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Sample records for thoracic fusion surgery

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

    PubMed Central

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

    2016-01-01

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

  2. [Surgery for thoracic tuberculosis].

    PubMed

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

    2015-01-01

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

  3. 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

  4. Incidence, Predictors, and Postoperative Complications of Blood Transfusion in Thoracic and Lumbar Fusion Surgery: An Analysis of 13,695 Patients from the American College of Surgeons National Surgical Quality Improvement Program Database.

    PubMed

    Aoude, Ahmed; Nooh, Anas; Fortin, Maryse; Aldebeyan, Sultan; Jarzem, Peter; Ouellet, Jean; Weber, Michael H

    2016-12-01

    Study Design Retrospective cohort study. Objective To identify predictive factors for blood transfusion and associated complications in lumbar and thoracic fusion surgeries. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify patients who underwent lumbar or thoracic fusion from 2010 to 2013. Multivariate analysis was used to determine predictive factors and postoperative complications associated with transfusion. Results Out of 13,695 patients, 13,170 had lumbar fusion and 525 had thoracic fusion. The prevalence of transfusion was 31.8% for thoracic and 17.0% for lumbar fusion. The multivariate analysis showed that age between 50 and 60, age between 61 and 70, age > 70, dyspnea, American Society of Anesthesiologists class 3, bleeding disease, multilevel surgery, extended surgical time, return to operation room, and higher preoperative blood urea nitrogen (BUN) were predictors of blood transfusion for lumbar fusion. Multilevel surgery, preoperative BUN, and extended surgical time were predictors of transfusion for thoracic fusion. Patients receiving transfusions who underwent lumbar fusion were more likely to develop wound infection, venous thromboembolism, pulmonary embolism, and myocardial infarction and had longer hospital stay. Patients receiving transfusions who underwent thoracic fusion were more likely to have extended hospital stay. Conclusion This study characterizes incidence, predictors, and postoperative complications associated with blood transfusion in thoracic and lumbar fusion. Pre- and postoperative planning for patients deemed to be at high risk of requiring blood transfusion might reduce postoperative complications in this population.

  5. Thoracic damage control surgery.

    PubMed

    Gonçalves, Roberto; Saad, Roberto

    2016-01-01

    The damage control surgery came up with the philosophy of applying essential maneuvers to control bleeding and abdominal contamination in trauma patients who are within the limits of their physiological reserves. This concept was extended to thoracic injuries, where relatively simple maneuvers can shorten operative time of in extremis patients. This article aims to revise the various damage control techniques in thoracic organs that must be known to the surgeon engaged in emergency care. RESUMO A cirurgia de controle de danos surgiu com a filosofia de se aplicar manobras essenciais para controle de sangramento e contaminação abdominal, em doentes traumatizados, nos limites de suas reservas fisiológicas. Este conceito se estendeu para as lesões torácicas, onde manobras relativamente simples, podem abreviar o tempo operatório de doentes in extremis. Este artigo tem como objetivo, revisar as diversas técnicas de controle de dano em órgãos torácicos, que devem ser de conhecimento do cirurgião que atua na emergência.

  6. Resection of Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament from a Posterior Approach under Intraoperative Neurophysiological Monitoring for Paralysis after Posterior Decompression and Fusion Surgery.

    PubMed

    Imagama, Shiro; Ando, Kei; Ito, Zenya; Kobayashi, Kazuyoshi; Hida, Tetsuro; Ito, Kenyu; Ishikawa, Yoshimoto; Tsushima, Mikito; Matsumoto, Akiyuki; Tanaka, Satoshi; Morozumi, Masayoshi; Machino, Masaaki; Ota, Kyotaro; Nakashima, Hiroaki; Wakao, Norimitsu; Nishida, Yoshihiro; Matsuyama, Yukihiro; Ishiguro, Naoki

    2016-12-01

    Study Design Prospective clinical study. Objective Posterior decompression and fusion surgery for beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) generally has a favorable outcome. However, some patients require additional surgery for postoperative severe paralysis, a condition that is inadequately discussed in the literature. The objective of this study was to describe the efficacy of a procedure we refer to as "resection at an anterior site of the spinal cord from a posterior approach" (RASPA) for severely paralyzed patients after posterior decompression and fusion surgery for beak-type T-OPLL. Methods Among 58 consecutive patients who underwent posterior decompression and fusion surgery for beak-type T-OPLL since 1999, 3 with postoperative paralysis (5%) underwent RASPA in our institute. Clinical records, the Japanese Orthopaedic Association score, gait status, intraoperative neurophysiological monitoring (IONM) findings, and complications were evaluated in these cases. Results All three patients experienced a postoperative decline in Manual Muscle Test (MMT) scores of 0 to 2 after the first surgery. RASPA was performed 3 weeks after the first surgery. All patients showed gradual improvements in MMT scores for the lower extremity and in ambulatory status; all could walk with a cane at an average of 4 months following RASPA surgery. There were no postoperative complications. Conclusions RASPA surgery for beak-type T-OPLL after posterior decompression and fusion surgery resulted in good functional outcomes as a salvage surgery for patients with severe paralysis. Advantages of RASPA include a wide working space, no spinal cord retraction, and additional decompression at levels without T-OPLL resection and spinal cord shortening after additional dekyphosis and compression maneuvers. When used with IONM, this procedure may help avoid permanent postoperative paralysis.

  7. Resection of Beak-Type Thoracic Ossification of the Posterior Longitudinal Ligament from a Posterior Approach under Intraoperative Neurophysiological Monitoring for Paralysis after Posterior Decompression and Fusion Surgery

    PubMed Central

    Imagama, Shiro; Ando, Kei; Ito, Zenya; Kobayashi, Kazuyoshi; Hida, Tetsuro; Ito, Kenyu; Ishikawa, Yoshimoto; Tsushima, Mikito; Matsumoto, Akiyuki; Tanaka, Satoshi; Morozumi, Masayoshi; Machino, Masaaki; Ota, Kyotaro; Nakashima, Hiroaki; Wakao, Norimitsu; Nishida, Yoshihiro; Matsuyama, Yukihiro; Ishiguro, Naoki

    2016-01-01

    Study Design Prospective clinical study. Objective Posterior decompression and fusion surgery for beak-type thoracic ossification of the posterior longitudinal ligament (T-OPLL) generally has a favorable outcome. However, some patients require additional surgery for postoperative severe paralysis, a condition that is inadequately discussed in the literature. The objective of this study was to describe the efficacy of a procedure we refer to as “resection at an anterior site of the spinal cord from a posterior approach” (RASPA) for severely paralyzed patients after posterior decompression and fusion surgery for beak-type T-OPLL. Methods Among 58 consecutive patients who underwent posterior decompression and fusion surgery for beak-type T-OPLL since 1999, 3 with postoperative paralysis (5%) underwent RASPA in our institute. Clinical records, the Japanese Orthopaedic Association score, gait status, intraoperative neurophysiological monitoring (IONM) findings, and complications were evaluated in these cases. Results All three patients experienced a postoperative decline in Manual Muscle Test (MMT) scores of 0 to 2 after the first surgery. RASPA was performed 3 weeks after the first surgery. All patients showed gradual improvements in MMT scores for the lower extremity and in ambulatory status; all could walk with a cane at an average of 4 months following RASPA surgery. There were no postoperative complications. Conclusions RASPA surgery for beak-type T-OPLL after posterior decompression and fusion surgery resulted in good functional outcomes as a salvage surgery for patients with severe paralysis. Advantages of RASPA include a wide working space, no spinal cord retraction, and additional decompression at levels without T-OPLL resection and spinal cord shortening after additional dekyphosis and compression maneuvers. When used with IONM, this procedure may help avoid permanent postoperative paralysis. PMID:27853667

  8. Robotic Surgery for Thoracic Disease.

    PubMed

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

    2016-01-01

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

  9. Nanotechnology applications in thoracic surgery.

    PubMed

    Hofferberth, Sophie C; Grinstaff, Mark W; Colson, Yolonda L

    2016-07-01

    Nanotechnology is an emerging, rapidly evolving field with the potential to significantly impact care across the full spectrum of cancer therapy. Of note, several recent nanotechnological advances show particular promise to improve outcomes for thoracic surgical patients. A variety of nanotechnologies are described that offer possible solutions to existing challenges encountered in the detection, diagnosis and treatment of lung cancer. Nanotechnology-based imaging platforms have the ability to improve the surgical care of patients with thoracic malignancies through technological advances in intraoperative tumour localization, lymph node mapping and accuracy of tumour resection. Moreover, nanotechnology is poised to revolutionize adjuvant lung cancer therapy. Common chemotherapeutic drugs, such as paclitaxel, docetaxel and doxorubicin, are being formulated using various nanotechnologies to improve drug delivery, whereas nanoparticle (NP)-based imaging technologies can monitor the tumour microenvironment and facilitate molecularly targeted lung cancer therapy. Although early nanotechnology-based delivery systems show promise, the next frontier in lung cancer therapy is the development of 'theranostic' multifunctional NPs capable of integrating diagnosis, drug monitoring, tumour targeting and controlled drug release into various unifying platforms. This article provides an overview of key existing and emerging nanotechnology platforms that may find clinical application in thoracic surgery in the near future.

  10. Evolution of thoracic surgery in Canada

    PubMed Central

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

    2015-01-01

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

  11. Doctors of Thoracic Surgery: The Division of Thoracic Surgery at Toronto General Hospital.

    PubMed

    Keshavjee, Shaf; Spatafora, Lisa

    2015-01-01

    The Division of Thoracic Surgery at Toronto General Hospital has a history of sustained excellence and commitment to patient care, research and innovation in Thoracic Surgery. Doctors of Thoracic Surgery (DOTSR) continues to be a leading thoracic division training surgeons who practice all over the world--impacting the treatment of patients with thoracic disease. Many leaders in our specialty worldwide have directly or indirectly trained in Toronto. At University Health Network and the University of Toronto, this academic division has continued to contribute and thrive in a highly supportive and productive research and clinical environment.

  12. 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

  13. Treatment of symptomatic thoracic disc herniations with lateral interbody fusion

    PubMed Central

    Parker, Rhiannon M.

    2015-01-01

    Background Symptomatic thoracic herniated discs have historically been treated using open exposures (i.e., thoracotomy), posing a clinical challenge given the approach related morbidity. Lateral interbody fusion (LIF) is one modern minimally disruptive alternative to thoracotomy. The direct lateral technique for lumbar pathologies has seen a sharp increase in procedural numbers; however application of this technique in thoracic pathologies has not been widely reported. Methods This study presents the results of three cases where LIF was used to treat symptomatic thoracic disc herniations. Indications for surgery included thoracic myelopathy, radiculopathy and discogenic pain. Patients were treated with LIF, without supplemental internal fixation, and followed for 24 months postoperatively. Results: Average length of hospital stay was 5 days. One patient experienced mild persistent neuropathic thoracic pain, which was managed medically. At 3 months postoperative all patients had returned to work and by 12 months all patients were fused. From preoperative to 24-month follow-up there were mean improvements of 83.3% in visual analogue scale (VAS), 75.3% in Oswestry Disability Index (ODI), and 79.2% and 17.4% in SF-36 physical (PCS) and mental component scores (MCS), respectively. Conclusions LIF is a viable minimally invasive alternative to conventional approaches in treating symptomatic thoracic pathology without an access surgeon, rib resection, or lung deflation. PMID:27683683

  14. Clinical innovations in Philippine thoracic surgery

    PubMed Central

    2016-01-01

    Thoracic surgery in the Philippines followed the development of thoracic surgery in the United States and Europe. With better understanding of the physiology of the open chest and refinements in thoracic anesthetic and surgical approaches, Filipino surgeons began performing thoracoplasties, then lung resections for pulmonary tuberculosis and later for lung cancer in specialty hospitals dealing with pulmonary diseases—first at the Quezon Institute (QI) and presently at the Lung Center of the Philippines although some university and private hospitals made occasional forays into the chest. Esophageal surgery began its early attempts during the post-World War II era at the Philippine General Hospital (PGH), a university hospital affiliated with the University of the Philippines. With the introduction of minimally invasive thoracic surgical approaches, Filipino thoracic surgeons have managed to keep up with their Asian counterparts although the problems of financial reimbursement typical of a developing country remain. The need for creative innovative approaches of a focused multidisciplinary team will advance the boundaries of thoracic surgery in the Philippines. PMID:27651936

  15. [Applications for bronchial blockers in thoracic surgery].

    PubMed

    García-Guasch, R; Campos, J H; Granell, M; Peña, J J

    2007-11-01

    One-lung ventilation is commonly used to facilitate visualization of the field during thoracic surgery. New devices for performing this technique that have become available over the past 2 decades include the Univent bronchial blocker incorporated in a single-lumen tube, the Arndt endobronchial blocker, and the Cohen endobronchial blocker. Although insertion of a double-lumen tube is still the method used most often to isolate the lung, bronchial blockade is an increasingly common technique and, in certain clinical settings, provides advantages over the double-lumen tube. This review provides an update on new concepts in the use of bronchial blockers as a technique for lung isolation and one-lung ventilation. The literature search was performed on MEDLINE through PubMed using the keywords bronchial blockers and thoracic surgery. The search span started with 1982-the year the first modern bronchial blocker was described - and ended with February 2006.

  16. Video-assisted thoracic surgery complications

    PubMed Central

    Kozak, Józef

    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

  17. The European general thoracic surgery database project.

    PubMed

    Falcoz, Pierre Emmanuel; Brunelli, Alessandro

    2014-05-01

    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.

  18. Video assisted thoracic surgery in children

    PubMed Central

    Shah, Rasik; Reddy, A Suyodhan; Dhende, Nitin P

    2007-01-01

    Thoracoscopic surgery, i.e., video assisted thoracic surgery (VATS) has been in use in children for last 98 years. Its use initially was restricted to the diagnostic purposes. However, with the improvement in the optics, better understanding of the physiology with CO2 insufflation, better capabilities in achieving the single lung ventilation and newer vessel sealing devices have rapidly expanded the spectrum of the indication of VATS. At present many complex lung resections, excision of mediastinal tumors are performed by VATS in the experienced centre. The VATS has become the standard of care in empyema, lung biopsy, Mediastinal Lymphnode biopsy, repair of diaphragmatic hernia, etc. The article discusses the indications of VATS, techniques to achieve the selective ventilation and surgical steps in the different surgical conditions in children. PMID:19789677

  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.

  20. Video-Assisted Thoracic Surgery Study Group.

    PubMed

    LoCicero, J

    1993-09-01

    Both patients and the medical profession are quick to embrace new technology, particularly when it may replace an existing surgical procedure. Unfortunately, the rapidity of acceptance is rarely associated with careful evaluation. Laparoscopy is a recent example of such widely embraced technology. Studies of laparoscopy that yielded good comparative data to more traditional methods were slow to accrue. This led to the exposure of its shortcomings through governmental reports and the lay press. To prevent this from happening in thoracoscopy, two types of studies are required so that valid conclusions about the new technology can be drawn. The first is an accounting of the new technology as procedures evolve around it. The data collected in such a study should contain basic information, including the indications for the procedure, how it was performed, procedure length, associated complications, and patient outcome. Such information provides a broad profile of the technology, emphasizing from the outset its potential strengths and weaknesses. The second type of study involves a more detailed concurrent comparison of the specific procedures utilizing this technology to the established traditional methods. Such randomized studies help to firmly establish through scientific process the place of the new technology. The Video-Assisted Thoracic Surgery Study Group was organized in early 1992 to address these concerns. From an initial four surgeons the group has grown to include more than 41 institutions. Currently the group is collecting data in a registry and has established three clinical trials to evaluate video-assisted thoracic surgery.(ABSTRACT TRUNCATED AT 250 WORDS)

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

    PubMed

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

    2013-10-01

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

  2. Minimally invasive thoracic surgery: new trends in Italy

    PubMed Central

    2015-01-01

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

  3. 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.

  4. Thoracic Endoscopic-Assisted Mini-Open Surgery for Thoracic and Thoracolumbar Spinal Cord Compression.

    PubMed

    Xu, Bao-Shan; Xu, Hai-Wei; Yuan, Qiu-Ming; Liu, Yue; Yang, Qiang; Jiang, Hong-Feng; Wang, Dong-Bin; Ji, Ning; Ma, Xin-Long; Zhang, Yang

    2016-11-01

    Intervertebral disc herniation is a common cause of spinal cord compression, especially for the thoracic and thoracolumbar spinal cord, which has limited buffer space in the spinal canal. Spinal cord compression usually causes decreased sensation and paralysis of limbs below the level of compression, urinary and fecal incontinence, and/or urinary retention, which brings great suffering to the patients and usually requires surgical intervention. Thoracotomy or abdominothoracic surgery is usually performed for the thoracolumbar cord compression caused by hard intervertebral disc herniation. However, there is high risk of trauma and complications with this surgery. To reduce the surgical trauma and obtain good visibility, we designed athoracic endoscopic-assisted mini-open surgery for thoracic and thoracolumbar disc herniation, and performed this procedure on 10 patients who suffered from hard thoracic or thoracolumbar spinal cord compression. During the procedure, the thoracic endoscopy provided clear vision of the surgical field with a good light source. The compression could be fully exposed and completely removed, and no nerve root injury or spinal cord damage occurred. All patients achieved obvious recovery of neurological function after this procedure. This technique possesses the merits of minimal trauma, increased safety, and good clinical results. The aim of this study is to introduce this thoracic endoscopic-assisted mini-open surgery technique, and we believe that this technique will be a good choice for the thoracic and thoracolumbar cord compression caused by hard intervertebral disc herniation.

  5. Thoracic and cardiovascular surgery in Japan during 2003: annual report by The Japanese Association for Thoracic Surgery.

    PubMed

    Kazui, Teruhisa; Wada, Hiromi; Fujita, Hiromasa

    2005-09-01

    The Japanese Association for Thoracic Surgery has conducted annual surveys of thoracic surgery to reveal the statistics of the number of procedures according to the operative category throughout the country since 1986. Here we have summarized the results from our annual survey of thoracic surgery performed during 2003. The incidence of hospital mortality was added to this survey to determine the nationwide status that could be useful not only for surgeons to compare their work with that of others, but also for the association to gain a better understanding of present problems as well as future prospects. Thirty-day mortality (sometimes termed operative mortality) is death within 30 days of operation regardless of the patient's geographic location. Thirty-day mortality includes death within 30 days of operation even though the patient is discharged from the hospital within 30 days of operation. Hospital mortality is death within any time interval after operation if the patient is not discharged from the hospital. Hospital-to-hospital transfer is not considered discharge; transfer to a nursing home or a rehabilitation unit is considered hospital discharge unless the patient subsequently dies of complications of the operation (the definitions of terms are based on the published guidelines of the Society of Thoracic Surgeons and the American Association for Thoracic Surgery (Edmunds LH, et al. Ann Thorac Surg 1996; 62: 932-5)). Thoracic surgery was classified into three categories as cardiovascular, general thoracic and esophageal surgery, and the pertinent data were examined and analyzed in each group. Access to the computerized data is offered to all members of this association. We honor and value your continued kind support.

  6. [Perioperative pain management for abdominal and thoracic surgery].

    PubMed

    Englbrecht, J S; Pogatzki-Zahn, E M

    2014-06-01

    Abdominal and thoracic surgical procedures can result in significant acute postoperative pain. Present evidence shows that postoperative pain management remains inadequate especially after "minor" surgical procedures. Various therapeutic options including regional anesthesia techniques and systemic pharmacotherapy are available for effective treatment of postoperative pain. This work summarizes the pathophysiological background of postoperative pain after abdominal and thoracic surgery and discusses the indication, effectiveness, risks, and benefits of the different therapeutic options. Special focus is given to the controversial debate about the indication for epidural analgesia, as well as various alternative therapeutic options, including transversus abdominis plane (TAP) block, paravertebral block (PVB), wound infiltration with local anesthetics, and intravenous lidocaine. In additional, indications and contraindications of nonopioid analgesics after abdominal and thoracic surgery are discussed and recommendations based on scientific evidence and individual risk and benefit analysis are made. All therapeutic options discussed are eligible for clinical use and may contribute to improve postoperative pain outcome after abdominal and thoracic surgical procedures.

  7. Research and education in thoracic surgery: the European trainees' perspective.

    PubMed

    Ilonen, Ilkka K; McElnay, Philip J

    2015-04-01

    Thoracic surgery training within Europe is diverse and a consensus may help to harmonise the training. Currently, training for thoracic surgery compromises thoracic, cardiothoracic and aspects of general surgical training. The recognition of specialist degrees should be universal and equal. Between different nations significant differences in training exist, especially in general surgery rotations and in the role of oesophageal surgery. The European board examination for thoracic surgery is one of the key ways to achieve harmonisation within the European Union (EU) and internationally. Further support and encouragement may be beneficial to promote diverse and engaging fellowships and clinical exchange programmes between nations. International fellowships may even benefit young residents, in both clinical and academic settings. Many studies currently would benefit from multi-centre and multi-national design, enhancing the results and giving better understanding of clinical scenarios. Educational content provided by independent organisations should be more recognised as an integral part in both resident training and continuing development throughout surgeons' careers. During annual society meetings, trainees should have some sessions that are aimed at enhancing their training and establishing networks of international peers.

  8. Thoracic surgery in India: challenges and opportunities

    PubMed Central

    2016-01-01

    India has the dubitable honor of being ranked first in the world with regards to lung disease burden. A good proportion of this disease burden is amenable to surgical treatment. However, patients have limited access to quality thoracic surgical care due to a number of obstacles. This review article summarizes these obstacles and the implied opportunities that exist in this nascent surgical discipline in the world’s second most populous country. PMID:27651933

  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.

  10. Minimally Invasive Direct Thoracic Interbody Fusion (MIS-DTIF): Technical Notes of a Single Surgeon Study

    PubMed Central

    Abbasi, Hamid

    2016-01-01

    Background Minimally invasive direct thoracic interbody fusion (MIS-DTIF) is a new single surgeon procedure for fusion of the thoracic vertebrae below the scapula (T6/7) to the thoracolumbar junction. In this proof of concept study, we describe the surgical technique for MIS-DTIF and report our experience and the perioperative outcomes of the first four patients who underwent this procedure. Study design/setting In this study we attempt to establish the safety and efficacy of MIS-DTIF. We have performed MIS-DTIF on six spinal levels in four patients with degenerative disk disease or disk herniation. We recorded surgery time, blood loss, fluoroscopy time, complications, and patient-reported pain. Methods Throughout the MIS-DTIF procedure, the surgeon is aided by biplanar fluoroscopic imaging and electrophysiological monitoring. The surgeon approaches the spine with a series of gentle tissue dilations and inserts a working tube that establishes a direct connection from the outside of the skin to the disk space. Through this working tube, the surgeon performs a discectomy and inserts an interbody graft or cage. The procedure is completed with minimally invasive (MI) posterior pedicle screw fixation. Results For the single level patients the mean blood loss was 90 ml, surgery time 43 minutes, fluoroscopy time 293 seconds, and hospital stay two days. For the two-level surgeries, the mean blood loss was 27 ml, surgery time 61 minutes, fluoroscopy time 321 seconds, and hospital stay three days. We did not encounter any clinically significant complications. Thirty days post-surgery, the patients reported a statistically significant reduction of 5.3 points on a 10-point sliding pain scale. Conclusions MIS-DTIF with pedicle screw fixation is a safe and clinically effective procedure for fusions of the thoracic spine. The procedure is technically straightforward and overcomes many of the limitations of the current minimally invasive (MI) approaches to the thoracic spine. MIS

  11. Modified uniportal video-assisted thoracic surgery in children

    PubMed Central

    Fernandez-Pineda, Israel; Seims, Aaron D.

    2016-01-01

    Video-assisted thoracic surgery (VATS) has been traditionally performed by a multi-port approach, but uniportal VATS is gaining popularity among thoracic surgeons. The use of only one intercostal space may result in less pain, but competition among camera and operating instruments may be a disadvantage. In children, the limited space in the thorax makes the uniportal VATS difficult to accomplish. We present a modification of the uniportal VATS, using a single skin incision but placing the thoracoscope in the superior or inferior intercostal space relative to the working instruments to increase instrument range of motion within a single intercostal space. PMID:27251823

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

    PubMed

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

    2012-06-01

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

  13. [Complications of thyroid surgery: cervical thoracic duct injuries].

    PubMed

    Avenia, N; Sanguinetti, A; Santoprete, S; Monacelli, M; Cirocchi, R; Lucchini, R; Galasse, S; Calzolari, F; Urbani, M; D'Ajello, F; Puma, F

    2010-10-01

    Thoracic duct injury is uncommon in surgery of the neck: relatively more common after laryngeal and esophageal surgery, rare in thyroid surgery. From January 1986 to June 2009 were treated 14 patients with lesions of the cervical thoracic duct undergo surgery for thyroid disease: 4 goitre cervico-mediastinal and 10 total thyroidectomy for cancer, 9 of which have laterocervical left lymphadenectomy. In 2 cases, the intraoperative detection has allowed immediate ligature. In 12 patients a cervical chylous fistula without chilothorax was found: 5 low-flow fistulas and 7 high-flow fistulas. Of the 5 cases of low-flow fistula, 4 were recovered after 1 month of conservative treatment, only 1 patient required surgical correction. The 7 patients with high-flow fistula were undergoing surgery: 4 in the first week post-operative and 3 after a period of more than 30 days of medical therapy. In patients with high-flow fistula prolonged medical treatment does not provide benefit and increase the risk of complications during and after surgery.

  14. Video-assisted thoracic surgery--state of the art.

    PubMed

    Weissberg, D; Schachner, A

    2000-01-01

    Video-assisted thoracic surgery (VATS) is one of the main medical revolutions of the past decade. For its satisfactory performance, the following prerequisites are essential: (1) knowledge and experience in thoracic surgery; (2) team of experienced anesthesiologists; (3) preoperative assessment of respiratory function; (4) adequate postoperative care; and (5) instruments specially designed for thoracoscopic surgery. VATS is routinely performed under general anesthesia with double lumen endotracheal intubation for separate control of each lung. Insufflation of carbon dioxide must not exceed 1-3 mm Hg. Too high pressure may cause harmful reduction of venous return and mediastinal shift with impairment of ventilation. Presence of adhesions should be determined by finger exploration of the pleural cavity. Operative ports should be placed carefully, avoiding damage to the intercostal nerves and vessels. The video technique can be used with efficiency for the following indications: pneumothorax, resection of pulmonary nodules, biopsies of lung, pleura and mediastinal structures, resection of mediastinal tumors, management of empyema, and hemostasis and closure of lacerations after trauma. Indications for esophageal procedures include esophagomyotomy for achalasia and resections of benign lesions. Repair of perforated esophagus is a matter of controversy, but in early stages it can be done thoracoscopically. Although video-pericardioscopy has been performed by some surgeons, this procedure can be done easier and faster using the direct approach without the video equipment. There are differences of opinion with regard to major pulmonary and esophageal resections for cancer. The apparent advantage of diminished pain is offset by inadequate resection, spread of malignant cells and potential damage to the resected specimen with loss of important information concerning pathology. Complications of VATS are few, and include prolonged air leak, dysrhythmia, respiratory failure

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

    PubMed Central

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

    2008-01-01

    The treatment of thoracic adolescent idiopathic scoliosis (AIS) of more than 80° traditionally consisted of a combined procedure, an anterior release performed through an open thoracotomy followed by a posterior fusion. Recently, some studies have reassessed the role of posterior fusion only as treatment for severe thoracic AIS; the correction rate of the thoracic curves was comparable to most series of combined anterior and posterior surgery, with shorter surgery time and without the negative effect on pulmonary function of anterior transthoracic exposure. Compared with other studies published so far on the use of posterior fusion alone for severe thoracic AIS, the present study examines a larger group of patients (52 cases) reviewed at a longer follow-up (average 6.7 years, range 4.5–8.5 years). The aim of the study was to evaluate the clinical and radiographic outcome of surgical treatment for severe thoracic (>80°) AIS treated with posterior spinal fusion alone, and compare comprehensively the results of posterior fusion with a hybrid construct (proximal hooks and distal pedicle screws) versus a pedicle screw instrumentation. All patients (n = 52) with main thoracic AIS curves greater than 80° (Lenke type 1, 2, 3, and 4), surgically treated between 1996 and 2000 at one institution, by posterior spinal fusion either with hybrid instrumentation (PSF–H group; n = 27 patients), or with pedicle screw-only construct (PSF–S group; n = 25 patients) were reviewed. There were no differences between the two groups in terms of age, Risser’s sign, Cobb preoperative main thoracic (MT) curve magnitude (PSF–H: 92° vs. PSF–S: 88°), or flexibility on bending films (PSF–H: 27% vs. PSF–S: 25%). Statistical analysis was performed using the t test (paired and unpaired), Wilcoxon test for non-parametric paired analysis, and the Mann–Whitney test for non-parametric unpaired analysis. At the last follow-up, the PSF–S group, when compared to the PSF

  16. 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 précis of the evolutionary history of minimally invasive thoracic surgery, and highlights the lessons it provides about its future. PMID:25379198

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

    PubMed Central

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

    2011-01-01

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

  18. Combination Treatment of Perioperative Rehabilitation and Psychoeducation Undergoing Thoracic Surgery

    PubMed Central

    Inoue, Takayuki; Nagaya, Motoki; Ito, Satoru; Nakajima, Hiroki; Hattori, Keiko; Kadono, Izumi; Yokoi, Kohei; Nishida, Yoshihiro

    2017-01-01

    Postoperative pulmonary complications are a risk associated with thoracic surgery. However, there have been few reports on cases at high risk of postoperative complications. Cancer patients often have negative automatic thoughts about illness, and these negative automatic thoughts are associated with reduced health behavior and physical activity. This case series demonstrates the successful combination treatment of perioperative rehabilitation and psychoeducation for negative automatic thoughts in two cancer patients who underwent thoracic surgery. One patient underwent pneumonectomy with laryngeal recurrent nerve paralysis; the other patient, who had a history of recurrent hepatic encephalopathy and dialysis, underwent S6 segmentectomy. Both patients had negative automatic thoughts about cancer-related stress and postoperative pain. The physical therapists conducted a perioperative rehabilitation program in which the patients were educated to replace their maladaptive thoughts with more adaptive thoughts. After rehabilitation, the patients had improved adaptive thoughts, increased physical activity, and favorable recovery without pulmonary complications. This indicates that the combination treatment of perioperative rehabilitation and psychoeducation was useful in two thoracic cancer surgery patients. The psychoeducational approach should be expanded to perioperative rehabilitation of patients with cancer. PMID:28280511

  19. Near-Infrared Fluorescence Imaging of Thoracic Duct Anatomy and Function in Open Surgery and Video-Assisted Thoracic Surgery

    PubMed Central

    Ashitate, Yoshitomo; Tanaka, Eiichi; Stockdale, Alan; Choi, Hak Soo; Frangioni, John V.

    2011-01-01

    Objective Chylothorax resulting from damage to the thoracic duct is often difficult to identify and repair. We hypothesized that near-infrared (NIR) fluorescent light could provide sensitive, real-time, high-resolution intraoperative imaging of thoracic duct anatomy and function. Methods In 16 rats (n=16), four potential NIR fluorescent lymphatic tracers were compared in terms of signal strength and imaging time: indocyanine green (ICG), the carboxylic acid of CW800, ICG adsorbed to human serum albumin (HSA), and CW800 conjugated covalently to HSA (HSA800). The optimal agent was validated in eight pigs approaching the size of humans, n = 6 by open surgery using the Fluorescence-Assisted Resection and Exploration (FLARE) imaging system and n = 2 by video-assisted thoracoscopic surgery (VATS) using the minimally invasive imaging system (m-FLARE). Lymphatic tracer injection site, dose, and timing were optimized. Results For signal strength, sustained imaging time, and clinical translatability, the best lymphatic tracer was ICG, which is already FDA-approved for other indications. In pigs, a simple subcutaneous injection of ICG into the lower leg, at a dose ≥36 μg/kg, provided thoracic duct imaging with an onset of 5 min after injection, sustained imaging for at least 60 min after injection, and a signal-to-background ratio ≥2. Using this technology, normal thoracic duct flow, collateral flow, injury models, and repair models could all be observed under direct visualization. Conclusions NIR fluorescent light could provide sensitive, sustained, real-time imaging of thoracic duct anatomy and function during both open surgery and VATS in animal models. PMID:21477818

  20. Video-assisted thoracoscopic surgery for acute thoracic trauma

    PubMed Central

    Goodman, Michael; Lewis, Jaime; Guitron, Julian; Reed, Michael; Pritts, Timothy; Starnes, Sandra

    2013-01-01

    Background: Operative intervention for thoracic trauma typically requires thoracotomy. We hypothesized that thoracoscopy may be safely and effectively utilized for the acute management of thoracic injuries. Materials and Methods: The Trauma Registry of a Level I trauma center was queried from 1999 through 2010 for all video-assisted thoracic procedures within 24 h of admission. Data collected included initial vital signs, operative indication, intraoperative course, and postoperative outcome. Results: Twenty-three patients met inclusion criteria: 3 (13%) following blunt injury and 20 (87%) after penetrating trauma. Indications for urgent thoracoscopy included diaphragmatic/esophageal injury, retained hemothorax, ongoing hemorrhage, and open/persistent pneumothorax. No conversions to thoracotomy were required and no patient required re-operation. Mean postoperative chest tube duration was 2.9 days and mean length of stay was 5.6 days. Conclusion: Video-assisted thoracoscopic surgery is safe and effective for managing thoracic trauma in hemodynamically stable patients within the first 24 h post-injury. PMID:23723618

  1. Noncardiac thoracic surgery in Abidjan, from 1977 to 2015

    PubMed Central

    Kendja, Flavien; Yangni-Angate, Hervé; Demine, Blaise; Ouédé, Raphaël; Kouacou, Maurice

    2016-01-01

    Background To report and analyze noncardiac thoracic operations performed at the Cardiology Institute of Abidjan (Institut de Cardiologie d’Abidjan) from 1977 to 2015. Methods This is a retrospective and descriptive study covering 39 years, from 1977 to 2015. This study period was divided into three periods of 13 years each: P1 from 1977 to 1989, P2 from 1990 to 2002 and P3 from 2003 to 2015. Medical records of 2014 operated patients were analyzed: 414 patients for P1, 464 patients for P2, 1,136 patients for P3. The records destroyed in a fire in 1997 were not included in the study. The age, sex, pathologies, types of operations, post-operative complications and mortality were analyzed with usual statistical tests. Results The average age varied from 35 years in P1 to 31.6 years in P3. Men predominate in all periods. Distribution of important groups of pathologies observed varies significantly over the three periods; In particular, we note an increase in trauma cases (tripling between P1 and P2, 140% between P2 and P3), and a decrease in tumors percentages, and infections and pulmonary sequelae of tuberculosis. Surgical management of thoracic trauma has increased (56.9% in P3) followed by the pleural surgery (21.3%) and pulmonary resections (13.9%). Persistent air leak >7 days was the predominant complication over the three periods. Postoperative empyema increased in P3 (14.7%). Close chest drainage-irrigation is the most frequent procedure performed to sterilize a major complication like postoperative empyema without bronchopleural fistula. Overall mortality decreased from 5.3% in P1 to 3.4% in P3. Conclusions Noncardiac thoracic surgery operations still concern infections, pulmonary sequelae of tuberculosis, thoracic tumors and many more thoracic trauma caused by current armed conflicts and terrorist attacks. But access to thoracic surgical care remains difficult for our population secondary to low economic status, and lack of a health insurance system

  2. [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.

