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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. [Dilemmas in thoracic surgery].

    PubMed

    Orel, J

    1980-01-01

    Advances in ventilation physiology have brought solutions to fundamental problems of thoracic surgery and suggested ways of coping with problems of surgical technique and cilincal pathology. The domain of thoracic surgery should cover all those areas requiring specific surgical approach to endothoracic organs, with particular emphasis on special preoperative and postoperative care of such patients. This applies to thoracic trauma as well. A specialist in general surgery the thoracic surgeon needs additional training in this specific field. Departments of thoracic surgery must be organized as special units of lagre medical centres, each serving an area of no less than one million inhabitants. We are moreover convinced that pediatric cases ought to be dealt with bu a skillful thoracic surgeon regularly working with children. In the field of surgery of lung carcinoma the effects of radicality and the influence of positive mediastinal lymph nodes on surgical outcome, as well as the selection of patients for postoperative radiotherapy are currently under discussion. Operative management of pulmonary tuberculosis is becoming simpler, the disease occurs in atypical forms and secondary complications, above all aspergillosis, are on the increase. The choice of thoracotomy for various intrathoracic interventions calls for greater selectivity. Tracheal resection with primary anastomosis has been fully accepted, whereas prosthetic reconstruction is still subject to major dilemmas. Surgical stabilization of the chest following trauma, as an alternative to internal pneumatic fixation, ought to be considered more often in the future. In the management of gastroesophageal reflux surgery tends to prevail over conservative methods of treatment, wherebu the correct choice of tests for the evaluation of reflux is a matter of great significance. Numerous problems accompanying gastroesophageal resection for carcinoma still await solutions. PMID:7456945

  3. [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

  4. [Rethoracotomy in thoracic surgery].

    PubMed

    Parshin, V D; Biriukov, Iu V; Gudovski?, A M; Grigor'eva, S P

    2012-01-01

    Technical progress of recent years allowed thoracic surgery to become a safer procedure. Experience of thoracic operations in our institution counts up to 14 962 cases (1963-2009 yy). Of them 223 (1.5%) patients had rethoracotomies on the reason of various operative complications. 112 patients had the intrapleural bleeding, 56 patients were reoperated on the reason of coagulated hemothorax, 57 patients demonstrated the bronchial stump insufficiency, and 11 were reoperated on other reasons. The frequency of rethoracotomy had decreased from 2.5 to 0.2%. The on-time rethoracotomy allows to save the patients' life and do not aggravate the overall result of the treatment. PMID:22810528

  5. Nonintubated anesthesia for thoracic surgery

    PubMed Central

    Wang, Bei

    2014-01-01

    Nonintubated thoracic surgery has been used in procedures including pleura, lungs and mediastinum. Appropriate anesthesia techniques with or without sedation allow thoracic surgery patients to avoid the potential risks of intubated general anesthesia, particularly for the high-risk patients. However, nonintubated anesthesia for thoracic surgery has some benefits as well as problems. In this review, the background, indication, perioperative anesthetic consideration and management, and advantages and disadvantages are discussed and summarized. PMID:25589994

  6. Evolution of thoracic surgery in Canada

    PubMed Central

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

    2015-01-01

    BACKGROUND: Canadas contributions toward the 21st centurys 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.

  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. 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

  9. Video-assisted thoracic surgery and pneumothorax.

    PubMed

    Paliouras, Dimitrios; Barbetakis, Nikolaos; Lazaridis, George; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Papaiwannou, Antonis; Karavergou, Anastasia; Lampaki, Sofia; Katsikogiannis, Nikolaos; Mpakas, Andreas; Tsakiridis, Kosmas; Korantzis, Ipokratis; Fassiadis, Nikolaos; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-02-01

    Video-assisted thoracoscopic surgery (VATS) is a type of thoracic surgery performed using a small video camera that is introduced into the patient's chest via a scope. It is considered a minimally invasive technique where the surgeon is able to view the instruments that are being used along with the anatomy on which the surgeon is operating. The camera and instruments are inserted through separate holes in the chest wall also known as "ports", depending on the patient and problem there are surgeries with one port "uniport", two or three ports. These small ports have the advantage that fewer infections are observed. This allows for a faster recovery. Traditionally, thoracic surgery performed for diagnosis or treatment of chest conditions has required access to the chest through thoracotomy or sternotomy incisions. Vats minimally invasive technique has replaced in many cases thoracotomy or sternotomy. In our current review we will present this technique in detail. PMID:25774310

  10. [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

  11. [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

  12. The European educational platform on thoracic surgery.

    PubMed

    Massard, Gilbert; Rocco, Gaetano; Venuta, Federico

    2014-05-01

    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

  13. Video-assisted thoracic surgery complications

    PubMed Central

    Kozak, Jzef

    2014-01-01

    Video-assisted thoracic surgery (VATS) is a miniinvasive technique commonly applied worldwide. Indications for VATS are very broad and include the diagnosis of mediastinal, lung and pleural diseases, as well as large resection procedures such as pneumonectomy. The most frequent complication is prolonged postoperative air leak. The other significant complications are bleeding, infections, postoperative pain and recurrence at the port site. Different complications of VATS procedures can occur with variable frequency in various diseases. Despite the large number of their types, such complications are rare and can be avoided through the proper selection of patients and an appropriate surgical technique. PMID:25561984

  14. 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

  15. The European general thoracic surgery database project

    PubMed Central

    Brunelli, Alessandro

    2014-01-01

    The European Society of Thoracic Surgeons (ESTS) Database is a free registry created by ESTS in 2001. The current online version was launched in 2007. It runs currently on a Dendrite platform with extensive data security and frequent backups. The main features are a specialty-specific, procedure-specific, prospectively maintained, periodically audited and web-based electronic database, designed for quality control and performance monitoring, which allows for the collection of all general thoracic procedures. Data collection is the backbone of the ESTS database. It includes many risk factors, processes of care and outcomes, which are specially designed for quality control and performance audit. The user can download and export their own data and use them for internal analyses and quality control audits. The ESTS database represents the gold standard of clinical data collection for European General Thoracic Surgery. Over the past years, the ESTS database has achieved many accomplishments. In particular, the database hit two major milestones: it now includes more than 235 participating centers and 70,000 surgical procedures. The ESTS database is a snapshot of surgical practice that aims at improving patient care. In other words, data capture should become integral to routine patient care, with the final objective of improving quality of care within Europe. PMID:24868445

  16. Non-intubated anesthesia in thoracic surgerytechnical 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

  17. Surgery for paediatric thoracic outlet syndrome.

    PubMed

    Teddy, P J; Johnson, R D; Cai, R R; Wallace, D

    2012-02-01

    The effectiveness of operative treatment of paediatric thoracic outlet syndrome (TOS) has been analysed, and an attempt made to improve the definition of the condition in terms of presentation, aetiology and diagnosis. A retrospective review of postoperative pain, functional capability and overall outcome was carried out on 13 patients (<18 years) treated by a single surgeon. In 20 operations, 17 were scalenotomies, and three were transaxillary rib resections (TARRs). Follow-up was 6-96 months post-operatively. Surgery alleviated many TOS symptoms, especially vascular compromise, although pain resolution was inconsistent and that of motor deficit poor. Mean functional improvement was good, and overall operative outcomes excellent. Therefore, surgery was successful for paediatric TOS in this series. Anatomical anomalies and sport participation may be related to early onset of TOS in many paediatric patients. PMID:22051028

  18. The Effectiveness of Preemptive Thoracic Epidural Analgesia in Thoracic Surgery

    PubMed Central

    Erturk, Engin; Aydogdu Kaya, Ferdane; Kutanis, Dilek; Besir, Ahmet; Akdogan, Ali; Geze, Skran; Tugcugil, Ersagun

    2014-01-01

    Background. The aim of this study is to investigate the effectiveness of preemptive thoracic epidural analgesia (TEA) comparing conventional postoperative epidural analgesia on thoracotomy. Material and Methods. Forty-four patients were randomized in to two groups (preemptive: Group P, control: Group C). Epidural catheter was inserted in all patients preoperatively. In Group P, epidural analgesic solution was administered as a bolus before the surgical incision and was continued until the end of the surgery. Postoperative patient controlled epidural analgesia infusion pumps were prepared for all patients. Respiratory rates (RR) were recorded. Patient's analgesia was evaluated with visual analog scale at rest (VASr) and coughing (VASc). Number of patient's demands from the pump, pump's delivery, and additional analgesic requirement were also recorded. Results. RR in Group C was higher than in Group P at postoperative 1st and 2nd hours. Both VASr and VASc scores in Group P were lower than in Group C at postoperative 1st, 2nd, and 4th hours. Patient's demand and pump's delivery count for bolus dose in Group P were lower than in Group C in all measurement times. Total analgesic requirements on postoperative 1st and 24th hours in Group P were lower than in Group C. Conclusion. We consider that preemptive TEA may offer better analgesia after thoracotomy. PMID:24745020

  19. Mayo Clinic: An Institutional History of General Thoracic Surgery.

    PubMed

    Gillaspie, Erin A; Nichols, Francis C; Allen, Mark S

    2015-01-01

    The Mayo Clinic was started in Rochester, MN after a 1883 tornado disaster. The Mayo brothers, William and Charles began thoracic surgical procedures early in their career. Dr. Samuel Robinson is recognized as the first thoracic surgeon at Mayo. He was followed by Drs. Harrington and Claret who became famous surgeons. Many other notable surgeons have help to build the thoracic surgical practice into what is today a world renown center of excellence in thoracic surgery. PMID:26811041

  20. History and current status of mini-invasive thoracic surgery

    PubMed Central

    He, Jianxing

    2011-01-01

    Mini-invasive thoracic technique mainly refers to a technique involving the significant reduction of the chest wall access-related trauma. Notably, thoracoscope is the chief representative. The development of thoracoscope technique is characterized by: developing from direct peep to artificial lighting, then combination with image and video technique in equipments; technically developing from diagnostic to therapeutic approaches; developing from simpleness to complexity in application scope; and usually developing together with other techniques. At present, the widely used mini-invasive thoracic surgery refers to the mini-open thoracic surgery performed mainly by using some instruments to control target tissues and organs based on the vision associated with multi-limb coordination, which may be hand-assisted if necessary. The mini-invasive thoracic surgery consists of three approaches including video-assisted thoracic surgery (VATS), video-assisted Hybrid and hand-assisted VATS. So far the mini-invasive thoracic technique has achieved great advances due to the development in instruments of mini-invasive thoracic surgery which has the following features: instruments of mini-invasive thoracic surgery appear to be safe and practical, and have successive improvement and diversification in function; the specific instruments of open surgeries has been successively developed into dedicated instruments of endoscopic surgery; the application of endoscopic mechanical suture device generates faster fragmentation and reconstruction of organ tissues; the specific delicated instruments of endoscopic surgery have rapid development and application; and the simple instruments structurally similar to the conventional instruments are designed according to the mini-incison. In addition, the mini-invasive thoracic technique is widely used in five aspects including diseases of pleura membrane and chest wall, lung diseases, esophageal diseases, mediastinal diseases and heart diseases. However, there remain many problems in specifications and trainings, economic cost, conservation and innovation. Therefore, particular attention should be paid to these problems. Nevertheless, the promotion of thoracic surgery appears promising in the future. PMID:22263074

  1. Women in Thoracic Surgery: 30 Years of History.

    PubMed

    Antonoff, Mara B; David, Elizabeth A; Donington, Jessica S; Colson, Yolonda L; Litle, Virginia R; Lawton, Jennifer S; Burgess, Nora L

    2016-01-01

    Women in Thoracic Surgery was founded in 1986, with 2016 marking its 30th anniversary. Reflecting back on thelast 3 decades of history, accomplishments, and enormous strides in our field, we review the past, present, and future of this organization. Although women still constitute a small minority of practicing surgeons in our field today, opportunities currently abound for women in thoracic surgery. Owing much to the early female pioneers in the field and to the support of male sponsors and our national societies, Women in Thoracic Surgery has grown and prospered, as have its members and the global community of female thoracic surgeons as a whole. In celebration of our 30th anniversary, we share with the readership the rich history of Women in Thoracic Surgery and its goals for the future. PMID:26694290

  2. Minimally invasive thoracic surgery: new trends in Italy.

    PubMed

    Pompeo, Eugenio

    2015-10-01

    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. 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

  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. Update on anesthetic complications of robotic thoracic surgery.

    PubMed

    Campos, J; Ueda, K

    2014-01-01

    In the last decade, there has been increasing use of the da Vinci robot surgical system to perform minimally invasive thoracic surgery. The robotic technology can be applied for surgery of the lungs, mediastinum, and esophagus. A number of case reports have been shown steep learning curve, and promising surgical outcome with this new technology. However, anesthesia management of the robotic thoracic surgery can be complex and requires further education. For example, most of the cases require sufficient lung collapse in order to provide adequate surgical field. In addition, a unique operative setting, such as patient positioning and capnothorax can make anesthesia management further challenging. Hence, anesthesiologists should have better awareness of adverse events or complications related to the robotic surgery to accomplish successful anesthesia management. This review will focus on the potential complications of robotic thoracic surgery involving the lungs, mediastinum and esophagus. PMID:23877310

  6. 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

  7. 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

  8. [The university in the development of thoracic surgery in Spain].

    PubMed

    Pars, Francisco; Balibrea, Jos Luis

    2005-11-01

    The present article analyzes the figures of the university professors who, from 1911, formed part of one of the basic pillars in the development of "Spanish Thoracic Surgery". At that time, there was a certain amount of infighting between general and specialized surgery, which was resolved by allowing specialization after a period of training in general surgery. Universities should not be denied the great merit of having produced well-trained surgeons with a broad general foundation who would later choose a specialty. The figures of Ricardo Lozano Monzn, Francisco Martn Lagos, Jos Gasc, Benjamn Narbona, Carlos Carbonell Antol, Rafael Vara Lpez, Alfonso de la Fuente Chaos and Jos M. Beltrn de Heredia with their previous training, corresponding precursors and respective schools are described. Their teaching, surgical practice, and scientific activity are also described. A future article based on the contribution of Valencia to the specialty of general thoracic surgery is also outlined. PMID:16420845

  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. 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

  11. 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

  12. The evolution of minimally invasive thoracic surgery: implications for the practice of uniportal thoracoscopic surgery

    PubMed Central

    2014-01-01

    The history of Minimally Invasive Surgery in the thorax is one of evolution, not revolution. The concept of video-assisted thoracic surgery (VATS) to greatly reduce the trauma of chest operations was born over two decades ago. Since then, it has undergone a series of step-wise modifications and improvement. The original practice of three access ports in a baseball diamond pattern was modified to suit operational needs, and gradually developed into next generation approaches, including Needlescopic and 2-port VATS. The logical, incremental progression has culminated in the Uniportal VATS approach which has stirred considerable interest within the field of Thoracic Surgery in recent years. This measured, evolutionary process has significant implications on how the surgeon should approach, master and realize the full potential of the Uniportal technique. This article gives a prcis of the evolutionary history of minimally invasive thoracic surgery, and highlights the lessons it provides about its future. PMID:25379198

  13. Extracorporeal instrument knotting technique for minimal access thoracic surgery

    PubMed Central

    Tian, Jintao; Song, Xiaoping; Chen, Yan

    2015-01-01

    Knot-tying technique is essential for surgery. We described here a novel instrument knotting technique that is simple, safe and useful in minithoracotomy. This technique was used on 14 consecutive patients that underwent selective minithoracotomy during the past half year. Both knot security and loop security could be easily achieved with this technique. No unraveling or dislodgement of the knot was noted. This method is simple, convenient and reliable to achieve secure flat square knots in limited, deep operating spaces. Its clinical advantages render it as a promising knot-tying technique that can be routinely used in a variety of thoracic surgery. PMID:26716046

  14. [Surgery of the diaphragm in the planned thoracic surgery].

    PubMed

    Parshin, V D; Parshin, V V; Mirzoian, O S; Stepanian, A

    2013-01-01

    122 patients with different diseases of the diaphragm were operated on during 1963-2011 yy. The majority of patients - 76 (62.3%) - had hernias of the weak phrenic zones. 14 (11.5%) and 17 (14.0%) patients had posttraumatic hernia and phrenic relaxation, respectively. The majority of patients had no complaints and the disease was diagnosed on the X-ray examination. Rarely, the compression syndrome, caused by the translocation of the bowel into the thoracic cavity, was registered. That clinically emerged as short breath, heaviness sensation and cardiac rhythm disorders. The worked out reconstructive operations allow to cure such patients with minimal risk. PMID:23996032

  15. Video-assisted thoracic surgery for cancer after thoracic aortic aneurysm repair.

    PubMed

    Taylor, Lauren J; Adesoye, Taiwo; Maloney, James D

    2016-02-01

    Video-assisted thoracoscopic surgery is increasingly accepted as an alternative to open thoracotomy and has established efficacy in the management of non-small-cell lung cancer, but the presence of extensive intrapleural adhesions has been considered a deterrent to a minimally invasive approach. We report the successful use of video-assisted thoracoscopic surgery in 3 patients with history of open thoracic aortic aneurysm repair who presented with left lower lobe stage I non-small-cell lung cancer. While this approach is feasible, it is technically demanding and thus, at the present time, we recommend that its use be limited to high-volume video-assisted thoracoscopic surgery centers. PMID:26430132

  16. Non-intubated thoracic surgeryA survey from the European Society of Thoracic Surgeons

    PubMed Central

    Sorge, Roberto; Akopov, Andrej; Congregado, Miguel; Grodzki, Tomasz

    2015-01-01

    Background A survey amongst the European Society of Thoracic Surgeons (ESTS) members has been performed to investigate the currents trends, rates of adoption as well as potential for future expansion of non-intubated thoracic surgery (NITS) performed under spontaneous ventilation. Methods A 14-question-based questionnaire has been e-mailed to ESTS members. To facilitate the completion of the questionnaire, questions entailed either quantitative or multiple-choice answers. Investigated issues included previous experience with NITS and number of procedures performed, preferred types of anesthesia protocols (i.e., thoracic epidural anesthesia, intercostal or paravertebral blocks, laryngeal mask, use of additional sedation), type of procedures, ideal candidates for NITS, main advantages and technical disadvantages. Non-univocal answer to multiple-choice questions was permitted. Results Out of 105 responders, 62 reported an experience with NITS. The preferred types of anesthesia were intercostal blocks with (59%) or without (50%) sedation, followed by laryngeal mask with sedation (43%) and thoracic epidural anesthesia with sedation (20%). The most frequently performed procedures included thoracoscopic management of recurrent pleural effusion (98%), pleural decortication for empyema thoracis and lung biopsy for interstitial lung disease (26% each); pericardial window and mediastinal biopsy (20% each). More complex procedures such as lobectomy, lung volume reduction surgery and thymectomy have been performed by a minority of responders (2% each). Poor-risk patients due to co-morbidities (70%) and patients with poor pulmonary function (43%) were considered the ideal candidates. Main advantages included faster, recovery (67%), reduced morbidity (59%) and shorter hospital stay with decreased costs (43% each). Reported technical disadvantages included coughing (59%) and poor maneuverability due to diaphragmatic and lung movements (56%). Overall, 69% of responders indicated that NITS procedures will be likely to increase in the near future. Conclusions Results of this survey, suggest that NITS is already quite widely adopted by ESTS members to perform simple thoracoscopic procedures. A future expanded adoption of this strategy is also hypothesized. PMID:25815298

  17. Nerve stimulator-guided thoracic paravertebral block for gynecomastia surgery.

    PubMed

    Jadon, Ashok

    2012-05-01

    Thoracic paravertebral block (TPVB) is gaining popularity for female breast surgeries due to various advantages like less nausea and vomiting and better post-operative pain relief, which helps in early ambulation and discharge from the hospital. Use of nerve stimulator during this block has further enhanced its success and safety profile. Male breast surgery is usually done either under general anaesthesia or local infiltrative anaesthesia combining with intravenous sedation. We postulated that the advantages of TPVB could be helpful for early mobilization and discharge of minor breast surgery in male patients. However, to our knowledge, there is no such report suggestive of TPVB for exclusive male breast surgery. We used nerve stimulator-guided TPVB for gynecomastia surgery in two patients where general anaesthesia was not feasible. Both patients had successful block and showed good post-operative recovery and were discharged on the same day. They had long post-operative pain relief without any block-related complication. A case report of two such cases of gynecomastia surgery (male breast surgery) done under TPVB is presented. PMID:22923833

  18. 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 6.7years, range 4.58.5years). 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 (PSFH group; n=27 patients), or with pedicle screw-only construct (PSFS group; n=25 patients) were reviewed. There were no differences between the two groups in terms of age, Rissers sign, Cobb preoperative main thoracic (MT) curve magnitude (PSFH: 92 vs. PSFS: 88), or flexibility on bending films (PSFH: 27% vs. PSFS: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for non-parametric paired analysis, and the MannWhitney test for non-parametric unpaired analysis. At the last follow-up, the PSFS group, when compared to the PSFH 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. ?0.54cm; 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: PSFH=0.5cm vs. PSFS=0cm). 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

  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. [Perioperative anticoagulant and antiplatelet treatment in general thoracic surgery].

    PubMed

    Schnell, J; Koryllos, A; Stoelben, E; Schler, B

    2014-09-01

    The perioperative use of anticoagulants in general thoracic surgery can be considered to be a "two-edged sword": the goal to minimise the risk of a thromboembolic episode is contrary to the ongoing effort of the surgeon to minimise the risk of intra- and postoperative blood loss. Dispositional factors such as excessive tobacco use are common for thoracic surgery patients and often lead to cardiovascular comorbidity which necessitates the use of anticoagulants or antiplatelet drugs. For deep venous thrombosis prophylaxis and for the indication and use of vitamin K antagonists or antiplatelet drugs it is proven in the literature that the risk profile of the patient and his/her classification in the appropriate risk group are of major importance. Through the individual risk profile of the patient it is possible to plan the appropriate perioperative anticoagulant therapy which will safely assist the surgeon and his/her patient during the peri- and postoperative phase on the knife-edge between blood loss and eminent thromboembolism. Unfortunately there are not enough existing data and published literature for evidence-based guidelines referring to the correct perioperative management for the new oral anticoagulants. Management algorithms are being recommended according to the multiple aspects of anticoagulant-treatment. PMID:25264718

  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. 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

  3. 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 5years have made possible a host of new applications in VATS. This article focuses on updates and cutting-edge applications in VATS. PMID:26410560

  4. 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

  5. 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

  6. [Respiratory support in anaesthetic management for thoracic surgery and their comparative characteristics: over 2000 anaesthesia experience].

    PubMed

    Vyzhigina, M A; Mizikov, V M; Sandrikov, V A; Luk'ianov, M V; Titov, V A; Zhukova, S G; Parshin, V D; Riabova, O S; Kurilova, O A; Alekseev, A V; Buniatian, A A

    2013-01-01

    The article deals with the first comparative study of haemodynamics, gas exchange, and metabolic lung finction in patients with underlying respiratory and cardiovascular diseases. Different anaesthesia and ventilation (conventional AVL, OLV differentiated ALV) techniques were used. Respiratory support methodology with the use of HFV or CPAP during the main phase of thoracic surgery in patients with severe associated cardio-respiratory diseases was developed. Indications for differentiated AL V in thoracic surgery were developed. PMID:24000649

  7. 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

  8. 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

  9. 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

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

    PubMed Central

    2015-01-01

    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

  11. 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

  12. 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

  13. 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

  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. 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

  16. Can thoracic paravertebral block replace thoracic epidural block in pediatric cardiac surgery? A randomized blinded study.

    PubMed

    El-Morsy, Gamal Z; El-Deeb, Alaa; El-Desouky, Tariq; Elsharkawy, Ashraf A; Elgamal, Mohamed Adel F

    2012-01-01

    To compare the outcomes of thoracic epidural block with thoracic paravertebral block for thoracotomy in pediatric patients. A prospective double-blind study. 60 pediatric patients aged 1-24 months, ASA II, III scheduled for thoracotomy were randomly allocated into two groups. After induction of general anesthesia, thoracic epidural catheter was inserted in group E (epidural) patients and thoracic paravertebral catheter was inserted in group P (paravertebral) patients. Post operative pain score was recorded hourly for 24 hours. Plasma cortisol level was recorded at three time points. Tidal breathing analysis was done preoperatively and 6 hours postoperatively. Analgesia, serum cortisol level, and pulmonary function parameters were comparable in the two groups. However, failure rate (incorrect placement of catheter) was significantly higher in epidural group than in paravertebral group (7% versus 0%, respectively). The complications were also significantly higher in epidural group (vomiting 14.8%, urine retention 11.1% and hypotension 14.8%) than paravertebral group (0%, 0%, and 3.6%, respectively). We conclude that both thoracic paravertebral block and thoracic epidural block results in comparable pain score and pulmonary function after thoracotomy in pediatric patients; the paravertebral block is associated with significantly less failure rate and side effects. PMID:23041682

  17. Uniportal video assisted thoracic surgery: summary of experience, mini-review and perspectives

    PubMed Central

    Calvo, Damiano; Criscione, Alessandra; Borrata, Francesco

    2015-01-01

    The uniportal-video assisted thoracic surgery (VATS) technique comprises operations which can be performed with skin incisions ranging from 2 to 8 cm and the manifest result of the introduction of the uniportal lobectomy had made possible to increase rapidly the number of published papers on this subject. Many of the large ensuing literature report incomplete historical information on uniportal VATS, and doubts exist about the indication of uniportal VATS for some thoracic oncologic pathologies. Known limitations have been overcome. On the other hand, the modern thoracic surgical team includes one surgeon, one assistant and a scrub nurse, and it is clear that the new generation of thoracic surgeons need to use the less used hand. The new technology which permitted the introduction of the uniportal VATS could influence the future need of thoracic surgeons worldwide. PMID:26543631

  18. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes andQuality.

    PubMed

    D'Agostino, Richard S; Jacobs, Jeffrey P; Badhwar, Vinay; Paone, Gaetano; Rankin, J Scott; Han, Jane M; McDonald, Donna; Shahian, David M

    2016-01-01

    The Society of Thoracic Surgeons Adult Cardiac Database is one of the longest-standing, largest, and most highly regarded clinical data registries in health care. It serves as the foundation for all quality measurement and improvement activities of The Society of Thoracic Surgeons. This report summarizes current aggregate national outcomes in adult cardiac surgery and reviews database-related activities in the areas of quality measurement and performance improvement. PMID:26616408

  19. [High level thoracic epidural analgesia as a special component of anesthesia during thoracic surgeries].

    PubMed

    Kurilova, O A; Vyzhigina, M A; Titov, V A; Kozlov, S P; Zhukova, S G; Parshin, V D

    2011-01-01

    This article is devoted to assessing the adequacy and safety of total intravenous anesthesia based on constant dosed infusion of propofol and high thoracic epidural analgesia in thoracic surgical procedures requiring an artificial one-lung ventilation in patients with concomitant chronic cardiorespiratory disorders compared to TIVA without a high thoracic epidural analgesia. Comparative analysis of gas exchange, metabolic rate, pressor, resistance and volumetric characteristics of pulmonary blood flow, central and intracardiac hemodynamics was conducted. We used high technology invasive monitoring system PICCOplus for transpulmonary thermodilution in combination with VoLEF for pulmonary thermodilution in changing modes of ventilation MV-MSL V-MV. MSL V lasted more than 1.5 hours. PMID:21688654

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

    PubMed Central

    Rimmer, Lara; Fok, Matthew; Bashir, Mohamad

    2014-01-01

    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.

