rapidly, from 5.5% of fusion cases in 2003 to 28.1% of fusion cases in 2008. BMP use was greater among patients with previous surgery and among those having complex fusion procedures (combined anterior and posterior approach, or greater than 2 disc levels). Major medical complications, wound complications, and 30-day rehospitalization rates were nearly identical with or without BMP. Reoperation rates were also very similar, , even after stratifying by previous surgery or surgical complexity, and after adjusting for demographic and clinical features. On average, adjusted hospital charges for operations involving BMP were about $15,000 greater than hospital charges for fusions without BMP, though reimbursement under Medicare's Diagnosis-Related Group (DRG) system averaged only about $850 greater Significantly fewer patients receiving BMP were discharged to a skilled nursing facility (15.9% vs. 19.0%, p<0.001) Conclusion In this older population having fusion surgery for lumbar stenosis, uptake of BMP was rapid, and greatest among patients with prior surgery or having complex fusion procedures. BMP appeared safe in the perioperative period, with no increase in major medical complications. Use of BMP was associated with greater hospital charges but fewer nursing home discharges, and was not associated with reduced likelihood of reoperation. PMID:21494195

  4. The game theory in thoracic surgery: from the intuitions of Luca Pacioli to the operating rooms management

    PubMed Central

    Ciocci, Argante; Viti, Andrea; Terzi, Alberto

    2015-01-01

    Game theory is a formal way to analyze the interactions among groups of subjects who behave each other. It has historically been of great interest in the economic fields in which decisions are made in a competitive environment. Game theory has fascinating potential if applied in the medical science. Few papers have been written about the application of game theory in surgery. The majority of scenarios of game theory in surgery fall into two main groups: cooperative and no cooperative games. PMID:26716049

  5. The game theory in thoracic surgery: from the intuitions of Luca Pacioli to the operating rooms management.

    PubMed

    Ciocci, Argante; Viti, Andrea; Terzi, Alberto; Bertolaccini, Luca

    2015-11-01

    Game theory is a formal way to analyze the interactions among groups of subjects who behave each other. It has historically been of great interest in the economic fields in which decisions are made in a competitive environment. Game theory has fascinating potential if applied in the medical science. Few papers have been written about the application of game theory in surgery. The majority of scenarios of game theory in surgery fall into two main groups: cooperative and no cooperative games. PMID:26716049

  6. Evaluation of current surgeon practice for patients undergoing lumbar spinal fusion surgery in the United Kingdom

    PubMed Central

    Rushton, Alison; White, Louise; Heap, Alison; Heneghan, Nicola

    2015-01-01

    AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic analysis. RESULTS: The response rate was 73.8%. Most surgeons (84%) were orthopaedic surgeons. Range of surgeon experience (1-15 years), number of operations performed in the previous 12 mo (4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients. CONCLUSION: Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfaction it is important that further research evaluates optimal management. PMID:26191495

  7. Prevalence and Risk Factors of Deep Vein Thrombosis in Patients Undergoing Lumbar Interbody Fusion Surgery

    PubMed Central

    Yang, Si-Dong; Ding, Wen-Yuan; Yang, Da-Long; Shen, Yong; Zhang, Ying-Ze; Feng, Shi-Qing; Zhao, Feng-Dong

    2015-01-01

    Abstract This cross-sectional study was designed to obtain the current prevalence of deep vein thrombosis (DVT) and analyze related risk factors in patients undergoing lumbar interbody fusion. Medical record data were collected from Department of Spinal Surgery, The Third Hospital of Hebei Medical University, between July 2014 and March 2015. Both univariate analysis and binary logistic regression analysis were performed to determine risk factors for DVT. A total of 995 patients were admitted into this study, including 484 men and 511 women, aged from 14 to 89 years old (median 50, IQR 19). The detection rate of lower limb DVT by ultrasonography was 22.4% (223/995) in patients undergoing lumbar interbody fusion. Notably, average VAS (visual analog scale) score in the first 3 days after surgery in the DVT group was more than that in the non-DVT group (Z = −21.69, P < 0.001). The logistic regression model was established as logit P = −13.257 + 0.056∗X1 − 0.243∗X8 + 2.085∗X10 + 0.001∗X12, (X1 = age; X8 = HDL; X10 = VAS; X12 = blood transfusion; x2 = 677.763, P < 0.001). In conclusion, advanced age, high postoperative VAS scores, and blood transfusion were risk factors for postoperative lower limb DVT. As well, the logistic regression model may contribute to an early evaluation postoperatively to ascertain the risk of lower limb DVT in patients undergoing lumbar interbody fusion surgery. PMID:26632909

  8. Thoracic ectopia cordis.

    PubMed

    Shad, Jimmy; Budhwani, Keshav; Biswas, Rakesh

    2012-01-01

    Ectopia cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect in fusion of the anterior chest wall resulting in extra thoracic location of the heart. Its estimated prevalence is 5.5-7.9 per million live births. The authors had one such case of a 15-h-old full-term male neonate weighing 2.25 kg with an externally visible, beating heart over the chest wall. The neonate had difficulty in respiration with peripheral cyanosis. Patient died of cardiorespiratory arrest before any surgical intervention could be undertaken inspite of best possible resuscitative measures. PMID:23035158

  9. Posterior Reversible Encephalopathy Syndrome Resolving Within 48 Hours in a Normotensive Patient Who Underwent Thoracic Spine Surgery

    PubMed Central

    Vakharia, Kunal; Siasios, Ioannis; Dimopoulos, Vassilios G.; Pollina, John

    2016-01-01

    Posterior reversible encephalopathy syndrome (PRES) usually manifests with severe headaches, seizures, and visual disturbances due to uncontrollable hypertension. A patient (age in the early 60s) with a history of renal cell cancer presented with lower-extremity weakness and paresthesias. Magnetic resonance imaging (MRI) of the thoracic spine revealed a T8 vertebral body metastatic lesion with cord compression at that level. The patient underwent preoperative embolization of the tumor followed by posterior resection and placement of percutaneous pedicle screws and rods. Postoperatively, the patient experienced decreased visual acuity bilaterally. Abnormal MRI findings consisted of T2 hyperintense lesions and fluid-attenuated inversion recovery changes in both occipital lobes, consistent with the unique brain imaging pattern associated with PRES. The patient’s blood pressure was normal and stable from the first day of hospitalization. The patient was kept on high-dose steroid therapy, which was started intraoperatively, and improved within 48 hours after symptom onset. PMID:26858804

  10. Posterior Reversible Encephalopathy Syndrome Resolving Within 48 Hours in a Normotensive Patient Who Underwent Thoracic Spine Surgery.

    PubMed

    Vakharia, Kunal; Siasios, Ioannis; Dimopoulos, Vassilios G; Pollina, John

    2016-03-01

    Posterior reversible encephalopathy syndrome (PRES) usually manifests with severe headaches, seizures, and visual disturbances due to uncontrollable hypertension. A patient (age in the early 60s) with a history of renal cell cancer presented with lower-extremity weakness and paresthesias. Magnetic resonance imaging (MRI) of the thoracic spine revealed a T8 vertebral body metastatic lesion with cord compression at that level. The patient underwent preoperative embolization of the tumor followed by posterior resection and placement of percutaneous pedicle screws and rods. Postoperatively, the patient experienced decreased visual acuity bilaterally. Abnormal MRI findings consisted of T2 hyperintense lesions and fluid-attenuated inversion recovery changes in both occipital lobes, consistent with the unique brain imaging pattern associated with PRES. The patient's blood pressure was normal and stable from the first day of hospitalization. The patient was kept on high-dose steroid therapy, which was started intraoperatively, and improved within 48 hours after symptom onset. PMID:26858804

  11. Minimally Invasive Extraforaminal Lumbar Interbody Fusion for Revision Surgery: A Technique through Kambin's Triangle

    PubMed Central

    Lee, Jun Gue; Kim, Hyeun Sung

    2015-01-01

    Objective The purpose of this study was to evaluate the clinical outcomes of minimally invasive extraforaminal lumbar interbody fusion (ELIF) for revision surgery. Methods From January 2011 to December 2012, 12 patients who underwent minimally invasive ELIF through the Kambin's triangle for revision surgery were included in this study. All patients underwent the surgical procedure in the following sequence: (1) epidural anesthesia, (2) exposing the Kambin's triangle toward the lateral part of the dura (partial resection of the superior articular process), (3) bilateral cage insertion for reinforcement of stabilization and fusion, and (4) percutaneous transpedicular screwing. Clinical outcomes were assessed using the visual analogue scale (VAS), and Oswestry disability index (ODI). Imaging and clinical findings including surgical techniques, clinical outcomes, and related complications were depicted and analyzed. Results The mean age of the patients (5 men, 7 women) was 60.7±13.4 years, and the mean follow-up period was 27.1±4.9 months. The mean VAS (back and leg) score improved significantly at final follow-up. The mean ODI score decreased as follows: preoperative, 76.78±6.08; 3 months after the surgery, 37.74±6.67; and at final follow-up, 29.91±2.98. Two patients presented with transient nerve root irritation, but there were no cases of incidental dural tear or serious infection. No significant neurological deterioration or major complication was noted in any of the patients. Conclusion Minimally invasive ELIF for revision surgery is an effective surgical option with a low complication rate. PMID:26834815

  12. The evolution of thoracic anesthesia.

    PubMed

    Brodsky, Jay B

    2005-02-01

    The specialty of thoracic surgery has evolved along with the modem practice of anesthesia. This close relationship began in the 1930s and continues today. Thoracic surgery has grown from a field limited almost exclusively to simple chest wall procedures to the present situation in which complex procedures, such as lung volume reduction or lung transplantation, now can be performed on the most severely compromised patient. The great advances in thoracic surgery have followed discoveries and technical innovations in many medical fields. One of the most important reasons for the rapid escalation in the number and complexity of thoracic surgical procedures now being performed has been the evolution of anesthesia for thoracic surgery. There has been so much progress in this area that numerous books and journals are devoted entirely to this subject. The author has been privileged to work with several surgeons who specialized in noncardiac thoracic surgery. As a colleague of 25 years, the noted pulmonary surgeon James B.D. Mark wrote, "Any operation is a team effort... (but) nowhere is this team effort more important than in thoracic surgery, where near-choreography of moves by all participants is essential. Exchange of information, status and plans are mandatory". This team approach between the thoracic surgeon and the anesthesiologist reflects the history of the two specialties. With new advances in technology, such as continuous blood gas monitoring and the pharmacologic management of pulmonary circulation to maximize oxygenation during one-lung ventilation, in the future even more complex procedures may be able to be performed safely on even higher risk patients. PMID:15707342

  13. Spontaneous thoracic duct cyst.

    PubMed

    Ray, J; Braithwaite, D; Patel, P J

    2003-05-01

    Spontaneous and asymptomatic supraclavicular thoracic duct cysts (lymphoceles ) are rare. Only five cases have been reported so far. They are more common after surgery or trauma and have been reported in the abdomen, mediastinum, pelvis and neck. They must be differentiated from other neck cysts as failure to recognise their attachment may result in the disastrous consequence of chylothorax. A high index of suspicion is necessary, and diagnosis usually can be established by fine-needle aspiration and suitable imaging. This case is reported along with a review of the literature and management options, including that of inadvertent damage to the thoracic duct. PMID:12750920

  14. Understanding Thoracic Outlet Syndrome

    PubMed Central

    Freischlag, Julie

    2014-01-01

    The diagnosis of thoracic outlet syndrome was once debated in the world of vascular surgery. Today, it is more understood and surprisingly less infrequent than once thought. Thoracic outlet syndrome (TOS) is composed of three types: neurogenic, venous, and arterial. Each type is in distinction to the others when considering patient presentation and diagnosis. Remarkable advances have been made in surgical approach, physical therapy, and rehabilitation of these patients. Dedicated centers of excellence with multidisciplinary teams have been developed and continue to lead the way in future research. PMID:25140278

  15. Recurrence of cervical spine instability in rheumatoid arthritis following previous fusion: can disease progression be prevented by early surgery?

    PubMed

    Agarwal, A K; Peppelman, W C; Kraus, D R; Pollock, B H; Stolzer, B L; Eisenbeis, C H; Donaldson, W F

    1992-09-01

    In a retrospective study, 110 patients with rheumatoid arthritis who had cervical spine fusion were evaluated for recurrence of cervical spine instability and resultant need for further surgery. Recurrence of cervical instability was correlated with initial radiographic abnormality, primary surgical procedure and interval between the 2 surgeries. There were 55 patients who had atlantoaxial subluxation (AAS) and required C1-C2 fusion as primary surgery. Three of these patients (5.5%) developed subaxial subluxation (SAS) and had a second procedure after a mean interval of 9 years. Twenty-two patients had AAS with superior migration of the odontoid (AAS-SMO) and had initial surgery of occiput-C3 fusion. Eight of these patients (36%) developed SAS and had a second surgery after a mean interval of 2.6 years. Of the 19 patients with primary radiographic deformity of SAS, one required further surgery for subluxation of an adjacent superior vertebra after a period of 6 years. Fourteen patients had combined deformity of AAS-SMO-SAS, and one required further surgery for SAS after an interval of 22 months. Recurrence of cervical instability following a previous fusion occurred in 15% of these 110 patients. It was seen in 5.5% of patients with initial deformity of AAS vs 36% of patients with AAS-SMO. No patients with C1-C2 fusion for AAS progressed to develop superior migration of the odontoid. We conclude that early C1-C2 fusion for AAS before development of SMO decreases the risk of further progression of cervical spine instability. The pattern of progression of cervical spine involvement, as discussed in the literature, is reviewed. PMID:1433002

  16. The Superiority of Intraoperative O-arm Navigation-assisted Surgery in Instrumenting Extremely Small Thoracic Pedicles of Adolescent Idiopathic Scoliosis: A Case-Control Study.

    PubMed

    Liu, Zhen; Jin, Mengran; Qiu, Yong; Yan, Huang; Han, Xiao; Zhu, Zezhang

    2016-05-01

    To investigate the accuracy of O-arm navigation-assisted screw insertion in extremely small thoracic pedicles and to compare it with free-hand pedicle screw insertion in adolescent idiopathic scoliosis (AIS).A total of 344 pedicle screws were inserted in apical region (defined as 2 vertebrae above and below the apex each) of 46 AIS patients (age range 13-18 years) with O-arm navigation and 712 screws were inserted in 92 AIS patients (age range 11-17 years) with free-hand technique. According to the narrowest diameter orthogonal to the long axis of the pedicle on a trajectory entering the vertebral body on preoperative computed tomography, the pedicles were classified into large (>3 mm) and small (≤3 mm) subgroups. Furthermore, a subset of extremely small pedicles (≤2 mm in the narrowest diameter) was specifically discussed. Screw accuracy was categorized as grade 0: no perforation, grade 1: perforation by less than 2 mm, grade 2: perforation by 2 to 4 mm, grade 3: perforation over 4 mm.In the O-arm group, the mean thoracic pedicle diameters were 2.23 mm (range 0.7-2.9 mm) and 3.48 mm (3.1-7.1 mm) for small and large pedicles, respectively. In the free-hand group, the small and large thoracic pedicle diameters were 2.42 mm (range 0.6-2.9 mm) and 3.75 mm (3.1-6.9 mm), respectively. The overall accuracies of screw insertion in large and small thoracic pedicles (grade 0, 1) were significantly higher in O-arm group (large: 93.8%, 210/224, small: 91.7%, 110/120) than those of free-hand group (large: 84.9%, 353/416, small: 78.4%, 232/296) (P < 0.05). Importantly, the overall accuracy of screw placement in extremely small pedicles was significantly higher in the O-arm group (84.3%, 48/57) compared with 62.7% (79/126) in free-hand group (P < 0.05), and the incidence of medial perforation was significantly lower in O-arm group (11.1%, 1/9) compared with 17.0% (8/47) in free-hand group (P < 0.05).The O-arm intraoperative navigation system should be acknowledged for its superiority in scoliosis surgery, since it permits more accurate and safer instrumentation for AIS patients with small and extremely small thoracic pedicles. PMID:27149486

  17. The role of thoracic surgery in the management of mesothelioma: an expert opinion on the limited evidence.

    PubMed

    Bertoglio, Pietro; Waller, David A

    2016-06-01

    Surgery has a key role at different points in the management of Malignant Pleural Mesothelioma. Diagnosis with video assisted thoracoscopy offers excellent sensitivity and specificity and a direct view of the pleural cavity to verify the extent of the tumor. Nodal involvement can be assessed by mediastinoscopy and either talc pleurodesis or partial pleurectomy can be used for symptom control in advanced stage disease. Extra Pleural Pneumonectomy (EPP) and Extended Pleurectomy Decortication (EPD) are used to prolong survival although the benefit of radical surgery has not has been fully clarified; EPP failed to show its benefit in the MARS trial and EPD is currently under investigation in the MARS2 trial. More randomized prospective trial data are needed to fully understand the role of radical surgery in the treatment of pleural mesothelioma. PMID:27015594

  18. Thoracic arachnoid cyst resection.

    PubMed

    Deutsch, Harel

    2014-09-01

    Arachnoid cysts in the spinal cord may be asymptomatic. In some cases arachnoid cysts may exert mass effect on the thoracic spinal cord and lead to pain and myelopathy symptoms. Arachnoid cysts may be difficult to visualize on an MRI scan because the thin walled arachnoid may not be visible. Focal displacement of the thoracic spinal cord and effacement of the spinal cord with apparent widening of the cerebrospinal fluid space is seen. This video demonstrates surgical techniques to remove a dorsal arachnoid cyst causing spinal cord compression. The surgery involves a thoracic laminectomy. The dura is opened sharply with care taken not to open the arachnoid so that the cyst can be well visualized. The thickened arachnoid walls of the cyst are removed to alleviate the compression caused by the arachnoid cyst. The video can be found here: http://youtu.be/pgUrl9xvsD0. PMID:25175582

  19. Postoperative Pain Management after Spinal Fusion Surgery: An Analysis of the Efficacy of Continuous Infusion of Local Anesthetics

    PubMed Central

    Reynolds, Richard A. K.; Legakis, Julie E.; Tweedie, Jillian; Chung, YoungKey; Ren, Emily J.; BeVier, Patricia A.; Thomas, Ronald L.; Thomas, Suresh T.

    2013-01-01

    Spinal fusion surgery is a major surgery that results in severe postoperative pain, therefore pain reduction is a primary concern. New strategies for pain management are currently under investigation and include multimodal treatment. A 3-year retrospective analysis of patients with idiopathic scoliosis undergoing spinal fusion surgery was performed at our hospital, assessing patient pain scores, opioid use, and recovery. We evaluated the effect of adding continuous infusion of local anesthetics (CILA) to a postoperative pain management protocol that includes intraoperative intrathecal morphine, as well as postoperative patient-controlled analgesia and oral opioid/acetaminophen combination. The study compared 25 patients treated according to the standard protocol, with 62 patients treated with CILA in addition to the pain management protocol. Patients in the CILA group used nearly 0.5 mg/kg less opioid analgesics during the first 24 hours after surgery. PMID:24436846

  20. [Commentary by the German Society for Thoracic and Cardiovascular Surgery on the positions statement by the German Cardiology Society on quality criteria for transcatheter aortic valve implantation (TAVI)].

    PubMed

    Cremer, Jochen; Heinemann, Markus K; Mohr, Friedrich Wilhelm; Diegeler, Anno; Beyersdorf, Friedhelm; Niehaus, Heidi; Ensminger, Stephan; Schlensak, Christian; Reichenspurner, Hermann; Rastan, Ardawan; Trummer, Georg; Walther, Thomas; Lange, Rüdiger; Falk, Volkmar; Beckmann, Andreas; Welz, Armin

    2014-12-01

    Surgical aortic valve replacement is still considered the first-line treatment for patients suffering from severe aortic valve stenosis. In recent years, transcatheter aortic valve implantation (TAVI) has emerged as an alternative for selected high-risk patients. According to the latest results of the German external quality assurance program, mandatory by law, the initially very high mortality and procedural morbidity have now decreased to approximately 6 and 12%, respectively. Especially in Germany, the number of patients treated by TAVI has increased exponentially. In 2013, a total of 10.602 TAVI procedures were performed. TAVI is claimed to be minimally invasive. This is true concerning the access, but it does not describe the genuine complexity of the procedure, defined by the close neighborhood of the aortic valve to delicate intracardiac structures. Hence, significant numbers of life-threatening complications may occur and have been reported. Owing to the complexity of TAVI, there is a unanimous concordance between cardiologists and cardiac surgeons in the Western world demanding a close heart team approach for patient selection, intervention, handling of complications, and pre- as well as postprocedural care, respectively. The prerequisite is that TAVI should not be performed in centers with no cardiac surgery on site. This is emphasized in all international joint guidelines and expert consensus statements. Today, a small number of patients undergo TAVI procedures in German hospitals without a department of cardiac surgery on site. To be noted, most of these hospitals perform less than 20 cases per year. Recently, the German Cardiac Society (DGK) published a position paper supporting this practice pattern. Contrary to this statement and concerned about the safety of patients treated this way, the German Society for Thoracic and Cardiovascular Surgery (DGTHG) still fully endorses the European (ESC/EACTS) and other actual international guidelines and consensus statements. Only the concomitance of departments for cardiac surgery and cardiology on site can provide optimal TAVI care. This commentary by the DGTHG delineates the data and resources upon which its opinion is based. PMID:25415629

  1. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery.

    PubMed

    Park, Sang-Heon

    2016-02-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  2. Perioperative lung-protective ventilation strategy reduces postoperative pulmonary complications in patients undergoing thoracic and major abdominal surgery

    PubMed Central

    2016-01-01

    The occurrence of postoperative pulmonary complications is strongly associated with increased hospital mortality and prolonged postoperative hospital stays. Although protective lung ventilation is commonly used in the intensive care unit, low tidal volume ventilation in the operating room is not a routine strategy. Low tidal volume ventilation, moderate positive end-expiratory pressure, and repeated recruitment maneuvers, particularly for high-risk patients undergoing major abdominal surgery, can reduce postoperative pulmonary complications. Facilitating perioperative bundle care by combining prophylactic and postoperative positive-pressure ventilation with intraoperative lung-protective ventilation may be helpful to reduce postoperative pulmonary complications. PMID:26885294

  3. The electronic cigarette. Official statement of the Spanish Society of Pneumology and Thoracic Surgery (SEPAR) on the efficacy, safety and regulation of electronic cigarettes.

    PubMed

    Jimenez Ruiz, Carlos A; Solano Reina, Segismundo; de Granda Orive, Jose Ignacio; Signes-Costa Minaya, Jaime; de Higes Martinez, Eva; Riesco Miranda, Juan Antonio; Altet Gómez, Neus; Lorza Blasco, Jose Javier; Barrueco Ferrero, Miguel; de Lucas Ramos, Pilar

    2014-08-01

    The electronic cigarette (EC) is a device formed by three basic elements: battery, atomizer and cartridge. When assembled, it looks like a cigarette. The cartridge contains different substances: propylene glycol, glycerine and, sometimes, nicotine. When the user "vapes", the battery is activated, the atomizer is heated and the liquid is drawn in and vaporized. The smoker inhales the mist produced. Various substances have been detected in this mist: formaldehyde, acetaldehyde and acrolein and some heavy metals. Although these are found in lower concentrations than in cigarettes, they may still be harmful for the human body. Several surveys show that 3-10% of smokers regularly use e-cigarettes. A randomized study has shown that the efficacy of e-cigarettes for helping smokers to quit is similar to nicotine patches. Nevertheless, the study has relevant methodological limitations and reliable conclusions cannot be deduced. This report sets down the Position Statement of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) on the efficacy and safety of e-cigarettes. This statement declares that e-cigarettes should be regulated as medicinal products. PMID:24684764

  4. Reduce chest pain using modified silicone fluted drain tube for chest drainage after video-assisted thoracic surgery (VATS) lung resection

    PubMed Central

    Li, Xin; Hu, Bin; Miao, Jinbai

    2016-01-01

    Background The aim of this study was to assess the feasibility, efficacy and safety of a modified silicone fluted drain tube after video-assisted thoracic surgery (VATS) lung resection. Methods The prospective randomized study included 50 patients who underwent VATS lung resection between March 2015 and June 2015. Eligible patients were randomized into two groups: experimental group (using the silicone fluted drain tubes for chest drainage) and control group (using standard drain tubes for chest drainage). The volume and characteristics of drainage, postoperative (PO) pain scores and hospital stay were recorded. All patients received standard care during hospital admission. Results In accordance with the exit criteria, three patients were excluded from study. The remaining 47 patients included in the final analysis were divided into two groups: experiment group (N=24) and control group (N=23). There was no significant difference between the two groups in terms of age, sex, height, weight, clinical diagnosis and type of surgical procedure. There was a trend toward less PO pain in experimental group on postoperative day (POD) 1, with a statistically significant difference. Patients in experimental group had a reduced occurrence of fever [temperature (T) >37.4 °C] compared to the control group. Conclusions The silicone fluted drain tube is feasible and safe and may relieve patient PO pain and reduce occurrence of fever without the added risk of PO complications. PMID:26941976

  5. Hybrid Surgery Combined with Dynamic Stabilization System and Fusion for the Multilevel Degenerative Disease of the Lumbosacral Spine

    PubMed Central

    Lee, Soo Eon; Kim, Hyun Jib

    2015-01-01

    Background As motion-preserving technique has been developed, the concept of hybrid surgery involves simultaneous application of two different kinds of devices, dynamic stabilization system and fusion technique. In the present study, the application of hybrid surgery for lumbosacral degenerative disease involving two-segments and its long-term outcome were investigated. Methods Fifteen patients with hybrid surgery (Hybrid group) and 10 patients with two-segment fusion (Fusion group) were retrospectively compared. Results Preoperative grade for disc degeneration was not different between the two groups, and the most common operated segment had the most degenerated disc grade in both groups; L4-5 and L5-S1 in the Hybrid group, and L3-4 and L4-5 in Fusion group. Over 48 months of follow-up, lumbar lordosis and range of motion (ROM) at the T12-S1 global segment were preserved in the Hybrid group, and the segmental ROM at the dynamic stabilized segment maintained at final follow-up. The Fusion group had a significantly decreased global ROM and a decreased segmental ROM with larger angles compared to the Hybrid group. Defining a 2-mm decrease in posterior disc height (PDH) as radiologic adjacent segment pathology (ASP), these changes were observed in 6 and 7 patients in the Hybrid and Fusion group, respectively. However, the last PDH at the above adjacent segment had statistically higher value in Hybrid group. Pain score for back and legs was much reduced in both groups. Functional outcome measured by Oswestry disability index (ODI), however, had better improvement in Hybrid group. Conclusion Hybrid surgery, combined dynamic stabilization system and fusion, can be effective surgical treatment for multilevel degenerative lumbosacral spinal disease, maintaining lumbar motion and delaying disc degeneration. PMID:26484008

  6. Metabolic syndrome and lumbar spine fusion surgery: epidemiology and perioperative outcomes

    PubMed Central

    Memtsoudis, Stavros G.; Kirksey, Meghan; Ma, Yan; Chiu, Ya Lin; Mazumdar, Madhu; Pumberger, Matthias; Girardi, Federico P.

    2011-01-01

    Study Design Analysis of the National Inpatient Sample database from 2000 to 2008. Objective To identify if metabolic syndrome is an independent risk factor for increased major perioperative complications, cost, length of stay and non-routine discharge. Summary of Background Data Metabolic syndrome is a combination of medical disorders that has been shown to increase the health risk of the general population. No study has analyzed its impact in the perioperative spine surgery setting. Methods We obtained the National Inpatient Sample from the Hospital Cost and Utilization Project for each year between 2000 and 2008. All patients undergoing primary posterior lumbar spine fusion were identified and separated into groups with and without metabolic syndrome. Patient demographics and health care system related parameters were compared. The outcomes of major complications, non-routine discharge, length of hospital stay and hospitalization charges were assessed for both groups. Regression analysis was performed to identify if the presence of metabolic syndrome was an independent risk factor for each outcome. Results An estimated 1,152,747 primary posterior lumbar spine fusion were performed between 2000 and 2008 in the US. The prevalence of metabolic syndrome as well as the comorbidities of the patients increased significantly over time. Patients with metabolic syndrome had significantly longer length of stay, higher hospital charges, higher rates of non-routine discharges and increased rates of major life-threatening complications compared to patients without metabolic syndrome. Conclusion Patients with metabolic syndrome undergoing primary posterior lumbar spinal fusion represent an increasing financial burden on the health care system. Clinicians should recognize that metabolic syndrome represents a risk factor for increased perioperative morbidity. PMID:22024892

  7. [Thoracic actinomycosis: three cases].

    PubMed

    Herrak, L; Msougar, Y; Ouadnouni, Y; Bouchikh, M; Benosmane, A

    2007-09-01

    Actinomycosis is a rare condition which, in the thoracic localisation, can mimic cancer or tuberculosis. We report a series of three case of thoracic actinomycosis treated in the Ibn Sina University Thoracic Surgery Unit in Rabat, Morocco. CASE N degrees 1: This 45-year-old patient presented a tumefaction on the left anterior aspect of the chest. Physical examination identified a parietal mass with fistulisation to the skin. Radiography demonstrated a left pulmonary mass. Transparietal puncture led to the pathological diagnosis of actinomycosis. The patient was given medical treatment and improved clinically and radiographically. CASE N degrees 2: This 68-year-old patient presented repeated episodes of hemoptysis. The chest x-ray revealed atelectasia of the middle lobe and bronchial fibroscopy demonstrated the presence of a bud in the middle lobar bronchus. Biopsies were negative. The patient underwent surgery and the histology examination of the operative specimen revealed pulmonary actinomycosis. The patient recovered well clinically and radiographically with antibiotic therapy. CASE N degrees 3: This 56-year-old patient presented cough and hemoptysis. Physical examination revealed a left condensation and destruction of the left lung was noted on the chest x-ray. Left pleuropulmonectomy was performed. Histological analysis of the surgical specimen identified associated Aspergillus and Actinomyces. The outcome was favorable with medical treatment. The purpose of this work was to recall the radiological, clinical, histological, therapeutic, outcome aspects of this condition and to relate the problems of differential diagnosis when can suggest other diseases. PMID:17978739

  8. Thoracic aortic aneurysm and dissection.

    PubMed

    Goldfinger, Judith Z; Halperin, Jonathan L; Marin, Michael L; Stewart, Allan S; Eagle, Kim A; Fuster, Valentin

    2014-10-21

    Aortic dissection is the most devastating complication of thoracic aortic disease. In the more than 250 years since thoracic aortic dissection was first described, much has been learned about diseases of the thoracic aorta. In this review, we describe normal thoracic aortic size; risk factors for dissection, including genetic and inflammatory conditions; the underpinnings of genetic diseases associated with aneurysm and dissection, including Marfan syndrome and the role of transforming growth factor beta signaling; data on the role for medical therapies in aneurysmal disease, including beta-blockers, angiotensin receptor blockers, and angiotensin-converting enzyme inhibitors; prophylactic surgery for aneurysm; surgical techniques for the aortic root; and surgical and endovascular management of aneurysm and dissection for different aortic segments. PMID:25323262

  9. Vasculopathy, Ischemia, and the Lateral Lumbar Interbody Fusion Surgery: Report of Three Cases.

    PubMed

    Allison, David W; Allen, Richard T; Kohanchi, David D; Skousen, Collin B; Lee, Yu-Po; Gertsch, Jeffrey H

    2015-12-01

    Multi-modal neurophysiologic monitoring consisting of triggered and spontaneous electromyography and transcranial motor-evoked potentials may detect and prevent both acute and slow developing mechanical and vascular nerve injuries in lateral lumbar interbody fusion (LLIF) surgery. In case report 1, a marked reduction in the transcranial motor-evoked potentials on the operative side alerted to a 28% decrease in mean arterial blood pressure in a 54-year-old woman during an L3-4, L4-5 LLIF. After hemodynamic stability was regained, transcranial motor-evoked potentials returned to baseline and the patient suffered no postoperative complications. In case report 2, a peroneal nerve train-of-four stimulation threshold of 95 mA portended the potential for a triggered electromyography false negative in a 70-year-old woman with type 2 diabetes, peripheral neuropathy, and body mass index of 30.7 kg/m undergoing an L3-4, L4-5 LLIF. Higher triggered electromyography threshold values were applied to this patient's relatively quiescent triggered electromyography and the patient suffered no postoperative complications. In case report 3, the loss of right quadriceps motor-evoked potentials detected a retractor related nerve injury in a 59-year-old man undergoing an L4-5 LLIF. The surgery was aborted, but the patient suffered persistent postoperative right leg paresthesia and weakness. These reports highlight the sensitivity of peripheral nerve elements to ischemia (particularly in the presence of vascular risk factors) during the LLIF procedure and the need for dynamic multi-modal intraoperative monitoring. PMID:26629762

  10. More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: In the lumbar spine, do more nerve root injuries occur utilizing minimally invasive surgery (MIS) techniques versus open lumbar procedures? To answer this question, we compared the frequency of nerve root injuries for multiple open versus MIS operations including diskectomy, laminectomy with/without fusion addressing degenerative disc disease, stenosis, and/or degenerative spondylolisthesis. Methods: Several of Desai et al. large Spine Patient Outcomes Research Trial studies showed the frequency for nerve root injury following an open diskectomy ranged from 0.13% to 0.25%, for open laminectomy/stenosis with/without fusion it was 0%, and for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion it was 2%. Results: Alternatively, one study compared the incidence of root injuries utilizing MIS transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) techniques; 7.8% of PLIF versus 2% of TLIF patients sustained root injuries. Furthermore, even higher frequencies of radiculitis and nerve root injuries occurred during anterior lumbar interbody fusions (ALIFs) versus extreme lateral interbody fusions (XLIFs). These high frequencies were far from acceptable; 15.8% following ALIF experienced postoperative radiculitis, while 23.8% undergoing XLIF sustained root/plexus deficits. Conclusions: This review indicates that MIS (TLIF/PLIF/ALIF/XLIF) lumbar surgery resulted in a higher incidence of root injuries, radiculitis, or plexopathy versus open lumbar surgical techniques. Furthermore, even a cursory look at the XLIF data demonstrated the greater danger posed to neural tissue by this newest addition to the MIS lumbar surgical armamentariu. The latter should prompt us as spine surgeons to question why the XLIF procedure is still being offered to our patients? PMID:26904372

  11. Thoracic textilomas: CT findings*

    PubMed Central

    Machado, Dianne Melo; Zanetti, Gláucia; Araujo, Cesar Augusto; Nobre, Luiz Felipe; Meirelles, Gustavo de Souza Portes; Pereira e Silva, Jorge Luiz; Guimarães, Marcos Duarte; Escuissato, Dante Luiz; Souza, Arthur Soares; Hochhegger, Bruno; Marchiori, Edson

    2014-01-01

    OBJECTIVE: The aim of this study was to analyze chest CT scans of patients with thoracic textiloma. METHODS: This was a retrospective study of 16 patients (11 men and 5 women) with surgically confirmed thoracic textiloma. The chest CT scans of those patients were evaluated by two independent observers, and discordant results were resolved by consensus. RESULTS: The majority (62.5%) of the textilomas were caused by previous heart surgery. The most common symptoms were chest pain (in 68.75%) and cough (in 56.25%). In all cases, the main tomographic finding was a mass with regular contours and borders that were well-defined or partially defined. Half of the textilomas occurred in the right hemithorax and half occurred in the left. The majority (56.25%) were located in the lower third of the lung. The diameter of the mass was ≤ 10 cm in 10 cases (62.5%) and > 10 cm in the remaining 6 cases (37.5%). Most (81.25%) of the textilomas were heterogeneous in density, with signs of calcification, gas, radiopaque marker, or sponge-like material. Peripheral expansion of the mass was observed in 12 (92.3%) of the 13 patients in whom a contrast agent was used. Intraoperatively, pleural involvement was observed in 14 cases (87.5%) and pericardial involvement was observed in 2 (12.5%). CONCLUSIONS: It is important to recognize the main tomographic aspects of thoracic textilomas in order to include this possibility in the differential diagnosis of chest pain and cough in patients with a history of heart or thoracic surgery, thus promoting the early identification and treatment of this postoperative complication. PMID:25410842

  12. Uniportal video-assisted thoracic (VATS) lobectomy

    PubMed Central

    2016-01-01

    Uniportal video assisted thoracic surgery (VATS) has become one of the most exciting new developments in minimally invasive thoracic surgery in recent years. While the debate over its purported advantages continues, this chapter instead focuses on the technical aspects of performing a lobectomy via the uniportal approach. Using clear medical illustrations to show how each step is performed, the key tips and tricks are laid out for the beginner hoping to learn the technique. PMID:27134841

  13. Long-Term Objective Physical Activity Measurements using a Wireless Accelerometer Following Minimally Invasive Transforaminal Interbody Fusion Surgery

    PubMed Central

    Mobbs, Ralph J.

    2016-01-01

    We report on a case of a patient who underwent minimally invasive transforaminal lumbar interbody fusion (mi-TLIF) with objective physical activity measurements performed preoperatively and postoperatively at up to 12-months using wireless accelerometer technology. In the first postoperative month following surgery, the patient had reduced mobility, taking 2,397 steps over a distance of 1.8 km per day. However, the number of steps taken and distance travelled per day had returned to baseline levels by the second postoperative month. At one-year follow-up, the patient averaged 5,095 steps per day in the month over a distance of 3.8 km; this was a 60% improvement in both steps taken and distance travelled compared to the preoperative status. The use of wireless accelerometers is feasible in obtaining objective physical activity measurements before and after lumbar interbody fusion and may be applicable to other related spinal surgeries as well. PMID:27114781

  14. Non-intubated anesthesia in thoracic surgery—technical issues

    PubMed Central

    2015-01-01

    Performing awake thoracic surgery (ATS) is technically more challenging than thoracic surgery under general anesthesia (GA), but it can result in a greater benefit for the patient. Local wound infiltration and lidocaine administration in the pleural space can be considered for ATS. More invasive techniques are local wound infiltration with wound catheter insertion, thoracic wall blocks, selective intercostal nerve blockade, thoracic paravertebral blockade and thoracic epidural analgesia, offering the advantage of a catheter placement which can also be continued for postoperative analgesia. PMID:26046050

  15. Evaluation of the stress distribution change at the adjacent facet joints after lumbar fusion surgery: a biomechanical study.

    PubMed

    Ma, Jianxiong; Jia, Haobo; Ma, Xinlong; Xu, Weiguo; Yu, Jingtao; Feng, Rui; Wang, Jie; Xing, Dan; Wang, Ying; Zhu, Shaowen; Yang, Yang; Chen, Yang; Ma, Baoyi

    2014-07-01

    Spinal fusion surgery has been widely applied in clinical treatment, and the spinal fusion rate has improved markedly. However, its postoperative complications, especially adjacent segment degeneration, have increasingly attracted the attention of spinal surgeons. The most common pathological condition at adjacent segments is hypertrophic degenerative arthritis of the facet joint. To study the stress distribution changes at the adjacent facet joint after lumbar fusion with pedicle screw fixation, human cadaver lumbar spines were used in the present study, and electrical resistance strain gauges were attached on L1-L4 articular processes parallel or perpendicular to the articular surface of facet joints. Subsequently, electrical resistance strain gauge data were measured using anYJ-33 static resistance strain indicator with three types of models: the intact model, the laminectomy model, and the fusion model with pedicle screw fixation. The strain changes in the measurement sites indirectly reflect the stress changes. Significant differences in strain were observed between the normal and laminectomy state at all facet joints. Significant differences in strain were observed between the normal and the pedicle screw fixation fusion state at the L1/2 and L3/4 facet joints. The increased stress on the facet joints after lumbar fusion with pedicle screw fixation may be the cause of adjacent segment degeneration. PMID:24963037

  16. Early and late outcomes after isolated aortic valve replacement in octogenarians: an Australasian Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database Study

    PubMed Central

    Saxena, Akshat; Poh, Chin-Leng; Dinh, Diem T.; Reid, Christopher M.; Smith, Julian A.; Shardey, Gilbert C.; Newcomb, Andrew E.

    2012-01-01

    OBJECTIVE The advent of percutaneous aortic valve implantation has increased interest in the outcomes of conventional aortic valve replacement in elderly patients. The current study critically evaluates the short-term and long-term outcomes of elderly (≥80 years) Australian patients undergoing isolated aortic valve replacement. METHODS Data obtained prospectively between June 2001 and December 2009 by the Australasian Society of Cardiac and Thoracic Surgeons National Cardiac Surgery Database Program were retrospectively analysed. Isolated aortic valve replacement was performed in 2791 patients; of these, 531 (19%) were at least 80 years old (group 1). The patient characteristics, morbidity and short-term mortality of these patients were compared with those of patients who were <80 years old (group 2). The long-term outcomes in elderly patients were compared with the age-adjusted Australian population. RESULTS Group 1 patients were more likely to be female (58.6% vs 38.0%, p < 0.001) and presented more often with co-morbidities including hypertension, cerebrovascular disease and peripheral vascular disease (all p < 0.05). The 30-day mortality rate was not independently higher in group 1 patients (4.0% vs 2.0%, p = 0.144). Group 1 patients had an independently increased risk of complications including new renal failure (11.7% vs 4.2%, p < 0.001), prolonged (≥24 h) ventilation (12.4% vs 7.2%, p = 0.003), gastrointestinal complications (3.0% vs 1.3%, p = 0.012) and had a longer mean length of intensive care unit stay (64 h vs 47 h, p < 0.001). The 5-year survival post-aortic valve replacement was 72%, which is comparable to that of the age-matched Australian population. CONCLUSION Conventional aortic valve replacement in elderly patients achieves excellent outcomes with long-term survival comparable to that of an age-adjusted Australian population. In an era of percutaneous aortic valve implantation, it should still be regarded as the gold standard in the management of aortic stenosis. PMID:21601470

  17. Linking the Congenital Heart Surgery Databases of the Society of Thoracic Surgeons and the Congenital Heart Surgeons’ Society: Part 1—Rationale and Methodology

    PubMed Central

    Jacobs, Jeffrey P.; Pasquali, Sara K.; Austin, Erle; Gaynor, J. William; Backer, Carl; Hirsch-Romano, Jennifer C.; Williams, William G.; Caldarone, Christopher A.; McCrindle, Brian W.; Graham, Karen E.; Dokholyan, Rachel S.; Shook, Gregory J.; Poteat, Jennifer; Baxi, Maulik V.; Karamlou, Tara; Blackstone, Eugene H.; Mavroudis, Constantine; Mayer, John E.; Jonas, Richard A.; Jacobs, Marshall L.