  3. A review of enhanced recovery for thoracic anaesthesia and surgery.

    PubMed

    Jones, N L; Edmonds, L; Ghosh, S; Klein, A A

    2013-02-01

    During the past decade, there has been a dramatic increase in the number of thoracic surgical procedures carried out in the UK. The current financial climate dictates that more efficient use of resources is necessary to meet escalating demands on healthcare. One potential means to achieve this is through the introduction of enhanced recovery protocols, designed to produce productivity savings by driving reduction in length of stay. These have been promoted by government bodies in a number of surgical specialties, including colorectal, gynaecological and orthopaedic surgery. This review focuses on aspects of peri-operative care that might be incorporated into such a programme for thoracic anaesthesia, for which an enhanced recovery programme has not yet been introduced in the UK, and a review of the literature specific to this area of practice has not been published before. We performed a comprehensive search for published work relating to the peri-operative management and optimisation of patients undergoing thoracic surgery, and divided these into appropriate areas of practice. We have reviewed the specific interventions that may be included in an enhanced recovery programme, including: pre-optimisation; minimising fasting time; thrombo-embolic prophylaxis; choice of anaesthetic and analgesic technique and surgical approach; postoperative rehabilitation; and chest drain management. Using the currently available evidence, the design and implementation of an enhanced recovery programme based on this review in selected patients as a package of care may reduce morbidity and length of hospital stay, thus maximising utilisation of available resources.

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

    PubMed

    París, Francisco; Balibrea, José 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 Monzón, Francisco Martín Lagos, José Gascó, Benjamín Narbona, Carlos Carbonell Antolí, Rafael Vara López, Alfonso de la Fuente Chaos and José M. Beltrán 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.

  5. [Biomedicine in thoracic surgery: state of the art].

    PubMed

    Leistner, M; Steinke, M; Walles, T

    2013-06-01

    Biomedicine represents a new scientific field at the interface of human, molecular and cell biology and medicine. Comprising the diverse disciplines of stem cell research, tissue engineering and material sciences, biomedicine gives rise to new approaches in research and therapy for - to date - unmet medical issues. Biomedical research is currently conducted in many medical, especially surgical subspecialties, and a number of successful developments have already been brought to clinical application. Concerning thoracic surgery, biomedical approaches are pursued primarily for tissue and organ replacement of the upper airways, lung and thoracic wall. In spite of a comparatively small research foundation, five different concepts have been clinically implemented worldwide, due to a lack of established treatment options in the case of extensive disease of the greater airways. In this review, the clinical background and the tissue-specific basics of tracheobronchial biomedicine are presented.

  6. 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

  7. Asian perspectives in thoracic surgery: clinical innovation in Taiwan

    PubMed Central

    Liu, Chao-Yu; Lin, Chen-Sung

    2016-01-01

    The development of minimally-invasive surgery of the thorax began in the 1990s, but not until the recent decade did we see dramatic improvements in patient care and refinement of technique. The current generation has witnessed the evolution from traditional thoracotomy, to a single-port, non-intubated thoracoscopic approach. The investigation of subxiphoid single-port, transumbilical approach, and natural orifice transluminal endoscopic surgery (NOTES) in animal model are also undergoing. In Taiwan, several talented young surgeons have vigorously devoted their ideas and innovations to this field, making the Taiwan surgical society vivid and prosperous. The desire to improve, and willingness to change are the foundation of those surgeons. Providing better patient care is their impetus to strive for improvement. This article provides an account of how minimally-invasive thoracic surgery has evolved in recent years, and what clinical innovations have been developed by the Taiwan surgical society. PMID:27651935

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

    PubMed Central

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

    2016-01-01

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

  9. 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

  10. Video-assisted thoracic surgery (VATS) lobectomy: focus on technique.

    PubMed

    Flores, Raja M

    2010-04-01

    BACKGROUND A clear definition of video-assisted thoracic surgery (VATS) lobectomy is lacking in the current peer-reviewed literature. Reported cases vary from four to six incisions in number, 4.0 to 10.0 cm in length, and with and without rib spreading; in addition, they include direct visualization through a utility incision. Described is a complete standardized three-incision thoracoscopic technique that maximizes the benefits of minimally invasive surgery without compromising oncologic principles. METHODS Patients with clinically suspected stage I non-small-cell lung cancer (NSCLC) were selected for VATS lobectomy on the basis of thoracic computed tomography. VATS lobectomies were performed using a standardized three-incision technique: a 2-cm camera port, a 2-cm posterior port, and a 4 cm utility incision without rib spreading. Hilar structures were individually ligated, fissures were completed, and lymph node dissection was performed entirely under thoracoscopic visualization. RESULTS From May 2002 to December 2009, VATS lobectomy was performed successfully in more than 600 patients at our institution. There were no operative deaths, and the median length of stay was 4 days. CONCLUSIONS Standardized VATS lobectomy is feasible, expeditious, and safe. This standardized three-incision technique utilizing a 4-cm utility incision without rib spreading may allow valid comparisons of conventional procedures in clinical trials.

  11. [Outpatient thoracic surgery: Evolution of the indications, current applications and limits].

    PubMed

    Bagan, P; Berna, P; De Dominicis, F; Lafitte, S; Zaimi, R; Dakhil, B; Das Neves Pereira, J-C

    2016-12-01

    The objectives of outpatient surgery are to reduce the risks connected to hospitalization, to improve postoperative recovery and to decrease the health costs. Few studies have been performed in the field of thoracic surgery and there remains great scope for progress in outpatient lung surgery. The purpose of this article is to present a revue of the current situation and the prospects for the development of out patient thoracic surgery.

  12. Pneumocephalus and Pneumorrhachis due to a Subarachnoid Pleural Fistula That Developed after Thoracic Spine Surgery

    PubMed Central

    Lee, Myung-Ki; Kim, Woo-Jae; Kim, Ho-Sang; Kim, Jeong-Ho; Kim, Yun-Suk

    2016-01-01

    Development of a communication between the spinal subarachnoid space and the pleural space after thoracic spine surgery is uncommon. Subarachnoid pleural fistula (SAPF), a distressing condition, involves cerebrospinal fluid leakage. Here we report an unusual case of SAPF, occurring after thoracic spine surgery, that was further complicated by pneumocephalus and pneumorrhachis postthoracentesis, which was performed for unilateral pleural effusion. PMID:27799999

  13. [Video-assisted thoracic surgery--lobectomy, pneumonectomy].

    PubMed

    Fanta, J

    1996-08-01

    Pneumonectomy performed by the V.A.T.S. method-Video Assisted Thoracic Surgery-calls for great skill, concentration and experience of the surgeon and puts greater demands on him than classical surgery. Minithoracotomy (5-10 cm) combined with videothoracoscopy have the joint advantages of miniinvasive operation and safety and radicality of the operation. During surgery lymphadeaectomy can be performed, it is possible to suture injured arteries or veins. Postoperative recovery is markedly better after V.A.T.S. than after conventional surgery. In the group of the first 11 V.A.T.S. lobectomies and one V.A.T.S. pneumonectomy the authors recorded a very low morbidity and zero mortality. The patients usually do not suffer from postoperative pain and rehabilitate well. The easier, less painful postoperative course is associated with earlier discharge, rapid convalescence and early return to work. V.A.T.S. is, no doubt, a benefit for the patient with regard to the postoperative response and course of recovery.

  14. From Diagnosis to Treatment: Clinical Applications of Nanotechnology in Thoracic Surgery.

    PubMed

    Digesu, Christopher S; Hofferberth, Sophie C; Grinstaff, Mark W; Colson, Yolonda L

    2016-05-01

    Nanotechnology is an emerging field with potential as an adjunct to cancer therapy, particularly thoracic surgery. Therapy can be delivered to tumors in a more targeted fashion, with less systemic toxicity. Nanoparticles may aid in diagnosis, preoperative characterization, and intraoperative localization of thoracic tumors and their lymphatics. Focused research into nanotechnology's ability to deliver both diagnostics and therapeutics has led to the development of nanotheranostics, which promises to improve the treatment of thoracic malignancies through enhanced tumor targeting, controlled drug delivery, and therapeutic monitoring. This article reviews nanoplatforms, their unique properties, and the potential for clinical application in thoracic surgery.

  15. One Hundred Years of History at Stanford University: Thoracic and Cardiovascular Surgery.

    PubMed

    Woo, Y Joseph; Reitz, Bruce A

    2015-01-01

    The history of thoracic and cardiovascular surgery at Stanford spans a century long period, beginning not long after the founding of Stanford University. Pioneering Stanford surgeons have made landmark discoveries and innovations in pulmonary, transplantation, thoracic aortic, mechanical circulatory support, minimally invasive, valvular, and congenital heart surgery. Fundamental research formed the foundation underlying these and many other advances. Educating and training the subsequent leaders of cardiothoracic surgery has throughout this century-long history constituted a mission of the highest merit.

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

    PubMed Central

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

    2015-01-01

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

  17. [Epidemiology of infections on a thoracic surgery service].

    PubMed

    Laxenaire, M C; Borgo, J; Hartemann, P; Villiaume, J M; Borelly, J

    1979-01-01

    The aim of the present work is to discover the origin of the post-operative infections presented by certain patients following surgery for pulmonary exeresis in a surgical unit that deals both with thoracic and general surgical patients (most commonly cancer surgery). A prospective epidaemiological investigation of 54 pulmonary cases was thus undertaken, lasting for a period of 6 months. This consisted in obtaining multiple microbiological specimens from the patient himself, but also from the patient's environment and from the hospital staff (more than 1000 specimens were examined). The study begins at the stage of entry of the patient to the hospital department and follows him through the operation theatre stage and the post-operative period in the intensive care unit. In the intensive care unit the patients will come into contact with other patients who have been admitted urgently. These cases may or may not be of a pulmonary nature. Among the 54 subjects studied, 19 presented with infectious post-operative complications that led to 2 deaths. In 9 cases the infection was due to auto-contamination. It would appear that the environment plays a very small rôle as a factor leading to the development of post-operative infection since very few of the specimens taken were postive and usually the staphylococci were of various different lysotypes and never corresponding to the lysotype of the infective organism. Some predisposing factors to infection were demonstrated: an association with alcoholism and chronic bronchitis, pre-operatory bronchial suppuration, and widespread pulmonary exeresis was found.

  18. Recent clinical innovations in thoracic surgery in Hong Kong

    PubMed Central

    Zhao, Ze-Rui; Li, Zheng; Situ, Dong-Rong

    2016-01-01

    The concept of personalized medicine, which aims to provide patients with targeted therapies while greatly reducing surgical trauma, is gaining popularity among Asian clinicians. Single port video-assisted thoracic surgery (VATS) has rapidly gained popularity in Hong Kong for major lung resections, despite bringing new challenges such as interference between surgical instruments and insertion of the optical source through a single incision. Novel types of endocutters and thoracoscopes can help reduce the difficulties commonly encountered during single-port VATS. Our region has been the testing ground and has led the development of many of these innovations. Performing VATS, in particular single-port VATS in hybrid operating theatre helps to localise small pulmonary lesions with real-time images, thus increasing surgical accuracy and pushes the boundaries in treating subcentimeter diseases. Such approach may be assisted by use of electromagnetic navigational bronchoscopy in the same setting. In addition, sublobar resection can also be more individualised according to pathologic tumour subtype that require rapid intraoperative diagnostic test to guide appropriate surgical therapy. A focus on technology and innovation for large tumours that require chest wall resection and reconstructions have also been on going, with new materials and prostheses that may be tailored to each individual needs. The current paper reviews the literature pertaining to the above topics and discusses recent related innovations in Hong Kong, highlighting the study results and future perspectives. PMID:27651937

  19. [Robot-assisted surgery in visceral and thoracic surgery gynaecology, urology--importantanaesthetic considerations].

    PubMed

    Schütt, Torben; Carstens, Arne; Egberts, Jan-Hendrik; Naumann, Carsten Maik; Höcker, Jan

    2015-02-01

    Robot-assisted surgery, as a development of laparoscopic surgery, has an increasing field of application. Beside urology, this technique has also been implemented in visceral and thoracic surgery and gynaecology. For the surgeon an enhanced view of the surgical field and a better mobility of the instruments are the most important advantages. Thus, it is possible to work more accurate and prevent inadvertent tissue damage. For the anaesthesiologist several characteristics are of importance. Limited access to the patient as a result of a special positioning requires adequate anaesthetic preparation. For many visceral and thoracic surgical interventions the head and airway of the patient is bedded remote from the anaesthesiologist. Therefore, a standardised order and protection of all i. v.-lines, cables and the ventilation-hose of the (double-lumen) tube is essential. After the roboter is connected to the patient, it is nearly impossible to change or extend patient monitoring. Especially in case of emergency, e. g. respiratory complications or heart failure, a close communication with the surgeon and a team approach are indispensable.

  20. Surface anatomy and surface landmarks for thoracic surgery: Part II.

    PubMed

    Smith, Shona E; Darling, Gail E

    2011-05-01

    Surface anatomy is an integral part of a thoracic surgeon's armamentarium to assist with the diagnosis, staging, and treatment of thoracic pathology. As reviewed in this article, the surface landmarks of the lungs, heart, great vessels, and mediastinum are critical for appropriate patient care and should be learned in conjunction with classic anatomy.

  1. 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.

  2. 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

  3. From "awake" to "monitored anesthesia care" thoracic surgery: A 15 year evolution.

    PubMed

    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.

  4. Report on First International Workshop on Robotic Surgery in Thoracic Oncology

    PubMed Central

    Veronesi, Giulia; Cerfolio, Robert; Cingolani, Roberto; Rueckert, Jens C.; Soler, Luc; Toker, Alper; Cariboni, Umberto; Bottoni, Edoardo; Fumagalli, Uberto; Melfi, Franca; Milli, Carlo; Novellis, Pierluigi; Voulaz, Emanuele; Alloisio, Marco

    2016-01-01

    A workshop of experts from France, Germany, Italy, and the United States took place at Humanitas Research Hospital Milan, Italy, on February 10 and 11, 2016, to examine techniques for and applications of robotic surgery to thoracic oncology. The main topics of presentation and discussion were robotic surgery for lung resection; robot-assisted thymectomy; minimally invasive surgery for esophageal cancer; new developments in computer-assisted surgery and medical applications of robots; the challenge of costs; and future clinical research in robotic thoracic surgery. The following article summarizes the main contributions to the workshop. The Workshop consensus was that since video-assisted thoracoscopic surgery (VATS) is becoming the mainstream approach to resectable lung cancer in North America and Europe, robotic surgery for thoracic oncology is likely to be embraced by an increasing numbers of thoracic surgeons, since it has technical advantages over VATS, including intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision. These advantages may make robotic surgery more accessible than VATS to trainees and experienced surgeons and also lead to expanded indications. However, the high costs of robotic surgery and absence of tactile feedback remain obstacles to widespread dissemination. A prospective multicentric randomized trial (NCT02804893) to compare robotic and VATS approaches to stages I and II lung cancer will start shortly. PMID:27822454

  5. Report on First International Workshop on Robotic Surgery in Thoracic Oncology.

    PubMed

    Veronesi, Giulia; Cerfolio, Robert; Cingolani, Roberto; Rueckert, Jens C; Soler, Luc; Toker, Alper; Cariboni, Umberto; Bottoni, Edoardo; Fumagalli, Uberto; Melfi, Franca; Milli, Carlo; Novellis, Pierluigi; Voulaz, Emanuele; Alloisio, Marco

    2016-01-01

    A workshop of experts from France, Germany, Italy, and the United States took place at Humanitas Research Hospital Milan, Italy, on February 10 and 11, 2016, to examine techniques for and applications of robotic surgery to thoracic oncology. The main topics of presentation and discussion were robotic surgery for lung resection; robot-assisted thymectomy; minimally invasive surgery for esophageal cancer; new developments in computer-assisted surgery and medical applications of robots; the challenge of costs; and future clinical research in robotic thoracic surgery. The following article summarizes the main contributions to the workshop. The Workshop consensus was that since video-assisted thoracoscopic surgery (VATS) is becoming the mainstream approach to resectable lung cancer in North America and Europe, robotic surgery for thoracic oncology is likely to be embraced by an increasing numbers of thoracic surgeons, since it has technical advantages over VATS, including intuitive movements, tremor filtration, more degrees of manipulative freedom, motion scaling, and high-definition stereoscopic vision. These advantages may make robotic surgery more accessible than VATS to trainees and experienced surgeons and also lead to expanded indications. However, the high costs of robotic surgery and absence of tactile feedback remain obstacles to widespread dissemination. A prospective multicentric randomized trial (NCT02804893) to compare robotic and VATS approaches to stages I and II lung cancer will start shortly.

  6. 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

  7. Minimalist video-assisted thoracic surgery biopsy of mediastinal tumors

    PubMed Central

    Tacconi, Federico; Rogliani, Paola; Cristino, Benedetto; Gilardi, Francesco; Palombi, Leonardo

    2016-01-01

    Background Mediastinal tumors often require surgical biopsy to achieve a precise and rapid diagnosis. However, subjects with mediastinal tumors may be unfit for general anesthesia, particularly when compression of major vessels or airways does occur. We tested the applicability in this setting of a minimalist (M) uniportal, video-assisted thoracic surgery (VATS) strategy carried out under locoregional anesthesia in awake patients (MVATS). Methods We analyzed in a comparative fashion including propensity score matching, data from a prospectively collected database of patients who were offered surgical biopsy for mediastinal tumors through either MVATS or standard VATS. Tested outcome measures included feasibility, diagnostic yield, and morbidity. Results A total of 24 procedures were performed through MVATS. Diagnostic yield was 100%. Median hospital stay and time interval to oncologic treatment were 2 days (IQR, 2–3 days) and 7 days (IQR, 5.5–11.5 days), respectively. At overall comparison (MVATS, N=24 vs. VATS, N=23), there was a significant difference in both frequency and severity of postoperative complication as measured by Clavien-Dindo classification (P<0.006). In a propensity score matched comparison (8 patients per group), grade 3 or 4 complications requiring aggressive management were found only in the general anesthesia group. Global time spent in the operating room was shorter in the MVATS group (P=0.05). Time interval to oncological treatment was the same between groups. Other differences were also found in SIRS score (P=0.05) and PaO2/FiO2 (P=0.04) thus suggesting better adaption to perioperative stress. Conclusions MVATS biopsy appears to be a reliable tool to optimize diagnostic assessment in patients with mediastinal tumors. It can offer high diagnostic accuracy due to large tissue samples, while reducing morbidity rate compared to the same operation under general anesthesia. More robust evaluation is needed to define the appropriateness of

  8. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2017 Update on Outcomes and Quality.

    PubMed

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

    2017-01-01

    Established in 1989, The Society of Thoracic Surgeons Adult Cardiac Surgery Database is one of the most comprehensive clinical data registries in health care. It is widely regarded as the gold standard for benchmarking risk-adjusted outcomes in cardiac surgery and is the foundation for all quality measurement and improvement activities of The Society of Thoracic Surgeons. This is the second in a series of annual reports that summarizes current aggregate national outcomes in cardiac surgery and reviews database-related activities in the areas of quality measurement and performance improvement during the past year.

  9. The Society of Thoracic Surgeons Adult Cardiac Surgery Database: 2016 Update on Outcomes and Quality.

    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.

  10. Isolated long thoracic nerve paralysis - a rare complication of anterior spinal surgery: a case report

    PubMed Central

    2009-01-01

    Introduction Isolated long thoracic nerve injury causes paralysis of the serratus anterior muscle. Patients with serratus anterior palsy may present with periscapular pain, weakness, limitation of shoulder elevation and scapular winging. Case presentation We present the case of a 23-year-old woman who sustained isolated long thoracic nerve palsy during anterior spinal surgery which caused external compressive force on the nerve. Conclusion During positioning of patients into the lateral decubitus position, the course of the long thoracic nerve must be attended to carefully and the nerve should be protected from any external pressure. PMID:19830192

  11. Prevention and Management of Nerve Injuries in Thoracic Surgery.

    PubMed

    Auchincloss, Hugh G; Donahue, Dean M

    2015-11-01

    Nerve injuries can cause substantial morbidity after thoracic surgical procedures. These injuries are preventable, provided that the surgeon has a thorough understanding of the anatomy and follows important surgical principles. When nerve injuries occur, it is important to recognize the options available in the immediate and postoperative settings, including expectant management, immediate nerve reconstruction, or auxiliary procedures. This article covers the basic anatomy and physiology of nerves and nerve injuries, an overview of techniques in nerve reconstruction, and a guide to the nerves most commonly involved in thoracic operative procedures.

  12. Can chronic neuropathic pain following thoracic surgery be predicted during the postoperative period?

    PubMed

    Searle, Robert D; Simpson, Matthew P; Simpson, Karen H; Milton, Richard; Bennett, Michael I

    2009-12-01

    Chronic pain following thoracic surgery is common and associated with neuropathic symptoms, however, the proportion of patients with neuropathic pain in the immediate postoperative period is unknown. We aimed to determine the proportion of patients who have neuropathic symptoms and signs immediately after, and at three months following thoracic surgery. The study was designed as a prospective observational cohort study. We identified patients with pain of predominantly neuropathic origin using the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) score in the immediate postoperative period and the self-report LANSS (S-LANSS) version three months after surgery. One hundred patients undergoing video assisted thoracic surgery (VATS) or thoracotomy completed LANSS scores preoperatively and in the immediate postoperative period. Eighty-seven percent completed three months S-LANSS follow-up scores. Eight percent of patients had positive LANSS scores in the immediate postoperative period; 22% of patients had positive S-LANSS scores three months following surgery. There was a significant association between positive scores in the acute and chronic periods (relative risk (RR) 3.5, [95% confidence interval (CI) 1.7-7.2]). Identifying pain of predominantly neuropathic origin in the postoperative period with a simple pain score can help identify those at risk of developing chronic pain with these features following thoracic surgery.

  13. Penetrating thoracic injury with retained foreign body: can video-assisted thoracic surgery take up the leading role in acute management?

    PubMed Central

    Yu, Peter S. Y.; Chan, Herman H. M.; Lau, Rainbow W. H.; Capili, Freddie G.; Underwood, Malcolm J.

    2016-01-01

    Video-assisted thoracic surgery (VATS) is widely adopted in acute management of patient with thoracic trauma, but its use in penetrating thoracic injuries with retained foreign bodies were rarely reported. We described three of such cases using VATS as the first line approach. Identification of injuries, control of bleeders, clot evacuation, resection of damaged lung parenchyma and safe retrieval of foreign bodies were all performed via complete VATS within short operative time. Patient were uneventfully discharged during early post-operative period. We suggest that, for haemodynamically stable patients, VATS offers a safe and minimally-invasive alternative to conventional thoracotomy for penetrating thoracic injury with retained foreign bodies. PMID:27621884

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

    PubMed

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

    2015-08-01

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

  15. The Frozen Elephant Trunk Technique: European Association for Cardio-Thoracic Surgery Position and Bologna Experience

    PubMed Central

    Di Marco, Luca; Pantaleo, Antonio; Leone, Alessandro; Murana, Giacomo; Di Bartolomeo, Roberto; Pacini, Davide

    2017-01-01

    Complex lesions of the thoracic aorta are traditionally treated in 2 surgical steps with the elephant trunk technique. A relatively new approach is the frozen elephant trunk (FET) technique, which potentially allows combined lesions of the thoracic aorta to be treated in a 1-stage procedure combining endovascular treatment with conventional surgery using a hybrid prosthesis. These are very complex and time-consuming operations, and good results can be obtained only if appropriate strategies for myocardial, cerebral, and visceral protection are adopted. However, the FET technique is associated with a non-negligible incidence of spinal cord injury, due to the extensive coverage of the descending aorta with the excessive sacrifice of intercostal arteries. The indications for the FET technique include chronic thoracic aortic dissection, acute or chronic type B dissection when endovascular treatment is contraindicated, chronic aneurysm of the thoracic aorta, and chronic aneurysm of the distal arch. The FET technique is also indicated in acute type A aortic dissection, especially when the tear is localized in the aortic arch; in cases of distal malperfusion; and in young patients. In light of the great interest in the FET technique, the Vascular Domain of the European Association for cardio-thoracic Surgery published a position paper reporting the current knowledge and the state of the art of the FET technique. Herein, we describe the surgical techniques involved in the FET technique and we report our experience with the FET technique for the treatment of complex aortic disease of the thoracic aorta. PMID:28180096

  16. Evaluation of Outcome of Transpedicular Decompression and Instrumented Fusion in Thoracic and Thoracolumbar Tuberculosis

    PubMed Central

    Jain, R.K.; Kiyawat, Vivek

    2017-01-01

    Study Design Retrospective analysis. Purpose We evaluated the functional, neurological, and radiological outcome in patients with thoracic and thoracolumbar tuberculosis operated through the transpedicular approach. Overview of Literature For surgical treatment of thoracic and thoracolumbar tuberculosis, the anterior approach has been the most popular because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The transpedicular approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach. Methods A total of 47 patients were diagnosed with tuberculosis of the thoracic or thoracolumbar region from August 2012 to August 2013. Of these, 28 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent transpedicular decompression and pedicle screw fixation with posterior fusion. Antituberculosis therapy was given till signs of radiological healing were evident (9–16 months). Functional outcome (visual analog scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediate postoperatively, and at 3 months, 6 months, and 1 year. Results Mean VAS score for back pain improved from 8.7 preoperatively to 1.1 at 1 year follow-up. Frankel grading preoperatively was grade B in 7, grade C in 11, and Grade D in 10 patients, which improved to grade D in 6 and grade E in 22 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. Mean correction of segmental kyphosis postoperatively was 10.5°. Mean loss of correction at final follow-up was 4.1°. Conclusions Transpedicular

  17. Bleeding risk associated with eptifibatide (Integrilin) bridging in thoracic surgery patients.

    PubMed

    Waldron, Nathan H; Dallas, Torijaun; Erhunmwunsee, Loretta; Wang, Tracy Y; Berry, Mark F; Welsby, Ian J

    2017-02-01

    Antiplatelet use for treatment of coronary artery disease (CAD) is common amongst thoracic surgery patients. Perioperative management of antiplatelet agents requires balancing the opposing risks of myocardial ischemia and excessive bleeding. Perioperative bridging with short-acting intravenous antiplatelet agents has shown promise in preventing myocardial ischemia, but may increase bleeding. We sought to determine whether perioperative bridging with eptifibatide increased bleeding associated with thoracic surgery. After Institutional Review Board approval, we identified thoracic surgery patients receiving eptifibatide at our institution (n = 30). These patients were matched 1:2 with control patients with CAD who did not receive eptifibatide from an institutional database of general thoracic surgery patients. The primary endpoint for our study was the number of units of blood transfused perioperatively. There were no differences in our primary endpoint, number of units of blood products transfused. There were also no differences noted between groups in intraoperative blood loss, chest tube duration, or postoperative length of stay (LOS). While there were no difference noted in overall complications, including our outcome of perioperative MI or death, composite cardiovascular events were more common in the eptifibatide group. In our retrospective exploratory analysis, eptifibatide bridging in patients with high-risk or recent PCI was not associated with an increased need for perioperative transfusion, bleeding, or increased LOS. In addition, we found a similar rate of perioperative mortality or myocardial infarction in both groups, though the ability of eptifibatide to protect against perioperative myocardial ischemia is unclear given different baseline CAD characteristics.

  18. Clinical use of near-infrared fluorescence imaging with indocyanine green in thoracic surgery: a literature review

    PubMed Central

    Chiu, Chien-Hung; Chao, Yin-Kai; Wen, Chih-Tsung; Chen, Wei-Hsun; Wu, Ching-Yang; Hsieh, Ming-Ju; Wu, Yi-Cheng; Liu, Hui-Ping

    2016-01-01

    Invisible near-infrared (NIR) fluorescence imaging with indocyanine green (ICG) has advantage in detecting for certain anatomy. The method is currently used in some types of surgery, such as sentinel lymph node (SLN) mapping, intraoperative solid tumor identification, and organ perfusion assessment. However, the literature of clinical application in thoracic surgery is lacking. This paper presents the advantages, current applications and potential developments of NIR fluorescence imaging with ICG in thoracic surgery. PMID:28066678

  19. [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.

  20. [Single-port video-assisted thoracic surgery in an awake patient].

    PubMed

    Alonso-García, F J; Navarro-Martínez, J; Gálvez, C; Rivera-Cogollos, M J; Sgattoni, C; Tarí-Bas, I M

    2016-03-01

    Video-assisted thoracic surgery is traditionally carried out with general anaesthesia and endotracheal intubation with double lumen tube. However, in the last few years procedures, such as lobectomies, are being performed with loco-regional anaesthesia, with and without sedation, maintaining the patient awake and with spontaneous breathing, in order to avoid the inherent risks of general anaesthesia, double lumen tube intubation and mechanical ventilation. This surgical approach has also shown to be effective in that it allows a good level of analgesia, maintaining a correct oxygenation and providing a better post-operative recovery. Two case reports are presented in which video-assisted thoracic surgery was used, a lung biopsy and a lung resection, both with epidural anaesthesia and maintaining the patient awake and with spontaneous ventilation, as part of a preliminary evaluation of the anaesthetic technique in this type of surgery.

  1. Applications of indocyanine green based near-infrared fluorescence imaging in thoracic surgery

    PubMed Central

    Zhou, Jian; Jiang, Guanchao; Wang, Jun

    2016-01-01

    Near-infrared (NIR) fluorescence guided surgery is an emerging technique. This technique uses the combination of dyes and NIR imaging devices to expand the visible spectrum. Thus it can provide more anatomic and functional information, and may facilitate a more complete resection of cancer, or better protection of important normal structures. Recently, significant progress has been made in the field of NIR fluorescence guided thoracic surgery. This may lead to better prognosis and health-economic outcomes. In this article, the current studies of indocyanine green (ICG) based NIR fluorescence guided thoracic surgeries are reviewed. The applications are classified into four categories, which are applications based on blood supply, lymphatic drainage, the enhanced permeability and retention (EPR) effect, and the other mechanisms. PMID:28066677

  2. 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

  3. Current Topics on Salvage Thoracic Surgery in Patients with Primary Lung Cancer

    PubMed Central

    2016-01-01

    Salvage primary tumor resection is sometimes considered for isolated local failures after definitive chemoradiation, urgent matters, such as hemoptysis (palliative intent), and in cases judged to be contraindicated for chemotherapy or definite radiation due to severe comorbidities, despite an initial clinical diagnosis of stage III or IV disease. However, salvage surgery is generally considered to be technically more difficult, with a potentially higher morbidity. This review discusses the current topics on salvage thoracic surgery such as the definition of salvage surgery and its outcome, and future perspectives. PMID:26948299

  4. The incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy

    PubMed Central

    Wang, Hui; Ma, Lei; Xue, Rui; Yang, Dalong; Wang, Tao; Wang, Yanhong; Yang, Sidong; Ding, Wenyuan

    2016-01-01

    Abstract The aim of this study was to explore the incidence and risk factors of postoperative neurological deterioration after posterior decompression with or without instrumented fusion for thoracic myelopathy, and hope to provide references in decision-making and surgical planning for both spinal surgeon and thoracic stenosis patients. By retrieving the medical records from January 2001 to November 2015, 168 patients were retrospectively reviewed. According to the occurrence of postoperative neurological deterioration, patients were divided into 2 groups: neurological deterioration (ND) group and non-ND group. To investigate risk values for the occurrence of ND, 3 categorized factors were analyzed statistically: patient characteristics—preoperative data of age, sex, body mass index, bone mineral density, the duration of disease (from first symptoms to operation), the preoperative neurological function (Frankel grade), and diagnosis; surgical variables—surgery time, the amount of bleeding, mean arterial pressure, intervertebral fusion or not, and instrumentation or not; radiographic parameters—the spinal canal occupancy ratio, location of the lesion, thoracic kyphosis, and kyphosis correction. Postoperative neurological deterioration was developed in 23 of 168 patients (13.7%), and were enrolled as ND group. There was no statistically significant difference between the 2 groups in age at operation, sex composition, body mass index, and bone mineral density. The preoperative diagnosis presented significant difference between the 2 groups, because ossification of posterior longitudinal ligament combined with ossification of the ligamentum flavum was more common in ND group, whereas ossification of the ligamentum flavum alone was more common in non-ND group. There was no difference between the 2 groups in mean surgery time, the incidence of intraoperative direct trauma, and the number of patients that received instrumentation. The mean bleeding was much more in

  5. 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.

  6. 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

  7. Is there a role for Gabapentin in preventing or treating pain following thoracic surgery?

    PubMed Central

    Zakkar, Mustafa; Frazer, Stephanie; Hunt, Ian

    2013-01-01

    A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether gabapentin, a commonly prescribed neuropathic analgesic and anticonvulsant, is safe and beneficial in patients with post-thoracotomy pain following thoracic surgery. Seventeen papers were identified using the search described below, and five papers presented the best evidence to reach conclusions regarding the issues of interest for this review. Side effects and complications as well as evidence of benefit, typically using various pain-scoring systems, were included in the assessment. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. The systematic review of two randomized controlled trials (RCTs) demonstrated that the use of a single dose gabapentin does not reduce pain scores or the need for epidural or morphine immediately in hospital following thoracic surgery. One double-blinded RCT used multiple doses of gabapentin perioperatively and showed that oral gabapentin administered preoperatively and during the first 2 days postoperatively, in conjunction with patient controlled analgesia morphine, provides effective analgesia in thoracic surgery with a consequent improvement in postoperative pulmonary function and less morphine consumption. One prospective clinical study comparing a 2-month course of gabapentin with naproxen sodium for chronic post thoracotomy pain following surgery showed significant improvement in both the visual analogue scale (VAS) score and the Leeds assessment of neuropathic symptoms and signs (LANSS) at 60 days in the gabapentin (P = 0.001). One prospective study of out-patients with chronic pain (>4 weeks since thoracotomy performed) suggested that gabapentin is effective, safe and well tolerated when used for persistent postoperative and post-traumatic pain in thoracic surgery patients. We conclude that

  8. German Heart Surgery Report 2015: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.

    PubMed

    Beckmann, Andreas; Funkat, Anne-Katrin; Lewandowski, Jana; Frie, Michael; Ernst, Markus; Hekmat, Khosro; Schiller, Wolfgang; Gummert, Jan F; Welz, Armin

    2016-09-01

    On the basis of a long-standing voluntary registry, which was founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), well-defined data of all heart, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during 2015 are analyzed. In 2015, a total of 103,967 heart surgery procedures (implantable cardioverter defibrillator, pacemaker, and extracardiac procedures without ECC excluded) were submitted to the database. Approximately 14.8% of the patients were at least 80 years old, resulting in an increase of 0.6% compared with the data of 2014. For 38,601 isolated coronary artery bypass grafting procedures (relationship on-/off-pump: 5:1), the unadjusted inhospital mortality was 2.7%. Concerning the 32,346 isolated heart valve procedures (including 10,606 catheter-based implantations) an unadjusted inhospital mortality of 4.4% was observed.This annual updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, demonstrates advancements in heart medicine, and enables internal/external quality assurance for all participants. In addition, the registry demonstrates that the provision of heart surgery in Germany is appropriate and patients are treated nationwide in a round-the-clock service.

  9. [Management of patients with arrhythmias undergoing thoracic surgery].