  2. 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

  3. Video-assisted thoracic surgery left upper lobectomy with systematic lymphadenectomy

    PubMed Central

    Pan, Xue; Li, Xiangnan; Zhu, Dengyan; Zhang, Chunyang; Zhao, Jia; Li, Wei

    2015-01-01

    A 62-year-old woman was referred to the Thoracic Surgery Department after computed tomography (CT) revealed a 1.0 cm 1.1 cm mass peripherally in the left upper lobe with spicular formation during her routine medical examination. The nature of the mass was confirmed to be adenocarcinoma by transpercutaneous lung biopsy. No metastasis or contraindication for surgery was found. Video-assisted thoracic surgery (VATS) left upper lobectomy with systematic lymphadenectomy was performed. Total surgery time was 80 min and blood loss was 50 mL. Postoperative pathological exam suggested adenocarcinoma, without evidence of lymph node metastasis in any station (T1aN0M0 stage IA). The patient was discharged home on the 10th postoperative day. PMID:26793365

  4. Video-assisted thoracic surgery left upper lobectomy with systematic lymphadenectomy.

    PubMed

    Pan, Xue; Zhang, Yan; Li, Xiangnan; Zhu, Dengyan; Zhang, Chunyang; Zhao, Jia; Li, Wei

    2015-12-01

    A 62-year-old woman was referred to the Thoracic Surgery Department after computed tomography (CT) revealed a 1.0 cm 1.1 cm mass peripherally in the left upper lobe with spicular formation during her routine medical examination. The nature of the mass was confirmed to be adenocarcinoma by transpercutaneous lung biopsy. No metastasis or contraindication for surgery was found. Video-assisted thoracic surgery (VATS) left upper lobectomy with systematic lymphadenectomy was performed. Total surgery time was 80 min and blood loss was 50 mL. Postoperative pathological exam suggested adenocarcinoma, without evidence of lymph node metastasis in any station (T1aN0M0 stage IA). The patient was discharged home on the 10(th) postoperative day. PMID:26793365

  5. 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

  6. [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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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

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

    PubMed

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

    2015-10-01

    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

  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. 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

  15. Prevalence, outcome and risk factors for postoperative pyothorax in 232 dogs undergoing thoracic surgery

    PubMed Central

    Meakin, L B; Salonen, L K; Baines, S J; Brockman, D J; Gregory, S P; Halfacree, Z J; Lipscomb, V J; Lee, K C

    2013-01-01

    Objective To determine the prevalence, outcome and risk factors for postoperative pyothorax in dogs undergoing thoracic surgery. Methods Case records were reviewed retrospectively to identify dogs with post thoracic surgery pyothorax, defined as septic neutrophilic inflammation within the pleural space based on cytology and/or a positive bacterial culture of pleural fluid. Those identified were reviewed for potential risk factors for postoperative pyothorax based on biological plausibility and previously published data. These potential risk factors were explored by multivariable logistic regression. Results Of 232 dogs undergoing thoracic surgery, 15 (65%) dogs developed pyothorax. Bacteria cultured included methicillin-resistant Staphylococcus aureus and multi-resistant Escherichia coli. Of these dogs, six died, four were euthanased and five were treated successfully. A diagnosis of idiopathic chylothorax [Odds Ratio (OR)=125, 95% Confidence Interval (CI)=27-585, P=0001], preoperative intrathoracic biopsy (OR=143, 95% CI=17-1187, P=0014) and preoperative thoracocentesis (OR=112, 95% CI=16-782, P=0015) were identified as independent risk factors for development of postoperative pyothorax. Clinical Significance Idiopathic chylothorax, intrathoracic biopsy and prior thoracocentesis are independent risk factors for postoperative pyothorax, which was associated with a 67% mortality rate. PMID:23581608

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

    PubMed

    Mller, Ina; Tnnies, 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

  17. [Antibiotic and antiseptic prophylaxis in thoracic surgery. Controlled study].

    PubMed

    Regnard, J F; Libert, J M; Rojas-Miranda, A; Marzelle, J; Levasseur, P

    1989-05-01

    The aim of this report was to evaluate perioperative antibiotherapy and antiseptic irrigation of the operative site in the prevention of post-pneumonectomy empyema. From 1984 to 1986, 171 patients undergoing pneumonectomy at our institution for bronchogenic carcinoma were randomly selected in 2 groups: group I (85 patients) received a "classical" prophylaxis: irrigation of the operative site with saline, plus a 7-day antibiotherapy (minocycline 200 mg/24 h) started the evening following surgery; group II (86 patients): irrigation of the operative site was performed with Povidone iodine (dilution 5%); antibiotherapy (cefotiam was given for a short period (2 g intraoperatively, 2 g 12 hours and 24 hours following surgery). We used a "pragmatic" approach in order to choose, whatever the results would be, a type of perioperative antibiotherapy. We thus accepted the choice, without the help of statistical tests, of the therapy that would best prevent infection, and, if both regimens would demonstrate the same efficacy, to leave the choice at random. The only statistical test was to calculate the "gamma-risk" that we choose the worst among the 2 regimens. Although no significant difference in the overall infection rate was observed between the 2 groups, there were 9 empyemas (5 of those with bronchial fistula) in group I and 3 empyemas (2 of those with bronchial fistula) in group II. The cefotiam-povidone iodine regimen is thus better than the minocycline-saline regimen in the prevention of post-pneumonectomy empyema (3.5% v.s. 10.5%). The "gamma-risk", ie the probability that the minocycline-saline regimen is the best, calculated from these percentages, is 0.03. PMID:2780105

  18. Major morbidity after video-assisted thoracic surgery lung resections: a comparison between the European Society of Thoracic Surgeons definition and the Thoracic Morbidity and Mortality system

    PubMed Central

    Papagiannopoulos, Kostas; Milton, Richard; Kefaloyannis, Emmanuel; Chaudhuri, Nilanjan; Poyser, Emily; Spencer, Nicholas; Brunelli, Alessandro

    2015-01-01

    Background The thoracic morbidity and mortality (TM&M) classification system univocally encodes the postoperative adverse events by their management complexity. This study aims to compare the distribution of the severity of complications according to the TM&M system versus the distribution according to the classification proposed by European Society of Thoracic Surgeons (ESTS) Database in a population of patients submitted to video assisted thoracoscopic surgery (VATS) lung resection. Methods A total of 227 consecutive patients submitted to VATS lobectomy for lung cancer were analyzed. Any complication developed postoperatively was graded from I to V according to the TM&M system, reflecting the increasing severity of its management. We verified the distribution of the different grades of complications and analyzed their frequency among those defined as major cardiopulmonary complications by the ESTS Database. Results Following the ESTS definitions, 20 were the major cardiopulmonary complications [atrial fibrillation (AF): 10, 50%; adult respiratory distress syndrome (ARDS): 1, 5%; pulmonary embolism: 2, 10%; mechanical ventilation >24 h: 1, 5%; pneumonia: 3, 15%; myocardial infarct: 1, 5%; atelectasis requiring bronchoscopy: 2, 10%] of which 9 (45%) were reclassified as minor complications (grade II) by the TM&M classification system. According to the TM&M system, 10/34 (29.4%) of all complications were considered minor (grade I or II) while 21/34 (71.4%) as major (IIIa: 8, 23.5%; IIIb: 4, 11.7%; IVa: 8, 23.5%; IVb: 1, 2.9%; V: 3, 8.8%). Other 14 surgical complications occurred and were classified as major complications according to the TM&M system. Conclusions The distribution of postoperative complications differs between the two classification systems. The TM&M grading system questions the traditional classification of major complications following VATS lung resection and may be used as an additional endpoint for outcome analyses. PMID:26380733

  19. [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

  20. 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

  1. [Effects of smoking on video-assisted thoracic surgery lobectomy for lung cancer].

    PubMed

    Nakanishi, Ryoichi; Nakagawa, Makoto; Tokufuchi, Hiroshi; Okumura, Takashi; Kuboi, Satoshi; Kido, Masamitsu

    2010-03-01

    The purpose of this study was to examine the effect of smoking on a video-assisted thoracic surgery lobectomy in 83 male patients with clinical stage I primary lung cancer. Forty-two patients who had smoked until 1 week to 2 months before surgery (Smoker group) were retrospectively compared with 35 ex-smokers who had continued smoking cessation for 15 years on average and 6 non-smokers (Non- & Ex-smoker group), regarding the demographic, perioperative, histopathologic and outcome variables. Except for age, cigarette consumption and comorbid chronic obstructive pulmonary disease (COPD), the two groups showed no differences in the demographic, operative and histopathologic variables. The smoker group demonstrated a significantly younger age (P = 0.0497), more cigarette consumption (P = 0.0086), more COPD (P = 0.0004), longer chest tube drainage (P = 0.0451), longer length of hospitalization (P = 0.0181) and more postoperative complications (P = 0.0278) than the ex- and non-smoker groups. No mortality was observed in either group. The two groups had comparable survival rates. The results indicate that an early cessation of smoking is desirable even when a video-assisted thoracic surgery lobectomy is performed. PMID:20232646

  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. Left lower lobectomy and systematic lymph node dissection by complete video-assisted thoracic surgery.

    PubMed

    Shi, Jian-Lin; Jiang, Li-Hong; Li, Ding-Biao; Deng, Shou-Jun; Wang, Yan-Fei; Li, Zhen-Hua

    2015-12-01

    A 50-year-old female was administered with left lower lobe lesion for 10 days. A preoperative chest computed tomography (CT) revealed a mass in the left basilar segment of the lung, about 2.1 cm 1.7 cm in size. Therefore, video-assisted thoracic surgery (VATS) left lower lobectomy was performed. The operation takes 60 minutes. During the operation, the estimated blood loss was 15 mL. The patient was discharged on postoperative day (POD) 6 with no complications. And the pathological results confirmed the diagnosis of adenocarcinoma with no lymph nodes metastasis. PMID:26793363

  5. [Ketamine versus propofol during one-lung ventilation in thoracic surgery].

    PubMed

    Vyzhigina, O A; Kurilova, O A; Riabova, O S; Titov, V A; Zhukova, S G; Parshin, V D

    2012-01-01

    A comparative analysis of gas, the metabolic rate, pressor, resistive and volumetric characteristics of pulmonary blood flow, central and intracardiac hemodynamics in patients undergoing thoracic surgery was conducted. 2 methods of anesthesia maintenance: on the basis of ketamine - fentanyl - pipecuronium and propofol - fentanyl - pipecuronim were compared. Invasive monitoring system PiCCOplus for the behaviour of the transpulmonary thermodilution (TT) in combination with VoLEF for the pulmonary thermodilution (PT) the change of ventilation mode ALV - OLV - ALV was used. OLV lasted for more than 1.5 hours. PMID:22993916

  6. 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

  7. 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

  8. Left lower lobectomy and systematic lymph node dissection by complete video-assisted thoracic surgery

    PubMed Central

    Shi, Jian-Lin; Jiang, Li-Hong; Deng, Shou-Jun; Wang, Yan-Fei; Li, Zhen-Hua

    2015-01-01

    A 50-year-old female was administered with left lower lobe lesion for 10 days. A preoperative chest computed tomography (CT) revealed a mass in the left basilar segment of the lung, about 2.1 cm 1.7 cm in size. Therefore, video-assisted thoracic surgery (VATS) left lower lobectomy was performed. The operation takes 60 minutes. During the operation, the estimated blood loss was 15 mL. The patient was discharged on postoperative day (POD) 6 with no complications. And the pathological results confirmed the diagnosis of adenocarcinoma with no lymph nodes metastasis.

  9. 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.

  10. Ipsilateral shoulder pain after thoracic surgery procedures under general and regional anesthesia a retrospective observational study

    PubMed Central

    Misio?ek, Hanna; Karpe, Jacek; Marcinkowski, Adrian; Jastrz?bska, Aleksandra; Szelka, Anna; Czarno?ycka, Adrianna; D?ugaszek, Micha?

    2014-01-01

    Background Ipsilateral shoulder pain (ISP) is a common complication of mixed etiology after thoracic surgery (its prevalence is estimated in the literature at between 42% and 97%). It is severe and resistant to treatment (patients complain of pain despite effective epidural analgesia at the surgical site). Aim of the study The aim of this retrospective, observational study was to evaluate the prevalence of ISP in patients operated on in our facility and to determine the risk factors for ISP development. Material and methods 68 patients after thoracotomy or videothoracoscopy (video-assisted thoracic surgery VATS) conducted under general and regional anesthesia were enrolled in the study and divided into two groups: group I without ISP and group II with postoperative ISP. We recorded age, sex, BMI, duration of surgery, type of surgery, type of regional anesthesia, and, in patients with epidural anesthesia, level of catheter placement. Results Statistically significant differences between the groups were obtained for BMI (24.67 and 27.68, respectively; p = 0.049), type of surgery (24% for thoracotomy and 0% for VATS, p = 0.026), and level of epidural catheter placement (4.35% for catheters placed at the level of Th5 or higher and 40.47% for catheters placed below Th5; p = 0.003). Conclusions The prevalence of ISP in our medical center amounts to 24% of thoracotomy patients. The fact that the difference in ISP prevalence was significantly related to the level of epidural catheter placement is consistent with the theory that ISP is related to phrenic nerve innervation. Moreover, epidural catheter placement is a modifiable factor, which can be used to reduce the prevalence of post-thoracotomy ISP. PMID:26336393

  11. 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

  12. [Perioperative management of a patient with general lymph-congestion following total spondylectomy with posterior and anterior fusion for first thoracic vertebral hemangioma].

    PubMed

    Hanzawa, K; Kamiyama, Y; Mizushima, A; Kanai, M; Miura, K; Fujino, S; Toyama, T

    2000-10-01

    A 50-year-old healthy woman was scheduled for surgery of the first thoracic vertebral (T 1) hemangioma accompanying rapidly aggravated neurological deficit in three months. Anesthesia was induced with intravenous fentanyl and propofol and maintained with isoflurane-oxygen-air inhalation, followed by propofol infusion combined with sevoflurane inhalation. Following posterior decompression of T 1 with fusion of C 6-T 3, consecutive total spondylectomy of T 1 with anterior fusion of C 7-T 2 was carried out. At the end of surgery, marked edema was noticed on her face, neck and bilateral upper extremities, possibly due to long manipulation around the left jugular angle. Next morning the edema spread to her whole body and the elevation of both diaphragms and the mediastinal expansion were recognized. Mechanical ventilation in the mode of IMV was performed until subsiding of edema on the fifth postoperative day. During this period, hypoxemia was frequently observed in spite of appropriate respiratory support. On the third postoperative day, bronchoscopic bronchial toilet was performed which brought the improvement of blood oxygenation. The occasional administration of furosemide was not effective to reduce general edema, but served for the acceleration of lymphatic drainage after the release of the thoracic duct obstruction and the patient was extubated uneventfully on the sixth postoperative day. PMID:11075557

  13. 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

  14. Early Removal of Urinary Catheter after Surgery Requiring Thoracic Epidural: A Prospective Trial

    PubMed Central

    Hu, Yinin; Craig, Sarah J.; Rowlingson, John C.; Morton, Steve P.; Thomas, Christopher J.; Persinger, Matthew B.; Isbell, James; Lau, Christine L.; Kozower, Benjamin D.

    2014-01-01

    OBJECTIVES To prevent urinary retention, urinary catheters are commonly removed only after thoracic epidural discontinuation following thoracotomy. However, prolonged catheterization increases the risk of infection. The purpose of this study was to determine the rates of urinary retention and catheter-associated infection following early catheter removal. DESIGN This study describes a prospective trial instituting an early urinary catheter removal protocol, compared to a historical control group of patients. SETTING The protocol was instituted at a single, academic thoracic surgery unit. PARTICIPANTS Participants comprised of patients undergoing operations requiring thoracotomy who received an intraoperative epidural for postoperative pain control. INTERVENTIONS An early urinary catheter removal protocol was instituted prospectively, with all catheters removed on or before postoperative day 2. Urinary retention was determined by bladder ultrasound, and treated with re-catheterization. MEASUREMENTS/MAIN RESULTS The primary outcomes were urinary retention rate, defined as bladder volume greater than 400 ml, and urinary tract infection rate. Results were compared to a retrospective cohort of 210 consecutive patients who underwent surgery before protocol initiation. Among the 101 prospectively-enrolled patients, urinary retention rate was higher (26.7% vs 12.4%, p = 0.003), while urinary tract infection rate improved moderately (1% vs 3.8%, p = 0.280). CONCLUSIONS Early removal of urinary catheters with thoracic epidurals in place is associated with a high incidence of urinary retention. However, an early catheter removal protocol may play a role in a multi-faceted approach to reducing the incidence of catheter-associated urinary tract infections. PMID:25281046

  15. Non-intubated video-assisted thoracic surgery management of secondary spontaneous pneumothorax

    PubMed Central

    Bolufer, Sergio; Navarro-Martinez, Jose; Lirio, Francisco; Corcoles, Juan Manuel; Rodriguez-Paniagua, Jose Manuel

    2015-01-01

    Secondary spontaneous pneumothorax (SSP) is serious entity, usually due to underlying disease, mainly chronic obstructive pulmonary disease (COPD). Its morbidity and mortality is high due to the pulmonary compromised status of these patients, and the recurrence rate is almost 50%, increasing mortality with each episode. For persistent or recurrent SSP, surgery under general anesthesia (GA) and mechanical ventilation (MV) with lung isolation is the gold standard, but ventilator-induced damages and dependency, and postoperative pulmonary complications are frequent. In the last two decades, several groups have reported successful results with non-intubated video-assisted thoracic surgery (NI-VATS) with thoracic epidural anesthesia (TEA) and/or local anesthesia under spontaneous breathing. Main benefits reported are operative time, operation room time and hospital stay reduction, and postoperative respiratory complications decrease when comparing to GA, thus encouraging for further research in these moderate to high risk patients many times rejected for the standard regimen. There are also reports of special situations with satisfactory results, as in contralateral pneumonectomy and lung transplantation. The aim of this review is to collect, analyze and discuss all the available evidence, and seek for future lines of investigation. PMID:26046045

  16. 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

  17. 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

  18. 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

  19. The Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model: Part 2Clinical Application

    PubMed Central

    Jacobs, Jeffrey P.; OBrien, Sean M.; Pasquali, Sara K.; Gaynor, J. William; Mayer, John E.; Karamlou, Tara; Welke, Karl F.; Filardo, Giovanni; Han, Jane M.; Kim, Sunghee; Quintessenza, James A.; Pizarro, Christian; Tchervenkov, Christo I.; Lacour-Gayet, Francois; Mavroudis, Constantine; Backer, Carl L.; Austin, Erle H.; Fraser, Charles D.; Tweddell, James S.; Jonas, Richard A.; Edwards, Fred H.; Grover, Frederick L.; Prager, Richard L.; Shahian, David M.; Jacobs, Marshall L.

    2016-01-01

    Background The empirically derived 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model incorporates adjustment for procedure type and patient-specific factors. The purpose of this report is to describe this model and its application in the assessment of variation in outcomes across centers. Methods All index cardiac operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (January 1, 2010, to December 31, 2013) were eligible for inclusion. Isolated patent ductus arteriosus closures in patients weighing less than or equal to 2.5 kg were excluded, as were centers with more than 10% missing data and patients with missing data for key variables. The model includes the following covariates: primary procedure, age, any prior cardiovascular operation, any noncardiac abnormality, any chromosomal abnormality or syndrome, important preoperative factors (mechanical circulatory support, shock persisting at time of operation, mechanical ventilation, renal failure requiring dialysis or renal dysfunction (or both), and neurological deficit), any other preoperative factor, prematurity (neonates and infants), and weight (neonates and infants). Variation across centers was assessed. Centers for which the 95% confidence interval for the observed-to-expected mortality ratio does not include unity are identified as lower-performing or higher-performing programs with respect to operative mortality. Results Included were 52,224 operations from 86 centers. Overall discharge mortality was 3.7% (1,931 of 52,224). Discharge mortality by age category was neonates, 10.1% (1,129 of 11,144); infants, 3.0% (564 of 18,554), children, 0.9% (167 of 18,407), and adults, 1.7% (71 of 4,119). For all patients, 12 of 86 centers (14%) were lower-performing programs, 67 (78%) were not outliers, and 7 (8%) were higher-performing programs. Conclusions The 2014 Society of Thoracic Surgeons Congenital Heart Surgery Database Mortality Risk Model facilitates description of outcomes (mortality) adjusted for procedural and for patient-level factors. Identification of low-performing and high-performing programs may be useful in facilitating quality improvement efforts. PMID:26245504

  20. 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

  1. 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

  2. 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

  3. A Minimally Invasive Endoscopic Surgery for Infectious Spondylodiscitis of the Thoracic and Upper Lumbar Spine in Immunocompromised Patients

    PubMed Central

    Chen, Hsin-Chuan; Huang, Teng-Le; Chen, Yen-Jen; Tsou, Hsi-Kai; Lin, Wei-Ching; Hung, Chih-Hung; Tsai, Chun-Hao; Hsu, Horng-Chaung; Chen, Hsien-Te

    2015-01-01

    This study evaluates the safety and effectiveness of computed tomography- (CT-) assisted endoscopic surgery in the treatment of infectious spondylodiscitis of the thoracic and upper lumbar spine in immunocompromised patients. From October 2006 to March 2014, a total of 41 patients with infectious spondylodiscitis underwent percutaneous endoscopic surgery under local anesthesia, and 13 lesions from 13 patients on the thoracic or upper lumbar spine were selected for evaluation. A CT-guided catheter was placed before percutaneous endoscopic surgery as a guide to avoid injury to visceral organs, major vessels, and the spinal cord. All 13 patients had quick pain relief after endoscopic surgery without complications. The bacterial culture rate was 77%. Inflammatory parameters returned to normal after adequate antibiotic treatment. Postoperative radiographs showed no significant kyphotic deformity when compared with preoperative films. As of the last follow-up visit, no recurrent infections were noted. Traditional transthoracic or diaphragmatic surgery with or without posterior instrumentation is associated with high rates of morbidity and mortality, especially in elderly patients, patients with multiple comorbidities, or immunocompromised patients. Percutaneous endoscopic surgery assisted by a CT-guided catheter provides a safe and effective alternative treatment for infectious spondylodiscitis of the thoracic and upper lumbar spine. PMID:26273644

  4. 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

  5. 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

  6. 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

  7. Tension Pneumothorax During Surgery for Thoracic Spine Stabilization in Prone Position

    PubMed Central

    Mathew, Paul S.; Kurnutala, Lakshmi N.; Soghomonyan, Suren; Bergese, Sergio D.

    2014-01-01

    The intraoperative progression of a simple or occult pneumothorax into a tension pneumothorax can be a devastating clinical scenario. Routine use of prophylactic thoracostomy prior to anesthesia and initiation of controlled ventilation in patients with simple or occult pneumothorax remains controversial. We report the case of a 75-year-old trauma patient with an insignificant pneumothorax on the right who developed an intraoperative tension pneumothorax on the left side while undergoing thoracic spine stabilization surgery in the prone position. Management of an intraoperative tension pneumothorax requires prompt recognition and treatment; however, the prone position presents an additional challenge of readily accessing the standard anatomic sites for pleural puncture and air drainage. PMID:26425610

  8. 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

  9. Left lower sleeve lobectomy and systematic lymph node dissection by single-incision video-assisted thoracic surgery

    PubMed Central

    Fan, Junqiang; Yao, Jie; Chang, Zhibo

    2015-01-01

    Sleeve lobectomy for selected cases of intratracheal tumor has better parenchyma preservation compared to pneumonectomy. And the left lower sleeve lobectomy is considered one of the most complex resections. Thanks to the advancement of equipment and accumulation of skills, video-assisted thoracic surgery (VATS) sleeve lobectomy has become safe and feasible. Typically, 3-4 ports are used, but the surgery can also be completed through one incision. A 51-year-old male patient with left lower central lung cancer underwent sleeve lobectomy and systematic mediastinal lymphadenectomy by single-incision VATS and recovered uneventfully. Sleeve lobectomy by single-incision video-assisted thoracic surgery is feasible and safe. PMID:26623113

  10. 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 patients 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

  11. [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

  12. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery?

    PubMed

    Gonzalez-Rivas, Diego; Bonome, Cesar; Fieira, Eva; Aymerich, Humberto; Fernandez, Ricardo; Delgado, Maria; Mendez, Lucia; de la Torre, Mercedes

    2016-03-01

    Thanks to the experience gained through the improvement of video-assisted thoracoscopic surgery (VATS) technique, and the enhancement of surgical instruments and high-definition cameras, most pulmonary resections can now be performed by minimally invasive surgery. The future of the thoracic surgery should be associated with a combination of surgical and anaesthetic evolution and improvements to reduce the trauma to the patient. Traditionally, intubated general anaesthesia with one-lung ventilation was considered necessary for thoracoscopic major pulmonary resections. However, thanks to the advances in minimally invasive techniques, the non-intubated thoracoscopic approach has been adapted even for use with major lung resections. An adequate analgesia obtained from regional anaesthesia techniques allows VATS to be performed in sedated patients and the potential adverse effects related to general anaesthesia and selective ventilation can be avoided. The non-intubated procedures try to minimize the adverse effects of tracheal intubation and general anaesthesia, such as intubation-related airway trauma, ventilation-induced lung injury, residual neuromuscular blockade, and postoperative nausea and vomiting. Anaesthesiologists should be acquainted with the procedure to be performed. Furthermore, patients may also benefit from the efficient contraction of the dependent hemidiaphragm and preserved hypoxic pulmonary vasoconstriction during surgically induced pneumothorax in spontaneous ventilation. However, the surgical team must be aware of the potential problems and have the judgement to convert regional anaesthesia to intubated general anaesthesia in enforced circumstances. The non-intubated anaesthesia combined with the uniportal approach represents another step forward in the minimally invasive strategies of treatment, and can be reliably offered in the near future to an increasing number of patients. Therefore, educating and training programmes in VATS with non-intubated patients may be needed. Surgical techniques and various regional anaesthesia techniques as well as indications, contraindications, criteria to conversion of sedation to general anaesthesia in non-intubated patients are reviewed and discussed. PMID:25896196

  13. 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

  14. 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

  15. 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.

  16. 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.

  17. 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 57.110.6 years (2476 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 137.447.8 minutes. Mean estimated blood loss was 60.7102.7 mL. Mean time of drainage was 3.02.1 days, and postoperative length of stay averaged 4.92.3 days. In the cases of primary lung cancer, the mean number of nodal stations explored was 7.21.3, with a mean of 20.86.3 lymph nodes resected. As to the mediastinal lymph node specifically, a mean of 4.41.0 nodal stations were explored, and the number of resected mediastinal lymph nodes averaged 12.85.1. No perioperative death or major complication occurred. Conclusions Uniportal VATS lobectomy in semiprone position is feasible and safe. PMID:26793366

  18. 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

  19. 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

  20. 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

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

    PubMed Central

    OBrien, 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 studys 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. Single-Port Video-Assisted Thoracic Surgery for Secondary Spontaneous Pneumothorax: Preliminary Results

    PubMed Central

    Kim, Min-Seok; Yang, Hee Chul; Bae, Mi-Kyung; Cho, Sukki; Kim, Kwhanmien; Jheon, Sanghoon

    2015-01-01

    Background The aim of this study was to evaluate the feasibility of single-port video-assisted thoracic surgery (VATS) in the treatment of secondary spontaneous pneumothorax (SSP). Methods Twenty-four patients who were scheduled to undergo single-port VATS for SSP were studied. The medical records of the patients were retrospectively reviewed. The mean follow-up duration was 26.119.8 months. In order to evaluate the feasibility of single-port VATS for SSP, the postoperative results of single-port VATS (n=15) in patients with emphysema were compared with those of emphysematous patients who underwent three-port VATS (n=15) during the study period. Results Single-port VATS was feasible in 19 of 24 patients (79.2%), while an additional port was needed in five patients. In the single-port VATS patients, the median operation time, duration of chest tube drainage, and hospital stay were 84.0 minutes, one day, and two days, respectively. Postoperative complications included prolonged chest tube drainage for more than five days (n=1), wound infection (n=1), and vocal fold palsy (n=1). No recurrence of pneumothorax was observed during the follow-up period. The median operation time, duration of chest tube drainage, and hospital stay of the emphysematous patients who underwent single-port VATS were shorter than those who underwent three-port VATS group (p<0.05 for all parameters). Conclusion Single-port VATS proved to be a feasible procedure in the treatment of patients with secondary spontaneous pneumothorax. PMID:26665104

  3. 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

  4. In patients undergoing thoracic surgery is paravertebral block as effective as epidural analgesia for pain management?

    PubMed

    Scarci, Marco; Joshi, Abhishek; Attia, Rizwan

    2010-01-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients undergoing thoracic surgery is paravertebral block (PVB) as effective as epidural analgesia for pain management? Altogether >184 papers were found using the reported search, seven of which represented the best evidence to answer the clinical question. All studies agreed that PVB is at least as effective as epidural analgesia for pain control post-thoracotomy. In one paper, the visual analogue pain score (VAS) at rest and on cough was significantly lower in the paravertebral group (P=0.02 and 0.0001, respectively). Pulmonary function, as assessed by peak expiratory flow rate (PEFR), was significantly better preserved in the paravertebral group. The lowest PEFR as a fraction of preoperative control was 0.73 in the paravertebral group in contrast with 0.54 in the epidural group (P<0.004). Oximetric recordings were better in the paravertebral group (96%) compared to the epidural group (95%) (P=0.0001). Another article reported that statistically significant differences (forced vital capacity 46.8% for PVB and 39.3% for epidural group P<0.05; forced expiratory volume in 1 s (FEV(1)) 48.4% in PVB group and 35.9% in epidural group, P<0.05) were reached in day 2 and continued until day 3. Plasma concentrations of cortisol, as marker of postoperative stress, increased markedly in both groups, but the increment was statistically different in favour of the paravertebral group (P=0.003). Epidural block was associated with frequent side-effects [urinary retention (42%), nausea (22%), itching (22%) and hypotension (3%) and, rarely, respiratory depression (0.07%)]. Additionally, it prolonged operative time and was associated with technical failure or displacement (8%). Epidurals were also related to a higher complication rate (atelectasis/pneumonia) compared to the PVB (2 vs. 0). PVB was found to be of equal efficacy to epidural anaesthesia, but with a favourable side effect profile, and lower complication rate. The reduced rate of complication was most marked for pulmonary complications and is accompanied by quicker return to normal pulmonary function. We conclude intercostal analgesia, in the form of PVB, can be at least as effective as epidural analgesia. PMID:19854794

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

    PubMed

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

    2016-02-01

    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?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

  6. 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

  7. 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

  8. Atrial Fibrillation Surgery - Maze Procedure

    MedlinePLUS

    ... a Thoracic Surgeon? Adult Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery Esophageal Surgery Lung/Thoracic Surgery Aneurysm Surgery Arrhythmia Surgery Atrial Fibrillation Surgery - Maze Procedure ...