    2014-01-01

    Purpose The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) is the largest Registry in the world of patients who have undergone congenital and pediatric cardiac surgical operations. The Congenital Heart Surgeons’ Society Database (CHSS-D) is an Academic Database designed for specialized detailed analyses of specific congenital cardiac malformations and related treatment strategies. The goal of this project was to create a link between the STS-CHSD and the CHSS-D in order to facilitate studies not possible using either individual database alone and to help identify patients who are potentially eligible for enrollment in CHSS studies. Methods Centers were classified on the basis of participation in the STS-CHSD, the CHSS-D, or both. Five matrices, based on CHSS inclusionary criteria and STS-CHSD codes, were created to facilitate the automated identification of patients in the STS-CHSD who meet eligibility criteria for the five active CHSS studies. The matrices were evaluated with a manual adjudication process and were iteratively refined. The sensitivity and specificity of the original matrices and the refined matrices were assessed. Results In January 2012, a total of 100 centers participated in the STS-CHSD and 74 centers participated in the CHSS. A total of 70 centers participate in both and 40 of these 70 agreed to participate in this linkage project. The manual adjudication process and the refinement of the matrices resulted in an increase in the sensitivity of the matrices from 93% to 100% and an increase in the specificity of the matrices from 94% to 98%. Conclusion Matrices were created to facilitate the automated identification of patients potentially eligible for the five active CHSS studies using the STS-CHSD. These matrices have a sensitivity of 100% and a specificity of 98%. In addition to facilitating identification of patients potentially eligible for enrollment in CHSS studies, these matrices will allow (1) estimation of the denominator of patients potentially eligible for CHSS studies and (2) comparison of eligible and enrolled patients to potentially eligible and not enrolled patients to assess the generalizability of CHSS studies. PMID:24668974

  18. Hospital and Surgeon Variation in Complications and Repeat Surgery Following Incident Lumbar Fusion for Common Degenerative Diagnoses

    PubMed Central

    Martin, Brook I; Mirza, Sohail K; Franklin, Gary M; Lurie, Jon D; MacKenzie, Todd A; Deyo, Richard A

    2013-01-01

    Objective To identify factors that account for variation in complication rates across hospitals and surgeons performing lumbar spinal fusion surgery. Data Sources Discharge registry including all nonfederal hospitals in Washington State from 2004 to 2007. Study Design We identified adults (n = 6,091) undergoing an initial inpatient lumbar fusion for degenerative conditions. We identified whether each patient had a subsequent complication within 90 days. Logistic regression models with hospital and surgeon random effects were used to examine complications, controlling for patient characteristics and comorbidity. Principal Findings Complications within 90 days of a fusion occurred in 4.8 percent of patients, and 2.2 percent had a reoperation. Hospital effects accounted for 8.8 percent of the total variability, and surgeon effects account for 14.4 percent. Surgeon factors account for 54.5 percent of the variation in hospital reoperation rates, and 47.2 percent of the variation in hospital complication rates. The discretionary use of operative features, such as the inclusion of bone morphogenetic proteins, accounted for 30 and 50 percent of the variation in surgeons' reoperation and complication rates, respectively. Conclusions To improve the safety of lumbar spinal fusion surgery, quality improvement efforts that focus on surgeons' discretionary use of operative techniques may be more effective than those that target hospitals. PMID:22716168

  19. The Significance of Removing Ruptured Intervertebral Discs for Interbody Fusion in Treating Thoracic or Lumbar Type B and C Spinal Injuries through a One-Stage Posterior Approach

    PubMed Central

    Zhang, Qian-Shi; Lü, Guo-Hua; Wang, Xiao-Bin; Li, Jing

    2014-01-01

    Objectives To identify the negative effect on treatment results of reserving damaged intervertebral discs when treating type B and type C spinal fracture-dislocations through a one-stage posterior approach. Methods This is a retrospective review of 53 consecutive patients who were treated in our spine surgery center from January 2005 to May 2012 due to severe thoracolumbar spinal fracture-dislocation. The patients in Group A (24 patients) underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression. In Group B (29 patients), the patients underwent long-segment instrumentation laminectomy with pedicle screw-rod fixators for neural decompression evacuating of the ruptured disc and inserting of a bone graft into the evacuated disc space for interbody fusion. The mean time between injury and operation was 4.1 days (range 2–15 days). The clinical, radiologic and complication outcomes were analyzed retrospectively. Results Periodic follow-ups were carried out until an affirmative union or treatment failure took place. A progressive kyphosis angle larger than 10°, loss of disc height, pseudoarthrosis, recurrence of dislocation or subluxation, or instrument failure before fusion were considered treatment failures. Treatment failures were detected in 13 cases in Group A (failure rate was 54.2%). In Group B, there were 28 cases in which definitive bone fusion was demonstrated on CT scans, and CT scans of the other cases demonstrated undefined pseudoarthrosis without hardware failure. There were statistically significant differences between the two groups (p<0.001 chi-square test). The neurologic recoveries, assessed by the ASIA scoring system, were not satisfactory for the neural deficit patients in either group, indicating there was no significant difference with regard to neurologic recovery between the two groups (p>0.05 Fisher's exact test). Conclusion Intervertebral disc damage is a common characteristic in type B and C spinal fracture-dislocation injuries. The damaged intervertebral disc should be removed and substituted with a bone graft because reserving the damaged disc in situ increases the risk of treatment failure. PMID:24827733

  20. Deformable registration of the inflated and deflated lung in cone-beam CT-guided thoracic surgery: Initial investigation of a combined model- and image-driven approach

    PubMed Central

    Uneri, Ali; Nithiananthan, Sajendra; Schafer, Sebastian; Otake, Yoshito; Stayman, J. Webster; Kleinszig, Gerhard; Sussman, Marc S.; Prince, Jerry L.; Siewerdsen, Jeffrey H.

    2013-01-01

    Purpose: Surgical resection is the preferred modality for curative treatment of early stage lung cancer, but localization of small tumors (<10 mm diameter) during surgery presents a major challenge that is likely to increase as more early-stage disease is detected incidentally and in low-dose CT screening. To overcome the difficulty of manual localization (fingers inserted through intercostal ports) and the cost, logistics, and morbidity of preoperative tagging (coil or dye placement under CT-fluoroscopy), the authors propose the use of intraoperative cone-beam CT (CBCT) and deformable image registration to guide targeting of small tumors in video-assisted thoracic surgery (VATS). A novel algorithm is reported for registration of the lung from its inflated state (prior to pleural breach) to the deflated state (during resection) to localize surgical targets and adjacent critical anatomy. Methods: The registration approach geometrically resolves images of the inflated and deflated lung using a coarse model-driven stage followed by a finer image-driven stage. The model-driven stage uses image features derived from the lung surfaces and airways: triangular surface meshes are morphed to capture bulk motion; concurrently, the airways generate graph structures from which corresponding nodes are identified. Interpolation of the sparse motion fields computed from the bounding surface and interior airways provides a 3D motion field that coarsely registers the lung and initializes the subsequent image-driven stage. The image-driven stage employs an intensity-corrected, symmetric form of the Demons method. The algorithm was validated over 12 datasets, obtained from porcine specimen experiments emulating CBCT-guided VATS. Geometric accuracy was quantified in terms of target registration error (TRE) in anatomical targets throughout the lung, and normalized cross-correlation. Variations of the algorithm were investigated to study the behavior of the model- and image-driven stages by modifying individual algorithmic steps and examining the effect in comparison to the nominal process. Results: The combined model- and image-driven registration process demonstrated accuracy consistent with the requirements of minimally invasive VATS in both target localization (∼3–5 mm within the target wedge) and critical structure avoidance (∼1–2 mm). The model-driven stage initialized the registration to within a median TRE of 1.9 mm (95% confidence interval (CI) maximum = 5.0 mm), while the subsequent image-driven stage yielded higher accuracy localization with 0.6 mm median TRE (95% CI maximum = 4.1 mm). The variations assessing the individual algorithmic steps elucidated the role of each step and in some cases identified opportunities for further simplification and improvement in computational speed. Conclusions: The initial studies show the proposed registration method to successfully register CBCT images of the inflated and deflated lung. Accuracy appears sufficient to localize the target and adjacent critical anatomy within ∼1–2 mm and guide localization under conditions in which the target cannot be discerned directly in CBCT (e.g., subtle, nonsolid tumors). The ability to directly localize tumors in the operating room could provide a valuable addition to the VATS arsenal, obviate the cost, logistics, and morbidity of preoperative tagging, and improve patient safety. Future work includes in vivo testing, optimization of workflow, and integration with a CBCT image guidance system. PMID:23298134

  1. Computer-Aided Surgery Does Not Increase the Accuracy of Dorsal Pedicle Screw Placement in the Thoracic and Lumbar Spine: A Retrospective Analysis of 2,003 Pedicle Screws in a Level I Trauma Center

    PubMed Central

    Kraus, Michael; Weiskopf, Julia; Dreyhaupt, Jens; Krischak, Gert; Gebhard, Florian

    2014-01-01

    Study Design A retrospective analysis of a prospective database. Objective Meta-analyses suggest that computer-assisted systems can increase the accuracy of pedicle screw placement for dorsal spinal fusion procedures. The results of further meta-analyses report that in the thoracic spine, both the methods have comparable placement accuracy. These studies are limited due to an abundance of screw classification systems. The aim of this study was to assess the placement accuracy and potentially influencing factors of three-dimensionally navigated versus conventionally inserted pedicle screws. Methods This was a retrospective analysis of a prospective database at a level I trauma center of pedicle screw placement (computer-navigated versus traditionally placed) for dorsal spinal stabilizations. The cases spanned a 5.5-year study period (January 1, 2005, to June 30, 2010). The perforations of the pedicle were differentiated in three grades based on the postoperative computed tomography. Results The overall placement accuracy was 86% in the conventional group versus 79% in the computer-navigated group (grade 0). The computer-navigated procedures were superior in the lumbar spine and the conventional procedures were superior in the thoracic spine, but both failed to be of statistical significance. The level of experience of the performing surgeon and the patient's body mass index did not influence the placement accuracy. The only significant influence was the spinal segment: the higher the spinal level where the fusion was performed, the more likely the screw was displaced. Conclusions The computer-navigated and conventional methods are both safe procedures to place transpedicular screws at the traumatized thoracic and lumbar spine. At the moment, three-dimensionally based navigation does not significantly increase the placement accuracy. PMID:25844281

  2. Delayed Presentation of Aortic Injury by a Thoracic Pedicle Screw.

    PubMed

    Sevuk, Utkan; Mesut, Abdullah; Kiraz, Ilker; Kose, Kaan; Ayaz, Firat; Erkul, Aylin

    2016-04-01

    Delayed presentation of a thoracic aortic injury is an extremely rare complication after spine surgery. We report a case of delayed presentation of a thoracic aortic injury with a vertebral pedicle screw after posterior spinal surgery without periaortic hematoma, hemorrhage or pseudoaneurysm formation and review the relevant literature. doi: 10.1111/jocs.12718 (J Card Surg 2016;31:220-230). PMID:26864154

  3. In patients undergoing video-assisted thoracic surgery for pleurodesis in primary spontaneous pneumothorax, how long should chest drains remain in place prior to safe removal and subsequent discharge from hospital?

    PubMed Central

    Dearden, Alexander S.; Sammon, Peter M.; Matthew, Eleanor F.

    2013-01-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was how long chest drains should be left in place following video-assisted thoracic surgery (VATS) pleurodesis for primary spontaneous pneumothorax. Altogether, a total of 730 papers were found using the reported search, of which eight represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We report that the main determining factor for the length of hospital stay following VATS pleurodesis is chest-drain duration. Providing no postoperative complications occur, and chest X-ray appearances of lung inflation are satisfactory, there is no documented contraindication to removing chest drains as early as 2 days postoperatively, with discharge the following day. Furthermore, leaving chest drains on water seal after a brief period of suction has been shown to benefit in reducing postoperative chest-drain duration and subsequent hospital stay. There is a paucity of literature directly addressing early vs late chest-drain removal protocols in this patient group. Hence, we conclude that, in clinical practice, the decision of when to remove chest drains postoperatively should remain guided empirically towards the individual patient. PMID:23403769

  4. Risk of Cancer After Lumbar Fusion Surgery With Recombinant Human Bone Morphogenic Protein-2 (rh-BMP-2)

    PubMed Central

    Cooper, Gregory S.; Kou, Tzuyung Doug

    2013-01-01

    Study Design. Retrospective cohort study among Medicare beneficiaries with lumbar spinal fusion surgery. Objective. To determine the risk of subsequent cancer among patients who received recombinant human bone morphogenic protein (rhBMP) at surgery compared with those who did not. Summary of Background Data. rhBMP is commonly used to promote bone union after spinal surgery. BMP receptors are present on multiple cancer types, but the risk of cancer after receiving rhBMP has not been well studied. Methods. We identified 146,278 subjects aged 67 years and older who underwent surgery in 2003 to 2008 and were followed through 2010 for a new diagnosis of 1 of 26 cancers. Proportional hazards models were used to determine cancer risk associated with rhBMP use. Results. rhBMP was administered in 15.1% of the cohort. After an overall average follow-up of 4.7 years, 15.4% of rhBMP-treated and 17.0% of untreated patients had a new cancer diagnosis, with most commonly recorded types as prostate, breast, lung, and colorectal. In a multivariate proportional hazards model, there was no association of rhBMP with cancer risk (hazard ratio: 0.99, 95% confidence interval: 0.95–1.02). There was also no association of rhBMP with the risk of any individual cancer types. The results were consistent in analyses using 2 secondary definitions of incident cancer. Conclusion. In this large population-based analysis of Medicare beneficiaries, we found no evidence that administration of rhBMP at the time of lumbar fusion surgery was associated with cancer risk. Level of Evidence: 4 PMID:23883824

  5. Ponte osteotomies in thoracic deformities.

    PubMed

    Pérez-Grueso, F Sánchez; Cecchinato, Riccardo; Berjano, Pedro

    2015-01-01

    Thoracic hyperkyphosis is a sagittal deformity that can cause back pain and neurological impairment, leading to difficulties in maintaining a straight gaze. Sagittal thoracic malalignment has different etiologies and different corrective strategies. An adequate preoperative planning is mandatory to address correctly the surgical treatment, using an appropriate sagittal deformities classification and the rules that relate pelvic parameters to spine curvatures to determine the correction needed to restore a good sagittal alignment. Ponte osteotomies are performed in long non-angular hyperkyphotic thoracic deformities, even if idiopathic scoliosis, rigid deformities or proximal junctional kyphosis after instrumented fusions can benefit from the application of this technique that requires a mobile anterior column for the correction of the deformity. Ponte's is, together with Smith-Petersen osteotomy, a posterior column osteotomy. The magnitude of correction can reach 10° per level if intervertebral discs are still mobile. PMID:25351838

  6. Thoracic aortic aneurysm

    MedlinePlus

    Aortic aneurysm - thoracic; Syphilitic aneurysm; Aneurysm - thoracic aortic ... The most common cause of a thoracic aortic aneurysm is hardening of the ... with high cholesterol, long-term high blood pressure, or who ...

  7. Fusion

    NASA Astrophysics Data System (ADS)

    Herman, Robin

    1991-06-01

    Acknowledgments; 1. The invention of Dr Spitzer; 2. Behind closed doors; 3. Friends and rivals; 4. Searching for answers; 5. Dawn of the tokamak; 6. Building big science; 7. Forming the major league; 8. The political plasma; 9. The modern fusion lab; 10. The plasma olympics; 11. Different directions; 12. Struggling to sell fusion; 13. In sight of breakeven; 14. Fusion's past and future; Notes; Glossary; Appendices; Index.

  8. Fusion

    NASA Astrophysics Data System (ADS)

    Herman, Robin

    2006-03-01

    Acknowledgments; 1. The invention of Dr Spitzer; 2. Behind closed doors; 3. Friends and rivals; 4. Searching for answers; 5. Dawn of the tokamak; 6. Building big science; 7. Forming the major league; 8. The political plasma; 9. The modern fusion lab; 10. The plasma olympics; 11. Different directions; 12. Struggling to sell fusion; 13. In sight of breakeven; 14. Fusion's past and future; Notes; Glossary; Appendices; Index.

  9. Paediatric spinal fusion surgery and the transition to home-based care: provider expectations and carer experiences.

    PubMed

    Barnard, Juliana G; Albright, Karen; Morrato, Elaine H; Nowels, Carolyn T; Benefield, Elise M; Hadley-Miller, Nancy A; Kempe, Allison; Erickson, Mark A

    2013-11-01

    There are more than 12 million children with special healthcare needs (CSHCNs) in the United States, many of whom require specialised health-care to treat chronic physical and developmental conditions. This study is a qualitative investigation of programme, surgical and at-home recovery experiences among CSHCNs and their family carers who participated in a spine surgical care programme at a paediatric hospital in the Western United States. The programme is designed to manage increased surgical risk and the transition of care from hospital to home for children with severe scoliosis undergoing spinal fusion surgery. We conducted 30 semi-structured in-depth interviews with 14 surgical team members and 16 family carers of children who had programme evaluations and spinal surgeries in 2006. Data were collected in 2008 and 2009 in hospital or at home locations to gather programme participation feedback from families and inform the adequacy of programme support to families during at-home recovery. Data were analysed by reflexive team and content analysis methodologies. Results showed the programme was effective at improving preoperative surgical evaluation and helping families to anticipate some aspects of the surgical experience and hospital discharge. However, the impact of spinal fusion surgery and the subsequent transition to home-based care was profoundly emotional for patients and their carers. Our data indicate that programme providers underestimated the extent of emotional trauma experienced by patients and families, particularly during the at-home recovery process. The data also suggest meaningful differences in providers' and carers' expectations for surgery. Carers' disappointment with their recovery experiences and the perceived lack of post-discharge support impacted their interpretations of and perspectives on their surgical experience. Implications of this research for surgical care programmes include the need for assessment and provision of support for physical, social, and emotional burdens experienced by patients and carers at pre-surgical, surgical and at-home recovery phases. PMID:23647700

  10. Reflecting the thoracic fellowship in Canada as a Japanese thoracic surgeon: is there anything we should follow?

    PubMed

    Komatsu, Teruya

    2011-01-01

    In Japanese surgical society, there have been urgent discussions as to the decrease in the number of junior doctors who want to be surgical specialists. This problem seems to have originated from the loss of attractiveness of surgery. One of the counter-measures to regain the attractiveness of surgical specialties might be a well-organized training system, for which the Japanese Board of General Thoracic Surgery (JBGTS), as well as those of other surgical subspecialties, has struggled. Fortunately, I had an opportunity of general thoracic surgery training in Canada, and had a chance to reflect on the thoracic training programs of both countries. Based on my experience as a thoracic fellow in Canada, I would like to introduce the Canadian way of thoracic surgery training, referring to the differences between each program. PMID:21881316

  11. Comparison Between Posterior Short-segment Instrumentation Combined With Lateral-approach Interbody Fusion and Traditional Wide-open Anterior-Posterior Surgery for the Treatment of Thoracolumbar Fractures.

    PubMed

    Li, Xiang; Zhang, Junwei; Tang, Hehu; Lu, Zhen; Liu, Shujia; Chen, Shizheng; Hong, Yi

    2015-11-01

    The aim of the study was to compare the radiographic and clinical outcomes between posterior short-segment pedicle instrumentation combined with lateral-approach interbody fusion and traditional anterior-posterior (AP) surgery for the treatment of thoracolumbar fractures.Lateral-approach interbody fusion has achieved satisfactory results for thoracic and lumbar degenerative disease. However, few studies have focused on the use of this technique for the treatment of thoracolumbar fractures.Inclusion and exclusion criteria were established. All patients who meet the above criteria were prospectively treated by posterior short-segment instrumentation and secondary-staged minimally invasive lateral-approach interbody fusion, and classified as group A. A historical group of patients who were treated by traditional wide-open AP approach was used as a control group and classified as group B. The radiological and clinical outcomes were compared between the 2 groups.There were 12 patients in group A and 18 patients in group B. The mean operative time and intraoperative blood loss of anterior reconstruction were significantly higher in group B than those in group A (127.1 ± 21.7 vs 197.5 ± 47.7 min, P < 0.01; 185.8 ± 62.3 vs 495 ± 347.4 mL, P < 0.01). Two of the 12 (16.7%) patients in group A experienced 2 surgical complications: 1 (8.3%) major and 1 (8.3%) minor. Six of the 18 (33%) patients in group B experienced 9 surgical complications: 3 (16.7%) major and 6 (33.3%) minor. There was no significant difference between the 2 groups regarding loss of correction (4.3 ± 2.1 vs 4.2 ± 2.4, P = 0.89) and neurological function at final follow-up (P = 0.77). In both groups, no case of instrumentation failure, pseudarthrosis, or nonunion was noted.Compared with the wide-open AP surgery, posterior short-segment pedicle instrumentation, combined with minimally invasive lateral-approach interbody fusion, can achieve similar clinical results with significant less operative time, blood loss, and surgical complication. This procedure seems to be a reasonable treatment option for selective patients with thoracolumbar fractures. PMID:26554800

  12. Single-stage posterior-only approach treating single-segment thoracic tubercular spondylitis

    PubMed Central

    Shen, Xiongjie; Liu, Hongzhe; Wang, Guoping; Liu, Xiangyang

    2015-01-01

    There are quite a few controversies on surgical management of single-segment thoracic spinal tuberculosis (STB) with neurological deficits. The present study was to compare single-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation (posterior-only surgery) with a combined posterior-anterior surgical approach for treatment of single-segment thoracic STB with neurological deficits and to determinethe clinical feasibility and effectiveness of posterior-only surgical treatment. Sixty patients with single-segment thoracic STB with neurological deficits were treated with one of two surgical procedures in our center from January 2003 to January 2013. Thirty patients were treated with posterior-only surgery (Group A) andthirty were treated with combined posterior-anterior surgery (Group B). The American Spinal Injury Association (ASIA) score system to evaluate the neurological deficits, thevisual analogue scale (VAS) to assess the degree of pain, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) to judge the activity of tuberculosis (TB), surgery duration, intraoperative blood loss, length of hospitalization, bonyfusion rates, and kyphosis correction of the two groups were compared. The average follow-up period was 36.5 ± 9.2 months for Group A and 34.6 ± 10.2 months for Group B. Under the ASIA score system, all patients improved with treatment. STB was completely cured and grafted bones were fused within 5-11 months in allpatients. There were no persistent or recurrent infections orobvious differences in radiological results between thegroups. The kyphosis deformity was significantly corrected after surgical management. The average operative duration, blood loss, length of hospital stay, and postoperative complication rateof Group A were lower than those of Group B. In conclusions, posterior-only surgery is feasible and effective, resulting in better clinical outcomes than combined posterior-anterior surgeries, especially in surgical time, blood loss, hospital stay, and complications. PMID:26617823

  13. Comparison of standard fusion with a "topping off" system in lumbar spine surgery: a protocol for a randomized controlled trial

    PubMed Central

    2011-01-01

    Background Fusion of lumbar spine segments is a well-established therapy for many pathologies. The procedure changes the biomechanics of the spine. Initial clinical benefits may be outweighed by ensuing damage to the adjacent segments. Various surgical devices and techniques have been developed to prevent this deterioration. "Topping off" systems combine rigid fusion with a flexible pedicle screw system to prevent adjacent segment disease (ASD). To date, there is no convincing evidence that these devices provide any patient benefits. Methods/Design The study is designed as a randomized, therapy-controlled trial in a clinical care setting at a university hospital. Patients presenting to the outpatient clinic with degenerative disc disease or spondylolisthesis will be assessed against study inclusion and exclusion criteria. After randomization, the control group will undergo conventional fusion. The intervention group will undergo fusion with a supplemental flexible pedicle screw system to protect the adjacent segment ("topping off"). Follow-up examination will take place immediately after treatment during hospital stay, after 6 weeks, and then after 6, 12, 24 and 36 months. Subsequently, ongoing assessments will be performed annually. Outcome measurements will include quality of life and pain assessments using questionnaires (SF-36™, ODI, COMI). In addition, clinical and radiologic ASD, work-related disability, and duration of work disability will be assessed. Inpatient and 6-month mortality, surgery-related data (e.g., intraoperative complications, blood loss, length of incision, surgical duration), postoperative complications, adverse events, and serious adverse events will be documented and monitored throughout the study. Cost-effectiveness analysis will also be provided. Discussion New hybrid systems might improve the outcome of lumbar spine fusion. To date, there is no convincing published data on effectiveness or safety of these topping off systems. High quality data is required to evaluate the benefits and drawbacks of topping off devices. If only because these devices are quite expensive compared to conventional fusion implants, nonessential use should be avoided. In fact, these high costs necessitate efforts by health care providers to evaluate the effects of these implants. Randomized clinical trials are highly recommended to evaluate the benefits or harm to the patient. Trial Registration ClinicalTrials.gov: NCT01224379 PMID:22008088

  14. Mid-Thoracic Spinal Injuries during Horse Racing: Report of 3 Cases and Review of Causative Factors and Prevention Measurements.

    PubMed

    Triantafyllopoulos, Ioannis; Panagopoulos, Andreas; Sapkas, George

    2013-01-01

    We report three cases of a rare pattern of mid-thoracic spine injuries after horse racing falls and discuss possible causative factors and prevention measurements to reduce injury rates in professional riding and racing. Three patients, 2 male and 1 female with a mean age of 28 years old, underwent surgical treatment for mid-thoracic fractures after professional equestrian activities. The ASIA scale was E in one patient, B in the other one and A in the third. Multilevel posterior fusion was used in two patients and somatectomy plus fusion in the other. Follow up evaluation included changing of the ASIA scale, functional outcome and participation in equestrian activities. One patient fully recovered after surgery. Two patients remained paraplegic despite early surgical treatment and prolonged rehabilitation therapy. All patients had ended their professional equestrian career. This report analyzes possible mechanisms of injury and the pattern of mid-thoracic spine fractures after professional horse riding injuries. Despite skill improvements and continued safety education for horse riding, prophylactic measures for both the head and the spine should be refined. According to our study, additional mid-thoracic spinal protection should be added. PMID:23841001

  15. Injection of Bupivacaine into Disc Space to Detect Painful Nonunion after Anterior Lumbar Interbody Fusion (ALIF) Surgery in Patients with Discogenic Low Back Pain

    PubMed Central

    Kimura, Seiji; Orita, Sumihisa; Inoue, Gen; Eguchi, Yawara; Takaso, Masashi; Ochiai, Nobuyasu; Kuniyoshi, Kazuki; Aoki, Yasuchika; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Sakuma, Yoshihiro; Kubota, Gou; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Yamauchi, Kazuyo; Toyone, Tomoaki; Nakamura, Junichi; Kishida, Shunji; Sato, Jun; Takahashi, Kazuhisa

    2014-01-01

    Purpose Bupivacaine is commonly used for the treatment of back pain and the diagnosis of its origin. Nonunion is sometimes observed after spinal fusion surgery; however, whether the nonunion causes pain is controversial. In the current study, we aimed to detect painful nonunion by injecting bupivacaine into the disc space of patients with nonunion after anterior lumbar interbody fusion (ALIF) surgery for discogenic low back pain. Materials and Methods From 52 patients with low back pain, we selected 42 who showed disc degeneration at only one level (L4-L5 or L5-S1) on magnetic resonance imaging and were diagnosed by pain provocation on discography and pain relief by discoblock (the injection of bupivacaine). They underwent ALIF surgery. If the patients showed low back pain and nonunion 2 years after surgery, we injected bupivacaine into the nonunion disc space. Patients showing pain relief after injection of bupivacaine underwent additional posterior fixation using pedicle screws. These patients were followed up 2 years after the revision surgery. Results Of the 42 patient subjects, 7 showed nonunion. Four of them did not show low back pain; whereas 3 showed moderate or severe low back pain. These 3 patients showed pain reduction after injection of bupivacaine into their nonunion disc space and underwent additional posterior fixation. They showed bony union and pain relief 2 years after the revision surgery. Conclusion Injection of bupivacaine into the nonunion disc space after ALIF surgery for discogenic low back pain is useful for diagnosis of the origin of pain. PMID:24532522

  16. Fusion with the Cross-Gender Group Predicts Genital Sex Reassignment Surgery.

    PubMed

    Swann, William B; Gómez, Ángel; Vázquez, Alexandra; Guillamón, Antonio; Segovia, Santiago; Carrillo, Beatriz; Carillo, Beatriz

    2015-07-01

    Transsexuals vary in the sacrifices that they make while transitioning to their cross-gender group. We suggest that one influence on the sacrifices they make is identity fusion. When people fuse with a group, a visceral and irrevocable feeling of oneness with the group develops. The personal self (the sense of "I" and "me") remains potent and combines synergistically with the social self to motivate behavior. We hypothesized that transsexuals who felt fused with the cross-gender group would be especially willing to make sacrifices while transitioning to that group. Our sample included 22 male-to-female (MtF) and 16 female-to-male (FtM) transsexuals. Consistent with expectation, those who were fused with their cross-gender group (1) expressed more willingness to sacrifice close relationships in the process of changing sex than non-fused transsexuals and (2) actually underwent irreversible surgical change of their primary sexual characteristics (vaginoplasty for MtF transsexuals and hysterectomy for FtM transsexuals). These outcomes were not predicted by a measure of "group identification," which occurs when membership in the group eclipses the personal self (the "I" and "me" is subsumed by the group; in the extreme case, brainwashing occurs). These findings confirm and extend earlier evidence that identity fusion is uniquely effective in tapping a propensity to make substantial sacrifices for the group. We discuss identity fusion as a social psychological determinant of the choices of transsexuals. PMID:25666854

  17. Thoracic outlet syndrome

    MedlinePlus

    ... tingling of the fingers A weak grip The thoracic outlet is the area between the ribcage and collarbone. ... with the nerves cause almost all cases of thoracic outlet syndrome. ... the spine to the ribs. People with this syndrome often ...

  18. Hybrid surgery versus anterior cervical discectomy and fusion for multilevel cervical degenerative disc diseases: a meta-analysis

    PubMed Central

    Tian, Peng; Fu, Xin; Li, Zhi-Jun; Sun, Xiao-Lei; Ma, Xin-Long

    2015-01-01

    The objective of this meta-analysis is to compare hybrid surgery (HS) and cervical discectomy and fusion (ACDF) for multilevel cervical degenerative disc diseases (DDD). Systematic searches of all published studies through March 2015 were identified from Cochrane Library, Medline, PubMed, Embase, ScienceDirect, CNKI, WANFANG DATA and CQVIP. Randomized controlled trials (RCTs) and non-RCTs involving HS and ACDF for multilevel DDD were included. All literature was searched and assessed by two independent reviewers according to the standard of Cochrane systematic review. Data of functional and radiological outcomes in two groups were pooled, which was then analyzed by RevMan 5.2 software. One RCT and four non-RCTs encompassing 160 patients met the inclusion criteria. Meta-analysis revealed significant differences in blood loss (p = 0.005), postoperative C2–C7 ROM (p = 0.002), ROM of superior adjacent segment (p < 0.00001) and ROM of inferior adjacent segment (p = 0.0007) between the HS group and the ACDF group. No significant differences were found regarding operation time (p = 0.75), postoperative VAS (p = 0.18) and complications (p = 0.73) between the groups. Hybrid surgery demonstrated excellent clinical efficacy and radiological results. Postoperative C2–C7 ROM was closer to the physiological status. No decrease in the ROM of the adjacent segment was noted in the hybrid surgery group. PMID:26307360

  19. [Ineffectiveness of incentive spirometry as coadjuvant of conventional physiotherapy for the prevention of postoperative respiratory complications after thoracic and esophageal surgery].

    PubMed

    Vilaplana, J; Sabaté, A; Ramon, R; Gasolibe, V; Villalonga, R

    1990-01-01

    We have studied the efficacy of routine use of incentive spirometry (IS) in two groups of patients: group 1 (n = 18) with IS, and group 2 (n = 19), no IS. All patients suffered from lung or esophagus neoplasm and received respiratory physiotherapy before and after the operation. They underwent high chest and abdomen surgery. The incidence of alterations of pulmonary auscultation, roentgenologic abnormalities and alterations of the alveolar-arterial difference of oxygen (D[A-a]O2) as well as postoperative complications were similar in both groups. Patients undergoing digestive surgery presented a higher frequency of pleural effusion (p less than 0.05) and of them, the subgroup with IS stayed at the hospital for a longer time (47.2 +/- 32 days) than the subgroup undergoing digestive surgery not submitted to IS (p less than 0.01) probably because of the higher incidence of neoplasms of the mean third of the esophagus in such group. In our study and in the context of the type of surgery studied, the routine use of IS does not decrease the frequency of clinical and roentgenologic alterations neither improves the efficacy of postoperative gas interchange. PMID:2098873

  20. Thoracic Duct Embolization for Chylous Leaks

    PubMed Central

    Chen, Eric; Itkin, Maxim

    2011-01-01

    Chylous leaks, such as chylothorax and chylopericardium, are uncommon effusions resulting from the leakage of intestinal lymphatic fluid from the thoracic duct (TD) and its tributaries, or intestinal lymphatic ducts. The cause can be either traumatic (thoracic surgery) or nontraumatic (idiopathic, malignancy). Treatment has traditionally consisted of dietary modification (nonfat diet) and/or surgery (TD ligation, pleurodesis). Thoracic duct embolization (TDE) has become a viable treatment alternative due to it high success rate and minimal complications. In this article, the authors describe the etiologies of chylothorax, patient population, outcomes, and long-term follow-up of TDE patients. Relevant lymphatic anatomy and physiology are reviewed, with special attention paid to the formation of the duct by tributaries at the cisterna chyli (CC). The technique of TDE is outlined, including bilateral pedal lymphangiography, TD cannulation, and embolic agents used for the procedure. PMID:22379277

  1. Description and design considerations of a randomized clinical trial investigating the effect of a multidisciplinary cognitive-behavioural intervention for patients undergoing lumbar spinal fusion surgery

    PubMed Central

    2014-01-01

    Background The ideal rehabilitation strategy following lumbar spinal fusion surgery has not yet been established. This paper is a study protocol, describing the rationale behind and the details of a cognitive-behavioural rehabilitation intervention for lumbar spinal fusion patients based on the best available evidence. Predictors of poor outcome following spine surgery have been identified to provide targets for the intervention, and the components of the intervention were structured in accordance with the cognitive-behavioural model. The study aims to compare the clinical and economical effectiveness of a cognitive-behavioural rehabilitation strategy to that of usual care for patients undergoing lumbar spinal fusion surgery. Methods/Design The study is a randomized clinical trial including 96 patients scheduled for lumbar spinal fusion surgery due to degenerative disease or spondylolisthesis. Patients were recruited in the period October 2011 to July 2013, and the follow-up period is one year from date of surgery. Patients are allocated on a 1:2 ratio (control: intervention) to either treatment as usual (control group), which implies surgery and the standard postoperative rehabilitation, or in addition to this, a patient education focusing on pain behaviour and pain coping (intervention group). It takes place in a hospital setting, and consists of six group-based sessions, managed by a multidisciplinary team of health professionals. The primary outcomes are disability (Oswestry Disability Index) and sick leave, while secondary outcomes include coping (Coping Strategies Questionnaire), fear-avoidance belief (Fear Avoidance Belief Questionnaire), pain (Low Back Pain Rating Scale, pain index), mobility during hospitalization (Cumulated Ambulation Score), generic health-related quality of life (EQ-5D) and resource use. Outcomes are measured using self report questionnaires, medical records and national registers. Discussion It is expected that the intervention can provide better functional outcome, less pain and earlier return to work after lumbar spinal fusion surgery. By combining knowledge and evidence from different knowledge areas, the project aims to provide new knowledge that can create greater consistency in patient treatment. We expect that the results can make a significant contribution to development of guidelines for good rehabilitation of patients undergoing lumbar spinal fusion. Trial registration Current Controlled Trials ISRCTN42281022. PMID:24581321

  2. Contemporary role of minimally invasive thoracic surgery in the management of pulmonary arteriovenous malformations: report of two cases and review of the literature

    PubMed Central

    Wang, Stephani C.; Rosen, Jonathan M.

    2016-01-01

    Pulmonary arteriovenous malformations (PAVM) can have potentially serious neurological and cardiac consequences if left untreated. Embolization has supplanted surgical resection as the first line treatment modality. However, this technique is not always successful and carries risks of air embolism, migration of the coil, myocardial rupture, vascular injury, pulmonary hypertension, and pulmonary infarction. We present two patients with symptomatic PAVM despite multiple embolizations: the first one with recurrent and persistent hemoptysis who underwent a thoracoscopic lobectomy, and the second one with chronic debilitating pleuritic pain subsequent to embolization who underwent a thoracoscopic wedge resection. Video-assisted thoracoscopic surgery (VATS) with lung resection was successfully performed in both patients, with complete resolution of their symptoms. We also review the literature regarding the contemporary role of surgery in PAVM, particularly thoracoscopy. PMID:26904229

  3. [Surgery].

    PubMed

    Roulin, D; Hbner, M; Demartines, N

    2013-01-16

    In 2012, an innovative approach for staged in situ liver transection was proposed that could allow for even more aggressive major hepatectomies. Otherwise, after 25 years, laparoscopy became "traditional" and other minimally invasive techniques continue to be developed but their indications deserve further investigation. Less aggressive treatment in non-complicated diverticulitis becomes more popular, and even antibiotic treatment has been challenged by a randomized study. In colorectal oncology, local resection or observation only seems to become a valuable approach in selected patients with complete response after neo adjuvant chemoradiation. Finally, enhanced recovery pathways (ERAS) have been validated and is increasingly accepted for colorectal surgery and ERAS principles are successfully applied in other surgical fields. PMID:23409643

  4. Real-time video fusion using a distributed architecture in robotic surgery

    NASA Astrophysics Data System (ADS)

    Kwartowitz, David M.; Rettmann, Maryam E.; Holmes, David R., III; Robb, Richard A.

    2009-02-01

    The use of medical robotics has been increasing in recent years. This increase in popularity can be attributed to the improvement in dexterity robots provide over traditional laparoscopy, as well as the increasing number of applications of robotic surgery. The daVinci from Intuitive Surgical, one of the more commonly used robotic surgery systems, relies on stereo laparoscopic video for guidance, which restricts visualization to only surface anatomy. Oftentimes the localization of subsurface anatomic structures is critical to the success of surgical intervention. The implementation of image guidance in medical robotics adds the ability to see into the surface; however, current implementations are restrictive in terms of flexibility or scalability, especially in the ability to process real-time video data. We present a system architecture which allows for use of multiple computers through a centralized database; which can fuse additional information to the real-time video stream. This architecture is independent of hardware or software and is extensible to a large number of clinical applications.

  5. Off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on simple congenital heart diseases (ASD, VSD and PDA) attached consecutive 210 cases report: A single institute experience

    PubMed Central

    2011-01-01

    Objective This paper intends to report our experiences by using an operation of off-pump occlusion of trans-thoracic minimal invasive surgery (OPOTTMIS) on the treatment of consecutive 210 patients with simple congenital heart diseases (CHD) including atrial septal defect (ASD), ventricular septal defect (VSD) and patent ductus arteriosus (PDA). Methods The retrospective clinical data of OPOTTMIS in our institute were collected and compared to other therapeutic measures adopted in the relevant literatures. After operation, all the patients received electrocardiography (ECG) and echocardiography (echo) once a month within the initial 3 months, and no less than once every 3 ~ 6 months later. Results The successful rate of the performed OPOTTMIS operation was 99.5%, the mortality and complication incidence within 72 hours were 0.5% and 4.8%, respectively. There were no major complications during peri-operation such as cardiac rupture, infective endocarditis, strokes, haemolysis and thrombosis. The post-operation follow-up outcomes by ECG and echo checks of 3 months to 5 years showed that there were no III° AVB, no obvious Occluder migration and device broken and no moderate cardiac valve regurgitation, except 1 VSD and 1 PDA with mild residual shunts, and 2 PDA with heart expansion after operation. However, all the patients' heart functions were in class I~II according to NYH standard. Conclusion The OPOTTMIS is a safe, less complex, feasible and effective choice to selected simple CHD patients with some good advantages and favorable short term efficacies. PMID:21486486

  6. A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries

    PubMed Central

    Parab, Swapnil Y; Divatia, Jigishu V; Chogle, Apurva

    2015-01-01

    Background and Aims: Traditional clinical methods like auscultation or inspection have been found to be inaccurate in confirmation of double-lumen tube (DLT) position. Lung ultrasonography (USG) reliably identifies the tidal movement (lung sliding) and the collapse of the lung (lung pulse). We intended to check whether the accuracy of clinical methods can be improved by the addition of USG in confirmation of left DLT (LDLT) position. Methods: A single centred, prospective, comparative study was conducted involving 70 patients undergoing thoracic surgeries requiring the use of LDLT. The patients were assigned to Group A - where LDLT position was assessed by using clinical methods alone, and Group B - where LDLT position was assessed by USG and clinical methods. The correct position was predicted when USG demonstrated the absence of lung sliding and the presence of lung pulse on the operative side, the presence of lung sliding on non-operative side, along with normal airway pressures and oxygenation. The final verification of LDLT position was done by direct observation of lung isolation by one surgeon who was blinded to the method of confirmation. Contingency tables were drawn to calculate sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each method. Results: Compared to clinical methods alone, addition of lung USG improved sensitivity (75% vs. 88%), specificity (18% vs. 75%) and accuracy (57% vs. 85%) for correct prediction of LDLT position. Conclusion: USG is a useful addition to the armamentarium of anaesthesiologist for the confirmation of LDLT position. PMID:26379290

  7. Flow capacity of skeletonized versus pedicled internal thoracic artery in coronary artery bypass graft surgery: systematic review, meta-analysis and meta-regression.

    PubMed

    Sá, Michel Pompeu Barros Oliveira; Cavalcanti, Paulo Ernando Ferraz; Santos, Henrique José de Andrade Costa; Soares, Artur Freire; Miranda, Rodrigo Gusmão Albuquerque; Araújo, Mayara Lopes; Lima, Ricardo Carvalho

    2015-07-01

    Many surgeons are concerned about the flow capacity of a skeletonized internal thoracic artery (ITA) in comparison with a pedicled ITA used during coronary artery bypass graft (CABG). This work aims to summarize the evidence comparing the flow capacity of a skeletonized versus pedicled ITA during CABG. We performed systematic review and meta-analysis according to the PRISMA statement based on a search in MEDLINE, EMBASE, CENTRAL/CCTR, ClinicalTrials.gov, SciELO, LILACS, Google Scholar and reference lists of relevant articles. Studies included were original studies whose populations comprised patients undergoing CABG; compared outcomes between skeletonized versus pedicled ITA; the outcomes included data regarding intraoperative flow capacity of the grafts; the studies were prospective or retrospective or non-randomized or randomized controlled trials. In total, eight studies were identified and reviewed for eligibility and data were extracted. Forest plots and the summarized difference in means including 95% confidence intervals (CIs) were estimated and meta-regressions were performed. There was a statistically significant difference in favour of the skeletonized ITA compared with the pedicled ITA in terms of flow capacity (random-effect model: additional 20.8 ml/min, 95% CI 6.6-35.0, P = 0.004), being the summary measures under the influence of heterogeneity of the effects, but free from publication bias. We observed a difference with regard to the type of study, since non-randomized studies together demonstrated the superiority of a skeletonized ITA (random-effect model: additional 32.3 ml/min, 95% CI 21.0-43.6, P < 0.001), but the randomized studies together did not show it (random-effect model: additional 13.2 ml/min, 95% CI -1.1 to 27.6, P = 0.071). Meta-regression demonstrated some modulation influence by female gender, age and diabetes on the flow capacity of grafts. In summary, in terms of flow capacity, a skeletonized ITA appears to be superior in comparison with a pedicled ITA during CABG. PMID:25228742

  8. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography.

    PubMed

    Patel, Manesh R; Dehmer, Gregory J; Hirshfeld, John W; Smith, Peter K; Spertus, John A; Masoudi, Frederick A; Dehmer, Gregory J; Patel, Manesh R; Smith, Peter K; Chambers, Charles E; Ferguson, T Bruce; Garcia, Mario J; Grover, Frederick L; Holmes, David R; Klein, Lloyd W; Limacher, Marian C; Mack, Michael J; Malenka, David J; Park, Myung H; Ragosta, Michael; Ritchie, James L; Rose, Geoffrey A; Rosenberg, Alan B; Russo, Andrea M; Shemin, Richard J; Weintraub, William S; Wolk, Michael J; Bailey, Steven R; Douglas, Pamela S; Hendel, Robert C; Kramer, Christopher M; Min, James K; Patel, Manesh R; Shaw, Leslee; Stainback, Raymond F; Allen, Joseph M

    2012-04-01

    The American College of Cardiology Foundation (ACCF), Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and the American Association for Thoracic Surgery, along with key specialty and subspecialty societies, conducted an update of the appropriate use criteria (AUC) for coronary revascularization frequently considered. In the initial document, 180 clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. This update provides a reassessment of clinical scenarios the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document, and the definition of appropriateness was unchanged. The technical panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate and likely to improve patients' health outcomes or survival. Scores of 1 to 3 indicate revascularization is considered inappropriate and unlikely to improve health outcomes or survival. Scores in the mid-range (4 to 6) indicate a clinical scenario for which the likelihood that coronary revascularization will improve health outcomes or survival is uncertain. In general, as seen with the prior AUC, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia is appropriate. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy are viewed less favorably. The technical panel felt that based on recent studies, coronary artery bypass grafting remains an appropriate method of revascularization for patients with high burden of coronary artery disease (CAD). Additionally, percutaneous coronary intervention may have a role in revascularization of patients with high burden of CAD. The primary objective of the appropriate use criteria is to improve physician decision making and patient education regarding expected benefits from revascularization and to guide future research. PMID:22424518

  9. An effective intra-operative neurophysiological monitoring scheme for aneurysm clipping and spinal fusion surgeries

    NASA Astrophysics Data System (ADS)

    Goryawala, Mohammed; Yaylali, Ilker; Cabrerizo, Mercedes; Vedala, Krishnatej; Adjouadi, Malek

    2012-04-01

    Somatosensory-evoked potentials (SSEPs) have been widely used for intra-operative neurophysiological monitoring (IONM). Currently at least 200-300 trials are required to generate a readable SSEP signal. This study introduces a novel approach that yields accurate detection results of the SSEP signal yet with a significantly reduced number of trials, resulting in an effectual monitoring process. The analysis was performed on data recorded in seven patients undergoing surgery, where the posterior tibial nerve was stimulated and the SSEP response was recorded from scalp electroencephalography using two bipolar electrodes, C3-C4 and CZ-FZ. The proposed approach employs an innovative, simple yet effective algorithm based on a patient-specific Gaussian template to detect the SSEP using only 30 trials. The time latencies of the P37 and N45 peaks are detected along with the peak-to-peak amplitudes. The time latencies are detected with a mean accuracy greater than 95%. Also, the P37 and N45 peak latencies and the peak-to-peak amplitude were found to be consistent throughout the surgical procedure within the 10% and 50% acceptable clinical limits, respectively. The results obtained support the assertion that the algorithm is capable of detecting SSEPs with high accuracy and consistency throughout the entire surgical procedure using only 30 trials.

  10. Thoracic outlet syndrome.

    PubMed

    Kuhn, John E; Lebus V, George F; Bible, Jesse E

    2015-04-01

    Thoracic outlet syndrome is a well-described disorder caused by thoracic outlet compression of the brachial plexus and/or the subclavian vessels. Neurogenic thoracic outlet syndrome is the most common manifestation, presenting with pain, numbness, tingling, weakness, and vasomotor changes of the upper extremity. Vascular complications of thoracic outlet syndrome are uncommon and include thromboembolic phenomena and swelling. The clinical presentation is highly variable, and no reproducible study exists to confirm the diagnosis; instead, the diagnosis is based on a physician's judgment after a meticulous history and physical examination. Both nonsurgical and surgical treatment methods are available for thoracic outlet syndrome. Whereas nonsurgical management appears to be effective in some persons, surgical treatment has been shown to provide predictable long-term cure rates for carefully selected patients. In addition, physicians who do not regularly treat patients with thoracic outlet syndrome may not have an accurate view of this disorder, its treatment, or the possible success rate of treatment. PMID:25808686

  11. Efficacy, Security, and Manageability of Gelified Hemostatic Matrix in Bleeding Control during Thoracic and Lumbar Spine Surgery: FloSeal versus Surgiflo.