    PubMed

    Ishibashi, H; Okubo, K

    2012-07-01

    Recentry, surgical candidates have become older and have more surgical risk factors, perioperative patient management become more important than before. In the patients with significant arrhythmia observed in the preoperative period, examination of the baseline heart disease, i.e. myocardial ischemia or congestive heart failure, is mandatory and, if necessary, adequate treatment such as defibrillator, the implantation of a pacemaker, anticoagulation therapy, or other medical therapy should be performed. In the patients with atrial fibrillation, clinical prediction rules such as the congestive heart failure, hypertension, age>75, diabetes, previous stroke or transient ischemic attack (TIA) [CHADS 2] score have been developed to identify those patients at highest risk for thrombo-embolism and can be used when assessing the need for bridging anticoagulation by heparin prior to surgery. The electrical stimulus from electrocautery may inhibit demand pacemakers or may reprogram the pacemaker. An asynchronous or non-sensing pacemaker mode is recommended in patients who are pacemaker dependent and whose underlying rhythm is unreliable. The device has to be checked to ensure appropriate programming and sensing pacing thresholds after surgery. The implantable cardioverter defibrillator should be turned off during surgery and switched on in the recovery phase before discharge to the ward.

  10. Real life cardio-thoracic surgery training in Europe: facing the facts.

    PubMed

    Sádaba, Justo Rafael; Loubani, Mahmoud; Salzberg, Sacha P; Myers, Patrick O; Siepe, Matthias; Sardari Nia, Peyman; O'Regan, David J

    2010-09-01

    The objective of this study was to determine the current status of training in cardio-thoracic surgery in Europe and the residents' perception of the effects of the full implementation of the European Working Time Directive (EWTD) on training. We conducted a web-based survey of trainees registered with the European Association of Cardio-Thoracic Surgery and 79 respondents form the basis for this analysis. A majority of trainees (69.6%) are aware of the implications of the EWTD and 58.7% believe it will have an impact on their training. Most residents (98.7%) work well over the time limitations stated in the Directive and 96.2% are of the opinion that a 48-hour week would be insufficient to meet their learning needs. A large proportion (60.5%) of European trainees are dissatisfied with their training and report low-levels of regular assessment of their progress (37.8%) and of training facilities (27.4%). Only 23.3% of European trainers appear to attend training courses. Striking differences exist among European countries with regards to standards of training. These findings are alarming. Training in cardio-thoracic surgery across the European Union requires urgent attention to unify and improve the standards of training and compensate the potential negative impact of the EWTD.

  11. Postoperative complications after thoracic surgery for lung cancer.

    PubMed

    Maugeri, Laura; Corbo, Giuseppe Maria; Valente, Salvatore

    2004-01-01

    Postoperative complications and related risk factors after lung reduction surgery are analyzed based on a review of the literature. In particular the pathogenesis of some of postoperative respiratory disorders is carefully assessed. Most commonly cardiac arrhythmias, respiratory failure, bronchopleural fistula are observed. Main risk factors for postoperative complications are old age, chronic obstructive pulmonary disease, coronary disease, poor nutritional state, neoadjuvant therapy. Attention should be paid to all these factors, both in preoperative assessment and postoperative care, to prevent and promptly treat postoperative complications.

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

    PubMed

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

    2015-12-01

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

  13. Non-grasping en bloc mediastinal lymph node dissection through uniportal video-assisted thoracic surgery for lung cancer surgery

    PubMed Central

    Liu, Chengwu; Ma, Lin; Guo, Chenglin

    2016-01-01

    Uniportal video-assisted thoracic surgery (VATS) has been demonstrated to be feasible, safe, and effective for lung cancer surgery compared with traditional multi-portal VATS. However, complete mediastinal lymph node dissection (MLND) through uniportal VATS is still a difficult work due to more limited access, and most thoracic surgeons use strategies of grasping, accompanied with which are complicated instrumentation and mutual interference among them. To simplify the instrumentation and make MLND more comfortable, we developed the method of “non-grasping en bloc MLND” and applied it during uniportal VATS lung cancer surgery. Two main instruments (suction and energy devices) were developed with diversified use. And only the two instruments were used during MLND following the strategy of “non-grasping”. This technique incorporates with several advantages, such as: simplified instrumentation, decreased risk of damages to lymph nodes, and en bloc dissection. Considering the limited access, this technique fits well with the uniportal procedure and truly interprets the concept of “less is more” during uniportal VATS MLND. PMID:27867574

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

    PubMed Central

    2016-01-01

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

  15. Acute gastric incarceration from thoracic herniation in pregnancy following laparoscopic antireflux surgery

    PubMed Central

    Brygger, Louise; Fristrup, Claus Wilki; Harbo, Frederik Severin Gråe; Jørgensen, Jan Stener

    2013-01-01

    Diaphragmatic hernia is a rare complication in pregnancy which due to misdiagnosis or management delays may be life-threatening. We report a case of a woman in the third trimester of pregnancy who presented with sudden onset of severe epigastric and thoracic pain radiating to the back. Earlier in the index pregnancy, she had undergone laparoscopic antireflux surgery (ARS) for a hiatus hernia because of severe gastro-oesophageal reflux. Owing to increasing epigastric pain a CT scan was carried out which diagnosed wrap disruption with gastric herniation into the thoracic cavity and threatened incarceration. This is, to our knowledge, the first report of severe adverse outcome after ARS during pregnancy, with acute intrathoracic gastric herniation. We recommend the avoidance of ARS in pregnancy, and the need to advise women undergoing ARS of the postoperative risks if pregnancy occurs within a few years of ARS. PMID:23378556

  16. Physiotherapy Practice Patterns for Management of Patients Undergoing Thoracic Surgeries in India: A Survey

    PubMed Central

    Sultanpuram, Sagarika; Ottayil, Zulfeequer C. P.

    2016-01-01

    Aim. The aim of the current study is to determine the practice patterns of physiotherapists for patients undergoing thoracic surgeries in India. Materials and Methodology. A cross-sectional survey was conducted across India in which 600 questionnaires were sent in emails to physiotherapists. The questionnaire addressed assessment and treatment techniques of thoracic surgery. Results. A total of 234 completed questionnaires were returned with a response rate of 39%, with the majority of responses received from Telangana, Karnataka, and Andhra Pradesh. More than 90% of the responders practiced physical examination, chest expansion, chest X-ray, ABG analysis, pulmonary function test, and SpO2 (oxygen saturation) as the assessment measures in both the pre- and the postoperative phase. Breathing exercises, incentive spirometry, thoracic expansion exercises, coughing and huffing, positioning, and modified postural drainage are found to be commonly used physiotherapy interventions, both pre- and postoperatively, with a response rate of more than 90%. A response rate of more than 84.6% indicated that patients are made to dangle their lower limbs over the edge of the bed on the 1st postoperative day. Mobilization, such as walking up to a chair, sit to stand exercises, and perambulation within the patient's room, was started on the 2nd postoperative day, as stated by more than 65% of the physiotherapists. Staircase climbing was started on the 5th postoperative day. The most commonly used functional evaluation prior to discharge was 6-minute walk test. This was, in fact, practiced by 77.4% of the physiotherapists in their clinical settings. Conclusion. The most predominantly employed assessment measures included were physical examination, chest expansion, ABG analysis, pulmonary function test, chest X-ray, SpO2 (oxygen saturation), peripheral muscle strength, and cardiopulmonary exercise. The physiotherapy interventions most commonly used were breathing exercises, thoracic

  17. Static and Dynamic Parameters in Patients With Degenerative Flat Back and Change After Corrective Fusion Surgery

    PubMed Central

    2016-01-01

    Objective To evaluate characteristics of static and dynamic parameters in patients with degenerative flat back (DFB) and to compare degree of their improvement between successful and unsuccessful surgical outcome groups Methods Forty-seven patients with DFB were included who took whole spine X-ray and three-dimensional motion analysis before and 6 months after corrective surgery. Forty-four subjects were selected as a control group. As static parameters, thoracic kyphosis (TK), thoracolumbar junction (TLJ), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), and pelvic tilt (PT) were measured. As dynamic parameters, maximal and minimal angle of pelvic tilt, lower limb joints, and thoracic and lumbar vertebrae column (dynamic TK and LL) in sagittal plane were obtained. Results The DFB group showed smaller TK and larger LL, pelvic posterior tilt, hip flexion, knee flexion, and ankle dorsiflexion than the control group. Most of these parameters were significantly corrected by fusion surgery. Dynamic spinal parameters correlated with static spinal parameters. The successful group obtained significant improvement in maximal and minimal dynamic LL than the unsuccessful group. Conclusion The DFB group showed characteristic lower limb and spinal angles in dynamic and static parameters. Correlation between static and dynamic parameters was found in spinal segment. Dynamic LL was good predictor of successful surgical outcomes. PMID:27606275

  18. A comparative cost analysis study of lobectomy performed via video-assisted thoracic surgery versus thoracotomy in Turkey

    PubMed Central

    Lacin, Tunc; Teker, Dilek; Okur, Erdal; Baysungur, Volkan; Kanbur, Serda; Misirlioglu, Aysun Kosif; Sonmez, Hakan; Yalcinkaya, Irfan; Kiyak, Mithat

    2014-01-01

    Introduction Cost analysis studies performed in western countries report that the overall cost of lobectomies performed via video-assisted thoracic surgery is similar to or less than those performed via thoracotomy. The situation may be different in a developing country. Aim We evaluated the cost differences of these two surgical methods. Material and methods We retrospectively reviewed the hospital records of 81 patients who underwent lobectomy either via video-assisted thoracic surgery (n = 32) or via thoracotomy (n = 49). Patient characteristics, pathology, perioperative complications, additional surgical procedures, length of hospital and intensive care unit stay, and outcomes of both groups were recorded. Detailed cost data for medications, anesthesia, laboratory, surgical instruments, disposable instruments and surgery cost itself were also documented. Statistical analyses were performed to compare the groups. Results The two groups were homogeneous in regard to age, sex, pathology and perioperative morbidity. The mean duration of hospitalization in the video-assisted thoracic surgery group was significantly shorter than that of the thoracotomy group (7.78 ±5.11 days vs. 10.65 ±6.57 days, p < 0.05). Overall final mean cost in the video-assisted thoracic surgery group was significantly higher than that of the thoracotomy group ($3970 ±1873 vs. $3083 ±1013, p = 0.002). This significant difference relies mostly on the cost of disposable surgical instruments, which were used much more in the video-assisted thoracic surgery group than the thoracotomy group ($2252 ±1856 vs. $427 ±47, p < 0.05). Conclusions In contrast to western countries, a video-assisted thoracic surgical lobectomy may cost more than a lobectomy via thoracotomy in a developing country. More expensive disposable surgical instruments and cheaper hospital stay charges lead to higher overall costs in video-assisted thoracic surgical lobectomy patients. PMID:25337166

  19. Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to ­­image-guided video-assisted thoracoscopic surgery

    PubMed Central

    Terra, Ricardo Mingarini; Andrade, Juliano Ribeiro; Mariani, Alessandro Wasum; Garcia, Rodrigo Gobbo; Succi, Jose Ernesto; Soares, Andrey; Zimmer, Paulo Marcelo

    2016-01-01

    ABSTRACT The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases. PMID:27812640

  20. [Non fusion techniques in spinal surgery].

    PubMed

    Schizas, C; Duff, J M; Tessitore, E; Faundez, A

    2009-12-16

    In order to prevent adjacent segment degeneration following spinal fusion new techniques are being used. Lumbar disc arthroplasty yields mid term results equivalent to those of spinal fusion. Cervical disc arthroplasty is indicated in the treatment of cervicobrachialgia with encouraging initial results. The ability of arthroplasty to prevent adjacent segment degeneration has yet to be proven. Although dynamic stabilization had not been proven effective in treating chronic low back pain, it might be useful following decompression of lumbar spinal stenosis in degenerative spondylolisthesis. Interspinal devices are useful in mild lumbar spinal stenosis but their efficacy in treating low back pain is yet to be proven. Confronted with a growing number of new technologies clinicians should remain critical while awaiting long term results.

  1. TNM Staging Matched-pair Comparison of Surgery After Neoadjuvant Chemoradiotherapy, Surgery Alone and Definitive Chemoradiotherapy for Thoracic Esophageal Squamous Cell Carcinoma

    PubMed Central

    Liu, ShiLiang; Qiu, Bo; Luo, GuangYu; Liang, Ying; Zheng, YuZhen; Chen, ZhaoLin; Luo, KongJia; Xi, Mian; Liu, Qing; Hu, YongHong; Li, Qun; Fu, JianHua; Liu, MengZhong; Yang, Hong; Liu, Hui

    2017-01-01

    Introduction: We used the TNM staging matched-pair approach to compare the efficacies of surgery after neoadjuvant chemoradiotherapy (NCT), surgery alone and definitive chemoradiotherapy (CCRT) in patients with localized advanced thoracic esophageal squamous cell carcinoma (ESCC). Methods: A total of 642 patients with ESCC from previous studies were studied. Patients whose treatment involved NCT + surgery and surgery alone were compared with patients receiving CCRT. Prospensity score matched-pair comparison based on pre-treatment TNM staging was developed to assess the efficacies of these treatment options. Results: Prospensity score matched-pair comparison to control for bias generated a cohort of 274 patients who were eligible for comparison. The 3-year OS rate was 70.0% in the NCT + surgery group, compared to 51.7% in the surgery group (p=0.000) and 61.9% in the CCRT group (p=0.082). With the TNM staging matched-pair approach, the CCRT group had more upper thoracic ESCC patients (43/92, 46.7%), while the surgery group had more lower thoracic ESCC patients (37/92, 40.2%). The 3-year OS rates were comparable between the surgery alone group and CCRT group (p=0.109). Conclusions: NCT plus surgery was superior in OS to surgery alone or CCRT. The 3-year OS rates were comparable between the surgery alone group and CCRT group with TNM staging matched-pair approach. Further investigation is warranted to confirm these findings. PMID:28367248

  2. 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.

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

    PubMed

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

    2014-01-01

    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.

  4. [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.

  5. Thoracic disc herniation: An unusual complication after prone positioning in spinal surgery

    PubMed Central

    Ebrahim, Mohammed Zahier; Vlok, Adriaan J.

    2016-01-01

    Neurological complications of the prone position have been well documented. Post-operative paraplegia and neurological deterioration unrelated to the site of surgery after proning in spinal surgery is a rare but potentially devastating complication. We describe the case of a 47 year old female who underwent an L4/5 discectomy and posterior instrumented fusion. A few hours after surgery she developed bilateral lower limb weakness with a T11 sensory level. Post-operative MRI revealed an acute disc herniation at the T11/12 level with associated spinal cord compression. This was not present on the pre-operative imaging. A subsequent T11/12 discectomy and instrumented fusion was performed and the patient's motor and sensory function returned to normal.

  6. Use of N-butyl-2-cyanoacrylate tissue glue in thoracic duct injury during neck dissection surgery.

    PubMed

    Blythe, J N St J; Habib, A; Gulati, A; Brennan, P A

    2011-09-01

    Although thoracic duct injury is an uncommon complication of neck dissection, it can have a significant physiological and immunological impact on the patient's recovery as well as having more serious effects. We report a novel technique of using cyanoacrylate tissue glue for managing thoracic duct damage when this is noted at the time of neck dissection surgery. We have used this technique in four patients with no post-operative chyle leak or added complications.

  7. An initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery

    PubMed Central

    Costa, Altair da Silva; Bachichi, Thiago; Holanda, Caio; Rizzo, Luiz Augusto Lucas Martins De

    2016-01-01

    ABSTRACT Objective: To report an initial experience with a digital drainage system during the postoperative period of pediatric thoracic surgery. Methods: This was a prospective observational study involving consecutive patients, ≤ 14 years of age, treated at a pediatric thoracic surgery outpatient clinic, for whom pulmonary resection (lobectomy or segmentectomy via muscle-sparing thoracotomy) was indicated. The parameters evaluated were air leak (as quantified with the digital system), biosafety, duration of drainage, length of hospital stay, and complications. The digital system was used in 11 children (mean age, 5.9 ± 3.3 years). The mean length of hospital stay was 4.9 ± 2.6 days, the mean duration of drainage was 2.5 ± 0.7 days, and the mean drainage volume was 270.4 ± 166.7 mL. The mean maximum air leak flow was 92.78 ± 95.83 mL/min (range, 18-338 mL/min). Two patients developed postoperative complications (atelectasis and pneumonia, respectively). The use of this digital system facilitated the decision-making process during the postoperative period, reducing the risk of errors in the interpretation and management of air leaks. PMID:28117476

  8. 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%).

  9. [Ectopic mediastinal parathyroid tumor resected by video-assisted thoracic surgery with intraoperative methylene blue infusion; report of a case].

    PubMed

    Okagawa, Takehiko; Hiramatsu, Yoshinori

    2014-03-01

    We report a surgical case of ectopic mediastinal parathyroid tumor resected by video-assisted thoracic surgery with intraoperative methylene blue infusion. It is often difficult to detect ectopic mediastinal parathyroid tumor during the operation because the tumor is soft, small and buried under mediastinal tissue. After methylene blue 4 mg/kg intravenously administration, the tumor was gradually dyed blue and easily detected and resected by video-assisted thoracic surgery. It is useful of methylene blue for detection of ectopic mediastinal parathyroid tumor.

  10. 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.

  11. Video-assisted thoracic surgery compared with posterolateral thoracotomy for mediastinal bronchogenic cysts in adult patients

    PubMed Central

    Guo, Chenglin; Mei, Jiandong; Liu, Chengwu; Deng, Senyi; Pu, Qiang; Lin, Feng

    2016-01-01

    Background Mediastinal bronchogenic cyst (MBC) is the most common primary cystic lesion of the mediastinum. This study aimed to investigate the efficacy and safety of video-assisted thoracic surgery (VATS) compared with posterolateral thoracotomy (PLT) for the treatment of MBCs in a large series. Methods Patients with MBCs who underwent surgical resection between August 2005 and December 2015 were identified from the electronic database of the Department of Thoracic Surgery, West China Hospital. The patient demographic characteristics, intraoperative findings, postoperative outcomes and follow-up information were reviewed and analyzed. Results A total of 99 patients underwent cystectomy were enrolled for the present study. Of those patients, 65 underwent VATS cystectomy (VATS group) and 34 underwent PLT cystectomy (PLT group) during the same period. The VATS group had shorter operative time than the PLT group (108.77±47.81 vs. 144.62±55.16, P=0.001), less intraoperative blood loss (median 20 vs. 100 mL, P<0.001), and less pleural drainage of the first three days after surgery (median 240 vs. 400 mL, P=0.002). In addition, the length of postoperative hospital stay and duration of chest drainage for the VATS group was also shorter than those of the PLT group (4.94±2.01 vs. 8.64±5.52 days, P=0.001; 2.52±1.29 vs. 3.71±1.55 days, P<0.001, respectively). No statistical significance was revealed among the two groups with regard to the maximum diameter of the cysts, pleural atresia, incomplete resection, surgery-related complications, duration of intensive care unit stay, and postoperative complications. Conclusions Both VATS and PLT are reliable approaches for the surgical resection of MBCs. The VATS approach is superior to PLT with shorter operative time, shorter duration of chest drainage, shorter postoperative hospital stay, less intraoperative blood loss, and less pleural drainage of the first three days after surgery. We conclude that VATS should be the

  12. VAC therapy for the treatment of complex wounds after cardio-thoracic surgery.

    PubMed

    De Caridi, Giovanni; Serra, Raffaele; Massara, Mafalda; Barone, Mario; Grande, Raffaele; Butrico, Lucia; Mastroroberto, Pasquale; de Franciscis, Stefano; Monaco, Francesco

    2016-10-01

    The aim of this study is to report our experience about the treatment of complex sternal and thoracic wounds following cardiothoracic surgery, using vacuum-assisted closure (VAC therapy. Twelve patients presenting with sternal (five cases) and thoracic (seven cases) wounds that were difficult to heal were treated through VAC therapy after the first surgical debridement. The duration of VAC application ranged from 12 to 36 days with an average hospital stay of 24·6 ± 11·4 days. During a mean follow-up of 12 months, we observed complete wound healing in seven cases (58·3%), in an average period of 25·5 ± 14·3 days; one patient died during follow-up, two patients were lost to follow-up and two patients required definitive surgical closure of the wound cavity. In conclusion, VAC therapy promotes faster wound healing, with shorter hospital stay and subsequent lesser in-hospital cost, reducing the mortality rate in the long run. It also promotes early rehabilitation and alleviates the need for a second procedure, thus improving patient satisfaction, with minimal discomfort or inconvenience.

  13. 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

  14. 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.

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

    PubMed

    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.

  16. Verification of Ultrasonic Image Fusion Technique for Laparoscopic Surgery

    NASA Astrophysics Data System (ADS)

    Zenbutsu, Satoki; Igarashi, Tatsuo; Mamou, Jonathan; Yamaguchi, Tadashi

    2012-07-01

    Laparoscopic surgery is one of the most challenging surgical operations, because inside information about the target organ cannot be fully understood from the laparoscopic image. Therefore, a fusion technique of laparoscopic and ultrasonic images is proposed for guidance during laparoscopic surgery. The proposed technique can display the internal organ structure by overlaying a three-dimensional (3D) ultrasonic image over a 3D laparoscopic image, which is acquired using a stereo laparoscope. The registration of the 3D images is performed by registering the surface of the target organ, which is found in the two 3D images without requiring the use of an external position detecting device. The proposed technique was evaluated experimentally using a tissue-mimicking phantom. Results obtained led to registration accuracy better than 2 cm. The total computation time was 3.1 min on a personal computer (Xeon processor, 3 GHz CPU). The structural information permits the visualization of target organs during laparoscopic surgery.

  17. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2017 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; Overman, David M; St Louis, James D; Karamlou, Tara; Pizarro, Christian; Hirsch-Romano, Jennifer C; McDonald, Donna; Han, Jane M; Becker, Susan; 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

    2017-03-01

    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 report 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 2012 to December 2015. This analysis documents the overall aggregate operative mortality (interquartile range among all participating programs) for the following procedural groups: off-bypass coarctation repair, 1.3% (0.0% to 1.8%); ventricular septal defect repair, 0.6% (0.0% to 0.9%); tetralogy of Fallot repair, 1.1% (0.0% to 1.4%); complete atrioventricular canal repair, 3.0% (0.0% to 4.7%); arterial switch operation, 2.7% (0.0% to 4.1%); arterial switch operation and ventricular septal defect repair, 5.3% (0.0% to 6.7%); Glenn/hemi-Fontan, 2.5% (0.0% to 4.5%); Fontan operation, 1.2% (0.0% to 1.2%); truncus arteriosus repair, 9.4% (0.0% to 16.7%); and Norwood procedure, 15.7% (8.9% to 25.0%).

  18. Development of a CD-ROM Internet Hybrid: a new thoracic surgery curriculum.

    PubMed

    Gold, Jeffrey P; Verrier, Edward A; Olinger, Gordon N; Orringer, Mark B

    2002-11-01

    The TSDA Prerequisite Curriculum Committee has successfully developed the content for a didactic curriculum to be mastered by the residents before their matriculation in a thoracic surgical residency program. In addition the committee assembled an innovative electronic format consisting of a CD-ROM Internet Hybrid to teach this curricular material. By use of a serialized CD-ROM Internet Hybrid it is possible to store relatively dense high bandwidth portions of the curriculum including video and audio materials on the CD-ROM and yet allow constant updating and interaction of the other portions of the curriculum. In addition, it is possible to track the performance and utilization by the residents during the entire course of their residency program. By studying the relationship between the utilization of the curriculum, particularly as it relates to certain subject areas, and comparing that to performance or standardized examinations as well as other measurements of resident satisfaction, the efficacy of the prerequisite curriculum will be tracked during the upcoming years. It is anticipated that the process of developing the content of the prerequisite curriculum will allow the residents and program directors to focus on the subject material currently deemed necessary for successful initiation of a thoracic surgery residency, and that by keeping this subject material outline up-to-date, the changing spectrum of what we anticipate our residents will know at the time of their matriculation will continue to mature. Although electronic-based education has been available for a number of years, a prospective randomized study comparing it with traditional textbook-based learning is novel. Multiple attempts have been made to implement Web-based or CD-ROM-based educational tools in other specialties with variable results. It is our anticipation that successful completion of this project will not only allow for the use of an innovative highly technical means of education for

  19. Causes of increased length of hospitalization on a general thoracic surgery service: a prospective observational study

    PubMed Central

    Irshad, Kashif; Feldman, Liane S.; Chu, Victor F.; Dorval, Jean-François; Baslaim, Ghassan; Morin, Jean E.

    2002-01-01

    Objective To characterize medical and nonmedical reasons for delayed discharge on a general thoracic surgery unit. Design A prospective observational cohort study. Setting A university-affiliated tertiary care institution. Patients Between February 1999 and July 2000, the in-hospital progress of 130 patients who had undergone an elective thoracic surgical procedure was evaluated prospectively. Baseline characteristics (age, sex, comorbid conditions and pulmonary function test results) were documented. Main outcome measures Complications that delayed the time when the patient was medically ready for discharge. The day the patient was deemed fit for discharge (medically required length of stay) was compared with the actual day of discharge (actual length of stay). Results The 3 most frequent complications that prevented discharge by postoperative day 6 were persistent air leaks, pulmonary infections and atrial fibrillation. The presence of a persistent air leak increased the medically required length of stay by a mean of 13.1 days (95% confidence interval [CI] 11.0–15.2 d), pneumonia by 9.6 days (95% CI 4.96–14.2 d) and atrial fibrillation by 2.4 days (95% CI −2.6 to 7.4 d). The mean medically required length of stay was 6.9 days, and this differed from the mean day on which the patient was actually discharged (7.35 d, p < 0.01), which contributed 44 excess days of hospitalization per 100 patients. The 2 most common causes of this discrepancy were the lack of home support (10.2% of patients) and the unavailability of convalescent facilities (7.1% of patients). Prolonged hospital stay for nonmedical reasons was associated with increased mean age (67.4 v. 60.7 yr, p = 0.05). Conclusions Length of hospitalization after elective thoracic surgery may be prolonged for medical or nonmedical reasons. Although complications like persistent air leak and pneumonia have an impact on medically required length of stay, social factors may also significantly delay discharge

  20. Cardiac surgery in Germany during 2012: a report on behalf of the German Society for Thoracic and Cardiovascular Surgery.

    PubMed

    Beckmann, Andreas; Funkat, Anne-Kathrin; Lewandowski, Jana; Frie, Michael; Schiller, Wolfgang; Hekmat, Khosro; Gummert, Jan F; Mohr, Friedrich Wilhelm

    2014-02-01

    On the basis of a voluntary registry of the German Society for Thoracic and Cardiovascular Surgery (GSTCVS), data of all cardiac surgical procedures performed in 79 German cardiac surgical units during the year 2012 are presented. In 2012, a total of 98,792 cardiac surgical procedures (ICD and pacemaker procedures excluded) were submitted to the registry. More than 13.8% of the patients were older than 80 years, which is a further increase in comparison to previous years. In-hospital mortality in 42,060 isolated coronary artery bypass grafting procedures (84.6% on-pump and 15.4% off-pump) was 2.9%. In 28,521 isolated valve procedures (including 6,804 catheter-based procedures), an in-hospital mortality of 4.8% was observed. This long-lasting registry of the GSTCVS will continue to be an important tool for quality control and voluntary public reporting by illustrating current facts and developments of cardiac surgery in Germany.

  1. Anterior surgery in the thoracic and lumbar spine: endoscopic techniques in children.

    PubMed

    Crawford, Alvin H

    2005-01-01

    Therapeutic modalities for disorders of the pediatric spine must include video-assisted thoracoscopy. The endoscopic approach to the spine has involved an evolutionary approach. What began as an isolated drainage of a vertebral abscess has continued as a method of single diskectomy, release of the anulus fibrosus with or without ligation of segmental vessels, rib resection for costoplasty, rib harvesting for intervertebral fusion and, most recently, insertion of correctional implants with or without spinal fusion. Video-assisted thoracoscopic surgery offers the potential to decrease surgical morbidity associated with traditional open procedures. The ability of video-assisted thoracoscopic surgery to achieve spinal release and the results of early outcomes and cost are comparable to those of open thoracotomy. The improvement in video technology with multichip cameras has significantly improved and enhanced the ability to identify structures in the chest through small incisions (portals). This technology allows spine surgeons to perform surgical intervention comparable to thoracotomy. Instead of using a 9- to 12-inch incision, four to five portals of approximately 2 cm are used; thus, the cosmetic efects of the scoliosis surgery are enhanced. The potential benefits of this procedure include diminished postoperative pain, decreased length of hospitalization, increased wound care, and early return to prehospital activities.

  2. [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)

  3. [Surgery of the descending thoracic and thoraco-abdominal arteries. Report of 105 cases].

    PubMed

    Zanetti, P P; Rosa, G; Sorisio, V; Cavanenghi, D; Amerio, G M; Stillo, R; Zappa, A; Cardellino, S; Franco, M; Muncinelli, M

    1997-07-01

    The Authors show their casistic of about 105 cases of thoracic descending and thoraco-abdominal aorta pathologies between 1.1.1993 and 30.12.1995. After a short introduction about the improvements in anesthesia and reanimation of these pathologies as well as the good reliability of diagnostic and currently available instruments, mortality and mobility parameters are taken into account, the last one referring to paraplegia and ARF. The casistic is evaluated splitting the cases into 2 groups, urgent surgery and election surgery, and differentiating the aneurysm type from the dissection type. Besides, the mortality and mobility are reported for any pathology, with a discussion of the parameters which drove the choice of the most suitable methodology to be adopted (ECC femoro-subclavian shunt, simple clamping). The results achieved show a mortality of 40% in urgency, between 5 and 15% in election, with a rate of paraplegia around 8-10% and a ARF between 5 and 15%. These data match the literature statistics and support the quality of the adopted methodologies.

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

    PubMed Central

    Yao, Feng; Yang, Haitang

    2016-01-01

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

  5. Sacroiliac Joint Fusion: One Year Clinical and Radiographic Results Following Minimally Invasive Sacroiliac Joint Fusion Surgery

    PubMed Central

    Kube, Richard A.; Muir, Jeffrey M.

    2016-01-01

    Background: Recalcitrant sacroiliac joint pain responds well to minimally-invasive surgical (MIS) techniques, although long-term radiographic and fusion data are limited. Objective: To evaluate the one-year clinical results from a cohort of patients with chronic sacroiliac (SI) joint pain unresponsive to conservative therapies who have undergone minimally invasive SI joint fusion. Methods: SI joint fusion was performed between May 2011 and January 2014. Outcomes included radiographic assessment of fusion status, leg and back pain severity via visual analog scale (VAS), disability via Oswestry Disability Index (ODI) and complication rate. Outcomes were measured at baseline and at follow-up appointments 6 months and 12 months post-procedure. Results: Twenty minimally invasive SI joint fusion procedures were performed on 18 patients (mean age: 47.2 (14.2), mean BMI: 29.4 (5.3), 56% female). At 12 months, the overall fusion rate was 88%. Back and leg pain improved from 81.7 to 44.1 points (p<0.001) and from 63.6 to 27.7 points (p=0.001), respectively. Disability scores improved from 61.0 to 40.5 (p=0.009). Despite a cohort containing patients with multiple comorbidities and work-related injuries, eight patients (50%) achieved the minimal clinically important difference (MCID) in back pain at 12 months, with 9 (69%) patients realizing this improvement in leg pain and 8 (57%) realizing the MCID in ODI scores at 12 months. No major complications were reported. Conclusion: Minimally invasive SI joint surgery is a safe and effective procedure, with a high fusion rate, a satisfactory safety profile and significant improvements in pain severity and disability reported through 12 months post-procedure. PMID:28144378

  6. Occipitocervical Fusion Surgery: Review of Operative Techniques and Results

    PubMed Central

    Kukreja, Sunil; Ambekar, Sudheer; Sin, Anthony H.; Nanda, Anil

    2015-01-01

    Objective Varying types of clinicoradiologic presentations at the craniovertebral junction (CVJ) influence the decision process for occipitocervical fusion (OCF) surgery. We discuss the operative techniques and decision-making process in OCF surgery based on our clinical experience and a literature review. Material and Methods A total of 49 consecutive patients who underwent OCF participated in the study. Sagittal computed tomography images were used to illustrate and measure radiologic parameters. We measured Wackenheim clivus baseline (WCB), clivus-canal angle (CCA), atlantodental distance (ADD), and Powers ratio (PR) in all the patients. Results Clinical improvement on Nurick grading was recorded in 36 patients. Patients with better preoperative status (Nurick grades 1–3) had better functional outcomes after the surgery (p = 0.077). Restoration of WCB, CCA, ADD, and PR parameters following the surgery was noted in 39.2%, 34.6%, 77.4%, and 63.3% of the patients, respectively. Complications included deep wound infections (n = 2), pseudoarthrosis (n = 2), and deaths (n = 4). Conclusion Conventional wire-based constructs are superseded by more rigid screw-based designs. Odontoidectomy is associated with a high incidence of perioperative complications. The advent of newer implants and reduction techniques around the CVJ has obviated the need for this procedure in most patients. PMID:26401473

  7. 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

  8. The Society of Thoracic Surgeons Congenital Heart Surgery Database Public Reporting Initiative.

    PubMed

    Jacobs, Jeffrey P

    2017-01-01

    Three basic principles provide the rationale for the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (CHSD) public reporting initiative: (1) Variation in congenital and pediatric cardiac surgical outcomes exist. (2) Patients and their families have the right to know the outcomes of the treatments that they will receive. (3). It is our professional responsibility to share this information with them in a format they can understand. The STS CHSD public reporting initiative facilitates the voluntary transparent public reporting of congenital and pediatric cardiac surgical outcomes using the STS CHSD Mortality Risk Model. The STS CHSD Mortality Risk Model is used to calculate risk-adjusted operative mortality and adjusts for the following variables: age, primary procedure, weight (neonates and infants), prior cardiothoracic operations, non-cardiac congenital anatomic abnormalities, chromosomal abnormalities or syndromes, prematurity (neonates and infants), and preoperative factors (including preoperative/preprocedural mechanical circulatory support [intraaortic balloon pump, ventricular assist device, extracorporeal membrane oxygenation, or cardiopulmonary support], shock [persistent at time of surgery], mechanical ventilation to treat cardiorespiratory failure, renal failure requiring dialysis and/or renal dysfunction, preoperative neurological deficit, and other preoperative factors). Operative mortality is defined in all STS databases as (1) all deaths, regardless of cause, occurring during the hospitalization in which the operation was performed, even if after 30 days (including patients transferred to other acute care facilities); and (2) all deaths, regardless of cause, occurring after discharge from the hospital, but before the end of the 30(th) postoperative day. The STS CHSD Mortality Risk Model has good model fit and discrimination with an overall C statistics of 0.875 and 0.858 in the development sample and the validation sample

  9. Uniportal video-assisted thoracic surgery colorectal lung metastasectomy in non-intubated anesthesia

    PubMed Central

    Sellitri, Francesco; Perroni, Gianluca; Schillaci, Orazio; Mineo, Tommaso Claudio

    2017-01-01

    Background More than ten years ago we started a program of video-assisted thoracic surgery (VATS) lung metastasectomy in non-intubated local anesthesia. In this study we investigated the effectiveness and long term results of this combined surgical-anesthesiological technique. Methods Between 2005 and 2014, 48 patients (25 men and 23 women) with pulmonary oligometastases from colorectal cancer, at the first episode, underwent VATS metastasectomy under non-intubated local anesthesia. Three patients required intubation for intolerance. In the same period 13 patients scheduled for non-intubated metastasectomy refused awake surgery and were used as a control group. Results The two groups were homogeneous for both demographic and pathological features. Mean number of lesions resected per patient were 1.51 (non-intubated) vs. 1.77 (control), respectively (P=0.1). The oxygenation was significantly lower in the non-intubated group especially at the end of the procedure, but the values inverted from the first postoperative hour. There was no mortality in any groups. The non-intubated group demonstrated a significant shorter overall operating time (P=0.04), better quality of recovery after both 24 (P=0.04) and 48 hours (P=0.04), shorter median hospital stay (P=0.03) and lower estimated costs (P=0.03), even excluding the hospital stay. Major morbidity rate was lower (6% vs. 23%) yet not significant (P=0.1). Both disease free survival and overall survival were similar between groups. Conclusions VATS lung metastasectomy in non-intubated local anesthesia was safely performed in selected patients with oligometastases with significant advantages in overall operative time, hospital stay and economical costs. Morbidity rate was lower yet not significant. Long term results were similar. PMID:28275472

  10. The Society of Thoracic Surgeons Congenital Heart Surgery Database: 2016 Update on Research.

    PubMed

    Jacobs, Marshall L; Jacobs, Jeffrey P; Pasquali, Sara K; Hill, Kevin D; Hornik, Christoph; O'Brien, Sean M; Shahian, David M; Habib, Robert H; Edwards, Fred H

    2016-09-01

    The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS CHSD) is the largest congenital and pediatric cardiac surgical clinical data registry in the world. With more than 400,000 total operations from nearly all centers performing pediatric and congenital heart operations in North America, the STS CHSD is an unparalleled platform for clinical investigation, outcomes research, and quality improvement activities in this subspecialty. In 2015, several major original publications reported analyses of data in the CHSD pertaining to specific diagnostic and procedural groups, age-defined cohorts, or the entire population of patients in the database. Additional publications reported the most recent development, evaluation, and application of metrics for quality measurement and reporting of pediatric and congenital heart operation outcomes. This use of the STS CHSD for outcomes research and for quality measurement continues to expand as database participation and the available wealth of data in it continue to grow. This article reviews outcomes research and quality improvement articles published in 2015 based on STS CHSD data.