  9. An Unusual Complication of Surgery for Type A Dissection Treated by Thoracic Endovascular Aortic Repair

    PubMed Central

    Petrilli, Giuseppe; Puppini, Giovanni; Torre, Salvo; Calzaferri, Daniele; Bugana, Antonella; Faggian, Giuseppe

    2013-01-01

    A 58-year-old man was admitted to our hospital for massive swelling in an anterior cervical location. Nine years earlier, he underwent surgical repair of a complex type A aortic dissection. This procedure was complicated by a fistula between the anastomosis of the graft and the descending aorta, resulting in massive presternal swelling. Therefore, we performed thoracic endovascular repair with successful sealing of the prosthetic leak, achieving progressive reduction in the collection of fluid. We propose thoracic endovascular aortic repair as an alternative to open surgical repair for the treatment of complicated cases.

  10. Postoperative Atrial fibrillation in Patients undergoing Non-cardiac Non-thoracic Surgery: A Practical Approach for the Hospitalist

    PubMed Central

    Joshi, Kirti K.; Tiru, Mihaela; Chin, Thomas; Fox, Marshal T.; Stefan, Mihaela S.

    2016-01-01

    New postoperative atrial fibrillation (POAF) is the most common perioperative arrhythmia and its reported incidence ranges from 0.4%26% in patients undergoing non-cardiac non-thoracic surgery. The incidence varies according to patient characteristics such as age, presence of structural heart disease and other co-morbidities, as well as the type of surgery performed. POAF occurs as a consequence of adrenergic stimulation, systemic inflammation, or autonomic activation in the intra or postoperative period (e.g. due to pain, hypotension, infection) in the setting of a susceptible myocardium and other predisposing factors (e.g. electrolyte abnormalities). POAF develops between day 1 and day 4 post-surgery and it is often considered a self-limited entity. Its acute management involves many of the same strategies used in non-surgical patients but the optimal long-term management is challenging because of the limited available evidence. Several studies have shown an association between occurrence of POAF and in-hospital morbidity, mortality, and length of stay. Although, traditionally, POAF was considered to have a generally favorable long-term prognosis, recent data have shown an association with an increased risk of stroke at one year after hospitalization. It is unknown, however, whether strategies to prevent POAF or for rate/rhythm control when it does occur, lead to a reduction in morbidity or mortality. This suggests the need for future studies to better understand the risks associated with POAF and to determine optimal strategies to minimize long-term thromboembolic risk. In this article, we summarize the current knowledge on epidemiology, pathophysiology, and short- and long-term management of POAF after non-cardiac non-thoracic surgery with the goal of providing a practical approach to managing these patients for the non-cardiologist clinician. PMID:26414594

  11. 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

  12. 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 ...

  13. The contributions of the Second Auxiliary Surgical Group to military surgery during World War II with special reference to thoracic surgery.

    PubMed Central

    Brewer, L A

    1983-01-01

    The outstanding scientific and surgical accomplishments of the Second Auxiliary Surgical Group in the Mediterranean Theater of Operations and the 7th Army in World War II were not exceeded by any other group in the United States Army Medical Corps. In the final 921-page report to the Surgeon General with 550 tables, 8801 severely wounded casualties out of a total of 22,000 treated were reviewed. In addition, the major portion of three books on war surgery and over 60 scientific articles were written by this group. The contributions in thoracic surgery that focused attention on physiologic principles and limited the indications for thoracotomy have stood the test of time. The author made the original description of the reaction of the lung to severe trauma of the brain, abdomen, and extremities by the development of "the wet lung of trauma" (RDS), while his introduction of a hand-operated, intermittent positive pressure oxygen respirator to treat the advanced form of this syndrome (pulmonary edema) ushered in a new form of treatment. Long-term, follow-up studies by the author confirm the validity of the physiologic approach to the treatment of thoracic trauma. Images Fig. 1. Fig. 2. Fig. 3. Fig. 4. Fig. 6. Fig. 7A and B. Fig. 8. PMID:6338843

  14. 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

  15. 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.

  16. 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

  17. 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.

  18. Selective versus nonselective thoracic fusion in Lenke 1C curves: a meta-analysis of baseline characteristics and postoperative outcomes.

    PubMed

    Boniello, Anthony J; Hasan, Saqib; Yang, Sun; Jalai, Cyrus M; Worley, Nancy; Passias, Peter G

    2015-12-01

    OBJECT Lenke 1C curves are challenging to manage surgically due to the structural thoracic deformity and nonstructural lumbar curve. Selective thoracic fusion (STF) is considered the standard of care because it preserves motion of the lumbar segment, yet nonselective STF (NSTF) remains prevalent. This study aims to identify baseline patient characteristics that drive treatment and to compare postoperative outcomes for both procedures. METHODS Studies that compared baseline and postoperative demographic data, health-related quality of life (HRQL) questionnaires, and radiographic parameters of patients with Lenke 1C curves undergoing STF or NSTF were identified for meta-analysis. The effect measure is expressed as a mean difference (MD) with 95% CI. A positive MD signifies a greater STF value, or a mean increase within the group. RESULTS One prospective and 6 retrospective case-control studies with sample size of 488 patients (344 STF and 144 NSTF) were identified. Baseline age, sex, and HRQLs were equivalent, except for better scores in the STF group for the Scoliosis Appearance Questionnaire (SAQ): Unrelated to Deformity item (3.47 vs 3.88, p = 0.01) and the Spine Research Society questionnaire, Item 22: Pain (4.13 vs 3.92, p = 0.04). Radiographic findings were significantly worse in NSTF, as measured by the thoracolumbar/lumbar (TL/L) Cobb angle (MD: -4.29, p < 0.01) and TL/L apical vertebral translation (AVT) (MD: -6.08, p < 0.01). Radiographic findings significantly improved in STF, as measured in the main thoracic (MT) Cobb angle (MD: -27.78, p < 0.01), TL/L Cobb angle (MD: -16.24, p < 0.01), MT:TL/L Cobb ratio (MD: -0.21, p < 0.01), coronal balance (MD: 0.47, p = 0.02), and thoracic kyphosis (MD: 7.87, p < 0.01); and in NSTF in proximal thoracic (PT) Cobb angle (24 vs 14.1, p < 0.01), MT Cobb angle (53.5 vs 20.5, p < 0.01), and TL/L Cobb angle (41.6 vs 16.6, p < 0.01). Postoperative TL/L Cobb angle (23.1 vs 16.6, p < 0.01) was significantly higher in STF; but PT Cobb angle, MT Cobb angle, and MT:TL/L Cobb ratio are equivalent. CONCLUSIONS Patients with larger lumbar compensatory curves displaying a larger degree of coronal translation, as measured by the TL/L AVT, are more likely to undergo an NSTF. Contrary to established guidelines, larger MT curve magnitudes and MT:TL/L Cobb angle ratios have not been found to influence the decision to pursue a selective thoracic fusion. Although overall both STF and NSTF groups are found to have effective postoperative coronal balance, the STF group has only modest improvements in the lumbar curve position as determined by a relatively unchanged TL/L AVT. Furthermore, surgeons may prefer NSTF in patients who may have a worse overall perception of their spinal deformity as measured by HRQL measures of pain and desire for appearance change. PMID:26315956

  19. 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

  20. [Impact of combined anesthesia using isoflurane on the development of adaptation mechanisms on changing ventilation conditions in thoracic surgery].

    PubMed

    Vyzhigina, M A; Riabova, O S; Kulagina, T Iu; Zhukova, S G; Parshin, V D; Sandrikov, V A; Buniatian, A A

    2006-01-01

    The paper deals with the effect of isoflurane (IF) as a component of combined anesthesia during thoracic interventions in the lateral position on the development of adaptation mechanisms to a change in artificial ventilation (AV) modes--from ventilation of both lungs to that of one lung (unilateral ventilation, ULV), long exposure to ULV and to a change from ULV to ventilation of both lungs. Eighteen patients at a high operation-anesthetic risk were examined. Measurements were made in 6 steps, including conditions in AV, exposure to ULV for 15-30, 55-60, and 80-120 minutes, AV after 20-min exposure to ULV, and at the end of surgery in the supine position. While analyzing the results, the authors made an important observation that IF has a property of preventing capillary formation in the ventilated portions, without impairing the mechanism of pulmonary hypoxic vasoconstriction in the area of atelectized alveoles. This contributed to the optimization of a ventilation-perfusion relationship and creates conditions for adequate oxygenation. The use of IF as a component of combined anesthesia during thoracic operations associated with a need for artificial unilateral ventilation in patients at a high operation-anesthetic risk created conditions for optimizing gas exchange and blood circulation at all stages of an operation and anesthesia. PMID:17184063

  1. 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.

  2. 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

  3. [Efficacy of vacuum-assisted closure therapy for various non-healing wounds after cardiovascular and thoracic surgery].

    PubMed

    Sugimoto, Ai; Aoki, Kenji; Saito, Masayuki; Ohzeki, Hajime

    2010-08-01

    Vacuum-assisted closure (VAC) therapy is an efficacious modality for treating chronic and difficult wounds. We present 3 cases that responded well to VAC therapy after cardiovascular and thoracic surgery: 1 methicillin-resistant Staphylococcus aureus (MRSA) wound infection after Stony's incision, 1 inguinal lymphorrhea, and 1 empyema after a traffic accident The duration of VAC therapy was 9, 18, and 90 days, respectively, and all 3 wounds healed completely. Familiar equipment and supplies available on the hospital ward were used, and patients were able to leave their beds. In this report, the efficacy of VAC therapy, the problems encountered, and the steps that could be taken to address them are discussed. PMID:20715462

  4. Non-intubated video-assisted thoracic surgery as the modality of choice for treatment of recurrent pleural effusions.

    PubMed

    Cox, Solange E; Katlic, Mark R

    2015-05-01

    This review will establish that the best mode of treatment for recurrent pleural effusions is non-intubated video-assisted thoracic surgery (VATS) with chemical talc pleurodesis. The nature of recurrent pleural effusions mandates that any definitive and effective treatment of this condition should ideally provide direct visualization of the effusion, complete initial drainage, a low risk outpatient procedure, a high patient satisfaction rate, a high rate of pleurodesis and a high diagnostic yield for tissue diagnosis. There are various methods available for treatment of this condition including thoracostomy tube placement with bedside chemical pleurodesis, thoracentesis, placement of an indwelling pleural catheter, pleurectomy and VATS drainage with talc pleurodesis. Of these treatment options VATS drainage with the use of local anesthetic and intravenous sedation is the method that offers most of the desired outcomes, thus making it the best treatment modality. PMID:26046044

  5. Tension Pneumothorax During Surgery for Thoracic Spine Stabilization in Prone Position: A Case Report and Review of Literature.

    PubMed

    Rankin, Demicha; Mathew, Paul S; Kurnutala, Lakshmi N; Soghomonyan, Suren; Bergese, Sergio D

    2014-01-01

    The intraoperative progression of a simple or occult pneumothorax into a tension pneumothorax can be a devastating clinical scenario. Routine use of prophylactic thoracostomy prior to anesthesia and initiation of controlled ventilation in patients with simple or occult pneumothorax remains controversial. We report the case of a 75-year-old trauma patient with an insignificant pneumothorax on the right who developed an intraoperative tension pneumothorax on the left side while undergoing thoracic spine stabilization surgery in the prone position. Management of an intraoperative tension pneumothorax requires prompt recognition and treatment; however, the prone position presents an additional challenge of readily accessing the standard anatomic sites for pleural puncture and air drainage. PMID:26425610

  6. 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.

  7. Ascending thoracic aorta aneurysm surgery and aortic valve repair during pregnancy.

    PubMed

    Gama, Pedro; Pancas, Rita; Antunes, Manuel J

    2009-01-01

    Open-heart surgery during pregnancy is challenging because it requires attention to both mother and fetus. A 31-year-old pregnant woman underwent surgery for a large ascending aorta aneurysm threatening rupture in the 12th week and then went on to a cesarean section at 38 weeks, which produced a healthy baby. PMID:19549048

  8. [Thoracic tumor-like fungal mycetoma: interest of large surgery with terbinafine].

    PubMed

    Diatta, B A; Ndiaye, M; Sarr, L; Diatta, B J M; Gueye, A B; Diop, A; Bangoura, M; Diouf, A B; Djioumoi, H; Hakim, H; Diallo, M; San, A D; Dieng, M T; Kane, A

    2014-12-01

    Fungal mycetoma are inflammatory pseudo-tumors of subcutaneous tissues and possibly bones due to exogenous fungi. They have a chronic course, often poly-fistulated with an emission of fungal grains. We report the case of a 65-year-old farmer with a thoracic fungal mycetoma discovered incidentally, associated with bone involvement. The diagnosis was confirmed by the positive culture to Madurella mycetomatis. The outcome was favorable with terbinafine 1g per day for 12 months associated with complete excision of oncologic type followed by a skin graft. PMID:25467818

  9. 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

  10. 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

  11. 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

  12. Herpes zoster--varicella complicating anterior thoracic surgery: 2 case reports.

    PubMed

    Godfrey, Elisha K; Brown, Christopher; Stambough, Jeffery L

    2006-06-01

    This article reviews the reactivation of the latent varicella-zoster virus infection within the sensory dorsal root ganglia resulting in shingles. Although the association between surgery and reactivation of the varicella-zoster virus is known, we feel it is important to keep the diagnosis of shingles in mind especially in a patient with sudden onset of increased pain after surgery. Our purpose is to report 2 rare clinical presentations of shingles after spinal surgery in which the patient's initial diagnosis was not clear until the classical rash was observed. Two case reports are presented in which 1 patient developed shingles 5 days after surgery with distribution of the maculopapular rash in a surgical incision, whereas the second patient did not present until 4 weeks after surgery with a disseminated picture. Early recognition of this postoperative problem is imperative for prompt and appropriate management, as misdiagnosis can lead to short-term and long-term pain control issues, postherpetic neuralgia, neuropathic pain, or other related sequelae. PMID:16778668

  13. Determining optimal fluid and air leak cut off values for chest drain management in general thoracic surgery

    PubMed Central

    Mesa-Guzman, Miguel; Periklis, Perikleous; Niwaz, Zakiyah; Socci, Laura; Raubenheimer, Hilgardt; Adams, Ben; Gurung, Lokesh; Uzzaman, Mohsin

    2015-01-01

    Background Chest drain duration is one of the most important influencing aspects of hospital stay but the management is perhaps one of the most variable aspects of thoracic surgical care. The aim of our study is to report outcomes associated with increasing fluid and air leak criteria of protocol based management. Methods A 6-year retrospective analysis of protocolised chest drain management starting in 2007 with a fluid criteria of 3 mL/kg increasing to 7 mL/kg in 2011 to no fluid criteria in 2012, and an air leak criteria of 24 hours without leak till 2012 when digital air leak monitoring was introduced with a criteria of <20 mL/min of air leak for more than 6 hours. Patient data were obtained from electronic hospital records and digital chest films were reviewed to determine the duration of chest tube drainage and post-drain removal complications. Results From 2009 to 2012, 626 consecutive patients underwent thoracic surgery procedures under a single consultant. A total of 160 did not require a chest drain and data was missing in 22, leaving 444 for analysis. The mean age [standard deviation (SD)] was 5719 years and 272 (61%) were men. There were no differences in the incidence of pneumothoraces (P=0.191), effusion (P=0.344) or re-interventions (P=0.431) for drain re-insertions as progressively permissive criteria were applied. The median drain duration dropped from 1-3 days (P<0.001) and accordingly hospital stay reduced from 4-6 days (P<0.001). Conclusions Our results show that chest drains can be safely removed without fluid criteria and air leak of less than 20 mL/min with median drain duration of 1 day, associated with a reduced length of hospital stay. PMID:26716045

  14. [Impact of thoracic and abdominopelvic surgery on the functional status in the elderly].

    PubMed

    Landi, Pablo J; Torrejn, Gisell A; Muios, Roberto; Freue, Roberto D; Semeniuk, Guillermo B

    2013-01-01

    The quality of life of older people is determined by their functional capacity, rather than by the number or type of disease suffered. We analyzed 43 patients over 65 years undergoing major surgery. Longitudinally continued evolution of functional status by analyzing six variables, activities of daily living (ADLs), instrumental activities of daily living (IADL), the get up and walk test, functional reach test of arm, strength of handgrip and walking speed, measured before surgery (baseline measurement) and at 1, 2, 3 and 4 months after discharge. The objectives were to estimate the impact that surgery has on functional status in the elderly, determine how long each of the measurements returned to preoperative values at 4 months follow-up. Recovery curves compared the baseline AIVD, grip strength and hand speed on the fly, between two groups defined by baseline walking speed in slow (< 0.8 m/s) and fast (> 0.8 m/s). The impact of surgery on physical fitness showed a statistically significant decrease in ADL, IADL, and the get up and walk test and walking speed, with variable time recovery beyond convalescence. All return to baseline at 4 months except test walking speed that exceeded the baseline. Functional status can be evaluated quickly and should be included in the preoperative evaluation, since it allows planning strategies to meet the needs and limitations of patients and their families, in the immediate postoperative period. PMID:23732198

  15. 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

  16. Remifentanil versus dexmedtomidine for posterior spinal fusion surgery

    PubMed Central

    Rahimzadeh, Poupak; Faiz, Seyed Hamid Reza; Alimian, Mahzad; Mohammadian Erdi, Ali

    2015-01-01

    Background: Controlling the hemodynamic situation of patients who have spinal operation is of prime importance, and maintaining the heart rate and blood pressure in normal or low- normal levels in these patients can reduce their bleeding loss. One of the commonly used drugs for this purpose is remifentanil. Another sedative-hypnotic-analgesic drug, with acceptable effects is dexmedetomidine. The aim of this study was to compare the effect of dexmedetomidine with remifentanil in spinal operation. Methods: In a double blind randomized clinical trial, using random sampling method, 60 patients with the age range of 15-65 years who were candidates for posterior spinal fusion operation were included. Induction of anesthesia was performed, and both groups received isoflurane 1% during the surgery. Remifentanil was injected via infusion pump in one group. The patients in the trial group received dexmedetomidine. As trial outcomes, heart rate and blood pressure were measured before, after induction and during the operation. Pain score, sedation score and the need to analgesic therapy were recorded in the recovery room and the ward. Independent sample t-test and chi-square were used for statistical analysis. Results: Dexmedetomidine had a significant lowering impact on intraoperative blood pressure and heart rate compared to remifentanil (p<0.001). The mean of sedation scores after extubation in patients who received dexmedetomidine was significantly higher than the sedation scores in patients who received remifentanil (p<0.001). The mean of post-extubation and recovery pain score in patients taking remifentanil was significantly higher than patients taking dexmedetomidine (p<0.05). Conclusion: Dexmedetomidine in patients with spinal operation is associated with lower postoperative pain score and intraoperative bleeding. Hemodynamic effects are significantly better in patients received dexmedetomidine. PMID:26478873

  17. 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.

  18. An outbreak of Pseudomonas aeruginosa infections following thoracic surgeries occurring via the contamination of bronchoscopes and an automatic endoscope reprocessor.

    PubMed

    Shimono, Nobuyuki; Takuma, Takahiro; Tsuchimochi, Noriko; Shiose, Akira; Murata, Masayuki; Kanamoto, Yoko; Uchida, Yujiro; Morita, Shigeki; Matsumoto, Hiroko; Hayashi, Jun

    2008-12-01

    An outbreak of Pseudomonas aeruginosa infections occurred after thoracic surgeries performed between May and June 2003. Clinical data of seven patients were reviewed and the fact was revealed that bronchoscopes were used during endotracheal intubation for one-lung ventilation in most patients. P. aeruginosa was recovered from the sputum of these patients at a very early stage post-operation. Environmental samples from bronchoscopes and an automated endoscope reprocessor (AER) were cultured and P. aeruginosa strains were recovered from all of them. All of these strains were confirmed to be identical by pulsed-field gel electrophoresis (PFGE). Inspection of the sterilization cycles of bronchoscopes revealed inappropriate management of bronchoscopes and a flaw in the AER; once its detergent tank was contaminated, it was not possible to disinfect it. After all the bronchoscopes had been disinfected, and the washing machine had been remodeled, with the washing process confirmed to be appropriate, the outbreak finally ended. This outbreak had two causes, a flaw in the AER and inappropriate disinfection procedures. Outbreaks associated with bronchoscopic examinations have been reported elsewhere. Bronchoscopes are widely used to facilitate endotracheal intubation, especially for one-lung anesthesia. Although they are used for only a short time during anesthetic procedures, we should handle them more carefully. PMID:19089555

  19. Video-assisted thoracoscopic surgery under O-arm navigation system guidance for the treatment of thoracic disk herniations: surgical techniques and early clinical results.

    PubMed

    Hur, Jung-Woo; Kim, Jin-Sung; Cho, Dong-Young; Shin, Jong-Mok; Lee, Jun-Ho; Lee, Sang-Ho

    2014-11-01

    This study describes the surgical technique and clinical results of video-assisted thoracoscopic surgery (VATS) assisted by an O-arm-based navigation system, used for the treatment of thoracic disk herniation (TDH). The trend toward the use of minimally invasive procedures with endoscopic visualization of the thoracic cavity in thoracic spine surgery has evolved. It is difficult to develop a new set of visuomotor skills unique to endoscopic procedures and understand the three-dimensional (3D) anatomy while performing a two-dimensional (2D) imaging procedure. Adding image guidance would have a positive impact on these procedures, making them safer and more precise. We report the results of 10 patients who underwent diskectomy for TDH using VATS assisted by an O-arm-based navigation system and describe the surgical technique. The average duration of the symptoms was 2.8 years; average operation time, 326.9 minutes; and average additional time required for the image guidance surgery using the O-arm-based navigation, ? 29.4 minutes. No complications occurred during the surgical procedure or the immediate postoperative period. The advantages of using navigational assistance during the surgical procedure include better visualization of the operative field, more accurate surgical planning, and optimization of the surgical approach involving the establishment of the correct drilling trajectory and safe decompression of the spinal cord, as well as the possibility of intraoperative control of bone resection. PMID:24570307

  20. Spinal fusion

    MedlinePLUS

    ... Anterior spinal fusion; Spine surgery - spinal fusion; Low back pain - fusion; Herniated disk - fusion ... If you had chronic back pain before surgery, you will likely still have some pain afterward. Spinal fusion is unlikely to take away all your pain ...

  1. A Newly Developed Robot Suit Hybrid Assistive Limb Facilitated Walking Rehabilitation after Spinal Surgery for Thoracic Ossification of the Posterior Longitudinal Ligament: A Case Report

    PubMed Central

    Ijiri, Kosei; Matsuda, Fumiyo; Tominaga, Hiroyuki; Biwa, Takanori; Yone, Kazunori; Sankai, Yoshiyuki

    2013-01-01

    Most patients with thoracic ossification of the posterior longitudinal ligament (OPLL) exhibit delayed recovery of gait dysfunction after spinal injury. The hybrid assistive limb (HAL) is a new robot suit controlling knee and hip joint motion by detecting very weak bioelectric signals on the surface of the skin. This study is to report the feasibility and benefits of patient-assistive HAL walking rehabilitation for facilitating locomotor function after spinal surgery. The patient was a 60-year-old woman with thoracic OPLL, and her motor and sensory paralyses did not improve after spinal surgery, indicating severe impairment in the paretic legs. The subject underwent 6 HAL sessions per week for 8 weeks, consisting of a standing and sitting exercise and walking on the ground with HAL. Clinical outcomes were evaluated before and after HAL training and 1 year after surgery. The subject improved considerably as a result of HAL training. Subsequently, her walking ability recovered rapidly, and she was able to walk unaided six months after surgery. This case study suggests that HAL training is a feasible and effective option to facilitating locomotor function and the early HAL training with physiotherapy may enhance motor recovery of patients with residual paralysis after surgery. PMID:24369516

  2. A newly developed robot suit hybrid assistive limb facilitated walking rehabilitation after spinal surgery for thoracic ossification of the posterior longitudinal ligament: a case report.

    PubMed

    Sakakima, Harutoshi; Ijiri, Kosei; Matsuda, Fumiyo; Tominaga, Hiroyuki; Biwa, Takanori; Yone, Kazunori; Sankai, Yoshiyuki

    2013-01-01

    Most patients with thoracic ossification of the posterior longitudinal ligament (OPLL) exhibit delayed recovery of gait dysfunction after spinal injury. The hybrid assistive limb (HAL) is a new robot suit controlling knee and hip joint motion by detecting very weak bioelectric signals on the surface of the skin. This study is to report the feasibility and benefits of patient-assistive HAL walking rehabilitation for facilitating locomotor function after spinal surgery. The patient was a 60-year-old woman with thoracic OPLL, and her motor and sensory paralyses did not improve after spinal surgery, indicating severe impairment in the paretic legs. The subject underwent 6 HAL sessions per week for 8 weeks, consisting of a standing and sitting exercise and walking on the ground with HAL. Clinical outcomes were evaluated before and after HAL training and 1 year after surgery. The subject improved considerably as a result of HAL training. Subsequently, her walking ability recovered rapidly, and she was able to walk unaided six months after surgery. This case study suggests that HAL training is a feasible and effective option to facilitating locomotor function and the early HAL training with physiotherapy may enhance motor recovery of patients with residual paralysis after surgery. PMID:24369516

  3. 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

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

    PubMed

    Dimova, Violeta; Ltsch, Jrn; Hhne, 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 ?-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

  5. Norman Barrett (1903-1979): Unorthodox pioneer of thoracic and oesophageal surgery.

    PubMed

    Eric, E; Agha, R; Camm, C

    2014-05-01

    It is an interesting quirk of medical history that the legacy of Norman Barrett most ostensibly lies in the name of a disease the he was quite emphatically wrong about, at least when he first described it. Indeed, there are those who argue to remove the eponym in favour of the title 'Columnar Lined Epithelium', in part because of what little Barrett actually had to do with the correct initial characterisation of this disease. Yet the sum of Norman Barrett's contributions to modern medicine is much more than a mistaken characterisation of a pathological process. Barrett was truly a pioneer of chest surgery in the UK - a speciality in its embryonic stages when he first qualified. He was also renowned as a teacher and academic of the highest calibre. In tracing the story of his life we can see how his natural attributes, life experiences and keen appreciation of the arts (especially history) facilitated personal success and such sharp insight into the vagaries of modern academic medicine. PMID:24802356

  6. 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

  7. 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.

  8. 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

  9. 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

  10. 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?g/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-?)] 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 24h 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

  11. 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

  12. 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; S, Michel Pompeu Barros de Oliveira; dos Santos, Ceclia 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

  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. 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.

  15. 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

  16. [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

  17. Thoracic epithelioid malignant vascular tumors: a clinicopathologic study of 52 cases with emphasis on pathologic grading and molecular studies of WWTR1-CAMTA1 fusions.

    PubMed

    Anderson, Todd; Zhang, Lei; Hameed, Meera; Rusch, Valerie; Travis, William D; Antonescu, Cristina R

    2015-01-01

    Malignant thoracic epithelioid vascular tumors are an uncommon and heterogenous group of tumors that include low-grade to intermediate-grade epithelioid hemangioendothelioma (EHE) and high-grade epithelioid angiosarcoma (EAS). We examine the morphologic and immunohistochemical features of 52 malignant epithelioid vascular tumors (10 low-grade EHE, 29 intermediate-grade EHE, and 13 EAS) involving the thorax (lung, pleura, mediastinum, heart, great vessels) including cases with exclusively thoracic disease (35) and with multiorgan disease including the thorax (17). Intermediate-grade EHE differs from low-grade EHE by the presence of necrosis, increased mitotic activity, and increased atypia. Morphologic features such as intranuclear inclusions, intracytoplasmic vacuoles, and stromal changes (chondroid, myxoid, or hyalinized stroma) are seen more frequently in EHE, whereas blood lakes, proliferation of slit-like vessels, and prominent nucleoli favor EAS. Fluorescence in situ hybridization analysis showed CAMTA1-WWTR1 fusions in 4/7 low-grade and 23/23 intermediate-grade EHE (P<0.001). In EAS, CAMTA1 rearrangement was negative in all cases, whereas a WWTR1 complex abnormality was found in 1/5 cases (P<0.001). This offers an objective means of differentiating intermediate-grade EHE from EAS, especially on limited biopsies. All cases show expression of at least 1 vascular marker, which allows differentiation from primary thoracic epithelial malignancies, although keratin expression is a potential pitfall with 29% of EHE and 25% of EAS showing keratin expression. Survival analysis shows that higher tumor grade for all tumors (P=0.026) as well as lung and pleural tumors only (P=0.010) and the presence of pleural involvement in lung and/or pleural tumors (P=0.042) correlate with poor prognosis. PMID:25353289

  18. A comparison of thoracic spinal anesthesia with low-dose isobaric and low-dose hyperbaric bupivacaine for orthopedic surgery: A randomized controlled trial

    PubMed Central

    Imbelloni, Luiz Eduardo; Gouveia, Marildo A.