    PubMed

    Landi, Alessandro; Gregori, Fabrizio; Marotta, Nicola; Delfini, Roberto

    2016-03-01

    Introduction Accurate hemostasis in surgical practice is critical. The need for optimal atraumatic hemostasis has become compelling in neurosurgery. A simple and safe gelified hemostatic matrix is often used. This prospective study evaluates two different hemostatics, FloSeal (Baxter Healthcare, Deerfield, Illinois, United States) and Surgiflo (Ethicon, Somerville, New Jersey, United States), for bleeding control during spine surgery, considering their efficacy, safety, and ease of use. Materials and Methods From January 2012 to December 2013, we recruited 149 patients. Inclusion criteria were age between 25 and 80 years, diagnosis of degenerative or traumatic pathology of the lumbar or thoracolumbar spine, and persistent bleeding not responding to standard hemostatic techniques. All patients underwent laminectomy or laminoarthrectomy, with exposure of the perivertebral venous plexus. Our aim was to stop the bleeding completely in the operative field by application of hemostatic gel. All patients were evaluated during the follow-up period with a clinical and neurologic examination. All patients underwent a computed tomography scan 3 months after the intervention. Results We included 149 patients in our study: 98 men and 51 women. Overall, 92 patients were affected by a degenerative condition and 57 by traumatic pathology. A total of 42 patients had anticoagulant and/or antiaggregant therapy preoperatively. In all cases, massive bleeding originated from the epidural venous plexus. FloSeal was used in 86 cases and Surgiflo in 63. A complete hemostasis was achieved in all patients within 3 minutes, 30 seconds and 7 minutes (FloSeal, 5 minutes, 35 seconds ± 52 seconds; Surgiflo, 5 minutes, 32 seconds ± 54 seconds). Statistical analysis did not show any association between coagulation time and hemostatics, age, sex, and the pathology treated. Previous therapy with antiaggregants and/or anticoagulants determined a slight increase in the time of hemostasis without any statistical differences. The clinical and radiological follow-up showed no evidence of postsurgical hematomas. Conclusions Comparative analysis of the two products did not show any relevant differences in terms of efficacy and ease of use or their effectiveness in bleeding control. Their use was valid even in patients who used antiaggregant/anticoagulant drugs preoperatively. Both FloSeal and Surgiflo can be considered good choices for controlling bleeding in spinal surgery. PMID:26351870

  12. Bilateral internal thoracic artery grafting

    PubMed Central

    2013-01-01

    The effectiveness of the left internal mammary artery graft to the anterior descending coronary artery as a surgical strategy has been shown to improve the survival rate and decrease the risk of adverse cardiac events in patients undergoing coronary bypass surgery. These clinical benefits appear to be related to the superior short and long-term patency rates of the internal thoracic artery graft. Although the advantages of using of both internal thoracic arteries (ITA) for bypass grafting have taken longer to prove, recent results from multiple data sets now support these findings. The major advantage of bilateral ITA grafting appears to be improved survival rate, while the disadvantages of complex ITA grafting include the increased complexity of operation, and an increased risk of wound complications. While these short-term disadvantages have been mitigated in contemporary surgical practice, they have not eliminated. Bilateral ITA grafting should be considered the procedure of choice for patients undergoing coronary bypass surgery that have a predicted survival rate of longer than ten years. PMID:23977627

  13. Staged treatment of thoracic and lumbar spinal tuberculosis with flow injection abscess

    PubMed Central

    Zeng, Hao; Zhang, Yupeng; Shen, Xiongjie; Luo, Chengke; Xu, Zhengquan; Liu, Zheng; Liu, Xiangyang; Wang, Xiyang

    2015-01-01

    The study was to investigate the feasibility and effectiveness of posterior-only approach combining with puncture drainage under CT-guide in staged treatment of thoracic and lumbar spinal tuberculosis with flow injection abscess. We retrospectively analyzed 15 patients (came from 72 cases with thoracic and lumbar spinal tuberculosis) with flow injection abscesses underwent surgery from January 2007 to February 2009, and evaluated the American Spinal Injury Association (ASIA) scoring system of nerve function, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), abscess absorption time and the Oswestry Disability Index (ODI), preoperatively and postoperatively. 15 patients were followed up for 13-37 months, no recurrence of tuberculosis, no fixation loosening and neurologic symptoms aggravated. The flow injection abscesses are absorbed within 3-6 months postoperative operation. In final follow-up, ESR went down to 5.2±2.1 mm/h from preoperative 79.6±14.8 mm/h, CRP decreased from preoperative 49.3±7.5 mg/L to 1.8±0.7 mg/L, ODI changed from 75.13±20.15 to 16.72±8.62, all of them changed significantly (P<0.05). In conclusions, one-stage posterior debridement, interbody fusion, pedicle screw fixation and two-stage CT-guided interventional therapy were safe and effective in treatment of the thoracic and lumbar spinal tuberculosis with flow injection abscess. PMID:26770442

  14. Advances in Weight Loss Surgery: The Fully Robotic Gastric Bypass

    MedlinePlus Videos and Cool Tools

    ... can be used in other operative specialties including cardiac surgery, thoracic surgery, which is pulmonary surgery. The ... and are morbidly obese have higher incidents of heart problems. The other things that we see are ...

  15. [Possibilities of videothoracoscopy for penetrating thoracic injuries].

    PubMed

    Voskresenskiĭ, O V; Radchenko, Iu A; Abakumov, M M

    2015-01-01

    It was analyzed the medical reports of 596 victims with thoracic injuries including 360 cases with following conventional therapeutic approach and 236 patients who underwent videothoracoscopy. We estimated condition severity in case of injuries of thoracic wall, lungs, pericardium and heart. Hemodynamic disorders were estimated according to Allgower-Burri shock index. Intrapleural bleeding was calculated using volume of hemothorax and time before injury and operation. Severity of physiological damages was determined using RTS criterion, anatomic--using ISS criterion. We estimated possibility for videothoracoscopy in patients with conventional therapeutic approach comparing severity of injuries, severity of condition in both groups and volume of surgery. Retrospective analysis revealed possibility of videothoracoscopy in 86.7% of victims with pulmonary injury, in 83.3% with bleeding at the muscular vessels of thoracic wall, in 40.3% with intercostal vessels injury, in 31.2% with heart injury, in 27.3% with damage of pericardium and in 18.8% with internal thoracic vessels injury. Our investigation revealed that videothoracoscopy may be used more widely in case of thoracic injury. PMID:26271560

  16. Endoscopic transforaminal thoracic foraminotomy and discectomy for the treatment of thoracic disc herniation.

    PubMed

    Nie, Hong-Fei; Liu, Kai-Xuan

    2013-01-01

    Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6-41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery. PMID:24455232

  17. Current challenges in endovascular therapy for thoracic aneurysms.

    PubMed

    Terzi, Francesca; Rocchi, Guido; Fattori, Rossella

    2016-05-01

    Surgical treatment of thoracic aortic aneurysms can be associated with high mortality and complication rates, resulting in prolonged hospital stay. Endovascular techniques for treating thoracic aortic disease have been rapidly embraced, showing limited mortality and major adverse events. Its wide availability and relative ease of application has changed and extended management options for thoracic aortic disease, including inpatients deemed unsuitable for open surgery. Rapid technical evolution has allowed it to be applied to even hostile anatomy and complex cases. However, as it is still a young technology, many unknowns remain, including long-term outcomes with respect to conservative treatment and open surgical repair. PMID:26757774

  18. Right main bronchial fracture resolution by digital thoracic drainage system.

    PubMed

    Cortés Julián, Gildardo; Mier, José M; Iñiguez, Marco A; Guzmán de Alba, Enrique

    2016-03-01

    Tracheobronchial stenosis is common in the thoracic surgery service, and iatrogenic injury of the airway after manipulation is not infrequent. When a digital thoracic drainage system came onto the market, many advantages were evident. A 24-year-old woman with critical right main bronchial stenosis underwent airway dilation that was complicated by a tear with a massive air leak, resulting in a total right pneumothorax. We employed a pleural drain connected to a digital thoracic drainage system. The drain was removed 2 days after successful resolution of the air leak. PMID:26660882

  19. Chimeric Anterolateral Thigh Flap for Total Thoracic Esophageal Reconstruction.

    PubMed

    Ruiz-Moya, Alejandro; Segura-Sampedro, Juan J; Sicilia-Castro, Domingo; Carvajo-Pérez, Francisco; Gómez-Cía, Tomás; Vázquez-Medina, Antonio; Ibáñez-Delgado, Francisco

    2016-01-01

    Gastric pull-up is generally the first choice for a total thoracic esophageal reconstruction. Malfunction of this gastric conduit is uncommon, but devastating when it occurs: it causes marked comorbidity to the patient, preventing oral intake and worsening quality of life. Secondary salvage thoracic esophageal reconstruction surgery is usually performed with free or pedicled jejunum flaps or colon interposition. We present a case of a total thoracic esophageal reconstruction with an externally monitored chimeric anterolateral thigh flap, extending from the cervical esophagus to the retrosternal gastroplasty remnant. Intestinal reconstructive techniques were not an available option for this patient. PMID:26694271

  20. One-Stage Posterior Debridement and Transpedicular Screw Fixation for Treating Monosegmental Thoracic and Lumbar Spinal Tuberculosis in Adults

    PubMed Central

    Liu, Zhili; Peng, Aifeng; Long, Xinhua; Yang, Dong; Huang, Shanhu

    2014-01-01

    Spinal tuberculosis is still prevalent in some developing countries. The purpose of this study is to investigate the efficacy and safety of one-stage posterior debridement, autogenous bone grafting, and transpedicular screw fixation in treating monosegmental thoracic and lumbar tuberculosis in adults. 37 patients were retrospectively reviewed in this study. The data of images, operative time and blood loss volume, perioperative complications, time to achieve bony fusion, VAS score, and neurologic function preoperatively and postoperatively were collected. The mean follow-up period was 21.5 ± 3.5 months. The tuberculosis was cured after surgery in all patients, and no recurrence was observed. Bony fusion was achieved in all patients with a mean time of 5.6 ± 2.5 months. Neurological outcome did not change in one case with grade A, and increased by 1–3 grades in the other patients with nerve deficit. The average preoperative and postoperative VAS scores were 5.5 ± 2.23 and 1.5 ± 1.22, respectively; the difference was significant (P < 0.05). There were three perioperative complications (8.1%, 3/37) observed in this study. In conclusion, the procedure of one-stage posterior debridement, interbody fusion with autogenous bone grafting, and posterior fixation with pedicle screw is effective and safe for treating monosegmental thoracic and lumbar spinal tuberculosis in adults. PMID:24701134

  1. Usefulness of an Image Fusion Model Using Three-Dimensional CT and MRI with Indocyanine Green Fluorescence Endoscopy as a Multimodal Assistant System in Endoscopic Transsphenoidal Surgery

    PubMed Central

    Inoue, Akihiro; Ohnishi, Takanori; Kohno, Shohei; Nishida, Naoya; Nakamura, Yawara; Ohtsuka, Yoshihiro; Matsumoto, Shirabe; Ohue, Shiro

    2015-01-01

    Purpose. We investigate the usefulness of multimodal assistant systems using a fusion model of preoperative three-dimensional (3D) computed tomography (CT) and magnetic resonance imaging (MRI) along with endoscopy with indocyanine green (ICG) fluorescence in establishing endoscopic endonasal transsphenoidal surgery (ETSS) as a more effective treatment procedure. Methods. Thirty-five consecutive patients undergoing ETSS in our hospital between April 2014 and March 2015 were enrolled in the study. In all patients, fusion models of 3D-CT and MRI were created by reconstructing preoperative images. In addition, in 10 patients, 12.5 mg of ICG was intravenously administered, allowing visualization of surrounding structures. We evaluated the accuracy and utility of these combined modalities in ETSS. Results. The fusion model of 3D-CT and MRI clearly demonstrated the complicated structures in the sphenoidal sinus and the position of the internal carotid arteries (ICAs), even with extensive tumor infiltration. ICG endoscopy enabled us to visualize the surrounding structures by the phasic appearance of fluorescent signals emitted at specific consecutive elapsed times. Conclusions. Preoperative 3D-CT and MRI fusion models with intraoperative ICG endoscopy allowed distinct visualization of vital structures in cases where tumors had extensively infiltrated the sphenoidal sinus. Additionally, the ICG endoscope was a useful real-time monitoring tool for ETSS. PMID:26339240

  2. Thoracic Outlet Syndrome

    MedlinePlus

    Thoracic outlet syndrome (TOS) causes pain in the shoulder, arm, and neck. It happens when the nerves or blood vessels just below your ... vein is compressed, your hand might be sensitive to cold, or turn pale or bluish. Your arm ...

  3. Thoracic trauma in horses.

    PubMed

    Hassel, Diana M

    2007-05-01

    Thoracic trauma represents an important cause of morbidity in mortality after injury in human beings and animals. After any form of suspected chest wall trauma, initial emergency management should include assurance of a patent airway and adequate ventilation, along with treatment for shock if present. As with any open wound, tetanus prophylaxis should be instituted. Types of trauma to the thoracic region of the horse include pectoral and axillary lacerations, penetrating chest wounds, flail chest, fractures of the ribs, blunt thoracic trauma, and several potential sequelae that include pneumothorax, pneumomediastinum, hemothorax, pleuritis, fistulae of the sternum or ribs, and diaphragmatic hernia. Emergency management of these various forms of thoracic trauma is discussed. PMID:17379110

  4. Trace Element Changes in Thoracic Aortic Dissection.

    PubMed

    Edvinsson, Marie; Ilbäck, Nils-Gunnar; Frisk, Peter; Thelin, Stefan; Nyström-Rosander, Christina

    2016-02-01

    Thoracic aortic dissection is a life-threatening condition with an incompletely understood pathogenesis. Trace elements are essential for the functioning of different processes in the body, including the immune system and associated responses to infection/inflammation. Because inflammation may be part of the pathogenesis of thoracic aortic dissection, we investigated whether trace element changes associated with inflammation occur in serum and tissue samples during the disease. The study included 21 patients undergoing surgery for thoracic aortic dissection, 10 forensic autopsy specimens for tissue controls and 23 healthy blood donors for serum controls. Levels of magnesium (Mg), calcium (Ca), vanadium (V), manganese (Mn), iron (Fe), cobalt (Co), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), cadmium (Cd) and mercury (Hg) were measured in the aortic tissue and serum by inductively coupled plasma-mass spectrometry (ICP-MS). In the serum, Ca, V, Cu and Zn decreased, whereas Fe increased. In the tissue, Cu and Zn decreased and Fe tended to increase. The Cu/Zn ratio in the serum, a marker of infection/inflammation, did not change in the patients. Concerning trace element changes in the serum and tissue, our data do not support the hypothesis that inflammation is involved in the pathogenesis of thoracic aortic dissection. PMID:26152852

  5. [Major thoracic trauma--sternal trauma].

    PubMed

    Dominioni, Lorenzo; Berizzi, Fabio; Imperatori, Andrea; Rovera, Francesca; Carcano, Giulio

    2005-01-01

    From 1999 to 2003, 101 patients (M/F = 83/18, mean age = 46 +/- 18 y) with thoracic trauma have been admitted to the Center for Thoracic Surgery in Varese. Over 50% of pts. with major thoracic trauma were treated by chest tube drainage; however, surgery was necessary just in 16/101 pts.; 29 pts. were admitted to ICU; deaths were 3/101. The Authors recorded 23/101 sternal fractures. Routine blood test, chest radiography and EKG were performed in all patients; in case of abnormal EKG, echocardiography was performed; in case of widened mediastinum, chest CT was mandatory. 13/23 pts. showed associated injuries, 12 pts. a non-aligned sternal fracture, 7 pts. mediastinal hematoma. Simple observation in hospital was indicated in 15/23 pts. with sternal fractures; chest tubes were positioned in 3 pts. (hemopneumothorax) and one patient was surgically treated because of painful sternal pseudoarthrosis (2 months after trauma). Admission in ICU was necessary in 3 pts. with non-aligned sternal fracture, mediastinal hematoma and associated injuries. No patient with sternal fracture died. PMID:16355852

  6. The Use of Bone Morphogenetic Protein in Pediatric Cervical Spine Fusion Surgery: Case Reports and Review of the Literature

    PubMed Central

    Molinari, Robert W.; Molinari, Christine

    2015-01-01

    Study Design Case report. Objective There is a paucity of literature describing the use of bone graft substitutes to achieve fusion in the pediatric cervical spine. The outcomes and complications involving the off-label use of bone morphogenetic protein (BMP)-2 in the pediatric cervical spine are not clearly defined. The purpose of this article is to report successful fusion without complications in two pediatric patients who had instrumented occipitocervical fusion using low-dose BMP-2. Methods A retrospective review of the medical records was performed, and the patients were followed for 5 years. Two patients under 10 years of age with upper cervical instability were treated with occipitocervical instrumented fusion using rigid occipitocervical fixation techniques along with conventionally available low-dose BMP-2. A Medline and PubMed literature search was conducted using the terms “bone morphogenetic protein,” “BMP,” “rh-BMP2,” “bone graft substitutes,” and “pediatric cervical spine.” Results Solid occipitocervical fusion was achieved in both pediatric patients. There were no reported perioperative or follow-up complications. At 5-year follow-up, radiographs in both patients showed successful occipital cervical fusion without evidence of instrumentation failure or changes in the occipitocervical alignment. To date, there are few published reports on this topic. Complications and the appropriate dosage application in the pediatric posterior cervical spine remain unknown. Conclusions We describe two pediatric patients with upper cervical instability who achieved successful occipital cervical fusion without complication using off-label BMP-2. This report underscores the potential for BMP-2 to achieve successful arthrodesis of the posterior occipitocervical junction in pediatric patients. Use should be judicious as complications and long-term outcomes of pediatric BMP-2 use remain undefined in the existing literature. PMID:26835215

  7. The Use of Bone Morphogenetic Protein in Pediatric Cervical Spine Fusion Surgery: Case Reports and Review of the Literature.

    PubMed

    Molinari, Robert W; Molinari, Christine

    2016-02-01

    Study Design Case report. Objective There is a paucity of literature describing the use of bone graft substitutes to achieve fusion in the pediatric cervical spine. The outcomes and complications involving the off-label use of bone morphogenetic protein (BMP)-2 in the pediatric cervical spine are not clearly defined. The purpose of this article is to report successful fusion without complications in two pediatric patients who had instrumented occipitocervical fusion using low-dose BMP-2. Methods A retrospective review of the medical records was performed, and the patients were followed for 5 years. Two patients under 10 years of age with upper cervical instability were treated with occipitocervical instrumented fusion using rigid occipitocervical fixation techniques along with conventionally available low-dose BMP-2. A Medline and PubMed literature search was conducted using the terms "bone morphogenetic protein," "BMP," "rh-BMP2," "bone graft substitutes," and "pediatric cervical spine." Results Solid occipitocervical fusion was achieved in both pediatric patients. There were no reported perioperative or follow-up complications. At 5-year follow-up, radiographs in both patients showed successful occipital cervical fusion without evidence of instrumentation failure or changes in the occipitocervical alignment. To date, there are few published reports on this topic. Complications and the appropriate dosage application in the pediatric posterior cervical spine remain unknown. Conclusions We describe two pediatric patients with upper cervical instability who achieved successful occipital cervical fusion without complication using off-label BMP-2. This report underscores the potential for BMP-2 to achieve successful arthrodesis of the posterior occipitocervical junction in pediatric patients. Use should be judicious as complications and long-term outcomes of pediatric BMP-2 use remain undefined in the existing literature. PMID:26835215

  8. Thoracic spine x-ray

    MedlinePlus

    Vertebral radiography; X-ray - spine; Thoracic x-ray; Spine x-ray; Thoracic spine films; Back films ... care provider's office. You will lie on the x-ray table in different positions. If the x-ray ...

  9. Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities.

    PubMed

    Bakaloudis, Georgios; Lolli, Francesco; Di Silvestre, Mario; Greggi, Tiziana; Astolfi, Stefano; Martikos, Konstantinos; Vommaro, Francesco; Barbanti-Brodano, Giovanni; Cioni, Alfredo; Giacomini, Stefano

    2011-05-01

    The traditional surgical treatment of severe spinal deformities, both in adult and pediatric patients, consisted of a 360° approach. Posterior-based spinal osteotomy has recently been reported as a useful and safe technique in maximizing kyphosis and/or kyphoscoliosis correction. It obviates the deleterious effects of an anterior approach and can increase the magnitude of correction both in the coronal and sagittal plane. There are few reports in the literature focusing on the surgical treatment of severe spinal deformities in large pediatric-only series (age <16 years old) by means of a posterior-based spinal osteotomy, with no consistent results on the use of a single posterior-based thoracic pedicle subtraction osteotomy in the treatment of such challenging group of patients. The purpose of the present study was to review our operative experience with pediatric patients undergoing a single level PSO for the correction of thoracic kyphosis/kyphoscoliosis in the region of the spinal cord (T12 and cephalad), and determine the safety and efficacy of posterior thoracic pedicle subtraction osteotomy (PSO) in the treatment of severe pediatric deformities. A retrospective review was performed on 12 consecutive pediatric patients (6 F, 6 M) treated by means of a posterior thoracic PSO between 2002 and 2006 in a single Institution. Average age at surgery was 12.6 years (range, 9-16), whereas the deformity was due to a severe juvenile idiopathic scoliosis in seven cases (average preoperative main thoracic 113°; 90-135); an infantile idiopathic scoliosis in two cases (preoperative main thoracic of 95° and 105°, respectively); a post-laminectomy kypho-scoliosis of 95° (for a intra-medullar ependimoma); an angular kypho-scoliosis due to a spondylo-epiphisary dysplasia (already operated on four times); and a sharp congenital kypho-scoliosis (already operated on by means of a anterior-posterior in situ fusion). In all patients a pedicle screws instrumentation was used, under continuous intra-operative neuromonitoring (SSEP, NMEP, EMG). At an average follow-up of 2.4 years (range, 2-6) the main thoracic curve showed a mean correction of 61°, or a 62.3% (range, 55-70%), with an average thoracic kyphosis of 38.5° (range, 30°-45°), for an overall correction of 65% (range, 60-72%). Mean estimated intra-operative blood loss accounted 19.3 cc/kg (range, 7.7-27.27). In a single case (a post-laminectomy kypho-scoliosis) a complete loss of NMEP occurred, promptly assessed by loosening of the initial correction, with a final negative wake-up test. No permanent neurologic damage, or instrumentation related complications, were observed. According to our experience, posterior-based thoracic pedicle subtraction osteotomies represent a valuable tool in the surgical treatment of severe pediatric spinal deformities, even in revision cases. A dramatic correction of both the coronal and sagittal profile may be achieved. Mandatory the use of a pedicle screws-only instrumentation and a continuous intra-operative neuromonitoring to obviate catastrophic neurologic complications. PMID:21468647

  10. Endovascular repair of thoracic aortic aneurysm

    PubMed Central

    Akin, Ibrahim; Kische, Stephan; Rehders, Tim C.; Nienaber, Christoph A.; Rauchhaus, Mathias

    2010-01-01

    A thoracic aortic aneurysm (TAA) is a potentially life-threatening condition with structural weakness of the aortic wall, which can progress to arterial dilatation and rupture. Today, both an increasing awareness of vascular disease and the access to tomographic imaging facilitate the diagnosis of TAA even in an asymptomatic stage. The risk of rupture for untreated aneurysms beyond a diameter of 5.6 cm ranges from 46% to 74% and the two-year mortality rate is greater than 70%, with most deaths resulting from rupture. Treatment options include surgical and non-surgical repair to prevent aneurysm enlargement and rupture. While most cases of ascending aortic involvement are subject to surgical repair (partially with valve-preserving techniques), aneurysm of the distal arch and descending thoracic aorta are amenable to emerging endovascular techniques as an alternative to classic open repair or to a hybrid approach (combining debranching surgery with stent grafting) in an attempt to improve outcomes. PMID:22419919

  11. Post-traumatic thoracic outlet syndromes.

    PubMed

    Casbas, Laurent; Chauffour, Xavier; Cau, Jérôme; Bossavy, Jean-Pierre; Midy, Dominique; Baste, Jean-Claude; Barret, André

    2005-01-01

    This retrospective study aims to clarify the mechanisms, frequency, symptoms, treatment, and outcome of post-traumatic thoracic outlet syndromes. A total of 13 patients (7 men and 6 women) with a mean age of 41 +/- 16 years were studied. Underlying injuries resulted from sports, road, and household accidents. Bone lesions were pseudarthrosis, hypertrophic callus, and luxations. Congenital anomalies were observed in five patients (38%). Vascular lesions included aneurysm of the subclavian artery or vein, acute ischemia, and subclavian vein thrombosis. Operative treatment involving orthopedic and/or vascular surgery was indicated in all patients. Post-traumatic thoracic outlet syndrome occurs in young subjects after violent trauma. Vascular complications are frequent and severe. Treatment achieves good results but benefits may be diminished by bone or nerve involvement. PMID:15714363

  12. Spontaneous thoracic spinal subarachnoid hemorrhage diagnosed with brain computed tomography.

    PubMed

    Sasaji, Tatsuro; Shinagawa, Kiyotsugu; Matsuya, Shigetsune

    2013-01-01

    Spontaneous thoracic spinal subarachnoid hemorrhage is rare, and thus no useful radiological findings for preoperative diagnosis have been reported. We experienced a patient with spontaneous thoracic spinal subarachnoid hemorrhage. A 37-year-old female presented with sudden-onset paraplegia and numbness in the trunk and bilateral lower extremities. The patient had no past history of trauma, lumbar puncture and bleeding disorder. T2-weighted sagittal magnetic resonance imaging (MRI) of the cervical and thoracic spines showed a mass occupied in the ventral space of spinal cord that was dorsally shifted. The mass extended from C6 to Th6 levels, with its largest size at Th2 level. Thoracic spine T2-weighted sagittal and axial MRI showed that the mass compressed spinal cord and was located in the intradural space. There was no spinal cord tumor and no spinal vascular malformation around the mass. Brain computed tomography (CT) showed a high-density area in the subarachnoid space, indicating the possibility of subarachnoid hemorrhage. Brain MRI showed no ruptured aneurysm. The patient was diagnosed as a spontaneous thoracic spinal subarachnoid hemorrhage and emergency surgery was selected. We performed right-side hemilaminectomy at Th1-Th6 and opened dura mater and arachnoid membrane. Hematoma was found in the ventral space of spinal cord and was removed. One year after surgery, numbness in the trunk and bilateral lower extremities had disappeared but paraplegia remained unchanged. Thoracic spine T2-weighted MRI confirmed no hematoma but showed a newly formed intradural cyst. Preoperative combination of brain CT and thoracic MRI is useful to diagnose thoracic spinal subarachnoid hemorrhage. PMID:24131866

  13. Subscapularis Transthoracic Versus Posterolateral Approaches in the Surgical Management of Upper Thoracic Tuberculosis: A Prospective, Randomized Controlled Study.

    PubMed

    Lin, Bin; Shi, Ji-Sheng; Zhang, Hai-Shen; Xue, Chao; Zhang, Bi; Guo, Zhi-Min

    2015-11-01

    The objective of the present study was to evaluate the clinical, radiological, and functional outcomes of a subscapularis transthoracic surgical approach and a posterolateral surgical approach with debridement, bone graft fusion, and internal fixation for the treatment of upper thoracic tuberculosis.There is currently debate over the best surgical approach for the treatment of upper thoracic tuberculosis. Traditionally, the subscapularis transthoracic approach has been preferred; however, the posterolateral approach has gained popularity in the past few years.A prospective, consecutive cohort of 43 upper thoracic tuberculosis patients with a mean age of 39 years (range: 20-52 years) was followed up for a minimum of 12 months (range: 12-60 months). Patients were randomly divided into 2 groups. Group A (n = 21) was treated by the subscapularis transthoracic approach and group B (n = 22) was treated by the posterolateral approach. All cases were evaluated for clinical, radiological, and functional outcomes. Intraoperative blood loss, operative duration, intraoperative and postoperative complications, hospital stay, the cure rate, fusion time, and the Frankel scale were used for clinical and functional evaluation, whereas the kyphosis angle was used for radiological evaluation.Grafted bones were fused by 10 months in all cases. There was no statistically significant difference between groups before surgery in terms of gender, age, segmental tuberculosis, erythrocyte sedimentation rate (ESR), Frankel scale, or Cobb's angle (P > 0.05). The average operative duration for Group B was lower than that of Group A. There were no significant differences in intraoperative blood loss, intraoperative and postoperative complications, hospital stay, grafted bone fusion time, or cure rate between groups (P > 0.05). The Cobb's angle correction rate for group B (68.5%) was significantly better than that of group A (30.9%). The neurological score showed significant postoperative improvement in both groups, with no significant difference between the groups.The subscapularis transthoracic approach and the posterolateral approach with debridement, bone graft fusion, and internal fixation are both sufficient and satisfactory for the surgical treatment of upper thoracic tuberculosis. However, the posterolateral approach is superior to the subscapularis transthoracic approach in terms of surgical trauma, operative time, and kyphosis correction. PMID:26632686

  14. Thoracic disc herniations.

    PubMed

    Dietze, D D; Fessler, R G

    1993-01-01

    Because of the protean nature of thoracic disc disease, surgeons should maintain a high order of suspicion of a thoracic disc herniation in the patient with unexplained localized back or torso pain and sensorimotor deficits. These patients should have MR imaging performed as a screening test, and, if suspicious for a thoracic disc herniation, confirmatory myelogram and postmyelogram CT imaging. Though the natural history is anecdotal, there appears to be a tendency for myelopathic symptoms and signs to be progressive, warranting surgical intervention. For radicular dysfunction or localized back pain, a conservative therapeutic plan is recommended. If intractable pain is demonstrated, and the diagnosis is certain, then surgical intervention is recommended. Once surgical intervention is recommended the surgical approach needs to be individualized according to the surgeon's skills and experience and the specifics of the patient's pathology. Appropriate surgical decision-making depends on an understanding of the variety of surgical options and their advantages and disadvantages, and an understanding of the biomechanical factors of the spine of the individual patient. Surgical concepts important to successful thoracic disc removal are (1) minimal spinal cord manipulation, (2) preservation of the neurovascular supply whenever possible, (3) minimal manipulation of the intercostal nerve, and (4) preservation of maximal bony and ligamentous attachments allowable for adequate exposure. Lastly it is recommended that the posterior longitudinal ligament be removed to ensure complete spinal cord decompression. PMID:8428158

  15. Case scenario - thoracic trauma.

    PubMed

    Michelet, P; Boussen, S

    2013-01-01

    Among trauma patients, blunt chest trauma remains a major cause of morbidity and mortality. We report the case of an 85-year old patient under new oral anticoagulant implicated in a multiple-vehicle accident. The patient presented a complex thoracic trauma involving multiple rib fractures, flail chest, hemothorax and lung contusions. All the thoracic lesions were situated at the left side. Despite the absence of neurological lesion and hemodynamic instability, the patient required the admission in our intensive care unit related to the worsening of a respiratory distress. This respiratory distress resulted from the association of the thoracic injuries with related hypoxemia and a high level of pain. The management of this case included the reversal of the anticoagulant therapy, use of non-invasive ventilation, the placement of a paravertebral block and the surgical fixation of the flail chest. We provide a discussion of the risk/benefit balance for all the medical and surgical strategies used in this case as the interest of chest ultrasonography in thoracic trauma situations. PMID:23916516

  16. A Meta Analysis of Lumbar Spinal Fusion Surgery Using Bone Morphogenetic Proteins and Autologous Iliac Crest Bone Graft

    PubMed Central

    Zhang, Haifei; Wang, Feng; Ding, Lin; Zhang, Zhiyu; Sun, Deri; Feng, Xinmin; An, Jiuli; Zhu, Yue

    2014-01-01

    Background Bone morphogenetic protein (BMPs) as a substitute for iliac crest bone graft (ICBG) has been increasingly widely used in lumbar fusion. The purpose of this study is to systematically compare the effectiveness and safety of fusion with BMPs for the treatment of lumbar disease. Methods Cochrane review methods were used to analyze all relevant randomized controlled trials (RCTs) published up to nov 2013. Results 19 RCTs (1,852 patients) met the inclusion criteria. BMPs group significantly increased fusion rate (RR: 1.13; 95% CI 1.05–1.23, P = 0.001), while there was no statistical difference in overall success of clinical outcomes (RR: 1.04; 95% CI 0.95–1.13, P = 0.38) and complications (RR: 0.96; 95% CI 0.85–1.09, p = 0.54). A significant reduction of the reoperation rate was found in BMPs group (RR: 0.57; 95% CI 0.42–0.77, p = 0.0002). Significant difference was found in the operating time (MD−0.32; 95% CI−0.55, −0.08; P = 0.009), but no significant difference was found in the blood loss, the hospital stay, patient satisfaction, and work status. Conclusion Compared with ICBG, BMPs in lumbar fusion can increase the fusion rate, while reduce the reoperation rate and operating time. However, it doesn’t increase the complication rate, the amount of blood loss and hospital stay. No significant difference was found in the overall success of clinical outcome of the two groups. PMID:24886911

  17. An extension-distraction injury of the thoracic spine with traumatic partial correction of thoracic kyphosis.

    PubMed

    Culotta, Brad A; Deinlein, Donald A; Theiss, Steven M; Lemons, Jack E

    2013-10-01

    Study Design The study is a case report. Objective The authors aim to report an unusual injury pattern in a patient previously treated for thoracic kyphoscoliosis. Methods A postoperative (computed tomography) CT of a healthy 24-year-old man who underwent posterior instrumentation and fusion for a kyphoscoliosis deformity was compared with a CT performed after a motor vehicle accident (MVA) 1 year later, which resulted in an extension-distraction injury of T8 with no neurologic deficit. Cobb angles of the thoracic sagittal images of both CTs were measured using a digital measuring device and the values were recorded. Results Initial postoperative sagittal CT images demonstrate a 67-degree residual thoracic kyphosis compared with the post-MVA sagittal CT images, which reveal a 54-degree thoracic kyphosis, a 13-degree improvement in sagittal alignment. Conclusion It is unusual for a patient with long posterior instrumentation of the spine to sustain a spinal fracture without breakage of the rods, which were 6-mm nickel-titanium alloy with two crosslinks. Although sustaining plastic deformation, the rods maintained their integrity to the degree that the patient required no subsequent treatment to his spine at 12 months follow-up. It is rare to sustain a vertebral fracture without implant failure, which occurred in this case. PMID:24436710

  18. Post-operative care to promote recovery for thoracic surgical patients: a nursing perspective.

    PubMed

    Yeung, Wilfred Wai Kit

    2016-02-01

    The change in patient population leads to an inevitable transformation among the healthcare system. Over the past decades, thoracic surgical technique has been evolving from conventional open thoracotomy to minimally invasive video assisted thoracoscopic surgery (VATS). Thoracic nursing team of Prince of Wales Hospital (PWH) grows together with the evolution and aims at providing holistic and quality care to patients require thoracic operation. In order to enhance patient post-operative recovery, few strategies have been implemented including early mobilization, staff training and clinical audit. On the other hand, nursing case management approach was proved to be a cost-effective method in managing patients. It is also suitable for thoracic patients, especially for those who are suffering from thoracic neoplasm. It is believed that, the introduction of nursing case management approach would provide a better holistic care to the thoracic patients. PMID:26941973

  19. Post-operative care to promote recovery for thoracic surgical patients: a nursing perspective

    PubMed Central

    2016-01-01

    The change in patient population leads to an inevitable transformation among the healthcare system. Over the past decades, thoracic surgical technique has been evolving from conventional open thoracotomy to minimally invasive video assisted thoracoscopic surgery (VATS). Thoracic nursing team of Prince of Wales Hospital (PWH) grows together with the evolution and aims at providing holistic and quality care to patients require thoracic operation. In order to enhance patient post-operative recovery, few strategies have been implemented including early mobilization, staff training and clinical audit. On the other hand, nursing case management approach was proved to be a cost-effective method in managing patients. It is also suitable for thoracic patients, especially for those who are suffering from thoracic neoplasm. It is believed that, the introduction of nursing case management approach would provide a better holistic care to the thoracic patients. PMID:26941973

  20. En bloc resection of a thoracic chordoma is possible using minimally invasive anterior access: An 8-year follow-up

    PubMed Central

    Goomany, Anand; Timothy, Jake; Robson, Craig; Rao, Abhay

    2016-01-01

    Thoracic spine chordomas are a rare clinical entity and present several diagnostic and management challenges. Posterior debulking techniques are the traditional approach for the resection of thoracic tumors involving the vertebral body. Anterior approaches to the thoracic spine enable complete tumor resection and interbody fusion. However, this approach has previously required a thoracotomy incision, which is associated with significant perioperative morbidity, pain, and the potential for compromised ventilation and subsequent respiratory sequelae. The extreme lateral approach to the anterior spine has been used to treat degenerative disorders of the lower thoracic and lumbar spine, and reduces the potential complications compared with the anterior transperitoneal/transpleural approach. However, such an approach has not been utilized in the treatment of thoracic chordomas. We describe the first case of an en bloc resection of a thoracic chordoma via a minimally invasive eXtreme lateral interbody fusion approach. PMID:26933363

  1. Normal and abnormal spine and thoracic cage development.

    PubMed

    Canavese, Federico; Dimeglio, Alain

    2013-01-01

    Development of the spine and thoracic cage consists of a complex series of events involving multiple metabolic processes, genes and signaling pathways. During growth, complex phenomena occur in rapid succession. This succession of events, this establishment of elements, is programmed according to a hierarchy. These events are well synchronized to maintain harmonious limb, spine and thoracic cage relationships, as growth in the various body segments does not occur simultaneously at the same magnitude or rate. In most severe cases of untreated progressive early-onset spinal deformities, respiratory insufficiency and pulmonary and cardiac hypertension (cor pulmonale), which characterize thoracic insufficiency syndrome (TIS), can develop, sometimes leading to death. TIS is the inability of the thorax to ensure normal breathing. This clinical condition can be linked to costo-vertebral malformations (e.g., fused ribs, hemivertebrae, congenital bars), neuromuscular diseases (e.g., expiratory congenital hypotonia), Jeune or Jarcho-Levin syndromes or to 50% to 75% fusion of the thoracic spine before seven years of age. Complex spinal deformities alter normal growth plate development, and vertebral bodies become progressively distorted, perpetuating the disorder. Therefore, many scoliotic deformities can become growth plate disorders over time. This review aims to provide a comprehensive review of how spinal deformities can affect normal spine and thoracic cage growth. Previous conceptualizations are integrated with more recent scientific data to provide a better understanding of both normal and abnormal spine and thoracic cage growth. PMID:24147251

  2. Using Provocative Discography and Computed Tomography to Select Patients with Refractory Discogenic Low Back Pain for Lumbar Fusion Surgery.

    PubMed

    Xi, Mengqiao Alan; Tong, Henry C; Fahim, Daniel K; Perez-Cruet, Mick

    2016-01-01

    Background Context Controversy remains over the use of provocative discography in conjunction with computed tomography (CT) to locate symptomatic intervertebral discs in patients with chronic, low back pain (LBP). The current study explores the relationship between discogenic pain and disc morphology using discography and CT, respectively, and investigates the efficacy of this combined method in identifying surgical candidates for lumbar fusion by evaluating outcomes. Methods 43 consecutive patients between 2006 and 2013 who presented with refractory low back pain and underwent discography and CT were enrolled in the study. For this study, "refractory LBP" was defined as pain symptoms that persisted or worsened after 6 months of non-operative treatments. Concordant pain was defined as discography-provoked LBP of similar character and location with an intensity of ≥ 8/10. Fusion candidates demonstrated positive-level discography and concordant annular tears on CT at no more than two contiguous levels, and at least one negative control disc with intact annulus. Surgical outcomes were statistically analyzed using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) for back-related pain and disability preoperatively, and 2 weeks, 3, 6, 12, and 24 months postoperatively. Results Annular tears were found in 87 discs. Concordant pain was reported by 9 (20.9%) patients at L3-L4, 21 (50.0%) at L4-L5, and 34 (82.9%) at L5-S1; pain occurred significantly more often in discs with annular tears than those without (p<0.001). Painless discs were independent of annulus status (p=0.90). 18 (42%) of the original 43 patients underwent lumbar fusion at L3-L4 (n=1(6%)), L4-L5 (n=6 (33%)), L5-S1 (n=5 (28%)), and two-level L4-S1 (n=6 (33%)) via a minimally invasive transforaminal lumbar interbody fusion (MITLIF) approach with the aim to replace the nucleus pulposus with bone graft material. Median follow-up time was 18 months (range: 12-78 months). VAS, ODI, and SF-36 scores demonstrated significant improvements at 10 out of 12 postoperative time points compared with preoperative baseline. Conclusions Lumbar discography with post-discography CT can be an effective method to evaluate patients with discogenic back pain refractory to non-operative treatments. Those patients with one- or two-level high concordant pain scores with associated annular tears and negative control disc represent good surgical candidates for lumbar interbody spinal fusion. PMID:27026838

  3. Using Provocative Discography and Computed Tomography to Select Patients with Refractory Discogenic Low Back Pain for Lumbar Fusion Surgery

    PubMed Central

    Tong, Henry C; Fahim, Daniel K; Perez-Cruet, Mick

    2016-01-01

    Background Context Controversy remains over the use of provocative discography in conjunction with computed tomography (CT) to locate symptomatic intervertebral discs in patients with chronic, low back pain (LBP). The current study explores the relationship between discogenic pain and disc morphology using discography and CT, respectively, and investigates the efficacy of this combined method in identifying surgical candidates for lumbar fusion by evaluating outcomes. Methods 43 consecutive patients between 2006 and 2013 who presented with refractory low back pain and underwent discography and CT were enrolled in the study. For this study, "refractory LBP" was defined as pain symptoms that persisted or worsened after 6 months of non-operative treatments. Concordant pain was defined as discography-provoked LBP of similar character and location with an intensity of ≥ 8/10. Fusion candidates demonstrated positive-level discography and concordant annular tears on CT at no more than two contiguous levels, and at least one negative control disc with intact annulus. Surgical outcomes were statistically analyzed using Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Short Form-36 (SF-36) for back-related pain and disability preoperatively, and 2 weeks, 3, 6, 12, and 24 months postoperatively. Results Annular tears were found in 87 discs. Concordant pain was reported by 9 (20.9%) patients at L3-L4, 21 (50.0%) at L4-L5, and 34 (82.9%) at L5-S1; pain occurred significantly more often in discs with annular tears than those without (p<0.001). Painless discs were independent of annulus status (p=0.90). 18 (42%) of the original 43 patients underwent lumbar fusion at L3-L4 (n=1(6%)), L4-L5 (n=6 (33%)), L5-S1 (n=5 (28%)), and two-level L4-S1 (n=6 (33%)) via a minimally invasive transforaminal lumbar interbody fusion (MITLIF) approach with the aim to replace the nucleus pulposus with bone graft material. Median follow-up time was 18 months (range: 12–78 months). VAS, ODI, and SF-36 scores demonstrated significant improvements at 10 out of 12 postoperative time points compared with preoperative baseline. Conclusions Lumbar discography with post-discography CT can be an effective method to evaluate patients with discogenic back pain refractory to non-operative treatments. Those patients with one- or two-level high concordant pain scores with associated annular tears and negative control disc represent good surgical candidates for lumbar interbody spinal fusion.

  4. Metabolic phenotype-microRNA data fusion analysis of the systemic consequences of Roux-en-Y gastric bypass surgery

    PubMed Central

    Wu, Q; Li, J V; Seyfried, F; le Roux, C W; Ashrafian, H; Athanasiou, T; Fenske, W; Darzi, A; Nicholson, J K; Holmes, E; Gooderham, N J

    2015-01-01

    Background/Objectives: Bariatric surgery offers sustained marked weight loss and often remission of type 2 diabetes, yet the mechanisms of establishment of these health benefits are not clear. Subjects/Methods: We mapped the coordinated systemic responses of gut hormones, the circulating miRNAome and the metabolome in a rat model of Roux-en-Y gastric bypass (RYGB) surgery. Results: The response of circulating microRNAs (miRNAs) to RYGB was striking and selective. Analysis of 14 significantly altered circulating miRNAs within a pathway context was suggestive of modulation of signaling pathways including G protein signaling, neurodegeneration, inflammation, and growth and apoptosis responses. Concomitant alterations in the metabolome indicated increased glucose transport, accelerated glycolysis and inhibited gluconeogenesis in the liver. Of particular significance, we show significantly decreased circulating miRNA-122 levels and a more modest decline in hepatic levels, following surgery. In mechanistic studies, manipulation of miRNA-122 levels in a cell model induced changes in the activity of key enzymes involved in hepatic energy metabolism, glucose transport, glycolysis, tricarboxylic acid cycle, pentose phosphate shunt, fatty-acid oxidation and gluconeogenesis, consistent with the findings of the in vivo surgery-mediated responses, indicating the powerful homeostatic activity of the miRNAs. Conclusions: The close association between energy metabolism, neuronal signaling and gut microbial metabolites derived from the circulating miRNA, plasma, urine and liver metabolite and gut hormone correlations further supports an enhanced gut-brain signaling, which we suggest is hormonally mediated by both traditional gut hormones and miRNAs. This transomic approach to map the crosstalk between the circulating miRNAome and metabolome offers opportunities to understand complex systems biology within a disease and interventional treatment setting. PMID:25783038

  5. Comparison of Hybrid Surgery Incorporating Anterior Cervical Discectomy and Fusion and Artificial Arthroplasty versus Multilevel Fusion for Multilevel Cervical Spondylosis: A Meta-Analysis.