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

    PubMed Central

    Tacconi, Federico

    2016-01-01

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

  12. Image-guided localization of small lung nodules in video-assisted thoracic surgery

    PubMed Central

    Zhao, Ze-Rui; Lau, Rainbow W. H.; Yu, Peter S. Y.; Wong, Randolph H. L.

    2016-01-01

    The advancement of imaging technology has recently facilitated single port minimally-invasive thoracic surgery techniques. Cone-beam computed tomography (CBCT) shows promising results in visualizing the target lesion and its surrounding critical anatomy, with an error of less than 2 mm. The integration of CBCT with the operating room (OR) to form the hybrid OR, provides unparalleled real-time imaging of the patient, which can be used with electromagnetic navigation bronchoscopy to confirm successful navigation and increase procedural accuracy particularly for small peripheral pulmonary targets. Furthermore, implantation of hookwires or microcoils that are widely used to localize the lesion can take place in the hybrid suite, eliminating the common complications and discomfort associated with the conventional workflow carried out in the radiology suite. Displacement leading to localization failure can be also reduced, and sublobar resection will be performed without resecting a larger area of parenchyma than desired. This one-stop, paradigm-shifting concept for simultaneously diagnosing and managing small pulmonary lesions in the hybrid OR can lead to reduced invasiveness and improved patient care. PMID:28066676

  13. Pain management in video assisted thoracic surgery: evaluation of localised partial rib resection. A new technique.

    PubMed

    Richardson, J; Sabanathan, S

    1995-10-01

    We undertook a re-evaluation of acute and chronic pain generation following Video Assisted Thoracic Surgery (VATS) with regard to chest wall trauma produced by the instruments and their ports. From intercostal space (ICS) measurements made on 40 patients, it was confirmed that both the camera and the staple gun port diameters are too large for insertion without trauma. An instrument was produced (the "Sari" Punch, Bolton Surgical Services, Sheffield, England) which cleanly excises an elipse of the superior aspect of a rib, prior to the introduction of the ports. At the same time, the recommended orbit of the instruments about the surgical focus was abandoned in favour of an alignment along one ICS so that only one nerve was potentially traumatised. These modifications were then combined with balanced, pre-emptive and continuous paravertebral analgesia and the efficacy of this approach was evaluated in nine patients undergoing VATS. Operation of the rib punch was easy in all patients and was carried out without clinical or radiological trauma to the rib. Insertion of the ports was easy and access was good to all intrathoracic structures. Postoperative analgesia was good and the mean hospital stay was 2.7 days (range 2-4). Follow-up two months later confirmed a satisfactory surgical procedure and no patients complained of chest wall pain or numbness. We conclude that pain generation with VATS must be seriously considered if the technique is to become truly successful. Balanced, pre-emptive, paravertebral analgesia will protect the central nervous system while the removal of an elipse of rib and alignment of the instruments along one ICS will reduce the likelihood of peripheral nerve trauma.

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

    PubMed Central

    Facktor, Matthew A.

    2015-01-01

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

  15. 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.

  16. The Effect of Perioperative Radiation Therapy on Spinal Bone Fusion Following Spine Tumor Surgery

    PubMed Central

    Kim, Tae-Kyum; Youn, Sang Min; Chang, Ung-Kyu

    2016-01-01

    Introduction Perioperative irradiation is often combined with spine tumor surgery. Radiation is known to be detrimental to healing process of bone fusion. We tried to investigate bone fusion rate in spine tumor surgery cases with perioperative radiation therapy (RT) and to analyze significant factors affecting successful bone fusion. Methods Study cohort was 33 patients who underwent spinal tumor resection and bone graft surgery combined with perioperative RT. Their medical records and radiological data were analyzed retrospectively. The analyzed factors were surgical approach, location of bone graft (anterior vs. posterior), kind of graft (autologous graft vs. allograft), timing of RT (preoperative vs. postoperative), interval of RT from operation in cases of postoperative RT (within 1 month vs. after 1 month) radiation dose (above 38 Gy vs. below 38 Gy) and type of radiation therapy (conventional RT vs. stereotactic radiosurgery). The bone fusion was determined on computed tomography images. Result Bone fusion was identified in 19 cases (57%). The only significant factors to affect bony fusion was the kind of graft (75% in autograft vs. 41 in allograft, p=0.049). Other factors proved to be insignificant relating to postoperative bone fusion. Regarding time interval of RT and operation in cases of postoperative RT, the time interval was not significant (p=0.101). Conclusion Spinal fusion surgery which was combined with perioperative RT showed relatively low bone fusion rate (57%). For successful bone fusion, the selection of bone graft was the most important. PMID:27847573

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

    PubMed

    Choi, Ji Won; Joo Ahn, Hyun; 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.

  18. Palliative stent graft placement combined with subsequent open surgery for retrograde ascending dissection intra-thoracic endovascular aortic repair

    PubMed Central

    Zhu, Kai; Guo, Changfa; Li, Jun

    2014-01-01

    Thoracic endovascular aortic repair (TEVAR) is an effective strategy for type B dissection. Retrograde ascending dissection (RAD) intra-TEVAR is a rare complication on clinic. In this case, a 48-year-old Chinese man with Stanford type B aortic dissection suffered acute RAD during the TEVAR. And palliative stent grafts placement was performed in a local hospital, which earned the time for transfer and subsequent total arch replacement surgery in Zhongshan Hospital Fudan University. This report suggests that the palliative strategy may be an option for RAD in some specific situation. PMID:25590002

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

    PubMed Central

    Misiołek, Hanna; Karpe, Jacek; Marcinkowski, Adrian; Jastrzębska, Aleksandra; Szelka, Anna; Czarnożycka, Adrianna; Długaszek, Michał

    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

  20. Does videomediastinoscopy with frozen sections improve mediastinal staging during video-assisted thoracic surgery pulmonary resections?

    PubMed Central

    Gonfiotti, Alessandro; Viggiano, Domenico; Borgianni, Sara; Borrelli, Roberto; Tancredi, Giorgia; Jaus, Massimo O.; Politi, Leonardo; Comin, Camilla E.; Voltolini, Luca

    2016-01-01

    Background To assess if video-mediastinoscopy (VM) with frozen sections (FS) combined with a video-assisted thoracic surgery major pulmonary resection (VMPRS) is able to improve VATS mediastinal intraoperative staging. Methods From June 2012 to March 2015 a total of 146 patients underwent VMPRS lymphadenectomy. NCCN guidelines were followed for pre-operative staging, including VM with FS in 27 patients (19%). Procedural time, dissected nodal stations, complications related to VM and VATS lymphadenectomy and definitive histology, were evaluated. Results Operative time for VATS resection with VM (group 1) and VATS pulmonary resection alone (group 2) was 198±64 vs. 167±43 min (P=0.003). Mean/median numbers of dissected nodal stations were 4.93±1.1/5 (range, 4–8) in group 1 and 3.25±0.5/5 (range, 3–8) in group 2 (P<0.001). Group 1 vs. group 2 right-sided lymphadenectomy (n=86) was performed at station 2R/4R in 18 (90%) and 46 (69.7%); at station 3a/3p in 14 (51.8%) and 22 (31%); at station 7 in 18 (90%) and 44 (66.7%); at station 8/9 in 11 (55%) and 24 (36.4%) respectively. On the left side (n=60) group 1 vs. group 2 lymphadenectomy resulted at station 4 in 6 (85.7%) and 38 (71.7%); at station 5/6 in 6 (85.7%) and 26 (49%); at station 7 in 6 (85.7%) and 33 (62.3%), and at station 8/9 in 1 (14.3%) and 18 (34%). There were no early deaths and recurrent laryngeal nerve palsy occurred in 1 (0.8%) in group 2. Pathological upstaging (pN1; pN2) was found in 5 patients (17%) in group 1, and 13 (11%) in group 2 (P=0.23). About FS (n=29), formal paraffin histology resulted in 0% of both, false negative and false positive results. Conclusions Based on our experience, the combination “VM with FS followed by VMPRS in sequence”, seems to be effective and offers an alternative approach to improve intraoperative mediastinal staging. PMID:28149542

  1. Applications for a hybrid operating room in thoracic surgery: from multidisciplinary procedures to --image-guided video-assisted thoracoscopic surgery.

    PubMed

    Terra, Ricardo Mingarini; Andrade, Juliano Ribeiro; Mariani, Alessandro Wasum; Garcia, Rodrigo Gobbo; Succi, Jose Ernesto; Soares, Andrey; Zimmer, Paulo Marcelo

    2016-01-01

    The concept of a hybrid operating room represents the union of a high-complexity surgical apparatus with state-of-the-art radiological tools (ultrasound, CT, fluoroscopy, or magnetic resonance imaging), in order to perform highly effective, minimally invasive procedures. Although the use of a hybrid operating room is well established in specialties such as neurosurgery and cardiovascular surgery, it has rarely been explored in thoracic surgery. Our objective was to discuss the possible applications of this technology in thoracic surgery, through the reporting of three cases. RESUMO O conceito de sala híbrida traduz a união de um aparato cirúrgico de alta complexidade com recursos radiológicos de última geração (ultrassom, TC, radioscopia e/ou ressonância magnética), visando a realização de procedimentos minimamente invasivos e altamente eficazes. Apesar de bem estabelecido em outras especialidades, como neurocirurgia e cirurgia cardiovascular, o uso da sala hibrida ainda é pouco explorado na cirurgia torácica. Nosso objetivo foi discutir as aplicações e as possibilidades abertas por essa tecnologia na cirurgia torácica através do relato de três casos.

  2. One Stage Posterior Minimal Laminectomy and Video-Assisted Thoracoscopic Surgery (VATS) for Removal of Thoracic Dumbbell Tumor

    PubMed Central

    Nam, Kyoung Hyup; Ahn, Hyo Yeoung; Cho, Jeong Su; Kim, Yeoung Dae; Choi, Byung Kwan; Han, In Ho

    2017-01-01

    Objective This study was conducted to assess the surgical results of one-stage posterior minimal laminectomy and video-assisted thoracoscopic surgery (VATS) for the treatment of thoracic dumbbell tumor and to describe its precise technique. In addition, we investigated the technique’s usefulness and limitations. Methods Seven cases of thoracic dumbbell tumor (two men and five women, mean age, 43 years) were analyzed retrospectively. Pathological findings included schwannoma in four patients, neurofibroma in two patients, and hemangioma in one patient. The location of tumors varied from T2/3 to T12/L1. Dumbbell tumors were resected by one-stage operation using posterior laminectomy followed by VATS without instrumentation. Clinical data were reviewed. Results The mean follow-up period was 25 months (range, 3–58 months), and the operative time ranged from 255 to 385 min (mean, 331 min), with estimated blood loss ranging from 110 to 930 mL (mean, 348 mL). The tumor was completely resected without instrumentation and postoperative instability in all cases. Postoperative complications included atelectasis and facial anhydrosis in one case each. Conclusion One-stage posterior minimal laminectomy and VATS may be a safe and less invasive technique for removal of thoracic dumbbell tumor without instability. This method has the advantage of early ambulation and rapid recovery because it reduces blood loss and postoperative pain. PMID:28264248

  3. Effects of Multilevel Facetectomy and Screw Density on Postoperative Changes in Spinal Rod Contour in Thoracic Adolescent Idiopathic Scoliosis Surgery

    PubMed Central

    Kokabu, Terufumi; Sudo, Hideki; Abe, Yuichiro; Ito, Manabu; Ito, Yoichi M.; Iwasaki, Norimasa

    2016-01-01

    Flattening of the preimplantation rod contour in the sagittal plane influences thoracic kyphosis (TK) restoration in adolescent idiopathic scoliosis (AIS) surgery. The effects of multilevel facetectomy and screw density on postoperative changes in spinal rod contour have not been documented. This study aimed to evaluate the effects of multilevel facetectomy and screw density on changes in spinal rod contour from before implantation to after surgical correction of thoracic curves in patients with AIS prospectively. The concave and convex rod shapes from patients with thoracic AIS (n = 49) were traced prior to insertion. Postoperative sagittal rod shape was determined by computed tomography. The angle of intersection of the tangents to the rod end points was measured. Multiple stepwise linear regression analysis was used to identify variables independently predictive of change in rod contour (Δθ). Average Δθ at the concave and convex side were 13.6° ± 7.5° and 4.3° ± 4.8°, respectively. The Δθ at the concave side was significantly greater than that of the convex side (P < 0.0001) and significantly correlated with Risser sign (P = 0.032), the preoperative main thoracic Cobb angle (P = 0.031), the preoperative TK angle (P = 0.012), and the number of facetectomy levels (P = 0.007). Furthermore, a Δθ at the concave side ≥14° significantly correlated with the postoperative TK angle (P = 0.003), the number of facetectomy levels (P = 0.021), and screw density at the concave side (P = 0.008). Rod deformation at the concave side suggests that corrective forces acting on that side are greater than on the convex side. Multilevel facetectomy and/or screw density at the concave side have positive effects on reducing the rod deformation that can lead to a loss of TK angle postoperatively. PMID:27564683

  4. Translational research in thoracic surgery-the National Taiwan University Hospital experience.

    PubMed

    Lin, Mong-Wei; Yang, Pei-Wen; Lee, Jang-Ming

    2016-08-01

    Thoracic surgeons should be more aware of the latest information about histopathological, genetic and epigenetic alterations that may influence treatment policy and patient outcome in the biomolecular era. Translational research studies often produce a promising diagnostic tool or new treatment that can be used clinically. The results of these translational studies may even change the practical guidelines and current staging system in thoracic malignancies. The following article summarizes the experiences of translational research in esophageal cancer and non-small cell lung cancer (NSCLC) at National Taiwan University Hospital in Taiwan.

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

    PubMed Central

    Fernandes, Anthony

    2016-01-01

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

  6. Effects of Strontium Ranelate on Spinal Interbody Fusion Surgery in an Osteoporotic Rat Model

    PubMed Central

    Tsai, Tsung-Ting; Ho, Natalie Yi-Ju; Lai, Po-Liang; Fu, Tsai-Sheng; Niu, Chi-Chien; Chen, Lih-Huei; Chen, Wen-Jer

    2017-01-01

    Osteoporosis is a bone disease that afflicts millions of people around the world, and a variety of spinal integrity issues, such as degenerative spinal stenosis and spondylolisthesis, are frequently concomitant with osteoporosis and are sometimes treated with spinal interbody fusion surgery. Previous studies have demonstrated the efficacy of strontium ranelate (SrR) treatment of osteoporosis in improving bone strength, promoting bone remodeling, and reducing the risk of fractures, but its effects on interbody fusion surgery have not been adequately investigated. SrR-treated rats subjected to interbody fusion surgery exhibited significantly higher lumbar vertebral bone mineral density after 12 weeks of treatment than rats subjected to the same surgery but not treated with SrR. Furthermore, histological and radiographic assessments showed that a greater amount of newly formed bone tissue was present and that better fusion union occurred in the SrR-treated rats than in the untreated rats. Taken together, these results show significant differences in bone mineral density, PINP level, histological score, SrR content and mechanical testing, which demonstrate a relatively moderate effect of SrR treatment on bone strength and remodeling in the specific context of recovery after an interbody fusion surgery, and suggest the potential of SrR treatment as an effective adjunct to spinal interbody fusion surgery for human patients. PMID:28052066

  7. 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 ...

  8. Does lumbar paraspinal muscles improve after corrective fusion surgery in degenerative flat black?

    PubMed Central

    Lee, Jung Hwan; Lee, Sang-Ho

    2017-01-01

    Background: Degenerative flat back (DFB) is characterized by sagittal imbalance resulting from the loss of lumbar lordosis (LL). Extensive degeneration and weakness of lumbar paraspinal extensor muscle (PSE) are thought to be the main cause of DFB. This study is to evaluate correlation between preoperative PSE conditions and angular severity of DFB and to evaluate correlation between preoperative PSE conditions and degree of improvement of DFB obtained by corrective surgery. Materials and Methods: Forty five patients with DFB who took magnetic resonance image (MRI) preoperatively and conducted simple radiography and three-dimensional gait analysis before and 6 months after corrective surgery were included. To determine the severity of PSE atrophy, the ratio between cross-sectional area of PSE and disc was calculated from L1–L2 to L4–L5 on MRI. To assess the degree of fat infiltration, the signal intensity of PSE was measured. Static parameters of spinopelvic segment were measured by simple radiography. Dynamic parameters of spinopelvic and lower limb joints were obtained by three-dimensional gait analysis. Results: In static parameters, thoracic angle was correlated with atrophy and fat infiltration of upper PSE. Thoracic angle was less improved after surgery, as atrophy of upper PSE was more severe. In dynamic parameters, thoracic angle showed correlation with upper PSE conditions, whereas lumbar angle had correlation with middle to lower PSE conditions. While thoracic kyphosis was less improved after surgery, as atrophy of upper PSE was more severe, LL was less improved, as atrophy and fat infiltration of PSE from L1–L2 to L4–L5 were more severe. Conclusions: Severity of atrophy or fat infiltration of PSE showed correlation with degree of angular deformity in patients with DFB and with less improvement after corrective surgery. Dynamic parameters showed more prominent correlation with PSE conditions than static parameters and also showed segmental

  9. Autonomic Dysreflexia-Like Syndrome in a T12 Paraplegic During Thoracic Spine Surgery

    DTIC Science & Technology

    2010-11-01

    or lumbar spinal cord lesions and paraplegia have been reported to exhibit catecholamine-induced hypertension and autonomic dys- function of central...cord origin. Roche et al.17 reported a series of 5 African American male patients with low thoracic or lumbar traumatic paraplegia exhibiting severe...Am Paraplegia Soc 1992;15:171–86 4. Amzallag M. Autonomic hyperreflexia. Int Anesthesiol Clin 1993;31:87–102 5. Karlsson AK. Autonomic dysreflexia

  10. Practice patterns in venous thromboembolism (VTE) prophylaxis in thoracic surgery: a comprehensive Canadian Delphi survey

    PubMed Central

    Agzarian, John; Linkins, Lori-Ann; Schneider, Laura; Hanna, Waël C.; Finley, Christian J.; Schieman, Colin; De Perrot, Marc; Crowther, Mark; Douketis, James

    2017-01-01

    Background The incidence of venous thromboembolic events (VTE) after resection of thoracic malignancies can reach 15%, but prophylaxis guidelines are yet to be established. We aimed to survey Canadian practitioners regarding perioperative risk factors for VTE, impact of those factors on extended prophylaxis selection, type of preferred prophylaxis, and timing of initiation and duration of thromboprophylaxis. Methods A modified Delphi survey was undertaken over three rounds with thoracic surgeons, thoracic anesthesiologists and thrombosis experts across Canada. Participants were asked to rate each parameter on a ten-point scale. Agreement was determined a priori as an item reaching a coefficient of variation of ≤30% (0.3), with the item then discontinued from later rounds. Results In total, 72, 57 and 50 respondents participated in three consecutive rounds, respectively. Consensus was reached on previous VTE, age, cancer diagnosis, thrombophilia, poor mobilization, extended resections, and pre-operative chemotherapy as risk factors. Consensus on risk factors impacting extended prophylaxis decisions was achieved on cancer diagnosis, obesity, previous VTE and poor mobilization. With respect to perioperative prophylaxis, once daily low-molecular-weight heparin (LMWH) was the only parameter that demonstrated agreement as a common practice pattern. No agreement was achieved regarding the role of mechanical prophylaxis, unfractionated heparin (UFH) or timing of initiation of peri-operative treatment. VTE prophylaxis until discharge reached agreement but there was substantial variability regarding the role of extended prophylaxis. Conclusions There is agreement between Canadian clinicians treating patients with thoracic malignancies regarding most risk factors for VTE, but there is no agreement on timing of initiation of prophylaxis, the agents used or factors mandating usage of extended prophylaxis. PMID:28203409

  11. 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.

  12. 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.

  13. 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

  14. The Multiple Benefits of Minimally Invasive Spinal Surgery: Results Comparing Transforaminal Lumbar Interbody Fusion and Posterior Lumbar Fusion

    PubMed Central

    Starkweather, Angela R.; Witek-Janusek, Linda; Nockels, Russ P.; Peterson, Jonna; Mathews, Herb L.

    2013-01-01

    Minimally invasive transforaminal lumbar interbody fusion (TLIF) offers equivalent postoperative fusion rates compared to posterior lumbar fusion (PLF) and minimizes the amount of iatrogenic injury to the spinal muscles. The objective of this study was to examine the difference in pain perception, stress, mood disturbance, quality of life, and immunological indices throughout the perioperative course among patients undergoing TLIF and PLF. A prospective, nonrandomized descriptive design was used to evaluate these measures among patients undergoing TLIF (n = 17) or PLF (n = 18) at 1 week prior to surgery (T1), the day of surgery (T2), 24 hours postoperatively (T3), and 6 weeks postoperatively (T4). Among TLIF patients, pain, stress, fatigue, and mood disturbance were significantly decreased at the 6-week follow-up visit (T4) compared to patients who underwent PLF. The TLIF group also demonstrated significantly higher levels (near baseline) of CD8 cells atT4 than the PLF group. Interleukin-6 levels were significantly higher in the TLIF group as well, which may be an indicator of ongoing nerve regeneration and healing. Knowledge concerning the effect of pain and the psychological experience on immunity among individuals undergoing spinal fusion can help nurses tailor interventions to improve outcomes, regardless of the approach used. PMID:18330408

  15. Impact of obesity on complications and outcomes: a comparison of fusion and nonfusion lumbar spine surgery.

    PubMed

    Onyekwelu, Ikemefuna; Glassman, Steven D; Asher, Anthony L; Shaffrey, Christopher I; Mummaneni, Praveen V; Carreon, Leah Y

    2017-02-01

    OBJECTIVE Prior studies have shown obesity to be associated with higher complication rates but equivalent clinical outcomes following lumbar spine surgery. These findings have been reproducible across lumbar spine surgery in general and for lumbar fusion specifically. Nevertheless, surgeons seem inclined to limit the extent of surgery, perhaps opting for decompression alone rather than decompression plus fusion, in obese patients. The purpose of this study was to ascertain any difference in clinical improvement or complication rates between obese and nonobese patients following decompression alone compared with decompression plus fusion for lumbar spinal stenosis (LSS). METHODS The Quality Outcomes Database (QOD), formerly known as the National Neurosurgery Quality and Outcomes Database (N(2)QOD), was queried for patients who had undergone decompression plus fusion (D+F group) versus decompression alone (D+0 group) for LSS and were stratified by a body mass index (BMI) ≥ 30 kg/m(2) (obese) or < 30 kg/m(2) (nonobese). Demographic, surgical, and health-related quality of life data were compared. RESULTS In the nonobese cohort, 947 patients underwent decompression alone and 319 underwent decompression plus fusion. In the obese cohort, 844 patients had decompression alone and 337 had decompression plus fusion. There were no significant differences in the Oswestry Disability Index score or in leg pain improvement at 12 months when comparing decompression with fusion to decompression without fusion in either obese or nonobese cohorts. However, absolute improvement in back pain was less in the obese group when decompression alone had been performed. Blood loss and operative time were lowest in the nonobese D+0 cohort and were higher in obese patients with or without fusion. Obese patients had a longer hospital stay (4.1 days) than the nonobese patients (3.3 days) when fusion had been performed. In-hospital stay was similar in both obese and nonobese D+0 cohorts. No

  16. A randomised controlled trial comparing Mediwrap heat retention and forced air warming for maintaining normothermia in thoracic surgery.

    PubMed

    Rathinam, Sridhar; Annam, Venkatesh; Steyn, Richard; Raghuraman, Govindan

    2009-07-01

    Hypothermia is one of the common complications in the perioperative period. Currently, normothermia is maintained with forced air warming (FAW) or passive heat retention methods. We compared the efficacy of the Mediwrap blanket with FAW in maintaining normothermia during intra-operative period in thoracic surgery in a prospective randomised controlled trial on 30 patients. Core temperature was measured at 30-min intervals in the perioperative period and the time taken to attain baseline in the postoperative periods in the two groups was compared. There was no difference in core temperatures between the groups during pre- and intra-operative period, with mean+/-S.D. final core temperatures of 36.2+/-0.6 degrees C with Mediwrap and 36+/-0.9 degrees C with the FAW blanket. However, the postoperative core temperatures were significantly higher in the Mediwrap group. The time required to reach baseline temperature was lower in the Mediwrap group with a mean+/-S.D. of 66+/-66 min as compared to 161+/-108 min in the FAW group. The Mediwrap blanket is as effective as the FAW blanket in maintaining core body temperature during thoracotomy when applied thirty minutes before the surgery.

  17. Rethinking N2 disease in the era of uniportal video-assisted thoracic surgery.

    PubMed

    Treasure, Tom; De Leyn, Paul

    2016-12-01

    Third Mediterranean Symposium on Thoracic Surgical Oncology, Catania, Italy, 21-22 April 2016 The primary justification for mediastinal lymphadenectomy is that it provides more complete nodal staging to help select best adjuvant treatments. There is a secondary argument that dissection of nodes might remove otherwise unrecognized nodal disease to increase the chance of cure. They have to be thought through again as patients look for less invasive treatments for their cancers such as videothoracoscopy and stereotactic radiotherapy. Evidence from analysis of Surveillance, Epidemiology and End Results data indicated that sampling or dissection can be performed adequately by surgeons using videothoracoscopy but stereotactic radiotherapy of its nature precludes intraoperative lymph node dissection and yet is being promoted as equivalent treatment. Consideration of these issues requires re-examination of the evidence that lymphadenectomy influences survival.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

    Landi, Pablo J; Torrejón, Gisell A; Muiños, 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.

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

    PubMed

    Wu, Meng-Shan; Su, Shu-Fen

    2016-04-01

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

  1. Effects of Intraoperative Dexmedetomidine on Postoperative Pain in Highly Nicotine-Dependent Patients After Thoracic Surgery: A Prospective, Randomized, Controlled Trial.

    PubMed

    Cai, Xingzhi; Zhang, Ping; Lu, Sufen; Zhang, Zongwang; Yu, Ailan; Liu, Donghua; Wu, Shanshan

    2016-05-01

    To investigate the effects of intraoperative dexmedetomidine on pain in highly nicotine-dependent patients after thoracic surgery.Highly nicotine-dependent men underwent thoracic surgery and received postoperative patient-controlled intravenous analgesia with sufentanil. In dexmedetomidine group (experimental group, n = 46), dexmedetomidine was given at a loading dose of 1 μg/kg for 10 minutes, followed by continuous infusion at 0.5 μg/kg/h until 30 minutes before the end of surgery. The saline group (control group, n = 48) received the same volume of saline. General anesthesia was administered via a combination of inhalation and intravenous anesthetics. If necessary, patients were administered a loading dose of sufentanil by an anesthesiologist immediately after surgery (0 hours). Patient-controlled analgesia was started when the patient's resting numerical rating scale (NRS) score was less than 4. Resting and coughing NRS scores and sufentanil dosage were recorded 0, 1, 4 hours, and every 4 hours until 48 hours after surgery. Dosages of other rescue analgesics were converted to the sufentanil dosage. Surgical data, adverse effects, and degree of satisfaction were obtained.Cumulative sufentanil dosage, resting NRS, and coughing NRS in the first 24 hours after surgery and heart rate were lower in the experimental compared with the control group (P <0.05). No patient experienced sedation or respiratory depression. Frequency of nausea and vomiting and degree of satisfaction were similar in both groups.Intraoperative dexmedetomidine was associated with reduced resting and coughing NRS scores and a sufentanil-sparing effect during the first 24 hours after thoracic surgery.

  2. Thoracic Duct Fistula after Thyroid Cancer Surgery: Towards a New Treatment?

    PubMed Central

    Rodier, Jean-François; Volkmar, Pierre-Philippe; Bodin, Frédéric; Frigo, Séverine; Ciftci, Sait; Dahlet, Christian

    2011-01-01

    The use of somatostatin analogs is a new conservative therapeutic approach for the treatment of chyle fistulas developing after thyroid cancer surgery. The combination therapy with a total parenteral nutrition should avoid the high morbidity of a re-intervention with an uncertain outcome. This promising trend is supported by the present case report of a chyle leak occurring after total thyroidectomy with central and lateral neck dissection for a papillary carcinoma, which was treated successfully without immediate or distant sequelae. PMID:21734879

  3. Society of Thoracic Surgeons

    MedlinePlus

    ... STS Participant User File Research Program Videos Lung Cancer Screening Adoption How to Build Your Academic Career New Technologies in Mitral Valve Replacement Enhanced Recovery Pathways in Thoracic Surgery New STS Clinical Practice Guidelines ...

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

    PubMed

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

    2013-05-01

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

  5. Pharmacological agents as cerebral protectants during deep hypothermic circulatory arrest in adult thoracic aortic surgery. A survey of current practice.

    PubMed

    Dewhurst, A T; Moore, S J; Liban, J B

    2002-10-01

    A postal survey was sent to members of the Association of Cardiothoracic Anaesthetists to ascertain current practice in the use of pharmacological agents as cerebral protectants during deep hypothermic circulatory arrest. The response rate was 60%. Eighty-three per cent of respondents used some form of pharmacological agent specifically for cerebral protection. Fifty-nine per cent of respondents used thiopental, 29% used propofol and 48% used a variety of other agents, the most common of these being a steroid. There were variations in the dose and timing of administration of drugs. Few respondents believed that there was a body of evidence to support this use of pharmacological agents. Only 35% of respondents believed there to be sufficient evidence to support the use of thiopental. Similarly, only 11% of respondents believe that there is evidence supporting the use of propofol, and 16% the use of steroids. The above findings demonstrate that it would not be possible to create a "best practice" set of guidelines at present. A national database of all cases of adult thoracic surgery involving deep hypothermic cardiac arrest, with methodology and outcome, could probably establish such guidelines, evidence based.

  6. Surgical treatment for pulmonary tuberculosis: is video-assisted thoracic surgery “better” than thoracotomy?

    PubMed Central

    Han, Yi; Zhen, Dezhi; Liu, Shuku; Qin, Ming; Zhou, Shijie; Yu, Daping; Song, Xiaoyun; Li, Yunsong; Xiao, Ning; Su, Chongyu; Shi, Kang

    2015-01-01

    Objective To compare video-assisted thoracoscopic surgery (VATS) lobectomy and conventional open lobectomy in patients with pulmonary tuberculosis (TB) who require surgery. Methods Forty patients with pulmonary TB who required lobectomy were randomized to receive either VATS or open lobectomy. Patient demographic, pulmonary function, operative, and postoperative data were compared between the groups. Results There were 20 patients who received VATS lobectomy (median age 31.5 years, range 19-67 years) and 20 that received open lobectomy (median age 33.5 years, range 16-60 years). The two groups were similar with respect to gender, age and pulmonary function (all, P>0.05). Lobectomy was completed by VATS in 19 of 20 patients (95%), and by thoracoscope-assisted mini-incision lobectomy in 1 patient. The median intraoperative blood loss was 345 mL (range, 100-800 mL), and the median duration of pleural cavity closed drainage was 5 days (range, 3-7 days). All open lobectomies were completed successfully, and the median intraoperative blood loss was 445 mL (range, 150-950 mL) and the median duration of pleural cavity closed drainage was 5 days (range, 3-9 days). No statistically significant differences were found between the groups with respect to operation completion rates, type of lung resection, intraoperative blood loss, closed pleural drainage duration and volume of postoperative chest drainage. The operation time, number of postoperative complications, postoperative pain index at 24 hours after surgery and postoperative hospital stay were all significantly less in the VATS group. With a median follow-up duration of 14 months (range, 8-18 months) no positive sputum examination results were found in either group. Conclusions VATS lobectomy is an effective and minimally invasive method for treating patients with pulmonary TB. PMID:26380771

  7. The impact of preoperative epidural injections on postoperative infection in lumbar fusion surgery.

    PubMed

    Singla, Anuj; Yang, Scott; Werner, Brian C; Cancienne, Jourdan M; Nourbakhsh, Ali; Shimer, Adam L; Hassanzadeh, Hamid; Shen, Francis H

    2017-03-14

    OBJECTIVE Lumbar epidural steroid injections (LESIs) are performed for both diagnostic and therapeutic purposes for a variety of indications, including low-back pain, the leading cause of disability and expense due to work-related conditions in the US. The steroid agent used in epidural injections is reported to relieve nerve root inflammation, local ischemia, and resultant pain, but the injection may also have an adverse impact on spinal surgery performed thereafter. In particular, the possibility that preoperative epidural injections may increase the risk of surgical site infection after lumbar spinal fusion has been reported but has not been studied in detail. The goal of the present study was to use a large national insurance database to analyze the association of preoperative LESIs with surgical site infection after lumbar spinal fusion. METHODS A nationwide insurance database of patient records was used for this retrospective analysis. Current Procedural Terminology codes were used to query the database for patients who had undergone LESI and 1- or 2-level lumbar posterior spinal fusion procedures. The rate of postoperative infection after 1- or 2-level posterior spinal fusion was analyzed. These study patients were then divided into 3 separate cohorts: 1) lumbar spinal fusion performed within 1 month after LESI, 2) fusion performed between 1 and 3 months after LESI, and 3) fusion performed between 3 and 6 months after LESI. The study patients were compared with a control cohort of patients who underwent lumbar fusion without previous LESI. RESULTS The overall 3-month infection rate after lumbar spinal fusion procedure was 1.6% (1411 of 88,540 patients). The infection risk increased in patients who received LESI within 1 month (OR 2.6, p < 0.0001) or 1-3 months (OR 1.4, p = 0.0002) prior to surgery compared with controls. The infection risk was not significantly different from controls in patients who underwent lumbar fusion more than 3 months after LESI

  8. 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

  9. Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery.