    2014-01-01

    Background: The thoracic spinal anesthesia was first described in 1909 and recently revised for various surgical procedures. This is a prospective study aims to evaluate the parameters of the thoracic spinal anesthesia (latency, motor block and paresthesia), the incidence of cardiovascular changes and complications comparing low doses of isobaric and hyperbaric bupivacaine. Materials and Methods: A total of 200 orthopedic patients operated under spinal anesthesia were included in this study. Spinal anesthesia was between T9-T10, with a 27G cutting point or pencil tip in lateral or sitting. Spinal anesthesia was performed with 0.5% bupivacaine isobaric or hyperbaric. Patients remained in cephalad or head down position 10-20 for 10 minutes. We evaluated the demographics, analgesia, and degree of motor block, incidence of paresthesia, bradycardia, hypotension, anesthesia success and neurological complications. Results: All patients developed spinal and there was no failure. The solution did not affect the onset of the blockade. The duration of motor block was greater than the sensitive with isobaric. The duration of sensory block was greater than the motor block with hyperbaric solution. The incidence of paresthesia was 4%, with no difference between the needles. The incidence of hypotension was 12.5% with no difference between the solutions. There was no neurological damage in all patients. Conclusion: The beginning of the block is fast regardless of the solution used. By providing a sensory block of longer duration than the motor block hyperbaric bupivacaine is reflected in a better indication. Thoracic spinal anesthesia provides excellent anesthesia for lower limb orthopedic surgery PMID:25886099

  19. 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

  20. 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

  1. Three-dimensional surgical simulation-guided navigation in thoracic surgery: a new approach to improve results in chest wall resection and reconstruction for malignant diseases

    PubMed Central

    Stella, Franco; Dolci, Giampiero; DellAmore, Andrea; Badiali, Giovanni; De Matteis, Massimo; Asadi, Nizar; Marchetti, Claudio; Bini, Alessandro

    2014-01-01

    OBJECTIVES Oncological surgery of the chest wall should be performed to achieve free margins of at least 2 cm for metastasis or 4 cm for primary tumours. When the lesion is not visible or palpable, difficulty in identification may lead to a larger incision and a resection wider than is necessary. METHODS We report three cases of non-palpable metastatic chest wall lesions in which the preoperative surgical planning and the intraoperative identification of the tumour, and thus the subsequent chest wall reconstruction, was supported using computer-based surgery. RESULTS The application of high-resolution three-dimensional imaging technology and navigational systems is used in preoperative surgical planning to provide virtual simulations of a patient's skeletal changes and new soft tissue profile. Intraoperatively, a mobile navigation probe was used to identify the lesion, matching surgical landmarks and the preoperative computed tomography imaging, achieving the radical resection of the tumour with correct but not excessive surgical margins. Two patients underwent partial sternectomy followed by sternal allograft reconstruction. The third patient underwent chest wall resection followed by reconstruction using titanium bars and vicryl mesh. In all cases, the postoperative period was uneventful. After a follow-up period of 13.9 and 8 months, respectively, all patients are disease free, without complications. CONCLUSIONS Application of navigation technology in thoracic surgery should be encouraged because it is easy to use and requires a limited learning curve. PMID:24144806

  2. [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

  3. 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

  4. 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.

  5. 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

  6. 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

  7. Thoracic ectopia cordis

    PubMed Central

    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 5.57.9 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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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

  14. Automated segmentation of the thyroid gland on thoracic CT scans by multiatlas label fusion and random forest classification.

    PubMed

    Narayanan, Divya; Liu, Jiamin; Kim, Lauren; Chang, Kevin W; Lu, Le; Yao, Jianhua; Turkbey, Evrim B; Summers, Ronald M

    2015-10-01

    The thyroid is an endocrine gland that regulates metabolism. Thyroid image analysis plays an important role in both diagnostic radiology and radiation oncology treatment planning. Low tissue contrast of the thyroid relative to surrounding anatomic structures makes manual segmentation of this organ challenging. This work proposes a fully automated system for thyroid segmentation on CT imaging. Following initial thyroid segmentation with multiatlas joint label fusion, a random forest (RF) algorithm was applied. Multiatlas label fusion transfers labels from labeled atlases and warps them to target images using deformable registration. A consensus atlas solution was formed based on optimal weighting of atlases and similarity to a given target image. Following the initial segmentation, a trained RF classifier employed voxel scanning to assign class-conditional probabilities to the voxels in the target image. Thyroid voxels were categorized with positive labels and nonthyroid voxels were categorized with negative labels. Our method was evaluated on CT scans from 66 patients, 6 of which served as atlases for multiatlas label fusion. The system with independent multiatlas label fusion method and RF classifier achieved average dice similarity coefficients of [Formula: see text] and [Formula: see text], respectively. The system with sequential multiatlas label fusion followed by RF correction increased the dice similarity coefficient to [Formula: see text] and improved the segmentation accuracy. PMID:26730397

  15. Multimodal perioperative management--combining thoracic epidural analgesia, forced mobilization, and oral nutrition--reduces hormonal and metabolic stress and improves convalescence after major urologic surgery.

    PubMed

    Brodner, G; Van Aken, H; Hertle, L; Fobker, M; Von Eckardstein, A; Goeters, C; Buerkle, H; Harks, A; Kehlet, H

    2001-06-01

    We sought in this prospective study to use a multimodal approach to reduce stress and improve recovery in patients undergoing major surgery. During an initial study period, 30 patients were randomly allocated to receive general anesthesia (GA; Group 1) or a combination of GA and intraoperative thoracic epidural analgesia (TEA; Group 2) when undergoing radical cystectomy. Parenteral nutrition was provided for 5 days after surgery. During the second period, 15 patients were treated with a multimodal approach (Group 3) consisting of intraoperative GA and TEA, postoperative patient-controlled TEA, early oral nutrition, and enforced mobilization. Data for plasma and urine catecholamines, plasma cortisol, the nitrogen balance, the postoperative inflammatory nutrition index, pain relief, fatigue, sleep, overnight recovery, recovery of bowel function, and mobilization were recorded up to the fifth postoperative day. Plasma concentrations of catecholamines and cortisol were comparable in all patients, but those in Group 3 had lower levels of urinary catecholamine excretion. Protein intake was more effective with parenteral nutrition. Nitrogen balances were less negative, and the postoperative inflammatory nutrition index score increased significantly in the traditional groups but not in Group 3. Multimodally treated patients reported less fatigue and better overnight recovery. Along with improved pain relief, recovery of bowel function, and ambulation, there were no differences in the postoperative complication rates among the three groups. The multimodal approach reduced stress and improved metabolism and recovery after radical cystectomy. PMID:11375853

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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

  1. The Latest in Surgical Management of Stage IIIA Non-Small Cell Lung Cancer: Video-Assisted Thoracic Surgery and Tumor Molecular Profiling.

    PubMed

    Woodard, Gavitt A; Jablons, David M

    2015-01-01

    Stage IIIA non-small cell lung cancer (NSCLC) remains a treatment challenge and requires a multidisciplinary care team to optimize survival outcomes. Thoracic surgeons play an important role in selecting operative candidates and assisting with pathologic mediastinal staging via cervical mediastinoscopy, endobronchial ultrasound, or esophageal ultrasound with fine needle aspiration. The majority of patients with stage IIIA disease will receive induction therapy followed by repeat staging before undergoing lobectomy or pneumonectomy; occasionally, a patient with an incidentally found, single-station microscopic IIIA tumor will undergo resection as the primary initial therapy. Multiple large clinical trials, including SWOG-8805, EORTC-8941, INT-0139, and ANITA, have shown 5-year overall survival rates of up to 30% to 40% using triple-modality treatments, and the best outcomes repeatedly are seen among patients who respond to induction treatment or who have tumors amenable to lobectomy instead of pneumonectomy. The need for a pneumonectomy is not a reason to deny patients an operation, because current operative mortality and morbidity rates are acceptably low at 5% and 30%, respectively. In select patients with stage IIIA disease, video-assisted thoracic surgery and open resections have been shown to have comparable rates of local recurrence and long-term survival. New developments in genetic profiling and personalized medicine are exciting areas of research, and early data suggest that molecular profiling of stage IIIA NSCLC tumors can accurately stratify patients by risk within this stage and predict survival outcomes. Future advances in treating stage IIIA disease will involve developing better systemic therapies and customizing treatment plans on the basis of an individual tumor's genetic profile. PMID:25993207

  2. 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

  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 Gmez, 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. 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

  6. 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

  7. Significance and function of different spinal collateral compartments following thoracic aortic surgery: immediate versus long-term flow compensation.

    PubMed

    Meffert, Philipp; Bischoff, Moritz S; Brenner, Robert; Siepe, Matthias; Beyersdorf, Friedhelm; Kari, Fabian A

    2014-05-01

    Iatrogenic paraplegia has been accompanying cardiovascular surgery since its beginning. As a result, surgeons have been developing many theories about the exact mechanisms of this devastating complication. Thus, the impact of single arteries that contribute to the spinal perfusion is one of the most discussed subjects in modern surgery. The subsequent decision of reattachment or the permanent disconnection of these intercostal arteries divides the surgical community. On the one hand, the anatomical or vascular approach pleads for the immediate reimplantation to reconstruct the anatomical situation. On the other hand, the decision of the permanent disconnection aims at avoiding stealing phenomenon away from the spinal vascular network. This spinal collateral network can be described as consisting of three components-the intraspinal and two paraspinal compartments-that feed the nutrient arteries of the spinal cord. The exact functional impact of the different compartments of the collateral network remains poorly understood. In this review, the function of the intraspinal compartment in the context of collateral network principle as an immediate emergency backup system is described. The exact structure and architectural principles of the intraspinal compartment are described. The critical parameters with regard to the risk of postoperative spinal cord ischaemia are the number of anterior radiculomedullary arteries (ARMAs) and the distance between them in relation to the longitudinal extent of aortic disease. The paraspinal network as a sleeping reserve is proposed as the long-term backup system. This sleeping reserve has to be activated by arteriogenic stimuli. These are presented briefly, and prior findings regarding arteriogenesis are discussed in the light of the collateral network concept. Finally, the role of preoperative visualization of the ARMAs in order to evaluate the risk of postoperative paraplegia is emphasized. PMID:24078102

  8. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion.

    PubMed

    Cobo Soriano, Javier; Sendino Revuelta, Marcos; Fabregate Fuente, Martn; Cimarra Daz, Ignacio; Martnez Urea, Paloma; Deglan Meneses, Roberto

    2010-11-01

    There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1 year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of "disc herniation", less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results. PMID:20135333

  9. Predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion

    PubMed Central

    Sendino Revuelta, Marcos; Cimarra Daz, Ignacio; Martnez Urea, Paloma; Deglan Meneses, Roberto

    2010-01-01

    There has been no agreement among different authors on guidelines to specify the situations in which arthrodesis is justified in terms of results, risks and complications. The aim of this study was to identify preoperative predictors of outcome after decompressive lumbar surgery and instrumented posterolateral fusion. A prospective observational study design was performed on 203 consecutive patients. Potential preoperative predictors of outcome included sociodemographic factors as well as variables pertaining to the preoperative clinical situation, diagnosis, expectations and surgery. Separate multiple linear regression models were used to assess the association between selected predictors and outcome variables, defined as the improvement after 1year on the visual analog scale (VAS) for back pain, VAS for leg pain, physical component scores (PCS) of SF-36 and Oswestry disability index (ODI). Follow-up was available for 184 patients (90.6%). Patients with higher educational level and optimistic preoperative expectations had a more favourable postoperative leg pain (VAS) and ODI. Smokers had less leg pain relief. Patients with better mental component score (emotional health) had greater ODI improvement. Less preoperative walking capacity predicted more leg pain relief. Patients with disc herniation had greater relief from back pain and more PCS and ODI improvement. More severe lumbar pain was predictive of less improvement on ODI and PCS. Age, sex, body mass index, analgesic use, surgeon, self-rated health, the number of decompressed levels and the length of fusion had no association with outcome. This study concludes that a higher educational level, optimistic expectations for improvement, the diagnosis of disc herniation, less walking capacity and good emotional health may significantly improve clinical outcome. Smoking and more severe lumbar pain are predictors of worse results. PMID:20135333

  10. 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

  11. Generation of virtual models for planning orthognathic surgery using a modified multimodal image fusion technique.

    PubMed

    Uechi, J; Tsuji, Y; Konno, M; Hayashi, K; Shibata, T; Nakayama, E; Mizoguchi, I

    2015-04-01

    Streak artefacts caused by dental metals deteriorate the quality of computed tomography (CT) images. We developed and evaluated a method for generating three-dimensional virtual models to plan orthognathic surgery in patients with multiple dental materials, to avoid the adverse effects of metal artefacts in image fusion. The method basically consists of four procedures: (1) fabrication of a splint in the open-mouth position with fiducial markers, (2) reconstruction of a virtual skull model in the open-mouth position from CT scanning, (3) reconstruction of two virtual dental models in the open-mouth position and either the intercuspal position (ICP) or centric relation (CR) from surface scanning, and (4) three serial steps of image registration and subsequent repositioning of the mandible to the ICP or CR. This method allows for the registration of skull and dental models under artefact-free conditions. To validate the method, CT and dental cast data from 30 patients were used. The registration accuracy was 0.080 mm for the initial registration, 0.033 mm for the second registration, and 0.028 mm for the third registration. The present method can be used to determine the occlusal relationships and craniofacial morphology of patients with dental metals and can be applied to computer-assisted diagnosis and surgery. PMID:25475849

  12. Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy

    PubMed Central

    Park, Young Sik

    2016-01-01

    Background Video-assisted thoracic surgery (VATS) and thoracotomy are standard treatment methods for early lung cancer. We compared their effects on the long-term recovery of pulmonary function in patients with stage I non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed 203 patients with early NSCLC who underwent VATS or thoracotomy at Seoul University Hospital from January 2005 to December 2010. Two matched groups (VATS and thoracotomy) each consisting of 60 patients were created via propensity score matching according to TNM stage, age, sex, smoking history, lung disease history, and preoperative pulmonary function. Results There were no significant differences in the recovery of forced expiratory volume in 1 second, the forced vital capacity (FVC), or the peak flow rate (PFR), presented as the postoperative value/predicted value, between the VATS and thoracotomy groups during the 12-month follow-up period. The standardized functional loss ratio [(measured postoperative value predicted postoperative value)/(predicted postoperative value 100)] did not differ between the two groups at 6 and 12 months. In an intragroup analysis, the postoperative FVC in the thoracotomy group remained below predicted postoperative value during the follow-up period and did not reach the predicted postoperative FVC (6 months/12 months: 6.58%/2.43%). The analgesic requirements and pain procedures were similar in the VATS and thoracotomy groups during the 12-month follow-up period. Conclusions There were no significant differences in pulmonary function recovery during the late postoperative period in NSCLC patients receiving VATS versus thoracotomy. We suggest that the volume of the resected lung and preoperative lung function are the main determinants of late recovery, rather than postoperative pain.

  13. [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

  14. Linking the Congenital Heart Surgery Databases of the Society of Thoracic Surgeons and the Congenital Heart Surgeons Society: Part 2Lessons Learned and Implications

    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 A link has been created between the Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSD) and the Congenital Heart Surgeons Society Database (CHSS-D). Five matrices have been created that facilitate the automated identification of patients who are potentially eligible for the five active CHSS studies using the STS-CHSD. These matrices are now used to (1) estimate the denominator of patients eligible for CHSS studies and (2) compare eligible and enrolled patients to potentially eligible and not enrolled patients to assess the generalizability of CHSS studies. Methods The matrices were applied to 40 consenting institutions that participate in both the STS-CHSD and the CHSS to (1) estimate the denominator of patients that are potentially eligible for CHSS studies, (2) estimate the completeness of enrollment of patients eligible for CHSS studies among all CHSS sites, (3) estimate the completeness of enrollment of patients eligible for CHSS studies among those CHSS institutions participating in each CHSS cohort study, and (4) compare eligible and enrolled patients to potentially eligible and not enrolled patients to assess the generalizability of CHSS studies. The matrices were applied to all participants in the STS-CHSD to identify patients who underwent frequently performed operations and compare eligible and enrolled patients to potentially eligible and not enrolled patients in following five domains: (1) age at surgery, (2) gender, (3) race, (4) discharge mortality, and (5) postoperative length of stay. Completeness of enrollment was defined as the number of actually enrolled patients divided by the number of patients identified as being potentially eligible for enrollment. Results For the CHSS Critical Left Ventricular Outflow Tract Study (LVOTO) study, for the Norwood procedure, completeness of enrollment at centers actively participating in the LVOTO study was 34%. For the Norwood operation, discharge mortality was 15% among 227 enrolled patients and 16% among 1768 nonenrolled potentially eligible patients from the 40 consenting institutions. Median postoperative length of stay was 31 days and 26 days for these enrolled and nonenrolled patients. For the CHSS anomalous aortic origin of a coronary artery (AAOCA)study, for AAOCA repair, completeness of enrollment at centers actively participating in the AAOCA study was 40%. Conclusion Determination of the denominator of patients eligible for CHSS studies and comparison of eligible and enrolled patients to potentially eligible and not enrolled patients provides an estimate of the extent to which patients in CHSS studies are representative of the overall population of eligible patients; however, opportunities exist to improve enrollment. PMID:24668975

  15. Lhermitte Sign as a Presenting Symptom of Thoracic Spinal Pathology: A Case Study

    PubMed Central

    Hills, Adam; Al-Hakim, Mazen

    2015-01-01

    A 54-year-old male with ankylosing spondylitis presented with complaints of progressively worsening bilateral leg weakness and difficulty ambulating of 2-week duration. He also felt a sharp, electric, shock-like sensation radiating from his lower back into his legs upon flexing the trunk. There was no history of trauma or other inciting events within the 2 weeks prior to presentation. Thoracic MRI at this visit showed a three-column fracture at T11-T12. He underwent spinal fusion surgery and within 2 days after surgery the radiating electrical sensation with spinal flexion had completely resolved. PMID:26339515

  16. Thoracic splenosis.

    PubMed Central

    Madjar, S.; Weissberg, D.

    1994-01-01

    BACKGROUND--Thoracic splenosis is an uncommon side effect of thoracoabdominal trauma involving injury to the diaphragm and spleen. Only 20 patients with a similar problem have been reported previously. METHODS--Two patients with thoracic splenosis were studied. RESULTS--One of the patients had undergone thoracotomy for resection of a "pulmonary nodule". The other remains under observation. CONCLUSION--Presence of a pulmonary nodule in a patient with history of injury to the diaphragm and spleen should arouse suspicion of splenosis. Appropriate investigation may prevent an unnecessary and potentially harmful operation. Images PMID:7974296

  17. Digital three-dimensional image fusion processes for planning and evaluating orthodontics and orthognathic surgery. A systematic review.

    PubMed

    Plooij, Joanneke M; Maal, Thomas J J; Haers, Piet; Borstlap, Wilfred A; Kuijpers-Jagtman, Anne Marie; Berg, Stefaan J

    2011-04-01

    The three important tissue groups in orthognathic surgery (facial soft tissues, facial skeleton and dentition) can be referred to as a triad. This triad plays a decisive role in planning orthognathic surgery. Technological developments have led to the development of different three-dimensional (3D) technologies such as multiplanar CT and MRI scanning, 3D photography modalities and surface scanning. An objective method to predict surgical and orthodontic outcome should be established based on the integration of structural (soft tissue envelope, facial skeleton and dentition) and photographic 3D images. None of the craniofacial imaging techniques can capture the complete triad with optimal quality. This can only be achieved by 'image fusion' of different imaging techniques to create a 3D virtual head that can display all triad elements. A systematic search of current literature on image fusion in the craniofacial area was performed. 15 articles were found describing 3D digital image fusion models of two or more different imaging techniques for orthodontics and orthognathic surgery. From these articles it is concluded, that image fusion and especially the 3D virtual head are accurate and realistic tools for documentation, analysis, treatment planning and long term follow up. This may provide an accurate and realistic prediction model. PMID:21095103

  18. Minimally Invasive Transforaminal Lumbar Interbody Fusion with Unilateral Pedicle Screw Fixation: Comparison between Primary and Revision Surgery

    PubMed Central

    Kang, Moo Sung; Kim, Kyung Hyun; Kuh, Sung Uk; Chin, Dong Kyu; Kim, Keun Su; Cho, Yong Eun

    2014-01-01

    Minimally invasive surgery with a transforaminal lumbar interbody fusion (MIS TLIF) is an important minimally invasive fusion technique for the lumbar spine. Lumbar spine reoperation is challenging and is thought to have greater complication risks. The purpose of this study was to compare MIS TLIF with unilateral screw fixation perioperative results between primary and revision surgeries. This was a prospective study that included 46 patients who underwent MIS TLIF with unilateral pedicle screw. The patients were divided into two groups, primary and revision MIS TLIF, to compare perioperative results and complications. The two groups were similar in age, sex, and level of operation, and were not significantly different in the length of follow-up or clinical results. Although dural tears were more common with the revision group (primary 1; revision 4), operation time, blood loss, total perioperative complication, and fusion rates were not significantly different between the two groups. Both groups showed substantial improvements in VAS and ODI scores one year after surgical treatment. Revision MIS TLIF performed by an experienced surgeon does not necessarily increase the risk of perioperative complication compared with primary surgery. MIS TLIF with unilateral pedicle screw fixation is a valuable option for revision lumbar surgery. PMID:24949483

  19. 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

  20. 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

  1. 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

  2. Linking the Congenital Heart Surgery Databases of the Society of Thoracic Surgeons and the Congenital Heart Surgeons Society: Part 1Rationale 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

  3. 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

  4. 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

  5. American Board of Surgery

    MedlinePLUS

    ... Feedback Joint Pathway - General & Thoracic Surgery Specialty Definition Vascular Surgery Training Pathways Related Policies Credit for Foreign Medical Education Early Specialization Program Exam Admissibility Policy Leave Policy Readmissibility Policy ...

  6. 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

  7. The Effects of Massage Therapy after Decompression and Fusion Surgery of the Lumbar Spine: a Case Study

    PubMed Central

    Keller, Glenda

    2012-01-01

    Background Spinal fusion and decompression surgery of the lumbar spine are common procedures for problems such as disc herniations. Various studies for postoperative interventions have been conducted; however, no massage therapy studies have been completed. Purpose The objective of this study is to determine if massage therapy can beneficially treat pain and dysfunction associated with lumbar spinal decompression and fusion surgery. Participants Client is a 47-year-old female who underwent spinal decompression and fusion surgery of L4/L5 due to chronic disc herniation symptoms. Research Design The research design was a case study in a private clinic involving the applications of seven, 30-minute treatments conducted over eight weeks. Common Swedish massage and myofascial techniques were applied to the back, shoulders, posterior hips, and posterior legs. Outcomes were assessed using the following measures: VAS pain scale, Hamstring Length Test, Oswestry Disability Index, and the Roland-Morris Disability Questionnaire. Results Hamstring length improved (in degrees of extension) from pretreatment measurements in the right leg of 40 and left leg 65 to post-treatment measurement at the final visit, when the results were right 50 and left 70. The Oswestry Disability Index improved 14%, from 50% to 36% disability. Roland-Morris Disability decreased 1 point, from 3/24 to 2/24. The VAS pain score decreased by 2 points after most treatments, and for three of the seven treatments, client had a post-treatment score of 0/10. Conclusions Massage for pain had short-term effects. Massage therapy seemed to lengthen the hamstrings bilaterally. Massage therapy does appear to have positive effects in the reduction of disability. This study is beneficial for understanding the relationship between massage therapy and clients who have undergone spinal decompression and fusion. Further research is warranted. PMID:23429839

  8. 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 ...

  9. A comprehensive assessment of the risk of bone morphogenetic protein use in spinal fusion surgery and postoperative cancer diagnosis.

    PubMed

    Cahill, Kevin S; McCormick, Paul C; Levi, Allan D

    2015-07-01

    The risk of postoperative cancer following the use of recombinant human bone morphogenetic protein (BMP)-2 in spinal fusion is one potential complication that has received significant interest. Until recently, there has been little clinical evidence to support the assertion of potential cancer induction after BMP use in spinal surgery. This report aims to summarize the findings from clinical data available to date from the Yale University Open Data Access (YODA) project as well as more recently published large database studies regarding the association of BMP use in spinal fusion and the risk of postoperative cancer. A detailed review was based on online databases, primary studies, FDA reports, and bibliographies of key articles for studies that assessed the efficacy and safety of BMP in spinal fusion. In an analysis of the YODA project, one meta-analysis detected a statistically significant increase in cancer occurrence at 24 months but not at 48 months, and the other meta-analysis did not detect a significant increase in postoperative cancer occurrence. Analysis of 3 large health care data sets (Medicare, MarketScan, and PearlDiver) revealed that none were able to detect a significant increase in risk of malignant cancers when BMP was used compared with controls. The potential risk of postoperative cancer formation following the use of BMP in spinal fusion must be interpreted on an individual basis for each patient by the surgeon. There is no conclusive evidence that application of the common formulations of BMP during spinal surgery results in the formation of cancer locally or at a distant site. PMID:25860517

  10. Foot Surgery

    MedlinePLUS

    ... not move. Fusions can be done with screws, plates or pins or a combination of these. Tendon Surgery: Surgery on the tendons can be performed for acute injuries such as ruptures but is also commonly done ...

  11. 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

  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 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?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

  14. Fusion

    NASA Astrophysics Data System (ADS)

    Herman, Robin

    1990-10-01

    The book abounds with fascinating anecdotes about fusion's rocky path: the spurious claim by Argentine dictator Juan Peron in 1951 that his country had built a working fusion reactor, the rush by the United States to drop secrecy and publicize its fusion work as a propaganda offensive after the Russian success with Sputnik; the fortune Penthouse magazine publisher Bob Guccione sank into an unconventional fusion device, the skepticism that met an assertion by two University of Utah chemists in 1989 that they had created "cold fusion" in a bottle. Aimed at a general audience, the book describes the scientific basis of controlled fusion--the fusing of atomic nuclei, under conditions hotter than the sun, to release energy. Using personal recollections of scientists involved, it traces the history of this little-known international race that began during the Cold War in secret laboratories in the United States, Great Britain and the Soviet Union, and evolved into an astonishingly open collaboration between East and West.

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

    PubMed Central

    Triantafyllopoulos, Ioannis; 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

  16. 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

  17. 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 C2C7 ROM (p?=?0.002), ROM of superior adjacent segment (p?surgery demonstrated excellent clinical efficacy and radiological results. Postoperative C2C7 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

  18. [A case of SAPHO syndrome with paraplegia due to a thoracic kyphosis].

    PubMed

    Fujii, Tomoko; Matsudaira, Koh; Oda, Hiromi; Seichi, Atsushi; Nakamura, Kozo

    2002-08-01

    A 63-year-old man visited our hospital in January 1993 because of back pain, which had been present for a year and persisted. The patient was diagnosed compression fracture of thoracic spine by another hospital. Thoracic plain radiographs revealed destructive and sclerotic changes with reduction of height of T 8, T 9 vertebral body. He had kyphosis on this level. Radiographs of the chest revealed hyperostosis of bilateral proximal clavicle. We diagnosed SAPHO syndrome (synovitis, acne, pustlosis, hyperostosis, and osteomyelitis: SAPHO) with T 8, T 9 spondylodiscitis, however without any skin manifestations. Oral indomethacin was effective, however thoracic kyphosis progressed gradually. Spastic gait and paraplegia appeared from February 1998, at last on July he was unable to walk independently. MRI showed the compression of spinal cord on T 8, T 9 level. We performed circumferential decompression and fusion with instrumentation. His paraplegia improved after surgery. We describe a rare case of SAPHO syndrome with paraplegia due to a thoracic kyphosis. PMID:12355864

  19. 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

  20. 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

  1. American Thoracic Society

    MedlinePLUS

    ... Infections Nursing Pediatrics Pulmonary Circulation Pulmonary Rehabilitation Respiratory Cell & Molecular Biology Respiratory Structure & Function Sleep & Respiratory Neurobiology Thoracic Oncology ...

  2. Acute shingles after resection of thoracic schwannoma.

    PubMed

    Muesse, Jason L; Blackmon, Shanda H; Harris, Richard L; Kim, Min P

    2012-01-01

    Herpes zoster is relatively uncommon after surgery in immunocompetent patients. To our knowledge, there have been no reports of herpes zoster after the resection of a thoracic schwannoma. We report the case of a 48-year-old woman in whom acute shingles developed after the video-assisted thoracic surgical resection of a posterior mediastinal schwannoma adjacent to the 4th thoracic vertebral body. The patient recovered after receiving timely antiviral therapy. Rash and pain are common in patients who have wound infections and contact dermatitis after surgery, so the possible reactivation of varicella virus might not be prominent in the surgeon's mind. This case serves as a reminder that viral infections such as shingles should be considered in the differential diagnosis of postoperative erythema and pain. PMID:22740749

  3. Acute Shingles after Resection of Thoracic Schwannoma

    PubMed Central

    Muesse, Jason L.; Blackmon, Shanda H.; Harris, Richard L.; Kim, Min P.