    PubMed

    Zang, Leyuan; Ma, Min; Hu, Jianxin; Qiu, Hao; Huang, Bo; Chu, Tongwei

    2015-01-01

    BACKGROUND Few studies have reported the safety and efficacy of hybrid surgery (HS), and some of the studies comparing HS with ACDF have reported conflicting results. We conducted this meta-analysis to clarify the advantages of HS in the treatment of multilevel cervical spondylosis. MATERIAL AND METHODS We performed a systematic literature search in PubMed, Medline, and CNKI to identify relevant controlled trials published up to October 2015. The standardized mean difference (SMD) and 95% confidence interval (95% CI) of the perioperative parameters, visual analogue scale pain score (VAS), neck disability index (NDI), and range of motion (ROM) of C2-C7 and adjacent segments were calculated. We also analyzed complications and Odom scale scores using risk difference (RD) and 95% CI. RESULTS In total, 7 studies were included. The pooled data exhibited significant differences in blood loss between the 2 groups. However, there was no evidence indicating significant differences in operation time, complications, VAS, NDI, or Odom scale scores. Compared with the ACDF group, the HS group exhibited significantly protected C2-C7 ROM and reduced adjacent-segment ROM. CONCLUSIONS The safety of HS may be as good as that of ACDF. Furthermore, HS is superior to ACDF in conserving cervical spine ROM and decreasing adjacent-segment ROM. However, the results should be accepted cautiously due to the limitations of the study. Studies with larger sample sizes and longer follow-up periods are required to confirm and update the results of the present study. PMID:26709008

  6. [Extra-thoracic sarcoidosis].

    PubMed

    Costa, Filipa; Arrobas, Ana

    2008-01-01

    Sarcoidosis is a multisystemic granulomatous disease of unknown aetiology, characterized by the presence of non-caseating epithelioid cell granulomas on tissue biopsy of affected organs. It may involve any organ, presenting in multiple forms to clinicians of different specialties. In its extra-thoracic form it may involve the liver (50-80%), spleen (40-80%), eye (20-50%), extrathoracic lymph nodes (30%), skin (25%), nervous system (10%), heart (5%), kidney, muscle and bone, sometimes without symptoms. The presence of extrathoracic disease may affect the prognosis and treatment options for sarcoidosis. The authors present a review of the major extra-thoracic manifestations of sarcoidosis regarding its clinical presentation, diagnosis, treatment, follow-up and prognosis. PMID:18265921

  7. Comparison of Hybrid Surgery Incorporating Anterior Cervical Discectomy and Fusion and Artificial Arthroplasty Versus Multilevel Fusion for Multilevel Cervical Spondylosis: A Meta-Analysis

    PubMed Central

    Zang, Leyuan; Ma, Min; Hu, Jianxin; Qiu, Hao; Huang, Bo; Chu, Tongwei

    2015-01-01

    Background Few studies have reported the safety and efficacy of hybrid surgery (HS), and some of the studies comparing HS with ACDF have reported conflicting results. We conducted this meta-analysis to clarify the advantages of HS in the treatment of multilevel cervical spondylosis. Material/Methods We performed a systematic literature search in PubMed, Medline, and CNKI to identify relevant controlled trials published up to October 2015. The standardized mean difference (SMD) and 95% confidence interval (95% CI) of the perioperative parameters, visual analogue scale pain score (VAS), neck disability index (NDI), and range of motion (ROM) of C2–C7 and adjacent segments were calculated. We also analyzed complications and Odom scale scores using risk difference (RD) and 95% CI. Results In total, 7 studies were included. The pooled data exhibited significant differences in blood loss between the 2 groups. However, there was no evidence indicating significant differences in operation time, complications, VAS, NDI, or Odom scale scores. Compared with the ACDF group, the HS group exhibited significantly protected C2-C7 ROM and reduced adjacent-segment ROM. Conclusions The safety of HS may be as good as that of ACDF. Furthermore, HS is superior to ACDF in conserving cervical spine ROM and decreasing adjacent-segment ROM. However, the results should be accepted cautiously due to the limitations of the study. Studies with larger sample sizes and longer follow-up periods are required to confirm and update the results of the present study. PMID:26709008

  8. Pros, cons, and costs of INFUSE in spinal surgery

    PubMed Central

    Epstein, Nancy E.

    2011-01-01

    Background: INFUSE (recombinant human bone morphogenetic protein-2 [rh-BMP-2]; Medtronic, Memphis, TN, USA) is approved by the Federal Drug Administration (FDA) only for use with the lumbar tapered fusion device (LT Cage; Medtronic) to perform single-level anterior lumbar interbody fusions (ALIF: L2-S1 levels). INFUSE, however, is widely utilized in an “off-label” capacity for anterior and/or posterior cervical, thoracic, and lumbar surgery. Nevertheless, Medicare and other insurance companies, are now increasingly denying reimbursement (average cost of a “large” INFUSE to the hospital without overhead $5000-6000) to hospitals for INFUSE when utilized “off-label”. Methods: This commentary looks at several representative studies citing the cons associated with utilizing INFUSE in spinal surgery, contraindications, complications, and cost factors. Results: There are multiple cons of utilizing INFUSE in an “off-label” capacity for spinal surgery. Direct contraindications include pregnancy, allergy to titanium, allergy to bovine type I collagen or rhBMP-2, infection, tumor, liver or kidney disease, immunosuppression (e.g., lupus, HIV/AIDS); contraindications are also seen in those receiving radiation, chemotherapy, or steroids. Reported complications include exuberant/ectopic bone formation, paralysis (cord, nerve damage), dural tears, bowel–bladder and sexual dysfunction, respiratory failure, inflammation of adjacent tissues, fetal developmental complications, scar, excessive bleeding, and even death. Complications are so prevalent in the anterior cervical spine, that many surgeons no longer use it in this region. Similarly, INFUSE complications and indications for posterior lumbar interbody fusions (PLIFs) and transforaminal interbody lumbar fusions (TLIFs) should also be reexamined. Conclusions: More surgeons need to question the safety, efficacy, and appropriate “off-label” use of INFUSE in all spine surgeries. PMID:21297932

  9. The biomolecular era for thoracic surgeons: the example of the ESTS Biology Club

    PubMed Central

    Opitz, Isabelle; D’Amico, Thomas A.

    2014-01-01

    Understanding basic mechanisms of lung disease may help to move forward the management of our patients. Molecular biology has affected our diagnostic and therapeutic pathways in the direction of personalized medicine not only for thoracic malignancies. Accordingly, thoracic surgeons are becoming increasingly aware that specific knowledge of genetic and epigenetic alterations may influence their clinical behavior—from the ward to the operating room (OR). In this continuously evolving scenario, surgical societies have perceived the increasing relevance of biomolecular medicine in the practice of modern thoracic surgery. More recently, in the spirit of mutual collaboration between sister societies, the European Society of Thoracic Surgeons (ESTS) has adopted the concept of the American Association for Thoracic Surgery (AATS) incorporating one session dedicated to the Biology Club within the Annual Meeting Program. The aim of the ESTS Biology Club is to outline and sponsor the new profile of the surgeon scientist during the only world meeting exclusively focused on general thoracic surgery. The following article will summarize the significance of this and give an update on molecular biology tools for thoracic malignancies. PMID:24868444

  10. [Josef Koncz (1916-1988)--pioneer of cardiac surgery].

    PubMed

    Schmitto, J D; Tjindra, C; Kolat, P; Hintze, E; Liakopoulos, O J; Popov, A F; Sellin, C; Dörge, H; Schöndube, F A

    2007-03-01

    Josef Koncz (1916-1988) was until given emeritus status in 1982 director of the Department of Cardiothoracic and Vascular Surgery, which was specifically founded for him in Goettingen, Germany. By the fusion of three different surgical branches the University hospital of Goettingen took over the role of a pacemaker and initiated a standard in the development of this new specialty in Germany. The scientific and clinical work done by the Department of Cardiothoracic and Vascular Surgery was shaped by the personality of the surgeon and scientist Josef Koncz. He was a successful surgeon and innovative pioneer in one person. Already in 1956, he started open-heart surgery and proceeded this technique in an impressing series. In 1965 he was the first in Germany who operated upon the transposition of the great vessels by Mustard's method and developed together with his long-standing assistant, Huschang Rastan, an operation technique to extend the left-ventricular outflow tract combined with tunnel-shaped subvalvular aortic valve stenosis. Another essential element of his work is related to the establishment of the Cardiothoracic and Vascular Surgery as an independent specialty, ending in the foundation of the German Society for Thoracic and Cardiovascular Surgery in 1971. PMID:17458023

  11. Thoracic trauma in horses.

    PubMed

    Sprayberry, Kim A; Barrett, Elizabeth J

    2015-04-01

    Traumatic injuries involving the thorax can be superficial, necessitating only routine wound care, or they may extend to deeper tissue planes and disrupt structures immediately vital to respiratory and cardiac function. Diagnostic imaging, especially ultrasound, should be considered part of a comprehensive examination, both at admission and during follow-up. Horses generally respond well to diligent monitoring, intervention for complications, and appropriate medical or surgical care after sustaining traumatic wounds of the thorax. This article reviews the various types of thoracic injury and their management. PMID:25770070

  12. Symptomatic Triple-Region Spinal Stenosis Treated with Simultaneous Surgery: Case Report and Review of the Literature

    PubMed Central

    Schaffer, Joseph C.; Raudenbush, Brandon L.; Molinari, Christine; Molinari, Robert W.

    2015-01-01

    Study Design Case report. Objectives Symptomatic triple-region spinal stenosis (TRSS), defined as spinal stenosis in three different regions of the spine, is extremely rare. To our knowledge, treatment with simultaneous decompressive surgery is not described in the literature. We report a case of a patient with TRSS who was treated successfully with simultaneous decompressive surgery in three separate regions of the spine. Methods A 50-year-old man presented with combined progressive cervical and thoracic myelopathy along with severe lumbar spinal claudication and radiculopathy. He underwent simultaneous decompressive surgery in all three regions of his spine and concomitant instrumented fusion in the cervical and thoracic regions. Results Estimated blood loss for the procedure was 600 mL total (250 mL cervical, 250 mL thoracic, 100 mL lumbar) and operative time was ∼3.5 hours. No changes were noted on intraoperative monitoring. The postoperative course was uncomplicated. The patient was discharged to inpatient rehabilitation on postoperative day (POD) 7 and discharged home on POD 11. At 6-month follow-up, his gait and motor function was improved and returned to normal in all extremities. He remains partially disabled due to chronic back pain. Conclusions This report is the first of symptomatic TRSS treated with simultaneous surgery in three different regions of the spine. Simultaneous triple region stenosis surgery appears to be an effective treatment option for this rare condition, but may be associated with prolonged hospital stay after surgery. PMID:26682102

  13. Symptomatic Triple-Region Spinal Stenosis Treated with Simultaneous Surgery: Case Report and Review of the Literature.

    PubMed

    Schaffer, Joseph C; Raudenbush, Brandon L; Molinari, Christine; Molinari, Robert W

    2015-12-01

    Study Design Case report. Objectives Symptomatic triple-region spinal stenosis (TRSS), defined as spinal stenosis in three different regions of the spine, is extremely rare. To our knowledge, treatment with simultaneous decompressive surgery is not described in the literature. We report a case of a patient with TRSS who was treated successfully with simultaneous decompressive surgery in three separate regions of the spine. Methods A 50-year-old man presented with combined progressive cervical and thoracic myelopathy along with severe lumbar spinal claudication and radiculopathy. He underwent simultaneous decompressive surgery in all three regions of his spine and concomitant instrumented fusion in the cervical and thoracic regions. Results Estimated blood loss for the procedure was 600 mL total (250 mL cervical, 250 mL thoracic, 100 mL lumbar) and operative time was ∼3.5 hours. No changes were noted on intraoperative monitoring. The postoperative course was uncomplicated. The patient was discharged to inpatient rehabilitation on postoperative day (POD) 7 and discharged home on POD 11. At 6-month follow-up, his gait and motor function was improved and returned to normal in all extremities. He remains partially disabled due to chronic back pain. Conclusions This report is the first of symptomatic TRSS treated with simultaneous surgery in three different regions of the spine. Simultaneous triple region stenosis surgery appears to be an effective treatment option for this rare condition, but may be associated with prolonged hospital stay after surgery. PMID:26682102

  14. Society of Thoracic Surgeons

    MedlinePlus

    ... in the STS National Database Is So Important Simulation Training: Will It Replace “See One, Do One, ... Mitral Valve Surgery Offers Viable Option for Select Heart Patients BMI Linked With Complications After Lung Cancer ...

  15. Thoracic aortic dissection and mycotic pseudoaneurysm in the setting of an unstable upper thoracic type b2 fracture.

    PubMed

    Chaudhary, Saad B; Roselli, Eric; Steinmetz, Michael; Mroz, Thomas E

    2012-09-01

    Thoracic type B2 fractures are high-energy injuries. It is crucial to maintain a high index of suspicion for concomitant visceral injuries. A 33-year-old man presented after a motor vehicle accident with a T4 type B2.3 fracture with an associated sternum fracture. He was treated with a T4 corpectomy and an expandable titanium cage and lateral plate construct at T3-T5. Two months later he developed focal kyphosis and loosening of his screws. This was addressed with an instrumented posterior fusion from T1 to T8 complicated by a wound infection, pneumonia, and fungal esophagitis requiring several debridements and vacuum assisted closure therapy. Worsening back pain prompted a thoracic computed tomography scan, revealing a dissecting thoracic-aortic aneurysm, which was treated with an endovascular stent graft. Few months later, he presented with fevers, chills, and hemoptysis secondary to Staphylococcus aureus bacteremia, endovascular leak, and T3-T5 osteomyelitis. He was transferred to our institution and restented by the cardiothoracic service. Subsequently, he underwent a thoracotomy, evacuation of infected aneurysmal hematoma with removal of instrumentation. A revision corpectomy with iliac crest autograft reconstruction was performed without complications. The patient's infection and thoracic pain resolved. However, there was a significant delay in treatment, resulting in substantial morbidity. Patients with thoracic type B2 fractures require careful evaluation for concomitant aortic and visceral injuries. Missed associated injuries result in increased morbidity and mortality. PMID:24353965

  16. Thoracic Insufficiency Syndrome.

    PubMed

    Mayer, Oscar; Campbell, Robert; Cahill, Patrick; Redding, Gregory

    2016-03-01

    Thoracic insufficiency syndrome (TIS) is a broad grouping of disorders that have a substantial impact on the chest wall, spine, and in many situations, both. While the conditions are varied, they share a potentially substantial impact on respiratory capacity and development over time and a presentation and need for intervention that is often in early childhood. Addressing these conditions has required a new paradigm that involves both deformity correction and a preservation of growth capacity. While there are now a number of options to treat severe spinal deformity early in life, when the deformity causes or is caused by a chest wall deformity, the Vertical Expandable Prosthetic Titanium Rib(VEPTR) is able to support surgical correction of both. The skeletal correction is often quite dramatic, but the functional measurements of quality of life and pulmonary function often do not show as dramatic and improvement, but consistently show a stabilization indicating control of the progressive thoracospinal disorder that produced TIS. PMID:26747620

  17. [Thoracic findings in neurofibromatosis].

    PubMed

    Camsari, Gngr; Gr, Aygn; Ozkan, Glcihan; Bakan, Nur Dilek; Zengin, Fatma; Klc, Ay?e

    2006-01-01

    Neurofibromatosis type 1 (von Recklinghausen' disease) is an autosomal dominant hereditary syndrome. It is characterized with multiple light brown (caf-au-lait) spots, Lisch nodules and neurofibromas. Thorax and lungs are affected in various forms. Four cases with symptoms of thoracic involvement were investigated in our clinic. Mean age was 46. All cases had dyspnoea and cough; two of them had chest pain. Skin lesions of neurofibromatosis type 1 (NF 1) were pathologically confirmed in all cases. Moreover, case 3 had diffuse interstitial fibrosis and honeycomb pattern. Case 2 had thorax deformity, kyphoscoliosis and intrathoracic benign mass. Case 1 had two neurofibrosarcoma masses on the right hemithorax. Case 4 had multiple intrathoracic neurofibromas. Cases 1 and 3 died within two years after diagnosis due to malignancy and respiratory failure, respectively. Cases 2 and 4 are still under our control. PMID:17001545

  18. Standard of Practice for the Endovascular Treatment of Thoracic Aortic Aneurysms and Type B Dissections

    SciTech Connect

    Fanelli, Fabrizio; Dake, Michael D.

    2009-09-15

    Thoracic endovascular aortic repair (TEVAR) represents a minimally invasive technique alternative to conventional open surgical reconstruction for the treatment of thoracic aortic pathologies. Rapid advances in endovascular technology and procedural breakthroughs have contributed to a dramatic transformation of the entire field of thoracic aortic surgery. TEVAR procedures can be challenging and, at times, extraordinarily difficult. They require seasoned endovascular experience and refined skills. Of all endovascular procedures, meticulous assessment of anatomy and preoperative procedure planning are absolutely paramount to produce optimal outcomes. These guidelines are intended for use in quality-improvement programs that assess the standard of care expected from all physicians who perform TEVAR procedures.

  19. Diabetic thoracic radiculopathy: an unusual cause of post-thoracotomy pain.

    PubMed

    Brewer, R; Bedlack, R; Massey, E

    2003-05-01

    Persistent pain is common following thoracotomy. A 64-year-old retired electrician with Type 2 diabetes presented with chest wall and abdominal pain 3 months following video-assisted thoracoscopic surgery (VATS). Postoperatively the patient had suffered pain despite a functioning thoracic epidural catheter. Following investigation, his persistent pain was due to diabetic thoracic radiculopathy (DTR). The disorder is characterized by pain, sensory loss, abdominal and thoracic muscle weakness in patients with diabetes. As in this patient, the pain and sensory loss usually resolve within one year after onset. The disorder may be distinguished from intercostal neuralgia based upon clinical and electromyographic features. PMID:12749978

  20. Update on the use of abdominal and thoracic endografts for treating aortic aneurysms.

    PubMed

    Chung, Christine; Fremed, Daniel; Han, Daniel; Faries, Peter; Marin, Michael

    2016-03-01

    Endovascular abdominal and thoracic aneurysm repair has heralded a paradigm shift in the management of abdominal and thoracic aortic aneurysms. Randomized controlled trials have suggested superior short-term and equivalent long-term outcomes of endovascular repair compared with open surgery. Existing endografts have undergone several modifications to meet anatomic challenges and improve patient results. In the past, endovascular repair has been limited to infrarenal abdominal aortic aneurysms and isolated thoracic aortic aneurysms. The advent of fenestrated and branched endografts have made endovascular repair of thoracoabdominal and juxtarenal aneurysms possible. Continued evolution of endograft technology will maximize the benefit and minimize complications in patients with a range of aneurysmal disease. PMID:26814185

  1. A fatal outcome of thoracic aortic aneurysm in a male patient with bicuspid aortic valve

    PubMed Central

    Michalak, Ewa; Michałowska, Ilona; Szpakowski, Eugeniusz; Konopka, Anna; Klisiewicz, Anna; Teresa Bilińska, Zofia

    2013-01-01

    Thoracic aortic aneurysm is often an asymptomatic but potentially lethal disease if its most catastrophic complication – aortic dissection – occurs. Thoracic aortic dissection is associated with a high mortality rate despite ongoing improvement in its management. We report a fatal outcome of thoracic aortic aneurysm in a male patient with bicuspid aortic valve. The patient was qualified for elective surgery of the ascending aorta and aortic valve at the age of 39 but he did not agree to undergo the proposed procedure. Three years later, he experienced acute aortic dissection and died despite a prompt diagnosis and complex management. PMID:24570730

  2. Thoracic surgical training in Europe: what has changed recently?

    PubMed Central

    Lerut, Antoon E. M. R.

    2016-01-01

    Training in thoracic surgery (TS) traditionally varies amongst countries in Europe. The theoretical content of the training, the length of training, the amount of self-performed procedures to be done and the definition of training units all differ in European countries. However, in the past two decades, several initiatives were taken to harmonize TS training in Europe. The purpose of this paper is to highlight these initiatives and their impact on today’s TS training in Europe. PMID:27047948

  3. Thoracic surgical training in Europe: what has changed recently?

    PubMed

    Depypere, Lieven P; Lerut, Antoon E M R

    2016-03-01

    Training in thoracic surgery (TS) traditionally varies amongst countries in Europe. The theoretical content of the training, the length of training, the amount of self-performed procedures to be done and the definition of training units all differ in European countries. However, in the past two decades, several initiatives were taken to harmonize TS training in Europe. The purpose of this paper is to highlight these initiatives and their impact on today's TS training in Europe. PMID:27047948

  4. [Angiography in thoracic outlet syndrome].

    PubMed

    Bogalho, L; Seixas, I; Martins, J M; Pisco, J M

    1998-01-01

    The thoracic outlet syndrome is a changeable clinical syndrome caused by compression of the neurovascular bundle of the upper extremity, within the cervicoaxillary channel. From April 1980 through May 1995, 24 patients with clinical thoracic outlet syndrome were evaluated by selective arteriography. The diagnosis was confirmed in seven patients, in 14 the exam was normal and in the last three cases another arterial pathology was detected--subclavian artery occlusion, subclavian artery kinking and vertebral steal syndrome. The authors' aim is to emphasize arteriography as a diagnostic exam for thoracic outlet syndrome, very useful in the detection and localization of arterial compression. It also allows the diagnosis of other arterial entities. PMID:9542176

  5. Solitary lymphoblastic lymphoma of the thoracic spine.

    PubMed

    Park, Dong Am; Park, Sang Gon; Kim, Seok Won

    2012-12-01

    Non-Hodgkin's lymphoma rarely originates from bone, and even more infrequently from a vertebral body. Lymphoblastic lymphoma is a rare type of non-Hodgkin's lymphoma, and results from an abnormality in adaptive immune cells. A 27-year-old man presented with a two-month history of night sweats, weight loss, and severe back pain. Radiological studies demonstrated an osteolytic lesion compressing the subarachnoid space at the T11 level. Posterolateral fusion with decompression was performed and a pathologic examination confirmed lymphoblastic lymphoma of the B-cell precursor type. To our knowledge, this is the first report of solitary lymphoblastic lymphoma from B-cell precursors in of the thoracic spine. Herein, we discuss the presenting symptoms and the management of this rare case of lymphoblastic lymphoma. PMID:23346332

  6. Treatment of middle-super thoracic fractures associated with the sternum fracture

    PubMed Central

    Huang, Zheyuan; Chen, Fengrong; Huang, Jianming; Jian, Guojian; Gong, Hao; Xu, Tianrui; Wang, Bowen; Chen, Ruisong; Chen, Xiaolin; Ye, Zhiyang; Wang, Jun; Xie, Desheng; Liu, Haoyuan

    2015-01-01

    To analyze the characteristics and treatment of middle-super thoracic fractures associated with the sternum fracture, twenty six patients with middle-super thoracic fractures associated with the sternum fracture were retrospectively reviewed. The intimate information of patients including age, gender, cause of injury, site of the sternal fracture, level and type of thoracic vertebral fracture, spinal cord injury and associated injuries were included in the analysis. There were 12 compressed fractures, 11 fracture-dislocations, two burst fracture and one burst-dislocation in this study. Six patients had a complete lesion of the spinal cord, nine sustained a neurologically incomplete injury and 11 were neurologically intact. Nine patients were treated non-operatively and 17 were underwent surgery. All patients were followed up for 8~99 months. Our results showed that road traffic accidents (RTA) and fall were the dominated in the causes. All six patients with a complete paralytic lesion were not recovered with any significant function. Four out of eleven neurologically intact patients had local pain although ten of them remained normal function and one patient turn up tardive paralysis. One of nine patients with incomplete paraplegia returned to normal and four recovered with some function. These study suggested that the sternum is one of the important parts in constructing thoracic cage and plays an important role in maintain the stabilization of the thoracic vertebra. Because of the unique anatomy and biomechanics of the thoracic cage, the classification commonly applied to thoracic vertebra fractures is not suitable for middle-super thoracic fractures associated with the sternum fracture. Middle-super thoracic fractures associated with the sternum fracture was marked by violent force, severe fractures of spine, severe injuries of spinal cord and high incidence of associated injuries. These cases confirm the existence and clinical relevance of the fourth column of the thoracic spine and its role for spinal stability in the patient with middle-super thoracic fracture. PMID:26309652

  7. Treatment of middle-super thoracic fractures associated with the sternum fracture.

    PubMed

    Huang, Zheyuan; Chen, Fengrong; Huang, Jianming; Jian, Guojian; Gong, Hao; Xu, Tianrui; Wang, Bowen; Chen, Ruisong; Chen, Xiaolin; Ye, Zhiyang; Wang, Jun; Xie, Desheng; Liu, Haoyuan

    2015-01-01

    To analyze the characteristics and treatment of middle-super thoracic fractures associated with the sternum fracture, twenty six patients with middle-super thoracic fractures associated with the sternum fracture were retrospectively reviewed. The intimate information of patients including age, gender, cause of injury, site of the sternal fracture, level and type of thoracic vertebral fracture, spinal cord injury and associated injuries were included in the analysis. There were 12 compressed fractures, 11 fracture-dislocations, two burst fracture and one burst-dislocation in this study. Six patients had a complete lesion of the spinal cord, nine sustained a neurologically incomplete injury and 11 were neurologically intact. Nine patients were treated non-operatively and 17 were underwent surgery. All patients were followed up for 8~99 months. Our results showed that road traffic accidents (RTA) and fall were the dominated in the causes. All six patients with a complete paralytic lesion were not recovered with any significant function. Four out of eleven neurologically intact patients had local pain although ten of them remained normal function and one patient turn up tardive paralysis. One of nine patients with incomplete paraplegia returned to normal and four recovered with some function. These study suggested that the sternum is one of the important parts in constructing thoracic cage and plays an important role in maintain the stabilization of the thoracic vertebra. Because of the unique anatomy and biomechanics of the thoracic cage, the classification commonly applied to thoracic vertebra fractures is not suitable for middle-super thoracic fractures associated with the sternum fracture. Middle-super thoracic fractures associated with the sternum fracture was marked by violent force, severe fractures of spine, severe injuries of spinal cord and high incidence of associated injuries. These cases confirm the existence and clinical relevance of the fourth column of the thoracic spine and its role for spinal stability in the patient with middle-super thoracic fracture. PMID:26309652

  8. Advances in chest drain management in thoracic disease.

    PubMed

    George, Robert S; Papagiannopoulos, Kostas

    2016-02-01

    An adequate chest drainage system aims to drain fluid and air and restore the negative pleural pressure facilitating lung expansion. In thoracic surgery the post-operative use of the conventional underwater seal chest drainage system fulfills these requirements, however they allow great variability amongst practices. In addition they do not offer accurate data and they are often inconvenient to both patients and hospital staff. This article aims to simplify the myths surrounding the management of chest drains following chest surgery, review current experience and explore the advantages of modern digital chest drain systems and address their disease-specific use. PMID:26941971

  9. Advances in chest drain management in thoracic disease

    PubMed Central

    George, Robert S.

    2016-01-01

    An adequate chest drainage system aims to drain fluid and air and restore the negative pleural pressure facilitating lung expansion. In thoracic surgery the post-operative use of the conventional underwater seal chest drainage system fulfills these requirements, however they allow great variability amongst practices. In addition they do not offer accurate data and they are often inconvenient to both patients and hospital staff. This article aims to simplify the myths surrounding the management of chest drains following chest surgery, review current experience and explore the advantages of modern digital chest drain systems and address their disease-specific use. PMID:26941971

  10. Surgical Treatment for Central Calcified Thoracic Disk Herniation: A Novel L-Shaped Osteotome.

    PubMed

    Zhuang, Qing-shan; Lun, Deng-xing; Xu, Zhao-wan; Dai, Wei-hua; Liu, Da-yong

    2015-09-01

    Few reports are available on the posterior transfacet approach for the treatment of central calcified thoracic disk herniation (TDH). The objective of this study was to assess outcomes and complications in a consecutive series of patients with TDH who underwent posterior transfacet decompression and diskectomy with segmental instrumentation and fusion. The data for 27 patients (16 males and 11 females) were retrospectively reviewed and analyzed, including clinical presentation, blood loss, operative time, pre- and postoperative complications, visual analog scale, Japanese Orthopedic Association (JOA) score, and Frankel grade. All patients underwent trans-facet decompression and segmental instrumentation with interbody fusion. Mean patient age at surgery was 55.2 years (range, 21-81 years). Average follow-up was 30±19 months (range, 12-50 months). All patients were successfully treated with posterior decompression and segmental instrumentation with interbody fusion. Average operative time was 124±58 minutes (range, 87-180 minutes). Mean blood loss was 439±225 mL (range, 300-1500 mL). Average pre- and postoperative JOA scores were 4.12±0.87 and 8.01±0.97 points, respectively. Overall JOA scores showed a significant postoperative improvement. Overall recovery rates were excellent in 12 patients, good in 6, fair in 5, and unchanged in 1. No patient was classified as worse. The results suggest that the posterior approach using a special L-shaped osteotome is feasible. No major complications occurred while achieving adequate decompression for central calcified TDH. PMID:26375537

  11. Strategies to treat thoracic aortitis and infected aortic grafts.

    PubMed

    Kahlberg, A; Melissano, G; Tshomba, Y; Leopardi, M; Chiesa, R

    2015-04-01

    Infectious thoracic aortitis is a rare disease, especially since the incidence of syphilis and tuberculosis has dropped in western countries. However, the risk to develop an infectious aortitis and subsequent mycotic aneurysm formation is still present, particularly in case of associated endocarditis, sepsis, and in immunosuppressive disorders. Moreover, the number of surgical and endovascular thoracic aortic repairs is continuously increasing, and infective graft complications are observed more frequently. Several etiopathogenetic factors may play a role in thoracic aortic and prosthetic infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination. Also, fistulization of the esophagus or the bronchial tree is commonly associated with these diseases, and it represents a critical event requiring a multidisciplinary management. Knowledge on underlying micro-organisms, antibiotic efficacy, risk factors, and prevention strategies has a key role in the management of this spectrum of infectious diseases involving the thoracic aorta. When the diagnosis of a mycotic aneurysm or a prosthetic graft infection is established, treatment is demanding, often including a number of surgical options. Patients are usually severely compromised by sepsis, and in most cases they are considered unfit for surgery for general clinical conditions or local concerns. Thus, results of different therapeutic strategies for infectious diseases of the thoracic aorta are still burdened with very high morbidity and mortality. In this manuscript, we review the literature regarding the main issues related to thoracic infectious aortitis and aortic graft infections, and we report our personal series of patients surgically treated at our institution for these conditions from 1993 to 2014. PMID:25608572

  12. [Thoracic outlet syndrome].

    PubMed

    Sonoo, Masahiro

    2014-12-01

    Thoracic outlet syndrome (TOS) is a well-known disorder, but its definition has been disputed. TOS is differentiated into five distinct disorders: arterial vascular, venous vascular, traumatic neurovascular, true neurologic (TN-TOS), and nonspecific TOS. TN-TOS is caused by compression of the lower plexus (T1>C8 roots and/or lower trunk) by a fibrous band. The most frequent presenting symptoms are insidious-onset atrophy and weakness of the intrinsic hand muscles, predominantly in the thenar eminence and radial digital flexors. Numbness and sensory loss are usually present, mainly in the ulnar forearm, although severe pain or pain/paresthesia proximal to the elbow can occur; however, sensory symptoms or signs can be absent in some patients. Nerve conduction studies are pathognomonic and show the loss or severe attenuation of the sensory nerve action potential (SNAP) of the medial antebrachial cutaneous nerve. Additionally, they show a severely depressed median compound muscle action potential (CMAP) and, subsequently, a depressed ulnar CMAP and SNAP. TN-TOS is a rare disorder, although its incidence may be higher than previously believed. Hirayama disease is an important differential diagnosis. Nonspecific TOS, which is mainly diagnosed by provocative maneuvers, corresponds to the classical concept of TOS. However, this concept is now challenged and the existence of nonspecific TOS is doubted. PMID:25475030

  13. Accuracy and efficacy of thoracic pedicle screws in scoliosis with patient-specific drill template.

    PubMed

    Lu, Sheng; Zhang, Yuan Z; Wang, Zheng; Shi, Ji H; Chen, Yu B; Xu, Xing M; Xu, Yong Q

    2012-07-01

    With the rapid increase in the use of thoracic pedicle screws in scoliosis, accurate and safe placement of screw within the pedicle is a crucial step during the scoliosis surgery. To make thoracic pedicle screw placement safer various techniques are used, Patient-specific drill template with pre-planned trajectory has been thought as a promising solution, it is critical to assess the efficacy, safety profile with this technique. In this paper, we develop and validate the accuracy and safety of thoracic transpedicular screw placement with patient-specific drill template technique in scoliosis. Patients with scoliosis requiring instrumentation were recruited. Volumetric CT scan was performed on each desired thoracic vertebra and a 3-D reconstruction model was generated from the CT scan data. The optimal screw size and orientation were determined and a drill template was designed with a surface that is the inverse of the posterior vertebral surface. The drill template and its corresponding vertebra were manufactured using rapid prototyping technique and tested for violations. The navigational template was sterilized and used intraoperatively to assist with the placement of thoracic screws. After surgery, the positions of the pedicle screws were evaluated using CT scan and graded for validation. This method showed its ability to customize the placement and the size of each pedicle screw based on the unique morphology of the thoracic vertebra. In all the cases, it was relatively very easy to manually place the drill template on the lamina of the vertebral body during the surgery. This method significantly reduces the operation time and radiation exposure for the members of the surgical team, making it a practical, simple and safe method. The potential use of such a navigational template to insert thoracic pedicle screws in scoliosis is promising. The use of surgical navigation system successfully reduced the perforation rate and insertion angle errors, demonstrating the clear advantage in safe and accurate pedicle screw placement of scoliosis surgery. PMID:22467276

  14. The dying thoracic patient.

    PubMed

    Krishna, G; Raffin, T A

    1998-08-01

    Health care providers should understand that the practice of good medicine includes not only diagnosing and curing diseases, but also effectively communicating with patients and families and helping terminally ill patients die a peaceful and dignified death. Patients in America come from varied backgrounds, and it is important for physicians to consider cultural and religious issues. Physicians should combine their clinical judgment with objective outcome data to provide optimal care for patients. Informed consent should be obtained from patients after offering a detailed plan of care that would include appropriate interventions and the consequences of no intervention. The physician should then assist the patient in making a decision that would provide the best possible future for that individual. The four fundamental principles of biomedical ethics, namely beneficence, nonmaleficence, autonomy, and justice, should be considered when analyzing an ethical problem. Voluntary active euthanasia, which means performing a deliberate act (e.g., administering a lethal injection) to end a patient's life, should not be performed by a physician. Withholding and withdrawing basic and advanced life support constitutes passive euthanasia. Good communication with patients early in the clinical course whenever possible results in an ethically correct decision. A nonconfrontational, sympathetic, and compassionate approach to family members and legal surrogates facing the immediate death of their loved ones leads to the best possible outcome. It is the duty of the physician to assure the patient and the family that he or she will not abandon the patient. Effective communication is the key to solving almost all ethical dilemmas when caring for the dying thoracic patient. PMID:9742345

  15. Robotic surgery

    MedlinePlus

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. ...

  16. Thyroid Surgery

    MedlinePlus

    ... Ways to Donate American Thyroid Association » Thyroid Surgery Thyroid Surgery Thyroid operations are advised for patients who ... Thyroid Nodules Thyroid Surgery Thyroid and Weight Thyroiditis Thyroid Surgery Resources Thyroid Surgery Brochure PDF Thyroid Surgery ...

  17. Robotic surgery of the skull base.

    PubMed

    Kupferman, Michael E; Hanna, Ehab

    2014-06-01

    Minimally invasive skull base surgery has advanced substantially with the advent of endoscopic technology, novel instrumentation, and intraoperative image-guidance capabilities. Robotic technology has been accepted into the surgeon's armamentarium, with its implementation into abdominal, thoracic, and head and neck surgery. However, the application of surgical robotics to the skull base has yet to be achieved. This article highlights current preclinical research and applications of robotic surgery to the skull base. PMID:24882799

  18. Post-surgical thoracic pseudomeningocele causing spinal cord compression.

    PubMed

    Macki, Mohamed; Lo, Sheng-fu L; Bydon, Mohamad; Kaloostian, Paul; Bydon, Ali

    2014-03-01

    Pseudomeningoceles are extradural cerebrospinal fluid collections categorized into three groups: traumatic, congenital, and iatrogenic. Iatrogenic pseudomeningoceles occur after durotomy, usually after cervical or lumbar spine surgery. Although many remain asymptomatic, pseudomeningoceles can compress or herniate the spinal cord and nerve roots. We present a 57-year-old woman who had a thoracic laminectomy and discectomy. Two weeks after surgery, she presented with lower extremity weakness and gait difficulty. Physical examination revealed hyperreflexia and a T11 sensory level. MRI revealed a pseudomeningocele compressing the thoracic spinal cord. The patient underwent surgical drainage of the cyst. On follow-up, she had complete resolution of her symptoms, and MRI did not show a residual lesion. To our knowledge, this is the second documented post-operative pseudomeningocele causing symptomatic spinal cord compression of the thoracic spine. In this article, a review of the literature is presented, including four reported patients with post-traumatic pseudomeningocele causing myelopathic symptoms and 20 patients with iatrogenic pseudomeningocele that resulted in neurological decline due to herniation or compression of neural tissue. Treatment options for these lesions include conservative management, epidural blood patch, lumbar subarachnoid drainage, and lumbo-peritoneal shunt placement. Surgical repair, usually by primary dural closure, remains the definitive treatment modality for iatrogenic symptomatic pseudomeningoceles. PMID:24210805

  19. Missed Traumatic Thoracic Spondyloptosis With no Neurological Deficit: A Case Report and Literature Review

    PubMed Central

    Farooque, Kamran; Khatri, Kavin; Gupta, Ankit

    2016-01-01

    Introduction Traumatic thoracic spondyloptosis is caused by high energy trauma and is usually associated with severe neurological deficit. Cases presenting without any neurological deficit can be difficult to diagnose and manage. Case Presentation We reported a four-week spondyloptosis of the ninth thoracic vertebra over the tenth thoracic vertebra, in a 20-year-old male without any neurological deficit. The patient had associated chest injuries. The spine injury was managed surgically with in-situ posterior instrumentation and fusion. The patient tolerated the operation well and postoperatively there was no neurological deterioration or surgical complication. Conclusions Patients presenting with spondyloptosis with no neurological deficit can be managed with in-situ fusion via pedicle screws, especially when presenting late and with minimal kyphosis. PMID:27218044

  20. Thoracic radiologic manifestations of melioidosis.

    PubMed

    Burivong, Wanaporn; Wu, Xiaohua; Saenkote, Wipawadee; Stern, Eric J

    2012-01-01

    Melioidosis (Burkholderia pseudomallei) is a gram-negative bacterial infection that is highly endemic in Southeast Asia and Oceania. Pulmonary disease is the most common form of involvement. The clinical-radiologic thoracic manifestations of melioidosis can be classified as acute, subacute, subclinical, and chronic forms. Radiographic findings include nodular, alveolar, or mixed infiltration/consolidation with or without cavities. Pleural effusion, pneumothorax, and pericardial involvement can be seen. Melioidosis can easily be confused with other infections, especially tuberculosis. Suspicion of this disease in the proper clinical radiologic setting is important for early diagnosis and treatment. In this article, we provide a broad clinical overview of melioidosis, review the radiologic thoracic manifestations of melioidosis with appropriate clinical correlation, as well as compare and contrast the imaging findings of thoracic melioidosis with other similar pulmonary infections. PMID:23009770

  1. A case of T2 radiculopathy after anterior C5–6 fusion

    PubMed Central

    Takenaka, Tomofumi; Ohnishi, Yu-ichiro; Oshino, Satoru

    2016-01-01

    Thoracic radiculopathy is a rare entity. Symptomatic adjacent-segment disease after anterior cervical fusion occurs commonly in the lower cervical spine segment. We describe the clinical presentation and treatment of T2 radiculopathy after C5–6 anterior fusion. A 60-year-old man presented with the right axillary pain for 3 months. He had undergone C5–6 anterior fusion for cervical spondylosis 5 years prior. Computed tomography (CT) and magnetic resonance images showed T2–3 degenerative disease. C5–6 anterior fusion exacerbated the T2–3 segment involved in the patient’s scoliotic deformity. After 2 months of conservative treatment, we decompressed the T2 foramen via T2–3 hemilaminectomy and partial facet resection. After the surgery, his symptoms disappeared. T2 radiculopathy is rare but should be considered in the differential diagnosis of chest pain. Surgeons should pay attention not only to adjacent-segment disease but also to segmental degeneration at the apex of a scoliotic deformity after cervical anterior fusion. PMID:27197614

  2. Primary Intradural Extramedullary Spinal Melanoma in the Lower Thoracic Spine

    PubMed Central

    Hering, Kathrin; Bresch, Anke; Lobsien, Donald; Mueller, Wolf; Kortmann, Rolf-Dieter; Seidel, Clemens

    2016-01-01

    Background Context. Up to date, only four cases of primary intradural extramedullary spinal cord melanoma (PIEM) have been reported. No previous reports have described a case of PIEM located in the lower thoracic spine with long-term follow-up. Purpose. Demonstrating an unusual, extremely rare case of melanoma manifestation. Study Design. Case report. Methods. We report a case of a 57-year-old female suffering from increasing lower extremity pain, left-sided paresis, and paraesthesia due to spinal cord compression caused by PIEM in the lower thoracic spine. Results. Extensive investigation excluded other possible primary melanoma sites and metastases. For spinal cord decompression, the tumor at level T12 was resected, yet incompletely. Adjuvant radiotherapy was administered two weeks after surgery. The patient was recurrence-free at 104 weeks after radiotherapy but presents with unchanged neurological symptoms. Conclusion. Primary intradural extramedullary melanoma (PIEM) is extremely rare and its clinical course is unpredictable. PMID:27127667

  3. [Thoracic ultrasound in penetrating chest trauma: the tactics management].

    PubMed

    Voskresenskiĭ, O V; Trofimova, E Iu; Radchenko, Iu A; Abakumov, M M

    2011-01-01

    The thoracic ultrasound for the detection of hemothorax and hemopericardium was performed in 655 patients with penetrating thoracic trauma. Ultrasound findings were compared with the results of surgical exploration. Sensitivity and specificity of ultrasound in detection of hemothorax was 72.1 and 90.1%; in detection of hemopericardium - 70.6 and 73.7%, respectively. The results of the US diagnostics depended on patients' position (supine or when seated) and on time interval between the examination and surgery. The isolated US investigation in supine position leads to the increase of false negative results. We consider that in hemodynamically stable patients the doutbtfull US data in detection of hemopericardium is the indication to videothoracoscopy. The lower-chest injuries with the US signs of hemothorax are considered to be the indication for VATS except for the obvious left-side thoracoabdominal injuries. PMID:22433517

  4. Neurological Complications Following Endoluminal Repair of Thoracic Aortic Disease

    SciTech Connect

    Morales, J. P.; Taylor, P. R.; Bell, R. E.; Chan, Y. C.; Sabharwal, T.; Carrell, T. W. G.; Reidy, J. F.

    2007-09-15

    Open surgery for thoracic aortic disease is associated with significant morbidity and the reported rates for paraplegia and stroke are 3%-19% and 6%-11%, respectively. Spinal cord ischemia and stroke have also been reported following endoluminal repair. This study reviews the incidence of paraplegia and stroke in a series of 186 patients treated with thoracic stent grafts. From July 1997 to September 2006, 186 patients (125 men) underwent endoluminal repair of thoracic aortic pathology. Mean age was 71 years (range, 17-90 years). One hundred twenty-eight patients were treated electively and 58 patients had urgent procedures. Anesthesia was epidural in 131, general in 50, and local in 5 patients. Seven patients developed paraplegia (3.8%; two urgent and five elective). All occurred in-hospital apart from one associated with severe hypotension after a myocardial infarction at 3 weeks. Four of these recovered with cerebrospinal fluid (CSF) drainage. One patient with paraplegia died and two had permanent neurological deficit. The rate of permanent paraplegia and death was 1.6%. There were seven strokes (3.8%; four urgent and three elective). Three patients made a complete recovery, one had permanent expressive dysphasia, and three died. The rate of permanent stroke and death was 2.1%. Endoluminal treatment of thoracic aortic disease is an attractive alternative to open surgery; however, there is still a risk of paraplegia and stroke. Permanent neurological deficits and death occurred in 3.7% of the patients in this series. We conclude that prompt recognition of paraplegia and immediate insertion of a CSF drain can be an effective way of recovering spinal cord function and improving the prognosis.