    PubMed

    Gessler, Florian; Mutlak, Haitham; Tizi, Karima; Senft, Christian; Setzer, Matthias; Seifert, Volker; Weise, Lutz

    2016-06-01

    OBJECTIVE The value of postoperative epidural analgesia after major spinal surgery is well established. Thus far, the use of patient-controlled epidural analgesia (PCEA) has been denied to patients undergoing debridement and instrumentation in spondylodiscitis, with the risk of increased postoperative pain resulting in prolonged recovery. The value of PCEA with special regard to infectious complications remains to be clarified. The present study examined the value of postoperative PCEA in comparison with intravenous analgesia in patients with spondylodiscitis undergoing posterior spinal surgery. METHODS Thirty-two patients treated surgically for spondylodiscitis of the thoracic and lumbar spine were prospectively included in a database and retrospectively reviewed for this study. Postoperative antibiotic treatment, functional capacity, pain levels, side effects, and complications were documented. Sixteen patients were given patient-demanded intravenous analgesia (PIA) followed by 16 patients assigned to PCEA. If PCEA was applied, the insertion of an epidural catheter was performed under the direct visual guidance of the surgeon at the end of the surgery. RESULTS Three patients intended for PCEA treatment were excluded due to predefined exclusion criteria. Postoperative pain was significantly lower in the PCEA group during the first 48 hours after surgery (p = 0.03). As determined by the trunk control test conducted at 8 (p < 0.001), 24 (p = 0.004), 48 (p = 0.015), 72 (p = 0.0031), and 96 hours (p < 0.001), patients in the PCEA treatment group displayed significantly increased mobilization capacity compared with those of the PIA group. Time until normal accomplishment of all mobilization maneuvers was reduced in the PCEA group compared with that in the PIA group (p = 0.04). No differences in complication rates were observed between the 2 groups (p = 0.52). CONCLUSIONS PCEA may reduce postoperative pain and lead to earlier achievement of functional capacity at a low

  10. 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.

  11. Norman Barrett (1903-79): unorthodox pioneer of thoracic and oesophageal surgery.

    PubMed

    Edison, E; Agha, R A; Camm, C F

    2013-05-01

    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 characterization of this disease. Yet the sum of Norman Barrett's contributions to modern medicine is much more than a mistaken characterization of a pathological process. Barrett was truly a pioneer of chest surgery in the UK - a specialty 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.

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

    PubMed

    Edison, E; Agha, R; Camm, C

    2016-05-01

    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.

  13. A novel combination of the Arndt endobronchial blocker and the laryngeal mask airway ProSeal™ provides one-lung ventilation for thoracic surgery.

    PubMed

    Li, Qiong; Li, Peiying; Xu, Jianghui; Gu, Huahua; Ma, Qinyun; Pang, Liewen; Liang, Weimin

    2014-11-01

    In this study, the feasibility and performance of the combination of the Arndt endobronchial blocker and the laryngeal mask airway (LMA) ProSeal™ in airway establishment, ventilation, oxygenation and lung isolation was evaluated. Fifty-five patients undergoing general anesthesia for elective thoracic surgeries were randomly allocated to group Arndt (n=26) or group double-lumen tube (DLT; n=29). Data concerning post-operative airway morbidity, ease of insertion, hemodynamics, lung collapse, ventilators, oxygenation and ventilation were collected for analysis. Compared with group DLT, group Arndt showed a significantly attenuated hemodynamic response to intubation (blood pressure, 149±31 vs. 115±16 mmHg; heart rate, 86±15 vs. 68±15 bpm), less severe injuries to the bronchus (injury score, 1.4±0.2 vs. 0.4±0.1) and vocal cords (injury score, 1.3±0.2 vs. 0.6±0.1), and lower incidences of post-operative sore throat and hoarseness. Furthermore, the novel combination of the Arndt and the LMA ProSeal showed similar ease of airway establishment, comparable ventilation and oxygenation performance, and an analogous lung isolation effect to DLT. The novel combined use of the Arndt endobronchial blocker and the LMA ProSeal can serve as a promising alternative for thoracic procedures requiring one-lung ventilation. The less traumatic properties and equally ideal lung isolation are likely to promote its use in rapidly spreading minimally invasive thoracic surgeries.

  14. Comparison of Perioperative Thoracic Epidural Fentanyl with Bupivacaine and Intravenous Fentanyl for Analgesia in Patients Undergoing Coronary Artery Bypass Grafting Surgery

    PubMed Central

    Sen, Amitabh Chanchal; Rajan, Sunil; Balachandran, Rakhi; Kumar, Lakshmi; Nair, Suresh Gangadharan

    2017-01-01

    Context: Two-thirds of patients undergoing coronary artery bypass grafting (CABG) surgery report moderate to severe pain, particularly with ambulatory or respiratory effort. Aims: The aim of this study is to compare the analgesic effect of perioperative thoracic epidural fentanyl with bupivacaine and intravenous fentanyl in patients undergoing CABG surgery. Settings and Design: The study was a prospective, randomized, nonblinded comparative study. Materials and Methods: A total of 60 patients coming under the American Society of Anesthesiologists Class III who were posted for CABG surgery were recruited in this study. The patients were randomized into one of two groups, higher thoracic epidural analgesia (HTEA) group receiving general anesthesia with thoracic epidural analgesia (TEA) in the postoperative period, and intravenous fentanyl analgesia group receiving general anesthesia with fentanyl infusion in the postoperative period. The pain was assessed at 4 h after extubation when the patient was fully awake, then at 8, 12, 18, and 24 h. Both groups received intravenous tramadol 100 mg as rescue analgesia whenever visual analog scale score was 5 and above. Heart rate, mean arterial pressure (MAP), sedation scores, and physiotherapy cooperation were also assessed. Statistical Analysis Used: The numerical data were analyzed using an independent t-test, repeated-measures ANOVA, and Mann–Whitney U-test. Results: Pain at rest and on cough was significantly lower in HTEA patients as compared to control group. Patients HTEA group got less frequent rescue analgesia than the control group. Physiotherapy cooperation was significantly better in HTEA patients at 4, 12, and 24 h postextubation. They also had significantly lower heart rate, MAP, and sedation scores. Conclusion: Perioperative TEA using fentanyl with bupivacaine provided optimal postoperative analgesia at rest and during coughing in patients following CABG surgery as compared to postoperative analgesia with

  15. Retrospective radiological outcome analysis following teriparatide use in elderly patients undergoing multilevel instrumented lumbar fusion surgery

    PubMed Central

    Kaliya-Perumal, Arun-Kumar; Lu, Meng-Ling; Luo, Chi-An; Tsai, Tsung-Ting; Lai, Po-Liang; Chen, Lih-Huei; Chen, Wen-Jer; Niu, Chi-Chien

    2017-01-01

    Abstract Elderly patients with chronic nonresolving symptoms due to degenerative spine pathologies are prone to have poor surgical outcomes and hardware-related complications, especially following multilevel instrumented lumbar fusion surgeries. With intention of analyzing if teriparatide can be an effective adjunct therapy to surgical management, radiological outcomes are studied. Sixty-two elderly patients were divided into 2 similar groups. Group 1 (n = 30; mean age = 69.83 years; fusion levels = 137; screws = 269) had taken teriparatide (20 mcg SC injection, once daily) for a duration of 7.4 ± 2.4 months following surgery and Group 2 (n = 32; mean age = 70.38 years; fusion levels = 144; screws = 283) did not take teriparatide. Radiological evaluation was done to determine the state of postero lateral fusion mass and to investigate the incidence of pedicle screw loosening at 1-year follow-up. Unilateral or bilateral bridging bone formation across the transverse process of adjacent vertebras showing continuous trabeculation suggestive of solid fusion was obtained in 66.7% patients in the teriparatide group and 50% patients in the control group (P = 0.20). 13.4% of the total no. of screws showed signs of loosening in the teriparatide group, compared to 24.4% in the control group (P = 0.001). Percentage of patients achieving solid fusion following teriparatide use was found to be more than that of the control group. This difference may have clinical importance but was not statistically significant. However, teriparatide use was more significantly influential in reducing the incidence of subsequent pedicle screw loosening. PMID:28151894

  16. Cytokine & chemokine response in the lungs, pleural fluid and serum in thoracic surgery using one-lung ventilation

    PubMed Central

    2011-01-01

    Background Thoracic surgery mandates usually a one-lung ventilation (OLV) strategy with the collapse of the operated lung and ventilation of the non-operated lung. These procedures trigger a substantial inflammatory response. The aim of this study was to analyze the cytokine and chemokine reaction in both lungs, pleural space and blood in patients undergoing lung resection with OLV with special interest in the chemokine growth-regulated peptide alpha (GROα) which is the human equivalent to the rat cytokine-induced neutrophil chemoattractant-1 (CINC-1). Methods Broncho-alveolar lavage (BAL) fluid of both the collapsed, operated and the ventilated, non-operated lung, respectively, pleural space drainage fluid and blood was collected and the concentrations of interleukin (IL)-6, IL-1RA and GROα were determined with enzyme-linked immunosorbent assays in 15 patients. Results Substantial inter-individual differences in the BAL fluid between patients in cytokine and chemokine levels occurred. In the pleural fluid and the blood these inter-individual differences were less pronounced. Both sides of the lung were affected and showed a significant increase in IL-6 and IL-1RA concentrations over time but not in GROα concentrations. Except for IL-6, which increased more in the collapsed, operated lung, no difference between the collapsed, operated and the ventilated, non-operated lung occurred. In the blood, IL-6 and IL-1RA increased early, already at the end of surgery. GROα was not detectable. In the pleural fluid, both cytokine and chemokine concentrations increased by day one. The increase was significantly higher in the pleural fluid compared to the blood. Conclusion The inflammatory response of cytokines affects both the collapsed, operated and the ventilated, non-operated lungs. The difference in extent of response underlines the complexity of the inflammatory processes during OLV. In contrast to the cytokines, the chemokine GROα concentrations did not react in the

  17. Awake palliative thoracic surgery in a high-risk patient: one-lung, non-invasive ventilation combined with epidural blockade.

    PubMed

    Guarracino, F; Gemignani, R; Pratesi, G; Melfi, F; Ambrosino, N

    2008-07-01

    We report the case of a terminally ill cancer patient with recurrent pericardial and bilateral pleural effusions who was scheduled for video-assisted thoracoscopic surgery. The operation was performed with the patient awake under epidural anaesthesia. The patient's cough reflex in response to lung manipulation was successfully minimised by the inhalation of aerosolised lidocaine. Video-assisted thoracic surgery requires the exclusion of a lung from ventilation. In order to support one-lung spontaneous ventilation in this high-risk patient, we successfully used non-invasive bilevel positive airway pressure ventilation via a facemask. Based on this preliminary experience, we think that critically ill patients scheduled for palliative surgery can be successfully managed with the combination of minimally invasive surgical techniques and neuraxial block with non-invasive lung ventilation.

  18. Bone substitutes and expanders in Spine Surgery: A review of their fusion efficacies

    PubMed Central

    Millhouse, Paul W; Kepler, Christopher K; Radcliff, Kris E.; Fehlings, Michael G.; Janssen, Michael E.; Sasso, Rick C.; Benedict, James J.; Vaccaro, Alexander R

    2016-01-01

    Study Design A narrative review of literature. Objective This manuscript intends to provide a review of clinically relevant bone substitutes and bone expanders for spinal surgery in terms of efficacy and associated clinical outcomes, as reported in contemporary spine literature. Summary of Background Data Ever since the introduction of allograft as a substitute for autologous bone in spinal surgery, a sea of literature has surfaced, evaluating both established and newly emerging fusion alternatives. An understanding of the available fusion options and an organized evidence-based approach to their use in spine surgery is essential for achieving optimal results. Methods A Medline search of English language literature published through March 2016 discussing bone graft substitutes and fusion extenders was performed. All clinical studies reporting radiological and/or patient outcomes following the use of bone substitutes were reviewed under the broad categories of Allografts, Demineralized Bone Matrices (DBM), Ceramics, Bone Morphogenic proteins (BMPs), Autologous growth factors (AGFs), Stem cell products and Synthetic Peptides. These were further grouped depending on their application in lumbar and cervical spine surgeries, deformity correction or other miscellaneous procedures viz. trauma, infection or tumors; wherever data was forthcoming. Studies in animal populations and experimental in vitro studies were excluded. Primary endpoints were radiological fusion rates and successful clinical outcomes. Results A total of 181 clinical studies were found suitable to be included in the review. More than a third of the published articles (62 studies, 34.25%) focused on BMP. Ceramics (40 studies) and Allografts (39 studies) were the other two highly published groups of bone substitutes. Highest radiographic fusion rates were observed with BMPs, followed by allograft and DBM. There were no significant differences in the reported clinical outcomes across all classes of bone

  19. Does video-assisted thoracic surgery provide a safe alternative to conventional techniques in patients with limited pulmonary function who are otherwise suitable for lung resection?

    PubMed

    Oparka, Jonathan; Yan, Tristan D; Ryan, Eilise; Dunning, Joel

    2013-07-01

    A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: does video-assisted thoracic surgery provide a safe alternative to conventional techniques in patients with limited pulmonary function who are otherwise suitable for lung resection? Altogether, more than 280 papers were found using the reported search, of which 7 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. One of the largest studies reviewed was a retrospective review of the Society of Thoracic Surgeons database. The authors compared 4531 patients who underwent lobectomy by video-assisted thoracic surgery (VATS) with 8431 patients who had thoracotomy. In patients with a predicted postoperative forced expiratory volume in 1 s (ppoFEV1%) of <60, it was demonstrated that thoracotomy patients have markedly increased pulmonary complications when compared with VATS patients (P = 0.023). Another study compared perioperative outcomes in patients with a ppoFEV1% of <40% who underwent thoracoscopic resection with similar patients who underwent open resection. Patients undergoing thoracoscopic resection as opposed to open thoracotomy had a lower incidence of pneumonia (4.3 vs 21.7%, P < 0.05), a shorter intensive care stay (2 vs 4 days, P = 0.05) and a shorter hospital stay (7 vs 10 days, P = 0.058). A similar study compared recurrence and survival in patients with a ppoFEV1% of <40% who underwent resection by VATS or anatomical segmentectomy (study group) with open resection (control group). Relative to the control group, patients in the study group had a shorter length of hospital stay (8 vs 12 days, P = 0.054) and an improved 5-year survival (42 vs 18%, P = 0.02). Analysis suggested that VATS lobectomy was the principal driver of survival benefit in the study group. We conclude that

  20. Lateral interbody fusion combined with open posterior surgery for adult spinal deformity.

    PubMed

    Strom, Russell G; Bae, Junseok; Mizutani, Jun; Valone, Frank; Ames, Christopher P; Deviren, Vedat

    2016-12-01

    OBJECTIVE Lateral interbody fusion (LIF) with percutaneous screw fixation can treat adult spinal deformity (ASD) in the coronal plane, but sagittal correction is limited. The authors combined LIF with open posterior (OP) surgery using facet osteotomies and a rod-cantilever technique to enhance lumbar lordosis (LL). It is unclear how this hybrid strategy compares to OP surgery alone. The goal of this study was to evaluate the combination of LIF and OP surgery (LIF+OP) for ASD. METHODS All thoracolumbar ASD cases from 2009 to 2014 were reviewed. Patients with < 6 months follow-up, prior fusion, severe sagittal imbalance (sagittal vertical axis > 200 mm or pelvic incidence-LL > 40°), and those undergoing anterior lumbar interbody fusion were excluded. Deformity correction, complications, and outcomes were compared between LIF+OP and OP-only surgery patients. RESULTS LIF+OP (n = 32) and OP-only patients (n = 60) had similar baseline features and posterior fusion levels. On average, 3.8 LIFs were performed. Patients who underwent LIF+OP had less blood loss (1129 vs 1833 ml, p = 0.016) and lower durotomy rates (0% vs 23%, p = 0.002). Patients in the LIF+OP group required less ICU care (0.7 vs 2.8 days, p < 0.001) and inpatient rehabilitation (63% vs 87%, p = 0.015). The incidence of new leg pain, numbness, or weakness was similar between groups (28% vs 22%, p = 0.609). All leg symptoms resolved within 6 months, except in 1 OP-only patient. Follow-up duration was similar (28 vs 25 months, p = 0.462). LIF+OP patients had significantly less pseudarthrosis (6% vs 27%, p = 0.026) and greater improvement in visual analog scale back pain (mean decrease 4.0 vs 1.9, p = 0.046) and Oswestry Disability Index (mean decrease 21 vs 12, p = 0.035) scores. Lumbar coronal correction was greater with LIF+OP surgery (mean [± SD] 22° ± 13° vs 14° ± 13°, p = 0.010). LL restoration was 22° ± 13°, intermediately between OP-only with facet osteotomies (11° ± 7°, p < 0.001) and

  1. Successful resuscitation of a patient who developed cardiac arrest from pulsed saline bacitracin lavage during thoracic laminectomy and fusion.

    PubMed

    Greenberg, Steven B; Deshur, Mark; Khavkin, Yevgeniy; Karaikovic, Elden; Vender, Jeffery

    2008-06-01

    A patient with a history of T12 burst fracture caused by a fall, and with progressive weakness and sensory loss in the left leg, survived a cardiac arrest after pulsed saline bacitracin lavage irrigation during a posterior spinal fusion.

  2. Interdisciplinary Cognitive-Behavioral Therapy as Part of Lumbar Spinal Fusion Surgery Rehabilitation

    PubMed Central

    Lindgreen, Pil; Rolving, Nanna; Nielsen, Claus Vinther; Lomborg, Kirsten

    2016-01-01

    BACKGROUND: Patients receiving lumbar spinal fusion surgery often have persisting postoperative pain negatively affecting their daily life. These patients may be helped by interdisciplinary cognitive-behavioral therapy which is recognized as an effective intervention for improving beneficial pain coping behavior, thereby facilitating the rehabilitation process of patients with chronic pain. PURPOSE: The purpose of this study was to describe the lived experience of patients recovering from lumbar spinal fusion surgery and to explore potential similarities and disparities in pain coping behavior between receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. METHODS: We conducted semistructured interviews with 10 patients; 5 receiving cognitive-behavioral therapy in connection with their lumbar spinal fusion surgery and 5 receiving usual care. We conducted a phenomenological analysis to reach our first aim and then conducted a comparative content analysis to reach our second aim. RESULTS: Patients' postoperative experience was characterized by the need to adapt to the limitations imposed by back discomfort (coexisting with the back), need for recognition and support from others regarding their pain, a relatively long rehabilitation period during which they “awaited the result of surgery”, and ambivalence toward analgesics. The patients in both groups had similar negative perception of analgesics and tended to abstain from them to avoid addiction. Coping behavior apparently differed among receivers and nonreceivers of interdisciplinary cognitive-behavioral group therapy. Receivers prevented or minimized pain by resting before pain onset, whereas nonreceivers awaited pain onset before resting. CONCLUSION: The postoperative experience entailed ambivalence, causing uncertainty, worry and insecurity. This ambivalence was relieved when others recognized the patient's pain and offered support. Cognitive-behavioral therapy as part of

  3. Diagnosis Accuracy of Mean Arterial Pressure Variation during a Lung Recruitment Maneuver to Predict Fluid Responsiveness in Thoracic Surgery with One-Lung Ventilation

    PubMed Central

    Kang, Woon-Seok; Oh, Chung-Sik; Park, Chulmin; Shin, Bo Mi; Yoon, Tae-Gyoon; Rhee, Ka-Young; Woo, Nam-Sik

    2016-01-01

    Background. Lung recruitment maneuver (LRM) during thoracic surgery can reduce systemic venous return and resulting drop in systemic blood pressure depends on the patient's fluid status. We hypothesized that changes in systemic blood pressure during the transition in LRM from one-lung ventilation (OLV) to two-lung ventilation (TLV) may provide an index to predict fluid responsiveness. Methods. Hemodynamic parameters were measured before LRM (T0); after LRM at the time of the lowest mean arterial blood pressure (MAP) (T1) and at 3 minutes (T2); before fluid administration (T3); and 5 minutes after ending it (T4). If the stroke volume index increased by >25% following 10 mL/kg colloid administration for 30 minutes, then the patients were assigned to responder group. Results. Changes in MAP, central venous pressure (CVP), and stroke volume variation (SVV) between T0 and T1 were significantly larger in responders. Areas under the curve for change in MAP, CVP, and SVV were 0.852, 0.759, and 0.820, respectively; the optimal threshold values for distinguishment of responders were 9.5 mmHg, 0.5 mmHg, and 3.5%, respectively. Conclusions. The change in the MAP associated with LRM at the OLV to TLV conversion appears to be a useful indicator of fluid responsiveness after thoracic surgery. Trial Registration. This trial is registered at Clinical Research Information Service with KCT0000774. PMID:27819002

  4. 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

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

    PubMed Central

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

    2015-01-01

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

  6. Economic Effects of Anti-Depressant Usage on Elective Lumbar Fusion Surgery

    PubMed Central

    Sayadipour, Amirali; Kepler, Chrisopher K.; Mago, Rajnish; Certa, Kenneth M.; Rasouli, Mohammad R.; Vaccaro, Alexander R.; Albert, Todd J.; Anderson, David G.

    2016-01-01

    Background: It has been suggested, although not proven, that presence of concomitant psychiatric disorders may increase the inpatient costs for patients undergoing elective surgery. This study was designed to test the hypothesis that elective lumbar fusion surgery is more costly in patients with under treatment for depression. Methods: This is a retrospective case-control study of 142 patients who underwent elective lumbar fusion. Of those 142 patients, 41 patients were chronically using an antidepressant medication that considered as a “study group”, and 101 patients were not taking an antidepressant medication that considered as a “control group”. Data was collected for this cohort regarding antidepressant usage patient demographics, length of stay (LOS), age-adjusted Charlson comorbidity index scores and cost. Costs were compared between those with a concomitant antidepressant usage and those without antidepressant usage using multivariate analysis. Results: Patients using antidepressants and those with no history of antidepressant usage were similar in terms of gender, age and number of operative levels. The LOS demonstrated a non-significant trend towards longer stays in those using anti-depressants. Total charges, payments, variable costs and fixed costs were all higher in the antidepressant group but none of the differences reached statistical significance. Using Total Charges as the dependent variable, gender and having psychiatric comorbidities were retained independent variables. Use of an antidepressant was independently predictive of a 36% increase in Total Charges. Antidepressant usage as an independent variable also conferred a 22% increase in cost and predictive of a 19% increase in Fixed Cost. Male gender was predictive of a 30% increase in Total Charges. Conclusion: This study suggests use of antidepressant in patients who undergo elective spine fusion compared with control group is associated with increasing total cost and length of

  7. Relaxation Training and Postoperative Music Therapy for Adolescents Undergoing Spinal Fusion Surgery.

    PubMed

    Nelson, Kirsten; Adamek, Mary; Kleiber, Charmaine

    2017-02-01

    Spinal fusion for idiopathic scoliosis is one of the most painful surgeries experienced by adolescents. Music therapy, utilizing music-assisted relaxation with controlled breathing and imagery, is a promising intervention for reducing pain and anxiety for these patients. It can be challenging to teach new coping strategies to post-operative patients who are already in pain. This study evaluated the effects of introducing music-assisted relaxation training to adolescents before surgery. Outcome measures were self-reported pain and anxiety, recorded on 0-10 numeric rating scale, and observed behavioral indicators of pain and relaxation. The training intervention was a 12-minute video about music-assisted relaxation with opportunities to practice before surgery. Forty-four participants between the ages of 10 and 19 were enrolled. Participants were randomly assigned to the experimental group that watched the video at the preoperative visit or to the control group that did not watch the video. All subjects received a music therapy session with a board certified music therapist on post-operative day 2 while out of bed for the first time. Pain and anxiety were significantly reduced from immediately pre-therapy to post-therapy (paired t-test; p).

  8. Mini-Open Anterior Lumbar Interbody Fusion Combined with Lateral Lumbar Interbody Fusion in Corrective Surgery for Adult Spinal Deformity

    PubMed Central

    Lee, Chong-Suh; Chung, Sung-Soo; Lee, Jun-Young; Yum, Tae-Hoon; Shin, Seong-Kee

    2016-01-01

    Study Design Prospective observational study. Purpose To introduce the techniques and present the surgical outcomes of mini-open anterior lumbar interbody fusion (ALIF) at the most caudal segments of the spine combined with lateral lumbar interbody fusion (LLIF) for the correction of adult spinal deformity Overview of Literature Although LLIF is increasingly used to correct adult spinal deformity, the correction of sagittal plane deformity with LLIF alone is reportedly suboptimal. Methods Thirty-two consecutive patients with adult spinal deformity underwent LLIF combined with mini-open ALIF at the L5–S1 or L4–S1 levels followed by 2-stage posterior fixation. ALIF was performed for a mean 1.3 levels and LLIF for a mean 2.7 levels. Then, percutaneous fixation was performed in 11 patients (percutaneous group), open correction with facetectomy with or without laminectomy in 16 (open group), and additional pedicle subtraction osteotomy (PSO) in 5 (PSO group). Spinopelvic parameters were compared preoperatively and postoperatively. Hospitalization data and clinical outcomes were recorded. Results No major medical complications developed, and clinical outcomes improved postoperatively in all groups. The mean postoperative segmental lordosis was greater after ALIF (17.5°±5.5°) than after LLIF (8.1°±5.3°, p <0.001). Four patients (12.5%) had lumbar lordosis with a pelvic incidence of ±9° preoperatively, whereas this outcome was achieved postoperatively in 30 patients (93.8%). The total increase in lumbar lordosis was 14.7° in the percutaneous group, 35.3° in the open group, and 57.0° in the PSO group. The ranges of potential lumbar lordosis increase were estimated as 4°–25°, 23°–42°, and 45°–65°, respectively. Conclusions Mini-open ALIF combined with LLIF followed by posterior fixation may be a feasible technique for achieving optimal sagittal balance and reducing the necessity of more extensive surgery. PMID:27994777

  9. Thoracic ectopia cordis.

    PubMed

    Shad, Jimmy; Budhwani, Keshav; Biswas, Rakesh

    2012-09-30

    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.

  10. 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 5.5–7.9 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

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

    PubMed

    Cobo Soriano, Javier; Sendino Revuelta, Marcos; Fabregate Fuente, Martín; Cimarra Díaz, Ignacio; Martínez Ureña, Paloma; Deglané 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.

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

    PubMed Central

    Sendino Revuelta, Marcos; Cimarra Díaz, Ignacio; Martínez Ureña, Paloma; Deglané 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 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

  13. Population pharmacokinetics of ϵ-aminocaproic acid in adolescents undergoing posterior spinal fusion surgery

    PubMed Central

    Stricker, P. A.; Gastonguay, M. R.; Singh, D.; Fiadjoe, J. E.; Sussman, E. M.; Pruitt, E. Y.; Goebel, T. K.; Zuppa, A. F.

    2015-01-01

    Background Despite demonstrated efficacy of ϵ-aminocaproic acid (EACA) in reducing blood loss in adolescents undergoing spinal fusion, there are no population-specific pharmacokinetic data to guide dosing. The aim of this study was to determine the pharmacokinetics of EACA in adolescents undergoing spinal fusion surgery and make dosing recommendations. Methods Twenty children ages 12–17 years were enrolled, with 10 children in each of two groups based on diagnosis (idiopathic scoliosis or non-idiopathic scoliosis). Previously reported data from infants undergoing craniofacial surgery were included in the model to enable dosing recommendations over a wide range of weights, ages, and diagnoses. A population non-linear mixed effects modelling approach was used to characterize EACA pharmacokinetics. Results Population pharmacokinetic parameters were estimated using a two-compartment disposition model with allometrically scaled weight and an age effect on clearance. Pharmacokinetic parameters for the typical patient were a plasma clearance of 153 ml min−1 70 kg−1 (6.32 ml min−1 kg−0.75), intercompartmental clearance of 200 ml min−1 70 kg−1 (8.26 ml min−1 kg−0.75), central volume of distribution of 8.78 litre 70 kg−1 (0.13 litre kg−1), and peripheral volume of distribution of 15.8 litre 70 kg−1 (0.23 litre kg−1). Scoliosis aetiology did not have a clinically significant effect on drug pharmacokinetics. Conclusions The following dosing schemes are recommended according to patient weight: weight <25 kg, 100 mg kg−1 loading dose and 40 mg kg−1 h−1 infusion; weight ≤25 kg–<50 kg, 100 mg kg−1 loading dose and 35 mg kg−1 h−1 infusion; and weight ≥50 kg, 100 mg kg−1 loading dose and 30 mg kg−1 h−1 infusion. An efficacy trial employing this dosing strategy is warranted. Clinical trial registration NCT01408823. PMID:25586726

  14. Presence of fusion in albinism after strabismus surgery augmented with botulinum toxin (type a) injection.

    PubMed

    Tavakolizadeh, Sepideh; Farahi, Azadeh

    2013-08-01

    It is commonly accepted that albino patients with strabismus rarely achieve binocularity and depth perception after strabismus surgery. The presence of retino-geniculo-cortical misrouting, a hallmark of the visual system in albinism, does not necessarily cause total loss of binocular vision, however, not even in albino patients with strabismus. Recently some degrees of stereopsis were reported in albinism patients with minimal clinical nystagmus, if any, in the absence of strabismus. It is possible that patients with albinism and strabismus have binocular visual potential which appears after strabismus correction and provides appropriate postoperative alignment in the long term. Here we present two cases of clinically diagnosed oculocutaneous albinism, an 18-year-old girl and a 16-year-old boy, both with exotropia ≥40 prism diopter, who gained acceptable alignment and fusion after surgical correction of their strabismus as demonstrated on Bagolini testing. In cases of albinism accompanied by visual pathway abnormalities and strabismus, binocular visual potential is not impossible, and some levels can be expected. Thus, these patients, like other cases of strabismus, may benefit from treatment of strabismus at an earlier age to achieve appropriate alignment, cosmetic satisfaction, and a possibly increased chance of fusion.

  15. 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

  16. 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.

  17. 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.

  18. 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.

  19. Comparison of minimally invasive surgery with standard open surgery for vertebral thoracic metastases causing acute myelopathy in patients with short- or mid-term life expectancy: surgical technique and early clinical results.

    PubMed

    Miscusi, Massimo; Polli, Filippo Maria; Forcato, Stefano; Ricciardi, Luca; Frati, Alessandro; Cimatti, Marco; De Martino, Luca; Ramieri, Alessandro; Raco, Antonino

    2015-05-01

    OBJECT Spinal metastasis is common in patients with cancer. About 70% of symptomatic lesions are found in the thoracic region of the spine, and cord compression presents as the initial symptom in 5%-10% of patients. Minimally invasive spine surgery (MISS) has recently been advocated as a useful approach for spinal metastases, with the aim of decreasing the morbidity associated with more traditional open spine surgery; furthermore, the recovery time is reduced after MISS, such that postoperative chemotherapy and radiotherapy can begin sooner. METHODS Two series of oncological patients, who presented with acute myelopathy due to vertebral thoracic metastases, were compared in this study. Patients with complete paraplegia for more than 24 hours and with a modified Bauer score greater than 2 were excluded from the study. The first group (n = 23) comprised patients who were prospectively enrolled from May 2010 to September 2013, and who were treated with minimally invasive laminotomy/laminectomy and percutaneous stabilization. The second group (n = 19) comprised patients from whom data were retrospectively collected before May 2010, and who had been treated with laminectomy and stabilization with traditional open surgery. Patient groups were similar regarding general characteristics and neurological impairment. Results were analyzed in terms of neurological recovery (American Spinal Injury Association grade), complications, pain relief (visual analog scale), and quality of life (European Organisation for Research and Treatment of Cancer [EORTC] QLQ-C30 and EORTC QLQ-BM22 scales) at the 30-day follow-up. Operation time, postoperative duration of bed rest, duration of hospitalization, intraoperative blood loss, and the need and length of postoperative opioid administration were also evaluated. RESULTS There were no significant differences between the 2 groups in terms of neurological recovery and complications. Nevertheless, the MISS group showed a clear and significant

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

    PubMed

    Bertoglio, Pietro; Waller, David A

    2016-06-01

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

  1. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery

    PubMed Central

    Balaji, V.; Kaila, R.; Wilson, L.

    2016-01-01

    Objectives We performed a systematic review of the literature to determine the safety and efficacy of bone morphogenetic protein (BMP) compared with bone graft when used specifically for revision spinal fusion surgery secondary to pseudarthrosis. Methods The MEDLINE, EMBASE and Cochrane Library databases were searched using defined search terms. The primary outcome measure was spinal fusion, assessed as success or failure in accordance with radiograph, MRI or CT scan review at 24-month follow-up. The secondary outcome measure was time to fusion. Results A total of six studies (three prospective and three retrospective) reporting on the use of BMP2 met the inclusion criteria (203 patients). Of these, four provided a comparison of BMP2 and bone graft whereas the other two solely investigated the use of BMP2. The primary outcome was seen in 92.3% (108/117) of patients following surgery with BMP2. Although none of the studies showed superiority of BMP2 to bone graft for fusion, its use was associated with a statistically quicker time to achieving fusion. BMP2 did not appear to increase the risk of complication. Conclusion The use of BMP2 is both safe and effective within the revision setting, ideally in cases where bone graft is unavailable or undesirable. Further research is required to define its optimum role. Cite this article: Mr P. Bodalia. Effectiveness and safety of recombinant human bone morphogenetic protein-2 for adults with lumbar spine pseudarthrosis following spinal fusion surgery: A systematic review. Bone Joint Res 2016;5:145–152. DOI: 10.1302/2046-3758.54.2000418. PMID:27121215

  2. Minimally invasive transforaminal lumbar interbody fusion with unilateral pedicle screw fixation: comparison between primary and revision surgery.

    PubMed

    Kang, Moo Sung; Park, Jeong Yoon; 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.

  3. Clinical Characteristics and Outcomes of Patients With Myocardial Infarction and Cardiogenic Shock Undergoing Coronary Artery Bypass Surgery: Data From The Society of Thoracic Surgeons National Database

    PubMed Central

    Acharya, Deepak; Gulack, Brian C.; Loyaga-Rendon, Renzo Y.; Davies, James E.; He, Xia; Brennan, J. Matthew; Thourani, Vinod H.; Williams, Matthew L.