    2012-01-01

    Herpes zoster is relatively uncommon after surgery in immunocompetent patients. To our knowledge, there have been no reports of herpes zoster after the resection of a thoracic schwannoma. We report the case of a 48-year-old woman in whom acute shingles developed after the video-assisted thoracic surgical resection of a posterior mediastinal schwannoma adjacent to the 4th thoracic vertebral body. The patient recovered after receiving timely antiviral therapy. Rash and pain are common in patients who have wound infections and contact dermatitis after surgery, so the possible reactivation of varicella virus might not be prominent in the surgeon's mind. This case serves as a reminder that viral infections such as shingles should be considered in the differential diagnosis of postoperative erythema and pain. PMID:22740749

  4. 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

  5. [Surgical management of thoracic aortic lesions. Aneurysm, dissection and traumatic rupture].

    PubMed

    Schumacher, H; Bckler, D; Allenberg, J-R

    2004-09-01

    Surgical management of distinct thoracic aneurysmal lesions stands at the crossroads. Until recently, the only treatment options for thoracic aortic lesions were surgical repair or medical management. There is increasing evidence that endovascular therapy will be useful in treating thoracic aortic disease, possibly becoming the preferred approach. Endovascular surgery will affect the incidence of open thoracic aortic surgery not only by producing a lower mortality risk but also a significantly lower incidence of paraplegia. In designing adequate treatment options of complex and difficult-to-treat thoracic aortic lesions, novel three-dimensional imaging reconstructions are mandatory. PMID:15316640

  6. Three-Dimensional Reconstruction of Thoracic Structures: Based on Chinese Visible Human

    PubMed Central

    Luo, Na; Tan, Liwen; Fang, Binji; Li, Ying; Xie, Bing; Liu, Kaijun; Chu, Chun; Li, Min

    2013-01-01

    We managed to establish three-dimensional digitized visible model of human thoracic structures and to provide morphological data for imaging diagnosis and thoracic and cardiovascular surgery. With Photoshop software, the contour line of lungs and mediastinal structures including heart, aorta and its ramus, azygos vein, superior vena cava, inferior vena cava, thymus, esophagus, diaphragm, phrenic nerve, vagus nerve, sympathetic trunk, thoracic vertebrae, sternum, thoracic duct, and so forth were segmented from the Chinese Visible Human (CVH)-1 data set. The contour data set of segmented thoracic structures was imported to Amira software and 3D thorax models were reconstructed via surface rendering and volume rendering. With Amira software, surface rendering reconstructed model of thoracic organs and its volume rendering reconstructed model were 3D reconstructed and can be displayed together clearly and accurately. It provides a learning tool of interpreting human thoracic anatomy and virtual thoracic and cardiovascular surgery for medical students and junior surgeons. PMID:24369489

  7. 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

  8. 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

  9. [Pulmonary Carcinoid Tumor with Cushing's Syndrome in a Patient who Underwent Pulmonary Resection by Video-Assisted Thoracic Surgery;Report of a Case].

    PubMed

    Sato, Hiroshi; Mishina, Taijiro; Miyajima, Masahiro; Watanabe, Atsushi

    2015-07-01

    Pulmonary carcinoid tumor with Cushing's syndrome is comparatively rare disease. It is difficult to make an early diagnosis due to small size lesion in its early stage. We report a case of pulmonary carcinoid tumor with Cushing's syndrome successfully localised by positron emission tomography/computed tomography and was resected in the early stage. The levels of serum cortisol and adrenocorticotropic hormone( ACTH) decreased immediately after surgery, and the symptoms of Cushing's syndrome were relieved. PMID:26197833

  10. In-hospital complications and mortality after elective spinal fusion surgery in the united states: a study of the nationwide inpatient sample from 2001 to 2005.

    PubMed

    Shen, Yang; Silverstein, Jonathan C; Roth, Steven

    2009-01-01

    Spinal fusion surgery has increased dramatically and patients presenting for surgery are often more medically challenging. We hypothesized that advanced age and coexisting morbidities have increased in the population undergoing spinal fusion and are associated with greater risks for immediate complications and mortality. The Nationwide Inpatient Sample was retrospectively reviewed for discharges after a principal procedure code for elective spinal fusion. Total records meeting study inclusion criteria were 254,640. Coexisting morbidities were tabulated using Elixhauser comorbidities and the Charlson comorbidity index. Logistic regression identified risk factors associated with in-hospital mortality and early complications. The largest increase in spinal fusion surgery was in patients >65 years. Overall, those with at least 1 comorbidity increased (49% to 62%; P=0.002), as did mean Charlson index (0.146 to 0.202; P<0.001). In-hospital mortality was 0.13%, but 0.29%, and 0.64% for patients of 65 to 74, and those >or=75 years, respectively. Adjusted odds ratios for complications in 65-year to 74-year olds versus <65 years was 1.78 (95% confidence interval, 1.71-1.84; P<0.001), and for mortality 3.81 (95% confidence interval, 2.62-5.55; P<0.001); risks increased with the number of coexisting morbidities. Congestive heart failure, chronic pulmonary disease, coagulopathy, metastatic cancer, renal failure, and weight loss significantly correlated with in-hospital mortality, whereas hypertension or hypothyroidism had, unexpectedly, the opposite effect. Although it is known for some other forms of complex surgery, we showed that elderly and medically complex spinal fusion patients were at increased risk for in-hospital mortality and early complications. The majority of complications were operative, pulmonary, cardiovascular, or genito-urinary. Patient risk correlated with the number and nature of coexisting morbidities. PMID:19098620

  11. 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.

  12. 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

  13. Single-incision video-assisted thoracic surgery lobectomy in the treatment of adult communicating bronchopulmonary foregut malformation with large aberrant artery

    PubMed Central

    Kim, Chang Wan

    2016-01-01

    Single-incision thoracoscopic surgery (SITS) is not yet widely used for treating pulmonary sequestration due to the difficulty of manipulating an aberrant systemic artery or working around inflamed tissue. It is also difficult to control massive bleeding if the aberrant artery ruptures during excision. We modified the SITS lobectomy technique so that it was suitable for treating pulmonary sequestration. We changed the order of excision of anatomical structures and introduced two-stage stapling of the aberrant artery for easy, safe stapling in SITS lobectomy. Single-port VATS is an acceptable method for major pulmonary resection for the treatment of intrapulmonary sequestration.

  14. [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

  15. 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

  16. 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

  17. 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

  18. Health-Related Quality of Life in Thoracic Aortic Disease: Part II. After Surgery on the Proximal (Root, Ascending, Arch) Aorta

    PubMed Central

    Olsson, Christian; Franco-Cereceda, Anders

    2013-01-01

    Background: Health-related quality of life (HRQOL) has been reported to be near-to-normal after operations on the proximal aorta. However, a thorough evaluation of variables related to postoperative HRQOL is lacking. We report HRQOL after surgery on the proximal aorta acknowledging current symptoms and conditions. If modifiable factors affect HRQOL, surgical treatment could be tailored to optimize outcomes. Methods: The short form 36 item (SF-36) questionnaire was used to measure HRQOL in eight domains and a physical component summary (PCS) and mental component summary (MCS) score. Median differences (?) between the component summary scores and a sex- and age-matched reference group from the general population were the primary outcome measures, along with comparisons of patient subgroups according to pathology (aneurysm versus dissection), aortic valve procedure, and circulatory arrest. Results: In 207 patients operated on the proximal aorta, after a mean of three years, there were no significant differences in median PCS (? = ?0.3 [95% confidence limits ?2.6, 2.0]) and MCS (? = 1.7 [?0.4, 2.9]) scores compared to the reference group, but median scores for the physical functioning, general health, and mental health domains were significantly lower. There were no statistically significant differences in PCS, MCS, or domain scores for patients with aneurysm versus dissection, for patients undergoing aortic valve procedures or not, or for patients managed with circulatory arrest or not. In multivariable analysis, exertional dyspnea was independently related to both ?PCS (?6.5 [?13, ?0.44]) and ?MCS (?7.5 [?13, ?1.6]), whereas age, exertional calf pain, and myocardial infarction were related only to ?PCS. Conclusions: Overall HRQOL after surgery on the proximal aorta is encouraging, which remains important when benchmarking against novel therapeutic procedures. At follow-up, HRQOL appears related to current symptoms and conditions, but not to operative procedures. To better understand their impact on HRQOL, prospective studies comparing pre- and postoperative scores are needed.

  19. 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

  20. 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.

  1. 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

  2. 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

  3. Transthoracic endoscopy for upper thoracic chemical sympathectomy.

    PubMed

    Bardaxoglou, E; Reigner, B; Enon, B; Tolstuchow, N; Lescali, F; Peret, M; Chevalier, J M

    1992-07-01

    Beginning in April 1989, we have performed eight upper thoracic chemical sympathectomies by transthoracic endoscopy. The indications were occlusive arterial disease in four patients and Raynaud's syndrome and palmar hyperhidrosis in two patients each. Transthoracic endoscopy was performed under general anesthesia, through the third costal interspace on the anterior mid-clavicular line. Five ml of phenol were injected into the parietal pleura covering the three proximal thoracic ganglia. The duration of thoracic drainage was 24 hours. The postoperative course was uneventful except for one case of subcutaneous emphysema and transient Horner's syndrome in three instances. There were no initial failures. Because of its simplicity and the short hospitalization period, chemical sympathectomy by transthoracic endoscopy constitutes a valuable alternative to conventional surgery. This technique is, however, limited in the case of antecedent pleuropulmonary disorders. PMID:1390030

  4. Pleural abnormalities: thoracic ultrasound to the rescue!

    PubMed Central

    Pathmanathan, Sega; Lakshminarayana, Umesh B.; Avery, Gerard R.; Kastelik, Jack A.; Morjaria, Jaymin B.

    2013-01-01

    Diaphragmatic hernias that are diagnosed in adulthood may be traumatic or congenital in nature. Therefore, respiratory specialists need to be aware of the presentation of patients with these conditions. In this report, we describe a case series of patients with congenital and traumatic diaphragmatic hernias and highlight a varied range of their presentations. Abnormalities were noted in the thorax on the chest radiographs, but it was unclear as to the nature of the anomaly. The findings on thoracic ultrasound conducted by a pulmonologist helped to direct appropriate investigations avoiding unnecessary interventions. Instead of pleural effusions, consolidation or collapse, thoracic computed tomography demonstrated diaphragmatic hernias which were managed either conservatively or by surgery. There is increasing evidence that pulmonary specialists should be trained in thoracic ultrasonography to identify pleural pathology as well as safely conducting pleural-based interventions. PMID:23819018

  5. Clinical feasibility and efficacy of video-assisted thoracic surgery (VATS) anatomical resection in patients with central lung cancer: a comparison with thoracotomy

    PubMed Central

    Jung, Hee Suk; Choi, Se Hoon; Kim, Yong Hee; Kim, Dong Kwan; Park, Seung Il

    2015-01-01

    Background The aim of this study is to evaluate the clinical feasibility and efficacy of video-assisted thoracoscopic surgery (VATS) anatomical pulmonary resection in patients with central lung cancer. Methods Between July 2004 and December 2011, 465 patients underwent anatomical pulmonary resection and systematic mediastinal lymph node sampling or dissection for central lung cancer. Because patients were not randomized to receive VATS, clinical outcomes were compared using a propensity score matching design, giving 88 patients in each group. Results A lobectomy was attempted in 69 patients of the thoracotomy group and 64 of the VATS group, bilobectomy in 19 patients of the thoracotomy group and 21 of the VATS group, and segmentectomy in 3 patients of the VATS group. There were no differences in the anatomical distribution of pulmonary resections between the two groups. There was no operation related in-hospital mortality. There were 34 postoperative complications in 30 patients, without significant differences between the two groups. The median hospital stay and chest tube indwelling period of the VATS group were shorter than those of the thoracotomy group by 2 days and 1 day, respectively (P<0.05). During a median follow-up of 32.5 months (range, 0.5-95.8 months), there was no difference between the two groups in 3-year recurrence-free or overall survivals (OS). Conclusions VATS anatomical pulmonary resection is safe and feasible for central lung cancer, providing a low operative mortality and favorable outcomes in selected patients. Further case studies with long-term outcome data are necessary to verify our conclusions. PMID:26623100

  6. [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

  7. 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

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

    PubMed

    Ruiz-Moya, Alejandro; Segura-Sampedro, Juan J; Sicilia-Castro, Domingo; Carvajo-Prez, Francisco; Gmez-Ca, Toms; Vzquez-Medina, Antonio; Ibez-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 ofa 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

  9. [Metastatic thoracic lymph node carcinoma from extra-thoracic malignancy or from unknown primary site].

    PubMed

    Bagan, P; Mordant, P; Pricopi, C; Le Pimpec Barthes, F; Riquet, M

    2013-12-01

    Malignant mediastinal lymph nodes without pulmonary disease may be lymphomatous or the metastases from thoracic or extrathoracic malignancy. More rarely, metastatic lymph nodes are without primary site. Surgery is generally diagnostic, restricted to confirming the metastatic process, because of too numerous and disseminated or unresectable lymph nodes. Radical surgery consisting in lymphadenectomy can be effective in case of mediastinal lymph node malignancy without other extra- and intrathoracic disease. We observed in our experience and in several case reports long-term good results in such cases. We suggest that including surgery in the multimodality treatment of mediastinal metastatic lymph nodes may be advisable in selected patients. PMID:24210159

  10. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization : a report of the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, and the American Society of Nuclear Cardiology. Endorsed by the American Society of Echocardiography, the Heart Failure Society of America, 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; Brindis, Ralph G; Beckman, Karen J; Chambers, Charles E; Ferguson, T Bruce; Garcia, Mario J; Grover, Frederick L; Holmes, David R; Klein, Lloyd W; Limacher, Marian; Mack, Michael J; Malenka, David J; Park, Myung H; Ragosta, Michael; Ritchie, James L; Rose, Geoffrey A; Rosenberg, Alan B; Shemin, Richard J; Weintraub, William S; Wolk, Michael J; Allen, Joseph M; Douglas, Pamela S; Hendel, Robert C; Peterson, Eric D

    2009-02-15

    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 appropriateness review of common clinical scenarios in which coronary revascularization is frequently considered. The clinical scenarios were developed to mimic common situations encountered in everyday practice and included information on symptom status, extent of medical therapy, risk level as assessed by noninvasive testing, and coronary anatomy. Approximately 180 clinical scenarios were developed by a writing committee and scored by a separate technical panel on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization was considered appropriate and likely to improve health outcomes or survival. Scores of 1 to 3 indicate revascularization was considered inappropriate and unlikely to improve health outcomes or survival. The mid range (4 to 6) indicates a clinical scenario for which the likelihood that coronary revascularization would improve health outcomes or survival was considered uncertain. For the majority of the clinical scenarios, the panel only considered the appropriateness of revascularization irrespective of whether this was accomplished by percutaneous coronary intervention (PCI) or coronary artery bypass graft surgery (CABG). In a select subgroup of clinical scenarios in which revascularization is generally considered appropriate, the appropriateness of PCI and CABG individually as the primary mode of revascularization was considered. In general, the use of coronary revascularization for patients with acute coronary syndromes and combinations of significant symptoms and/or ischemia was viewed favorably. In contrast, revascularization of asymptomatic patients or patients with low-risk findings on noninvasive testing and minimal medical therapy were viewed less favorably. It is anticipated that these results will have an impact on physician decision making and patient education regarding expected benefits from revascularization and will help guide future research. PMID:19127535

  11. Thoracic Outlet Syndrome

    MedlinePLUS

    ... NINDS Funding Information Research Programs Training & Career Awards Enhancing Diversity Find People About NINDS NINDS Thoracic Outlet ... Funding | News From NINDS | Find People | Training | Research | Enhancing Diversity Careers@NINDS | FOIA | Accessibility Policy | Contact Us | ...

  12. Thoracic Outlet Syndrome

    MedlinePLUS

    Thoracic outlet syndrome (TOS) causes pain in the arm, shoulder, 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 ...

  13. Society of Thoracic Surgeons

    MedlinePLUS

    ... to Content Skip to Navigation Login For Cardiothoracic Surgeons What's New Education Annual Meeting Online Now Available ... Bavaria Elected President of The Society of Thoracic Surgeons Robert A. Guyton Honored for Leadership, Service to ...

  14. Thoracic Malignancy Steering Committee

    Cancer.gov

    The Thoracic Malignancy Steering Committee evaluates and prioritizes concepts for phase 3 and large phase 2 therapeutic clinical trials to be conducted in the NCI National Clinical Trials Network (NCTN).

  15. 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

  16. 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

  17. 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

  18. Spontaneous decrease in the size of a residual thoracic intradural lipoma.

    PubMed

    Akyuz, Mahmut; Goksu, Ethem; Tuncer, Recai

    2005-02-01

    Intradural spinal lipomas of thoracic cord are quite rare. It is known that lipomas are hamartomas, which change their size with alterations of body fat. An 18-year-old male patient, with a thoracic intradural lipoma showing spontaneous decrease in the size of a residual lipoma and tethering of the cord 4 years after surgery, is presented in this report. PMID:16156032

  19. Oblique Lumbar Interbody Fusion for Revision of Non-union Following Prior Posterior Surgery: A Case Report.

    PubMed

    Phan, Kevin; Mobbs, Ralph J

    2015-11-01

    We report the case of a 75-year-old lady who presented with a L2-3 non-union 18 months following a L2-3 and L3-4 posterior decompression and transforaminal lumbar interbody fusion. Halo of the L2 pedicle screws on imaging was consistent with a non-union at the L2-3 level. An anterior lumbar interbody fusion (ALIF) approach was originally considered. However, due to the high lumbar approach and patient habitus [body mass index (BMI) > 35], a decision was made to approach the L2-3 level using an oblique technique. This involved dissection anterior to the psoas muscle to access the L2-3 disc space. The psoas, kidney and retroperitoneum were retracted using a Synframe for the oblique trajectory. Removal of the prior trans-foraminal lumbar interbody fusion cage was performed via the oblique approach and insertion of a revised implant. The operation was completed successfully with no perioperative complications noted. Length of stay was 3 days, with the patient achieving rapid pain relief. In the present report, we report the first case using an oblique lumbar interbody fusion (OLIF) approach for revision of a prior posterior fusion non-union at the L2,3 level. The OLIF technique is feasible for revision of a non-union of upper lumbar levels, with satisfactory fusion achieved with acceptable feasibility. PMID:26791588

  20. 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

  1. 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

  2. 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

  3. 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

  4. Penetrating paediatric thoracic injury.

    PubMed

    Coley, E; Roach, P; Macmillan, A I; West, A T H; Johnston, A M

    2011-09-01

    Paediatric penetrating chest trauma is common in conflict, but rarely seen in peacetime. We describe the successful hospital management of a five year old female civilian casualty with life threatening penetrating thoracic trauma caused by a fragment from an explosive device. PMID:21977715

  5. Complications associated with thoracic pedicle screws in spinal deformity

    PubMed Central

    Li, Gang; Lv, Guohua; Passias, Peter; Kozanek, Michal; Metkar, Umesh S.; Liu, Zhongjun; Wood, Kirkham B.; Rehak, Lubos

    2010-01-01

    Thoracic pedicle screws have superior anchoring strength compared with other available fixation techniques. However, these are not universally accepted in many developing countries because of the concerns regarding safety and complications. In addition, there is evidence that pedicle morphology is unique in Chinese patients. The goal of this study was to analyze the complications seen at our institution, while using thoracic pedicle screws for the treatment of thoracic deformity, and to determine the safety of our techniques for the treatment of thoracic deformity in a Chinese population. From 1998 to 2005, there were 208 thoracic deformity patients treated at our institution, 70 of whom were male and 138 were female. Their age ranged from 11 to 55years (mean of 14.9years). All of them underwent corrective deformity surgery using posterior pedicle screw systems and follow-up was available for at least 3years. Etiologic diagnoses included adolescent idiopathic scoliosis in 119 patients, congenital kyphoscoliosis in 38, adult scoliosis in 37 and undetermined in 14. Screw positions were evaluated using intraoperative and postoperative radiographs and a CT scan was performed when a concern for screw malposition was present. All radiographic evaluations were carried out in a double-blinded fashion. A total of 1,123 thoracic pedicle screws were inserted (5.4 thoracic screws/patient). The deformity correction rate was 81, 65 and 62% for idiopathic, congenital and adult scoliosis patients, respectively. The overall complication rate was 16.5% at the final follow-up. Complication rates directly and indirectly related to pedicle screws were 7.2 and 9.3%, respectively. There were no significant screw-related neurologic or visceral complications that adversely affected long-term results. The complications seen with thoracic pedicle screws in a Chinese population were similar to other populations and could be utilized safely for the treatment of thoracic deformity in this population. PMID:20237943

  6. [Treatment of thoracic malignancy accompanied with cardiovascular disease].

    PubMed

    Sasai, T; Sakakibara, S; Harada, A; Sasaki, K; Kato, Y; Matsuyama, K; Matsushima, S; Gomibuchi, M; Tanaka, S; Shouji, T

    1993-10-01

    We treated 10 cases of thoracic malignancy accompanied with cardiovascular disease. Among thoracic malignancy, 7 cases were lung cancer and 3 were esophageal cancer. Accompanied cardiovascular diseases were ischemic heart disease (2 cases), valvular disease (3 cases), WPW syndrome (1 case), aortic aneurysm (4 cases). The mean age was 66, ranged from 51 to 79. The simultaneous occurrence of the two lesions were observed in 6 cases and thoracic malignancy was diagnosed after a varying interval of time following surgery of cardiovascular disease in 4 cases. In cases of thoracic malignancy accompanied with heart disease, the treatment of heart disease should precede the operation of malignant disease to reduce the risk of surgery. For the patient with esophageal cancer, posterior mediastinal esophagostomy should be applied who may have heart surgery in future. In cases of coexisting malignancy and aortic aneurysm, the priority of treatment should be determined considering the size of aneurysm. If the transverse diameter of aneurysm is larger than 7 cm, there is a high risk of rupture, so surgery for the aneurysm precedes operation of malignant diseases. It is desirable to avoid concomitant operation of malignancy and cardiovascular disease. PMID:8230901

  7. Thoracic outlet syndrome

    MedlinePLUS

    ... remove the extra rib and break up tight fiber bands may ease symptoms in some patients. Surgery can be successful in more than half of patients. A few patients have symptoms that return after surgery.

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  13. 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 1.051.23, P?=?0.001), while there was no statistical difference in overall success of clinical outcomes (RR: 1.04; 95% CI 0.951.13, P?=?0.38) and complications (RR: 0.96; 95% CI 0.851.09, p?=?0.54). A significant reduction of the reoperation rate was found in BMPs group (RR: 0.57; 95% CI 0.420.77, 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 doesnt 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

  14. Mediastinal thoracic duct cyst.

    PubMed Central

    Gowar, F J

    1978-01-01

    A case of mediastinal thoracic duct cyst is described; it is believed to be the first to be reported in Britain. Five surgically treated cases have been reported but in none was the diagnosis made before operation. Symptoms are caused by pressure of the cyst on the trachea and oesophagus and my be aggravted by eating a fatty meal. Differential diagnosis from other mediastinal tumours, especially bronchogenic cyst and neurofibroma, could perhaps be established before operation by lymphangiography. Images PMID:746509

  15. After Heart Surgery, House Calls by Physician Assistants Help

    MedlinePLUS

    ... at the annual meeting of the Society of Thoracic Surgeons in Phoenix. "Adult cardiac surgery has one of the highest readmission rates for ... a peer-reviewed medical journal. SOURCE: Society of Thoracic Surgeons, news release, Jan. 26, ... Surgery Recent Health News Related MedlinePlus Health ...

  16. 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.

  17. 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

  18. Reasons to participate in European Society of Thoracic Surgeons database

    PubMed Central

    2015-01-01

    The process of data collection inevitably involves costs at various levels. Nevertheless, this effort is essential to base our knowledge and the consequent decision making on solid foundations. The European Society of Thoracic Surgeons (ESTS) database collects a large amount of data on general thoracic surgery derived from about 60 units representative of 11 nations. Since its beginning in 2001, the ESTS database has contributed to increase the knowledge and the quality of care in our specialty. The present paper illustrates the ultimate finalities and the obtained results of this data collection, providing a broad overview of the motivations to participate to the ESTS database. PMID:25984355

  19. 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

  20. Commentary on the effect of steroid use in anterior cervical discectomy and fusion surgery; a randomized controlled trial by Shiveindra B. et al. Journal of Neurosurgery Spine 2015;23:137-43

    PubMed Central

    Epstein, Nancy E.

    2015-01-01

    Background: Steroids are often used in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery to limit postoperative dysphagia. However, a major concern remains steroids impact is on fusion. Methods: In this prospective, randomized, double-blinded controlled study, the authors assessed the impact of steroids on swallowing/airway and fusion rates in 112 patients undergoing multilevel ACDF. The patients were randomly assigned to saline or dexamethasone groups prior to surgery; multiple other variables including different outcome analyses were also utilized over a 2-year postoperative period. The patients were followed for 1, 3, 6, 12, and 24 months postoperatively, and computed tomography (CT) studies were performed at 6, 12, and 24 postoperative months to establish fusion. Results: The authors found no significant 2-year differences in the clinical parameters or surgical outcomes for patients undergoing ACDF with or without steroids. Steroids reduced dysphagia in the 1st postoperative month, produced a trend for reducing postoperative airway complications (e.g., intubation), and length of stay. Notably, CT-fusion rates with steroids were reduced at the 6th postoperative month but equalized by the 1st postoperative year. Conclusions: The authors concluded that dexamethasone administered at the time of ACDF surgery improved swallowing within the 1st postoperative month, reduced perioperative airway complications, reduced the length of stay, and reduced 6 month but not 12 month fusion rates. Although the findings regarding postoperative dysphagia are helpful, the performance of multiple 3D-CT scans postoperatively to document fusion would appear to subject these patients to excessive radiation exposure without sufficient clinical indications. PMID:26605114

  1. [Endovascular interventions of the descending thoracic aorta].

    PubMed

    Doss, Mirko; Wood, Jeffrey P; Balzer, Joern; Thalhammer, Alex; Martens, Sven; Wimmer-Greinecker, Gerhard; Vogl, Thomas; Moritz, Anton

    2006-08-01

    Endovascular interventions of the descending thoracic aorta have been established as an alternative to conventional open surgery. Initially, they were limited to elective patients with a high risk profile for open surgery, but soon their use was extended to emergencies as well. In the elective setting, endovascular interventions significantly lowered short-term morbidity and mortality. These excellent perioperative results were reproducible in the emergency setting, thereby leading to superior outcomes for patients treated by endovascular stent grafts when compared to the conventional open surgical approach. However, some questions regarding long-term durability of these devices remain unanswered. Stent-graft failures at mid and long-term follow-up have been reported in the literature. The progressive nature of stent graft-related mid- and long-term complications stresses the need for continued surveillance of these patients. PMID:16944062

  2. 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

  3. 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

  4. Thoracic spine x-ray

    MedlinePLUS

    Vertebral radiography; X-ray - spine; Thoracic x-ray; Spine x-ray; Thoracic spine films; Back films ... The test is done in a hospital radiology department or in the health care provider's office. You will lie on the x-ray table in different positions. If the x-ray ...

  5. 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

  6. 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

  7. 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

  8. [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

  9. 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

  10. 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

  11. 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.

  12. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis.