  5. Atypical Giant Hydatid Cyst at the Thoracic Wall Causing Bone and Soft Tissue Destruction: Report of a Case

    PubMed Central

    Zeybek, Arife; Erdoğan, Abdullah; Akdeniz, Şirin; Kenar, Gökçen; Dertsiz, Levent; Demircan, Abid

    2013-01-01

    Hydatid cyst is a zoonotic disease that is common in the Mediterranean region. Thoracic wall, rib or extrapulmonary intrathoracic localization of the cysts is very rare. Giant extrapulmonary intrathoracic hydatid cysts can lead to both diagnostic and treatment difficulties and can be confused with tumor. We present a case of a hydatid cyst with thoracic wall involvement mimicking tumor. We confirmed diagnosis only by surgical exploration and histopathological examination because radiology is not conclusive .Surgical treatment involved the total extirpation of cyst together wide debridement and resection of affected tissue. Primary thoracic wall closures were performed. In thoracic wall localization of cyst, post-operative course of albendazole for 6 weeks associated with surgery can help in sterilizing the cyst and reduce the recurrence rate. In this article, we presented a thoracic wall hydatidosis which is very uncommon asymptomatic presentation of hydatid cyst disease with its surgical management. PMID:24349755

  6. [A case of thoracic actinomycosis].

    PubMed

    Denisova, O A; Cherniavskaia, G M; Beloborodova, É I; Topol'nitskiĭ, E B; Iakimenko, Iu V; Chernogoriuk, G É; Beloborodova, E V; Strezh, Iu A; Vil'danova, L R

    2014-01-01

    A case of thoracic actinomycosis manifest as round shadow in the lung is described. Diagnosis was based on the presence of actinomycetes in a transthoracic lung biopsy sample. Treatment for 3 months resulted in recovery. No relapse was documented during 1 year follow-up period. PMID:25265662

  7. Arthroscopic partial wrist fusion.

    PubMed

    Ho, Pak-Cheong

    2008-12-01

    The wide intraarticular exposure of the wrist joint under arthroscopic view provides an excellent ground for various forms of partial wrist fusion. Combining with percutaneous fixation technique, arthroscopic partial wrist fusion can potentially generate the best possible functional outcome by preserving the maximal motion pertained with each type of partial wrist fusion because the effect of extraarticular adhesion associated with open surgery can be minimized. From November 1997 to May 2008, the author had performed 12 cases of arthroscopic partial wrist fusion, including scaphotrapeziotrapezoid fusion in 3, scaphoidectomy and 4-corner fusion in 4, radioscapholunate fusion in 3, radiolunate fusion in 1, and lunotriquetral fusion in 1 case. Through the radiocarpal or midcarpal joint, the corresponding articular surfaces were denuded of cartilage using arthroscopic burr and curette. Carpal bones involved in the fusion process were then transfixed with K wires percutaneously after alignment corrected and confirmed under fluoroscopic control. Autogenous cancellous bone graft or bone substitute were inserted and impacted to the fusion site through cannula under direct arthroscopic view. Final fixation could be by multiple K wires or cannulated screw system. Early mobilization was encouraged. Surgical complications were minor, including pin tract infection, skin burn, and delay union in 1 case. Uneventful radiologic union was obtained in 9 cases, stable fibrous union in 2, and nonunion in 1. The average follow-up period was 70 months. Symptom was resolved or improved, and functional motion was gained in all cases. All surgical scars were almost invisible, and aesthetic outcome was excellent. PMID:19060685

  8. Emergency Thoracic US: The Essentials.

    PubMed

    Wongwaisayawan, Sirote; Suwannanon, Ruedeekorn; Sawatmongkorngul, Sorravit; Kaewlai, Rathachai

    2016-01-01

    Acute thoracic symptoms are common among adults visiting emergency departments in the United States. Adults with these symptoms constitute a large burden on the overall resources used in the emergency department. The wide range of possible causes can make a definitive diagnosis challenging, even after clinical evaluation and initial laboratory testing. In addition to radiography and computed tomography, thoracic ultrasonography (US) is an alternative imaging modality that can be readily performed in real time at the patient's bedside to help diagnose many thoracic diseases manifesting acutely and in the trauma setting. Advantages of US include availability, relatively low cost, and lack of ionizing radiation. Emergency thoracic US consists of two main parts, lung and pleura US and focused cardiac US, which are closely related. Acoustic mismatches among aerated lungs, pleura, chest wall, and pathologic conditions produce artifacts useful for diagnosis of pneumothorax and pulmonary edema and help in detection of subpleural, pleural, and chest wall pathologic conditions such as pneumonia, pleural effusion, and fractures. Visual assessment of cardiac contractility and detection of right ventricular dilatation and pericardial effusion at focused cardiac US are critical in patients presenting with acute dyspnea and trauma. Additional US examinations of the inferior vena cava for noninvasive volume assessment and of the groin areas for detection of deep venous thrombosis are often performed at the same time. This multiorgan US approach can provide valuable information for emergency treatment of both traumatic and nontraumatic thoracic diseases involving the lungs, pleura, chest wall, heart, and vascular system. Online supplemental material is available for this article. (©)RSNA, 2016. PMID:27035835

  9. Cosmetic Surgery

    MedlinePlus

    ... Looking and feeling your best Cosmetic surgery Cosmetic surgery Teens might have cosmetic surgery for a number ... my body? What are the risks of cosmetic surgery? top People who have cosmetic surgery face many ...

  10. Imaging Techniques for Diagnosis of Thoracic Aortic Atherosclerosis

    PubMed Central

    Jansen Klomp, Wouter W.; Brandon Bravo Bruinsma, George J.; van 't Hof, Arnoud W.; Grandjean, Jan. G.; Nierich, Arno P.

    2016-01-01

    The most severe complications after cardiac surgery are neurological complications including stroke which is often caused by emboli merging from atherosclerosis in the ascending aorta to the brain. Information about the thoracic aorta is crucial in reducing the embolization risk for both surgical open and closed chest procedures such as transaortic heart valve implantation. Several techniques are available to screen the ascending aorta, for example, transesophageal echocardiography (TEE), epiaortic ultrasound, TEE A-view method, manual palpation, computed tomography, and magnetic resonance imaging. This paper provides a description of the advantages and disadvantages of these imaging techniques. PMID:26966580

  11. Imaging Techniques for Diagnosis of Thoracic Aortic Atherosclerosis.

    PubMed

    Jansen Klomp, Wouter W; Brandon Bravo Bruinsma, George J; van 't Hof, Arnoud W; Grandjean, Jan G; Nierich, Arno P

    2016-01-01

    The most severe complications after cardiac surgery are neurological complications including stroke which is often caused by emboli merging from atherosclerosis in the ascending aorta to the brain. Information about the thoracic aorta is crucial in reducing the embolization risk for both surgical open and closed chest procedures such as transaortic heart valve implantation. Several techniques are available to screen the ascending aorta, for example, transesophageal echocardiography (TEE), epiaortic ultrasound, TEE A-view method, manual palpation, computed tomography, and magnetic resonance imaging. This paper provides a description of the advantages and disadvantages of these imaging techniques. PMID:26966580

  12. [Perioperative Pain Management of Minimally Invasive Esophagectomy with Bilateral Continuous Thoracic Paravertebral Block].

    PubMed

    Hida, Kumiko; Murata, Hiroaki; Sakai, Akiko; Ogami, Keiko; Maekawa, Takuji; Hara, Tetsuya

    2016-02-01

    Minimally invasive esophagectomy has become popular as a surgical procedure for esophageal cancer. We describe bilateral continuous thoracic paravertebral blocks for perioperative pain management in 3 patients who underwent minimally invasive esophagectomy. After anesthesia induction, bilateral thoracic paravertebral catheters were placed under ultrasound guidance with the patients in left lateral decubitus position at the sixth or seventh right intercostal space and eighth or ninth left intercostal space, respectively. Multiple ports for thoracoscopic procedures were located between the right third and ninth intercostal spaces. Laparoscopy-assisted gastric tube reconstruction was performed with skin incisions at bilateral T7-10 dermatomes. Intraoperative intermittent bolus injections of ropivacaine through the thoracic paravertebral catheters were used in combination with sevoflurane-remifentanil anesthesia, followed by continuous thoracic paravertebral infusion of ropivacaine for postoperative analgesia with continuous intravenous fentanyl infusion and periodical intravenous acetaminophen administration. Numerical rating scales of postoperative pain at rest and when coughing were 4 or less for 48 hr after surgery. No complications related to thoracic paravertebral catheterization were observed. Bilateral continuous thoracic paravertebral blocks at different intercostal levels can provide good perioperative analgesia for minimally invasive esophagectomy. PMID:27017762

  13. Reoperation for thoracic outlet syndrome.

    PubMed

    Sessions, R T

    1989-01-01

    The clinical history and operative findings in a group of 60 patients who underwent reoperation for thoracic outlet syndrome (TOS) are presented. The patients were severely disabled by arm, shoulder, and neck pain and presented with physical findings pointing to scar fixation of the brachial plexus in the neck (upper tract recurrence) or at the thoracic outlet (lower tract recurrence). The causes of recurrence of TOS as discovered at operation are outlined. Basic principles governing the surgical management of recurrent TOS are elimination of the known causes of recurrence, thorough neurolysis of the brachial plexus, and coverage of the nerves with healthy fat. The role of an expanded PTFE surgical membrane (Gortex) as an adjunct to prevent recurrent scarring is discussed. The surgeon who operates on patients with recurrent TOS must be capable of managing the potential intraoperative complications of severe nerve injury and life threatening bleeding. PMID:2745532

  14. Giant Thoracic Schwannoma in a Rhesus Macaque (Macaca mulatta)

    PubMed Central

    Alves, Derron A; Bell, Todd M; Benton, Carrie; Rushing, Elisabeth J; Stevens, Edward L

    2010-01-01

    A 15-y-old male rhesus macaque with a 3-d history of labored breathing, was culled from a nonhuman primate research colony after thoracic radiographs and exploratory surgery revealed a 10-cm, well-circumscribed space-occupying mass in the posterior thoracic cavity. The multilobulated cystic and necrotic neoplasm was composed of interlacing streams and fascicles of neoplastic spindle cells arranged in Antoni A, and less commonly, Antoni B patterns. Verocay bodies were present also. The neoplasm was encapsulated mostly, and histomorphologic features were benign. Immunohistochemistry indicated that neoplastic cells were positive for vimentin, S100, glial fibrillary acidic protein, and nerve growth factor receptor. Reticulin histochemical staining and immunohistochemical stains for collagen IV and laminin showed a prominent basal lamina surrounding the neoplastic cells. The histologic features and results of the immunohistochemical stains confirmed peripheral nerve origin and were consistent with schwannoma. To our knowledge, this is the first case of thoracic schwannoma in a rhesus macaque and the second reported case of schwannoma in a nonhuman primate. PMID:21205456

  15. Endovascular Repair of Contained Rupture of the Thoracic Aorta

    SciTech Connect

    Morgan, Robert; Loosemore, Tom; Belli, Anna-Maria

    2002-08-15

    Purpose: To assess the efficacy of stent-grafts for the treatment of acute rupture of the thoracic aorta. Methods: Four patients with acute contained ruptures of the thoracic aorta were treated by insertion of stent-grafts. The underlying aortic lesions were aneurysm, acute aortic ulcer, acute type B dissection and giant cell aortitis. The procedures were performed under general anesthesia in three patients and local anesthesia in one patient. Results: All stent-grafts were successfully deployed. All patients survived the procedure and are now alive and well at follow-up (mean 6.3 months, range 44 days-16 months). One patient underwent a second stent procedure 10 days after the first procedure because of a proximal endoleak. All hemothoraces have resolved. There were no complications. Conclusion:Treatment of acute contained ruptures of the thoracic aorta by the insertion of stent-grafts is feasible. The technical success rates,complication rates and patient survival compare favorably with emergency surgery.

  16. Recurrent thoracic outlet syndrome after first rib resection.

    PubMed

    Roos, D B

    1980-01-01

    After initial relief of severe thoracic outlet syndrome by transaxillary resection of the first rib, a few patients may gradually develop recurrent neurologic symptoms in the neck, shoulder, arm and hand caused by postoperative scar tissue entrapment of segments of the brachial plexus. Once they begin, these symptoms may relentlessly progress to the extent they become unresponsive to all forms of conservative management. Two distinct patterns of recurrent TOS, which may occur separately or simultaneously, have been identified. Clinical measures that have proved effective in establishing the diagnosis of these types, the surgical techniques developed to offer relief, and measures to help prevent recurrence are discussed in this paper. A series of 76 patients who underwent operation for disabling recurrent TOS is presented. The principals of the etiology, diagnosis and surgical treatment described have offered significant, if not total, relief of the severe symptoms. The operations which have proved to be the most effective, however, are high-risk, technically demanding procedures which should be performed only by surgeons with wide experience in the anatomy and surgery of the thoracic outlet region. Although these techniques may offer patients significant relief, prevention of the recurrent thoracic outlet syndrome is still the best cure. PMID:7223265

  17. Clinical outcomes after decompressive laminectomy for symptomatic ossification of ligamentum flavum at the thoracic spine.

    PubMed

    Zhong, Zhao-Ming; Wu, Qian; Meng, Ting-Ting; Zhu, Yong-Jian; Qu, Dong-Bin; Wang, Ji-Xing; Jiang, Jian-Ming; Lu, Kai-Wu; Zheng, Shuai; Zhu, Si-Yuan; Chen, Jian-Ting

    2016-06-01

    Ossification of the ligamentum flavum (OLF) is a rare disease that causes acquired thoracic spinal canal stenosis and thoracic myelopathy. The aim of this study was to investigate clinical outcomes of symptomatic thoracic OLF treated using posterior decompressive laminectomy. We retrospectively analyzed the medical records of 22 patients who underwent posterior decompressive laminectomy for symptomatic thoracic OLF. The surgical results were evaluated using the modified Japanese Orthopaedic Association (JOA) scoring system and Hirabayashi recovery rate. The intensity of pain was evaluated using a visual analog scale (VAS). The mean duration of follow-up was 35.6months. The mean JOA score was significantly improved at final follow-up (9.18±standard deviation of 1.53 points [range, 6-11 points]) compared with before surgery (5.64±2.04 points [range, 3-9 points]) (P<0.001). The mean Hirabayashi recovery rate was 65.49% (range, 20-100%). Recovery outcomes were excellent in nine patients, good in eight patients, fair in four patients and unchanged in one patient. No patient was classified as deteriorated. The VAS scores were 2.82±3.08 before surgery and 0.59±1.05 at final follow-up (P=0.001). Surgical complications, which resolved after appropriate and prompt treatment, included dural tear in five patients, cerebrospinal fluid leakage in one patient, immediate postoperative neurologic deterioration in one patient, epidural hematoma in one patient, and wound infection in one patient. Our findings suggest that posterior decompressive laminectomy is an effective treatment for symptomatic thoracic OLF and provides satisfactory clinical improvement, but surgery for thoracic OLF is associated with a relatively high incidence of complications. PMID:26898582

  18. Endovascular Management of Thoracic Aortic Aneurysms

    SciTech Connect

    Fattori, Rossella Russo, Vincenzo; Lovato, Luigi; Buttazzi, Katia; Rinaldi, Giovanni

    2011-12-15

    The overall survival of patients with thoracic aortic aneurysm (TAA) has improved significantly in the past few years. Endovascular treatment, proposed as an alternative to surgery, has been considered a therapeutic innovation because of its low degree of invasiveness, which allows the treatment of even high-surgical risk patients with limited complications and mortality. A major limitation is the lack of adequate evidence regarding long-term benefit and durability because follow-up has been limited to just a few years even in the largest series. The combination of endovascular exclusion with visceral branch revascularization for the treatment of thoraco-abdominal aortic aneurysms involving the visceral aorta has also been attempted. As an alternative, endografts with branches represent a technological evolution that allows treatment of complex anatomy. Even if only small numbers of patients and short follow-up are available, this technical approach, which has with limited mortality (<10%) and paraplegia rates, to expand endovascular treatment to TAA seems feasible. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis.

  19. Minimally invasive esophageal resection and intrathoracic anastomosis for lower thoracic esophageal cancer with single position

    PubMed Central

    Zhao, Lufeng; Ge, Jianjun; Li, Wenshan; Luo, Yaping

    2015-01-01

    There are various esophagectomy approaches for lower thoracic esophageal cancer, and the minimally invasive esophagectomy (MIE) approach shows the advantages of less discomfort, shorter length of stay and a faster recovery to baseline status than open approaches. The current study reports a case of lower thoracic esophageal cancer was treated using a single-position, minimally invasive surgical technique with laparoscopy and thoracoscopy. A 68-year-old man, whose gastroscopy identified the esophageal carcinoma, came to our medical center due to dysphagia for over 1 year. The patient underwent tumor radical resection and intrathoracic anastomosis by laparoscopy and thoracoscopy with single position. The patient has recovered well after the surgery. PMID:26380776

  20. Thoracic aorta aneurysm open repair in heart transplant recipient; the anesthesiologist's perspective.

    PubMed

    Monaco, Fabrizio; Oriani, Alessandro; De Luca, Monica; Bignami, Elena; Sala, Alessandra; Chiesa, Roberto; Melissano, Germano; Zangrillo, Alberto

    2016-01-01

    Many years following transplantation, heart transplant recipients may require noncardiac major surgeries. Anesthesia in such patients may be challenging due to physiological and pharmacological problems regarding allograft denervation and difficult immunosuppressive management. Massive hemorrhage, hypoperfusion, renal, respiratory failure, and infections are some of the most frequent complications related to thoracic aorta aneurysm repair. Understanding how to optimize hemodynamic and infectious risks may have a substantial impact on the outcome. This case report aims at discussing risk stratification and anesthetic management of a 54-year-old heart transplant female recipient, affected by Marfan syndrome, undergoing thoracic aorta aneurysm repair. PMID:26750703

  1. Endovascular Repair of Descending Thoracic Aortic Aneurysm

    PubMed Central

    2005-01-01

    Executive Summary Objective To conduct an assessment on endovascular repair of descending thoracic aortic aneurysm (TAA). Clinical Need Aneurysm is the most common condition of the thoracic aorta requiring surgery. Aortic aneurysm is defined as a localized dilatation of the aorta. Most aneurysms of the thoracic aorta are asymptomatic and incidentally discovered. However, TAA tends to enlarge progressively and compress surrounding structures causing symptoms such as chest or back pain, dysphagia (difficulty swallowing), dyspnea (shortness of breath), cough, stridor (a harsh, high-pitched breath sound), and hoarseness. Significant aortic regurgitation causes symptoms of congestive heart failure. Embolization of the thrombus to the distal arterial circulation may occur and cause related symptoms. The aneurysm may eventually rupture and create a life-threatening condition. The overall incidence rate of TAA is about 10 per 100,000 person-years. The descending aorta is involved in about 30% to 40% of these cases. The prognosis of large untreated TAAs is poor, with a 3-year survival rate as low as 25%. Intervention is strongly recommended for any symptomatic TAA or any TAA that exceeds twice the diameter of a normal aorta or is 6 cm or larger. Open surgical treatment of TAA involves left thoracotomy and aortic graft replacement. Surgical treatment has been found to improve survival when compared with medical therapy. However, despite dramatic advances in surgical techniques for performing such complex operations, operative mortality from centres of excellence are between 8% and 20% for elective cases, and up to 50% in patients requiring emergency operations. In addition, survivors of open surgical repair of TAAs may suffer from severe complications. Postoperative or postprocedural complications of descending TAA repair include paraplegia, myocardial infarction, stroke, respiratory failure, renal failure, and intestinal ischemia. The Technology Endovascular aortic aneurysm repair (EVAR) using a stent graft, a procedure called endovascular stent-graft (ESG) placement, is a new alternative to the traditional surgical approach. It is less invasive, and initial results from several studies suggest that it may reduce mortality and morbidity associated with the repair of descending TAAs. The goal in endovascular repair is to exclude the aneurysm from the systemic circulation and prevent it from rupturing, which is life-threatening. The endovascular placement of a stent graft eliminates the systemic pressure acting on the weakened wall of the aneurysm that may lead to the rupture. However, ESG placement has some specific complications, including endovascular leak (endoleak), graft migration, stent fracture, and mechanical damage to the access artery and aortic wall. The Talent stent graft (manufactured by Medtronic Inc., Minneapolis, MN) is licensed in Canada for the treatment of patients with TAA (Class 4; licence 36552). The design of this device has evolved since its clinical introduction. The current version has a more flexible delivery catheter than did the original system. The prosthesis is composed of nitinol stents between thin layers of polyester graft material. Each stent is secured with oversewn sutures to prevent migration. Review Strategy Objectives To compare the effectiveness and cost-effectiveness of ESG placement in the treatment of TAAs with a conventional surgical approach To summarize the safety profile and effectiveness of ESG placement in the treatment of descending TAAs Measures of Effectiveness Primary Outcome Mortality rates (30-day and longer term) Secondary Outcomes Technical success rate of introducing a stent graft and exclusion of the aneurysm sac from systemic circulation Rate of reintervention (through surgical or endovascular approach) Measures of Safety Complications were categorized into 2 classes: Those specific to the ESG procedure, including rates of aneurysm rupture, endoleak, graft migration, stent fracture, and kinking; and Those due to the intervention, either surgical or endovascular. These include paraplegia, stroke, cardiovascular events, respiratory failure, real insufficiency, and intestinal ischemia. Inclusion Criteria Studies comparing the clinical outcomes of ESG treatment with surgical approaches Studies reporting on the safety and effectiveness of the ESG procedure for the treatment of descending TAAs Exclusion Criteria Studies investigating the clinical effectiveness of ESG placement for other conditions such as aortic dissection, aortic ulcer, and traumatic injuries of the thoracic aorta Studies investigating the aneurysms of the ascending and the arch of the aorta Studies using custom-made grafts Literature Search The Medical Advisory Secretariat searched The International Network of Agencies for Health Technology Assessment and the Cochrane Database of Systematic Reviews for health technology assessments. It also searched MEDLINE, EMBASE, Medline In-Process & Other Non-Indexed Citations, and Cochrane CENTRAL from January 1, 2000 to July 11, 2005 for studies on ESG procedures. The search was limited to English-language articles and human studies. One health technology assessment from the United Kingdom was identified. This systematic review included all pathologies of the thoracic aorta; therefore, it did not match the inclusion criteria. The search yielded 435 citations; of these, 9 studies met inclusion criteria. Summary of Findings Mortality The results of a comparative study found that in-hospital mortality was not significantly different between ESG placement and surgery patients (2 [4.8%] for ESG vs. 6 [11.3%] for surgery). Pooled data from case series with a mean follow-up ranging from 12 to 38 months showed a 30-day mortality and late mortality rate of 3.9% and 5.5%, respectively. These rates are lower than are those reported in the literature for surgical repair of TAA. Case series showed that the most common cause of early death in patients undergoing endovascular repair is aortic rupture, and the most common causes of late death are cardiac events and aortoesophageal or aortobronchial fistula. Technical Success Rate Technical success rates reported by case series are 55% to 100% (100% and 94.4% in 2 studies with all elective cases, 89% in a study with 5% emergent cases, and 55% in a study with 42% emergent cases). Surgical Reintervention In the comparative study, 3 (7.1%) patients in the ESG group and 14 (26.5%) patients in the surgery group required surgical reintervention. In the ESG group, the reasons for surgical intervention were postoperative bleeding at the access site, paraplegia, and type 1 endoleak. In the surgical group, the reasons for surgery were duodenal perforation, persistent thoracic duct leakage, false aneurysm, and 11 cases of postoperative bleeding. Pooled data from case series show that 9 (2.6%) patients required surgical intervention. The reasons for surgical intervention were endoleak (3 cases), aneurysm enlargement and suspected infection (1 case), aortic dissection (1 case), pseudoaneurysm of common femoral artery (1 case), evacuation of hematoma (1 case), graft migration (1 case), and injury to the access site (1 case). Endovascular Revision In the comparative study, 3 (7.1%) patients required endovascular revision due to persistent endoleak. Pooled data from case series show that 19 (5.3%) patients required endovascular revision due to persistent endoleak. Graft Migration Two case series reported graft migration. In one study, 3 proximal and 4 component migrations were noted at 2-year follow-up (total of 5%). Another study reported 1 (3.7%) case of graft migration. Overall, the incidence of graft migration was 2.6%. Aortic Rupture In the comparative study, aortic rupture due to bare stent occurred in 1 case (2%). The pooled incidence of aortic rupture or dissection reported by case series was 1.4%. Postprocedural Complications In the comparative study, there were no statistically significant differences between the ESG and surgery groups in postprocedural complications, except for pneumonia. The rate of pneumonia was 9% for those who received an ESG and 28% for those who had surgery (P = .02). There were no cases of paraplegia in either group. The rate of other complications for ESG and surgery including stroke, cardiac, respiratory, and intestinal ischemia were all 5.1% for ESG placement and 10% for surgery. The rate for mild renal failure was 16% in the ESG group and 30% in the surgery group. The rate for severe renal failure was 11% for ESG placement and 10% for surgery. Pooled data from case series show the following postprocedural complication rates in the ESG placement group: paraplegia (2.2%), stroke (3.9%), cardiac (2.9%), respiratory (8.7%), renal failure (2.8%), and intestinal ischemia (1%). Time-Related Outcomes The results of the comparative study show statistically significant differences between the ESG and surgery group for mean operative time (ESG, 2.7 hours; surgery, 5 hours), mean duration of intensive care unit stay (ESG, 11 days; surgery, 14 days), and mean length of hospital stay (ESG, 10 days; surgery, 30 days). The mean duration of intensive care unit stay and hospital stay derived from case series is 1.6 and 7.8 days, respectively. Ontario-Based Economic Analysis In Ontario, the annual treatment figures for fiscal year 2004 include 17 cases of descending TAA repair procedures (source: Provincial Health Planning Database). Fourteen of these have been identified as “not ruptured” with a mean hospital length of stay of 9.23 days, and 3 cases have been identified as “ruptured,” with a mean hospital length of stay of 28 days. However, because one Canadian Classification of Health Interventions code was used for both procedures, it is not possible to determine how many were repaired with an EVAR procedure or with an open surgical procedure. Hospitalization Costs The current fiscal year forecast of in-hospital direct treatment costs for all in-province procedures of repair of descending TAAs is about $560,000 (Cdn). The forecast in-hospital total cost per year for in-province procedures is about $720,000 (Cdn). These costs include the device cost when the procedure is EVAR (source: Ontario Case Costing Initiative). Professional (Ontario Health Insurance Plan) Costs Professional costs per treated patient were calculated and include 2 preoperative thoracic surgery or EVAR consultations. The professional costs of an EVAR include the fees paid to the surgeons, anesthetist, and surgical assistant (source: fee service codes). The procedure was calculated to take about 150 minutes. The professional costs of an open surgical repair include the fees of the surgeon, anesthetist, and surgical assistant. Open surgical repair was estimated to take about 300 minutes. Services provided by professionals in intensive care units were also taken into consideration, as were the costs of 2 postoperative consultations that the patients receive on average once they are discharged from the hospital. Therefore, total Ontario Health Insurance Plan costs per treated patient treated with EVAR are on average $2,956 (ruptured or not ruptured), as opposed to $5,824 for open surgical repair and $6,157 for open surgical repair when the aneurysm is ruptured. Conclusions Endovascular stent graft placement is a less invasive procedure for repair of TAA than is open surgical repair. There is no high-quality evidence with long-term follow-up data to support the use of EVAR as the first choice of treatment for patients with TAA that are suitable candidates for surgical intervention. However, short- and medium-term outcomes of ESG placement reported by several studies are satisfactory and comparable to surgical intervention; therefore, for patients at high risk of surgery, it is a practical option to consider. Short- and medium-term results show that the benefit of ESG placement over the surgical approach is a lower 30-day mortality and paraplegia rate; and shorter operative time, ICU stay, and hospital stay. PMID:23074469

  2. Thoracic spine sports-related injuries.

    PubMed

    Menzer, Heather; Gill, G Keith; Paterson, Andrew

    2015-01-01

    Although sports-related injuries to the thoracic spine are relatively uncommon, they are among the most feared due to the potential for catastrophic neurologic injury. The increased biomechanical support of the thoracic spine makes injuries in this region particularly rare compared with the cervical and lumbar spine. As a result, thoracic spine injuries can be missed easily, difficult to diagnose, and problematic to treat. Recognition of mechanism and awareness of injury patterns help physicians determine a diagnosis and create an index of suspicion for unstable thoracic spine injuries. Aggressive full-contact sports receive the most attention for spinal injury; however several sports with repetitive loading of the spine can cause severe injuries, including rowing, gymnastics, and golf. The goal of this article was to provide an overview of the unique anatomic and biomechanical features of the thoracic spine and to discuss some of the more common thoracic injuries that can affect athletes. PMID:25574880

  3. [Traumatic fracture of the thoracic spine T1-T10].

    PubMed

    Falavigna, Asdrubal; Righesso Neto, Orlando; Ferraz, Fernando Antonio Patriani; Boniatti, Mrcio Manozzo

    2004-12-01

    We describe the incidence, causes, management and prognosis of traumatic fractures of the thoracic spine from T1 to T10 in surgical cases of traumatic fractures of spine during the period from June 1994 to June 2003 studied retrospectively. The type of fracture was determined according to the Gertzbein classification, and the degree of stability using the Denis classification. The neurological picture at admission and 30 days after surgery was evaluated using the ASIA/IMSOP classification. Surgery was performed in patients with complete spinal cord injury (n=7) for the purpose of stabilization using the posterior approach. In cases without spinal cord injury or incomplete injury (n=12), the surgical procedure was performed aiming to decompress the nerve tissue, to correct the alignment of the spine and to stabilize the spine. PMID:15608977

  4. Posterior spinal fusion for adolescent idiopathic thoracolumbar/lumbar scoliosis: clinical outcomes and predictive radiological factors for extension of fusion distal to caudal end vertebra.

    PubMed

    Roberts, S B; Tsirikos, A I; Subramanian, A S

    2014-08-01

    Clinical, radiological, and Scoliosis Research Society-22 questionnaire data were reviewed pre-operatively and two years post-operatively for patients with thoracolumbar/lumbar adolescent idiopathic scoliosis treated by posterior spinal fusion using a unilateral convex segmental pedicle screw technique. A total of 72 patients were included (67 female, 5 male; mean age at surgery 16.7 years (13 to 23)) and divided into groups: group 1 included 53 patients who underwent fusion between the vertebrae at the limit of the curve (proximal and distal end vertebrae); group 2 included 19 patients who underwent extension of the fusion distally beyond the caudal end vertebra. A mean scoliosis correction of 80% (45% to 100%) was achieved. The mean post-operative lowest instrumented vertebra angle, apical vertebra translation and trunk shift were less than in previous studies. A total of five pre-operative radiological parameters differed significantly between the groups and correlated with the extension of the fusion distally: the size of the thoracolumbar/lumbar curve, the lowest instrumented vertebra angle, apical vertebra translation, the Cobb angle on lumbar convex bending and the size of the compensatory thoracic curve. Regression analysis allowed an equation incorporating these parameters to be developed which had a positive predictive value of 81% in determining whether the lowest instrumented vertebra should be at the caudal end vertebra or one or two levels more distal. There were no differences in the Scoliosis Research Society-22 outcome scores between the two groups (p = 0.17). In conclusion, thoracolumbar/lumbar curves in patients with adolescent idiopathic scoliosis may be effectively treated by posterior spinal fusion using a unilateral segmental pedicle screw technique. Five radiological parameters correlate with the need for distal extension of the fusion, and an equation incorporating these parameters reliably informs selection of the lowest instrumented vertebra. PMID:25086125

  5. Heart Surgery

    MedlinePlus

    ... heart with a healthy heart from a donor Traditional heart surgery, often called open-heart surgery, is ... off-pump, or beating heart, surgery. It's like traditional open-heart surgery because the chest bone is ...

  6. Lung surgery

    MedlinePlus

    ... Lung tissue removal; Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... do surgery on your lungs are thoracotomy and video-assisted thoracoscopic surgery (VATS). Lung surgery using a ...

  7. Cataract Surgery

    MedlinePlus

    ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ... Uveitis Focus On Pediatric Ophthalmology Education Center Oculofacial Plastic Surgery Center Laser Surgery Education Center Redmond Ethics Center ...

  8. Subsequent surgery rates after cervical total disc replacement using a Mobi-C Cervical Disc Prosthesis versus anterior cervical discectomy and fusion: a prospective randomized clinical trial with 5-year follow-up.

    PubMed

    Jackson, Robert J; Davis, Reginald J; Hoffman, Gregory A; Bae, Hyun W; Hisey, Michael S; Kim, Kee D; Gaede, Steven E; Nunley, Pierce Dalton

    2016-05-01

    OBJECTIVE Cervical total disc replacement (TDR) has been shown in a number of prospective clinical studies to be a viable treatment alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative disc disease. In addition to preserving motion, evidence suggests that cervical TDR may result in a lower incidence of subsequent surgical intervention than treatment with fusion. The goal of this study was to evaluate subsequent surgery rates up to 5 years in patients treated with TDR or ACDF at 1 or 2 contiguous levels between C-3 and C-7. METHODS This was a prospective, multicenter, randomized, unblinded clinical trial. Patients with symptomatic degenerative disc disease were enrolled to receive 1- or 2-level treatment with either TDR as the investigational device or ACDF as the control treatment. There were 260 patients in the 1-level study (179 TDR and 81 ACDF patients) and 339 patients in the 2-level study (234 TDR and 105 ACDF patients). RESULTS At 5 years, the occurrence of subsequent surgical intervention was significantly higher among ACDF patients for 1-level (TDR, 4.5% [8/179]; ACDF, 17.3% [14/81]; p = 0.0012) and 2-level (TDR, 7.3% [17/234]; ACDF, 21.0% [22/105], p = 0.0007) treatment. The TDR group demonstrated significantly fewer index- and adjacent-level subsequent surgeries in both the 1- and 2-level cohorts. CONCLUSIONS Five-year results showed treatment with cervical TDR to result in a significantly lower rate of subsequent surgical intervention than treatment with ACDF for both 1 and 2 levels of treatment. Clinical trial registration no.: NCT00389597 ( clinicaltrials.gov ). PMID:26799118

  9. [Sources and developments in heart surgery].

    PubMed

    Borst, H G

    1992-01-01

    This contribution deals with the development of the individual ramifications of cardiac surgery from their inception to the presence and especially highlights the personalities responsible for these breakthroughs. The trials and errors of these developments are described along with the multitude of presently unanswered questions including those related to thoracic organ transplantation, cardiac assistance, and replacement as well as the socio-economical aspects of modern cardiac surgery. PMID:1441775

  10. Full Endoscopic Spinal Surgery Techniques: Advancements, Indications, and Outcomes

    PubMed Central

    Yue, James J.; Long, William

    2015-01-01

    Advancements in both surgical instrumentation and full endoscopic spine techniques have resulted in positive clinical outcomes in the treatment of cervical, thoracic, and lumbar spine pathologies. Endoscopic techniques impart minimal approach related disruption of non-pathologic spinal anatomy and function while concurrently maximizing functional visualization and correction of pathological tissues. An advanced understanding of the applicable functional neuroanatomy, in particular the neuroforamen, is essential for successful outcomes. Additionally, an understanding of the varying types of disc prolapse pathology in relation to the neuroforamen will result in more optimal surgical outcomes. Indications for lumbar endoscopic spine surgery include disc herniations, spinal stenosis, infections, medial branch rhizotomy, and interbody fusion. Limitations are based on both non spine and spine related findings. A high riding iliac wing, a more posteriorly located retroperitoneal cavity, an overly distal or proximally migrated herniated disc are all relative contra-indications to lumbar endoscopic spinal surgery techniques. Modifications in scope size and visual field of view angulation have enabled both anterior and posterior cervical decompression. Endoscopic burrs, electrocautery, and focused laser technology allow for the least invasive spinal surgical techniques in all age groups and across varying body habitus. Complications include among others, dural tears, dysesthsia, nerve injury, and infection. PMID:26114086

  11. [Wound infection and its treatment. In thoracic and cardiovascular surgery].

    PubMed

    Kalmar, P; Akrami, R; Rodewald, G

    1982-01-01

    Wound infections following aseptic operations are considered to be hospital infections. Among 4,166 patients operated on between 1973 and 1980 for cardiovascular diseases, there have been wound infections in 58 cases (1.4%) and associated sternal or mediastinal infection in 11 cases (0.26%). One-third of the infections were caused by staphylococci. In superficial infections therapy consisted in healing by second intention. In deep infections surgical intervention with débridement and irrigation was the method of choice. PMID:7169860

  12. Whole organ and tissue reconstruction in thoracic regenerative surgery.

    PubMed

    Lim, Mei Ling; Jungebluth, Philipp; Ajalloueian, Fatemeh; Friedrich, Linda Helen; Gilevich, Irina; Grinnemo, Karl-Henrik; Gubareva, Elena; Haag, Johannes C; Lemon, Greg; Sjöqvist, Sebastian; Caplan, Arthur L; Macchiarini, Paolo

    2013-10-01

    Development of novel prognostic, diagnostic, and treatment options will provide major benefits for millions of patients with acute or chronic respiratory dysfunction, cardiac-related disorders, esophageal problems, or other diseases in the thorax. Allogeneic organ transplant is currently available. However, it remains a trap because of its dependency on a very limited supply of donated organs, which may be needed for both initial and subsequent transplants. Furthermore, it requires lifelong treatment with immunosuppressants, which are associated with adverse effects. Despite early clinical applications of bioengineered organs and tissues, routine implementation is still far off. For this review, we searched the PubMed, MEDLINE, and Ovid databases for the following keywords for each tissue or organ: tissue engineering, biological and synthetic scaffold/graft, acellular and decelluar(ized), reseeding, bioreactor, tissue replacement, and transplantation. We identified the current state-of-the-art practices in tissue engineering with a focus on advances during the past 5 years. We discuss advantages and disadvantages of biological and synthetic solutions and introduce novel strategies and technologies for the field. The ethical challenges of innovation in this area are also reviewed. PMID:24079685

  13. Clinical pathway for thoracic surgery in an Italian centre

    PubMed Central

    Salati, Michele; Tiberi, Michela; Sabbatini, Armando; Gentili, Paolo

    2016-01-01

    Clinical care pathways are developed to standardize postoperative patient care and the main impetus is to improve quality of care, decrease variation in care and reduce costs. We report the clinical pathway of care adopted at our centre since the introduction of Uniportal VATS program for major lung resections. PMID:26941966

  14. Clinical pathway for thoracic surgery in an Italian centre.

    PubMed

    Refai, Majed; Salati, Michele; Tiberi, Michela; Sabbatini, Armando; Gentili, Paolo

    2016-02-01

    Clinical care pathways are developed to standardize postoperative patient care and the main impetus is to improve quality of care, decrease variation in care and reduce costs. We report the clinical pathway of care adopted at our centre since the introduction of Uniportal VATS program for major lung resections. PMID:26941966

  15. Medical teleconference about thoracic surgery using free Internet software.

    PubMed

    Obuchi, Toshiro; Shiono, Hiroyuki; Shimada, Junichi; Kaga, Kichizo; Kurihara, Masatoshi; Iwasaki, Akinori

    2011-11-01

    Surgical teleconferences using advanced academic networks are becoming common; however, reports regarding Internet teleconferencing using free software packages such as Skype, USTREAM, and Dropbox are very rare. Teleconferences concerning mainly surgical techniques were held five times between Fukuoka University Hospital and other institutions from April to September 2010. These teleconferences used Skype and USTREAM as videophones to establish communication. Both PowerPoint presentations and surgical videos were made. These presentation files were previously sent to all stations via mail, e-mail, or Dropbox, and shared. A slide-show was simultaneously performed following the presenter's cue in each station. All teleconferences were successfully completed, even though there were minor instances of the Skype link being broken for unknown reasons during the telecommunication. Internet surgical teleconferences using ordinary software are therefore considered to be sufficiently feasible. This method will become more convenient and common as the Internet environments advance. PMID:21969167

  16. Video-assisted thoracic surgery for pulmonary sequestration.

    PubMed

    Aydoğdu, Koray; Sayılır, Ebru; İncekara, Funda; Fındık, Göktürk; Kaya, Sadi

    2015-11-01

    Bronchopulmonary sequestration is a rare developmental abnormality. Most cases are asymptomatic and found incidentally. The definitive treatment for bronchopulmonary sequestration is surgical excision. An 18-year-old man was admitted to our clinic with longstanding cough, fever, and dense sputum. Chest computed tomography identified cystic bronchiectasis in common areas of the left lower lobe, and parenchymal destruction with air-fluid levels. A left lower lobectomy was performed via a video-thoracoscopic approach. PMID:25957092

  17. Comparison of thoracic manipulation with incentive spirometry in preventing postoperative atelectasis.

    PubMed

    Sleszynski, S L; Kelso, A F

    1993-08-01

    Atelectasis is a preventable complication that often occurs after upper abdominal surgery. In our 1-year randomized, researcher-blinded trial, low-risk cholecystectomy patients were subjected to either the thoracic lymphatic pump (n = 21) or incentive spirometry (n = 21) to prevent atelectasis. The treatment groups were equal with respect to risk factors for atelectasis and deviation of preoperative respiratory parameters (forced vital capacity [FVC] and forced expiratory volume in one second [FEV1]) from the predicted values. Atelectasis occurred in 2 (5%) of 21 patients regardless of whether incentive spirometry or thoracic lymphatic pump treatment was used. Study patients treated with the thoracic lymphatic pump technique had an earlier recovery and quicker return toward preoperative values for FVC and FEV1 than patients treated with incentive spirometry. PMID:8407387

  18. Surgical complications associated with spinal decompression surgery in a Japanese cohort.

    PubMed

    Takai, Keisuke; Matsumoto, Takahiro; Yabusaki, Hajime; Yokosuka, Junichi; Hatanaka, Ryo; Taniguchi, Makoto

    2016-04-01

    The aim of the present study was to identify risk factors for perioperative complications associated with spinal surgery for cervical, thoracic, and lumber spinal stenosis in a Japanese cohort. Patients with spinal stenosis who underwent spinal surgery between 2008 and 2012 were included. Neurological and/or surgical site complications within 30days of index surgery were retrospectively collected, and the rates of complications were calculated. Using univariate and multivariate logistic regression analyses, risk factors for complications were identified. A total of 364 patients underwent 407 spinal surgeries. Of the 407 surgeries performed, 236 were cervical, 28 were thoracic, and 143 were lumbar surgeries. Ossification of the ligamentum flavum was the most common diagnosis in patients with thoracic stenosis (85%), whereas spinal degenerative stenosis and disc herniation were the two most common diagnoses in patients with cervical and lumbar stenosis. Laminoplasty and laminectomy alone were the two most frequently performed procedures. The rate of complications was greater in patients with thoracic stenosis (36%) than in those with cervical (16%) or lumbar stenosis (13%, p=0.013). After a multivariate analysis, only thoracic stenosis (odds ratio 2.87) remained an independent risk factor for surgical complications. The novel result of the present study was that the level of stenosis in the spine had a significant impact on complications after spinal surgery in a Japanese cohort. The result can be explained by the fact that challenging ossified lesions are a common cause of thoracic stenosis in eastern Asia. PMID:26791473

  19. Biomarkers in descending thoracic aortic dissection.

    PubMed

    Shalhub, Sherene; Dua, Anahita; Brooks, Jared

    2014-12-01

    The clinical application of serum biomarkers (d-dimer, C-reactive protein) to predict the natural history of descending thoracic aortic dissection remains elusive. In this review, our current understanding of biomarkers in descending thoracic aortic dissection detection, predicting complications, and aiding in patient management is discussed. PMID:26073830

  20. Retropancreatic Teratoma with Intra-thoracic Extension

    PubMed Central

    Bakhshi, Girish D.; Wankhede, Kishor R.; Bhadarwar, Ajay H.; Tayade, Mukund B.; Shenoy, Sachin S.; Gore, Sandeep T.