    2016-01-01

    Background Acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is associated with substantial mortality. We evaluated outcomes of patients in The Society of Thoracic Surgeons Adult Cardiac Surgery Database who underwent coronary artery bypass graft surgery (CABG) in the setting of AMI-CS. Methods All patients with AMI-CS who underwent nonelective CABG or CABG with ventricular assist device implantation within 7 days after myocardial infarction were enrolled. The primary analysis sample consisted of patients who underwent surgery between June 2011 and December 2013. Baseline characteristics, operative findings, outcomes, and the utilization of mechanical circulatory support (MCS) were assessed in detail in this population. We also evaluated trends in unadjusted mortality for all patients undergoing CABG or CABG with ventricular assist device for AMI-CS from January 2005 to December 2013. Results A total of 5,496 patients met study criteria, comprising 1.5% of all patients undergoing CABG during the study period. Overall operative mortality was 18.7%, decreasing from 19.3% in 2005 to 18.1% in 2013 (p < 0.001). Use of MCS increased from 5.8% in 2011 to 8.8% in 2013 (p = 0.008). Patients receiving MCS had a high proportion of cardiovascular risk factors or high clinical acuity. Patients requiring preoperative and patients requiring intraoperative or postoperative MCS had operative mortality of 37.2% and 58.4%, respectively. Patients undergoing CABG as a salvage procedure had an operative mortality of 53.3%, and a high incidence of reoperation (21.8%), postoperative respiratory failure requiring prolonged ventilation (59.7%), and renal failure (18.5%). Conclusions Most patients undergoing CABG for AMI-CS have a sizeable but not prohibitive risk. Patients who require MCS and those undergoing operation as a salvage procedure reflect higher risk populations. PMID:26718859

  4. Thoracic arachnoid cyst resection.

    PubMed

    Deutsch, Harel

    2014-09-01

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

  5. Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in Multilevel Cervical Disc Diseases

    PubMed Central

    Zhang, Jianfeng; Meng, Fanxin; Ding, Yan; Li, Jie; Han, Jian; Zhang, Xintao; Dong, Wei

    2016-01-01

    Abstract To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases. Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF. To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data. Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2–C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS. The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical

  6. 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

  7. Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery

    PubMed Central

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Wang, Qian; Zhang, Lijun; Ding, Wenyuan

    2017-01-01

    Abstract Both general anesthesia (GA) and cervical plexus anesthesia (CPA) can be used for anterior cervical discectomy and fusion (ACDF) surgery. The aim of this study was to evaluate the influence of anesthetic techniques on perioperative mortality and morbidity in patients undergoing cervical surgery. From January 2008 to December 2015, 356 patients who underwent 1-level ACDF for cervical spinal myelopathy were prospectively reviewed. They were assigned to receive GA (group A) and CPA (group B). The analgesic efficacy of the block was assessed by anesthesia preparation time, the maximum heart rate, and mean arterial blood pressure changes compared with the baseline, time of postoperative revival, and duration of recovery stay. Duration of surgery, blood loss, and anesthesia medical cost were also recorded. Numerical rating scale (NRS) was used to evaluate pain at different time points. Postoperative nausea and vomiting (PONV) was assessed, and postoperative average administered dosages of meperidine and metoclopramide were also recorded. The spinal surgeon satisfaction, anesthetist satisfaction, and patient satisfaction were assessed. Both the anesthesia induction time and postoperative revival time were longer in group A than that in group B; both the duration of surgery and recovery stay were also longer in group A than that in group B, whereas there was no difference in blood loss between the 2 groups. The average dosage of both meperidine and metoclopramide was more in group A than that in group B, and the anesthesia medical cost was greater in group A than that in group B. There were no significant differences in baseline data of systolic blood pressure, diastolic blood pressure, and heart rate between the 2 groups. But the intraoperative data of systolic blood pressure, diastolic blood pressure, and heart rate were higher/larger in group B than that in group A. In group A, there was no complaint of pain in the surgery procedure, but the pain increased

  8. Recommendations for fitness for work medical evaluations in chronic respiratory patients. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR).

    PubMed

    Martínez González, Cristina; González Barcala, Francisco Javier; Belda Ramírez, José; González Ros, Isabel; Alfageme Michavila, Inmaculada; Orejas Martínez, Cristina; González Rodríguez-Moro, José Miguel; Rodríguez Portal, José Antonio; Fernández Álvarez, Ramón

    2013-11-01

    Chronic respiratory diseases often cause impairment in the functions and/or structure of the respiratory system, and impose limitations on different activities in the lives of persons who suffer them. In younger patients with an active working life, these limitations can cause problems in carrying out their normal work. Article 41 of the Spanish Constitution states that «the public authorities shall maintain a public Social Security system for all citizens guaranteeing adequate social assistance and benefits in situations of hardship». Within this framework is the assessment of fitness for work, as a dual-nature process (medico-legal) that aims to determine whether it is appropriate or not to recognise a person's right to receive benefits which replace the income that they no longer receive as they cannot carry out their work, due to loss of health. The role of the pulmonologist is essential in evaluating the diagnosis, treatment, prognosis and functional capacity of respiratory patients. These recommendations seek to bring the complex setting of fitness for work evaluation to pulmonologists and thoracic surgeons, providing action guidelines that allow them to advise their own patients about their incorporation into working life.

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

    PubMed

    Phan, Kevin; Mobbs, Ralph J

    2016-04-01

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

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

    PubMed

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

    2014-12-01

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

  11. 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.

  12. Spinal Fusion

    MedlinePlus

    ... concept of fusion is similar to that of welding in industry. Spinal fusion surgery, however, does not ... bone taken from the patient has a long history of use and results in predictable healing. Autograft ...

  13. Cardio-thoracic surgical experience in Gabon

    PubMed Central

    Mbamendame, Sylvestre; Ngakani Offobo, Silvère; Kaba, Mory Mamadi; Mbourou, Jean Bernard; Diané, Charles

    2016-01-01

    Our experience in cardio-thoracic surgery focuses on thoracic activity. The minimum fare for traumatisms, infectious pathology and tumoral pathology requires, for its improvement, the acquisition of a technical platform and of an adequate medical infrastructure, with a rational organisation of the care sequence. Vascular surgery calls for the training of qualified human resources, and the great demand in heart surgery calls upon the public powers for the construction of infrastructures, and the formation of necessary superstructures. PMID:27904845

  14. Fluorodeoxyglucose (FDG) uptake in pulmonary rheumatoid nodules diagnosed by video-assisted thoracic surgery lung biopsy: two case reports and a review of the literature.

    PubMed

    Saraya, Takeshi; Tanaka, Ryota; Fujiwara, Masachika; Koji, Hitoshi; Oda, Miku; Ogawa, Yukari; Nagatomo, Tomoko; Watanabe, Masato; Yokoyama, Takuma; Ishii, Haruyuki; Takei, Hidefumi; Goya, Tomoyuki; Takizawa, Hajime; Goto, Hajime

    2013-03-01

    Two cases of rheumatoid nodules evaluated by fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) and video-assisted thoracic surgery (VATS) biopsy are reported. The first case was that of a 44-year-old woman who presented with a cavitated nodule with intense standardized uptake values (SUVs) both in the early (max 3.4) and delayed (max 4.4) phases, suggesting malignancy. However, after VATS biopsy, she was diagnosed as having a rheumatoid nodule with vasculitis. The second case was that of a 74-year-old woman admitted with bilateral lung nodules, two of which showed intense early (max 2.2) and delayed (max 6.0) phase SUVs, and mild early (max 0.6) and delayed (max 0.9) phase SUVs. These two nodules were finally proven to be a lung cancer and rheumatoid nodule without vasculitis, respectively. These cases show that rheumatoid nodules with an enhanced inflammatory process, such as vasculitis, can appear false-positive for malignancy on FDG-PET/CT scan images.

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

    PubMed

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

    2014-08-01

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

  16. 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

  17. Surgical results and complications of anterior decompression and fusion as a revision surgery after initial posterior surgery for cervical myelopathy due to ossification of the posterior longitudinal ligament.

    PubMed

    Odate, Seiichi; Shikata, Jitsuhiko; Soeda, Tsunemitsu; Yamamura, Satoru; Kawaguchi, Shinji

    2017-04-01

    OBJECTIVE Ossification of the posterior longitudinal ligament (OPLL) is a progressive disease. An anterior cervical decompression and fusion (ACDF) procedure for cervical OPLL is theoretically feasible, as the lesion exists anteriorly; however, such a procedure is considered technically demanding and is associated with serious complications. Cervical laminoplasty is reportedly an effective alternative procedure with few complications; it is recognized as a comparatively safe procedure, and has been widely used as an initial surgery for cervical OPLL. After posterior surgery, some patients require revision surgery because of late neurological deterioration due to kyphotic changes in cervical alignment or OPLL progression. Here, the authors retrospectively investigated the surgical results and complications of revision ACDF after initial posterior surgery for OPLL. METHODS This was a single-center, retrospective study. Between 2006 and 2013, 19 consecutive patients with cervical OPLL who underwent revision ACDF at the authors' institution after initial posterior surgery were evaluated. The mean age at the time of revision ACDF was 66 ± 7 years (± SD; range 53-78 years). The mean interval between initial posterior surgery and revision ACDF was 63 ± 53 months (range 3-235 months). RESULTS The mean follow-up period after revision ACDF was 41 ± 26 months (range 24-108 months). Before revision ACDF, the mean maximum thickness of the ossified posterior longitudinal ligament was 7.2 ± 1.5 mm (range 5-10 mm), and the mean C2-7 angle was 1.3° ± 14° (range -40° to 24°). The K-line was plus (OPLL did not exceed the K-line) in 8 patients and minus in 11 (OPLL exceeded the K-line). The mean Japanese Orthopaedic Association score improved from 10 ± 3 (range 3-15) before revision ACDF to 11 ± 4 (range 4-15) at the last follow-up, and the mean improvement rate was 18% ± 18% (range 0%-60%). A total of 16 surgery-related complications developed in 12 patients (63%). The

  18. Video-Assisted Thoracoscopic Surgery and Minimal Access Spinal Surgery Compared in Anterior Thoracic or Thoracolumbar Junctional Spinal Reconstruction: A Case-Control Study and Review of the Literature

    PubMed Central

    Lee, Ching-Yu; Wu, Meng-Huang; Li, Yen-Yao; Cheng, Chin-Chang; Lee, Chien-Yin

    2016-01-01

    There are no published reports that compare the outcomes of video-assisted thoracoscopic surgery (VATS) and minimal access spinal surgery (MASS) in anterior spinal reconstruction. We conducted a retrospective case-control study in a single center and systematically reviewed the literature to compare the efficacy and safety of VATS and MASS in anterior thoracic (T) and thoracolumbar junctional (TLJ) spinal reconstruction. From 1995 to 2012, there were 111 VATS patients and 76 MASS patients treated at our hospital. VATS patients had significantly (p < 0.001) longer operating times and significantly (p < 0.022) higher thoracotomy conversion rates. We reviewed 6 VATS articles and 10 MASS articles, in which there were 625 VATS patients and 399 MASS patients. We recorded clinical complications and a thoracotomy conversion rate from our cases and the selected articles. The incidence of approach-related complications was significantly (p = 0.021) higher in VATS patients. The conversion rate was 2% in VATS patients and 0% in MASS patients (p = 0.001). In conclusion, MASS is associated with reduction in operating time, approach-related complications, and the thoracotomy conversion rate. PMID:28101511

  19. Flexion myelopathy of the thoracic spine. Case report.

    PubMed

    Fujibayashi, Shunsuke; Neo, Masashi; Nakamura, Takashi

    2007-01-01

    The authors report a rare case of surgically treated symptomatic thoracic kyphosis caused by dynamic compression in an elderly man. Myelopathy due to thoracic kyphosis has been reported in patients with congenital kyphosis, Scheuermann dorsal kyphosis, and Cushing disease, but to the authors' knowledge this is the first report of dynamic kyphosis in an elderly person. This otherwise healthy 84-year-old man presented with a 2-year history of progressive difficulty in walking and bilateral leg dysesthesia. Despite several cervical and lumbar surgeries, his symptoms gradually worsened. A radiological examination revealed severe thoracic kyphosis, with a lateral Cobb angle of 59 degrees from T-2 to T-12. On a dynamic computed tomography (CT) myelogram, severe thoracic spinal cord draping and stretching on flexion was demonstrated. On extension, however, imaging studies failed to show draping or stretching. Posterior corrective fusion was performed with instrumentation from T-2 to T-9. Postoperative CT myelography demonstrated no significant spinal cord compression with restoration of the cerebrospinal fluid space anterior to the spinal cord, and the successful correction of the kyphosis to 44 degrees. The patient's neurological sequelae gradually resolved throughout 6 months of follow up.

  20. [Guidelines for intensive care in cardiac surgery patients: haemodynamic monitoring and cardio-circulatory treatment guidelines of the German Society for Thoracic and Cardiovascular Surgery and the German Society of Anaesthesiology and Intensive Care Medicine].

    PubMed

    Carl, M; Alms, A; Braun, J; Dongas, A; Erb, J; Goetz, A; Göpfert, M; Gogarten, W; Grosse, J; Heller, A; Heringlake, M; Kastrup, M; Kröner, A; Loer, S; Marggraf, G; Markewitz, A; Reuter, M; Schmitt, D V; Schirmer, U; Wiesenack, C; Zwissler, B; Spies, C

    2007-03-01

    Hemodynamic monitoring and adequate volume-therapy, as well as the treatment with positive inotropic drugs and vasopressors, are the basic principles of the postoperative intensive care treatment of patient after cardiothoracic surgery. The goal of these S3 guidelines is to evaluate the recommendations in regard to evidence based medicine and to define therapy goals for monitoring and therapy. In context with the clinical situation the evaluation of the different hemodynamic parameters allows the development of a therapeutic concept and the definition of goal criteria to evaluate the effect of treatment. Up to now there are only guidelines for subareas of postoperative treatment of cardiothoracic surgical patients, like the use of a pulmonary artery catheter or the transesophageal echocardiography. The German Society for Thoracic and Cardiovascular Surgery and the German Society for Anaesthesiology and Intensive Care Medicine made an approach to ensure and improve the quality of the postoperative intensive care medicine after cardiothoracic surgery by the development of S3 consensus-based treatment guidelines. Goal of this guideline is to assess available monitoring methods and their risks as well as the differentiated therapy of volume-replacement, positive inotropic support and vasoactive drugs, the therapy with vasodilators, inodilators and calcium-sensitizers and the use of intra-aortic balloon pumps. The guideline has been developed according to the recommendations for the development of guidelines by the Association of the Scientific Medical Societies in Germany (AWMF). The presented key messages of the guidelines were approved after two consensus meetings under the moderation of the Association of the Scientific Medical Societies in Germany (AWMF).

  1. A Modified EXIT-to-ECMO with Optional Reservoir Circuit for Use during an EXIT Procedure Requiring Thoracic Surgery.

    PubMed

    Matte, Gregory S; Connor, Kevin R; Toutenel, Nathalia A; Gottlieb, Danielle; Fynn-Thompson, Francis

    2016-03-01

    A 34 year old mother with a history of polyhydraminos and premature rupture of membranes presented for an ex utero intrapartum treatment (EXIT) procedure to deliver her 34 week gestation fetus. The fetus had been diagnosed with a large cervical mass which significantly extended into the right chest. The mass compressed and deviated the airway and major neck vessels posteriorly. Imaging also revealed possible tumor involvement with the superior vena cava and right atrium. The plan was for potential extracorporeal membrane oxygenation (ECMO) during the EXIT procedure (EXIT-to-ECMO) and the potential for traditional cardiopulmonary bypass (CPB) for mediastinal tumor resection. A Modified EXIT-To-ECMO with Optional Reservoir (METEOR) circuit was devised to satisfy both therapies. A fetal airway could not be established during the EXIT procedure and so the EXIT-to-ECMO strategy was utilized. The fetus was then delivered and transferred to an adjoining operating room (OR). Traditional cardiopulmonary bypass with a cardiotomy venous reservoir (CVR) was utilized during the establishment of an airway, tumor biopsy and partial resection. The patient was eventually transitioned to our institution's standard ECMO circuit and then transferred to the intensive care unit. The patient was weaned from ECMO on day of life (DOL) eight and had a successful tumor resection on DOL 11. The patient required hospitalization for numerous interventions including cardiac surgery at 4 months of age. She was discharged to home at 5 months of age.

  2. Thoracic osteophyte: rare cause of esophageal perforation.

    PubMed

    Rathinam, S; Makarawo, T; Norton, R; Collins, F J

    2010-01-01

    Esophageal perforation is a difficult problem in thoracic surgery. Esophageal perforations can be spontaneous, iatrogenic, or malignant. We report two cases of esophageal perforations caused by thoracic osteophytes and different management strategies leading to successful outcomes. An 80-year-old male presented with chest pain and dysphagia following a fall. On endoscopy, an esophageal perforation and foreign body was noted which was confirmed as a thoracic osteophyte on computed tomography scan. He was managed conservatively as he declined surgery. A 63-year-old male was admitted with dysphagia following a food bolus obstruction. Following esophagoscopy and dilatation, there was clinical and radiological evidence of perforation. During surgery, a thoracic osteophyte was identified as the cause of perforation. The perforation was closed in layers and the osteophyte was trimmed. Both patients recovered well. Thoracic osteophytes are a rare cause of esophageal perforations and a high index of suspicion is required in patients with osteoarthritis who present with esophageal perforations.

  3. Linking the Congenital Heart Surgery Databases of the Society of Thoracic Surgeons and the Congenital Heart Surgeons’ Society: Part 2—Lessons 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

  4. The role of physical therapy and rehabilitation after lumbar fusion surgery for degenerative disease: a systematic review.

    PubMed

    Madera, Marcella; Brady, Jeremy; Deily, Sylvia; McGinty, Trent; Moroz, Lee; Singh, Devender; Tipton, George; Truumees, Eeric

    2017-03-10

    OBJECTIVE The purpose of this study was to provide a systematic and comprehensive review of the existing literature regarding postfusion rehabilitation. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, the authors conducted an exhaustive review of multiple electronic databases. Potential articles were screened using inclusion/exclusion criteria. Two authors independently analyzed these studies using predefined data fields, including study quality indicators such as level of evidence and availability of accepted patient-reported outcomes measures. These findings were synthesized in a narrative format. A third author resolved disagreements regarding the inclusion of a study. RESULTS Twenty-one articles with I or II levels of evidence were included in the review. The authors divided the findings of the literature review into several groups: rehabilitation terminology, timing and duration of postfusion rehabilitation, the need for rehabilitation relative to surgery-related morbidity, rehabilitation's relationship to outcomes, and cognitive and psychosocial aspects of postsurgical rehabilitation. Current evidence generally supports formal rehabilitation after lumbar fusion surgery. Starting physical therapy at the 12-week postoperative mark results in better outcomes at lower cost than an earlier, 6-week start. Where available, psychosocial support improves outcomes. However, a number of the questions could not be answered with high-grade evidence. In these cases, the authors used "best evidence available" to make recommendations. There are many cases in which different types of caregivers use clinical terminology differently. The data supporting an optimal protocol for postfusion rehabilitation remains elusive but, using the data available, the authors have crafted recommendations and a model protocol, which is currently undergoing prospective study. CONCLUSIONS Rehabilitation has long been a common feature in

  5. 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

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

    PubMed Central

    2015-01-01

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

  7. Junctional disc herniation syndrome in post spinal fusion treated with endoscopic spine surgery.

    PubMed

    Chiu, John C; Clifford, Thomas; Princenthal, Robert; Shaw, Stephen

    2005-01-01

    Fusions of the cervical and lumbar spine are often followed within months or several years by protrusion of discs at the adjacent level or levels. Biomechanical alterations and mobility lost at the fused levels are thought to be transferring the stress to the adjacent segments or discs, which results in accelerated degeneration of the discs and causes disc protrusion. This post-spinal fusion "junctional disc herniation syndrome" (JDHS), or the post-spinal fusion "adjacent segment disease (ASD)" can occur from 15% to 52% of post-spinal fusion, in both superior and/or inferior adjacent levels. The ways in which endoscopic minimally invasive spinal discectomy procedure can be used to treat this JDHS and preserve spinal segmental motion are discussed herein. Also, case illustrations are presented.

  8. Cervical artificial disc replacement versus fusion in the cervical spine: a systematic review comparing multilevel versus single-level surgery

    PubMed Central

    Kepler, Christopher K.; Brodt, Erika D.; Dettori, Joseph R.; Albert, Todd J.

    2012-01-01

    Study design: Systematic review. Clinical questions: What is the effectiveness of multilevel cervical artificial disc replacement (C-ADR) compared with multilevel fusion with respect to pain and functional outcomes, and are the two procedures comparable in terms of safety? What is the effectiveness of multilevel C-ADR compared with single-level C-ADR with respect to pain and functional outcomes, and are the two procedures comparable in terms of safety? Methods: A systematic review was undertaken for articles published up to October 2011. Electronic databases and reference lists of key articles were searched to identify studies comparing multilevel C-ADR with multilevel anterior cervical discectomy and fusion (ACDF) or comparing multilevel C-ADR with single-level C-ADR. Studies which compared these procedures in the lumbar or thoracic spine or that reported alignment outcomes only were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results: Two studies compared multilevel C-ADR with multilevel ACDF. While both reported improved Neck Disability Index (NDI) and Short-Form 36 (SF-36) scores after C-ADR compared with ACDF, only one study reported statistically significant results. Seven studies compared single-level C-ADR with multilevel C-ADR. Results were similar in terms of overall success, NDI and SF-36 scores, and patient satisfaction. There is discrepant information regarding rates of heterotopic ossification; dysphagia rate may be higher in multilevel C-ADR. Conclusions: The literature suggests that outcomes are at least similar for multilevel C-ADR and ACDF and may favor C-ADR. Future studies are necessary before firm recommendations can be made favoring one treatment strategy. Multilevel C-ADR seems to have similar results to single-level C-ADR but may have higher rates of heterotopic ossification and dysphagia. PMID:23236310

  9. Antimicrobial Prophylaxis in Instrumented Spinal Fusion Surgery: A Comparative Analysis of 24-Hour and 72-Hour Dosages

    PubMed Central

    Abraham, Vineet Thomas; Ravichandran, Mirunalini; Achimuthu, Rajamani

    2016-01-01

    Study Design Prospective study. Purpose To compare the efficacy of 24-hour and 72-hour antibiotic prophylaxis in preventing surgical site infections (SSIs). Overview of Literature Antimicrobial prophylaxis in surgical practice has become a universally accepted protocol for minimizing postoperative complications related to infections. Although prophylaxis is an accepted practice, a debate exists with regard to the antibiotic type and its administration duration for various surgical procedures. Methods Our institute is a tertiary care hospital with more than 100 spinal surgeries per year for various spine disorders in the department of orthopedics. We conducted this prospective study in our department from June 2012 to January 2015. A total of 326 patients were enrolled in this study, with 156 patients in the 72-hour antibiotic prophylaxis group (group A) and 170 patients in the 24-hour group (group B). Cefazolin was the antibiotic used in both groups. Two surgeons were involved in conducting all the spinal procedures. Our study compared SSIs among patients undergoing instrumented spinal fusion. Results The overall rate of SSIs was 1.8% with no statistical difference between the two groups. Conclusions The 24-hour antimicrobial prophylaxis is as effective as the 72-hour dosage in instrumented spinal fusion surgery. PMID:27994776

  10. Outcome of posterior decompression with instrumented fusion surgery for K-line (-) cervical ossification of the longitudinal ligament.

    PubMed

    Saito, Junya; Maki, Satoshi; Kamiya, Koshiro; Furuya, Takeo; Inada, Taigo; Ota, Mitsutoshi; Iijima, Yasushi; Takahashi, Kazuhisa; Yamazaki, Masashi; Aramomi, Masaaki; Mannoji, Chikato; Koda, Masao

    2016-10-01

    We investigated the outcome of posterior decompression and instrumented fusion (PDF) surgery for patients with K-line (-) ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, who may have a poor surgical prognosis. We retrospectively analyzed the outcome of a series of 27 patients who underwent PDF without correction of cervical alignment for K-line (-) OPLL and were followed-up for at least 1 year after surgery. We had performed double-door laminoplasty followed by posterior instrumented fusion without excessive correction of cervical spine alignment. The preoperative Japanese Orthopedic Association (JOA) score for cervical myelopathy was 8.0 points and postoperative JOA score was 11.9 points on average. The mean JOA score recovery rate was 43.6%. The average C2-C7 angle was 2.2° preoperatively and 3.1° postoperatively. The average maximum occupation ratio of OPLL was 56.7%. In conclusion, PDF without correcting cervical alignment for patients with K-line (-) OPLL showed moderate neurological recovery, which was acceptable considering K-line (-) predicts poor surgical outcomes. Thus, PDF is a surgical option for such patients with OPLL.

  11. Single-port video-assisted thoracic surgery in the treatment of non-small cell lung cancer: a propensity-matched comparative analysis

    PubMed Central

    Meng, Shenglan; Mei, Longyong; Guan, Chen

    2016-01-01

    Background Video-assisted thoracic surgery (VATS)-assisted lobectomy is widely used to treat non-small cell lung carcinoma (NSCLC). There are no reports concerning the comparison between single-port VATS and two-port VATS in treating NSCLC. This study aimed to compare the perioperative and short-term follow-up results between these two methods for treating NSCLC. Methods A retrospective surgical evaluation of patients undergoing either single-port VATS or two-port VATS for NSCLC between January 2013 and June 2015 was conducted. The propensity score (PS) matching method was used to reduce selection bias by creating two groups. After generating the PSs, 1:1 ratio and nearest-neighbor score matching was completed. The primary outcome measures were surgical time, blood loss, drainage time, length of hospital stay, postoperative pain score and patient satisfaction score. The data were analyzed statistically with P<0.05 defined as statistically significant. Results Of the 143 patients who met the inclusion criteria, 66 (46.2%) were operated on using two-port VATS and 77 (53.8%) using single-port VATS. After 1-to-1 PS matching, 63 pairs were selected. Both groups were well balanced for age, gender, body mass index, pulmonary function, preoperative comorbidity, tumor size and tumor type. The single-port VATS group had less blood loss, less postoperative pain, and a higher satisfaction score than those in the two-port VATS group, with statistical significance. Postoperative complications occurred in 2 (2/63, 3.2%) patients in the single-port VATS group and 6 (6/63, 9.5%) patients in the two-port VATS group, not a significant difference. No deaths occurred during the follow-up period. Conclusions A single-port VATS-assisted lobectomy is suggested to be safe and feasible for treating NSCLC. Compared with two-port VATS, single-port VATS has many advantages, including reduced blood loss, less postoperative pain and a higher satisfaction score. PMID:27867563

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

    PubMed Central

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

    2014-01-01

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

  13. Comparison of a tube-holder (Rescuefix) versus tape-tying for minimizing double-lumen tube displacement during lateral positioning in thoracic surgery

    PubMed Central

    Byun, Sung Hye; Kang, Su Hwang; Kim, Jong Hae; Ryu, Taeha; Kim, Baek Jin; Jung, Jin Yong

    2016-01-01

    lower the incidence of DLT repositioning compared with the tape-tying method. Therefore, Rescuefix appears to be an effective alternative to minimizing DLT displacement during lateral positioning in thoracic surgery. Trial registration: http://cris.nih.go.kr identifier: KCT0001949. PMID:27495093

  14. Pain acceptance potentially mediates the relationship between pain catastrophizing and post-surgery outcomes among compensated lumbar fusion patients

    PubMed Central

    Dance, Cassie; DeBerard, M. Scott; Gundy Cuneo, Jessica

    2017-01-01

    Purpose Chronic low back pain is highly prevalent and often treatment recalcitrant condition, particularly among workers’ compensation patients. There is a need to identify psychological factors that may predispose such patients to pain chronicity. The primary aim of this study was to examine whether pain acceptance potentially mediated the relationship between pain catastrophizing and post-surgical outcomes in a sample of compensated lumbar fusion patients. Patients and methods Patients insured with the Workers Compensation Fund of Utah and who were at least 2 years post-lumbar fusion surgery completed an outcome survey. These data were obtained from a prior retrospective-cohort study that administered measures of pain catastrophizing, pain acceptance, mental and physical health, and disability. Results Of the 101 patients who completed the outcome survey, 75.2% were male with a mean age of 42.42 years and predominantly identified as White (97.0%). The majority of the participants had a posterior lumbar interbody fusion surgery. Pain acceptance, including activity engagement and pain willingness, was significantly correlated with better physical health and mental health, and lower disability rates. Pain catastrophizing was inversely correlated with measures of pain acceptance (activity engagement r=−0.67, p<0.01, pain willingness r=−0.73, p<0.01) as well as the outcome measures: mental health, physical health, and disability. Pain acceptance significantly mediated the relationship between pain catastrophizing and both mental and physical health and also the relationship between pain catastrophizing and disability. Conclusion This study demonstrated that the relationship between pain catastrophizing and negative patient outcomes was potentially mediated by pain acceptance. Understanding this mediating relationship offers insight into how pain acceptance may play a protective role in patients’ pain and disability and has potential implications for pain

  15. 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

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

    PubMed

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

    2015-08-26

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

  17. Preserving Posterior Complex Can Prevent Adjacent Segment Disease following Posterior Lumbar Interbody Fusion Surgeries: A Finite Element Analysis

    PubMed Central

    Huang, Yun-Peng; Du, Cheng-Fei; Cheng, Cheng-Kung; Zhong, Zheng-Cheng; Chen, Xuan-Wei; Wu, Gui; Li, Zhe-Cheng; Ye, Jin-Duo; Lin, Jian-Hua; Wang, Li Zhen

    2016-01-01

    Objective To investigate the biomechanical effects of the lumbar posterior complex on the adjacent segments after posterior lumbar interbody fusion (PLIF) surgeries. Methods A finite element model of the L1–S1 segment was modified to simulate PLIF with total laminectomy (PLIF-LAM) and PLIF with hemilaminectomy (PLIF-HEMI) procedures. The models were subjected to a 400N follower load with a 7.5-N.m moment of flexion, extension, torsion, and lateral bending. The range of motion (ROM), intradiscal pressure (IDP), and ligament force were compared. Results In Flexion, the ROM, IDP and ligament force of posterior longitudinal ligament, intertransverse ligament, and capsular ligament remarkably increased at the proximal adjacent segment in the PLIF-LAM model, and slightly increased in the PLIF-HEMI model. There was almost no difference for the ROM, IDP and ligament force at L5-S1 level between the two PLIF models although the ligament forces of ligamenta flava remarkably increased compared with the intact lumbar spine (INT) model. For the other loading conditions, these two models almost showed no difference in ROM, IDP and ligament force on the adjacent discs. Conclusions Preserved posterior complex acts as the posterior tension band during PLIF surgery and results in less ROM, IDP and ligament forces on the proximal adjacent segment in flexion. Preserving the posterior complex during decompression can be effective on preventing adjacent segment degeneration (ASD) following PLIF surgeries. PMID:27870867

  18. [Japanese Board Certified Thoracic Surgeon].

    PubMed

    Chihara, Koji

    2017-01-01

    The Japanese Board of General Thoracic Surgery (JBGTS) consisted by Japanese Association of Chest Surgery (JACS) and The Japanese Association of Thoracic Surgery (JATS) has been certified Japanese Board Certified Thoracic Surgeon (JBCTS) since 2004. At present, JBCTS is obtained by being of Certified Surgeon by Japan Surgical Society( JSS), completion of minimum requirement of surgical experience, scientific papers, presentation at medical assembly, learning of postgraduate educational programs, and examination approximate 11 years after graduation of medical school. Thirteen hundreds JBCTS throughout Japan are engaged in operation for 77,000 cases/year, including 38,000 lung cancer patients/year. The operative volume has been growing lineally these 30 years, and operative mortality in lung cancer patients has been less than 1% these several years. Japanese Medical Specialty Board (JMSB) published a guideline of the new system of medical specialty certification system in Jury 2014, in which fundamental structure is consisted by basic specialties of 19 medical fields and following subspecialties and program based system rather than curriculum based system. According to this guideline, JBGTS has been collaborated with JSS in order to establish sequential programs of the 2 specialties, and proposed an improved certification system to accomplish the mission that it educates trainees to be thoracic surgical professionals who is able to perform safe and standalized procedures.

  19. 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

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

    2013-05-01

    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.

  20. 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

  1. Postoperative Increase in Occiput–C2 Angle Negatively Impacts Subaxial Lordosis after Occipito–Upper Cervical Posterior Fusion Surgery

    PubMed Central

    Inada, Taigo; Furuya, Takeo; Kamiya, Koshiro; Ota, Mitsutoshi; Maki, Satoshi; Suzuki, Takane; Takahashi, Kazuhisa; Yamazaki, Masashi; Aramomi, Masaaki; Mannoji, Chikato

    2016-01-01

    Study Design Retrospective case series. Purpose To elucidate the impact of postoperative occiput–C2 (O–C2) angle change on subaxial cervical alignment. Overview of Literature In the case of occipito–upper cervical fixation surgery, it is recommended that the O–C2 angle should be set larger than the preoperative value postoperatively. Methods The present study included 17 patients who underwent occipito–upper cervical spine (above C4) posterior fixation surgery for atlantoaxial subluxation of various etiologies. Plain lateral cervical radiographs in a neutral position at standing were obtained and the O–C2 angle and subaxial lordosis angle (the angle between the endplates of the lowest instrumented vertebra (LIV) and C7 vertebrae) were measured preoperatively and postoperatively soon after surgery and ambulation and at the final follow-up visit. Results There was a significant negative correlation between the average postoperative alteration of O–C2 angle (DO–C2) and the average postoperative alteration of subaxial lordosis angle (Dsubaxial lordosis angle) (r=–0.47, p=0.03). Conclusions There was a negative correlation between DO–C2 and Dsubaxial lordosis angles. This suggests that decrease of mid-to lower-cervical lordosis acts as a compensatory mechanism for lordotic correction between the occiput and C2. In occipito-cervical fusion surgery, care must be taken to avoid excessive O–C2 angle correction because it might induce mid-to-lower cervical compensatory decrease of lordosis. PMID:27559456

  2. 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.

  3. Multiple-hook fixation in revision spinal deformity surgery for patients with a previous multilevel fusion mass: technical note and preliminary outcomes.

    PubMed

    Liu, Ning; Wood, Kirkham B

    2017-03-01

    OBJECTIVE A previous multilevel fusion mass encountered during revision spinal deformity surgery may obscure anatomical landmarks, making instrumentation unworkable or incurring substantial blood loss and operative time. This study introduced a surgical technique of multiple-hook fixation for fixating previous multilevel fusion masses in revision spinal deformity surgeries and then evaluated its outcomes. METHODS Patients with a previous multilevel fusion mass who underwent revision corrective surgery down to the lumbosacral junction were retrospectively studied. Multiple hooks were used to fixate the fusion mass and linked to distal pedicle screws in the lumbosacral-pelvic complex. Radiological and clinical outcomes were evaluated. RESULTS The charts of 8 consecutive patients with spinal deformity were retrospectively reviewed (7 women, 1 man; mean age 56 years). The primary diagnoses included flat-back deformity (6 cases), thoracolumbar kyphoscoliosis (1 case), and lumbar spondylosis secondary to a previous scoliosis fusion (1 case). The mean follow-up duration was 30.1 months. Operations were performed at T3/4-ilium (4 cases), T7-ilium (1 case), T6-S1 (1 case), T12-S1 (1 case), and T9-L5 (1 case). Of 8 patients, 7 had sagittal imbalance preoperatively, and their mean C-7 plumb line improved from 10.8 ± 2.9 cm preoperatively to 5.3 ± 3.6 cm at final follow-up (p = 0.003). The mean lumbar lordosis of these patients at final follow-up was significantly greater than that preoperatively (35.2° ± 12.6° vs 16.8° ± 11.8°, respectively; p = 0.005). Two perioperative complications included osteotomy-related leg weakness in 1 patient and a stitch abscess in another. CONCLUSIONS The multiple-hook technique provides a viable alternative option for fixating a previous multilevel fusion mass in revision spinal deformity surgery.

  4. Fusion of cone-beam CT and 3D photographic images for soft tissue simulation in maxillofacial surgery

    NASA Astrophysics Data System (ADS)

    Chung, Soyoung; Kim, Joojin; Hong, Helen

    2016-03-01

    During maxillofacial surgery, prediction of the facial outcome after surgery is main concern for both surgeons and patients. However, registration of the facial CBCT images and 3D photographic images has some difficulties that regions around the eyes and mouth are affected by facial expressions or the registration speed is low due to their dense clouds of points on surfaces. Therefore, we propose a framework for the fusion of facial CBCT images and 3D photos with skin segmentation and two-stage surface registration. Our method is composed of three major steps. First, to obtain a CBCT skin surface for the registration with 3D photographic surface, skin is automatically segmented from CBCT images and the skin surface is generated by surface modeling. Second, to roughly align the scale and the orientation of the CBCT skin surface and 3D photographic surface, point-based registration with four corresponding landmarks which are located around the mouth is performed. Finally, to merge the CBCT skin surface and 3D photographic surface, Gaussian-weight-based surface registration is performed within narrow-band of 3D photographic surface.