    PubMed

    Campbell, Robert M; Smith, Melvin D; Mayes, Thomas C; Mangos, John A; Willey-Courand, Donna B; Kose, Nusret; Pinero, Ricardo F; Alder, Marden E; Duong, Hoa L; Surber, Jennifer L

    2003-03-01

    1. Thoracic insufficiency syndrome is the inability of the thorax to support normal respiration or lung growth. 2. The rare condition of fused ribs and congenital scoliosis may result in a three-dimensional thoracic deformity with adverse effects on thoracic growth and function with development of thoracic insufficiency syndrome. 3. The normal thorax is defined by two characteristics: normal, stable volume and the ability to change that volume. Volume depends on the width and depth of the rib cage, and the thoracic spine provides height. The ability to change volume, termed thoracic function, is provided by the diaphragm and the secondary muscles of respiration. 4. On radiographs, the loss of the vertical height of the lung of the concave, restricted hemithorax is defined by the percentage of space available for the lung. 5. Spine rotation causes a windswept thorax, with both restriction of the volume of the convex hemithorax and restriction of the motion of the involved ribs. 6. Constrictive three-dimensional deformity of the thorax may cause extrinsic, restrictive lung disease. 7. Progressive thoracic insufficiency syndrome is diagnosed on the basis of clinical signs of respiratory insufficiency, loss of chest wall mobility as demonstrated by the thumb excursion test, worsening indices of three-dimensional thoracic deformity on radiographs and computed tomography scans, or a relative decline in percent predicted vital capacity due to thoracic "failure to thrive," as demonstrated by pulmonary function tests. 8. Treatment of progressive thoracic insufficiency syndrome should provide an acute increase in the thoracic volume with stabilization of any flail chest-wall defects and maintain these improvements as the patient grows, without the need for spine fusion. PMID:12637423

  13. [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

  14. 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

  15. 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

  16. Anaesthesia for robotic gynaecological surgery.

    PubMed

    Gupta, K; Mehta, Y; Sarin Jolly, A; Khanna, S

    2012-07-01

    Robotic surgery is gaining widespread popularity due to advantages such as reduced blood loss, reduced postoperative pain, shorter hospital stay and better visualisation of fine structures. Robots are being used in urological, cardiac, thoracic, orthopaedic, gynaecological and general surgery. Robotic surgery received US Food and Drug Administration approval for use in gynaecological surgery in 2005. The various gynaecological robotic operations being performed are myomectomy, total and supracervical hysterectomy, ovarian cystectomy, sacral colpopexy, tubal reanastomosis, lymph node dissection, surgery of retroperitoneal ectopic pregnancy, Moskowitz procedure and endometriosis surgery. The anaesthetic considerations include difficult access to the patient intraoperatively, steep Trendelenburg position, long surgical duration and the impact of pneumoperitoneum. We highlight the complications encountered in these surgeries and methods to prevent these complications. Robotic gynaecological surgery can be safely performed after considering the physiological effects of the steep Trendelenburg position and of pneumoperitoneum. The benefits of the surgical procedure should be weighed against the risks in patients with underlying cardiorespiratory problems. PMID:22813488

  17. Picture preferences of thoracic surgeons.

    PubMed

    Hirsh, K; McConathy, D A

    1986-01-01

    A mail survey instrument assessed whether thoracic surgeons prefer schematic, semi-schematic or realistic surgical illustrations for educational purposes in print media. Respondents, active members of the American Association of Thoracic Surgeons (N = 292), ranked preferences for the illustration treatments and supplied demographic information. Data analysis revealed significant differences between preferences for illustration treatments. The schematic treatment was the least preferable treatment. Realistic and semi-schematic illustrations were preferred about equally. PMID:2423514

  18. Methods for the postoperative management of the thoracic oncology patients: lessons from the clinic.

    PubMed

    Leuzzi, Giovanni; Facciolo, Francesco; Pastorino, Ugo; Rocco, Gaetano

    2015-12-01

    Oncological thoracic surgery comprises challenging procedures not only from a surgical point of view but also regarding the postoperative management. The most significant procedures performed for malignancy are those requiring resection of the lung, the pleura, the esophagus, mediastinal structures, the chest wall and airways. Especially after major procedures, postoperative complications occur frequently and usually require a multidisciplinary approach involving thoracic surgeons, anesthesiologists, pulmonologist, physiotherapists and oncologists. Thus, a proper postoperative management is as important as the surgical procedure to achieve the best outcome following surgery. In this article, we provide an overview of the basic principles for management of postoperative imaging and drain system and review the main postoperative complications following thoracic surgery, focusing also on new strategies to prevent them. PMID:26536136

  19. [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

  20. Central nervous system protection in cardiac surgery.

    PubMed

    Reich, David L

    2010-03-01

    Neurological dysfunction and stroke following cardiac surgery and thoracic surgery requiring hypothermic circulatory arrest is a well-defined problem. The original studies in CABG patients identified risk factors, such as prior stroke and lower educational level. There is older evidence suggesting that higher perfusion pressures during cardiopulmonary bypass are helpful. Hyperthermia during rewarming on cardiopulmonary bypass and postoperative hyperthermia have been associated with adverse cognitive outcomes. Glucose management intraoperatively remains controversial, but most now advocate for moderate glucose control using insulin, if required. The subset of patients having thoracic aortic surgery requiring periods of aortic discontinuity are particularly problematic. A cerebral protection strategy should be determined, and this may include hypothermic circulatory arrest, selective cerebral perfusion, or retrograde cerebral perfusion. All of these techniques have been associated with good surgical outcomes, but there is little information on cognitive outcomes of thoracic aortic surgery. PMID:20472620

  1. 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

  2. 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

  3. 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

  4. [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

  5. 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. ...

  6. 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.

  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. What Is a Thoracic Surgeon?

    MedlinePLUS

    ... to provide the highest quality patient care through education, research, and advocacy. Printer-friendly version ... Cardiac Surgery What is Pediatric Heart Disease? What is Risk Adjustment? Valve Repair/Replacement Surgery ...

  9. Early Results from Posterior Cervical Fusion with a Screw-Rod System

    PubMed Central

    Kim, Sang Hyun; Shin, Dong Ah; Yi, Seung; Yoon, Do Heum; Kim, Keung Nyun

    2007-01-01

    Purpose We performed 65 cases of posterior fusion surgery for cervical and/or high thoracic lesions using a polyaxial screw-rod system. Patients and Methods A total of 486 screws were implanted in 65 patients. Results Fixation of the screws was carried out over an average of 2.9 spinal segments. Upon evaluation by postoperative CT scans, twelve (2.5%) screws had suboptimal trajectories but two of these revealed radiculopathy in one patient and required screw repositioning. No vascular sequelae resulted. There has been no segmental motion in any of the cases to date. As for other complications, there was one case of dural tearing and two cases of lateral mass fractures. There were no infections or other wound healing problems or hardware failures. No patients had neurological deterioration after surgery. There were statistically significant improvements in the mean Neck Disability Index (NDI) scores and Visual Analogue Scale (VAS) scores in the preoperative and late postoperative follow-up evaluations. Although further studies are required to establish the long-term results of fusion rates and clinical outcomes. Conclusion We cautiously suggest that the posterior polyaxial screw-rod system can be safely used as a primary or additional fusion method in this risky region. The successful and safe use of this method is dependent on a precise preoperative surgical plan and tactics for ensuring safe screw fixation. PMID:17594152

  10. Spontaneous healing of retroperitoneal chylous leakage following anterior lumbar spinal surgery: a case report and literature review.

    PubMed

    Su, I-Chang; Chen, Chang-Mu

    2007-12-01

    Cisterna chyli is prone to injury in any retroperitoneal surgery. However, retroperitoneal chylous leakage is a rare complication after anterior spinal surgery. To the best of our knowledge, only ten cases have been reported in the English literature. We present a case of a 49-year-old man who had lumbar metastasis and associated radiculopathy. He had transient retroperitoneal chylous leakage after anterior tumor decompression, interbody bony fusion, and instrumental fixation from L2 to L4. The leakage stopped spontaneously after we temporarily clamped the drain tube. Intraperitoneal ascites accumulation developed thereafter due to nutritional loss and impaired hepatic reserves. We gathered ten reported cases of chylous leak after anterior thoracolumbar or lumbar spinal surgery, and categorized all these cases into two groups, depending on the integrity of diaphragm. Six patients received anterior spinal surgery without diaphragm splitting. Postoperative chylous leak stopped after conservative treatment. Another five cases received diaphragm splitting in the interim of anterior spinal surgery. Chylous leakage stopped spontaneously in four patients. The remaining one had a chylothorax secondary to postop chyloretroperitoneum. It was resolved only after surgical intervention. In view of these cases, all the chylous leakage could be spontaneously closed without complications, except for one who had a secondary chylothorax and required thoracic duct ligation and chemopleurodesis. We conclude that intraoperative diaphragm splitting or incision does not increase the risk of secondary chylothorax if it was closed tightly at the end of the surgery and the chest tube drainage properly done. PMID:17273839

  11. Innominate artery cannulation during aortic surgery.

    PubMed

    Berretta, Paolo; Alfonsi, Jacopo; Di Bartolomeo, Roberto; Di Eusanio, Marco

    2015-01-01

    During aortic surgery, the cannulation of arteries preserving an antegrade flow in the thoracic aorta [ascending aorta, axillary artery, innominate artery (IA) and carotid artery] has been associated with superior survival and neurological outcomes compared with the cannulation of the femoral artery. However, the ideal site of cannulation for both cardiopulmonary bypass (CPB) and antegrade selective cerebral perfusion remains under debate. Here, we present our technique of IA cannulation for CPB and antegrade selective cerebral perfusion during surgery of the thoracic aorta. PMID:26658194

  12. 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

  13. 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

  14. Acute Traumatic Thoracic Aortic Injury: Considerations and Reflections on the Endovascular Aneurysm Repair

    PubMed Central

    Di Marco, Luca; Pacini, Davide; Di Bartolomeo, Roberto

    2013-01-01

    Traumatic rupture of the thoracic aorta is a life-threatening lesion and it occurs in 10 to 30% of fatalities from blunt thoracic trauma and is the second most common cause of death after head injury. Immediate surgery is often characterized by a high mortality and morbidity rate. Delayed repair of traumatic aortic injuries has significant survival benefits and a much lower mortality rate compared with early open repair. Despite developments in operative techniques, there still remains considerable operative mortality and morbidity associated with a surgical approach even if delayed. Endovascular stent grafts for the thoracic aorta represents an alternative to the conventional approach for traumatic aortic rupture. Because of the lower invasivity avoiding thoracotomy and use of heparin, endovascular repair can be applied in acute patients without the risk of destabilizing pulmonary, head or abdominal traumatic lesions. However, despite the good deal of convincing evidence for endovascular treatment for thoracic aortic diseases and for traumatic aortic injuries as a valid and efficacious alternative to surgery, several reports show a variety of late complications of thoracic endografts especially for first-generation stent-grafts. In light of this, is the endovascular treatment really safe, efficacious and free from complications in the long term? This manuscript aims to offer a moment of reflection on this important chapter of aortic pathology.

  15. 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

  16. Cosmetic Surgery

    MedlinePLUS

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

  17. 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.

  18. 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

  19. 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.

  20. 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

  1. Aberrent Thoracic Duct Cyst in Postrior Mediastinum

    PubMed Central

    Park, Soo Jin; Park, Seonng Yong; Choi, Ho

    2015-01-01

    Thoracic duct cysts in the upper portion of the diaphragm are mostly found in the neck and are rarely found in the mediastinum. Thoracic duct cysts should be differentiated from other mediastinal tumors or cysts, and surgical treatment is required to avoid the development of chylothorax if the cyst ruptures. Herein, we report the case of a patient with a thoracic cyst located just above the diaphragm that was treated with surgical resection. PMID:26078934

  2. [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

  3. International participation in the Society of Thoracic Surgeons National Database.

    PubMed

    Shapira, Oz M; Badhwar, Vinay; Shahian, David; Jacobs, Jeffrey P; Izhar, Uzi; Bao, Yusheng; Korach, Amit; Lattouf, Omar M; Grover, Fredrick L; Puskas, John D

    2014-04-01

    In 2011 The Society of Thoracic Surgeons (STS) Workforce on National Databases established the International Database Task Force devoted to expanding participation in the STS National Database internationally. The vision for this initiative was to assist in the globalization of outcomes data and share knowledge, facilitating a worldwide quality collaborative in cardiac surgery. The Department of Cardiothoracic Surgery at Hadassah Medical Center, Jerusalem, Israel, was among the first of several international sites to join the collaborative. This report outlines the rationale behind clinical databases outside of North America submitting data to the STS National Database and reviews the unique challenges and practical steps of integration through experiences by Hadassah Medical Center. Our hope is that this procedural learning will serve as a template to assist future international program integration. PMID:24694401

  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. Quality of life after intervention on the thoracic aorta.

    PubMed

    Jarral, Omar A; Kidher, Emaddin; Patel, Vanash M; Nguyen, Bao; Pepper, John; Athanasiou, Thanos

    2016-02-01

    Surgery on the thoracic aorta is challenging and historically associated with significant mortality and morbidity. In recent times, there has been increased emphasis on the importance of health-related quality of life (HRQOL) measures. It is seen as a development beyond isolated markers of outcome such as operative mortality and is particularly applicable to aortic surgery given the number of asymptomatic patients operated on (for prognostic grounds), and rapidly advancing endovascular technologies which require proper assessment. This systematic review provides an outline of all available literature detailing HRQOL in patients receiving intervention (both open and endovascular) on the thoracic aorta. In total, 30 studies were identified encompassing 4746 patients undergoing a variety of procedures from aortic root replacement to thoracoabdominal aortic aneurysm repair. While there were deficiencies in the underlying literature such as lack of baseline HRQOL assessment, the majority of the studies confirm that HRQOL after major aortic surgery (including on the elderly and in emergency situations) is acceptable and compares well to matched general populations. Strategies for improving the HRQOL in aortic surgery are summarized and include the need for surgeons to plan cerebral protection methods more carefully and to develop operative strategies to avoid reoperation or reintervention, as this is associated with deterioration of long-term HRQOL. Randomized studies measuring baseline and follow-up HRQOL at specific set points are needed. Innovative research methods could be employed in future studies with the aim of correlating HRQOL with imaging or physiological/inflammation biomarkers, or other end points such as aortic stiffness or wall shear stress to characterize disease progression and prognosis. PMID:25855594

  6. 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

  7. Contamination of underwater seal drainage systems in thoracic surgery.

    PubMed

    Hornick, P; John, L C; Wallis, J; Wilkins, V; Rees, G M; Edmondson, S J

    1992-01-01

    The incidence of bacteriological contamination of drainage fluid (water constituting the underwater seal plus drainage effluent) was studied in 38 patients (50 chest drains), up to 6 days after thoracotomy. No bacteriological contamination was demonstrated in any of the samples taken during this period of time. We conclude that the underwater seal drainage system may be left for up to 6 days postoperatively without change of any of its components and without risk of contamination. PMID:1736790

  8. 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; Sjqvist, 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

  9. 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

  10. [Thoracic surgery for patients with deep vein thrombosis].

    PubMed

    Sekine, Y; Koh, E

    2012-07-01

    Deep vein thrombosis (DVT) is a main cause of pulmonary thromboembolism (PTE), and therefore both diseases are categorized as a serial pathophysiology of venous thromboembolism (VTE). Treatment goals for DVT include stopping clot propagation and preventing the recurrence of thrombus, the occurrence of PTE, and the development of pulmonary hypertension, which can be a complication of multiple recurrent pulmonary emboli. Clinical guidelines stratify the risk of VTE to 4 levels and recommend the treatment options. In high or extremely high risk patients for VTE, the use of low-dose heparin is recommended. The prevention against VTE, such as elastic compression stockings and intermittent sequential pneumatic leg compression( ISPC), is the most important prophylactic treatment against perioperative PTE by reducing thrombotic risk in low or moderate high risk patients for VET. Since there is no clear evidence that screening all or even selected patients for thrombophilias improves long-term outcomes, the physician's clinical judgment, and consultation with appropriate subspecialists should guide management perioperatively. Once PTE is suspected, immediate and accurate diagnosis and appropriate treatment are mandatory. PMID:22868431

  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. Subarachnoidal pleural fistula after resection of intradural thoracic disc herniation and multimodal treatment with noninvasive positive pressure ventilation (NPPV).

    PubMed

    Schlag, Holger R; Muquit, Samiul; Hristov, Tanyo B; Morassi, Guiseppe; Boszczyk, Bronek Maximilian; Shafafy, Masood

    2016-01-01

    Subarachnoid pleural fistula (SPF) is a type of cerebrospinal fluid (CSF) fistula that can arise as a complication following transthoracic resection of intervertebral disc herniation in the thoracic spine. It is an abnormal communication between the subarachnoid and pleural space. Negative intrapleural pressure promotes CSF leak due to a suction effect into the pleural cavity, with little chance of spontaneous closure. Due to the risk of severe complications with CSF leak into the thoracic cavity, early diagnosis and treatment are mandatory. However, management can be challenging. We report a case of a 72-year-old woman who underwent anterior thoracic surgery to treat thoracic myelopathy caused by an ossified intradural disc herniation. The postoperative period was complicated by a subarachnoidal pleural fistula. We describe our successful treatment of this using noninvasive positive pressure ventilation and lumbar CSF drainage and review other methods reported in the literature. PMID:26215176

  13. Percutaneous laser disc decompression for thoracic disc disease: report of 10 cases

    PubMed Central

    Haufe, Scott M.W.; Mork, Anthony R.; Pyne, Morgan; Baker, Ryan A.

    2010-01-01

    Background: Discogenic pain or herniation causing neural impingement of the thoracic vertebrae is less common than that in the cervical or lumbar regions. Treatment of thoracic discogenic pain usually involves conservative measures. If this fails, conventional fusion or discectomy can be considered, but these procedures carry significant risk. Objectives: To assess the efficacy and safety of percutaneous laser disc decompression (PLDD) for the treatment of thoracic disc disease. Methods: Ten patients with thoracic discogenic pain who were unresponsive to conservative intervention underwent the PLDD procedure. Thoracic pain was assessed using the Visual Analog Scale (VAS) scores preoperatively and at 6-month intervals with a minimum of 18-months follow-up. Patients were diagnosed and chosen for enrollment based on abnormal MRI findings and positive provocative discograms. Patients with gross herniations were not included. Results: Length of follow-up ranged from 18 to 31 months (mean: 24.2 mo). Median pretreatment thoracic VAS score was 8.5 (range: 5-10) and median VAS score at final follow-up was 3.8 (range: 0-9). Postoperative improvement was significant with a 99% confidence interval. Of interest, patients generally fell into two groups, those with significant pain reduction and those with little to no improvement. Although complications such as pneumothorax, discitis, or nerve damage were possible, no adverse events occurred during the procedures. Limitations: The study is limited by its small size and lack of a sham group. Larger controlled studies are warranted. Conclusions: With further clinical evidence, PLDD could be considered a viable option with a low risk of complication for the treatment of thoracic discogenic pain that does not resolve with conservative treatment. PMID:20567616

  14. 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

  15. 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

  16. Exposure latitude for thoracic radiography

    NASA Astrophysics Data System (ADS)

    Van Metter, Richard L.; Lemmers, Henri E. A. S. J.; Schultze Kool, Leo J.

    1992-06-01

    The chest PA examination is one of the single most performed studies in radiology today. It can provide a wealth of information in a single examination. As in many other areas of radiology there is a conflict between high contrast, which enables subtle structures to be visualized, and wide latitude, which allows all areas of interest in the chest to be displayed in a single image. In order to optimize the design of receptor systems it is useful to establish and understand the latitude required for thoracic imaging. We have measured the distributions of x-ray transmittance within the lungs, heart, and abdomen for a population of 868 out-patients. The measurements were made with a resolution element approximately 2 X 2 cm, at a single x-ray beam quality, and with a low-scatter slot-beam geometry. Under these conditions, the required receptor latitude for capturing each area of interest in the thorax is derived as a function of body habitus. To capture all three regions the required receptor latitude for the PA examination varies from 11:1 to 81:1 with increasing patient size. The implications of these results for thoracic image-receptor design is discussed.

  17. 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

  18. 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

  19. 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

  20. 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.

  1. Dystrophic thoracic spine dislocation associated with type-1 neurofibromatosis: Case report and rationale for treatment

    PubMed Central

    Meneses-Quintero, David; Alvarado-Gmez, Fernando; Alcal-Cerra, Gabriel

    2015-01-01

    The authors report a rare case of spontaneous dystrophic thoracic spine dislocation in a 14-year-old boy with neurofibromatosis type 1 (NF-1). Anteroposterior and lateral standing radiographs showed a dysplastic kyphoscoliotic deformity, with the thoracic kyphosis and scoliosis measuring 75 and 69, respectively. Three-dimensional reconstruction after computed tomography demonstrated spondyloptosis at T5-T6 with overlapping of T5 over T6 and T7. The patient underwent circumferential fusion with anterior fibular strut grafting mechanically secured between the inferior and superior endplates of T5 and T7 followed by an instrumented posterior fusion from T2 to L1 and thoracoplasty. There was satisfactory resolution of the deformity with stabilization at the last follow-up evaluation. PMID:25972714

  2. Dystrophic thoracic spine dislocation associated with type-1 neurofibromatosis: Case report and rationale for treatment.

    PubMed

    Meneses-Quintero, David; Alvarado-Gmez, Fernando; Alcal-Cerra, Gabriel

    2015-01-01

    The authors report a rare case of spontaneous dystrophic thoracic spine dislocation in a 14-year-old boy with neurofibromatosis type 1 (NF-1). Anteroposterior and lateral standing radiographs showed a dysplastic kyphoscoliotic deformity, with the thoracic kyphosis and scoliosis measuring 75 and 69, respectively. Three-dimensional reconstruction after computed tomography demonstrated spondyloptosis at T5-T6 with overlapping of T5 over T6 and T7. The patient underwent circumferential fusion with anterior fibular strut grafting mechanically secured between the inferior and superior endplates of T5 and T7 followed by an instrumented posterior fusion from T2 to L1 and thoracoplasty. There was satisfactory resolution of the deformity with stabilization at the last follow-up evaluation. PMID:25972714

  3. 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

  4. 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

  5. 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

  6. 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.

  7. Thoracic Extraosseous Epidural Cavernous Hemangioma

    PubMed Central

    Asil, Kiyasettin; Ceylan, Davut; Erdem, Sahin

    2015-01-01

    Cavernous hemangiomas were first reported in 1929 by Globus and Doshay, and are defined as benign vascular structures developed between the neural tissues occurring in the central nervous system, consisting of a dilated vascular bed. Cavernous hemangiomas comprise nearly 5-12% of all spinal vascular malformations; however, existence in the epidural space without bone involvement is rare. Only 4% of all cavernous hemangiomas (0.22/1.000.000) are purely epidural cavernous hemangiomas. In this case report, we removed a hemorrhagic thoracic mass presenting with progressive neurological deficits in a 55-year-old male patient. We found this case to be appropriate for presentation due to the rare occurrence of this type of cavernous hemangioma. PMID:25674348

  8. Management of thoracic outlet syndrome.

    PubMed Central

    Dale, W A; Lewis, M R

    1975-01-01

    This overall management program for thoracic outlet compression syndrome is based upon experience with 153 extremities in 149 patients and the results of others. The following conclusions are documented and discussed. 1) Diagnosis is based chiefly upon history; physical signs are inconstant and often absent. 2) Major vascular problems are unusual; angiography is not always necessary. 3) Electromyography is not always critical but does aid in diagnosis of carpal tunnel syndrome. 4) Non-operative treatment relieves most patients; operative decompression is indicated for a minority. 5) Transxillary first rib resection, with removal of cervical rib is the best operation. 6) Carpal tunnel decompression should be done concomitantly when needed. 7) Operation is relatively safe. Images Fig. 2. Fig. 3A. Fig. 3B. Fig. 4. Fig. 6. Fig. 7. Fig. 8. Fig. 9. Fig. 10. PMID:1130876

  9. The thoracic surgical industrial complex.

    PubMed

    Starr, A

    1986-08-01

    The thoracic surgical industrial complex is an industry worth $2 billion per year and is shaped by six dominant forces, three positive and three negative. The three positive forces are technological innovation, entrepreneurial activity, and the flow of capital and the three opposing forces, government regulation, cost-containment, and the excessive costs of product liability insurance. We are now at a critical time in the evolution of this industry, with growth being enhanced in areas of lesser risk, namely, nonimplantable devices, at the expense of high-risk implantable devices. The future of the artificial heart hinges on the balance between the six forces, and this analysis examines the possibilities for timely development of this ultimate implantable device. PMID:3527091

  10. [Thoracic nocardiosis - a clinical report].

    PubMed

    Vale, Artur; Guerra, Miguel; Martins, Daniel; Lameiras, Angelina; Miranda, Jos; Vouga, Lus

    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. A comprehensive study of physical parameters, biomechanical properties, and statistical correlations of iliac crest bone wedges used in spinal fusion surgery. I. Physical parameters and their correlations.

    PubMed

    Wolfinbarger, L; Zhang, Y; Adam, B L; Sutherland, V; Homsi, D; Brame, B

    1994-02-01

    Iliac crest bone wedges are commonly used in spinal fusion procedures and must be capable of withstanding considerable mechanical stress during the healing process. The variability of "quality" of bone materials used in the production of bone wedges suggests that some bone materials may not be suitable for use in vertebral fusion procedures and some quantifiable means of predicting the suitability of bone wedges would be desirable. A total of 250 iliac crest wedges were used in this study. Physical parameters of iliac crest wedges, such as total cross-sectional area, cancellous cross-sectional area, cortical cross-sectional area, percentage of cortical cross-sectional area, "width," and apparent density were determined. The statistical correlations among physical parameters were investigated. These correlations revealed that the relative percentage of cortical and cancellous bone remained fairly constant at 41% and 59%, respectively, regardless of total cross-sectional area of a wedge, that apparent density did not appreciably change with donor age, and that ash (inorganic) and organic content (weight) correlated well with the apparent density. PMID:8171358

  12. 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.

  13. 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.

  14. 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

  15. 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

  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. Genetics Home Reference: Asphyxiating thoracic dystrophy

    MedlinePLUS

    ... with asphyxiating thoracic dystrophy may live only into infancy or early childhood. However, in people who survive ... individuals may live into adolescence or adulthood. After infancy, people with this condition may develop life-threatening ...

  18. 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

  19. Patient specific stress and rupture analysis of ascending thoracic aneurysms.

    PubMed

    Trabelsi, Olfa; Davis, Frances M; Rodriguez-Matas, Jose F; Duprey, Ambroise; Avril, Stphane

    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 (?=-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

  20. [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

  1. [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

  2. 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

  3. 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

  4. 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

  5. Pregnancy after thoracic organ transplantation.

    PubMed

    Wu, Danny W; Wilt, Jessie; Restaino, Susan

    2007-12-01

    A growing number of heart, heart-lung, or lung transplant recipients are women of reproductive age. Fertility and pregnancy are important issues in this group of patients and often pose complex medical, psychosocial, and ethical problems. Many successful pregnancy outcomes have been reported following heart or lung transplantation. Nevertheless, these patients are at risk of certain maternal, fetal, and neonatal complications, including hypertension, preeclampsia, infection, preterm birth, and low birth weight. The physiological changes that occur in pregnancy are generally well tolerated by patients who have undergone thoracic organ transplant(s). The risk of allograft rejection during and after pregnancy is significant, and it is important to maintain an adequate level of immunosuppression. Pregnancies among lung transplant recipients are at higher risk for certain complications. The rate for graft rejection, independent of pregnancy status, is higher in this population. The long-term graft and patient outcomes citing a 50% 5-year mortality will be critical while counseling these patients regarding the impact of pregnancy on survival, and the ability to participate in raising the child. A multi-disciplinary team, involving specialists in maternal fetal medicine, cardiology or pulmonary medicine, transplant medicine, anesthesiology, high-risk nursing, neonatology, psychology, genetics, and social service, is crucial to the care of these patients. This team approach should be initiated at the time of pretransplant and preconception counseling and be continued through the prenatal and postpartum periods. The management plan should be individualized according to the status of the mother, the fetus, and the allograft. For most cases, given the need for close collaboration and frequent monitoring, these patients are best managed at their primary transplant institution in collaboration with local or referring physicians. PMID:18063119

  6. [Endovascular repair for ruptured thoracic aortic aneurysm and traumatic aortic injury].

    PubMed

    Nakai, Mikizo; Okuyama, Michihiro; Shimizu, Shuji; Kato, Gentaro; Ochi, Yoshiki; Okada, Masahiro

    2011-01-01

    In contrast to high mortality of open surgery for thoracic aortic catastrophes including ruptured thoracic aortic aneurysm (RTAA) and traumatic aortic injury (TAI), excellent short-term outcomes of thoracic endovascular aortic repair (TEVAR) have recently been reported. We report our single-center experiences with TEVAR for aortic catastrophes. Thirteen patients with thoracic aortic catastrophes (RTAA in 7 patients, TAI in 6 patients) have received TEVAR from February 2004 to June 2010. In cases of RTAA, 5 descending aortic aneurysm ruptures and 2 aortic arch aneurysm ruptures were included. In patients with arch aneurysm ruptures, fenestrated stent grafting (SG) and SG combined with arch debranching were performed. In all cases of TAI, aortic injuries occurred near the isthmus and 5 patients received fenestrated SG. The initial success rate was 100% and there was no perioperative death. Mean duration of observation was 24 months, which revealed 4 late deaths. The causes of late death were liver failure, cerebral contusion, senility and unknown. A patient with RTAA experienced a type III endoleak as an aorta-related event 24 months after operation. There was no enlargement of aneurysm in any patient. TEVAR for aortic catastrophes seems to be performed safely with acceptable outcomes. Although morphological incompatibility, unstable preoperative haemodynamics and longer time for preparation may become impediments to perform TEVAR, we believe that TEVAR should be the 1st choice for life-threatening aortic catastrophes. However, a careful follow-up is necessary because TEVAR has several unique late complications. PMID:21229682

  7. Permanent Iodine-125 Interstitial Planar Seed Brachytherapy for Close or Positive Margins for Thoracic Malignancies

    SciTech Connect

    Mutyala, Subhakar; Stewart, Alexandra; Khan, Atif J.; Cormack, Robert A.; O'Farrell, Desmond; Sugarbaker, David; Devlin, Phillip M.