    2013-01-01

    Primary retroperitoneal teratoma is a rare entity in adults. We present a case of 23-yearsold female who presented with complaint of abdominal pain in left upper quadrant. Computed tomography scan revealed a retroperitoneal retropancreatic teratoma near celiac axis with intra thoracic extension. Laparotomy with tumor resection was done. The case report is interesting for intra thoracic extension of retropancreatic teratoma. PMID:24765493

  1. Spinal dermoid sinus in a Dachshund with vertebral and thoracic limb malformations

    PubMed Central

    2014-01-01

    Background Dermoid sinus is an uncommon epithelial-lined fistula that may be associated with vertebral malformations. In humans, Klippel-Feil syndrome (KFS) is a rare condition characterized by congenital cervical vertebral fusion and may be associated with other developmental defects, including dermoid sinus. The present case report describes an adult Dachshund with cervical and cranial thoracic vertebral malformations as well as thoracic limb malformations resembling KFS with a concurrent type IV dermoid sinus. Case presentation A 1.5 year-old Dachshund with congenital thoracic limbs deformities and cervical-thoracic vertebral malformations presented with cervical hyperesthesia, rigidity of the cervical musculature and tetraparesis. Neurologic, radiographic, and computed tomography (CT) (2D, 3D, CT fistulography) examinations revealed skeletal anomalies, a dermoid sinus in the cranial thoracic region and epidural gas within the vertebral canal. Surgical resection and histopathological evaluation of the sinus tract were performed and confirmed a type IV dermoid sinus. The clinical signs progressively recovered postoperatively, and no recurrent signs were observed after 6 months of follow-up. Conclusions Cervical vertebral malformations associated with limbs anomalies have not been reported in dogs and may represent a condition similar to KFS in humans. KFS can occur concurrently with other congenital conditions including dermoid sinus and should be included among the complex congenital anomalies described in dogs. PMID:24593884

  2. The Thoracic Shape of Hominoids

    PubMed Central

    Chan, Lap Ki

    2014-01-01

    In hominoids, the broad thorax has been assumed to contribute to their dorsal scapular position. However, the dorsoventral diameter of their cranial thorax was found in one study to be longer in hominoids. There are insufficient data on thoracic shape to explain the relationship between broad thorax and dorsal scapular position. The current study presents data on multilevel cross-sectional shape and volume distribution in a range of primates. Biplanar radiographs of intact fluid-preserved cadavers were taken to measure the cross-sectional shape of ten equally spaced levels through the sternum (called decisternal levels) and the relative volume of the nine intervening thoracic segments. It was found that the cranial thorax of hominoids is larger and broader (except in the first two decisternal levels) than that of other primates. The cranial thorax of hominoids has a longer dorsoventral diameter because the increase in dorsoventral diameter caused by the increase in the volume of the cranial thorax overcompensates for the decrease caused by the broadening of the cranial thorax. The larger and broader cranial thorax in hominoids can be explained as a locomotor adaptation for scapular gliding and as a respiratory adaptation for reducing the effects of orthograde posture on ventilation-perfusion inequality. PMID:24818026

  3. Future of thoracic PET scanning.

    PubMed

    Johnson, Geoffrey B; Peller, Patrick J; Kemp, Bradley J; Ryu, Jay H

    2015-01-01

    The advances in PET scanning for thoracic diseases that are deemed most likely to have clinical impact in the near-term future are highlighted in this article. We predict that the current practice of medicine will continue to embrace the power of molecular imaging and specifically PET scanning. 18F-fluorodeoxyglucose-PET scanning will continue to evolve and will expand into imaging of inflammatory disorders. New clinically available PET scan radiotracers, such as PET scan versions of octreotide and amyloid imaging agents, will expand PET imaging into different disease processes. Major improvements in thoracic PET/CT imaging technology will become available, including fully digital silicone photomultipliers and Bayesian penalized likelihood image reconstruction. These will result in significant improvements in image quality, improving the evaluation of smaller lung nodules and metastases and allowing better prediction of prognosis. The birth of clinical PET/MRI scan will add new imaging opportunities, such as better PET imaging of pleural diseases currently obscured by complex patient motion. PMID:25560859

  4. Crossed-screw fixation of the unstable thoracic and lumbar spine.

    PubMed

    Benzel, E C; Baldwin, N G

    1995-01-01

    An ideal spinal construct should immobilize only the unstable spinal segments, and thus only the segments fused. Pedicle fixation techniques have provided operative stabilization with the instrumentation of a minimal number of spinal segments; however, some failures have been observed with pedicle instrumentation. These failures are primarily related to excessive preload forces and limitations caused by the size and orientation of the pedicles. To circumvent these problems, a new technique, the crossed-screw fixation method, was developed and is described in this report. This technique facilitates short-segment spinal fixation and uses a lateral extracavitary approach, which provides generous exposure for spinal decompression and interbody fusion. The technique employs two large transverse vertebral body screws (6.5 to 8.5 mm in diameter) to bear axial loads, and two unilateral pedicle screws (placed on the side of the exposure) to restrict flexion and extension deformation around the transverse screws and to provide three-dimensional deformity correction. The horizontal vertebral body and the pedicle screws are connected to rods and then to each other via rigid crosslinking. The transverse vertebral body screws are unloaded during insertion by placing the construct in a compression mode after the interbody bone graft is placed, thus optimizing the advantage gained by the significant "toe-in" configuration provided and further decreasing the chance for instrumentation failure. The initial results of this technique are reported in a series of 10 consecutively treated patients, in whom correction of the deformity was facilitated. Follow-up examination (average 10.1 months after surgery) demonstrated negligible angulation. Chronic pain was minimal. The crossed-screw fixation technique is biomechanically sound and offers a rapid and safe form of short-segment three-dimensional deformity correction and solid fixation when utilized in conjunction with the lateral extracavitary approach to the unstable thoracic and lumbar spine. This approach also facilitates the secure placement of an interbody bone graft. PMID:7815111

  5. Computed tomography of thoracic and lumbar spine fractures that have been treated with Harrington instrumentation

    SciTech Connect

    Golimbu, C.; Firooznia, H.; Rafii, M.; Engler, G.; Delman, A.

    1984-06-01

    Twenty patients with fractures of the thoracic and lumbar spine underwent computed tomography (CT) following Harrington distraction instrumentation and a spinal fusion. CT was done to search for a cause of persistent cord or nerve root compression in those patients who failed to improve and completely recover their partial neurologic deficit (14 cases). The most common abnormality was the presence of residual bone fragments originating in the burst fracture of a vertebral body displaced posteriorly, into the spinal canal. In patients with complications in the late recovery period, CT found exuberant callus indenting the canal or lack of fusion of the bone grafts placed in the anterolateral aspect of the vertebral bodies. This experience indicates that CT is the modality of choice for spinal canal evaluation in those patients who fail to have an optimal clinical course following fractures of the thoracic and lumbar spine treated with Harrington rods.

  6. Effect of thoracic arthrodesis in prepubertal New Zealand white rabbits on cardio-pulmonary function

    PubMed Central

    Canavese, Federico; Dimeglio, Alain; Barbetta, Davide; Pereira, Bruno; Fabbro, Sergio; Bassini, Federica; Canavese, Bartolomeo

    2014-01-01

    Background: This experimental study was aimed at evaluating the type of cardiac and pulmonary involvement, in relation to changes of the thoracic spine and cage in prepubertal rabbits with nondeformed spine following dorsal arthrodesis. The hypothesis was that T1-T12 arthrodesis modified thoracic dimensions, but would not modify cardiopulmonary function once skeletal maturity was reached. Materials and Methods: The study was conducted in 16 female New Zealand White (NZW) rabbits. Nine rabbits were subjected to T1-T12 dorsal arthrodesis while seven were sham-operated. Echocardiographic images were obtained at 12 months after surgery and parameters for 2-dimensional and M-mode echocardiographic variables were assessed. One week before echocardiographic examination, blood samples were withdrawn from the animals’ central artery of the left ear to obtain blood gas values. One week after echocardiographic assessment, a thoracic CT scan was performed under general anesthesia. Chest depth (CD) and width (CW), thoracic kyphosis (ThK) and sternal length (StL) were measured; thoracic index (ThI), expressed as CD/CW ratio. All subjects were euthanized after the CT scan. Heart and lungs were subsequently removed to measure weight and volume. Results: The values for 2-dimensional and M-mode echocardiographic variables were found to be uniformly and significantly higher, compared to those reported in anesthetized rabbits. CD, ThK, and StL were considerably lower in operated rabbits, as compared to the ones that were sham-operated. Similarly, the ThI was lower in operated rabbits than in sham-operated ones. Conclusion: Irregularities in thoracic cage growth resulting from thoracic spine arthrodesis did not alter blood and echocardiographic parameters in NZW rabbits. PMID:24741141

  7. Massive Chylopericardium after Coronary Artery Bypass Surgery

    PubMed Central

    Pellegrini, Ronald V.; Travers, Daniel J.; Marrangoni, Albert G.; Dimarco, Ross F.; Bekoe, Seth; Grant, Kathleen J.; Woelfel, George F.

    1987-01-01

    Massive isolated chylopericardium is a rare postoperative complication of coronary artery bypass surgery. In the following case, massive chylopericardium developed after a coronary artery bypass procedure in which the left internal mammary artery was used for revascularization. The chylopericardium resulted from direct trauma to the thoracic duct during mobilization of the left internal mammary artery to its origin at the subclavian artery. With adequate drainage, the problem was resolved. In cases in which drainage persists, ligation of the thoracic duct may be necessary. (Texas Heart Institute Journal 1987; 14:318-320) Images PMID:15227320

  8. Minimally invasive mediastinal surgery

    PubMed Central

    Melfi, Franca M. A.; Mussi, Alfredo

    2016-01-01

    In the past, mediastinal surgery was associated with the necessity of a maximum exposure, which was accomplished through various approaches. In the early 1990s, many surgical fields, including thoracic surgery, observed the development of minimally invasive techniques. These included video-assisted thoracic surgery (VATS), which confers clear advantages over an open approach, such as less trauma, short hospital stay, increased cosmetic results and preservation of lung function. However, VATS is associated with several disadvantages. For this reason, it is not routinely performed for resection of mediastinal mass lesions, especially those located in the anterior mediastinum, a tiny and remote space that contains vital structures at risk of injury. Robotic systems can overcome the limits of VATS, offering three-dimensional (3D) vision and wristed instrumentations, and are being increasingly used. With regards to thymectomy for myasthenia gravis (MG), unilateral and bilateral VATS approaches have demonstrated good long-term neurologic results with low complication rates. Nevertheless, some authors still advocate the necessity of maximum exposure, especially when considering the distribution of normal and ectopic thymic tissue. In recent studies, the robotic approach has shown to provide similar neurological outcomes when compared to transsternal and VATS approaches, and is associated with a low morbidity. Importantly, through a unilateral robotic technique, it is possible to dissect and remove at least the same amount of mediastinal fat tissue. Preliminary results on early-stage thymomatous disease indicated that minimally invasive approaches are safe and feasible, with a low rate of pleural recurrence, underlining the necessity of a “no-touch” technique. However, especially for thymomatous disease characterized by an indolent nature, further studies with long follow-up period are necessary in order to assess oncologic and neurologic results through minimally invasive approaches. Furthermore, increased robotic experience and studies, including randomized controlled trials, are needed to validate the findings of the current literature. PMID:26904426

  9. Minimally invasive mediastinal surgery.

    PubMed

    Melfi, Franca M A; Fanucchi, Olivia; Mussi, Alfredo

    2016-01-01

    In the past, mediastinal surgery was associated with the necessity of a maximum exposure, which was accomplished through various approaches. In the early 1990s, many surgical fields, including thoracic surgery, observed the development of minimally invasive techniques. These included video-assisted thoracic surgery (VATS), which confers clear advantages over an open approach, such as less trauma, short hospital stay, increased cosmetic results and preservation of lung function. However, VATS is associated with several disadvantages. For this reason, it is not routinely performed for resection of mediastinal mass lesions, especially those located in the anterior mediastinum, a tiny and remote space that contains vital structures at risk of injury. Robotic systems can overcome the limits of VATS, offering three-dimensional (3D) vision and wristed instrumentations, and are being increasingly used. With regards to thymectomy for myasthenia gravis (MG), unilateral and bilateral VATS approaches have demonstrated good long-term neurologic results with low complication rates. Nevertheless, some authors still advocate the necessity of maximum exposure, especially when considering the distribution of normal and ectopic thymic tissue. In recent studies, the robotic approach has shown to provide similar neurological outcomes when compared to transsternal and VATS approaches, and is associated with a low morbidity. Importantly, through a unilateral robotic technique, it is possible to dissect and remove at least the same amount of mediastinal fat tissue. Preliminary results on early-stage thymomatous disease indicated that minimally invasive approaches are safe and feasible, with a low rate of pleural recurrence, underlining the necessity of a "no-touch" technique. However, especially for thymomatous disease characterized by an indolent nature, further studies with long follow-up period are necessary in order to assess oncologic and neurologic results through minimally invasive approaches. Furthermore, increased robotic experience and studies, including randomized controlled trials, are needed to validate the findings of the current literature. PMID:26904426

  10. [Thoracic nocardiosis - a clinical report].

    PubMed

    Vale, Artur; Guerra, Miguel; Martins, Daniel; Lameiras, Angelina; Miranda, José; Vouga, Luís

    2014-01-01

    Nocardia genus microorganisms are ubiquitous, Gram positive aerobic bacterias, responsible for disease mainly in immunocompromised hosts, with cellular immune response commitment. Inhalation is the main form of transmition and pulmonary disease is the most frequent presentation. Dissemination may occur by contiguity and also via hematogenous. The clinical and imaging presentation is not specific, and diagnosis is obtained after identification of Nocardia bacteria in biological samples. Since there are no reliable studies that indicate the best therapeutic option, treatment should be individualized and based on antimicrobial susceptibility testing. Surgical drainage should also be considered in all patients. The authors present a clinical case of a patient with thoracic nocardiosis, and make a short literature review on the theme. PMID:25596394

  11. Ossification of thoracic ligamenta flava

    SciTech Connect

    Kudo, S.; Minoru, O.; Russell, W.J.

    1983-07-01

    Although ligamentum flavum ossification (LFO) often occurs in normal persons, there are no reports of its detection on lateral chest radiographs made during screening examinations. Review of 1,744 consecutive lateral chest radiographs identified LFO in 6.2% of males and 4.8% of females. LFO occurred mainly at the intervertebral segments from T9-T10 through T12-L1. Most prevalent was the hook-shaped LFO, protruding inferoirly from the inferior facets into the projections of the intervertabral foramina. Though LFO can cause severe neurologic symptoms, none of the affected persons in this study reported such symptoms. LFO was first visualized radiographically when the subjects were 20-40 years old, and it may be a physiologic condition. The LFO in these cases existed independent of thoracic posterior longitudinal ligament ossification, diffuse idiopathic skeletal hyperostosis, and degenerative osteoarthritis.

  12. Outpatient Surgery

    MedlinePlus

    Policymakers | Members | Patients | News Media Anesthesia 101 Patient Safety Stories Resources About Home » Patients » Preparing For Surgery » Types of Surgery » Outpatient Surgery Share this Page Preparing For ...

  13. Plastic Surgery

    MedlinePlus

    ... How Can I Help a Friend Who Cuts? Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A A ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word "plastic" ...

  14. Radiofrequency Ablation of Lung Tumours with the Patient Under Thoracic Epidural Anaesthesia

    SciTech Connect

    Pouliquen, Cassiopee; Kabbani, Youssef Saignac, Pierre; Gekiere, Jean-Pierre; Palussiere, Jean

    2011-02-15

    Radiofrequency ablation of lung tumours is a curative technique that is newly considered being offered to nonsurgical patients. It is of major interest because it enables local destruction of the tumour without surgery and spares healthy parenchyma. However, some patients have previous serious respiratory failure, thus ruling out mechanical ventilation. To operate with the patient under thoracic epidural is an answer to this problem. Our experience shows that the procedure is able to be performed completely without converting to general anaesthesia.

  15. Radiation-induced long thoracic nerve palsy

    SciTech Connect

    Pugliese, G.N.; Green, R.F.; Antonacci, A.

    1987-09-15

    The incidence of long thoracic nerve palsy after radical mastectomy has been documented to be approximately 10%. No cases have been reported after the more recent treatment for breast cancer, lumpectomy with axillary dissection. This more recent surgical procedure is customarily followed by aggressive radiation therapy to the remaining breast tissue. This is the first case report of a patient with radiation-induced long thoracic nerve palsy. The patient was a young woman who underwent left breast quadrantectomy and axillary dissection for breast cancer. After radiation therapy, she had isolated left long thoracic nerve palsy. The diagnosis was confirmed by electrodiagnostic studies. Almost full recovery occurred after 5 months.

  16. Treatment of thoracic wounds with adapted vacuum therapy.

    PubMed

    de Abreu, Igor Renato L B; Pontes, Edgard P O; Tamagno, Mauro F L; Sardenberg, Rodrigo Afonso; Younes, Riad Naim; Abrão, Fernando Conrado

    2014-01-01

    This is a report of seven cases of infected thoracic wounds treated with an adapted low-cost vacuum therapy in the Thoracic Surgery Unit of Santa Marcelina Hospital. The vacuum system used was designed and adapted to our hospital due to financial limitations on the acquisition of commercial kits. The vacuum-assisted closure kit used in this study consisted of chlorhexidine sponges (which are usually used for antisepsis of the surgical team), a 16F nasogastric tube, and two sterile adhesive films (OPSITE) for surgical field reinforcement. The mean duration of vacuum therapy was 13.4 days (range, 10-20 days), with an average of three dressing changes (range, 1-5). After treatment with vacuum-assisted closure, three wounds (3/7) were closed with simple primary sutures, one of the lesions (1/7) was closed by muscle flap rotation, and three wounds (3/7) healed by second intention. This adapted vacuum therapy was safe and easy to apply in our institution, including its use in patients with thoracostomies. PMID:24026077

  17. Tracheo-Bronchial Obstruction and Esophageal Perforation after TEVAR for Thoracic Aortic Rupture

    PubMed Central

    Fukui, Daisuke; Tanaka, Haruki; Komatsu, Kazunori; Ohtsu, Yoshinori; Terasaki, Takamitsu; Wada, Yuko; Takano, Tamaki; Koike, Shoichiro; Amano, Jun

    2014-01-01

    A 67-year-old man was referred to our hospital for an ascending aortic aneurysm, thoracoabdominal aortic aneurysm and aortic regurgitation. Graft repair of the thoracic aortic arch and aortic valve replacement was given priority and completed, however he developed descending aortic rupture before the second scheduled surgery, and endovascular stent grafting was performed. He subsequently developed tracheobronchial obstruction and esophageal perforation. The patient underwent urgent esophagectomy and enterostomy with continuity later reestablished. However, he died of sepsis 5 months after surgery. Despite the less invasive nature of endovascular treatment, esophageal perforation can nevertheless occur and postoperative vigilance is well warranted. PMID:25593630

  18. Thoracic endovascular aortic repair for patent ductus arteriosus in an elderly patient with congestive heart failure.

    PubMed

    Kato, Gentaro; Nakai, Mikizo; Tokunaga, Noriyuki; Shimizu, Shuji; Okada, Masahiro

    2016-05-01

    In elderly patients, open surgery for patent ductus arteriosus (PDA) is more difficult than that in children and often requires a cardiopulmonary bypass. We report the case of a 67-year-old patient with a PDA that was successfully treated with thoracic endovascular aortic repair (TEVAR). The patient was diagnosed with congestive heart failure (ejection fraction, 36 %) and PDA (9.7 mm in diameter). TEVAR was successfully performed to exclude the PDA. After TEVAR, the patient's heart failure was well controlled by diuretics. TEVAR may be a good alternative to open surgery. PMID:25056455

  19. Extent of intraoperative muscle dissection does not affect long-term outcomes after minimally invasive surgery versus open-transforaminal lumbar interbody fusion surgery: A prospective longitudinal cohort study

    PubMed Central

    Adogwa, Owoicho; Johnson, Kwame; Min, Elliot T.; Issar, Neil; Carr, Kevin R.; Huang, Kevin; Cheng, Joseph

    2012-01-01

    Background: Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) versus open TLIF, addressing lumbar degenerative disc disease (DDD) or grade I spondylolisthesis (DS), are associated with shorter hospital stays, decreased blood loss, quicker return to work, and equivalent short- and long-term outcomes. However, no prospective study has assessed whether the extent of intraoperative muscle trauma utilizing creatinine phosphokinase levels (CPK) differently impacts long-term outcomes. Methods: Twenty-one patients underwent MIS-TLIF (n = 14) versus open-TLIF (n = 7) for DDD or DS. Serum CPK levels were measured at baseline, and postoperatively (days 1, 7, and 1.5, 3 and 6 months). The correlation between the extent of intraoperative muscle trauma and two-year improvement in functional disability was evaluated (multivariate regression analysis). Additionally, baseline and two-year changes in Visual Analog Scale (VAS)-leg pain (LP), VAS-back pain (BP), Oswestry Disability Index (ODI), Short-Form-36 (SF-36) Physical Component Score (PCS) and SF-36 Mental Component Score (MCS), and postoperative satisfaction with surgical care were assessed. Results: Although the mean change from baseline in the serum creatine phosphokinase level on POD 1 was greater for MIS-TLIF (628.07) versus open-TLF (291.42), this did not correlate with lesser two-year improvement in functional disability. Both cohorts also showed similar two-year improvement in VAS-LP, ODI, and SF-36 PCS/MCS. Conclusion: Increased intraoperative muscle trauma unexpectedly observed in higher postoperative CPK levels for MIS-TLIF versus open-TLIF did not correlate with any differences in two-year improvement in pain and functional disability. PMID:23248754

  20. Patient specific stress and rupture analysis of ascending thoracic aneurysms.

    PubMed

    Trabelsi, Olfa; Davis, Frances M; Rodriguez-Matas, Jose F; Duprey, Ambroise; Avril, Stéphane

    2015-07-16

    An ascending thoracic aortic aneurysm (ATAA) is a serious medical condition which, more often than not, requires surgery. Aneurysm diameter is the primary clinical criterion for determining when surgical intervention is necessary but, biomechanical studies have suggested that the diameter criterion is insufficient. This manuscript presents a method for obtaining the patient specific wall stress distribution of the ATAA and the retrospective rupture risk for each patient. Five human ATAAs and the preoperative dynamic CT scans were obtained during elective surgeries to replace each patient's aneurysm with a synthetic graft. The material properties and rupture stress for each tissue sample were identified using bulge inflation tests. The dynamic CT scans were used to generate patient specific geometries for a finite element (FE) model of each patient's aneurysm. The material properties from the bulge inflation tests were implemented in the FE model and the wall stress distribution at four different pressures was estimated. Three different rupture risk assessments were compared: the maximum diameter, the rupture risk index, and the overpressure index. The peak wall stress values for the patients ranged from 28% to 94% of the ATAA's failure stress. The rupture risk and overpressure indices were both only weakly correlated with diameter (ρ=-0.29, both cases). In the future, we plan to conduct a large experimental and computational study that includes asymptomatic patients under surveillance, patients undergoing elective surgery, and patients who have experienced rupture or dissection to determine if the rupture risk index or maximum diameter can meaningfully differentiate between the groups. PMID:25979384

  1. Sequential Changes of Plasma C-Reactive Protein, Erythrocyte Sedimentation Rate and White Blood Cell Count in Spine Surgery : Comparison between Lumbar Open Discectomy and Posterior Lumbar Interbody Fusion

    PubMed Central

    Choi, Man Kyu; Kim, Kee D; Ament, Jared D.

    2014-01-01

    Objective C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often utilized to evaluate for postoperative infection. Abnormal values may be detected after surgery even in case of non-infection because of muscle injury, transfusion, which disturbed prompt perioperative management. The purpose of this study was to evaluate and compare the perioperative CRP, ESR, and white blood cell (WBC) counts after spine surgery, which was proved to be non-infection. Methods Twenty patients of lumbar open discectomy (LOD) and 20 patients of posterior lumbar interbody fusion (PLIF) were enrolled in this study. Preoperative and postoperative prophylactic antibiotics were administered routinely for 7 days. Blood samples were obtained one day before surgery and postoperative day (POD) 1, POD3, and POD7. Using repeated measures ANOVA, changes in effect measures over time and between groups over time were assessed. All data analysis was conducted using SAS v.9.1. Results Changes in CRP, within treatment groups over time and between treatment groups over time were both statistically significant F(3,120)=5.05, p=0.003 and F(1,39)=7.46, p=0.01, respectively. Most dramatic changes were decreases in the LOD group on POD3 and POD7. Changes in ESR, within treatment groups over time and between treatment groups over time were also found to be statistically significant, F(3,120)=6.67, p=0.0003 and F(1,39)=3.99, p=0.01, respectively. Changes in WBC values also were be statistically significant within groups over time, F(3,120)=40.52, p<0.001, however, no significant difference was found in between groups WBC levels over time, F(1,39)=0.02, p=0.89. Conclusion We found that, dramatic decrease of CRP was detected on POD3 and POD7 in LOD group of non-infection and dramatic increase of ESR on POD3 and POD7 in PLIF group of non-infection. We also assumed that CRP would be more effective and sensitive parameter especially in LOD than PLIF for early detection of infectious complications. Awareness of the typical pattern of CRP, ESR, and WBC may help to evaluate the early postoperative course. PMID:25368764

  2. Thoracic radiculopathy caused by a myodil cyst.

    PubMed

    Fitzpatrick, M O; Goyal, K; Johnston, R A

    2000-08-01

    We report the case of a myodil cyst causing a thoracic radiculopathy in a patient who had undergone a myelogram 30 years previously. Although myodil is no longer used, sequelae can continue to be seen for many years. PMID:11045204

  3. Experimental laparoscopic and thoracoscopic discectomy and instrumented spinal fusion. A feasibility study using a porcine model.

    PubMed

    Mühlbauer, M; Ferguson, J; Losert, U; Koos, W T

    1998-03-01

    To explore the safety and the effectiveness of laparoscopic and thoracoscopic spinal surgery, an acute/non-survival animal trial was performed in 5 pigs using rigid and flexible endoscopes, flouroscopy, a holmium-YAG laser, and prototype instruments and implants. Our study aimed to approach the intervertebral disc space and spinal canal using laparoscopic and thoracoscopic techniques and to explore the potential and limits for endoscopic anterior spinal decompression and fusion. In a lateral recumbency access was provided to the anterolateral aspect of the lumbar spine from L1/2 to L7/S1, the thoracic spine was accessible from T2/3 to the diaphragmatic insertion. Complete disc space emptying with penetration into the spinal canal could be performed, epidural bleeding could be controlled by a hemostatic sponge, however bleeding restricted visualization for further endoscopic manipulation in the spinal canal. Intervertebral fusion was accomplished at T6/7, L4/5 and L7/S1 using small fragment plates with 3.5 mm screws and iliac bone grafts or prototype carbon fiber cages. On post mortem examination we found no dural tears and no nerve root damage, all animals had stabilized fusion sites and good implant position. We conclude that minimally invasive thoracoscopic and laparoscopic approaches to the spine are feasible and safe to perform disc decompression and implant placement for spinal fusion. In addition to currently performed laparoscopic interbody fusion, also plate fixation to reestablish lordosis of the lumbar spine is feasible at least in the porcine model. Careful disc decompression must be performed prior to implant introduction to prevent iatrogenic disc protrusion and spinal cord or nerve root compression. However, further surgical exploration of the spinal canal using these techniques does not provide adequate visualization of epidural spaces and therefore must be regarded as unsafe. PMID:9565956

  4. [Closed thoracic trauma and concomitant diseases].

    PubMed

    Milkov, B O; Tsybyrne, K A; Smirnova, N A; Kulachek, F G; Khmelevskiĭ, N M; Iatskiv, V V; Slivka, V P

    1989-01-01

    Examined were 340 patients with closed thoracic trauma and posttraumatic pneumonia. Often, this complication was revealed in the elderly and senile. Chronic non-specific diseases of the lungs, pneumothorax predisposed to occurrence of posttraumatic pneumonia. The methods for treatment of a given complication have been developed. Diseases of the heart, vascular system in thoracic trauma can cause the aggravation of a patient's state up to lethal outcome. PMID:2615202

  5. [Shock score and surgical tactics for thoracic injury treatment].

    PubMed

    Voskresenskiĭ, O V; Abakumov, M M; Radchenko, Iu A

    2009-01-01

    Results of surgical treatment of 216 patients with thoracic injuries were retrospectively analyzed. 111 (51,4%) were operated on with the use of open technologies, whereas the rest 105 (48,6%) patients were treated with the use of videothoracoscopy. Patients were divided into 2 groups according to the shock score value. Was demonstrated, that videothoracoscopic operation was reasonable by shock score value less then 1,5. In patients with the shock score value more then 1,5, open surgery was more appropriate. Success of videothoracoscopic injury repair is stipulated also by detailed preoperative diagnostics, detecting the extent of the injury of the thorax and wounds of other regions, requiring urgent treatment. PMID:20037511

  6. Lateral Transpsoas Fusion: Indications and Outcomes

    PubMed Central

    Patel, Vishal C.; Park, Daniel K.; Herkowitz, Harry N.

    2012-01-01

    Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures. PMID:23213303

  7. Cytomegalovirus Immunoglobulin After Thoracic Transplantation

    PubMed Central

    Grossi, Paolo; Mohacsi, Paul; Szabolcs, Zoltán; Potena, Luciano

    2016-01-01

    Abstract Cytomegalovirus (CMV) is a highly complex pathogen which, despite modern prophylactic regimens, continues to affect a high proportion of thoracic organ transplant recipients. The symptomatic manifestations of CMV infection are compounded by adverse indirect effects induced by the multiple immunomodulatory actions of CMV. These include a higher risk of acute rejection, cardiac allograft vasculopathy after heart transplantation, and potentially bronchiolitis obliterans syndrome in lung transplant recipients, with a greater propensity for opportunistic secondary infections. Prophylaxis for CMV using antiviral agents (typically oral valganciclovir or intravenous ganciclovir) is now almost universal, at least in high-risk transplants (D+/R−). Even with extended prophylactic regimens, however, challenges remain. The CMV events can still occur despite antiviral prophylaxis, including late-onset infection or recurrent disease, and patients with ganciclovir-resistant CMV infection or who are intolerant to antiviral therapy require alternative strategies. The CMV immunoglobulin (CMVIG) and antiviral agents have complementary modes of action. High-titer CMVIG preparations provide passive CMV-specific immunity but also exert complex immunomodulatory properties which augment the antiviral effect of antiviral agents and offer the potential to suppress the indirect effects of CMV infection. This supplement discusses the available data concerning the immunological and clinical effects of CMVIG after heart or lung transplantation. PMID:26900989

  8. Prevalence, Distribution, and Significance of Incidental Thoracic Ossification of the Ligamentum Flavum in Korean Patients with Back or Leg Pain : MR-Based Cross Sectional Study

    PubMed Central

    Moon, Bong Ju; Kuh, Sung Uk; Kim, Sungjun; Kim, Keun Su; Cho, Yong Eun

    2015-01-01

    Objective Thoracic ossification of the ligamentum flavum (OLF) is a relatively rare disease. Because of ambiguous clinical symptom, it is difficult for early diagnosis of OLF and subsequent treatment can be delayed or missed. Therefore, the purpose of this study is to comprehensively assess the prevalence and distribution of thoracic OLF by magnetic resonance imaging (MRI) and coexisting spinal disease in Korean patients with back pain or leg pain. Methods The sample included 2134 Korean patients who underwent MRI evaluation for back pain. The prevalence and distribution of thoracic OLF were assessed using lumbar MRI with whole spine sagittal images. Additionally, we examined the presence of coexisting lumbar and cervical diseases. The presence of thoracic OLF as well as clinical parameters such as age, sex, and surgery were retrospectively reviewed. Results The prevalence of thoracic OLF in total patients was 16.9% (360/2134). The prevalence tended to increase with aging and was higher in women than in men. The lower thoracic segment of T10-11 was the most frequently affected segment. Of the 360 patients with OLF, 31.9% had coexisting herniated thoracic discs at the same level. Approximately 74% of the patients with OLF had coexisting lumbar and cervical disease. Nine (2.5%) of 360 OLF patients underwent surgery for thoracic lesion. Conclusion The prevalenceof thoracic OLF was relatively higher than those of previous reports. And coexisting lumbar and cervical disease were very frequent. Therefore, we should check coexisting spinal diseases and the exact diagnostic localization of ossification besides lumbar disease. PMID:26361526

  9. Applications of robotics for laryngeal surgery

    PubMed Central

    Hillel, Alexander T.; Kapoor, Ankur; Simaan, Nabil; Taylor, Russell H.; Flint, Paul

    2014-01-01

    Synopsis The author presents the clinical application of robotics to laryngeal surgery in terms of enhancement of surgical precision and performance of other minimally invasive procedures not feasible with current instrumentation. Presented in this article are comparisons of human arm with robotic arm in terms of degrees of freedom and discussion of surgeries and outcomes with use of the robotic arm. Robotic equipment for laryngeal surgery has the potential to overcome many of the limitations of endolaryngeal procedures by improving optics, increasing instrument degrees of freedom, and modulating tremor. Outside of laryngology, a multi-armed robotic system would have utility in microvascular procedures at the base of the skull, sinus surgery, and single port gastrointestinal and thoracic access surgery. PMID:18570959

  10. Thoracic spinal cord herniation in a patient with long-standing ankylosing spondylitis.

    PubMed

    Liu, Zhen; Wang, Wei-jun; Sun, Chao; Zhu, Zhe-zhang; Qiu, Yong

    2011-07-01

    The objective of this study was to describe an adult male patient with ankylosing spondylitis (AS) associated with thoracic spinal cord herniation (TSCH). TSCH is a scarce entity presented as a displacement of thoracic cord through an anterior or anterolateral dural defect. More importantly, the co-occurrence of AS and thoracic spinal cord herniation is exceptional. To date, only one case of SCH in association with AS has been reported in the literature. A 56-year-old male patient presented with the progressive difficulty in walking and numbness of both lower limbs for the past 18 months. The patient was diagnosed as AS when he was 30 years old. Sagittal MRI of thoracic spine showed dural defect of the posterior aspect of T11 and 12 vertebral bodies. Axial T2-weighted MRI demonstrated that spinal cord was displaced ventrally and to the right. The diagnosis of TSCH with AS was established. The prognosis was explained to the patient. We recommended duraplasty for dural repair to the patient, but he refused surgery. The results demonstrated that TSCH associated with long-standing AS was very uncommon, and MRI is recommended to rule out SCH in the long-standing AS patients with neurologic symptoms. The SCH in AS might be caused by inflammation, and thoracolumbar hyperkyphosis results from AS might be associated with the development of SCH. PMID:20936535

  11. Ruptured Thoracic Aortic Aneurysm Infected with Listeria Monocytogenes: A Case Report and a Review of Literature

    PubMed Central

    Masuda, Shigeki; Takeuchi, Nobuhiro; Takada, Masanori; Fujita, Koichi; Nishibori, Yoshiharu; Maruyama, Takao

    2013-01-01

    A 75-year-old male with a history of alcoholic liver cirrhosis, sigmoid colon cancer, and metastatic liver cancer was admitted to our institution with a complaint of a prickly feeling in his chest. On admission, a chest radiograph revealed a normal cardio-thoracic ratio of 47%. Echocardiography revealed pericardial effusion and blood chemical analyses revealed elevated C-reactive protein levels (14.7 mg/dL). On day 3, chest radiography revealed cardiomegaly with a cardio-thoracic ratio of 58% and protrusion of the left first arch. Contrast-enhanced chest computed tomography revealed a saccular aneurysm in the aortic arch with surrounding hematoma; thus, a ruptured thoracic aortic aneurysm was suspected. Emergency surgery was performed, which revealed a ruptured aortic aneurysm with extensive local inflammation. The diagnosis of an infected aortic rupture was therefore confirmed. The aneurysm and abscess were resected, followed by prosthetic graft replacement and omental packing. Histopathology of the resected aneurysm revealed gram-positive bacilli; and Listeria monocytogenes was confirmed as the causative organism by culture. Postoperative course was uneventful; on postoperative day 60, the patient was ambulatory and was discharged. Here we report the case of a male with a ruptured thoracic aortic aneurysm infected with L. monocytogenes. PMID:25512697

  12. Thoracic aortic aneurysm: reading the enemy's playbook.

    PubMed

    Elefteriades, John A

    2008-05-01

    The vast database of the Yale Center for Thoracic Aortic Disease--which includes information on 3000 patients with thoracic aortic aneurysm or dissection, with 9000 catalogued images and 9000 patient-years of follow-up--has, over the last decade, permitted multiple glimpses into the "playbook" of this virulent disease. Understanding the precise behavioral features of thoracic aortic aneurysm and dissection permits us more effectively to combat this disease. In this monograph, we will first review certain fundamentals--in terms of anatomy, nomenclature, imaging, diagnosis, medical, surgical, and stent treatment. After reviewing these fundamentals, we will proceed with a detailed exploration of lessons learned by peering into the operational playbook of thoracic aortic aneurysm and dissection. Among the glimpses afforded in the behavioral playbook of this disease are the following: 1 Thoracic aortic aneurysm, while lethal, is indolent. Mortality usually does not occur until after years of growth. 2 The aneurysmal ascending thoracic aorta grows slowly: about 0.1 cm per year (the descending aorta grows somewhat faster). 3 Over a patient's lifetime, "hinge points" at which the likelihood of rupture or dissection skyrockets are seen at 5.5 cm for the ascending and 6.5 cm for the descending aorta. Intervening at 5 cm diameter for the ascending and 6 cm for the descending prevents most adverse events. 4 Symptomatic aneurysms require resection regardless of size. 5 The yearly rate of rupture, dissection, or death is 14.1% for a patient with a thoracic aorta of 6 cm diameter. 6 The mechanical properties of the aorta deteriorate markedly at 6 cm diameter (distensibility falls, and wall stress rises)--a finding that "dovetails" perfectly with observations of the clinical behavior of the thoracic aorta. 7 Thoracic aortic aneurysm and dissection are largely inherited diseases, with a predominantly autosomal-dominant pattern. The specific genetics are being elucidated at the molecular level. 8 Matrix metalloproteinase overactivity participates in the destructive processes that degrade an aorta in individuals genetically preprogrammed to develop aneurysms. 9 Most dissections are brought on via presumed momentary hypertensive crises by severe exercise or emotion. We look forward to a future in which the aneurysm diathesis can be determined by a genetic test (RNA or DNA based), in which matrix metalloproteinases can be specifically antagonized by medications, in which exercise and emotion can be modulated in susceptible patients, and in which mechanical properties of the aorta (in addition to simple dimension) can be assessed serially to guide the timing of operation more precisely. Genetic-based therapies (eg, development of drugs on the basis of discovered molecular proteomics) will likely become possible to prevent susceptible patients from forming aneurysms over the long term. PMID:18439439

  13. Precise delineation of clinical target volume for crossing-segments thoracic esophageal squamous cell carcinoma based on the pattern of lymph node metastases

    PubMed Central

    Dong, Yuanli; Guan, Hui; Huang, Wei; Zhang, Zicheng; Zhao, Dongbo; Liu, Yang; Zhou, Tao

    2015-01-01

    Background This work aims to investigate lymph node metastases (LNM) pattern of crossing-segments thoracic esophageal squamous cell carcinoma (ESCC) and its significance in clinical target volume (CTV) delineation. Methods From January 2000 to December 2014, 3,587 patients with thoracic ESCC underwent surgery including esophagectomy and lymphadenectomy at Shandong Cancer Hospital and Institute. Information of tumor location based on preoperative endoscopic ultrasonography (EUS) and postoperative pathological results were retrospectively collected. The extent of the irradiation field was determined based on LNM pattern. Results Among the patients reviewed, 1,501 (41.8%) were crossing-segments thoracic ESCC patients. The rate of LNM were 12.1%, 15.2%, 8.0%, 3.0%, and 7.1% in neck, upper mediastinum, middle mediastinum, lower mediastinum, and abdominal cavity for patients with upper-middle thoracic ESCC, 10.3%, 8.2%, 11.0%, 4.8%, 8.2% for middle-upper thoracic ESCC, 4.8%, 4.8%, 24.1%, 6.3%, 22.8% for middle-lower thoracic ESCC and 3.9%, 3.1%, 22.8%, 11.9%, 25.8% for lower-middle thoracic ESCC, respectively. The top three sites of LNM were 105 (12.1%), 108 (6.1%), 101 (6.1%) for upper-middle thoracic ESCC, 108 (8.2%), 105 (7.5%), 106 (6.8%) for middle-upper thoracic ESCC, 1 (18.8%), 108 (17.9%), 107 (9.6%) for middle-lower thoracic ESCC, 1 (21.3%), 108 (16.1%), 107 (10.1%) for lower-middle thoracic ESCC. Conclusions Crossing-segments thoracic ESCC was remarkably common among patients. When delineating their CTV, tumor location should be taken into consideration seriously. For upper-middle and middle-upper thoracic ESCC, abdominal cavity may be free from irradiation. For middle-lower and lower-middle thoracic ESCC, besides irradiation of relative mediastinal, irradiation of abdominal cavity can’t be neglected. PMID:26793353

  14. Strabismus Surgery

    MedlinePlus

    ... figures 2 and 3]. What is an adjustable suture? Strabismus surgery involves sewing the eye muscle to ... of the muscle. Standard strabismus surgery (no adjustable suture) utilizes a permanent knot. Adjustable suture technique utilizes ...

  15. Turbinate surgery

    MedlinePlus

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery ... There are several types of turbinate surgery: Turbinectomy: All or part of the lower turbinate is taken out. This can be done in several different ways, but sometimes a ...

  16. After Surgery

    MedlinePlus

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  17. Cosmetic Surgery

    MedlinePlus

    ... should be certified by the American Board of Plastic Surgery. How many years has the doctor performed this ... of Plastic Surgeons (ASPS)/ The American Board of Plastic Surgery (ABPS) – All of the surgeons listed through this ...

  18. Minimally invasive approach to thoracic effusions in patients with ventricular assist devices.

    PubMed

    Gilbert, Sebastien; Kilic, Arman; Yaeger, Karl; Toyoda, Yoshiya; Bermudez, Christian; Siegenthaler, Michael P; Kormos, Robert L

    2012-01-01

    The aim of this study was to compare our experience between open and video-assisted thoracic surgery (VATS) approaches to the management of thoracic effusions in ventricular assist device (VAD) patients. This was a retrospective review of a prospectively collected database of VAD patients at a single institution. Patients who were operated on for pericardial and/or pleural effusions were included. Primary outcomes included operative mortality and morbidity as well as effusion recurrence. From 1993 to 2009, 360 adult patients underwent VAD placement. Twenty-three patients (11.9%) required operative management of pleural (n = 24), pericardial (n = 13) or both pleural and pericardial (n = 6) effusions [open = 20 (47%); VATS = 23 (53%)]. Drainage with decortication was performed in five patients, with the remaining undergoing drainage alone. Open and VATS patients were similar in age, gender and indication for VAD support. Conversion from VATS to open was necessary in four patients (17%). There was no operative mortality and no difference in perioperative complications between approaches. The open and VATS approaches had similar rates of pleural (open = 63%; VATS = 41%; P = 0.42) and pericardial (open = 31%; VATS = 17%; P = 1) effusion recurrences. In spite of apparent challenges, the VATS approach may be as safe and effective as open surgery for the management of pleural and pericardial effusions in VAD patients in centres with significant minimally invasive thoracic experience. PMID:22108930

  19. Nuclear Fusion

    NASA Astrophysics Data System (ADS)

    Veres, G.

    This chapter is devoted to the fundamental concepts of nuclear fusion. To be more precise, it is devoted to the theoretical basics of fusion reactions between light nuclei such as hydrogen, helium, boron, and lithium. The discussion is limited because our purpose is to focus on laboratory-scale fusion experiments that aim at gaining energy from the fusion process. After discussing the methods of calculating the fusion cross section, it will be shown that sustained fusion reactions with energy gain must happen in a thermal medium because, in beam-target experiments, the energy of the beam is randomized faster than the fusion rate. Following a brief introduction to the elements of plasma physics, the chapter is concluded with the introduction of the most prominent fusion reactions ongoing in the Sun.

  20. Mirror fusion

    NASA Astrophysics Data System (ADS)

    Harrison, M. A.; McGregor, C. K.

    1980-07-01

    Progress reported in the mirror fusion energy program covers (1) fusion, plasma theory, and computation; (2) magnetic mirror system and tandem mirror experiments; (3) superconducting magnetic development; (4) fusion reactor materials; (5) experiments in the mirror fusion test facility; and (6) design and construction of the facility. Topics covered include fiber optic communication links; desorption of deuterium and contaminants; neutral beam injection; operating point for the Yin-Yang cell; and reverse field pinch.

  1. Performing an Anterior Cervical Discectomy and Fusion.

    PubMed

    Schroeder, Gregory D; Kurd, Mark F; Millhouse, Paul W; Vaccaro, Alexander R; Hilibrand, Alan S

    2016-06-01

    An anterior cervical discectomy and fusion is one of the most common procedures performed in spine surgery. It allows for a direct decompression of the spinal cord and the neural foramen. When performed properly, the results of this procedure are some of the best in spine surgery. PMID:27187618

  2. [Thoracic oncology in Archivos de Bronconeumología 2008].

    PubMed

    de Cos-Escuín, Julio Sánchez

    2009-01-01

    The articles on thoracic oncology published in this journal during the year 2008 are briefly commented on. As regards the epidemiology, it is noted that the standardised incidence rate of lung cancer in males is starting to decline, and there is another study that analysed links between two common diseases, COPD and lung cancer. Other works have focused on aspects such as diagnosis, staging or prognosis, and analysing the value of positron emission tomography in the assessment of a solitary pulmonary nodule, the effectiveness of aspiration transbronchial needle aspiration in mediastinal staging, the prognostic significance of the over-expression and amplification of c-erbB-2 in patients with small cell carcinoma. As regards treatment, other authors analysed the survival of patients with N2 lung cancer detected during or after lung resection surgery. The new therapeutic technique of ablation of lung tumours by radiofrequency in the early stages is the subject of two publications that describe its basis, indications, contraindications and first results. Lastly, the communication skills needed to inform patients, surgery of lung metastases, and the presentation of an unusual case of carcinoid tumour were the subjects of other articles. PMID:19303529

  3. In situ replacement of the thoracic aorta using an equine pericardial roll graft for an aortobronchial fistula due to aortic rupture.