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

    PubMed Central

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

    2015-01-01

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

  6. 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

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

    PubMed

    Komatsu, Teruya

    2011-01-01

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

  8. 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.

  9. Anterior column reconstruction with PMMA: an effective long-term alternative in spinal oncologic surgery.

    PubMed

    Salem, Khalid M I; Fisher, Charles G

    2016-12-01

    A number of anterior reconstruction options are available in patients managed for symptomatic metastatic spinal column disease. Polymethylmethacrylate (PMMA) has been traditionally used as a reconstruction option in patients with limited life expectancy as an anterior fusion is not expected. In this article, we present the outcome of a 13-year follow-up of a long anterior reconstruction using PMMA of the upper thoracic spine in a myelopathic female secondary to a compressive breast metastasis affecting the upper 4 thoracic vertebrae. We discuss the use of PMMA in spinal oncological surgery and review the evidence pertinent to its use.

  10. Hybrid Surgery Versus Anterior Cervical Discectomy and Fusion in Multilevel Cervical Disc Diseases: A Meta-Analysis.

    PubMed

    Zhang, Jianfeng; Meng, Fanxin; Ding, Yan; Li, Jie; Han, Jian; Zhang, Xintao; Dong, Wei

    2016-05-01

    To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to

  11. Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery: A randomized clinical trial.

    PubMed

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Wang, Qian; Zhang, Lijun; Ding, Wenyuan

    2017-02-01

    Both general anesthesia (GA) and cervical plexus anesthesia (CPA) can be used for anterior cervical discectomy and fusion (ACDF) surgery. The aim of this study was to evaluate the influence of anesthetic techniques on perioperative mortality and morbidity in patients undergoing cervical surgery.From January 2008 to December 2015, 356 patients who underwent 1-level ACDF for cervical spinal myelopathy were prospectively reviewed. They were assigned to receive GA (group A) and CPA (group B). The analgesic efficacy of the block was assessed by anesthesia preparation time, the maximum heart rate, and mean arterial blood pressure changes compared with the baseline, time of postoperative revival, and duration of recovery stay. Duration of surgery, blood loss, and anesthesia medical cost were also recorded. Numerical rating scale (NRS) was used to evaluate pain at different time points. Postoperative nausea and vomiting (PONV) was assessed, and postoperative average administered dosages of meperidine and metoclopramide were also recorded. The spinal surgeon satisfaction, anesthetist satisfaction, and patient satisfaction were assessed.Both the anesthesia induction time and postoperative revival time were longer in group A than that in group B; both the duration of surgery and recovery stay were also longer in group A than that in group B, whereas there was no difference in blood loss between the 2 groups. The average dosage of both meperidine and metoclopramide was more in group A than that in group B, and the anesthesia medical cost was greater in group A than that in group B. There were no significant differences in baseline data of systolic blood pressure, diastolic blood pressure, and heart rate between the 2 groups. But the intraoperative data of systolic blood pressure, diastolic blood pressure, and heart rate were higher/larger in group B than that in group A. In group A, there was no complaint of pain in the surgery procedure, but the pain increased after GA, with

  12. Spine surgery - discharge

    MedlinePlus

    ... symptoms should get better in a few weeks. Recovery after laminectomy and fusion surgery is longer. You will not be able ... discharge; Anterior spinal fusion - discharge; Spine surgery - spinal fusion - discharge Images Spinal surgery -- cervical - series References Agrawal BM, Zeidman SM, Rhines L, ...

  13. 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.

  14. Taking Statins May Boost Heart Surgery Outcomes

    MedlinePlus

    ... taking your statin for even one day before cardiac surgery may increase your risk of death after surgery," ... cause-and-effect relationship. SOURCE: The Annals of Thoracic Surgery , news release, March 16, 2017 HealthDay Copyright (c) ...

  15. American Thoracic Society

    MedlinePlus

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

  16. Video-Assisted Thoracoscopic Surgery Plus Lumbar Mini-Open Surgery for Adolescent Idiopathic Scoliosis

    PubMed Central

    Chong, Hyon Su; Kim, Hak Sun; Ankur, Nanda; Kho, Phillip Anthony; Kim, Sung Jun; Kim, Do Yeon; Park, Jin Oh; Moon, Seong Hwan; Lee, Hwan Mo

    2011-01-01

    Purpose The objectives of this study are to describe the outcome of adolescent idiopathic scoliosis (AIS) patients treated with Video Assisted Thoracoscopic Surgery (VATS) plus supplementary minimal incision in the lumbar region for thoracic and lumbar deformity correction and fusion. Materials and Methods This is a case series of 13 patients treated with VATS plus lumbar mini-open surgery for AIS. A total of 13 patients requiring fusions of both the thoracic and lumbar regions were included in this study: 5 of these patients were classified as Lenke type 1A and 8 as Lenke type 5C. Fusion was performed using VATS up to T12 or L1 vertebral level. Lower levels were accessed via a small mini-incision in the lumbar area to gain access to the lumbar spine via the retroperitoneal space. All patients had a minimum follow-up of 1 year. Results The average number of fused vertebrae was 7.1 levels. A significant correction in the Cobb angle was obtained at the final follow-up (p = 0.001). The instrumented segmental angle in the sagittal plane was relatively well-maintained following surgery, albeit with a slight increase. Scoliosis Research Society-22 (SRS-22) scores were noted have significantly improved at the final follow-up (p < 0.05). Conclusion Indications for the use of VATS may be extended from patients with localized thoracic scoliosis to those with thoracolumbar scoliosis. By utilizing a supplementary minimal incision in the lumbar region, a satisfactory deformity correction may be accomplished with minimal post-operative scarring. PMID:21155045

  17. Thoracic duct cyst of posterior mediastinum: a "challenging" differential diagnosis.

    PubMed

    Electra, Michalopoulou-Manoloutsiou; Evangelia, Athanasiou; Mattheos, Bobos; Dimitris, Hatzibougias I; Zarogoulidis, Paul; Tsavlis, Drosos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Charalampidis, Chralampos; Fassiadis, Nikolaos; Mparmpetakis, Nikolaos; Pavlidis, Pavlos; Andreas, Mpakas; Stamatis, Arikas; Alexandros, Kolettas; Kosmas, Tsakiridis

    2016-05-01

    Thoracic duct cysts of the mediastinum are extremely rare entities and their pathogenesis still remains unknown. Imaging methods are not specific and show a cystic mass, however the real nature of the lesion is confirmed only with the help of histopathological examination after surgical excision. Here, we present a case of thoracic cyst in a 28-year-old female, lining in posterior lower mediastinum. The cyst was removed by video-assisted thoracic surgery (VATS) and the histopathological findings were that of thoracic duct cyst. Through this case, we propose an ideal surgical approach and diagnostic procedure.

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

    PubMed

    Bakhos, Charles T; 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.

  19. [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.

  20. Clinical Guideline for Treatment of Symptomatic Thoracic Spinal Stenosis.

    PubMed

    Chen, Zhong-qiang; Sun, Chui-guo

    2015-08-01

    Thoracic spinal stenosis is a relatively common disorder causing paraplegia in the population of China. Until nowadays, the clinical management of thoracic spinal stenosis is still demanding and challenging with lots of questions remaining to be answered. A clinical guideline for the treatment of symptomatic thoracic spinal stenosis has been created by reaching the consensus of Chinese specialists using the best available evidence as a tool to aid practitioners involved with the care of this disease. In this guideline, many fundamental questions about thoracic spinal stenosis which were controversial have been explained clearly, including the definition of thoracic spinal stenosis, the standard procedure for diagnosing symptomatic thoracic spinal stenosis, indications for surgery, and so on. According to the consensus on the definition of thoracic spinal stenosis, the soft herniation of thoracic discs has been excluded from the pathological factors causing thoracic spinal stenosis. The procedure for diagnosing thoracic spinal stenosis has been quite mature, while the principles for selecting operative procedures remain to be improved. This guideline will be updated on a timely schedule and adhering to its recommendations should not be mandatory because it does not have the force of law.

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

    PubMed Central

    2011-01-01

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

  2. The efficacy and cost-effectiveness of cell saver use in instrumented posterior correction and fusion surgery for scoliosis in school-aged children and adolescents.

    PubMed

    Miao, Yu-Liang; Ma, Hua-Song; Guo, Wen-Zhi; Wu, Ji-Gong; Liu, Yan; Shi, Wen-Zhu; Wang, Xiao-Ping; Mi, Wei-Dong; Fang, Wei-Wu

    2014-01-01

    Posterior spinal instrumentation and fusion surgery in school-aged children and adolescents is associated with the potential for massive intraoperative blood loss, which requires significant allogeneic blood transfusion. Until now, the intraoperative use of the cell saver has been extensively adopted; however, its efficacy and cost-effectiveness have not been well established. Therefore, the aim of this study is to determine the efficacy and cost-effectiveness of intraoperative cell saver use. This study was a single-center, retrospective study of 247 school-aged and adolescent patients who underwent posterior spinal instrumentation and fusion surgery between August 2007 and June 2013. A cell saver was used intraoperatively in 67 patients and was not used in 180 patients. Matched case-control pairs were selected using a propensity score to balance potential confounders in baseline characteristics. Allogeneic red blood cell (RBC) and plasma transfusions as well as blood transfusion costs were analyzed. The propensity score matching produced 60 matched pairs. Compared to the control group, the cell saver group had significantly fewer intraoperative allogeneic RBC transfusions (P = 0.012). However, when the combined postoperative and total perioperative periods were evaluated for the use of allogeneic RBC transfusion, no significant differences were observed between the two groups (P = 0.813 and P = 0.101, respectively). With regard to the total cost of perioperative transfusion of all blood products (RBC and plasma), costs for the control group were slightly lower than those of the cell saver group, but this variance did not reach statistical significance (P = 0.095). The use of the cell saver in posterior spinal instrumentation and fusion surgery in school-aged children and adolescents was able to decrease the amount of intraoperative allogeneic RBC transfusion but failed to decrease total perioperative allogeneic RBC transfusion. Moreover, the use of the cell saver

  3. Applying the Mini-Open Anterolateral Lumbar Interbody Fusion with Self-Anchored Stand-Alone Polyetheretherketone Cage in Lumbar Revision Surgery

    PubMed Central

    Kuang, Lei; Chen, Yuqiao; Li, Lei; Lü, Guohua

    2016-01-01

    The author retrospectively studied twenty-two patients who underwent revision lumbar surgeries using ALLIF with a self-anchored stand-alone polyetheretherketone (PEEK) cage. The operation time, blood loss, and perioperative complications were evaluated. Oswestry disability index (ODI) scores and visual analog scale (VAS) scores of leg and back pain were analyzed preoperatively and at each time point of postoperative follow-up. Radiological evaluation including fusion, disc height, foraminal height, and subsidence was assessed. The results showed that the ALLIF with a self-anchored stand-alone PEEK cage is safe and effective in revision lumbar surgery with minor surgical trauma, low access-related complication rates, and satisfactory clinical and radiological results. PMID:27885355

  4. Subscapularis Transthoracic Versus Posterolateral Approaches in the Surgical Management of Upper Thoracic Tuberculosis

    PubMed Central

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

    2015-01-01

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

  5. [The effect of continuous thoracic peridural anesthesia on the pulmonary function of patients undergoing colon surgery. Results of a randomized study of 116 patients].

    PubMed

    Bredtmann, R D; Kniesel, B; Herden, H N; Teichmann, W

    1991-01-01

    In a prospective randomized clinical investigation, we examined the influence of continuous thoracic epidural analgesia (TEA) on pulmonary function and pathologic chest X-ray findings. METHODS. One hundred sixteen patients having resection and/or anastomosis of the colon participated in this study; 57 were randomly assigned to the epidural group, whereas 59 were given systemic analgesia. Both groups were comparable with regard to ASA classification and pre-existing disease, as well as operative procedures and surgeons. Bupivacaine 0.75% was given to the TEA patients pre- and intraoperatively (epidural catheter T8/9), and postoperatively they received bupivacaine 0.25% continuously by motor pump for 3 days. We aimed to reach an analgesic spread from T5 to L2. In order to maintain sufficient analgesia, we had to increase the dosage from 19.2 mg/h on the evening of the operative day to 22.2 mg on the 3rd postoperative day. However, under these conditions the number of blocked segments decreased from 9.3 postoperatively to 6.6 on the 3rd postoperative day. Balanced anesthesia (isoflurane plus fentanyl) was given to the control group. Postoperatively, these patients received systemic analgesia on request (piritramide i.m., tramadol, or a simple analgesic). Vital capacity and pain score (10-point nominal analog score) were evaluated at 1, 8, 24, 36, 48, 60 and 72 h postoperatively. Blood gas analyses were taken at 1, 8, 24, 48 and 72 h, and chest X-rays were performed on the 1st, 3rd, and 8th postoperative days. Statistically significant results are indicated by "*" (P less than 0.05) and "*" (P less than 0.005) and "***" (P less than 0.001). The standard deviations were shown in cases of statistical significance. RESULTS. There were significantly lower pain scores by 1.0-2.2 points at 1, 8, 24 and 36 h postoperatively in the TEA group. Fourteen patients in group I required adjustments of the postoperative pain treatment regime: 6 had a unilateral epidural block; in 4

  6. 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

  7. Change of paradigm in thoracic radionecrosis management.

    PubMed

    Dast, S; Assaf, N; Dessena, L; Almousawi, H; Herlin, C; Berna, P; Sinna, R

    2016-06-01

    Classically, muscular or omental flaps are the gold standard in the management of thoracic defects following radionecrosis debridement. Their vascular supply and antibacterial property was supposed to enhance healing compared with cutaneous flaps. The evolution of reconstructive surgery allowed us to challenge this dogma. Therefore, we present five consecutive cases of thoracic radionecrosis reconstructed with cutaneous perforator flaps. In four patients, we performed a free deep inferior epigastric perforator (DIEP) flap and one patient had a thoracodorsal perforator (TDAP) flap. Median time healing was 22.6 days with satisfactory cutaneous covering and good aesthetic results. There were no flap necrosis, no donor site complications. We believe that perforator flaps are a new alternative, reliable and elegant option that questions the dogma of muscular flaps in the management of thoracic radionecrosis.

  8. Comparisons of single-injection thoracic paravertebral block with ropivacaine and bupivacaine in breast cancer surgery: A prospective, randomized, double-blinded study

    PubMed Central

    Sahu, Ashutosh; Kumar, Rajnish; Hussain, Mumtaz; Gupta, Ajit; Raghwendra, K. H.

    2016-01-01

    Background: Regional anesthesia using paravertebral block has been suggested as an ideal adjunct to general anesthesia for modified radical mastectomy. Paravertebral block is an effective management of peri-operative pain for Modified radical mastectomy, however, there are no established guidelines regarding what is the most suitable strategy when varying drugs and dosages between different groups. Aim: To evaluate the effectiveness of paravertebral block comparing the most frequently employed drugs in this procedure (bupivacaine vs ropivacaine). Study Design: Prospective randomized double blind study. Methods: A total 70 ASA I and II adult female patients undergoing Modified radical mastectomy under paravertebral block followed by general anesthesia were randomly divided into two groups. The first group was administered 0.375% Ropivacaine in a dose 0.25 ml /kg in paravertebral block. The second group was administered bupivacaine 0.375% in dose 0.25 ml /kg in paravertebral block. Standard induction technique followed. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), were recorded pre block, post block 5 min, post block 10 min, at skin incision, post skin incision initially at 5 interval for first 15 min till one hour, and every 30 min till end of surgery. Post-operative visual analogue score for pain was recorded at 1 hr, 6 hr and 24 hr. Statistical Analysis: Chi-square test (Fisher's exact test) for qualitative variables. Independent sample t-test for quantitative data. Results: Ropivacaine and Bupivacaine had no difference in intraoperative analgesia as shown by intraoperative hemodynamic parameters. Bupivacaine got better post-operative VAS scores (P < 0.05) in mean and after first, 6 h and 24 h. PMID:27746568

  9. Limited access surgery for 360 degrees in-situ fusion in a dysraphic patient with high-grade spondylolisthesis.

    PubMed

    König, M A; Boszczyk, B M

    2012-03-01

    Progressive high-grade spondylolisthesis can lead to spinal imbalance. High-grade spondylolisthesis is often reduced and fused in unbalanced pelvises, whereas in-situ fusion is used more often in balanced patients. The surgical goal is to recreate or maintain sagittal balance but if anatomical reduction is necessary, the risk of nerval damage with nerve root disruption in worst cases is increased. Spinal dysraphism like spina bifida or tethered cord syndrome make it very difficult to achieve reduction and posterior fusion due to altered anatomy putting the focus on anterior column support. Intensive neural structure manipulation should be avoided to reduce neurological complications and re-tethering in these cases. A 26-year-old patient with a history of diastematomyelia, occult spina bifida and tethered cord syndrome presented with new onset of severe low back pain, and bilateral L5/S1 sciatica after a fall. The X-ray demonstrated a grade III spondylolisthesis with spina bifida and the MRI scan revealed bilateral severely narrowed exit foramina L5 due to the listhesis. Because she was well balanced sagittally, the decision for in-situ fusion was made to minimise the risk of neurological disturbance through reduction. Anterior fusion was favoured to minimise manipulation of the dysraphic neural structures. Fusion was achieved via isolated access to the L4/L5 disc space. A L5 transvertebral hollow modular anchorage (HMA) screw was passed into the sacrum from the L4/L5 disc space and interbody fusion of L4/L5 was performed with a cage. The construct was augmented with pedicle screw fixation L4-S1 via a less invasive bilateral muscle split for better anterior biomechanical support. The postoperative course was uneventful and fusion was CT confirmed at the 6-month follow-up. At the last follow-up, she worked full time, was completely pain free and not limited in her free-time activities. The simultaneous presence of high-grade spondylolisthesis and spinal dysraphism

  10. Chitin Oligosaccharide (COS) Reduces Antibiotics Dose and Prevents Antibiotics-Caused Side Effects in Adolescent Idiopathic Scoliosis (AIS) Patients with Spinal Fusion Surgery

    PubMed Central

    Qu, Yang; Xu, Jinyu; Zhou, Haohan; Dong, Rongpeng; Kang, Mingyang; Zhao, Jianwu

    2017-01-01

    Antibiotics are always considered for surgical site infection (SSI) in adolescent idiopathic scoliosis (AIS) surgery. However, the use of antibiotics often causes the antibiotic resistance of pathogens and side effects. Thus, it is necessary to explore natural products as drug candidates. Chitin Oligosaccharide (COS) has anti-inflammation and anti-bacteria functions. The effects of COS on surgical infection in AIS surgery were investigated. A total of 312 AIS patients were evenly and randomly assigned into control group (CG, each patient took one-gram alternative Azithromycin/Erythromycin/Cloxacillin/Aztreonam/Ceftazidime or combined daily), experiment group (EG, each patient took 20 mg COS and half-dose antibiotics daily), and placebo group (PG, each patient took 20 mg placebo and half-dose antibiotics daily). The average follow-up was one month, and infection severity and side effects were analyzed. The effects of COS on isolated pathogens were analyzed. SSI rates were 2%, 3% and 8% for spine wounds and 1%, 2% and 7% for iliac wound in CG, EG and PG (p < 0.05), respectively. COS reduces the side effects caused by antibiotics (p < 0.05). COS improved biochemical indexes and reduced the levels of interleukin (IL)-6 and tumor necrosis factor (TNF) alpha. COS reduced the antibiotics dose and antibiotics-caused side effects in AIS patients with spinal fusion surgery by improving antioxidant and anti-inflammatory activities. COS should be developed as potential adjuvant for antibiotics therapies. PMID:28335413

  11. A Case of Successful Foraminotomy for Severe Bilateral C5 Palsy following Posterior Decompression and Fusion Surgery for Cervical Ossification of Posterior Longitudinal Ligament

    PubMed Central

    Toyone, Tomoaki; Shirahata, Toshiyuki; Ozawa, Tomoyuki; Matsuoka, Akira; Jin, Yoichi; Inagaki, Katsunori

    2016-01-01

    We report a very rare (5~7%) case of bilateral C5 palsy after cervical surgery. A 71-year-old male patient with cervical ossification of posterior longitudinal ligament (OPLL) with foraminal stenosis at bilateral C4/5 underwent posterior decompression and fusion surgery. After surgery, muscle weakness in his both deltoid and biceps was detected and gradually deteriorated to complete paralysis. Postoperative MRI showed sufficient decompression of the spinal cord and posterior shifting. Subsequently, an additional bilateral foraminotomy at C4/5 was performed, with a suspicion that bilateral foraminal stenosis at C4/5 may have been the cause of the paresis. After foraminotomy, muscular contraction was seen in both deltoid and biceps. Finally, complete motor recovery was achieved in a year. Although the gold standard procedure for the prevention and treatment of postoperative C5 palsy has not yet been established, an additional foraminotomy may be recommended for severe C5 palsy in cases of foraminal stenosis even after the occurrence of palsy. PMID:27672463

  12. Posterior corrective surgery with a multilevel transforaminal lumbar interbody fusion and a rod rotation maneuver for patients with degenerative lumbar kyphoscoliosis.

    PubMed

    Matsumura, Akira; Namikawa, Takashi; Kato, Minori; Ozaki, Tomonori; Hori, Yusuke; Hidaka, Noriaki; Nakamura, Hiroaki

    2017-02-01

    The purpose of this study was to assess the clinical results of posterior corrective surgery using a multilevel transforaminal lumbar interbody fusion (TLIF) with a rod rotation (RR) and to evaluate the segmental corrective effect of a TLIF using CT imaging. The medical records of 15 consecutive patients with degenerative lumbar kyphoscoliosis (DLKS) who had undergone posterior spinal corrective surgery using a multilevel TLIF with an RR technique and who had a minimum follow-up of 2 years were retrospectively reviewed. Radiographic parameters were evaluated using plain radiographs, and segmental correction was evaluated using CT imaging. Clinical outcomes were evaluated with the Scoliosis Research Society Patient Questionnaire-22 (SRS-22) and the SF-36. The mean follow-up period was 46.7 months, and the mean age at the time of surgery was 60.7 years. The mean total SRS-22 score was 2.9 before surgery and significantly improved to 4.0 at the latest follow-up. The physical functioning, role functioning (physical), and social functioning subcategories of the SF-36 were generally improved at the latest follow-up, although the changes in these scores were not statistically significant. The bodily pain, vitality, and mental health subcategories were significantly improved at the latest follow-up (p < 0.05). Three complications occurred in 3 patients (20%). The Cobb angle of the lumbar curve was reduced to 20.3° after surgery. The overall correction rate was 66.4%. The pelvic incidence-lumbar lordosis (preoperative/postoperative = 31.5°/4.3°), pelvic tilt (29.2°/18.9°), and sagittal vertical axis (78.3/27.6 mm) were improved after surgery and remained so throughout the follow-up. Computed tomography image analysis suggested that a 1-level TLIF can result in 10.9° of scoliosis correction and 6.8° of lordosis. Posterior corrective surgery using a multilevel TLIF with an RR on patients with DLKS can provide effective correction in the coronal plane but allows only

  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 1.05–1.23, P = 0.001), while there was no statistical difference in overall success of clinical outcomes (RR: 1.04; 95% CI 0.95–1.13, P = 0.38) and complications (RR: 0.96; 95% CI 0.85–1.09, p = 0.54). A significant reduction of the reoperation rate was found in BMPs group (RR: 0.57; 95% CI 0.42–0.77, p = 0.0002). Significant difference was found in the operating time (MD−0.32; 95% CI−0.55, −0.08; P = 0.009), but no significant difference was found in the blood loss, the hospital stay, patient satisfaction, and work status. Conclusion Compared with ICBG, BMPs in lumbar fusion can increase the fusion rate, while reduce the reoperation rate and operating time. However, it doesn’t increase the complication rate, the amount of blood loss and hospital stay. No significant difference was found in the overall success of clinical outcome of the two groups. PMID:24886911

  14. Rare case of thoracic kidney detected by renal scintigraphy

    PubMed Central

    Natarajan, Aravintho; Agrawal, Archi; Purandare, Nilendu; Shah, Sneha; Rangarajan, Venkatesh

    2016-01-01

    Intrathoracic kidney is a rare congenital abnormality with lowest frequency among all renal ectopias. Patients with thoracic kidneys are usually asymptomatic, and the condition is usually discovered incidentally during radiological evaluation for other conditions or during thoracic surgery. We report a case of a 62-year-old male who was referred to our department for renal scintigraphy for a nonvisualized left kidney on ultrasonography report. Both Tc-99m dimercaptosuccinic acid and diethylenetriaminepentaacetic acid scans revealed a left thoracic kidney which was confirmed by CT scan of the thorax and abdomen. PMID:27385896

  15. Thoracic kidney associated with congenital diaphragmatic hernia.

    PubMed

    Rattan, Kamal N; Rohilla, Seema; Narang, Rajat; Rattan, Simmi K; Maggu, Sarita; Dhaulakhandi, Dhara B

    2009-09-01

    We report three cases of ectopic thoracic (or superior ectopic) kidney; one in a neonate and two in 6-month-old children, associated with congenital diaphragmatic hernia. In all cases the diagnosis was made during surgery and confirmed by intravenous pyelography, sonography and magnetic resonance imaging in the postoperative period. Because of the rarity of this condition we report these cases together with a wide review of the published reports.

  16. [Videothoracospy in thoracic trauma and penetrating injuries].

    PubMed

    Lang-Lazdunski, L; Chapuis, O; Pons, F; Jancovici, R

    2003-03-01

    Videothoracoscopy represents a valid and useful approach in some patients with blunt chest trauma or penetrating thoracic injury. This technique has been validated for the treatment of clotted hemothorax or posttraumatic empyema, traumatic chylothorax, traumatic pneumothorax, in patients with hemodynamic stability. Moreover, it is probably the most reliable technique for the diagnosis of diaphragmatic injury. It is also useful for the extraction of intrathoracic projectiles and foreign bodies. This technique might be useful in hemodynamically stable patients with continued bleeding or for the exploration of patients with penetrating injury in the cardiac area, although straightforward data are lacking to confirm those indications. Thoracotomy or median sternotomy remain indicated in patients with hemodynamic instability or those that cannot tolerate lateral decubitus position or one-lung ventilation. Performing video-surgery in the trauma setting require expertise in both video-assisted thoracic surgery and chest trauma management. The contra-indications to videothoracoscopy and indications for converting the procedure to an open thoracotomy should be perfectly known by surgeons performing video-assisted thoracic surgery in the trauma setting. Conversion to thoracotomy or median sternotomy should be performed without delay whenever needed to avoid blood loss and achieve an adequate procedure.

  17. Thoracic aortic aneurysm

    MedlinePlus

    ... common cause of a thoracic aortic aneurysm is hardening of the arteries . This condition is more common ... aortic aneurysm repair - open Aortic aneurysm repair - endovascular Hardening of the arteries High blood pressure Marfan syndrome ...

  18. Anterior cervical discectomy and fusion in the outpatient ambulatory surgery setting compared with the inpatient hospital setting: analysis of 1000 consecutive cases.

    PubMed

    Adamson, Tim; Godil, Saniya S; Mehrlich, Melissa; Mendenhall, Stephen; Asher, Anthony L; McGirt, Matthew J

    2016-06-01

    OBJECTIVE In an era of escalating health care costs and pressure to improve efficiency and cost of care, ambulatory surgery centers (ASCs) have emerged as lower-cost options for many surgical therapies. Anterior cervical discectomy and fusion (ACDF) is one of the most prevalent spine surgeries performed, and the frequency of its performance is rapidly increasing as the aging population grows. Although ASCs offer significant cost advantages over hospital-based surgical centers, concern over the safety of outpatient ACDF has slowed its adoption. The authors intended to 1) determine the safety of the first 1000 consecutive ACDF surgeries performed in their outpatient ASC, and 2) compare the safety of these outpatient ACDFs with that of consecutive ACDFs performed during the same time period in the hospital setting. METHODS A total of 1000 consecutive patients who underwent ACDF in an ACS (outpatient ACDF) and 484 consecutive patients who underwent ACDF at Vanderbilt University Hospital (inpatient ACDF) from 2006 to 2013 were included in this retrospective study of patients' medical records. Data were collected on patient demographics, comorbidities, operative details, and perioperative and 90-day morbidity. Perioperative morbidity and hospital readmission were compared between the outpatient and inpatient ACDF groups. RESULTS Of the first 1000 outpatient ACDF cases performed in the authors' ASC, 629 (62.9%) were 1-level and 365 (36.5%) were 2-level ACDFs. Mean patient age was 49.5 ± 8.6, and 484 (48.4%) were males. All patients were observed postoperatively at the ASC postanesthesia care unit (PACU) for 4 hours before being discharged home. Eight patients (0.8%) were transferred from the surgery center to the hospital postoperatively (for pain control [n = 3], chest pain and electrocardiogram changes [n = 2], intraoperative CSF leak [n = 1], postoperative hematoma [n = 1], and profound postoperative weakness and surgical reexploration [n = 1]). No perioperative

  19. The Society of Thoracic Surgeons National Database 2016 Annual Report.

    PubMed

    Jacobs, Jeffrey P; Shahian, David M; Prager, Richard L; Edwards, Fred H; McDonald, Donna; Han, Jane M; D'Agostino, Richard S; Jacobs, Marshall L; Kozower, Benjamin D; Badhwar, Vinay; Thourani, Vinod H; Gaissert, Henning A; Fernandez, Felix G; Wright, Cameron D; Paone, Gaetano; Cleveland, Joseph C; Brennan, J Matthew; Dokholyan, Rachel S; Brothers, Leo; Vemulapalli, Sreekanth; Habib, Robert H; O'Brien, Sean M; Peterson, Eric D; Grover, Frederick L; Patterson, G Alexander; Bavaria, Joseph E

    2016-12-01

    The art and science of outcomes analysis, quality improvement, and patient safety continue to evolve, and cardiothoracic surgery leads many of these advances. The Society of Thoracic Surgeons (STS) National Database is one of the principal reasons for this leadership role, as it provides a platform for the generation of knowledge in all of these domains. Understanding these topics is a professional responsibility of all cardiothoracic surgeons. Therefore, beginning in January 2016, The Annals of Thoracic Surgery began publishing a monthly series of scholarly articles on outcomes analysis, quality improvement, and patient safety. This article provides a summary of the status of the STS National Database as of October 2016 and summarizes the articles about the STS National Database that appeared in The Annals of Thoracic Surgery 2016 series, "Outcomes Analysis, Quality Improvement, and Patient Safety."

  20. Source and route of methicillin-resistant Staphylococcus epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of special scrub suits.

    PubMed

    Tammelin, A; Hambraeus, A; Ståhle, E

    2001-04-01

    The objective of this study was to trace the source and route of transmission of methicillin-resistant Staphylococcus epidermidis (MRSE) in the surgical wound during cardio-thoracic surgery, and to investigate the possibility of reducing wound contamination by wearing special scrub suits. In total 65 elective operations for coronary artery bypass grafting (CABG) with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves, and from patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Samples were also taken from the wound just before closure. Total counts of bacteria on sternal skin and from the wound (cfu/cm2) were calculated as well as total counts of bacteria in the air (cfu/m3). Strains of MRSE recovered from the different sampling sites were compared by pulsed field gel electrophoresis (PFGE). It was found that wearing special scrub suits did not reduce the number of air-samples where MRSE was found compared with conventional scrub suits. The risk factor most strongly associated with MRSE in the wound at the end of the operation was preoperative carriage of MRSE on sternal skin; RR 2.42 [95% CI 1.43-4.10], P= 0.021. By use of PFGE, it was possible to identify the probable source for four MRSE isolates recovered from the wound. In three cases the source was the patients own skin. Finding MRSE in air-samples, or on the hands of the scrubbed team, were not risk factors for the recovery of MRSE in the wound at the end of operation. In conclusion, with a total bacterial air count around 20 cfu/m3 and a low proportion of MRSE, the reduction of total air counts by use of tightly

  1. 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

  2. Freeze-Dried Platelet-Rich Plasma Accelerates Bone Union with Adequate Rigidity in Posterolateral Lumbar Fusion Surgery Model in Rats

    NASA Astrophysics Data System (ADS)

    Shiga, Yasuhiro; Orita, Sumihisa; Kubota, Go; Kamoda, Hiroto; Yamashita, Masaomi; Matsuura, Yusuke; Yamauchi, Kazuyo; Eguchi, Yawara; Suzuki, Miyako; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Abe, Koki; Kanamoto, Hirohito; Inoue, Masahiro; Kinoshita, Hideyuki; Aoki, Yasuchika; Toyone, Tomoaki; Furuya, Takeo; Koda, Masao; Takahashi, Kazuhisa; Ohtori, Seiji

    2016-11-01

    Fresh platelet-rich plasma (PRP) accelerates bone union in rat model. However, fresh PRP has a short half-life. We suggested freeze-dried PRP (FD-PRP) prepared in advance and investigated its efficacy in vivo. Spinal posterolateral fusion was performed on 8-week-old male Sprague-Dawley rats divided into six groups based on the graft materials (n = 10 per group): sham control, artificial bone (A hydroxyapatite–collagen composite) –alone, autologous bone, artificial bone + fresh-PRP, artificial bone + FD-PRP preserved 8 weeks, and artificial bone + human recombinant bone morphogenetic protein 2 (BMP) as a positive control. At 4 and 8 weeks after the surgery, we investigated their bone union–related characteristics including amount of bone formation, histological characteristics of trabecular bone at remodeling site, and biomechanical strength on 3-point bending. Comparable radiological bone union was confirmed at 4 weeks after surgery in 80% of the FD-PRP groups, which was earlier than in other groups (p < 0.05). Histologically, the trabecular bone had thinner and more branches in the FD-PRP. Moreover, the biomechanical strength was comparable to that of autologous bone. FD-PRP accelerated bone union at a rate comparable to that of fresh PRP and BMP by remodeling the bone with thinner, more tangled, and rigid trabecular bone.

  3. Freeze-Dried Platelet-Rich Plasma Accelerates Bone Union with Adequate Rigidity in Posterolateral Lumbar Fusion Surgery Model in Rats

    PubMed Central

    Shiga, Yasuhiro; Orita, Sumihisa; Kubota, Go; Kamoda, Hiroto; Yamashita, Masaomi; Matsuura, Yusuke; Yamauchi, Kazuyo; Eguchi, Yawara; Suzuki, Miyako; Inage, Kazuhide; Sainoh, Takeshi; Sato, Jun; Fujimoto, Kazuki; Abe, Koki; Kanamoto, Hirohito; Inoue, Masahiro; Kinoshita, Hideyuki; Aoki, Yasuchika; Toyone, Tomoaki; Furuya, Takeo; Koda, Masao; Takahashi, Kazuhisa; Ohtori, Seiji

    2016-01-01

    Fresh platelet-rich plasma (PRP) accelerates bone union in rat model. However, fresh PRP has a short half-life. We suggested freeze-dried PRP (FD-PRP) prepared in advance and investigated its efficacy in vivo. Spinal posterolateral fusion was performed on 8-week-old male Sprague-Dawley rats divided into six groups based on the graft materials (n = 10 per group): sham control, artificial bone (A hydroxyapatite–collagen composite) –alone, autologous bone, artificial bone + fresh-PRP, artificial bone + FD-PRP preserved 8 weeks, and artificial bone + human recombinant bone morphogenetic protein 2 (BMP) as a positive control. At 4 and 8 weeks after the surgery, we investigated their bone union–related characteristics including amount of bone formation, histological characteristics of trabecular bone at remodeling site, and biomechanical strength on 3-point bending. Comparable radiological bone union was confirmed at 4 weeks after surgery in 80% of the FD-PRP groups, which was earlier than in other groups (p < 0.05). Histologically, the trabecular bone had thinner and more branches in the FD-PRP. Moreover, the biomechanical strength was comparable to that of autologous bone. FD-PRP accelerated bone union at a rate comparable to that of fresh PRP and BMP by remodeling the bone with thinner, more tangled, and rigid trabecular bone. PMID:27833116

  4. Early removal of urinary catheters in patients with thoracic epidural catheters.

    PubMed

    Tripepi-Bova, Kathleen A; Sun, Zhiyuan; Mason, David; Albert, Nancy M

    2013-01-01

    The purpose of this study was to determine whether early removal of urinary catheters in patients with thoracic epidurals resulted in urinary retention (>500 mL by bladder scanner). Patients were given up to 8 hours to void before further intervention. Of 61 patients, only 4 (6.6%) required urinary catheter reinsertion due to urinary retention. Early removal of urinary catheters after thoracic surgery in patients with thoracic epidurals was safe, with minimal urinary retention.