    2010-03-15

    Purpose: To assess toxicity and outcome following permanent iodine-125 seed implant as an adjunct to surgical resection in cases of advanced thoracic malignancy. Methods and Materials: An institutional review board-approved retrospective review was performed. Fifty-nine patients were identified as having undergone thoracic brachytherapy seed implantation between September 1999 and December 2006. Data for patient demographics, tumor details, and morbidity and mortality were recorded. Results: Fifty-nine patients received 64 implants. At a median follow-up of 17 months, 1-year and 2-year Kaplan-Meier rates of estimated overall survival were 94.1% and 82.0%, respectively. The 1-year and 2-year local control rates were 80.1% and 67.4%, respectively. The median time to develop local recurrence was 11 months. Grades 3 and 4 toxicity rates were 12% at 1 year. Conclusions: This review shows relatively low toxicity for interstitial planar seed implantation after thoracic surgical resection. The high local control results suggest that an incomplete oncologic surgery plus a brachytherapy implant for treating advanced thoracic malignancy merit further investigation.

  8. 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

  9. Evaluation of the effectiveness of thoracic sympathectomy in the treatment of primary hyperhidrosis of hands and armpits using the measurement of skin resistance

    PubMed Central

    Jab?o?ski, S?awomir; Rzepkowska-Misiak, Beata; Piskorz, ?ukasz; Brocki, Marian; Wcis?o, Szymon; Smigielski, Jacek; Kordiak, Jacek

    2012-01-01

    Introduction Hyperhidrosis is excessive sweating beyond the needs of thermoregulation. It is disease which mostly affects young people, often carrying a considerable amount of socio-economic implications. Thoracic sympathectomy is now considered to be the "gold standard" in the treatment of idiopathic hyperhidrosis of hands and armpits. Aim Assessment of early effectiveness of thoracic sympathectomy using skin resistance measurements performed before surgery and in the postoperative period. Material and methods A group of 20 patients with idiopathic excessive sweating of hands and the armpit was enrolled in the study. Patients underwent two-stage thoracic sympathectomy with resection of Th2-Th4 ganglions. The skin resistance measurements were made at six previously designated points on the day of surgery and the first day after the operation. Results In all operated patients we obtained complete remission of symptoms on the first day after the surgery. Inhibition of sweating was confirmed using the standard starch iodine (Minor) test. At all measurement points we obtained a statistically significant increase of skin resistance, assuming p < 0.05. To check whether there is a statistically significant difference in the results before and after surgery we used sequence pairs Wilcoxon test. Conclusions Thoracic sympathectomy is an effective curative treatment for primary hyperhidrosis of hands and armpits. Statistically significant increase of skin resistance in all cases is a good method of assessing the effectiveness of the above surgery in the early postoperative period. PMID:23256019

  10. 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

  11. Application of lamina replantation with ARCH plate fixation in thoracic and lumbar intraspinal tumors

    PubMed Central

    ZHOU, DONG; NONG, LU-MING; GAO, GONG-MIN; JIANG, YU-QIN; XU, NAN-WEI

    2013-01-01

    The aim of the present study was to investigate the clinical effects of lamina replantation with ARCH plate fixation on patients with thoracic and lumbar intraspinal tumors, following laminectomy. Thirteen patients with thoracic and lumbar intraspinal tumors underwent total lamina replantation with ARCH plate fixation and repair of the supraspinous ligaments, following laminectomy and tumor enucleation. To investigate the clinical effect of lamina replantation with ARCH plate fixation, pre- and postoperative visual analog scale (VAS), and Oswestry Disability Index (ODI) scores were determined, and pre- and postoperative X-ray and magnetic resonance imaging (MRI) examinations were conducted. Computed tomography (CT) examinations were also included in the follow-up. No complications were observed pre- or postoperatively. The VAS and ODI results 2 weeks following surgery and at the final follow-up examination demonstrated a significant improvement compared with the corresponding preoperative results. The X-ray examination results indicated a satisfactory internal fixation location, without any characteristics of a fracture, lumbar scoliosis, kyphosis or instability. Following the surgery, the CT and MRI examination results demonstrated that healing of the lamina bone and repair of the supraspinous ligament had occurred without tumor recurrence or spinal epidural scar recompression. Two of the 13 cases were lost to follow-up. The results indicated that in patients with thoracic and lumbar intraspinal tumors, lamina replantation with ARCH plate fixation following total laminectomy is effective and provides thoracolumbar stability. Furthermore, this has been identified to be an effective technique for preventing intraspinal scar proliferation. PMID:24137233

  12. [Bilateral chylothorax after gastric surgery].

    PubMed

    Medina, E; Anguiano, M P; Agudo, O; Lobo, J; Tihista, J A; Alonso, I; Calvo, A

    2005-01-01

    Chylothorax is a lymphatic effusion of chylous in the pleural space due to thoracic duct obstruction or injury. The most frequent aetiology is cancer; it is also related to chest trauma and iatrogenic. We describe the case of bilateral chylothorax in a 76-year-old woman, right predominant, during the post-operational phase of gastric surgery. This presented itself with respiratory insufficiency and tachycardia without initial haemodynamic compromise. It presented a favourable evolution after conservative treatment, cessation of oral intake and TPN and chest tube during 10 to 14 days. PMID:16421622

  13. 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.

  14. Genetics Home Reference: Familial thoracic aortic aneurysm and dissection

    MedlinePLUS

    ... OMIM Genetic disorder catalog Conditions > Familial thoracic aortic aneurysm and dissection (often shortened to familial TAAD ) On ... 2015 What is familial TAAD? Familial thoracic aortic aneurysm and dissection (familial TAAD) involves problems with the ...

  15. Genetics Home Reference: Familial thoracic aortic aneurysm and dissection

    MedlinePLUS

    ... literature OMIM Genetic disorder catalog Conditions > Familial thoracic aortic aneurysm and dissection (often shortened to familial TAAD ) On ... January 2015 What is familial TAAD? Familial thoracic aortic aneurysm and dissection (familial TAAD) involves problems with the ...

  16. 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.

  17. Harlequin Syndrome After Thoracic Paravertebral Block.

    PubMed

    Nagasaka, Yasuko; Wasner, Gunnar; Sharma, Balram; Fleischmann, Katharine

    2016-02-01

    Harlequin syndrome is characterized by the sudden onset of unilateral facial flushing and sweating, often preceded by exercise, excessive heat, or, rarely, regional anesthesia. Although the exact mechanism remains unclear, it is often referred to as transient or permanent interruption of the sympathetic nervous system. We present a case of Harlequin syndrome without Horner syndrome in a patient with unilateral right-sided facial flushing that started shortly after a left-sided thoracic paravertebral nerve block for a mastectomy. We discuss the interruption of the sympathetic and parasympathetic nervous system and the levels of spinal nerve block associated with a thoracic paravertebral nerve block. PMID:26513674

  18. 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

  19. 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

  20. 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

  1. 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.

  2. 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 ...

  3. 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 ...

  4. Cataract Surgery

    MedlinePLUS

    ... Prevention News Ask an Eye M.D. Espaol Cataracts What Are Cataracts? Cataract Symptoms Who Is at ... Lens Replacement and Cataract Surgery Cataract Vision Simulator Cataract Surgery Written by: Kierstan Boyd Reviewed by: Elena ...

  5. Cataract Surgery

    MedlinePLUS

    ... Ophthalmologist Español Eye Health / Eye Health A-Z Cataracts Sections What Are Cataracts? Cataract Symptoms Who Is ... Lens Replacement and Cataract Surgery Cataract Vision Simulator Cataract Surgery Written by: Kierstan Boyd Reviewed by: Elena ...

  6. 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.

  7. Thoracic Myoepithelial Tumors: A Pathologic and Molecular Study of 8 Cases With Review of the Literature.

    PubMed

    Leduc, Charles; Zhang, Lei; z, Buge; Luo, Jean; Fukuoka, Junya; Antonescu, Cristina R; Travis, William D

    2016-02-01

    Thoracic myoepithelial tumors (MTs) are a rare group of tumors showing predominant or exclusive myoepithelial differentiation. They are poorly characterized from both a morphologic and genetic standpoint, in particular features that separate benign from malignant behavior. We examined the histologic and immunohistochemical features of 8 primary thoracic MTs and performed fluorescence in situ hybridization for EWSR1, FUS, PLAG1, and HMGA2, as well as several partner genes. Half (4/8) of the MTs occurred in large airways, and 3 had infiltrative borders. All cases showed immunoreactivity for epithelial markers, in conjunction with S100 protein or myogenic markers. MTs showed morphologic characteristics analogous to MTs at other sites, with no tumors having ductal differentiation. Necrosis and/or lymphovascular invasion was present in 5 cases, with mitotic activity ranging from 0 to 6 mitoses/2 mm (mean 1). Metastases occurred in 2 cases, and no patients died of disease. Gene rearrangements were identified in half of the cases, with EWSR1-PBX1, EWSR1-ZNF444, and FUS-KLF17 fusions identified in 1 case each and 1 case having EWSR1 rearrangement with no partner identified. No cases were found to have HMGA2 or PLAG1 abnormalities. Compared with fusion-negative tumors, fusion-positive tumors tended to occur in patients who were younger (50 vs. 58 y), female (1:3 vs. 3:1 male:female ratio), and demonstrated predominantly spindle and clear cell morphology. Using a combined data set of our case series with 16 cases from the literature, poor prognosis was significantly correlated with metastases (P=0.003), necrosis (P=0.027), and ?5 mitoses/2 mm/10 high-power field (P=0.005). In summary, we identify a subset of thoracic MTs harboring rearrangements in EWSR1 or FUS, and our data suggest that necrosis and increased mitotic activity correlate with aggressive clinical behavior. PMID:26645726

  8. Novel Axillary Approach for Brachial Plexus in Robotic Surgery: A Cadaveric Experiment

    PubMed Central

    Tetik, Cihangir; Uzun, Metin

    2014-01-01

    Brachial plexus surgery using the da Vinci surgical robot is a new procedure. Although the supraclavicular approach is a well known described and used procedure for robotic surgery, axillary approach was unknown for brachial plexus surgery. A cadaveric study was planned to evaluate the robotic axillary approach for brachial plexus surgery. Our results showed that robotic surgery is a very useful method and should be used routinely for brachial plexus surgery and particularly for thoracic outlet syndrome. However, we emphasize that new instruments should be designed and further studies are needed to evaluate in vivo results. PMID:25140251

  9. Chronic pain and the thoracic spine.

    PubMed

    Louw, Adriaan; Schmidt, Stephen G

    2015-07-01

    In recent years there has been an increased interest in pain neuroscience in physical therapy.1,2 Emerging pain neuroscience research has challenged prevailing models used to understand and treat pain, including the Cartesian model of pain and the pain gate.2-4 Focus has shifted to the brain's processing of a pain experience, the pain neuromatrix and more recently, cortical reorganisation of body maps.2,3,5,6 In turn, these emerging theories have catapulted new treatments, such as therapeutic neuroscience education (TNE)7-10 and graded motor imagery (GMI),11,12 to the forefront of treating people suffering from persistent spinal pain. In line with their increased use, both of these approaches have exponentially gathered increasing evidence to support their use.4,10 For example, various randomised controlled trials and systematic reviews have shown that teaching patients more about the biology and physiology of their pain experience leads to positive changes in pain, pain catastrophization, function, physical movement and healthcare utilisation.7-10 Graded motor imagery, in turn, has shown increasing evidence to help pain and disability in complex pain states such as complex regional pain syndrome (CRPS).11,12 Most research using TNE and GMI has focussed on chronic low back pain (CLBP) and CRPS and none of these advanced pain treatments have been trialled on the thoracic spine. This lack of research and writings in regards to the thoracic spine is not unique to pain science, but also in manual therapy. There are, however, very unique pain neuroscience issues that skilled manual therapists may find clinically meaningful when treating a patient struggling with persistent thoracic pain. Utilising the latest understanding of pain neuroscience, three key clinical chronic thoracic issues will be discussed - hypersensitisation of intercostal nerves, posterior primary rami nerves mimicking Cloward areas and mechanical and sensitisation issues of the spinal dura in the thoracic spine. PMID:26308707

  10. 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.

  11. 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

  12. Dry needling for the management of thoracic spine pain.

    PubMed

    Fernndez-de-Las-Peas, Csar; 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

  13. Percutaneous radiofrequency upper thoracic sympathectomy.

    PubMed

    Wilkinson, H A

    1996-04-01

    Between June 1979 and May 1994, I performed 148 unilateral or bilateral sympathectomies on 247 limbs in 110 patients using a percutaneous radiofrequency technique, usually on an outpatient surgery basis. Patient ages ranged from 10 to 81 years, with 45 male and 65 female patients. Four patients had unsuccessfully undergone prior open surgical sympathectomy. Patients suffered from hyperhidrosis, vascular occlusion, Raynaud's disease or other chronic vasculopathies, painful causalgia or reflex sympathetic dystrophy, or Prinzmetal's angina. The sympathectomy technique has evolved over this 15-year period and is currently in its third phase. Changes in the procedure were based on anatomic and clinical/radiographic correlations and careful patient follow-up. Current modifications have reduced the frequency of both early and late failures. The present technique (Phase III) relies on neuroleptanalgesia with superficial local anesthesia only and does not require general anesthesia, intubation, or lung collapse. Two 18-gauge radiofrequency TIC needle electrodes (Radionics, Burlington, MA) are used. A series of three lesions is rostrocaudally made at each of the ganglion sites selected in an attempt to destroy the entire fusiform ganglion. Lesion sites are targeted by C-arm fluoroscopy and electrical stimulation, which produces a threshold of sensory awareness of > 1.0 V. Lesion effectiveness is monitored by bilateral finger plethysmography and hand skin temperature measurement. With the Phase III technique, the sympathetic activity in 96% of operated limbs after 2 years and in 91% of operated limbs after 3 years continues to be completely or largely interrupted. By comparison, I achieved similar success in 83 and 72% operated limbs with the Phase I technique and in 77 and 71% with the Phase II technique. Symptomatic pneumothorax, in six patients, has been the only serious complication. When necessary, a subsequent operation can easily be performed and is effective. PMID:8692390

  14. Damage of the long thoracic and dorsal scapular nerve after traumatic shoulder dislocation: case report and review of the literature.

    PubMed

    Jerosch, J; Castro, W H; Geske, B

    1990-01-01

    A judo injury resulted in an anterior shoulder dislocation with a concomitant lesion of the long thoracic and the dorsal scapula nerve. This injury led to loss of function and extreme instability of the shoulder. Stabilization of the glenohumeral joint was successfully accomplished by surgery. The athlete declined further operative approaches to stabilize the scapula. The patient was able to return to the former level of athletic activity. PMID:2075821

  15. 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.

  16. 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.

  17. Single-stage Anterior and Posterior Fusion Surgery for Correction of Cervical Kyphotic Deformity Using Intervertebral Cages and Cervical Lateral Mass Screws: Postoperative Changes in Total Spine Sagittal Alignment in Three Cases with a Minimum Follow-up of Five Years

    PubMed Central

    OGIHARA, Satoshi; KUNOGI, Junichi

    The surgical treatment of cervical kyphotic deformity remains challenging. As a surgical method that is safer and avoids major complications, the authors present a procedure of single-stage anterior and posterior fusion to correct cervical kyphosis using anterior interbody fusion cages without plating, as illustrated by three consecutive cases. Case 1 was a 78-year-old woman who presented with a dropped head caused by degeneration of her cervical spine. Case 2 was a 54-year-old woman with athetoid cerebral palsy. She presented with cervical myelopathy and cervical kyphosis. Case 3 was a 71-year-old woman with cervical kyphotic deformity following a laminectomy. All three patients underwent anterior release and interbody fusion with cages and posterior fusion with cervical lateral mass screw (LMS) fixation. Postoperative radiographs showed that correction of kyphosis was 39 in case 1, 43 in case 2, and 39 in case 3. In all three cases, improvement of symptoms was established without major perioperative complications, solid fusion was achieved, and no loss of correction was observed at a minimum follow-up of 61 months. We also report that preoperative total spine sagittal malalignment was improved after corrective surgery for cervical kyphosis and was maintained at the latest follow-up in all three cases. The combination of anterior fusion cages and LMS is considered a safe and effective procedure in cases of severe cervical kyphotic deformity. Preoperative total spine sagittal malalignment improved, accompanied by correction of cervical kyphosis, and was maintained at last follow-up in all three cases. PMID:26119893

  18. 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.

  19. "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.

  20. 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 620 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

  1. [Acute jaw-thoracic pain and syncope in a 41-year-old man].

    PubMed

    Gnther, S; Mudra, H; Reichelt, A; Khaladj, N; Hagl, C; Pichlmaier, M

    2014-10-01

    A 41-year-old physically active man with no significant past medical history presented with sudden thoracic pain. The patient was referred to the next tertiary care hospital. A CT scan showed an ectasia of the ascending aorta with irregularities of the aortic wall without dissection. Despite initial refusal, the patient was referred to a university hospital with experience in aortic surgery. A triphase ECG-synchronized cardiothoracic flash protocol performed on a 256line CT scanner confirmed an aortic intramural hematoma and a covered aortic perforation. Shortly afterwards the patient collapsed and had to be resuscitated. PMID:25139704

  2. 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

  3. Early reoperation performed for the management of complications in patients undergoing general thoracic surgical procedures

    PubMed Central

    Foroulis, Christophoros N.; Kleontas, Athanasios; Karatzopoulos, Avgerinos; Nana, Chryssoula; Tagarakis, George; Tossios, Paschalis; Anastasiadis, Kyriakos

    2014-01-01

    Objective To detect the rate and predisposing factors for the development of postoperative complications requiring re-operation for their control in the immediate postoperative period. Methods During the time period 2009-2012, 719 patients (male: 71.62%, mean age: 5419 years) who underwent a wide range of general thoracic surgery procedures, were retrospectively collected. Data of patients who underwent early re-operation for the management of postoperative complications were assessed for identification of the responsible causative factors. Results Overall, 33/719 patients (4.6%) underwent early re-operation to control postoperative complications. Early re-operation was obviated by the need to control bleeding or to drain clotted hemothoraces in nine cases (27.3%), to manage a prolonged air leak in six cases (18.2%), to drain a post-thoracotomy empyema in five cases (15.2%), to revise the thoracotomy incision or an ischemic musculocutaneous flap in five cases (15.2%), to manage a bronchopleural fistula in four cases (12.1%), to manage persistent atelectasis of the remaining lung in two cases (6.1%), to cease a chyle leak in one case (3%) and to plicate the right hemidiaphragm in another one case (3%). The factors responsible for the development of complications requiring reopening of the chest for their management were technical in 17 cases (51.5%), initial surgery for lung or pleural infections in 9 (27.3%), the recent antiplatelet drug administration in 4 (12.1%) and advanced lung emphysema in 3 (9.1%). Mortality of re-operations was 6.1% (2/33) and it was associated with the need to proceed with completion pneumonectomy in the two cases with persistent atelectasis of the remaining lung and permanent parenchymal damage. The majority of complications requiring reoperation were observed after lung parenchyma resection (17 out of the 228 procedures/7.4%) or pleurectomy (7 out of the 106 procedures/6.5%). Reoperations after video-assisted thoracic surgery (VATS) were uncommon (2 out of the 99 procedures/2%). Conclusions The rate of complications requiring reoperation after general thoracic surgery procedures is low and it is mainly related to technical issues from the initial surgery, the recent administration of antiplatelet drugs, the presence of advanced emphysema and surgery for infectious diseases. The need to proceed with completion pneumonectomy has serious risk for fatal outcome. PMID:24672696

  4. Plasma fusion and cold fusion

    SciTech Connect

    Hideo, Kozima

    1996-12-31

    Fundamental problems of plasma fusion (controlled thermonuclear fusion) due to the contradicting demands of the magnetic confinement of plasma and suppression of instabilities occurring on and in plasma are surveyed in contrast with problems of cold fusion. Problems in cold fusion due to the complicated constituents and types of force are explained. Typical cold fusion events are explained by a model based on the presence of trapped neutrons in cold fusion materials. The events include Pons-Fleishmann effect, tritium anomaly, helium 4 production, and nuclear transmutation. Fundamental hypothesis of the model is an effectiveness of a new concept--neutron affinity of elements. The neutron affinity is defined and some bases supporting it are explained. Possible justification of the concept by statistical approach is given.

  5. 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

  6. 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

  7. [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

  8. 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

  9. 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

  10. 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

  11. 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

  12. 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

  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. Successful anterior fusion following posterior cervical fusion for revision of anterior cervical discectomy and fusion pseudarthrosis.

    PubMed

    Elder, Benjamin D; Sankey, Eric W; Theodros, Debebe; Bydon, Mohamad; Rory Goodwin, C; Lo, Sheng-Fu; Kosztowski, Thomas A; Belzberg, Allen J; Wolinsky, Jean-Paul; Sciubba, Daniel M; Gokaslan, Ziya L; Bydon, Ali; Witham, Timothy F

    2016-02-01

    Pseudarthrosis occurs after approximately 2-20% of anterior cervical discectomy and fusion (ACDF) procedures; it is unclear if posterior or anterior revision should be pursued. In this study, we retrospectively evaluate the outcomes in 22 patients with pseudarthrosis following ACDF and revision via posterior cervical fusion (PCF). Baseline demographics, preoperative symptoms, operative data, time to fusion failure, symptoms of pseudarthrosis, and revision method were assessed. Fusion outcome and clinical outcome were determined at last follow-up (LFU). Thirteen females (59%) and 9 (41%) males experienced pseudarthrosis at a median of 11 (range: 3-151)months after ACDF. Median age at index surgery was 51 (range: 33-67)years. All patients with pseudarthrosis presented with progressive neck pain, with median visual analog scale (VAS) score of 8 (range: 0-10), and/or myeloradiculopathy. Patients with pseudarthrosis <12months compared to >12months after index surgery were older (p=0.013), had more frequent preoperative neurological deficits (p=0.064), and lower baseline VAS scores (p=0.006). Fusion was successful after PCF in all patients, with median time to fusion of 10 (range: 2-14)months. Eighteen patients fused both anteriorly and posteriorly, two patients fused anteriorly only, and two patients fused posteriorly only. Median VAS neck score at LFU significantly improved from the time of pseudarthrosis (p=0.012). While uncommon, pseudarthrosis may occur after ACDF. All patients achieved successful fusion after subsequent posterior cervical fusion, with 91% fusing a previous anterior pseudarthrosis after posterior stabilization. Neck pain significantly improved by LFU in the majority of patients in this study. PMID:26482460

  15. 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

  16. Traumatic chylothorax following blunt thoracic trauma: two conservatively treated cases.

    PubMed

    Apostolakis, Efstratios; Akinosoglou, Karolina; Koletsis, Efstratios; Dougenis, Dimitrios

    2009-01-01

    Chylothorax is rare following blunt thoracic trauma; its diagnosis is usually delayed until the puncture or drainage of posttraumatic pleural effusion and its cause is not clear. Mostly, it is attributed to injury or overstretching of major thoracic duct by fractures or other injury of neighboring thoracic spine. We describe of two cases, one unilateral and one bilateral, of chylothorax, both after blunt thoracic trauma. In the first case, there were associated fractures of lower thoracic vertebrae, whereas in the other there was no obvious cause, except striking osteophytic degeneration alongside the thoracic spine. Both cases were successfully treated after 16 and 23 days, respectively, with drainage, starvation, reexpansion of the lung(-s), and total parenteral nutrition. We believe that with the "triad of RST" ("reexpansion, starvation diet, TPN"), conservative treatment will be successful in the majority of cases. PMID:19267837

  17. Harrington-Luque and Cotrel-Dubousset instrumentation for idiopathic thoracic scoliosis. A postoperative comparison using segmental radiologic analysis.

    PubMed

    Wojcik, A S; Webb, J K; Burwell, R G

    1990-05-01

    This article reports a comparison of the Cotrel-Dubousset (CD) operation with the Harrington-Luque (HL) procedure for the treatment of adolescent idiopathic thoracic scoliosis. Thirty-nine patients were studied preoperatively and postoperatively using segmental radiologic measurements including Cobb angle, end-vertebra angles (EVAs), surgical flexibility index, vertebral rotation, displacement and tilt, convex and concave rib-vertebra angles (RVAs), and kyphosis and lordosis. Cotrel-Dubousset is not significantly different from HL with respect to Cobb angle (%), surgical flexibility index, apical vertebral displacement, apical vertebral rotation, apical rib-vertebra angles, kyphosis, and lordosis. It is significantly better than the HL with respect to the correction of vertebral displacement at T10-11; lower EVA of the thoracic curve; vertebral rotation mainly above the apex; convex RVAs above the apex; and concave RVAs at T10. The surgical correction of vertebral tilt above and below the apex of the thoracic curve is significantly related to the correction of convex and concave RVAs. The view that persistent deformity of ribs is a factor needing surgical correction in some patients with adolescent idiopathic thoracic scoliosis having posterior instrumentation and fusion needs further evaluation. PMID:2363071

  18. 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

  19. [Precise surgery].

    PubMed

    Dong, Jiahong; Zhang, Ning

    2015-05-01

    Surgery has passed through an intuitive and an empirical era and has now entered its modern phase. The enormous progress in biomedicine, the rise of evidence-based medicine and the consensus on the need for humanistic patient care, have laid a foundation for a new surgical paradigm. Based on a series of studies and practices, we advocated the concept of 'Precision Surgery'. It covers the entire operation-centered surgical practice. The strategy of precision surgery is to seek a balance of maximizing the removal of the target lesion, while maximizing the functional liver remnant and minimizing surgical invasiveness. We propose that the concept of precision surgery should be considered for wider application within liver surgery and various surgical fields, and finally realize the multi-objective optimization with certainty-based practice to ensure maximized recovery for each patient. PMID:26082243

  20. 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

  1. Thoracic region self-mobilization: a clinical suggestion.

    PubMed

    Johnson, Katherine D; Grindstaff, Terry L

    2012-04-01

    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

  2. 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.

  3. Application of three dimensional reconstruction technique in selection of incision of thoracic surgical operation with robot

    PubMed Central

    Wen, Jiaxin; Hou, Xiaobin; Chu, Xiangyang; Xue, Xinying; Xue, Zhiqiang

    2015-01-01

    Objective: To evaluate a new method to plan the incisions of thoracic surgical operation with robot using three-dimensional (3D) reconstruction techniques. Methods: Three-dimensional reconstruction techniques were used to reconstruct the chest CT of patients with the software OSIRIX (APPLE). Tumor location, size and relationship with the vein and artery were unambiguously obtained. The location of the incision was predetermined prior to the surgery. The operation time, set up time and work time were evaluated to assess the efficacy of this preplanning methodology. Results: A total of 4 cases are reported here. Tumors of different homogeneities were assessed, located in a 3D mode, and preplanned incisions successfully made to perform the procedure. This resulted in overall reduction of operation time and also provided effective visualization of the tumor during surgery. Conclusion: Our results suggest that this method can show the location of tumor, help in planning of appropriate incisions and define 3D anatomical relationships. PMID:26770374

  4. Endovascular interventions for descending thoracic aortic aneurysms: The pivotal role of the clinical nurse in postoperative care.