    PubMed

    Yamamoto, Hiroshi; Yamamoto, Fumio; Ishibashi, Kazuyuki; Chida, Yoshifumi; Minamiya, Yoshihiro; Nanjo, Hiroshi

    2009-08-01

    A 74-year-old woman with massive hemoptysis and shock who had been diagnosed with thoracic aortic rupture underwent in situ replacement of the thoracic aorta using an equine pericardial roll graft. The lower lobe of the left lung was resected because of a massive hematoma and adhesion to the wall of the thoracic aorta. Intraoperative microscopic examination of the resected aortic wall revealed Gram-positive bacteria (alpha-streptococcus in bacterial cultivation). Histology of the resected aorta revealed abscess formation in the media and adventitia of the aortic wall associated with disruption of the media (dissection). Postoperative computed tomography revealed no fluid collection around the graft 1 month after surgery, and magnetic resonance imaging showed no significant graft dilation 20 months after operation. The equine pericardium can be an option of alternative graft materials for in situ replacement of the thoracic aorta in patients with an aortobronchial fistula due to aortic rupture. PMID:19779789

  4. Lateral Lumbar Interbody Fusion.

    PubMed

    Pawar, Abhijit; Hughes, Alexander; Girardi, Federico; Sama, Andrew; Lebl, Darren; Cammisa, Frank

    2015-12-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques. PMID:26713134

  5. Lateral Lumbar Interbody Fusion

    PubMed Central

    Hughes, Alexander; Girardi, Federico; Sama, Andrew; Lebl, Darren; Cammisa, Frank

    2015-01-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques. PMID:26713134

  6. Genetics Home Reference: familial thoracic aortic aneurysm and dissection

    MedlinePlus

    ... Genetics Home Health Conditions familial TAAD familial thoracic aortic aneurysm and dissection Enable Javascript to view the expand/ ... All Open All Close All Description Familial thoracic aortic aneurysm and dissection ( familial TAAD ) involves problems with the ...

  7. Connective Tissue Disease-related Thoracic Disease.

    PubMed

    Tsuchiya, Yutaka; Fischer, Aryeh; Solomon, Joshua J; Lynch, David A

    2015-06-01

    Pulmonary involvement is a frequent manifestation of connective tissue disease (CTD)-related thoracic disease. It is important to characterize the underlying pattern when pulmonary involvement occurs in a patient with CTD, and to exclude other causes. A systematic approach, evaluating each compartment of the lung (airway, interstitium, pleura, pulmonary vasculature) may be helpful. In complex cases, a multidisciplinary approach should be considered, potentially including the pulmonologist, rheumatologist, radiologist, pathologist, and sometimes the infectious disease specialist or oncologist. New techniques, such as quantitative computed tomography and MRI, are expected to be helpful for evaluation and management of CTD-associated thoracic disease. PMID:26024605

  8. Blunt thoracic trauma. Analysis of 515 patients.

    PubMed Central

    Shorr, R M; Crittenden, M; Indeck, M; Hartunian, S L; Rodriguez, A

    1987-01-01

    A retrospective analysis of 515 cases of blunt chest trauma is presented. The overall thoracic morbidity rate was 36% and mortality rate was 15.5%. Atelectasis was the most common complication. Severe chest trauma can be present in the absence of rib or other thoracic bony fractures. Emergency thoracotomies for resuscitation of the patient with blunt chest trauma with absent vital signs proved unsuccessful in 39 of 39 patients. A high index of suspicion for blunt chest injury occurring in blunt trauma, coupled with an aggressive diagnostic and therapeutic approach, remains the cornerstone of treatment to minimize the morbidity and mortality of such injuries. PMID:3606246

  9. Efficacy and safety of posteromedial translation for correction of thoracic curves in adolescent idiopathic scoliosis using a new connection to the spine: the Universal Clamp.

    PubMed

    Mazda, Keyvan; Ilharreborde, Brice; Even, Julien; Lefevre, Yan; Fitoussi, Franck; Penneçot, Georges-François

    2009-02-01

    Correction of adolescent idiopathic scoliosis (AIS) has been reported with various systems. All-screw constructs are currently the most popular, but they have been associated with a significant decrease in thoracic kyphosis, with a potential risk of junctional kyphosis, not observed with hybrid constructs in the literature. In addition, it is important to weigh potential advantages of pedicle screw fixation against risks specific to its use. Because hybrid constructs are associated with a lower risk of complications and better sagittal correction than all-screw constructs, at present we use lumbar pedicle screws combined with a new sublaminar connection to the spine (Universal Clamps) at thoracic levels. The purpose of this study was to determine the efficacy and safety of the Universal Clamp (UC) posteromedial translation technique for correction of AIS. Seventy-five consecutive patients underwent posterior spinal fusion and hybrid instrumentation for progressive AIS. Correction was performed at the thoracic level using posteromedial translation. At the lumbar level, correction was performed using in situ contouring and compression/distractions maneuvers. A minimum 2-year follow-up was required. Medical data and radiographs were prospectively analyzed and compared using a paired t test. The average age at surgery was 15 years and 4 months (+/-19 months). The average number of levels fused was 12+/-1.6. The mean follow-up was 30+/-5 months. The average preoperative Cobb angle of the major curve was 60 degrees+/-20 degrees. The immediate postoperative major curve correction averaged 66+/-13%. The average loss of correction of the major curve between the early postoperative assessment and latest follow-up was 3.5 degrees+/-1.4 degrees . The mean Cincinnati correction index was 1.7+/-0.8 postoperatively, and 1.57+/-1 at last follow up. The mean rotation of the apical vertebra was corrected from 23.3 degrees+/-9 degrees preoperatively to 7.3 degrees+/-5 degrees at last follow up (69% improvement, P<0.0001). In the sagittal plane, the mean thoracic kyphosis improved from 23.8 degrees+/-14.2 degrees preoperatively to 32.3 degrees+/-7.3 degrees at last follow up. For the 68 patients who had a normokyphotic or a hypokyphotic sagittal modifier, thoracic kyphosis increased from 20.5 degrees+/-9.9 degrees to 31.8 degrees+/-7.4 degrees, corresponding to a mean kyphosis correction of 55% at last follow up. No intraoperative complication occurred and none of the patients developed proximal junctional kyphosis during the follow up. The principal limitation of the UC technique was the rate of proximal posterior prominence (14.6%), leading us to recommend the use of conventional claws at the upper extremity of the construct. The technique was safe, and reduced operative time, radiation exposure, and blood loss. While achieving correction of deformity in the coronal and axial planes equivalent to the best reported results of all-screw or previous hybrid constructs, the UC hybrid technique appears to provide superior correction in the sagittal plane. The excellent outcome in all three planes was maintained at 2 year follow up. PMID:19089466

  10. Current trends in pedicle screw stimulation techniques: lumbosacral, thoracic, and cervical levels.

    PubMed

    Isley, Michael R; Zhang, Xiao-Feng; Balzer, Jeffrey R; Leppanen, Ronald E

    2012-06-01

    Unequivocally, pedicle screw instrumentation has evolved as a primary construct for the treatment of both common and complex spinal disorders. However an inevitable and potentially major complication associated with this type of surgery is misplacement of a pedicle screw(s) which may result in neural and vascular complications, as well as impair the biomechanical stability of the spinal instrumentation resulting in loss of fixation. In light of these potential surgical complications, critical reviews of outcome data for treatment of chronic, low-back pain using pedicle screw instrumentation concluded that "pedicle screw fixation improves radiographically demonstrated fusion rates;" however the expense and complication rates for such constructs are considerable in light of the clinical benefit (Resnick et al. 2005a). Currently, neuromonitoring using free-run and evoked (triggered) electromyography (EMG) is widely used and advocated for safer and more accurate placement of pedicle screws during open instrumentation procedures, and more recently, guiding percutaneous placement (minimally invasive) where the pedicle cannot be easily inspected visually. The latter technique, evoked or triggered EMG when applied to pedicle screw instrumentation surgeries, has been referred to as the pedicle screw stimulation technique. As concluded in the Position Statement by the American Society of Neurophysiological Monitoring (ASNM), multimodality neuromonitoring using free-run EMG and the pedicle screw stimulation technique was considered a practice option and not yet a standard of care (Leppanen 2005). Subsequently, the American Association of Neurological Surgeons/Congress of Neurological Surgeons (AANS/CNS) Joint Section on Disorders of the Spine and Peripheral Nerves published their "Guidelines for the Performance of Fusion Procedures for Degenerative Disease of the Lumbar Spine" (Heary 2005, Resnick et al. 2005a, Resnick et al. 2005b). It was concluded that the "primary justification" of intraoperative neuromonitoring"... is the perception that the safety and efficacy of pedicle screw fixation are enhanced..." (Resnick et al. 2005b). However in summarizing a massive (over 1000 papers taken from the National Library of Medicine), contemporary, literature review spanning nearly a decade (1996 to 2003), this invited panel (Resnick et al. 2005b) recognized that the evidence-based documents contributing to the parts related to pedicle screw fixation and neuromonitoring were "... full of potential sources of error ..." and lacked appropriate, randomized, prospective studies for formulating rigid standards and guidelines. Nevertheless, current trends support the routine use and clinical utility of these neuromonitoring techniques. In particular free-run and triggered EMG have been well recognized in numerous publications for improving both the accuracy and safety of pedicle screw implantation. Currently, treatment with pedicle screw instrumentation routinely involves all levels of the spine - lumbosacral, thoracic, and cervical. Significant historical events, various neuromonitoring modalities, intraoperative alarm criteria, clinical efficacy, current trends, and caveats related to pedicle screw stimulation along the entire vertebral column will be reviewed. PMID:22808751

  11. Late failure of posterior fixation without bone fusion for vertebral metastases

    PubMed Central

    Bellato, Renato Tavares; Teixeira, William Gemio Jacobsen; Torelli, Alessandro Gonzalez; Cristante, Alexandre Fogaça; de Barros, Tarcísio Eloy Pessoa; de Camargo, Olavo Pires

    2015-01-01

    ABSTRACT OBJECTIVE : To verify the frequency of late radiological com-plications in spinal fixation surgeries performed without fu-sion in oncological patients METHODS : This is a retrospective analysis analysing failure in cases of non-fused vertebral fixation in an oncology reference hospital between 2009 and 2014. Failure was defined as implant loosening or bre-akage, as well as new angular or translation deformities RESULTS : One hundred and five cases were analyzed. The most common site of primary tumor was the breast and the most common place of metastasis was the thoracic spine. The average follow-up was 22.7 months. Nine cases (8%) of failure were reported, with an average time until failure of 9.5 months. The most common failure was implant loosening. No case required further surgery CONCLUSION : The occurrence of failure was not different than that reported for fused cases. The time interval until failure was higher than the median of survival of the majority (88%) of cases. Level of Evidence IV, Therapeutic Study. PMID:27057142

  12. Amelioration of caudal thoracic syringohydromyelia following surgical management of an adjacent arachnoid cyst.

    PubMed

    Oxley, W; Pink, J

    2012-01-01

    A nine-year-old male, neutered, pug was presented for investigation of progressive ambulatory paraparesis and pelvic limb ataxia of three months' duration. Magnetic resonance imaging was suggestive of caudal thoracic syringohydromyelia with an adjacent intradural arachnoid cyst. The cyst was marsupialised following dorsal laminectomy. Neurological status had improved 10 weeks following surgery when repeat magnetic resonance imaging revealed reduced spinal cord compression both as a result of resolution of the cyst and reduction in size of the syringohydromyelia. At 17 months following surgery, the dog showed further improvements in neurological status, exhibiting mild pelvic limb ataxia and proprioceptive deficits. Improved cerebrospinal fluid flow following surgery may have played a role in the improvement in both conditions. The presence of syringohydromyelia in this context does not preclude a favourable clinical outcome following surgical management. PMID:22122126

  13. Anterior surgery for adolescent idiopathic scoliosis.

    PubMed

    Helenius, Ilkka

    2013-02-01

    Anterior open scoliosis surgery using the dual rod system is a safe and rather effective procedure for the correction of scoliosis (50-60 %). Thoracic hypokyphosis and rib hump correction with open anterior rather than posterior instrumentation appear to be the better approaches, although the latter is somewhat controversial with current posterior vertebral column derotation devices. In patients with Risser grade 0, hyperkyphosis and adding-on may occur with anterior thoracic spine instrumentation. Anterior thoracoscopic instrumentation provides a similar correction (65 %) with good cosmetic outcomes, but it is associated with a rather high risk of instrumentation (pull-out, pseudoarthrosis) and pulmonary complications. Approximately 80 % of patients with adolescent idiopathic scoliosis (AIS) curves of >70° have restrictive lung disease or smaller than normal lung volumes. AIS patients undergoing anterior thoracotomy or anteroposterior surgery will demonstrate a significant decrease in percentage of predicted lung volumes during follow-up. The thoracoabdominal approach and thoracoscopic approach without thoracoplasty do not produce similar changes in detrimental lung volume. In patients with severe AIS (>90°), posterior-only surgery with TPS provides similar radiographic correction of the deformity (44 %) with better pulmonary function outcomes than anteroposterior surgery. Vascular spinal cord malfunction after segmental vessel ligation during anterior scoliosis surgery has been reported. Based on the current literature, the main indication for open anterior scoliosis instrumentation is Lenke 5C thoracolumbar or lumbar AIS curve with anterior instrumentation typically between T11 and L3. PMID:24432061

  14. Endovascular Repair of Localized Pathological Lesions of the Descending Thoracic Aorta: Midterm Results

    SciTech Connect

    Attia, Cherif; Villard, Jacques; Boussel, Loic; Farhat, Fadi; Robin, Jacques; Revel, Didier; Douek, Philippe

    2007-07-15

    The endoluminal stent-graft represents an attractive and a less invasive technique for treatment of various diseases of the descending thoracic aorta. The purpose of this study was to evaluate the Talent endovascular stent-graft for the treatment of various localized diseases of the descending thoracic aorta. Over a 3-year period, Talent thoracic endografts were placed in 40 patients with a high surgical risk, presenting a localized lesion of the descending thoracic aorta: degenerative aneurysm (n = 13), acute traumatic rupture (n = 11), acute Stanford type B aortic dissection (n = 6), false aneurysm (n = 7), and penetrating atherosclerotic ulcer (n = 3). Fifteen patients (37.5%) were treated as emergencies. The feasibility of endovascular treatment and sizing of the aorta and stent-grafts were determined preoperatively by magnetic resonance angiography (MRA) and intraoperative angiography. Immediate and mid-term technical and clinical success was assessed by clinical and MRA follow-up. Endovascular treatment was completed successfully in all 40 patients, with no conversion to open repair or intraoperative mortality. The mean operative time was 37.5 {+-} 7 min. The overall 30-day mortality rate was 10% (n = 4), all in emergency cases, for causes not related to the endograft. The primary technical success was 92.5%. The mean follow-up period was 15 {+-} 5 months. The survival rate was 95% (n = 35). Diminution of the aneurismal size was observed in 47.5% (n = 19). We conclude that endovascular treatment of the various localized diseases of the descending thoracic aorta is a promising, feasible, alternative technique to open surgery in well-selected patients.

  15. Endograft Collapse After Endovascular Treatment for Thoracic Aortic Disease

    SciTech Connect

    Bandorski, Dirk Brueck, Martin; Guenther, Hans-Ulrich; Manke, Christoph

    2010-06-15

    Endovascular treatment is an established therapy for thoracic aortic disease. Collapse of the endograft is a potentially fatal complication. We reviewed 16 patients with a thoracic endograft between 2001 and 2006. Medical records of the treated patients were studied. Data collected include age, gender, diagnosis, indication for endoluminal treatment, type of endograft, and time of follow up. All patients (n = 16; mean age, 61 years; range, 21-82 years) underwent computed tomography (CT) for location of the lesion and planning of the intervention. Time of follow-up with CT scan ranged from 1 to 61 months. Indications for endovascular treatment were degenerative aneurysm (n = 7; 44%), aortic dissection (n = 2; 12%), perforated aortic ulcer (n = 4; 25%), and traumatic aortic injury (n = 3; 19%). Three patients suffered from a collapse of the endograft (one patient distal, two patients proximal) between 3 and 8 days after endovascular treatment. These patients were younger (mean age, 37 {+-} 25 years vs. 67 {+-} 16 years; P < 0.05) and showed more oversizing (proximal, 36 {+-} 19.8% vs. 29 {+-} 20.7% [P > 0.05]; distal, 45 {+-} 23.5% vs. 38 {+-} 21.7% [P > 0.05]). Proximal collapse was corrected by placing a bare stent. In conclusion, risk factors for stent-graft collapse are a small lumen of the aorta and a small radius of the aortic arch curvature (young patients), as well as oversizing, which is an important risk factor and is described for different types of endografts and protheses (Gore TAG and Cook Zenith). Dilatation of the collapsed stent-graft is not sufficient. Following therapy implantation of a second stent or surgery is necessary in patients with a proximal endograft collapse. Distal endograft collapse can possibly be treated conservatively under close follow-up.

  16. Transient Monoplegia as a Result of Unilateral Femoral Artery Ischemia Detected by Multimodal Intraoperative Neuromonitoring in Posterior Scoliosis Surgery

    PubMed Central

    Pankowski, Rafal; Roclawski, Marek; Dziegiel, Krzysztof; Ceynowa, Marcin; Mikulicz, Marcin; Mazurek, Tomasz; Kloc, Wojciech

    2016-01-01

    Abstract This is to report a case of 16-year-old girl with transient right lower limb monoplegia as a result of femoral artery ischemia detected by multimodal intraoperative spinal cord neuromonitoring (MISNM) during posterior correction surgery of adolescent idiopathic scoliosis. A patient with a marfanoid body habitus and LENKE IA type scoliosis with the right thoracic curve of 48° of Cobb angle was admitted for posterior spinal fusion from Th6 to L2. After selective pedicle screws instrumentation and corrective maneuvers motor evoked potentials (MEP) began to decrease with no concomitant changes in somato-sensory evoked potentials recordings. The instrumentation was released first partially than completely with rod removal but the patient demonstrated constantly increasing serious neurological motor deficit of the whole right lower limb. Every technical cause of the MEP changes was eliminated and during the wake-up test the right foot was found to be pale and cold with no popliteal and dorsalis pedis pulses palpable. The patient was repositioned and the pelvic pad was placed more cranially. Instantly, the pulse and color returned to the patient's foot. Following MEP recordings showed gradual return of motor function up to the baseline at the end of the surgery, whereas somato-sensory evoked potentials were within normal range through the whole procedure. This case emphasizes the importance of the proper pelvic pad positioning during the complex spine surgeries performed in prone position of the patient. A few cases of neurological complications have been described which were the result of vascular occlusion after prolonged pressure in the inguinal area during posterior scoliosis surgery when the patient was in prone position. If incorrectly interpreted, they would have a significant impact on the course of scoliosis surgery. PMID:26871822

  17. Endovascular Stent Graft Placement in the Treatment of Ruptured Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta: Case Report and Review of the Literature

    SciTech Connect

    Dogan, Sozen Memis, Ahmet; Kale, Arzum Buket, Suat

    2009-05-15

    We report a successful repair of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta by endovascular stent graft placement. This procedure is starting to be accepted as an alternative method to surgery, and we review similar cases in the literature.

  18. Postoperative cognitive dysfunction and neuroinflammation; Cardiac surgery and abdominal surgery are not the same.

    PubMed

    Hovens, Iris B; van Leeuwen, Barbara L; Mariani, Massimo A; Kraneveld, Aletta D; Schoemaker, Regien G

    2016-05-01

    Postoperative cognitive dysfunction (POCD) is a debilitating surgical complication, with cardiac surgery patients at particular risk. To gain insight in the mechanisms underlying the higher incidence of POCD after cardiac versus non-cardiac surgery, systemic and central inflammatory changes, alterations in intraneuronal pathways, and cognitive performance were studied after cardiac and abdominal surgery in rats. Male Wistar rats were subjected to ischemia reperfusion of the upper mesenteric artery (abdominal surgery) or the left coronary artery (cardiac surgery). Control rats remained naïve, received anesthesia only, or received thoracic sham surgery. Rats were subjected to affective and cognitive behavioral tests in postoperative week 2. Plasma concentrations of inflammatory factors, and markers for neuroinflammation (NGAL and microglial activity) and the BDNF pathway (BDNF, p38MAPK and DCX) were determined. Spatial memory was impaired after both abdominal and cardiac surgery, but only cardiac surgery impaired spatial learning and object recognition. While all surgical procedures elicited a pronounced acute systemic inflammatory response, NGAL and TNFα levels were particularly increased after abdominal surgery. Conversely, NGAL in plasma and the paraventricular nucleus of the hypothalamus and microglial activity in hippocampus and prefrontal cortex on postoperative day 14 were increased after cardiac, but not abdominal surgery. Both surgery types induced hippocampal alterations in BDNF signaling. These results suggest that POCD after cardiac surgery, compared to non-cardiac surgery, affects different cognitive domains and hence may be more extended rather than more severe. Moreover, while abdominal surgery effects seem limited to hippocampal brain regions, cardiac surgery seems associated with more wide spread alterations in the brain. PMID:26867718

  19. Sensor fusion for laparoscopic surgery skill acquisition.

    PubMed

    Anderson, Fraser; Birch, Daniel W; Boulanger, Pierre; Bischof, Walter F

    2012-01-01

    Surgical techniques are becoming more complex and require substantial training to master. The development of automated, objective methods to analyze and evaluate surgical skill is necessary to provide trainees with reliable and accurate feedback during their training programs. We present a system to capture, visualize, and analyze the movements of a laparoscopic surgeon for the purposes of skill evaluation. The system records the upper body movement of the surgeon, the position, and orientation of the instruments, and the force and torque applied to the instruments. An empirical study was conducted using the system to record the performances of a number of surgeons with a wide range of skill. The study validated the usefulness of the system, and demonstrated the accuracy of the measurements. PMID:23098188

  20. Fusion breeder

    SciTech Connect

    Moir, R.W.

    1982-04-20

    The fusion breeder is a fusion reactor designed with special blankets to maximize the transmutation by 14 MeV neutrons of uranium-238 to plutonium or thorium to uranium-233 for use as a fuel for fission reactors. Breeding fissile fuels has not been a goal of the US fusion energy program. This paper suggests it is time for a policy change to make the fusion breeder a goal of the US fusion program and the US nuclear energy program. The purpose of this paper is to suggest this policy change be made and tell why it should be made, and to outline specific research and development goals so that the fusion breeder will be developed in time to meet fissile fuel needs.

  1. Fusion breeder

    SciTech Connect

    Moir, R.W.

    1982-02-22

    The fusion breeder is a fusion reactor designed with special blankets to maximize the transmutation by 14 MeV neutrons of uranium-238 to plutonium or thorium to uranium-233 for use as a fuel for fission reactors. Breeding fissile fuels has not been a goal of the US fusion energy program. This paper suggests it is time for a policy change to make the fusion breeder a goal of the US fusion program and the US nuclear energy program. The purpose of this paper is to suggest this policy change be made and tell why it should be made, and to outline specific research and development goals so that the fusion breeder will be developed in time to meet fissile fuel needs.

  2. Dry needling for the management of thoracic spine pain.

    PubMed

    Fernández-de-Las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-07-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars. PMID:26309385

  3. "Polarized" Fusion

    NASA Astrophysics Data System (ADS)

    Schieck, Hans Paetz Gen.

    Increasing energy demand in view of limited supply, as well as environmental and nuclear-safety concerns leading to increased emphasis on renewable energy sources such as solar or wind energy are expected to focus public and scientific interest increasingly also on fusion energy. With the decision to build ITER (low-density magnetic confinement) and also continuing research on (high-density) inertial-confinement fusion (cf. the inauguration of the laser fusion facility at the Lawrence Livermore National Laboratory) prospects of fusion energy have probably entered a new era.

  4. Fusion Implementation

    SciTech Connect

    J.A. Schmidt

    2002-02-20

    If a fusion DEMO reactor can be brought into operation during the first half of this century, fusion power production can have a significant impact on carbon dioxide production during the latter half of the century. An assessment of fusion implementation scenarios shows that the resource demands and waste production associated with these scenarios are manageable factors. If fusion is implemented during the latter half of this century it will be one element of a portfolio of (hopefully) carbon dioxide limiting sources of electrical power. It is time to assess the regional implications of fusion power implementation. An important attribute of fusion power is the wide range of possible regions of the country, or countries in the world, where power plants can be located. Unlike most renewable energy options, fusion energy will function within a local distribution system and not require costly, and difficult, long distance transmission systems. For example, the East Coast of the United States is a prime candidate for fusion power deployment by virtue of its distance from renewable energy sources. As fossil fuels become less and less available as an energy option, the transmission of energy across bodies of water will become very expensive. On a global scale, fusion power will be particularly attractive for regions separated from sources of renewable energy by oceans.

  5. Syndrome of fascial incarceration of the long thoracic nerve: winged scapula☆

    PubMed Central

    Silva, Jefferson Braga; Gerhardt, Samanta; Pacheco, Ivan

    2015-01-01

    Objective To analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula. Methods Six patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up. Results The patients achieved improvement of their symptoms 6–20 months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders. Conclusion The approach of early surgical release seems to be a better predictor for recovery from non-traumatic paralysis of the anterior serratus muscle. PMID:26535205

  6. A Rare Cause of Postoperative Abdominal Pain in a Spinal Fusion Patient.

    PubMed

    Horn, Pamela L; Beeb, Allan C; King, Denis R

    2015-09-01

    We present the case of a 12-year-old girl who underwent an uncomplicated posterior spinal fusion with instrumentation for scoliosis and who later developed nausea, emesis, and abdominal pain. We discuss the epidemiology, prevalence, anatomic findings, symptoms, diagnostic tests, and clinical management, including nonsurgical and surgical therapies, of superior mesenteric artery syndrome (SMAS), a rare condition. Over a 2-week period, the patient developed an uncommon type of bowel obstruction likely related to her initial thin body habitus, correction of her deformity, and weight loss after surgery. The patient returned to the operating room for placement of a Stamm gastrostomy feeding tube with insertion of a transgastric-jejunal (G-J) feeding tube. The patient had the G-J feeding tube in place for approximately 6 weeks to augment her enteral nutrition. As she gained weight, her duodenal emptying improved, and she gradually transitioned to normal oral intake. She has done well since the G-J feeding tube was removed. Posterior spinal fusion for adolescent idiopathic scoliosis is a relatively common procedure, and SMAS is a rare condition. However, in the case of an asthenic adolescent with postoperative weight loss, intestinal obstruction can develop. When planning operative spinal correction in scoliosis patients who have a low body mass index at the time of surgery and who have increased thoracic stiffness, be alert for signs and symptoms of SMAS. This rare complication can develop, and timely diagnosis and medical management will decrease morbidity and shorten the length of time needed for nutritional rehabilitation. PMID:26372764

  7. Tennis elbow surgery - discharge

    MedlinePlus

    ... surgery - discharge; Lateral tendinosis surgery - discharge; Lateral tennis elbow surgery - discharge ... had surgery to repair a tendon in your elbow . The surgeon made a cut (incision) over the ...

  8. Transpedicular closing wedge osteotomy in the treatment of thoracic and lumbar kyphotic deformity with different etiologies.

    PubMed

    He, Qingyi; Xu, Jianzhong

    2013-12-01

    Transpedicular closing wedge osteotomy (CWO) has become popular in correcting thoracic and lumbar kyphotic deformity (TLKD). Our study aims to evaluate the efficacy of CWO in treating TLKD of different etiologies. CWO was performed on 25 patients with thoracic and lumbar kyphosis, of whom 10 had ankylosing spondylitis, 10 had post-traumatic thoracolumbar fractures, and 5 had tuberculosis. Mean follow-up period was 24 months. Pre- and postoperative kyphotic Cobb angles and the horizontal distance between C7 and S1 in the lateral view were measured. Back pain and disability were assessed by visual analog score (VAS) and oswestry disability index (ODI). Postoperative complications were also recorded. Kyphotic deformity was successfully corrected, and 100% osteotomic site fusion was obtained in all cases. Average operative duration was 255.6 min and blood loss was 1,675.6 ml. Average correction angels were 37.6°. The horizontal distance between C7 and S1 was 88.28 mm before the operation and 20.84 mm after the operation. Pre- and postoperative mean VAS of back pain in all cases was 7.6 and 2.6 respectively. Pre- and postoperative mean ODI was 61.8 and 27.32 receptively. Six complications were registered in six patients. Pedicle subtraction osteotomy is an effective and safe surgical method to correct thoracic and lumbar kyphosis of different etiologies. PMID:23412221

  9. Postoperative stabilization of the posttraumatic thoracic and lumbar spine: a review of concepts and orthotic techniques.

    PubMed

    Benzel, E C; Larson, S J

    1989-03-01

    A review of 109 case histories of patients who had undergone a spine fusion and/or posterior instrumentation procedure for thoracic and/or lumbar spine trauma was performed with respect to efficacy of several postoperative external splinting techniques. These data formed the basis for a review of external spinal splinting techniques. The type of orthosis that appears to offer the most efficacious immobilization and maximum patient comfort for fractures in the upper thoracic region in a body shell jacket extending from the submental and suboccipital regions to the lumbar region (modified Minerva jacket). To gain a lower point of fixation in patients with mid-to-low lumbar fractures, it was found that an extended body shell or an extension of a body jacket to one leg (hip spica) was necessary. Thoracic and thoracolumbar injuries may be stabilized with either a Jewett brace or a body jacket. The lack of maintenance of the cylindrical body shell, as well as excessive discomfort, make the Jewett brace and similar orthotic devices a second choice to body shell jackets for fractures in this region. The application of plastic polymer (Thermoplast) to spine splinting techniques offers the patient increased comfort and stability, as well as facilitating easy application and a more snug fit. PMID:2520056

  10. Maze Surgery

    MedlinePlus

    ... patients may also receive a pacemaker during the surgery. Recovery Time You can expect to stay in the hospital for 5 to 7 days or longer, including at least 1 to 2 days in the ... control any fluid buildup after surgery. You may also need to take aspirin for ...

  11. Unnecessary surgery.

    PubMed Central

    Leape, L L

    1989-01-01

    The extent of unnecessary surgery has been the object of considerable speculation and occasional wild accusation in recent years. Most evidence of the existence of unnecessary surgery, such as information from studies of geographic variations and the results of second surgical opinion programs, is circumstantial. However, results from the few studies that have measured unnecessary surgery directly indicate that for some highly controversial operations the fraction that are unwarranted could be as high as 30 percent. Most unnecessary surgery results from physician uncertainty about the effectiveness of an operation. Elimination of this uncertainty requires more efficient production and dissemination of scientific information about clinical effectiveness. In the absence of adequate data from scientific studies, the use of a consensus of expert opinion, disseminated by means of comprehensive practice guidelines, offers the best opportunity to identify and eliminate unnecessary surgery. PMID:2668237

  12. Refractive Surgery

    PubMed Central

    Kellum, Keith

    2000-01-01

    The concept of surgically altering the eye to correct refractive errors has been considered for hundreds of years, but only in the past 60 years has interest grown considerably due to the development of modern refractive surgery techniques such as astigmatic keratotomies to correct astigmatism induced by cataract surgery and future technologies currently being investigated. Modern refractive surgery is more involved than setting the correct parameters on the laser. Patient selection and examination, proper technique, and postoperative follow-up for potential complications are essential for a successful refractive procedure. Critical evaluation of new techniques is vital to avoid the pitfall of overly exuberant enthusiasm for new and unproven methods of refractive surgery. Kellum K. Refractive surgery. The Ochsner Journal 2000; 2:164-167. PMID:21765686

  13. A GRIA2 and PAX8-positive renal solitary fibrous tumor with NAB2-STAT6 gene fusion.

    PubMed

    Ichiyanagi, Osamu; Ito, Hiromi; Takai, Satoshi; Naito, Sei; Kato, Tomoyuki; Nagaoka, Akira; Yamakawa, Mitsunori

    2015-01-01

    Solitary fibrous tumor (SFT) is a rare neoplasm composed of mesenchymal-derived spindle cells. Although SFT occurs anywhere in the body, they most frequently affects the thoracic region. Here, we reported an extremely rare case of an extrathoracic SFT occurring primarily in the kidney. To our knowledge, little information has been described on the immunohistochemistry (IHC) and genetics of renal SFT.A 41-year old Japanese female came to our hospital for further examination of a left kidney mass detected incidentally with ultrasound. Extensive investigation of the tumor, including physical, laboratory, and image examinations led to a clinical diagnosis of renal cancer (cT1aN0M0), which were in most parts imbedded in the lower polar parenchyma. The patient underwent laparoscopic radical nephrectomy. The mass was diagnosed pathologically as SFT originating from the kidney, but not as renal carcinoma. Microscopically, the tumor was composed of spindle-shape cells distributed variably in dense collagenous stroma and had a focal hemangiopericytomatous staghorn-like vascular pattern. Mitotic figures, atypical structures, necrosis and hemorrhage were not identified. No adjuvant therapies were given postoperatively. The patient has been free of tumor recurrence for 25 months since the surgery. IHC revealed that the tumor diffusely expressed CD34, CD99, Bcl2, PAX8, NAB2, STAT6, and GRIA2. The tumor stained negatively for desmin, S-100, c-Kit, CK-AE1/AE3, CDK4 and MDM2. A NAB2-SATA6 gene fusion was detected in tumor cells by reverse transcription-polymerase chain reaction, direct sequencing, and an in situ proximity ligation brightfield assay. The gene fusion occurred as an 831 bp truncation of exon 2 in NAB2 connected to the beginning of exon 3 in STAT6. We have reported a case of GRIA2 and PAX8-positive SFT occurring primarily in the kidney with such NAB2-STAT6 gene fusion for the first time. Diffuse expression of PAX8 in the tumor might present with a renal origin. Reportedly, benign histology of SFT cannot necessarily predict favorable clinical prognosis. Genetic alterations recently identified in SFT could possibly refer to risk stratification for tumor recurrence. However, malignant preponderance of extrathoracic SFT over thoracic SFT remains unexplained so far. Long-term follow-up after surgery should be performed in the present case. PMID:26337721

  14. [Digital thoracic radiology: devices, image processing, limits].

    PubMed

    Frija, J; de Géry, S; Lallouet, F; Guermazi, A; Zagdanski, A M; De Kerviler, E

    2001-09-01

    In a first part, the different techniques of digital thoracic radiography are described. Since computed radiography with phosphore plates are the most commercialized it is more emphasized. But the other detectors are also described, as the drum coated with selenium and the direct digital radiography with selenium detectors. The other detectors are also studied in particular indirect flat panels detectors and the system with four high resolution CCD cameras. In a second step the most important image processing are discussed: the gradation curves, the unsharp mask processing, the system MUSICA, the dynamic range compression or reduction, the soustraction with dual energy. In the last part the advantages and the drawbacks of computed thoracic radiography are emphasized. The most important are the almost constant good quality of the pictures and the possibilities of image processing. PMID:11567193

  15. Acute Aortic Syndromes and Thoracic Aortic Aneurysm

    PubMed Central

    Ramanath, Vijay S.; Oh, Jae K.; Sundt, Thoralf M.; Eagle, Kim A.

    2009-01-01

    Acute and chronic aortic diseases have been diagnosed and studied by physicians for centuries. Both the diagnosis and treatment of aortic diseases have been steadily improving over time, largely because of increased physician awareness and improvements in diagnostic modalities. This comprehensive review discusses the pathophysiology and risk factors, classification schemes, epidemiology, clinical presentations, diagnostic modalities, management options, and outcomes of various aortic conditions, including acute aortic dissection (and its variants intramural hematoma and penetrating aortic ulcers) and thoracic aortic aneurysms. Literature searches of the PubMed database were conducted using the following keywords: aortic dissection, intramural hematoma, aortic ulcer, and thoracic aortic aneurysm. Retrospective and prospective studies performed within the past 20 years were included in the review; however, most data are from the past 15 years. PMID:19411444

  16. Endovascular repair of thoracic aortic aneurysms.

    PubMed

    Cartes-Zumelzu, F; Lammer, J; Kretschmer, G; Hoelzenbein, T; Grabenwöger, M; Thurnher, S

    2000-03-01

    The standard technique for the treatment of descending thoracic aortic aneurysms is elective open surgical repair with graft interposition. This standard approach, although steadily improving, is associated with high morbidity and substantial mortality rates and implies a major surgical procedure with lateral thoracotomy, use of cardiopulmonary bypass, long operation times and a variety of peri- and postoperative complications. This and the success of the first endoluminal treatment of abdominal aortic aneurysms by Parodi et al. prompted the attention to be thrown on the treatment of descending thoracic aortic aneurysms with endoluminal stent-grafts in many large centres. The aim of this new minimally invasive technique is to exclude the aneurysm from blood flow and in consequence to avoid pressure stress on the aneurysmatic aortic wall, by avoiding a large open operation with significant perioperative morbidity. The potentially beneficial effect of this new treatment approach was evaluated in the course of this study. PMID:10875224

  17. Kuntz's fiber: the scapegoat of surgical failure in sympathetic surgery.

    PubMed

    Lin, C C; Wu, H H

    2001-01-01

    Resection of Kuntz's fiber is considered a guarantee to treat Hyperhidrosis in sympathetic surgery. The incidence of Kuntz's fiber is about 60.0% in clinical studies while the surgical failure rate is about 1.5% when Kuntz's fiber is preserved on Endoscopic Thoracic Sympathetic Block by clamping, which is performed by clamping the upper and lower end of ganglion. We found that supererogatory resection of Kuntz's fiber is inessential; clamping of upper and lower ends of the ganglia should be a complete procedure in sympathetic surgery. Kuntz's fiber plays only anatomic, and no clinical role in surgical failure of sympathetic surgery. PMID:11695786

  18. Extraosseous Thoracic Foraminal Osteoblastoma: Diagnostic Dilemma and Management with 3 Year Follow-Up

    PubMed Central

    Hadgaonkar, Shailesh Ramakant; Shah, Kunal Chandrakant; Khurjekar, Ketan Shripad; Sancheti, Parag Kantilal

    2014-01-01

    Osteoblastomas are bone forming lesions arising mainly from posterior elements of the vertebra. They are commonly encountered in the cervical and lumbar regions. We present a case of a thoracic osteoblastoma which is extra osseous and is not communicating with any part of the vertebra present intraforaminally. This is a rare presentation of an osteoblastoma. Imaging studies do not accurately diagnose the osteiod lesion. The size of the lesion and cortical erosion seen on the computed tomography scan help in differentiating the osteoid osteoma and osteoblastoma, but they are less sensitive and specific. Thus a histopathology is the investigation of choice to diagnose the osteoblastoma. Early and adequate removal of mass prevents malignant transformation, metastasis, and recurrence. In our case we excised the pars interarticularis unilaterally, removed the osteoid mass intact, and performed unilateral instrumented fusion. There was no recurrence and solid fusion was seen at 3 years follow up. PMID:25346825

  19. Cartilage calcification in the human thoracic column.

    PubMed

    Dhem, A; Passelecq, E; Peten, E

    1987-01-01

    A histological and microradiological study of the cartilage calcification processes in the human thoracic column of an old man has been performed. Two different types of cartilage mineralization have been identified. The first corresponds to a calcification of the hyaline cartilage ground substance where chondrocytes are apparently intact. The second is a real mineralization of the chondrocyte lacunae in an uncalcified matrix, which we have called cartilaginous necrosis. PMID:3661115

  20. Rare thoracic cancers, including peritoneum mesothelioma.

    PubMed

    Siesling, Sabine; van der Zwan, Jan Maarten; Izarzugaza, Isabel; Jaal, Jana; Treasure, Tom; Foschi, Roberto; Ricardi, Umberto; Groen, Harry; Tavilla, Andrea; Ardanaz, Eva

    2012-05-01

    Rare thoracic cancers include those of the trachea, thymus and mesothelioma (including peritoneum mesothelioma). The aim of this study was to describe the incidence, prevalence and survival of rare thoracic tumours using a large database, which includes cancer patients diagnosed from 1978 to 2002, registered in 89 population-based cancer registries (CRs) and followed-up to 31st December 2003. Over 17,688 cases of rare thoracic cancers were selected based on the list of the RACECARE project. Mesothelioma was the most common tumour (19 per million per year) followed by epithelial tumours of the trachea and thymus (1.3 and 1.7, respectively). The age standardised incidence rates of epithelial tumours of the trachea was double in Eastern and Southern Europe versus the other European regions: 2 per million per year. Epithelial tumours of the thymus had the lowest incidence in Northern and Eastern Europe and UK and Ireland(1) and somewhat higher incidence in Central and Southern Europe.(2) Highest incidence in mesothelioma was seen in UK and Ireland(23) and lowest in Eastern Europe.(4) Patients with tumours of the thymus had the best prognosis (1-year survival 85%, 66% at 5 years). Five year survival was lowest for the mesothelioma 5% compared to 14% of patients with tumours of the trachea. Mesothelioma was the most prevalent rare cancer (12,000 cases), followed by thymus (7000) and trachea (1400). Cancer Registry (CR) data play an important role in revealing the burden of rare thoracic cancers and monitoring the effect of regulations on asbestos use and smoking related policies. PMID:22406029

  1. Ossification of spinal ligaments causing thoracic radiculomyelopathy

    SciTech Connect

    Miyasaka, K.; Kaneda, K.; Ito, T.; Takei, H.; Sugimoto, S.; Tsuru, M.

    1982-05-01

    The authors reviewed 14 cases of thoracic radiculomyelopathy due mainly to ossification of the ligamentum flavum, posterior longitudinal ligament, or both. Other spinal ligamentous structures were occasionally involved, including the joint capsule, the anterior longitudinal ligament, or even the dura mater; sclerosis of the lamina or shortening of the predicles was sometimes seen. Plain radiographs illustrate the characteristic features of these lesions and are indispensable for screening, while CT accurately defines the extent of ossification.

  2. Mini Transsternal Approach to the Anterior High Thoracic Spine (T1–T4 Vertebrae)

    PubMed Central

    Thakur, Bhaskar; Tsoti, Sandra Maria; Anichini, Giulio; Vergani, Francesco; Malik, Irfan

    2016-01-01

    Purpose. The anterior high thoracic spine is one of the most complex segments to be accessed surgically due to anatomical constraints and transitional characteristics. We describe in detail the mini transsternal approach to metastatic, infective, traumatic, and degenerative pathologies of T1 to T4 vertebral bodies. We analyse our surgical series, indications, and outcomes. Methods. Over a 5-year period 18 consecutive patients with thoracic myelopathy due to metastatic, infective, traumatic, and degenerative pathologies with T1 to T4 vertebral bodies involvement received a mini transsternal approach with intraoperative monitoring. Frankel scoring system was used to grade the neurological status. Results. Mean follow-up was 40 months. 78% patients improved in Frankel grade after surgery and 22% patients remained unchanged. Average operation time was 210 minutes. There were no intraoperative complications. One patient developed postoperative pneumonia successfully treated with antibiotics. Conclusion. The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca. This approach overcomes the anatomical constraints of this region and provides adequate room for optimal reconstruction and preservation of spinal alignment in the cervicothoracic transition zone with good functional patient outcomes. PMID:27218104

  3. Thoracic arachnoiditis, arachnoid cyst and syrinx formation secondary to myelography with Myodil, 30 years previously.