    PubMed

    Dolinger, Cami; Strider, David V

    2010-12-01

    Descending thoracic aortic aneurysms (dTAA) comprise 40% of all aneurysms arising from the thoracic aorta. Because rupture of thoracic aneurysms is associated with a 94% mortality rate, timely detection, surveillance and treatment is imperative. Endovascular stent-graft repair of thoracic aneurysms was first performed in 1992 and has become an accepted treatment option for this condition in select candidates. There is an abundance of information for the care of patients after open surgical repair of dTAA. However, still relatively few written guidelines exist in the nursing literature for postoperative care and complications associated with endovascular stent-graft repair. The prevalence of aortic endografting, however, now makes it necessary for nurses to have a solid knowledge base in the operative procedure, complications and postoperative care for this patient population. Ideal candidates for aortic endografting undergo CTA or MRI preoperatively and fit a set of strict anatomic criteria to ensure proper delivery and fixation of the device. The early postoperative care focuses on minimizing pulmonary complications, paraplegia, renal failure and embolic complications such as stroke and limb ischemia through skilled nursing assessment and interventions. Late complications such as stent-graft migration, kinking, stent fracture and endoleak are often without symptoms, making it necessary for patients to be educated about these potential complications and to be encouraged to comply with lifelong follow up. This overview provides a sound cognitive framework for nurses practicing in a vascular surgery milieu. PMID:21074117

  5. 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

  6. Improvement of Severe Heart Failure after Endovascular Stent Grafting for Thoracic Aortic Aneurysm.

    PubMed

    Yamaguchi, Toshihiro; Amiya, Eisuke; Watanabe, Masafumi; Komuro, Issei

    2015-12-01

    Afterload is considered to be an important factor regulating heart failure. Aortic structure or pathology may affect afterload to various extents. However, the contribution of aortic diseases, such as aortic aneurysm or aortic dissection, to heart failure status has not been completely elucidated.Here we describe a 78-year-old patient with severe heart failure who made a dramatic recovery from cardiac decompensation following endovascular thoracic aortic aneurysm surgery. He previously underwent graft replacement for impending rupture of the descending aorta and replacement of both the mitral valve and aortic valve to address valve regurgitation. Subsequently, his left ventricular (LV) function became severely depressed (13%) and serum brain natriuretic peptide (BNP) level remained high (approximately 880-3520 pg/mL). Conversely, his aortic arch was dilated to 70 mm and required surgical intervention. Despite his extremely high vascular surgery risk due to severely depressed cardiac function, stent grafting for thoracic aortic aneurysm was successfully performed. Furthermore, the severity of his depressed cardiac function and heart failure dramatically improved following stent grafting. The left ventricular ejection fraction improved from 13% presurgery to 55% postsurgery and the serum BNP level had significantly decreased to 70- 240 pg/mL. These improvements helped to alleviate the patient's heart failure symptoms, including shortness of breath.This case suggests a possible beneficial effect of aortic aneurysm repair for improving cardiac function and heart failure; our study presents a new concept of another extrinsic factor that can affect cardiac function through modulation of afterload. PMID:26549286

  7. (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

  8. 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)

  9. The reported thoracic injuries in Homer's Iliad.

    PubMed

    Apostolakis, Efstratios; Apostolaki, Georgia; Apostolaki, Mary; Chorti, Maria

    2010-01-01

    Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%), the stones (7.4%), the arrow (5.5%) and the sword (5.5%). We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim), medium (those which cause the victim to abandon the battlefield), and severe (those which cause death of the victim). According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95%) and the remaining 8 an Achaean (21.05%). The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield. PMID:21087529

  10. The reported thoracic injuries in Homer's Iliad

    PubMed Central

    2010-01-01

    Homer's Iliad is considered to be a prominent and representative work of the tradition of the ancient Greek epic poetry. In this poem Homer presents the battles which took place during the last year of the 10-year lasting Trojan War between Achaeans and Trojans. We wanted to examine the chest wounds, especially those which are described in detail, according to their localization, severity and mortality. Finally, there are reported 54 consecutive thoracic injuries in the Iliad. The mostly used weapons were the spear (63%), the stones (7.4%), the arrow (5.5%) and the sword (5.5%). We divided the injuries according to their severity in mild (those which did not cause serious injury to the victim), medium (those which cause the victim to abandon the battlefield), and severe (those which cause death of the victim). According to this classification, the reported injuries were mild in 11.11%, medium in 18.52%, and severe in the last 70.37% of the reported cases. In other words, 89% of the injuries belong to the medium or severe category of thoracic injury. As far as the mortality of the injuries is concerned, 38 out of 54 thoracic injuries include death, which makes the mortality percentage reach 70.37%. Concerning the "allocation of the roles", the Achaean were in 68% perpetrators and the Trojans in only 32%. In terms of gravity, out of 38 mortal injuries 30 involve a Trojan (78.95%) and the remaining 8 an Achaean (21.05%). The excellent and detailed description of the injuries by Homer, as well as of the symptoms, may reveal a man with knowledge of anatomy and medicine who cared for the injured warriors in the battlefield. PMID:21087529

  11. 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.

  12. Thoracic Outlet Syndrome Following Breast Implant Rupture

    PubMed Central

    Caplash, Yugesh; Giri, Pratyush; Kearney, Daniel; Wagstaff, Marcus

    2015-01-01

    Summary: We present a patient with bilateral breast implant rupture who developed severe locoregional silicone granulomatous lymphadenopathy. Poly Implant Prothese silicone implants had been used for bilateral breast augmentation 5 years prior. Extracapsular implant rupture and bilateral axillary lymphadenopathy indicated explantation, capsulectomy, and selective lymph node excision. Histology demonstrated silicone lymphadenopathy with no evidence of malignancy. Over the subsequent 12 months, she developed progressive locoregional lymphadenopathy involving bilateral cervical, axillary, and internal mammary groups, resulting in bilateral thoracic outlet syndrome. We report the unusual presentation, progression, and the ultimate surgical management of this patient. PMID:25878942

  13. 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

  14. 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

  15. Pneumocephalus and Pneumorrhachis After Spinal Surgery

    PubMed Central

    Akyz, Orhan; Gkp?nar, Deniz; Ayd?n, Emsal; Ayd?n, Serglen; Duymu?, Mahmut; ???ar, Gl?en; zdemir, Murat

    2016-01-01

    Summary Background Pneumocephalus and pneumorrhachis are rare complications of neurosurgery. When a closed system such as the head and spinal area get injuried, it becomes open and the air can come in through that opening. In this case, we present a case of pneumocephalus and pneumorrhachis after spinal fusion surgery. Case Report Herein we present a case of diagnosis and treatment of pneumocephalus and pneumorrhachis after spinal fusion surgery. Conclusions Our patient developed postoperative pneumocephalus and pneumorrhachis as a late complication secondary to an infection. We wanted it to be considered as an important problem.

  16. 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

  17. 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 ...

  18. Plastic Surgery

    MedlinePLUS

    ... procedure that can help smooth or camouflage severe acne scars) sometimes feel more comfortable with their appearance ... procedures teens choose include nose reshaping, ear surgery, acne and acne scar treatment, and breast reduction. previous ...

  19. Cosmetic Surgery

    MedlinePLUS

    ... defect or cosmetic flaw that has diminished their self-esteem over time. It's important to remember that cosmetic ... can create both physical changes and changes in self-esteem. But if you are seeking surgery with the ...

  20. Rodding Surgery

    MedlinePLUS

    ... Rods can be made of stainless steel or titanium. Regular rods do not expand. They have many ... v regular), the rod materials (stainless steel v titanium) and the age for a first rodding surgery. ...

  1. Considering Surgery?

    MedlinePLUS

    ... I should know about this surgery? Choosing a Surgeon Your primary care doctor may suggest a surgeon to you. Your state or local medical society can tell you about your surgeon's training. Try to choose a surgeon who operates ...

  2. Thyroid Surgery

    MedlinePLUS

    ... thyroid surgery, requiring treatment with thyroid hormone (see Hypothyroidism brochure ). This is especially true if you had ... Radioactive Iodine Low Iodine Diet Thyroid Function Tests Hypothyroidism Hyperthyroidism Thyroid Disease and Complementary and Alternative Medicine ...

  3. Heart Surgery

    MedlinePLUS

    ... the Risks Clinical Trials Links Related Topics Aneurysm Coronary Artery Bypass Grafting Heart Transplant Pacemakers Ventricular Assist Device Send a ... common type of heart surgery for adults is coronary artery bypass grafting (CABG). During CABG, a healthy artery or vein ...

  4. 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

  5. [Robotic surgery].

    PubMed

    Moreno-Portillo, Mucio; Valenzuela-Salazar, Carlos; Quiroz-Guadarrama, Csar David; Pachecho-Gahbler, Carlos; Rojano-Rodrguez, Martn

    2014-12-01

    Medicine has experienced greater scientific and technological advances in the last 50 years than in the rest of human history. The article describes relevant events, revises concepts and advantages and clinical applications, summarizes published clinical results, and presents some personal reflections without giving dogmatic conclusions about robotic surgery. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) defines robotic surgery as a surgical procedure using technology to aid the interaction between surgeon and patient. The objective of the surgical robot is to correct human deficiencies and improve surgical skills. The capacity of repeating tasks with precision and reproducibility has been the base of the robots success. Robotic technology offers objective and measurable advantages: -?Improving maneuverability and physical capacity during surgery. -?Correcting bad postural habits and tremor. -?Allowing depth perception (3D images). -?Magnifying strength and movement limits. -?Offering a platform for sensors, cameras, and instruments. Endoscopic surgery transformed conceptually the way of practicing surgery. Nevertheless in the last decade, robotic assisted surgery has become the next paradigm of our era. PMID:25643879

  6. 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 ...

  7. 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/?-catenin signaling was operative in developing the embryonic ventral body wall using Axin2(LacZ) and BatGal reporter mice. While Wnt/?-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 ?-catenin independent Wnt signaling as determined by in vitro assays. Deletion of Lrp5 and Lrp6 receptors, which mediate Wnt/?-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/?-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

  8. Surgical efficacy of minimally invasive thoracic discectomy.

    PubMed

    Elhadi, Ali M; Zehri, Aqib H; Zaidi, Hasan A; Almefty, Kaith K; Preul, Mark C; Theodore, Nicholas; Dickman, Curtis A

    2015-11-01

    We aimed to determine the clinical indications and surgical outcomes for thoracoscopic discectomy. Thoracic disc disease is a rare degenerative process. Thoracoscopic approaches serve to minimize tissue injury during the approach, but critics argue that this comes at the cost of surgical efficacy. Current reports in the literature are limited to small institutional patient series. We systematically identified all English language articles on thoracoscopic discectomy with at least two patients, published from 1994 to 2013 on MEDLINE, Science Direct, and Google Scholar. We analyzed 12 articles that met the inclusion criteria, five prospective and seven retrospective studies comprising 545 surgical patients. The overall complication rate was 24% (n=129), with reported complications ranging from intercostal neuralgia (6.1%), atelectasis (2.8%), and pleural effusion (2.6%), to more severe complications such as pneumonia (0.8%), pneumothorax (1.3%), and venous thrombosis (0.2%). The average reported postoperative follow-up was 20.5 months. Complete resolution of symptoms was reported in 79% of patients, improvement with residual symptoms in 10.2%, no change in 9.6%, and worsening in 1.2%. The minimally invasive endoscopic approaches to the thoracic spine among selected patients demonstrate excellent clinical efficacy and acceptable complication rates, comparable to the open approaches. Disc herniations confined to a single level, with small or no calcifications, are ideal for such an approach, whereas patients with calcified discs adherent to the dura would benefit from an open approach. PMID:26206758

  9. 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

  10. Low thoracic epidural anaesthesia for elective cholecystectomy in a patient with congenital heart disease and pulmonary hypertension.

    PubMed

    Mallampati, S R

    1983-01-01

    A 52-year-old male with pulmonary hypertension secondary to partial anomalous pulmonary venous return unassociated with atrial septal defect was given thoracic epidural anaesthesia for elective cholecystectomy. Partial anomalous pulmonary venous return is a rare congenital anomaly characterized by increased pulmonary blood flow which in severe cases results in pulmonary hypertension subjecting the right ventricle to strain. An epidural catheter was placed at the T11-T12 interspace and anaesthesia was established to the T4 dermatomal level with bupivacaine (180 mg) and lidocaine (100 mg). Central venous pressure, pulmonary artery pressure, radial artery pressure, and cardiac output were monitored. There was minimal change in pulmonary arterial pressure, although there was a significant drop in systemic arterial pressure. Thoracic epidural block is recommended for upper abdominal surgery in clinical situations with pulmonary hypertension. PMID:6824989

  11. 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

  12. Current status of robotic surgery in Japan.

    PubMed

    Nishimura, Kazuo

    2015-03-01

    The da Vinci S surgical system (Intuitive Surgical) was approved as a medical device in 2009 by the Japanese Ministry of Health, Labour and Welfare. Robotic surgery has since been used in gastrointestinal, thoracic, gynecological, and urological surgeries. In April 2012, robotic-assisted laparoscopic radical prostatectomy (RALP) was first approved for insurance coverage. Since then, RALP has been increasingly used, with more than 3,000 RALP procedures performed by March 2013. By July 2014, 183 institutions in Japan had installed the da Vinci surgical system. Other types of robotic surgeries are not widespread because they are not covered by public health insurance. Clinical trials using robotic partial nephrectomy and robotic gastrectomy for renal and gastric cancers, respectively, have recently begun as advanced medical treatments to evaluate health insurance coverage. These procedures must be evaluated for efficacy and safety before being covered by public health insurance. Other types of robotic surgery are being evaluated in clinical studies. There are several challenges in robotic surgery, including accreditation, training, efficacy, and cost. The largest issue is the cost-benefit balance. In this review, the current situation and a prospective view of robotic surgery in Japan are discussed. PMID:25763120

  13. Current status of robotic surgery in Japan

    PubMed Central

    2015-01-01

    The da Vinci S surgical system (Intuitive Surgical) was approved as a medical device in 2009 by the Japanese Ministry of Health, Labour and Welfare. Robotic surgery has since been used in gastrointestinal, thoracic, gynecological, and urological surgeries. In April 2012, robotic-assisted laparoscopic radical prostatectomy (RALP) was first approved for insurance coverage. Since then, RALP has been increasingly used, with more than 3,000 RALP procedures performed by March 2013. By July 2014, 183 institutions in Japan had installed the da Vinci surgical system. Other types of robotic surgeries are not widespread because they are not covered by public health insurance. Clinical trials using robotic partial nephrectomy and robotic gastrectomy for renal and gastric cancers, respectively, have recently begun as advanced medical treatments to evaluate health insurance coverage. These procedures must be evaluated for efficacy and safety before being covered by public health insurance. Other types of robotic surgery are being evaluated in clinical studies. There are several challenges in robotic surgery, including accreditation, training, efficacy, and cost. The largest issue is the cost-benefit balance. In this review, the current situation and a prospective view of robotic surgery in Japan are discussed. PMID:25763120

  14. GenTAC Registry Report: Gender Differences Among Individuals with Genetically-Triggered Thoracic Aortic Aneurysm and Dissection

    PubMed Central

    Holmes, Kathryn W.; Maslen, Cheryl L.; Kindem, Mark; Kroner, Barbara L.; Song, Howard K.; Ravekes, William; Dietz, H.C.; Weinsaft, Jonathan W.; Roman, Mary J.; Devereux, Richard B.; Pyeritz, Reed E.; Bavaria, Joseph; Milewski, Karianna; Milewicz, Dianna; LeMaire, Scott A.; Hendershot, Tabitha; Eagle, Kim A.; Tolunay, H. Eser; Desvigne-Nickens, Patrice; Silberbach, Michael

    2013-01-01

    Previous data suggest women are at increased risk of death from aortic dissection. Therefore, we analyzed data from the GenTAC registry, the NIH-sponsored program that collects information about individuals with genetically-triggered thoracic aortic aneurysms and cardiovascular conditions. We performed cross-sectional analyses in adults with Marfan syndrome (MFS), familial thoracic aortic aneurysm or dissection (FTAAD), bicuspid aortic valve (BAV) with thoracic aortic aneurysm or dissection, and subjects under 50 years of age with thoracic aortic aneurysm or dissection (TAAD<50y). Women comprised 32% of 1449 subjects and were 21% of subjects with BAV, 34% with FTAAD, 22% with TAAD <50y, and 47% with MFS. Thoracic aortic dissections occurred with equal gender frequency yet women with BAV had more extensive dissections. Aortic size was smaller in women but was similar after controlling for BSA. Age at operation for aortic valve dysfunction, aneurysm or dissection did not differ by gender. Multivariate analysis (adjusting for age, BSA, hypertension, study site, diabetes, and subgroup diagnoses) showed that women had fewer total aortic surgeries (OR= 0.65, p < 0.01) and were less likely to receive angiotensin converting enzyme inhibitors (ACEi) (OR=0.68, p < 0.05). As in BAV, other genetically-triggered aortic diseases such as FTAAD and TAAD<50 are more common in males. In women, decreased prevalence of aortic operations and less treatment with ACEi may be due to their smaller absolute aortic diameters. Longitudinal studies are needed to determine if women are at higher risk for adverse events. PMID:23444191

  15. 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)

  16. Aberrant Dual Origin of the Dorsal Scapular Nerve and Its Communication with Long Thoracic Nerve: An Unusual Variation of the Brachial Plexus

    PubMed Central

    Sarda, Rohit Kumar; Chhetri, Kalpana; Lama, Polly; Tamang, Binod Kumar

    2015-01-01

    Pre and post-fixed variations at roots of the brachial plexus have been well documented, however little is known about the variations that exist in the branches which arise from the brachial plexus. In this paper, we describe about one such rare variation related to the dorsal scapular and the long thoracic nerve, which are the branches arising from the roots of the brachial plexus. The variation was found during routine dissection. The dorsal scapular nerve, which routinely arises from the fifth cervical nerve root (C5), was seen to receive contributions from C5 as well as sixth cervical nerve (C6), while the long thoracic nerve arose from C6 and seventh cervical nerves (C7) only. Furthermore along with variations in origin of the dorsal scapular and long thoracic nerves, the brachial plexus was seen to exist as a prefixed plexus receiving a contribution from C4 nerve root. An aberrant communicating branch between the dorsal scapular and long thoracic nerve was also identified. Knowledge about the course and anatomy of such variations can be vital for understanding the aetiology of various conditions such as winging of scapula, interscapular pain, administration of cervical nerve blocks, surgeries and for effective management of regions and muscles supplied by dorsal scapular and long thoracic nerve. PMID:26266108

  17. Thoracic size-selective sampling of fibres: performance of four types of thoracic sampler in laboratory tests.

    PubMed

    Jones, A D; Aitken, R J; Fabris, J F; Kauffer, E; Liden, G; Maynard, A; Riediger, G; Sahle, W

    2005-08-01

    The counting of fibres on membrane filters could be facilitated by using size-selective samplers to exclude coarse particulate and fibres that impede fibre counting. Furthermore, the use of thoracic size selection would also remove the present requirement to discriminate fibres by diameter during counting. However, before thoracic samplers become acceptable for sampling fibres, their performance with fibres needs to be determined. This study examines the performance of four thoracic samplers: the GK2.69 cyclone, a Modified SIMPEDS cyclone, the CATHIA sampler (inertial separation) and the IOM thoracic sampler (porous foam pre-selector). The uniformity of sample deposit on the filter samples, which is important when counts are taken on random fields, was examined with two sizes of spherical particles (1 and 10 microm) and a glass fibre aerosol with fibres spanning the aerodynamic size range of the thoracic convention. Counts by optical microscopy examined fields on a set scanning pattern. Hotspots of deposition were detected for one of the thoracic samplers (Modified SIMPEDS with the 10 microm particles and the fibres). These hotspots were attributed to the inertial flow pattern near the port from the cyclone pre-separator. For the other three thoracic samplers, the distribution was similar to that on a cowled sampler, the current standard sampler for fibres. Aerodynamic selection was examined by comparing fibre concentration on thoracic samples with those measured on semi-isokinetic samples, using fibre size (and hence calculated aerodynamic diameter) and number data obtained by scanning electron microscope evaluation in four laboratories. The size-selection characteristics of three thoracic samplers (GK2.69, Modified SIMPEDS and CATHIA) appeared very similar to the thoracic convention; there was a slight oversampling (relative to the convention) for d(ae) < 7 microm, but that would not be disadvantageous for comparability with the cowled sampler. Only the IOM thoracic sampler tended to undersample the fibres relative to the thoracic convention. With the data divided into four classes based on fibre length, the size-selection characteristics appeared to be unaffected by fibre length for GK2.69, Modified SIMPEDS and CATHIA. Only the IOM thoracic sampler (with the foam selector) showed slightly lower selection for longer length classes of fibres. These results indicate that the tested samplers follow the thoracic sampling convention for fibres, and may be used to improve the quality and reliability of samples that are taken when there is likely to be significant background dust. PMID:15790615

  18. 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

  19. Polarized fusion

    NASA Astrophysics Data System (ADS)

    Engels, R.; Grigoryev, K.; Kochenda, L.; Kravtsov, P.; Mikirtytchiants, M.; Rathmann, F.; Paetz gen. Schieck, H.; Strher, H.; Trofimov, V.; Vasilyev, A.; Vznuzdaev, M.

    2014-01-01

    Since more than 50 years it has been discussed to increase the gain of nuclear fusion reactors with the use of polarized fuel. For example, the total cross sections of the fusion reactions d + t ? 4He + n or 3He + d ? 4He + p are increased by a factor of about 1.5 if the spins of both incoming particles are aligned. But before polarized fuel can be used for energy production in the different types of reactors, a number of questions must be answered. In this contribution we give an overview on our various activities in this field of research.

  20. Bilateral Functional Thoracic Outlet Syndrome in a Collegiate Football Player

    PubMed Central

    Robey, Jason H.

    2009-01-01

    Background Thoracic Outlet Syndrome (TOS) involves compression of the brachial plexus, subclavius artery and vein. Many studies discuss efficacy of surgery and few discuss conservative treatment. It is unknown what specific forms of conservative treatment are best. Objective Describe conservative management for TOS using unique exercises. Case Description A collegiate football player reported numbness/tingling down his right arm after a right brachial plexus stretch injury. Seven months later, he was diagnosed with recurrent cervical traction neuropraxia. Two months later, he reported bilateral symptoms and was diagnosed with functional TOS. The athlete began shoulder strengthening (deltoid, middle trapezius, rhomboids, pectoralis major, latissimus dorsi, biceps, upper trapezius and rotator cuff) and stretching (pectoralis, scalene and upper trapezius) which failed to resolve his symptoms after four weeks. Surgical resection of bilateral first ribs and quitting football was recommended by four physicians. Unique therapeutic exercises developed by the Postural Restoration Institute were used to optimize respiration/posture via muscle activation and inhibition. After six weeks, the athlete was asymptomatic and returned to football but still experienced paresthesia with contact. Additional exercises were prescribed and remaining symptoms were abolished. Outcomes The Northwick Park Neck Pain Questionnaire was 55.5% at initial and 0% at four weeks and discharge. Discussion Athlete did not demonstrate relief of symptoms from shoulder stretching and strengthening. Intervention designed to optimize respiration/posture by repositioning the pelvis/trunk via specific muscle inhibition and activation resulted in abolishing the athlete's symptoms. Management that aims to optimize respiration via muscle inhibition, activation, and repositioning warrants further research. PMID:21509101

  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. [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

  3. [Foreskin surgery].

    PubMed

    Kolehmainen, Maija; Taskinen, Seppo; Ossi, Lindell

    2010-01-01

    Balanitis, phimosis and foreskin adhesions are common indications for foreskin surgery during childhood. In phimosis, the foreskin cannot be drawn behind the glans penis because of the narrow external opening of the former. It is important to be able to distinguish between physiologic and pathologic phimosis, since their treatment is different. In adulthood, the need for surgery can be caused by phimosis, a difficult sequel of paraphimosis, recurrent inflammations of the glans penis and foreskin, diseases and cancers of the skin as well as difficulties at intercourse due to the shortness of the frenulum of the prepuce of the penis. PMID:20405611

  4. Association of race and socioeconomic status with the use of endovascular repair to treat thoracic aortic diseases

    PubMed Central

    Johnston, William F.; LaPar, Damien J.; Newhook, Timothy E.; Stone, Matthew L.; Upchurch, Gilbert R.; Ailawadi, Gorav

    2014-01-01

    Objective Descending thoracic aortic diseases may be treated with either open thoracic aortic repair or thoracic endovascular aortic repair (TEVAR). Previous studies have demonstrated that race and socioeconomic status (SES) affect access to care and treatment allocation in vascular surgery. We hypothesized that racial minorities and lower SES patients have decreased propensity to have their thoracic aortic disease treated with TEVAR. Methods Weighted discharge records for patients who underwent either open thoracic aortic repair or TEVAR between 2005 and 2008 were evaluated using the Nationwide Inpatient Sample. Patient records were stratified by therapeutic intervention (open repair vs TEVAR). Differences in baseline comorbidities, race, and SES were compared. To account for the effects of comorbidities and other factors, hierarchical logistic regression modeling was used to determine the likelihood for TEVAR performance based on differences in patients race and SES. Results A total of 60,784 thoracic repairs were analyzed, the majority (79.4%) of which were open repairs. The most common race was white (78.2%), followed by black (9.1%), Hispanic (5.7%), Asian or Pacific Islander (2.9%), and Native American (0.7%). Patients were divided into quartiles according to SES with 20.6% of patients in the lowest SES quartile, 24.3% in the second quartile, 26.4% in the third quartile, and 28.8% in the highest SES quartile. Indications for treatment were similar for both treatment groups. After adjusting for multiple patient and hospital factors, race and SES were significantly associated with treatment modality for thoracic aortic disease. Black, Hispanic, and Native American populations had increased adjusted odds ratios of TEVAR performance compared with white patients. Similarly, lower SES correlated with increased use of TEVAR. Conclusions Contrary to our initial hypothesis, racial minorities (Black, Hispanic, and Native American) and patients with lower median household incomes have a greater association with the performance for TEVAR after accounting for patient comorbid disease, indication for treatment, payer status, and hospital volume. These results indicate that traditional racial disparities do not persist in TEVAR allocation. PMID:23911247

  5. Endovascular treatment of thoracic aortic fistulas.

    PubMed

    Lobon, Bertrand; Roux, Daniel; Mugniot, Antoine; Rousseau, Herv; Crene, Alain; Glock, Yves; Fournial, Grard

    2002-07-01

    Aortoesophageal and aortobronchial fistulas constitute a problem in therapy because of the high rates of morbidity and mortality associated with operation. From May 1996 to March 2000, we treated by an endovascular procedure one aortoesophageal and three aortobronchial fistulas. There was no postoperative death. We noted one peripheral vascular complication that required a surgical procedure, one postoperative confusion, and one inflammatory syndrome. In one case, because of a persistent leakage after 21 months, we had to implant a second endovascular stent graft. A few weeks later the reopening of this patient's esophageal fistula led to his death by mediastinitis 25 months after the first procedure. The few cases published seem to bear out the interest, observed in our 4 patients, of an endovascular approach to treat complex lesions such as fistulas of the thoracic aorta especially in emergency or palliative cases. PMID:12118773

  6. [Septic complications of penetrating thoracic injuries].

    PubMed

    Danielian, Sh N; Abakumov, M M; Voskresenskiĭ, O V; Radchenko, Iu A; Chernen'kaia, T V

    2010-01-01

    224 cases of septic complications after penetrating thoracic injuries were analyzed. Pleura empyem was observed in 105 of 7572 patients (overall number of the injured), lung abscess - in 22 cases, pericarditis was diagnosed in 108 patients, costal and sternal osteomyelitis - in 26 and mediastinitis - in 21 patients. Overall frequency of septic complication was 2,96%. Main reasons of septic complications were: massive blood loss, initial contamination, thoracotomy through the initially infected wound, long -lasting and coagulated hemothorax and late diagnosis and hospitalization. Staphylococcus aureus was the most frequent microbe detected - 29,4%. Lethality rate was 9,8% (22 patients). Adequate drainage of the wound allowed rehabilitation of the majority of patients. Cases with costal osteomyelitis required major surgical dissection in 73,1%. PMID:21169927

  7. Thoracic Bone Tumors Every Radiologist Should Know.

    PubMed

    Jokerst, Clint; McFarland, William; Swanson, Jonathan; Mohammed, Tan-Lucien H

    2016-01-01

    The thoracic cage provides the structural support that makes respiration possible, provides protection to vital organs such as the lungs, heart, liver, and spleen, and serves as an anchor point for the upper extremities. Neoplasms of the bony thorax are not an uncommon incidental finding at both radiography and cross-sectional imaging. Some tumors have a characteristic appearance and it is important that an accurate differential diagnosis be provided. Misidentification could lead to unnecessary imaging or procedures with associated cost, morbidity, and mortality. The purpose of this article is to serve as a quick review of bone tumors commonly encountered in the thorax and that every radiologist should know. Please note that there are also several non-neoplastic osseous lesions that may mimic bone tumors such as osteomyelitis and eosinophilic granuloma; however, these entities are beyond the scope of this review and would not be discussed. PMID:26254813

  8. Thoracic spine compression fracture after TASER activation.

    PubMed

    Sloane, Christian M; Chan, Theodore C; Vilke, Gary M

    2008-04-01

    The TASER is a less lethal weapon seeing increased use by police jurisdictions across the country. As a result, subjects of TASER use are being seen with increasing frequency in emergency departments across the country. The potential injury patterns of the device are important for emergency physicians to understand. This report describes the case of an officer who complained of back pain after a single 5-s TASER discharge during a routine training exercise. Subsequent evaluation led to the diagnosis of an acute thoracic vertebral compression fracture. We discuss the potential mechanisms of injury in this case. Because we were unable to find any cases like this in our review of TASER-related injuries, we liken it to compression fractures that have been documented after seizures. We recommend that physicians consider obtaining back radiographs to rule out a vertebral compression fracture in any individual who has sustained a TASER discharge and has ongoing or persistent back pain. PMID:18191526

  9. [Fractures of the thoracic and lumbar spine].

    PubMed

    Gonschorek, O; Hauck, S; Wei, T; Bhren, V

    2015-09-01

    Fractures of the thoracic and lumbar spine result from high velocity trauma, assuming bone density is normal. The main location of fractures is the thoracolumbar junction. Most injuries can be treated conservatively; however, patients transferred to hospitals and spine centers represent a preselection with more severe trauma and a higher incidence of operative treatment. There is a large variety of operative techniques that can be used, which can be principally differentiated by the approach: posterior or anterior. Dorsal approaches are differentiated by the instrumentation for spondylodesis as open or percutaneous techniques. Minimally invasive options are favored more and more. For osteoporotic bone, cement augmented solutions may be used. Correct reduction of mainly kyphotic malalignment is crucial for the long-term outcome. Biomechanically stable reconstruction of the anterior spinal column is important mainly for the thoracolumbar junction. PMID:26307631

  10. Respiratory Displacement of the Thoracic Aorta: Physiological Phenomenon With Potential Implications for Thoracic Endo