    PubMed

    Gnanalingham, Kanna K; Joshi, Shabin Man; Sabin, Ian

    2006-10-01

    Spinal arachnoiditis can rarely occur following irritation from foreign body substances, including certain oil based contrast agents used for myelography. We describe a patient with thoracic arachnoiditis, arachnoid cyst and syringomyelia, 30 years following a myelogram with Myodil. A 62-year-old female presented with chronic thoraco-lumbar back pain, a spastic paraparesis and sphincter disturbance. She had undergone a myelogram with Myodil, 30 years previously for investigation of back pain. A MRI scan revealed evidence of arachnoiditis, thoracic syringomyelia (T6-T8) and an anteriorly placed, extramedullary, arachnoid cyst at T10-T12, compressing the cord. At surgery, T7-T10 thoracic laminectomies were carried out and syringo- and cysto-subarachnoid shunts were inserted. At 12 months follow-up, the sphincter disturbance, lower limb weakness and mobility problems had almost resolved. Although, the use of oil based contrast agents such as Myodil has been discontinued, the present case illustrates some of the rare sequelae of its use, manifesting decades later. Aggressive surgical intervention produced symptomatic benefit. PMID:16944225

  4. Application of percutaneous vertebroplasty in the treatment of multiple thoracic metastases

    PubMed Central

    LIU, WENHUA; ZHOU, SHIJUN; WANG, SHAOFENG

    2015-01-01

    The present study aimed to explore the clinical implications of percutaneous vertebroplasty (PVP) in the treatment of multiple thoracic metastases. A total of 104 involved vertebrae of 28 patients with multiple thoracic metastases underwent PVP and the injection of bone cement. The pain relief rate and activity of daily life were assessed, and the morphological changes of the involved vertebral bodies and the invasiveness of the intraspinal tumor were also observed at 1 week, and 3, 6 and 12 months post-surgery, respectively. The pain relief rate increased at each time-point following PVP. The quality of life scores were also significantly higher than the pre-operative scores. After 12 months of follow-up, the post-operative heights of the anterior border, center and posterior border of the vertebral bodies were not noted to be statistically different from those prior to PVP (P>0.05). The present study concluded that PVP has a good analgesic effect on multiple thoracic metastases. PVP not only improves the quality of life of patients significantly, but also prevents further vertebral collapse and the invasiveness of intraspinal tumors, avoiding the nerve dysfunction caused by spinal cord compression. PMID:26137145

  5. Thoracic epidural anesthesia: Effects on splanchnic circulation and implications in Anesthesia and Intensive care

    PubMed Central

    Siniscalchi, Antonio; Gamberini, Lorenzo; Laici, Cristiana; Bardi, Tommaso; Faenza, Stefano

    2015-01-01

    AIM: To evaluate the currently available evidence on thoracic epidural anesthesia effects on splanchnic macro and microcirculation, in physiologic and pathologic conditions. METHODS: A PubMed search was conducted using the MeSH database. Anesthesia, Epidural was always the first MeSH heading and was combined by boolean operator AND with the following headings: Circulation, Splanchnic; Intestines; Pancreas and Pancreatitis; Liver Function Tests. EMBASE, Cochrane library, ClinicalTrials.gov and clinicaltrialsregister.eu were also searched using the same terms. RESULTS: Twenty-seven relevant studies and four ongoing trials were found. The data regarding the effects of epidural anesthesia on splanchnic perfusion are conflicting. The studies focusing on regional macro-hemodynamics in healthy animals and humans undergoing elective surgery, demonstrated no influence or worsening of regional perfusion in patients receiving thoracic epidural anesthesia (TEA). On the other hand most of the studies focusing on micro-hemodynamics, especially in pathologic low flow conditions, suggested that TEA could foster microcirculation. CONCLUSION: The available studies in this field are heterogeneous and the results conflicting, thus it is difficult to draw decisive conclusions. However there is increasing evidence deriving from animal studies, that thoracic epidural blockade could have an important role in modifying tissue microperfusion and protecting microcirculatory weak units from ischemic damage, regardless of the effects on macro-hemodynamics. PMID:25685727

  6. Thoracic disease in children with AIDS.

    PubMed

    Marks, M J; Haney, P J; McDermott, M P; White, C S; Vennos, A D

    1996-11-01

    Knowledge of common and uncommon thoracic pathologic conditions in children with acquired immunodeficiency syndrome (AIDS) can expedite disease management. Chest radiography, computed tomography (CT), and magnetic resonance (MR) imaging are useful in cases involving possible complications of thoracic AIDS. Lymphocytic interstitial pneumonitis (LIP) is generally seen on plain radiographs and CT scans as a diffuse, symmetric, reticulonodular or nodular pattern, occasionally associated with mediastinal or hilar adenopathy. Chronic consolidations and bronchiectasis may be observed in pediatric AIDS patients with no evidence of previous LIP. Bacterial pneumonia, a frequent initial manifestation of AIDS, appears as lobar or segmental consolidations on radiographs. Radiographic findings of Pneumocystis carinii pneumonia, the most common infection, include rapidly progressive increased air-space opacity with air bronchograms. Lymphoma often appears as a mediastinal or hilar mass, often without involvement of the lung parenchyma. Thoracic smooth muscle tumors have also been observed in children with AIDS. Multilocular thymic cysts have low attenuation on CT scans and increased signal intensity on T2-weighted MR images. Most pediatric AIDS patients with cardiac disease have cardiomegaly, often associated with pulmonary edema, at chest radiography. An esophagogram may show ulceration, plaque formation, mucosal edema, and dysmotility in patients with candidal esophagitis. PMID:8946540

  7. Foot Surgery

    MedlinePlus

    ... do not move. Fusions can be done with screws, plates or pins or a combination of these. ... cutting of bones in a precise fashion). Bone screws, pins, wires, staples, and other fixation devices (both ...

  8. Endovascular treatment of atherosclerotic and other thoracic aortic aneurysms.

    PubMed

    Fattori, Rossella; Russo, Vincenzo

    2007-06-01

    The incidence of thoracic aortic aneurysms (TAAs) is increasing with the present rate of occurrence at 10.9 cases per 100,000 people per year. The estimated 5-year risk of rupture of a TAA with a diameter between 4 and 5.9 cm is 16%, but it rises to 31% for aneurysms ≥ 6 cm. Despite increasing awareness of the importance of early diagnosis and treatment options, there are no clear guidelines available at the time of writing. Nor is there any clear evidence for specific pharmacological treatment able to resolve or delay the disease progression. Endovascular treatment (EVT), proposed as an alternative to surgery, has been considered a therapeutic innovation, especially because it is minimally invasive, which allows treatment even in high surgical risk patients. Vascular imaging is crucial for patient selection, endoprosthesis choice, and planning of the treatment because not all aneurysms are suitable. Early and midterm results are encouraging, but long-term results are necessary to definitively assess reliability of stent-graft materials and improvement in patient survival. In the choice between surgical or endovascular repair of TAAs, many factors must be considered, including the clinical situation, comorbidities, anatomy, choice of equipment, and last, but not less important, experience of the clinical team. PMID:21326796

  9. (Video Assisted) thoracoscopic surgery: Getting started

    PubMed Central

    Molnar, Tamas F

    2007-01-01

    Thoracoscopic surgery without or with video assistance (VATS) is simpler and easier to learn as it seems to be. Potential benefits of the procedure in rural surgical environment are outlined while basic requirements and limitations are listed. Thoracoscopy kit, thoracotomy tray at hand, patient monitoring, proper drainage system, pain control and access to chest physiotherapy are the basic requirements. Having headlight, bronchoscope, Ligasure and mechanical staplers offer clear advantages but they are not indispensable. Exploration and evacuation of pleural space, pleurodesis, surgery for Stage I and II thoracic empyema are evidenced fields of VATS procedures. Some of the cases can be performed under controlled local anesthesia. Acute chest trauma cannot be recommended for VATS treatment. Lung cancer is out of the scope of rural surgery. PMID:19789679

  10. Emerging alternative model for cardiothoracic surgery training in India

    PubMed Central

    Vaithianathan, Rajan; Panneerselvam, Senthil

    2013-01-01

    Background In India, cardiothoracic (CT) surgery training follows a 3+3-year model, where 3 years of general surgery residency with certification (MS/DNB) is required for entering 3 years of thoracic surgery residency (MCh/DNB). There are two certifying boards at the national level. One being the Medical Council of India (MCI), which oversees the major accreditation process involving the undergraduate and postgraduate medical education in India, and the other being the National Board of Examinations (NBE), which was formed for the purpose of establishing a uniform standard of postgraduate medical education. Recently, the latter body has come up with an alternative model for thoracic surgery residency in India. This model includes an integrated 6-year residency, with lesser emphasis on general surgical skills and greater exposure to CT surgery. Conclusions Changes to the current model of training for CT surgery is the need of the hour and should be initiated very soon by the MCI to meet the future demand for CT surgeons in India. An integrated training program is essential to create a new generation of cardiovascular specialists. Future directions to achieve this goal must include modifications to the undergraduate programs so as to infuse interest for CT surgery in the young minds of medical students. PMID:23651927

  11. Brain surgery

    MedlinePlus

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  12. Retrospective review of thoracic neural damage during lung ablation - what the interventional radiologist needs to know about neural thoracic anatomy

    SciTech Connect

    Palussiere, Jean; Canella, Mathieu; Cornelis, Francois; Catena, Vittorio; Descat, Edouard; Brouste, Veronique; Montaudon, Michel

    2013-12-15

    Background and Purpose: Radiofrequency ablation (RFA) is associated with low neural morbidity compared with surgery, which commonly causes debilitating long-term pain. The purpose was to review the thoracic neural anatomy relevant to percutaneous RFA and to retrospectively review symptomatic nerve injury after lung RFA at our institution. Materials and Methods: We retrospectively examined all symptomatic nerve injuries occurring after computed tomography (CT)-guided RFA treatment of lung tumors for 462 patients/509 procedures/708 lesions treated at our large tertiary referral centre during 10 years. Results: Eight patients experienced neurological complications after heating during the RFA procedure. These complications occurred in the phrenic (n = 1), brachial (n = 3), left recurrent (n = 1), and intercostal nerves (n = 2) and the stellate ganglion (n = 1). Three were grade 2, four grade 3 and one grade 4 injuries (CTCAE v3). Conclusion: Although rare, neurological complications can occur after RFA, and they can occasionally be severe. To prevent these complications, it is important for the interventional radiologist to be aware of the anatomy of nervous structures and to attempt to identify nerves on CT scans during the RFA procedure. Creating a pneumothorax can be useful to avoid nerve damage and related clinical complications.

  13. CT and MRI in the Evaluation of Thoracic Aortic Diseases

    PubMed Central

    2013-01-01

    Computed tomography (CT) and magnetic resonance imaging (MRI) are the most commonly used imaging examinations to evaluate thoracic aortic diseases because of their high spatial and temporal resolutions, large fields of view, and multiplanar imaging reconstruction capabilities. CT and MRI play an important role not only in the diagnosis of thoracic aortic disease but also in the preoperative assessment and followup after treatment. In this review, the CT and MRI appearances of various acquired thoracic aortic conditions are described and illustrated. PMID:24396601

  14. THORACIC REGION SELF-MOBILIZATION: A CLINICAL SUGGESTION

    PubMed Central

    Grindstaff, Terry L.

    2012-01-01

    Limitations in thoracic spine motion may be due to restrictions in contractile or non-contractile tissues. Joint mobilizations are indicated when hypomobility of a joint (non-contractile tissue) is identified. The ability for a patient to perform self-mobilizations of the thoracic spine and ribs may help maximize intervention outcomes. The purpose of this article is to describe a low cost, portable device which can be used for thoracic spine self-mobilization techniques. PMID:22530198

  15. Telepresence surgery system enhances medical student surgery training.

    PubMed

    Kaufmann, C; Rhee, P; Burris, D

    1999-01-01

    The telepresence surgery system (TeSS) permits the surgeon to operate on a patient across distances. This is achieved through real-time 3D video vision, stereo audio, and remote instrument control with haptic feedback. Telepresence surgery has been proposed to be useful in providing specialist operative consultation to remote areas. Remotely mentoring medical students with no surgical experience through complex procedures provides an even greater challenge. Third-year medical students with no prior operative experience were mentored exclusively through use of TeSS during a standard surgical skills lab. This two-day laboratory includes abdominal procedures and thoracic procedures. The medical students were alone in the operating room and the teaching surgeon was in an entirely separate room. Anatomy, surgical principles, and adjunct techniques were taught to the students. The students felt the experience was better than standard because of the enhanced learning secondary to the required verbal accuracy in describing the procedures. In addition, they felt they had better visibility since the instructor was not standing in the way. The telepresence surgery system can be successfully used to remotely mentor and enhance introductory surgical training for inexperienced medical students. PMID:10538350

  16. Horner's syndrome after paediatric cardiac surgery: case report and review of the literature.

    PubMed

    Nasser, Bana A; Mesned, Abdulrahman; Moazamy, Yousry E; Kabbani, Mohamed S

    2015-03-01

    Iatrogenic Horner's syndrome is a rare complication that can occur after trauma, cervical central line insertion, chest tube insertion, and rarely following adult thoracic and neck surgery, especially in high risk patients with hypertension and diabetes. The majority of cases reported in the literature describe non-iatrogenic Horner's syndrome in adults as an unusual presentation for cervical tumours or apical lung carcinoma. In children, there are some reports describing acquired Horner's syndrome following trauma or invasive intervention near the cervical-thoracic area. Less has been written about the incidence of Horner's syndrome following paediatric cardiac surgery. PMID:24717921

  17. Intraoperative Neurophysiologic Monitoring (INM) in scoliosis surgery.

    PubMed

    Pankowski, Rafal; Dziegiel, Krzysztof; Roclawski, Marek; Smoczynski, Andrzej; Ceynowa, Marcin; Kloc, Wojciech; Wasilewski, Wojciech; Jende, Piotr; Liczbik, Wieslaw; Beldzinski, Piotr; Libionka, Witold; Pierzak, Olaf; Adamski, Stanislaw; Niedbala, Miroslaw

    2012-01-01

    Even among skilled spinal deformity surgeons, neurologic deficits are inherent potential complications of spine surgery. The aim was to assess the meaning of changes and to evaluate the critical rates of Somatosensory Evoked Potentials (SEP) and Motor Evoked Potentials (MEP) for Neurologic Deficit (ND) occurrence associated with scoliosis surgery. A Group of 30 patients with idiopathic scoliosis treated surgically by posterior correction and stabilisation were included. Patients were matched by age, sex, aetiology, Cobb angle, and surgical criteria. Data on three planar scoliosis correction and concomitant (INM) alarms were compared. Radiographic assessment was performed from radiographs taken before surgery and just after it. The (INM) was performed with the use of ISSIS (Inomed) in every patients the same fashion. The average thoracic curve correction was 69.7% and lumbar 69.8%. The average preoperative Apical Vertebral Rotation was 23.5° for thoracic and 27.9° for lumbar curves and postoperatively 10.9° and 14.3° respectively. There was a significant variability of SEP during surgery with only 7 (23%) patients with stable SEP. 15(50%) patients had a decrease of SEP below 50% and 8(27%) had severe decrease of SEP below 50% what caused us to stop surgery or to decrease correction of curves. There was a MEP decrease in 11(37%) patients and in 6 (20%) directly after correction up to 50% of normal value. In 5 of 30 (17%) patients there was a significant decrease of MEP below 50% and we immediately released the implant. The SEP decrease up to 50% without any MEP change did not influenced the outcome. There was no correlation between flexibility and correction of the curve and SEP and MEP decrease. The safe level for MEP was not determined but its meaning for the outcome was more important than SEP value. The need of (INM) during scoliosis surgery to avoid (ND) was confirmed. PMID:22744519

  18. Bariatric surgery

    PubMed Central

    Karmali, Shahzeer; Stoklossa, Carlene Johnson; Sharma, Arya; Stadnyk, Janet; Christiansen, Sandra; Cottreau, Danielle; Birch, Daniel W.

    2010-01-01

    Abstract OBJECTIVE To review the management of bariatric surgical patients. QUALITY OF EVIDENCE MEDLINE, EMBASE, and Cochrane Library databases were searched, as well as PubMed US National Library, from January 1950 to December 2009. Evidence was levels I, II, and III. MAIN MESSAGE Bariatric surgery should be considered for obese patients at high risk of morbidity and mortality who have not achieved adequate weight loss with lifestyle and medical management and who are suffering from the complications of obesity. Bariatric surgery can result in substantial weight loss, resolution of comorbid conditions, and improved quality of life. The patient’s weight-loss history; his or her personal accountability, responsibility, and comprehension; and the acceptable level of risk must be taken into account. Complications include technical failure, bleeding, abdominal pain, nausea or vomiting, excess loose skin, bowel obstruction, ulcers, and anastomotic stricture. Lifelong monitoring by a multidisciplinary team is essential. CONCLUSION Limited long-term success of behavioural and pharmacologic therapies in severe obesity has led to renewed interest in bariatric surgery. Success with bariatric surgery is more likely when multidisciplinary care providers, in conjunction with primary care providers, assess, treat, monitor, and evaluate patients before and after surgery. Family physicians will play a critical role in counseling patients about bariatric surgery and will need to develop skills in managing these patients in the long-term. PMID:20841586

  19. Tennis elbow surgery

    MedlinePlus

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is usually an outpatient surgery. This means you will not stay in the hospital overnight. You will be given medicine ( ...

  20. Spinal fusion

    MedlinePlus

    ... the wound or vertebral bones Damage to a spinal nerve, causing weakness, pain, loss of sensation, problems with your bowels or bladder The vertebrae above and below the fusion are more likely to wear away, leading to more problems later

  1. Fusion Power.

    ERIC Educational Resources Information Center

    Dingee, David A.

    1979-01-01

    Discusses the extraordinary potential, the technical difficulties, and the financial problems that are associated with research and development of fusion power plants as a major source of energy. (GA)

  2. Predictors of surgical outcome in thoracic ossification of the ligamentum flavum: focusing on the quantitative signal intensity

    PubMed Central

    Zhang, JingTao; Wang, LinFeng; Li, Jie; Yang, Peng; Shen, Yong

    2016-01-01

    The association between intramedullary increased signal intensity (ISI) on T2-weighted magnetic resonance imaging (MRI) and surgical outcome in thoracic ossification of the ligamentum flavum (OLF) remains controversial. We aimed to determine the impact of signal change ratio (SCR) on thoracic OLF surgical outcomes. We retrospectively reviewed 96 cases of thoracic OLF surgery and investigated myelopathy severity, symptom duration, MRI and computed tomographic findings, surgical technique and postoperative recoveries. Surgical outcomes were evaluated according to the modified Japanese Orthopaedic Association (JOA) score and recovery rate. JOA recovery rate <50% was defined as a poor surgical outcome. By multivariate logistic regression analysis, we identified risk factors associated with surgical outcomes. Forty patients (41.7%) had a recovery rate of <50%. In receiver operating characteristic (ROC) curves, the optimal preoperative SCR cutoff value as a predictor of poor surgical outcome was 1.54. Multivariate logistic regression analysis revealed that a preoperative SCR ≥1.54 and symptom duration >12 months were significant risk factors for a poor surgical outcome. These findings suggest that preoperative SCR and duration of symptoms were significant risk factors of surgical outcome for patients with thoracic OLF. Patients with preoperative SCR ≥1.54 can experience poor postoperative recovery. PMID:26960572

  3. Surgical treatment of ectopic adrenocorticotropic hormone syndrome with intra-thoracic tumor

    PubMed Central

    Zhou, Xiang; Hang, Junbiao; Che, Jiaming; Chen, Zhongyuan; Qiu, Weicheng; Ren, Jian; Yang, Xiaoqing; Xiang, Jie

    2016-01-01

    Background The study was to review the clinical manifestations and laboratory examinations of ectopic adrenocorticotropic hormone (ACTH) syndrome, and to analyze the efficacy of surgical treatment. Methods The clinical data, surgical therapy, and outcome of 23 cases of ectopic ACTH syndrome accompanied by intra-thoracic tumors were reviewed. The tumors were removed from all the patients according to the principles of radical resection. Results The tumors were confirmed as associated with ectopic ACTH secretion in 19 cases. Hyperglycemia and hypokalemia were recovered, while plasma cortisol, plasma ACTH and 24-hour urinary free cortisol (UFC) levels were significantly reduced after surgery in these 19 cases. Recurrences of the disease were found in six cases during following-up, and five of them died. Conclusions The thoracic cavity should be a focus in routine examinations of patients with symptoms of Cushing’s syndrome (CS), because ectopic ACTH-producing tumors are commonly found in bronchus/lung and mediastinum. Despite the incidence of the pulmonary nodule secondary to opportunistic infection in some cases, surgery is still the first choice if the tumor is localized. The surgical procedure should be performed according to the principles in resection of lung cancer and mediastinal tumor. The surgical efficacy is significant for short-term periods; however, the recurrence of the disease in long-term periods is in great part related to distal metastasis or relapse of the tumor. PMID:27162663

  4. Transient Monoplegia as a Result of Unilateral Femoral Artery Ischemia Detected by Multimodal Intraoperative Neuromonitoring in Posterior Scoliosis Surgery: A Case Report.

    PubMed

    Pankowski, Rafal; Roclawski, Marek; Dziegiel, Krzysztof; Ceynowa, Marcin; Mikulicz, Marcin; Mazurek, Tomasz; Kloc, Wojciech

    2016-02-01

    This is to report a case of 16-year-old girl with transient right lower limb monoplegia as a result of femoral artery ischemia detected by multimodal intraoperative spinal cord neuromonitoring (MISNM) during posterior correction surgery of adolescent idiopathic scoliosis.A patient with a marfanoid body habitus and LENKE IA type scoliosis with the right thoracic curve of 48° of Cobb angle was admitted for posterior spinal fusion from Th6 to L2. After selective pedicle screws instrumentation and corrective maneuvers motor evoked potentials (MEP) began to decrease with no concomitant changes in somato-sensory evoked potentials recordings.The instrumentation was released first partially than completely with rod removal but the patient demonstrated constantly increasing serious neurological motor deficit of the whole right lower limb. Every technical cause of the MEP changes was eliminated and during the wake-up test the right foot was found to be pale and cold with no popliteal and dorsalis pedis pulses palpable. The patient was repositioned and the pelvic pad was placed more cranially. Instantly, the pulse and color returned to the patient's foot. Following MEP recordings showed gradual return of motor function up to the baseline at the end of the surgery, whereas somato-sensory evoked potentials were within normal range through the whole procedure.This case emphasizes the importance of the proper pelvic pad positioning during the complex spine surgeries performed in prone position of the patient. A few cases of neurological complications have been described which were the result of vascular occlusion after prolonged pressure in the inguinal area during posterior scoliosis surgery when the patient was in prone position. If incorrectly interpreted, they would have a significant impact on the course of scoliosis surgery. PMID:26871822

  5. Cell fusion.

    PubMed Central

    Podbilewicz, Benjamin

    2006-01-01

    Selective cell fusion is a natural part of development. It is found in sexually reproducing organisms that require fertilization to propagate and in muscles, placenta, bones, lens of the eye and stem cells. Cell fusion is particularly important in the development of C. elegans: in addition to 300 sperm and oocytes that fuse during fertilization, 300 of the 1090 somatic cells born, fuse throughout development. Studies of cell fusion in C. elegans have shown that although different types of cells fuse, cell membrane merger is initiated through a common mechanism involving the action of one gene, eff-1. In worms with mutations that inactivate eff-1, almost none of the 300 somatic cells that normally fuse do so, but appear to differentiate, attach and behave in the same way as fusing cells. Such worms develop and survive but have numerous morphological, behavioral and fertility defects associated to cell fusion failure in the epidermis, pharynx, male tail, vulva and uterus. Cell fusion in embryonic dorsal epithelial cells has been analyzed in great detail by confocal microscopy using membrane fluorescent probes, apical junction markers and cytoplasmic aqueous fluorescent probes allowing the direct observation of membrane disappearance, pore expansion and cytoplasmic content mixing. The complete elimination of the membranes between two fusing cells takes about 30 min and involves vesiculation of the fusing membranes. Genetic and cell biological evidence indicates that eff-1 activity is both necessary and sufficient to fuse epithelial and myoepithelial cells in vivo. Based on electron microscopic analyses of intermediates of cell fusion in eff-1 mutants, it appears that eff-1 is required for both initiation and expansion of fusion pores, similar to the fusogen of Influenza virus. While only one gene encoding a novel candidate component of the cell membrane fusion machinery has been found, the nematode's cell fusion program is under the control of many cell-specific transcriptional regulators. A large number of these conserved regulators prevent cell fusion by repressing eff-1 activity. For example, if either ceh-16/engrailed or the GATA factor EGL-18/ELT-5 is inactivated, the lateral epidermal cells that normally do not fuse in the embryo will fuse causing embryonic lethality. And if either the Hox protein lin-39/Deformed or its cofactor ceh-20/Extradenticle is inactivated, the ventral epidermal vulval precursor cells that normally do not fuse in the larvae will fuse and the hermaphrodite will have no vulva. In addition, there is evidence for coordinated and complex regulation of lin-39 in the ventral epidermis by Ras, Wnt, Rb/E2F, NuRD and lin-15 pathways. It appears that in many cells that normally do not fuse, specific transcription complexes repress eff-1 expression preventing cell fusion. ref-2 (REgulator of Fusion-2) encodes a Zn-finger protein that is required to generate ventral Pn.p cells and to keep them unfused both in males and hermaphrodites. ref-2 is necessary, but not sufficient, to maintain Pn.p cells unfused. This review shows that far from cell fusion being an unusual phenomenon, there is the clear prospect that animal cells in all tissues are intrinsically programmed to fuse, and are only prevented from fusing by transcriptional and post-transcriptional control mechanisms. There are three major questions that remain open for future research: (1) How does eff-1 fuse cells? (2) How do Ras, Wnt, Rb, NuRD, E2F, heterochronic and other pathways control cell fusion? (3) What are the implications of cell fusion beyond worms? PMID:18050486

  6. Arachnoiditis ossificans after spinal surgery.

    PubMed

    Liu, Li-Di; Zhao, Song; Liu, Wan-Guo; Zhang, Shao-Kun

    2015-05-01

    This article presents an unusual case of arachnoiditis ossificans after spinal surgery. A case of arachnoiditis ossificans secondary to lumbar fixation and decompression surgery for the treatment of multilevel lumbar fractures is reported and the relevant literature is reviewed. A 29-year-old man who previously underwent posterior pedicle screw fixation and fusion for multiple lumbar spine fractures reported lower back stiffness and discomfort 23 months postoperatively. A laminectomy was performed at L2 and at L3-L4. At L2, bone fragments from the burst fracture had injured the dural sac and some nerve roots. A posterolateral fusion was performed using allogeneic bone. Postoperatively, there were no signs of fever, infection, or systemic inflammatory responses. Arachnoiditis ossificans of the thecal sac from L1-L5 was diagnosed by magnetic resonance imaging and computed tomography at the 2-year follow-up. His postoperative neurological status progressively improved and he regained motor and sensory functions. Because of neurological improvements, fixation hardware was removed without further decompression. The authors report a case of arachnoiditis ossificans secondary to lumbar fixation and decompression surgery, which involved a large region. Arachnoiditis ossificans is a relatively rare disorder with unclear etiologies and limited treatment options. Spinal surgical intervention of arachnoiditis ossificans should be carefully considered because it may lead to poor outcomes and multiple revision surgeries. PMID:25970374

  7. Digital subtraction angiography of the thoracic aorta

    SciTech Connect

    Grossman, L.B.; Buonocore, E.; Modic, M.T.; Meaney, T.F.

    1984-02-01

    Forty-three patients with acquired and congenital abnormalities of the thoracic aorta were studied using digital subtraction angiography (DSA) after an intravenous bolus injection of 40 ml of contrast material. Abnormalities studied included coarctation, pseudocoarctation, Marfan syndrome, cervical aorta, double aortic arch, aneurysm, dissection, and tumor. Twenty-four patients also had conventional angiography. DSA was accurate in 95% of cases; in the other 5%, involving patients with acute type I dissection, the coronary arteries could not be seen. The authors concluded that in 92% of their patients, DSA could have replaced the standard aortogram.

  8. Nail surgery.

    PubMed

    Haneke, Eckart

    2013-01-01

    Nail surgery is a special branch of hand and dermatologic surgery. It is not widely performed, and many physicians do not feel at ease to perform it. The objective of this contribution is to give a short overview of the most important surgical procedures in clinical practice. References from the literature and the author's own experiences are condensed to describe what a dermatologic practitioner with knowledge of the nail and some surgical skills can perform. Nail surgery is a precise technique that requires careful administration and attention to details. Proper patient preparation starts with a patient history to identify potential contraindications and to prevent unnecessary complications. The author recommends isopropyl alcohol scrub and chlorhexidine for disinfection and ropivacaine 1% for anesthesia. The technique used for anesthesia depends on the type of surgery. Surgical procedures are described for diagnostic biopsies, nail avulsion in general, onychogryposis, paronychia treatment, hematomas and bone fracture due to trauma, removal of subungual foreign bodies, ingrowing nails, pincer nails, warts, ungual fibrokeratomas, digital myxoid pseudocyst, subungual exostoses, and various tumors. If performed correctly with adequate skills, nail surgery will lead to functionally and aesthetically satisfying results in the majority of instances. PMID:24079580

  9. Pelvic Fixation in Adult and Pediatric Spine Surgery: Historical Perspective, Indications, and Techniques: AAOS Exhibit Selection.

    PubMed

    Jain, Amit; Hassanzadeh, Hamid; Strike, Sophia A; Menga, Emmanuel N; Sponseller, Paul D; Kebaish, Khaled M

    2015-09-16

    Achieving solid osseous fusion across the lumbosacral junction has historically been, and continues to be, a challenge in spine surgery. Robust pelvic fixation plays an integral role in achieving this goal. The goals of this review are to describe the history of and indications for spinopelvic fixation, examine conventional spinopelvic fixation techniques, and review the newer S2-alar-iliac technique and its outcomes in adult and pediatric patients with spinal deformity. Since the introduction of Harrington rods in the 1960s, spinal instrumentation has evolved substantially. Indications for spinopelvic fixation as a means to achieve lumbosacral arthrodesis include a long arthrodesis (five or more vertebral levels) or use of three-column osteotomies in the lower thoracic or lumbar spine, surgical treatment of high-grade spondylolisthesis, and correction of lumbar deformity and pelvic obliquity. A variety of techniques have been described over the years, including Galveston iliac rods, Jackson intrasacral rods, the Kostuik transiliac bar, iliac screws, and S2-alar-iliac screws. Modern iliac screws and S2-alar-iliac screws are associated with relatively low rates of pseudarthrosis. S2-alar-iliac screws have the advantages of less implant prominence and inline placement with proximal spinal anchors. Collectively, these techniques provide powerful methods for obtaining control of the pelvis in facilitating lumbosacral arthrodesis. PMID:26378268

  10. Thoracic Extradural Cavernous Hemangioma Mimicking a Dumbbell-Shaped Tumor

    PubMed Central

    Jeong, Won Joo; Choi, Il; Seong, Han Yu

    2015-01-01

    Dumbbell-shaped spinal extradural cavernous hemangioma is rare. The differential diagnosis of dumbbell-shaped spinal tumors based on magnetic resonance imaging includes schwannoma and lymphoma. Here, we report a dumbbell-shaped spinal extradural cavernous hemangioma with intrathoracic growth on T2-3 in a 64-year-old man complaining of right side infrascapular area back pain with no neurologic deficit. The cavernous hemangioma was resected through combined video-assisted thoracoscopy and laminectomy without a fusion procedure. The patient had tolerable operative wound pain with no neurologic deficit after surgery. Based on magnetic resonance imaging findings and a review of the literature, we discuss cavernous hemangioma among the differential diagnosis of paravertebral dumbbell-shaped spinal tumors and the importance of complete resection. PMID:26279817

  11. [Metabolic surgery].

    PubMed

    Jurowich, C; Germer, C T; Seyfried, F; Thalheimer, A

    2012-06-01

    The prevalence of obesity and diabetes mellitus type 2 is constantly rising worldwide and is one of the most threatening global health and health economic problems. Whereas bariatric surgery is well established in the treatment of morbid obesity, the surgical treatment options for type 2 diabetes mellitus alone are still under discussion (metabolic surgery). Bariatric procedures differ considering weight loss and influencing associated comorbidities. Detailed knowledge of available surgical treatment options for morbid obesity, the risks and requirements of laparoscopic skills, effectiveness and, as far as already known, mechanisms of action are crucial for appropriate implementation. PMID:22695815

  12. Mesenchymal Wnt signaling promotes formation of sternum and thoracic body wall.

    PubMed

    Snowball, John; Ambalavanan, Manoj; Cornett, Bridget; Lang, Richard; Whitsett, Jeffrey; Sinner, Debora

    2015-05-15

    Midline defects account for approximately 5% of congenital abnormalities observed at birth. However, the molecular mechanisms underlying the formation of the ventral body wall are not well understood. Recent studies linked mutations in Porcupine-an O-acetyl transferase mediating Wnt ligand acylation-with defects in the thoracic body wall. We hypothesized that anomalous Wnt signaling is involved in the pathogenesis of defective closure of the thoracic body wall. We generated a mouse model wherein Wntless (Wls), which encodes a cargo receptor mediating secretion of Wnt ligands, was conditionally deleted from the developing mesenchyme using Dermo1Cre mice. Wls(f/f);Dermo1(Cre/+) embryos died during mid-gestation. At E13.5, skeletal defects were observed in the forelimbs, jaw, and rib cage. At E14.5, midline defects in the thoracic body wall began to emerge: the sternum failed to fuse and the heart protruded through the body wall at the midline (ectopia cordis). To determine the molecular mechanism underlying the phenotype observed in Wls(f/f);Dermo1(Cre/+) embryos, we tested whether Wnt/β-catenin signaling was operative in developing the embryonic ventral body wall using Axin2(LacZ) and BatGal reporter mice. While Wnt/β-catenin signaling activity was observed at the midline of the ventral body wall before sternal fusion, this pattern of activity was altered and scattered throughout the body wall after mesenchymal deletion of Wls. Mesenchymal cell migration was disrupted in Wls(f/f);Dermo1(Cre/+) thoracic body wall partially due to anomalous β-catenin independent Wnt signaling as determined by in vitro assays. Deletion of Lrp5 and Lrp6 receptors, which mediate Wnt/β-catenin signaling in the mesenchyme, partially recapitulated the phenotype observed in the chest midline of Wls(f/f);Dermo1(Cre/+) embryos supporting a role for Wnt/β-catenin signaling activity in the normal formation of the ventral body wall mesenchyme. We conclude that Wls-mediated secretion of Wnt ligands from the developing ventral body wall mesenchyme plays a critical role in fusion of the sternum and closure of the secondary body wall. Thus, impaired Wls activity in the ventral body wall mesenchyme is a mechanism underlying ectopia cordis and unfused sternum. PMID:25727890

  13. Microneurolysis and decompression of long thoracic nerve injury are effective in reversing scapular winging: Long-term results in 50 cases

    PubMed Central

    Nath, Rahul K; Lyons, Andrew B; Bietz, Gabriel

    2007-01-01

    Background Long thoracic nerve injury leading to scapular winging is common, often caused by closed trauma through compression, stretching, traction, direct extrinsic force, penetrating injury, or neuritides such as Parsonage-Turner syndrome. We undertook the largest series of long thoracic nerve decompression and neurolysis yet reported to demonstrate the usefulness of long thoracic nerve decompression. Methods Winging was bilateral in 3 of the 47 patients (26 male, 21 female), yielding a total of 50 procedures. The mean age of the patients was 33.4 years, ranging from 24–57. Causation included heavy weight-lifting (31 patients), repetitive throwing (5 patients), deep massage (2 patients), repetitive overhead movement (1 patient), direct trauma (1 patient), motor bike accident (1 patient), and idiopathic causes (9 patients). Decompression and microneurolysis of the long thoracic nerve were performed in the supraclavicular space. Follow-up (average of 25.7 months) consisted of physical examination and phone conversations. The degree of winging was measured by the operating surgeon (RKN). Patients also answered questions covering 11 quality-of-life facets spanning four domains of the World Health Organization Quality of Life questionnaire. Results Thoracic nerve decompression and neurolysis improved scapular winging in 49 (98%) of the 50 cases, producing "good" or "excellent" results in 46 cases (92%). At least some improvement occurred in 98% of cases that were less than 10 years old. Pain reduction through surgery was good or excellent in 43 (86%) cases. Shoulder instability affected 21 patients preoperatively and persisted in 5 of these patients after surgery, even in the 5 patients with persistent instability who experienced some relief from the winging itself. Conclusion Surgical decompression and neurolysis of the long thoracic nerve significantly improve scapular winging in appropriate patients, for whom these techniques should be considered a primary modality of functional restoration. PMID:17343759

  14. Thoracic Ganglioneuromas Resulting in Nonimmune Hydrops Fetalis

    PubMed Central

    Singh, Paul; Jodicke, Cristiano; Swanson, Tara; Maulik, Dev

    2014-01-01

    Introduction Most often, ganglioneuromas affect older pediatric and adult patients. They are typically slow growing tumors that remain clinically silent until they become large enough to cause symptoms by compression of adjacent structures. Case We report a case of a 22-year-old Hispanic gravida 2 para 1 female patient who was found to have massive hydrops fetalis at 20 completed gestational weeks. Fetal echocardiography revealed a narrowed distal ductal arch and proximal descending aorta. Cesarean delivery was undertaken at 29 completed gestational weeks for refractory labor and nonreassuring fetal status. The neonate expired at 47 minutes of life despite aggressive resuscitation. At autopsy, multiple thoracic masses were found adjacent to a compressed proximal descending aorta. Histological and immunohistochemical analysis confirmed the diagnosis of a ganglioneuroma, a rare type of neural crest tumor. Discussion A variety of intrathoracic masses have previously been reported to cause hydrops fetalis including teratomas, fibrosarcomas, and lymphangiomas. To our knowledge, this case is the first description of hydrops fetalis caused by ganglioneuromas. We propose that multiple thoracic ganglioneuromas led to biventricular distal outflow tract obstruction and hydrops fetalis. PMID:25032061

  15. Basic thoracic ultrasound for the respiratory physician.

    PubMed

    Jimborean, Gabriela; Ianoşi, Edith Simona; Nemeş, Roxana Maria; Toma, Tudor P

    2015-01-01

    Thoracic ultrasound (TUS) evolved in the last ten years as the method of choice for evaluating pleural abnormalities and for guiding lung procedures. TUS can "see" almost all structures in the chest, including thoracic wall, pleura, pleural space, the heart, the great vessels and the peripheral layers of the lungs. However, there is still a great need to develop TUS services in respiratory departments in Romania. To facilitate this development we reviewed the literature and selected what we considered to be essential practical information for the beginner in TUS, including technique, normal findings, and common abnormalities. Moreover, we describe here a step-by-step scanning technique for chest physicians. Our aim is to raise awareness of TUS. Because TUS is rapid, accurate, noninvasive and can be applied in any ward, we recommend facilitating the training of all junior respiratory doctors in this technique, as it is likely to improve patient experience, clinical effectiveness and to reduce costs with chest radiographs or CT scans in the future. PMID:26738366

  16. [Ischemic optic neuropathy after lumbar spine surgery].

    PubMed

    Bermejo-Alvarez, M A; Carpintero, M; García-Carro, G; Acebal, G; Fervienza, P; Cosío, F

    2007-12-01

    Ischemic optic neuropathy is the most common cause of visual complications after non-ophthalmic surgery. The incidence has varied in different case series, but prone-position spine surgery appears to be involved in most of the reports. We present the case of a 47-year-old woman who developed near total blindness in the left eye following lumbar spine fusion surgery involving the loss of 900 mL of blood. An ophthalmic examination including inspection of the ocular fundus, fluorescein angiography, and visual evoked potentials returned a diagnosis of retrolaminar optic neuropathy. Outcome was poor. PMID:18200998

  17. Laser fusion

    SciTech Connect

    Smit, W.A.; Boskma, P.

    1980-12-01

    Unrestricted laser fusion offers nations an opportunity to circumvent arms control agreements and develop thermonuclear weapons. Early laser weapons research sought a clean radiation-free bomb to replace the fission bomb, but this was deceptive because a fission bomb was needed to trigger the fusion reaction and additional radioactivity was induced by generating fast neutrons. As laser-implosion experiments focused on weapons physics, simulating weapons effects, and applications for new weapons, the military interest shifted from developing a laser-ignited hydrogen bomb to more sophisticated weapons and civilian applications for power generation. Civilian and military research now overlap, making it possible for several countries to continue weapons activities and permitting proliferation of nuclear weapons. These countries are reluctant to include inertial confinement fusion research in the Non-Proliferation Treaty. 16 references. (DCK)

  18. Diagnosing Cervical Fusion: A Comprehensive Literature Review

    PubMed Central

    Sethi, Nanin; Devney, James; Steiner, Holly L.

    2008-01-01

    Study Design Comprehensive literature review. Purpose To document the criteria for fusion utilized in these studies to determine if a consensus on the definition of a solid fusion exists. Overview of Literature Numerous studies have reported on fusion rates following anterior cervical arthrodesis. There is a wide discrepancy in the fusion rates in these studies. While factors such as graft type, Instrumentation, and technique play a factor in fusion rate, another reason for the difference may be a result of differences in the definition of fusion following anterior cervical spine surgery. Methods A comprehensive English Medline literature review from 1966 to 2004 using the key words "anterior," "cervical," and "fusion" was performed. We divided these into two groups: newer studies done between 2000 and 2004, and earlier studies done between 1966 and 2000. These articles were then analyzed for the number of patients, follow-up period, graft type, and levels fused. Moreover, all of the articles were examined for their definition of fusion along with their fusion rate. Results In the earlier studies from 1966 to 2000, there was no consensus for what constituted a solid fusion. Only fifteen percent of these studies employed the most stringent definition of a solid fusion which was the presence of bridging bone and the absence of motion on flexion and extension radiographs. On the other hand, the later studies (2000 to 2004) used such a definition a majority (63%) of the time, suggesting that a consensus opinion for the definition of fusion is beginning to form. Conclusions Our study suggests that over the past several years, a consensus definition of fusion is beginning to form. However, a large percentage of studies are still being published without using stringent fusion criteria. To that end, we recommend that all studies reporting on fusion rates use the most stringent criteria for solid fusion following anterior cervical spine surgery: the absence of motion on flexion/extension views and presence of bridging trabeculae on lateral x-rays. We believe that a universal adoption of such uniform criteria will help to standardize such studies and make it more possible to compare one study with another. PMID:20404968

  19. Carotid artery surgery

    MedlinePlus

    Carotid endarterectomy; CAS surgery; Carotid artery stenosis - surgery; Endarterectomy - carotid artery ... through the catheter around the blocked area during surgery. Your carotid artery is opened. The surgeon removes ...

  20. Surgical Results of Lumbar Interbody Fusion Using Calcium Phosphate Cement

    PubMed Central

    HIRASAWA, Motohiro; MURE, Hideo; TOI, Hiroyuki; NAGAHIRO, Shinji

    2014-01-01

    Clinical and radiological outcomes of lumbar interbody fusion using artificial fusion cages filled with calcium phosphate cements (CPCs) were retrospectively reviewed. Between 2002 and 2011, 25 patients underwent lumbar interbody fusion at Tokushima University Hospital, and 22 patients were enrolled in this study. Of these, 5 patients received autologous local bone grafts and 17 received CPC. Japan Orthopedic Association (JOA) score was used for clinical outcome assessments. Lumbar radiography and computed tomography (CT) were performed at 12, 24 months and last follow-up period to assess bony fusion. The mean JOA score of all patients improved from 9.3 before surgery to 21.0 at 24 months after surgery. Fusion had occurred in 5 of 5 patients in the local bone graft group and in 16 of 17 patients in CPC group at 24 months postoperatively. No surgically related complication was occurred in both groups. CPC is a useful and safe graft material for lumbar interbody fusion. PMID:25169138

  1. Multimodal intraoperative neuromonitoring in corrective surgery for adolescent idiopathic scoliosis: Evaluation of 354 consecutive cases

    PubMed Central

    Kundnani, Vishal K; Zhu, Lisa; Tak, HH; Wong, HK

    2010-01-01

    Background: Multimodal intraoperative neuromonitoring is recommended during corrective spinal surgery, and has been widely used in surgery for spinal deformity with successful outcomes. Despite successful outcomes of corrective surgery due to increased safety of the patients with the usage of spinal cord monitoring in many large spine centers, this modality has not yet achieved widespread popularity. We report the analysis of prospectively collected intraoperative neurophysiological monitoring data of 354 consecutive patients undergoing corrective surgery for adolescent idiopathic scoliosis (AIS) to establish the efficacy of multimodal neuromonitoring and to evaluate comparative sensitivity and specificity. Materials and Methods: The study group consisted of 354 (female = 309; male = 45) patients undergoing spinal deformity corrective surgery between 2004 and 2008. Patients were monitored using electrophysiological methods including somatosensory-evoked potentials and motor-evoked potentials simultaneously. Results: Mean age of patients was 13.6 years (±2.3 years). The operative procedures involved were instrumented fusion of the thoracic/lumbar/both curves, Baseline somatosensory-evoked potentials (SSEP) and neurogenic motor-evoked potentials (NMEP) were recorded successfully in all cases. Thirteen cases expressed significant alert to prompt reversal of intervention. All these 13 cases with significant alert had detectable NMEP alerts, whereas significant SSEP alert was detected in 8 cases. Two patients awoke with new neurological deficit (0.56%) and had significant intraoperative SSEP + NMEP alerts. There were no false positives with SSEP (high specificity) but 5 patients with false negatives with SSEP (38%) reduced its sensitivity. There was no false negative with NMEP but 2 of 13 cases were false positive with NMEP (15%). The specificity of SSEP (100%) is higher than NMEP (96%); however, the sensitivity of NMEP (100%) is far better than SSEP (51%). Due to these results, the overall sensitivity, specificity and positive predictive value of combined multimodality neuromonitoring in this adult deformity series was 100, 98.5 and 85%, respectively. Conclusion: Neurogenic motor-evoked potential (NMEP) monitoring appears to be superior to conventional SSEP monitoring for identifying evolving spinal cord injury. Used in conjunction, the sensitivity and specificity of combined neuromonitoring may reach up to 100%. Multimodality monitoring with SSEP + NMEP should be the standard of care. PMID:20165679

  2. Preprosthetic Surgery.

    PubMed

    Ephros, Hillel; Klein, Robert; Sallustio, Anthony

    2015-08-01

    Preprosthetic oral and maxillofacial surgery has changed dramatically over the last 3 decades. Surgical preparation for dentures has been displaced by site development for implants. Nonetheless, there is still a role to play for several preprosthetic procedures. In this article, historical context is provided, enduring concepts are reviewed, and procedures that remain relevant are described and discussed. PMID:26231818

  3. Cosmetic surgery.

    PubMed Central

    Harris, D. L.

    1989-01-01

    The psychotherapeutic nature of cosmetic surgery is emphasised by outlining the range of symptoms from which patients suffer and by explaining the sequence of psychological reactions which cause them. The principles which govern the selection of patients are defined. A brief account of each of the main cosmetic operations is given together with notes on their limitations and risks. PMID:2589786

  4. Arthroscopic Surgery.

    ERIC Educational Resources Information Center

    Connors, G. Patrick

    Arthroscopic surgery (or microsurgery) is a significant breakthrough in treating knee injuries. Its applications range from basic diagnosis to arthroscopic menisectomy, although its use in some procedures is still highly controversial. Many surgeons perform the diagnostic procedure, but follow this with the conventional surgical approach.…