  5. Study designs in thoracic surgery research

    PubMed Central

    Terzi, Alberto; Bertolaccini, Luca

    2016-01-01

    In this short review, we’ll try to specify the differences between evaluation procedures of groups of data, as they present to researchers. The way and time data are gathered defines the type of study is going to shape. When we observe a cluster of data without deliberately interfering with the process we mean to evaluate, we perform an observational study. Observational studies are the main topic of this issue. Upon the contrary, experimental studies imply the direct action of the observer on the study population in order to define the role of a given exposure. The topic of experimental study design will be covered in another issue of this series. PMID:27747029

  6. [Re-operations in thoracic surgery].

    PubMed

    Kurbonov, Amn; Makhmadov, F I; Nazirboev, K R

    2016-01-01

    Цель исследования - оптимизация выполнения повторных вмешательств у больных с заболеваниями и травмами органов грудной полости (ГП) в случае возникновения послеоперационных осложнений. Материал и методы. Проведен анализ результатов лечения 1258 больных с различными заболеваниями и повреждениями органов ГП. В послеоперационном периоде ввиду возникших осложнений у 58 (4,6%) больных выполнена реторакотомия, а в 15 (1,1%) случаях - применены видеоторакоскопические технологии. Показаниями к повторным операциям были: внутриплевральное кровотечение, несостоятельность культи бронха, несостоятельность эзофагогастроанастомоза, длительное просачивание воздуха по дренажам вследствие негерметичности легочной паренхимы, свернувшийся гемоторакс. После выполнения реторакотомии послеоперационные осложнения отмечены у 16 больных (в том числе у 14 - с летальными исходами), тогда как после видеоторакоскопических вмешательств скончался 1 пациент. Вывод. Залогом успешного оперативного устранения ранних послеоперационных осложнений в хирургии органов ГП являются ранняя диагностика и выбор рационального хирургического доступа.

  7. 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

  8. Small cervical incision facilitates minimally invasive resection of non-invasive thoracic inlet tumor

    PubMed Central

    Deng, Han-Yu; Li, Zhi-Hui; Wang, Zhi-Qiang; Wang, Yun-Cang; Li, Gang; Liu, Lun-Xu

    2016-01-01

    Background A challenge for resection of thoracic inlet tumors lies in that high risk of injuring vital blood vessels and brachial plexus still exists during the resection. And the standard surgical approach for resection of thoracic inlet tumors has not yet been well established. Methods Small cervical incision-assisted minimally invasive surgical technique was developed and carried out in patients with non-invasive thoracic inlet tumor in our department. Results We successfully performed the small cervical incision-assisted minimally invasive surgery in two patients with thoracic inlet tumors. The thoracic inlet tumors of the two patients were removed completely without any postoperative complications, and the patients achieved quick rehabilitation after surgery. This combined approach compensates the blind area of thoracoscope in visualizing the superior end of thoracic inlet tumors, and thus enables us to complete the resection safely and confidently. Conclusions Small cervical incision did facilitate the minimally invasive resection of non-invasive thoracic inlet tumor. Hopefully, this combined approach of video-assisted thoracoscopic surgery (VATS) with small cervical incision could be widely utilized in resecting thoracic inlet tumors by general thoracic surgeon. PMID:27867570

  9. [Blunt thoracic injury].

    PubMed

    Miura, H; Taira, O; Hiraguri, S; Uchida, O; Hagiwara, M; Ikeda, T; Kato, H

    1998-06-01

    Of 161 patients with blunt thoracic injury, 135 were male (83.9%) and 26 were female. The most common cause of injury was traffic accidents (130 patients, 80.7%), followed by falls (22 patients), and crushing (7 patients). There were 46 third decade and 36 second decade patients. Thirty-two patients had single thoracic injury and the other had multiple organ injury. The most common associated injury was head injury (65 patients). Most traffic accidents involved motor cycle accident. Forty-four patients died, 32 within 24 hours, and 4 died to thoracic injury. These 4 patients were shock on arrival and died within 24 hours. The injury severity score, which was under 30 in 78.3% of patients, correlated to the mortality rate. Rib fracture was the most common thoracic injury in 96 patients followed by hemothorax in 91, pulmonary contusion in 79, and pneumothorax in 64. Most of the thoracic injuries were treated conservatively. Thoracotomy was performed in 6 patients. Other than one patient with rupture of the left pulmonary vein, 5 patients recovered. Continued bleeding at a rate of more than 200 ml/h from the chest drainage tube or no recovery from shock and large air leakage preventing re-expansion of the lung are indications for emergency thoracotomy. Thoracotomy should also be considered after conservative treatment in patients with continued air leakage or intrabronchial bleeding negatively affecting respiration. Indications for thoracotomy should be determined individually based on evaluating of vital sign.

  10. 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

  11. Risk Factors of Proximal Junctional Kyphosis after Multilevel Fusion Surgery: More Than 2 Years Follow-Up Data

    PubMed Central

    Kim, Do Keun; Kim, Ji Yong; Kim, Do Yeon; Rhim, Seung Chul; Yoon, Seung Hwan

    2017-01-01

    Objective Proximal junctional kyphosis (PJK) is radiologic finding, and is defined as kyphosis of >10° at the proximal end of a construct. The aim of this study is to identify factors associated with PJK after segmental spinal instrumented fusion in adults with spinal deformity with a minimum follow-up of 2 years. Methods A total of 49 cases of adult spinal deformity treated by segmental spinal instrumented fusion at two university hospitals from 2004 to 2011 were enrolled in this study. All enrolled cases included at least 4 or more levels from L5 or the sacral level. The patients were divided into two groups based on the presence of PJK during follow-up, and these two groups were compared to identify factors related to PJK. Results PJK was observed in 16 of the 49 cases. Age, sex and mean follow-up duration were not statistically different between two groups. However, mean bone marrow density (BMD) and mean back muscle volume at the T10 to L2 level was significantly lower in the PJK group. Preoperatively, the distance between the C7 plumb line and uppermost instrumented vertebra (UIV) were no different in the two groups, but at final follow-up a significant intergroup difference was observed. Interestingly, spinal instrumentation factors, such as, receipt of a revision operation, the use of a cross-link, and screw fracture were no different in the two groups at final follow-up. Conclusion Preoperative BMD, sagittal imbalance at UIV, and thoracolumbar muscle volume were found to be strongly associated with the presence of PJK. PMID:28264237

  12. Complete thoracic ectopia cordis.

    PubMed

    Alphonso, N; Venugopal, P S; Deshpande, R; Anderson, D

    2003-03-01

    Thoracic ectopia cordis is a rare congenital defect with very few reported survivors after surgical correction. We report a case of complete thoracic ectopia cordis with double outlet right ventricle. The diagnosis was established antenatally and a repair was undertaken soon after birth. The child remained stable and was extubated on the fifth post-operative day. Forty-eight hours later the child succumbed to an unexplained respiratory arrest. Also presented is a review of the different surgical strategies for this unusual condition.

  13. Video-assisted thoracic lobectomy for lung cancer in Italy: the 'VATS Group' Project.

    PubMed

    Crisci, Roberto; Droghetti, Andrea; Migliore, Marcello; Bertani, Alessandro; Gonfiotti, Alessandro; Solli, Piergiorgio

    2016-12-01

    As part of the third Mediterranean Symposium in Thoracic Surgical Oncology, we introduce the Italian VATS Group ( http://vatsgroup.org/sito/index.php ). This national collaborative initiative was established in 2013 and started to recruit patients in January 2014; as of July 2016, 3680 patients have been enrolled in the database. Three different video-assisted thoracic surgery approaches have been predominantly used by Italian thoracic surgery centers, 71% of them preferentially adopting a multi-portal approach, with a 20% recorded morbidity. The majority of the cases were stage I adenocarcinomas of the lung. Conversion to open surgery occurred in 9% of the cases. The study suggests video-assisted thoracic surgery lobectomy as a 'gold standard' for the surgical treatment of early-stage lung cancer in Italy.

  14. Thoracic duct cyst of posterior mediastinum: a “challenging” differential diagnosis

    PubMed Central

    Electra, Michalopoulou-Manoloutsiou; Evangelia, Athanasiou; Mattheos, Bobos; Dimitris, Hatzibougias I.; Tsavlis, Drosos; Kougioumtzi, Ioanna; Machairiotis, Nikolaos; Charalampidis, Chralampos; Fassiadis, Nikolaos; Mparmpetakis, Nikolaos; Pavlidis, Pavlos; Andreas, Mpakas; Stamatis, Arikas; Alexandros, Kolettas; Kosmas, Tsakiridis

    2016-01-01

    Thoracic duct cysts of the mediastinum are extremely rare entities and their pathogenesis still remains unknown. Imaging methods are not specific and show a cystic mass, however the real nature of the lesion is confirmed only with the help of histopathological examination after surgical excision. Here, we present a case of thoracic cyst in a 28-year-old female, lining in posterior lower mediastinum. The cyst was removed by video-assisted thoracic surgery (VATS) and the histopathological findings were that of thoracic duct cyst. Through this case, we propose an ideal surgical approach and diagnostic procedure. PMID:27275479

  15. Revision surgery for curve progression after implant removal following posterior fusion only at a young age in the treatment of congenital scoliosis

    PubMed Central

    Chang, Dong-Gune; Yang, Jae Hyuk; Lee, Jung-Hee; Lee, Jung-Sub; Suh, Seung-Woo; Kim, Jin-Hyok; Oh, Seung-Yeol; Cho, Woojin; Park, Jong-Beom; Suk, Se-Il

    2016-01-01

    Abstract Rationale: Congenital scoliosis due to a hemivertebra creates a wedge-shaped deformity, which progresses and causes severe spinal deformities as an individual grows. The treatment of congenital scoliosis focuses on early diagnosis and appropriate surgical management before the development of severe deformity. Patient concerns: We report the case of a 4-year-old male child with a left thoracolumbar scoliosis of 27° (T10-T12) due to a T11 hemivertebra who was treated by posterior fusion and pedicle screw fixation at the age of 4 years. The implant was removed due to pain secondary to implant prominence after 4 years without definitive revision surgery, which led to significant progression of the scoliosis, to 50°. The indication for posterior vertebral column resection (PVCR) is a congenital spinal deformity with a curve magnitude greater than 30° with fast progression. This includes documented progression of the curve by more than 5° in a 6- month period, failure of conservative treatment, or both. Outcomes: The patient underwent PVCR of the T11 hemivertebra. Nine years after the revision surgery with PVCR, the patient showed satisfactory results and his spine was well balanced. Lessons: This case shows that removal of an implant that was not the only cause of curve progression at a young age may lead to progression of scoliosis and, therefore, should be avoided unless it is absolutely necessary. Conclusion: Congenital scoliosis due to a hemivertebra at a young age could be treated by hemivertebra resection or anterior and posterior epiphysiodesis as definitive surgical treatment. The patient was eventually treated with PVCR, which achieved satisfactory correction without curve progression in a long-term follow-up. PMID:27893663

  16. [Robotic surgery].

    PubMed

    Sándor, József; Haidegger, Tamás; Kormos, Katalin; Ferencz, Andrea; Csukás, Domokos; Bráth, Endre; Szabó, Györgyi; Wéber, György

    2013-10-01

    Due to the fast spread of laparoscopic cholecystectomy, surgical procedures have been changed essentially. The new techniques applied for both abdominal and thoracic procedures provided the possibility for minimally invasive access with all its advantages. Robots - originally developed for industrial applications - were retrofitted for laparoscopic procedures. The currently prevailing robot-assisted surgery is ergonomically more advantageous for the surgeon, as well as for the patient through the more precise preparative activity thanks to the regained 3D vision. The gradual decrease of costs of robotic surgical systems and development of new generations of minimally invasive devices may lead to substantial changes in routine surgical procedures.

  17. 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

  18. Traumatic rupture of the thoracic aorta

    PubMed Central

    Keen, G.; Bradbrook, R. A.; McGinn, F.

    1969-01-01

    Seven patients who had traumatic ruptures of the thoracic aorta are reported. Four of these died within a few hours of admission, allowing no opportunity for diagnosis or treatment. However, three survived long enough for elective surgery to be undertaken. A diagnosis of ruptured aorta was missed in one patient (case 2), and the difficulties of diagnosing this condition, even during thoracotomy, are emphasized. The value of serial chest radiography and forward aortography is discussed. Two of these patients underwent successful aortic repair, using left atrio-femoral bypass. Images PMID:5763507

  19. ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes : A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons.

    PubMed

    Patel, Manesh R; Calhoon, John H; Dehmer, Gregory J; Grantham, James Aaron; Maddox, Thomas M; Maron, David J; Smith, Peter K

    2017-03-06

    The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes (ACS) and stable ischemic heart disease were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and in an effort to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing ACS and stable ischemic heart disease individually. This document presents the AUC for ACS. Clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, presence of clinical instability or ongoing ischemic symptoms, prior reperfusion therapy, risk level as assessed by noninvasive testing, fractional flow reserve testing, and coronary anatomy. This update provides a reassessment of clinical scenarios that 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 but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization. A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range (4 to 6

  20. Non-intubated thoracic surgery—A 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

  1. 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

  2. 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 ...

  3. Long thoracic nerve injury.

    PubMed

    Wiater, J M; Flatow, E L

    1999-11-01

    Injury to the long thoracic nerve causing paralysis or weakness of the serratus anterior muscle can be disabling. Patients with serratus palsy may present with pain, weakness, limitation of shoulder elevation, and scapular winging with medial translation of the scapula, rotation of the inferior angle toward the midline, and prominence of the vertebral border. Long thoracic nerve dysfunction may result from trauma or may occur without injury. Fortunately, most patients experience a return of serratus anterior function with conservative treatment, but recovery may take as many as 2 years. Bracing often is tolerated poorly. Patients with severe symptoms in whom 12 months of conservative treatment has failed may benefit from surgical reconstruction. Although many surgical procedures have been described, the current preferred treatment is transfer of the sternal head of the pectoralis major tendon to the inferior angle of the scapula reinforced with fascia or tendon autograft. Many series have shown good to excellent results, with consistent improvement in function, elimination of winging, and reduction of pain.

  4. [Development of treatment of severe thoracic injuries].

    PubMed

    Le Brigand, H

    1975-11-01

    About 25 p. 100 of cases of closed trauma of the thorax may be classified as severe, for they rapidly endanger life. Their treatment has made considerable progress since the report of J. Dor and H. Le Brigand in 1960. However, when severe trauma is treated, the mortality has remained unchanged over the last ten years. The treatment of fractures of the sternum includes respiratory assistance and internal fixation of the fractured bones, these two methods together, when correctly applied, give good results. Endothoracic lesions are now better recognised. Hemothorax and pneumothorax are now treated by a well recognised method. Visceral lesions, such as bronchial rupture, or major vascular ruptures, e.g. aorta, and heart lesions may be diagnosed at an early stage and be operated on more often. On the other hand, it is now better recognised that diffuse pulmonary lesions, e.g. pulmonary contusions or "shock lung", which is usually treated by artificial respiration alone, still may have a poor prognosis in some cases. From this it results that many surgical teams have enlarged the indications for early thoracotomy in the same way as laparotomy is more often carried out in abdominal trauma. In fact, these indications require circumspection and thoracotomy should only be carried out in specialised thoracic surgery units. If this is not available, aspiration, drainage, tracheotomy, continuous extension, are still applicable, but it is also necessary for them to be carried out correctly; if not, failures and complications of these minor measures are frequent. The use of these methods has shown the existence of therapeutic failures, including major bilateral bony lesions, diffuse severe lung injuries with resistant anoxia, complex multiple injuries with thoracic involvement and, finally, combined thoracic and cranial lesions, the mortality of which is about 50 p. 100. These facts explain why treatment of severe thoracic trauma gives variable results. The mortality varies from

  5. Prenatal development of the fetal thoracic sympathetic trunk in sheep (Ovis aries).

    PubMed

    Nourinezhad, Jamal; Gilanpour, Hassan; Radmehr, Bijan

    2013-10-01

    This study aims at clarifying the detailed morphological and topographical changes of the thoracic part of the sympathetic trunk of sheep during fetal development. Bilateral micro-dissection of the thoracic sympathetic trunk was performed on 40 sheep fetuses aged 6-20 weeks (18 males and 22 females) under a stereomicroscope. The cervicothoracic ganglion (CTG) was observed on 75/80 sides (93.7%) and was composed of the caudal cervical and the first thoracic ganglia on 45/80 sides (56.2%), and of the caudal cervical and the first two thoracic ganglia on 30/80 sides (37.5%). The presence of the two last (12th-13th) thoracic ganglia was not constant. The influence of the sex, the side of the body, and the ages of the fetus on the morphology and topography of the thoracic sympathetic trunk in sheep were identified. In spite of the differences in the morphology and topography of the thoracic sympathetic trunk between early and late fetal developments, the morphology and topography of the older fetal thoracic sympathetic trunk tended to be similar to that of the adult sheep. To comprehend the comparative morphology of the fetal thoracic sympathetic trunk more completely, our results were compared with previous studies. Consequently, differences and similarities in the composition and position of the CTG, presence of single caudal cervical ganglion without fusion to the thoracic ganglia, and absence of the thoracic ganglia, and presence of splitting of the interganglionic branch were found among sheep, pig, and human fetuses. Therefore, sheep might be the appropriate animal model to be applied in human sympathetic nervous system.

  6. Long thoracic nerve paralysis associated with thoracic outlet syndrome.

    PubMed

    Nakatsuchi, Y; Saitoh, S; Hosaka, M; Uchiyama, S

    1994-01-01

    Two cases of long thoracic nerve palsy associated with thoracic outlet syndrome are reported. Both patients had abnormal posture, with low-set shoulders and winged scapulae. Clinically there was weakness of the serratus anterior muscle with partial denervotion on electromyography. The diagnosis of thoracic outlet syndrome was based on positive vascular tests and brachial plexus nerve compression symptoms induced by the vascular testing positions. An orthosis that held the shoulder in an elevated position was used in both cases. Complete recovery of shoulder function and relief of the symptoms was achieved in both cases at 8 and 13 months, respectively, after application of the orthosis.

  7. Thoracic duct lymphography by subcutaneous contrast agent injection in a dog with chylothorax

    PubMed Central

    Iwanaga, T.; Tokunaga, S.; Momoi, Y.

    2016-01-01

    A 4-year-old male Japanese Shiba Inu presented with recurrent chylothorax. The thoracic duct was successfully imaged using computed tomography after the injection of an iodine contrast agent into the subcutaneous tissue surrounding the anus. The thoracic duct was successfully ligated and pericardectomy performed via an open thoracotomy. Pleural effusion improved but relapsed a week after the surgery. A second lymphography revealed a collateral thoracic duct that was not detected during the first lymphography. The collateral duct was ligated and chylothorax was resolved after the second surgery. The lymphography applied in this study was minimally-invasive and easily provided images of the thoracic duct in a dog with chylothorax. PMID:27995081

  8. Treatment of Descending Thoracic Aneurysm with an Intraaortic Occluder

    PubMed Central

    Liotta, Domingo; Frank, L.; Del Rio, M.; Gallo, A.; Navia, J.; Bertolozzi, E.; Bracco, D.; Cesareo, V.

    1987-01-01

    Elective treatment of descending thoracic aneurysms involves direct surgery, with Dacron graft replacement of the diseased aortic segment. When the patient's condition contraindicates major surgery, however, the surgeon should consider using an extraanatomic approach—implanting an ascending aorta-to-abdominal aorta Dacron bypass graft in a ventral position and leaving the diseased segment undisturbed. After such a procedure, the descending thoracic aorta must be excluded from the normal circulation. For this purpose, we have designed an intraaortic occluding technique in which an umbrella-like device is implanted immediately distal to the left subclavian artery. This technique has proved safe and uncomplicated in canine experiments and is ready for clinical trials. (Texas Heart Institute Journal 1987; 14:196-205) Images PMID:15229741

  9. Surgical Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair

    PubMed Central

    Kim, Chang-Young; Kim, Yeon Soo; Ryoo, Ji Yoon

    2014-01-01

    It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair. PMID:24570865

  10. Utilization of paraspinal muscles for triggered EMG during thoracic pedicle screw placement.

    PubMed

    Silverstein, Justin W; Mermelstein, Laurence E

    2010-03-01

    A novel intraoperative neurophysiological technique for testing the integrity of the pedicle during screw fixation for spinal deformity surgery is presented. The thoracic paraspinal muscles at the appropriate level are used as the electromyogram (EMG) pick-up for direct current stimulation of the thoracic pedicle screw at that level. This technique is shown to give reliable and reproducible results. This technique is found to produce more reliable data than the methods most commonly used at this time.

  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. Transient cortical blindness after thoracic endovascular aneurysm repair.

    PubMed

    Vallabhaneni, Raghuveer; Jim, Jeffrey; Derdeyn, Colin P; Sanchez, Luis A

    2011-05-01

    We report a patient who presented with transient cortical blindness 12 hours after completion of a thoracic endovascular aneurysm repair. Computed tomography of the brain demonstrated no acute findings. The patient's symptoms resolved spontaneously after 72 hours. To our knowledge, this is the first report of transient cortical blindness after endovascular aortic aneurysm repair. This is an uncommon diagnosis that is important to recognize in a modern vascular surgery practice.

  13. Iatrogenic Injury to the Long Thoracic Nerve

    PubMed Central

    Bizzarri, Federico; Davoli, Giuseppe; Bouklas, Dimitri; Oricchio, Luca; Frati, Giacomo; Neri, Eugenio

    2001-01-01

    After heart surgery, complications affecting the brachial plexus have been reported in 2% to 38% of cases. The long thoracic nerve is vulnerable to damage at various levels, due to its long and superficial course. This nerve supplies the serratus anterior muscle, which has an important role in the abduction and elevation of the superior limb; paralysis of the serratus anterior causes “winged scapula,” a condition in which the arm cannot be lifted higher than 90° from the side. Unfortunately, the long thoracic nerve can be damaged by a wide variety of traumatic and nontraumatic occurrences, ranging from viral or nonviral disease to improper surgical technique, to the position of the patient during transfer to a hospital bed. Our patient, a 62-year-old man with triple-vessel disease, underwent myocardial revascularization in which right and left internal thoracic arteries and the left radial artery were grafted to the right coronary, descending anterior, and obtuse marginal arteries, respectively. Despite strong recovery and an apparently good postoperative course, the patient sued for damages due to subsequent winging of the left scapula. In this instance, the legal case has less to do with the cause of the lesion (which remains unclear) than with failure to adequately inform the patient of possible complications at the expense of the nervous system. The lesson is that each patient must receive detailed written and oral explanation of the potential benefits and all conceivable risks of a procedure. (Tex Heart Inst J 2001;28:315–7) PMID:11777160

  14. The thoracic anterior spinal cord adhesion syndrome

    PubMed Central

    Taylor, T R; Dineen, R; White, B; Jaspan, T

    2012-01-01

    Objectives This study included a series of middle-aged male and female patients who presented with chronic anterior hemicord dysfunction progressing to paraplegia. Imaging of anterior thoracic cord displacement by either a dural adhesion or a dural defect with associated cord herniation is presented. Methods This is a retrospective review of cases referred to a tertiary neuroscience centre over a 19-year period. Imaging series were classified by two experienced neuroradiologists against several criteria and correlated with clinical examination and/or findings at surgery. Results 16 cases were available for full review. Nine were considered to represent adhesions (four confirmed surgically) and four to represent true herniation (three confirmed surgically). In the three remaining cases the diagnosis was radiologically uncertain. Conclusion The authors propose “thoracic anterior spinal cord adhesion syndrome” as a novel term to describe this patient cohort and suggest appropriate clinicoradiological features for diagnosis. Several possible aetiologies are also suggested, with disc rupture and inflammation followed by disc resorption and dural pocket formation being a possible mechanism predisposing to herniation at the extreme end of a clinicopathological spectrum. PMID:22665931

  15. Expert's comment concerning Grand Rounds case entitled "Limited access surgery for 360 degrees in situ fusion in a dysraphic patient with high grade spondylolisthesis" (by M. A. König and B. M. Boszczyk).

    PubMed

    Lamartina, Claudio

    2012-03-01

    The case of a 26 year-old woman with high grade spondylolisthesis, history of diastematomyelia and tethered cord, with acute onset of back pain and bilateral sciatica after a fall. This comment will focus on three issues: indication for surgery, indication for reduction and levels to be included in fusion. Surgery is indicated in this case for intermittent urinary incontinence and saddle anesthesia, and failure of conservative treatment to control pain. Other important determinant of surgical indication is risk of progression, depending rather on the degree of dysplasia as classified by Marchetti-Bartolozzi than on the degree of slip as classified by Meyerding. High dysplastic olisthesis is identified by excessive pelvic retroversion. Reduction is indicated in patients with high torque through L5-S1. L5 severity index (SI) correlates with the magnitud of torque through L5-S1. Similarly, the decision to include L4 in fusion can be made based on the value of SI for L4.

  16. [Inflammatory aneurysms of the thoracic aorta. Surgical aspects].

    PubMed

    Kieffer, E; Chiche, L; Bertal, A; Bahnini, A; Koskas, F

    1997-12-01

    In the Western world, inflammatory aneurysms account for only 1 to 5%, of all operated thoracic aorta aneurysms. Takayasu's disease is by far the commonest cause although all forms of aortitis may result in aneurysm formation. Usually observed in young patients, these aneurysms are suitable for often major surgery with results that are globally better than in degenerative or dissecting aneurysms. However, they pose, two specific problems: the progression of the inflammatory disease which may require pre- and/or post-operative steroid therapy and that of the risk, at least in theory, of a late pseudo-aneurysm, which justifies regular long-term follow-up after surgery.

  17. Acute cholecystitis developed immediately after thoracic kyphoplasty -A case report-

    PubMed Central

    An, Sang-Bum; Yim, Jiyeon; Kim, Eunjung; Shin, Jae-Hyuck; Lee, Sang Chul

    2012-01-01

    Postoperative acute cholecystitis is a rare complication of orthopaedic surgery and is unrelated to the biliary tract. In particular, in the case of immediate postoperative state after surgery such as kyphoplasty at the thoracic vertebra, symptoms related to inflammation mimic those of abdominal origin, so the diagnosis and the treatment of acute cholecystitis can be delayed leading to a fatal outcome. It is important that physicians should be aware of the postoperative patient's condition in order to make an early diagnosis and determine treatment. PMID:23060986

  18. 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

  19. 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.

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

    PubMed Central

    Farooque, Kamran; Khatri, Kavin; Gupta, Ankit

    2016-01-01

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

  1. An Injectable Method for Posterior Lateral Spine Fusion

    DTIC Science & Technology

    2013-09-01

    spine area but is also used to treat diseases in the cervical and thoracic spine regions [2]. Spinal fusion has been developed with the bone...Lateral Spine Fusion PRINCIPAL INVESTIGATOR: Dr. Elizabeth Olmsted-Davis CONTRACTING ORGANIZATION: Baylor College of Medicine...Method for Posterior Lateral Spine Fusion 5b. GRANT NUMBER W81XWH-12-1-0475 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) Dr. Elizabeth A

  2. Utility of multilevel lateral interbody fusion of the thoracolumbar coronal curve apex in adult deformity surgery in combination with open posterior instrumentation and L5-S1 interbody fusion: a case-matched evaluation of 32 patients.

    PubMed

    Theologis, Alexander A; Mundis, Gregory M; Nguyen, Stacie; Okonkwo, David O; Mummaneni, Praveen V; Smith, Justin S; Shaffrey, Christopher I; Fessler, Richard; Bess, Shay; Schwab, Frank; Diebo, Bassel G; Burton, Douglas; Hart, Robert; Deviren, Vedat; Ames, Christopher

    2017-02-01

    OBJECTIVE The aim of this study was to evaluate the utility of supplementing long thoracolumbar posterior instrumented fusion (posterior spinal fusion, PSF) with lateral interbody fusion (LIF) of the lumbar/thoracolumbar coronal curve apex in adult spinal deformity (ASD). METHODS Two multicenter databases were evaluated. Adults who had undergone multilevel LIF of the coronal curve apex in addition to PSF with L5-S1 interbody fusion (LS+Apex group) were matched by number of posterior levels fused with patients who had undergone PSF with L5-S1 interbody fusion without LIF (LS-Only group). All patients had at least 2 years of follow-up. Percutaneous PSF and 3-column osteotomy (3CO) were excluded. Demographics, perioperative details, radiographic spinal deformity measurements, and HRQoL data were analyzed. RESULTS Thirty-two patients were matched (LS+Apex: 16; LS: 16) (6 men, 26 women; mean age 63 ± 10 years). Overall, the average values for measures of deformity were as follows: Cobb angle > 40°, sagittal vertical axis (SVA) > 6 cm, pelvic tilt (PT) > 25°, and mismatch between pelvic incidence (PI) and lumbar lordosis (LL) > 15°. There were no significant intergroup differences in preoperative radiographic parameters, although patients in the LS+Apex group had greater Cobb angles and less LL. Patients in the LS+Apex group had significantly more anterior levels fused (4.6 vs 1), longer operative times (859 vs 379 minutes), and longer length of stay (12 vs 7.5 days) (all p < 0.01). For patients in the LS+Apex group, Cobb angle, pelvic tilt (PT), lumbar lordosis (LL), PI-LL (lumbopelvic mismatch), Oswestry Disability Index (ODI) scores, and visual analog scale (VAS) scores for back and leg pain improved significantly (p < 0.05). For patients in the LS-Only group, there were significant improvements in Cobb angle, ODI score, and VAS scores for back and leg pain. The LS+Apex group had better correction of Cobb angles (56% vs 33%, p = 0.02), SVA (43% vs 5%, p = 0

  3. T cells generated in the absence of a thoracic thymus fail to establish homeostasis.

    PubMed

    Smolarchuk, Christa; Zhu, Lin Fu; Chan, William F N; Anderson, Colin C

    2014-08-01

    Cervical thymus mimics the thoracic thymus in supporting T-cell development and exists in a subset of mice and humans. Importantly, it remains unknown whether the cervical thymus can generate T cells that are self-tolerant in the complete absence of signals from the thoracic thymus. Using a fetal liver reconstitution model in thoracic thymectomized RAG(-/-) mice, we found that T cells could be generated without contribution from the thoracic thymus. However, these mice had decreased T cells, increased proportions of effector memory T cells and Treg phenotype cells, increased serum IgG1/2b, and increased frequency of T cells expressing IFN-γ, IL-17 or IL-10. Half of the mice that received a thoracic thymectomy and fetal liver cells, unlike sham surgery controls, developed substantial morbidity with age. Disease was associated with lymphopenia-driven activation rather than inherent defects in the cervical thymus, as both thoracic and cervical thymocytes could generate disease in lymphopenic recipients. Administration of the homeostatic cytokine IL-7 caused a rapid, transient increase in T-cell numbers and reduced the time to disease onset. Together the data suggests that the cervical thymus can function in the complete absence of the thoracic thymus; however, the T cells generated do not establish homeostasis.

  4. Higher Flexibility and Better Immediate Spontaneous Correction May Not Gain Better Results for Nonstructural Thoracic Curve in Lenke 5C AIS Patients

    PubMed Central

    Zhang, Yanbin; Lin, Guanfeng; Wang, Shengru; Zhang, Jianguo; Shen, Jianxiong; Wang, Yipeng; Guo, Jianwei; Yang, Xinyu; Zhao, Lijuan

    2016-01-01

    Study Design. Retrospective study. Objective. To study the behavior of the unfused thoracic curve in Lenke type 5C during the follow-up and to identify risk factors for its correction loss. Summary of Background Data. Few studies have focused on the spontaneous behaviors of the unfused thoracic curve after selective thoracolumbar or lumbar fusion during the follow-up and the risk factors for spontaneous correction loss. Methods. We retrospectively reviewed 45 patients (41 females and 4 males) with AIS who underwent selective TL/L fusion from 2006 to 2012 in a single institution. The follow-up averaged 36 months (range, 24–105 months). Patients were divided into two groups. Thoracic curves in group A improved or maintained their curve magnitude after spontaneous correction, with a negative or no correction loss during the follow-up. Thoracic curves in group B deteriorated after spontaneous correction with a positive correction loss. Univariate analysis and multivariate analysis were built to identify the risk factors for correction loss of the unfused thoracic curves. Results. The minor thoracic curve was 26° preoperatively. It was corrected to 13° immediately with a spontaneous correction of 48.5%. At final follow-up it was 14° with a correction loss of 1°. Thoracic curves did not deteriorate after spontaneous correction in 23 cases in group A, while 22 cases were identified with thoracic curve progressing in group B. In multivariate analysis, two risk factors were independently associated with thoracic correction loss: higher flexibility and better immediate spontaneous correction rate of thoracic curve. Conclusion. Posterior selective TL/L fusion with pedicle screw constructs is an effective treatment for Lenke 5C AIS patients. Nonstructural thoracic curves with higher flexibility or better immediate correction are more likely to progress during the follow-up and close attentions must be paid to these patients in case of decompensation. Level of Evidence: 4

  5. Thoracic Radiculopathy due to Rare Causes

    PubMed Central

    2016-01-01

    Thoracic radiculopathy represents an uncommon spinal disorder that is frequently overlooked in the evaluation of thoracic, or abdominal pain syndrome. The clinical representation of this uncommon disorder is often atypical. With many differential diagnoses to consider, it is not surprising that the cause of thoracic radiculopathy is often not discovered for months, or years, after the symptoms arise. We report two rare cases of thoracic radiculopathy; one case was caused by extraskeletal Ewing sarcoma (EES) along the thoracic paraspinal area, and the other by foraminal stenosis, due to a bony spur of the thoracic vertebra. As such, thoracic radiculopathy should be considered in the diagnosis of patients with thoracic and abdominal pain, especially if initial diagnostic studies are inconclusive. PMID:27446792

  6. Insurance Status is Associated with Acuity of Presentation and Outcomes for Thoracic Aortic Operations

    PubMed Central

    Andersen, Nicholas D.; Brennan, J. Matthew; Zhao, Yue; Williams, Judson B.; Williams, Matthew L.; Smith, Peter K.; Scarborough, John E.; Hughes, G. Chad

    2014-01-01

    Background Non-elective procedure status is the greatest risk factor for postoperative morbidity and mortality in patients undergoing thoracic aortic operations. We hypothesized that uninsured patients were more likely to require non-elective thoracic aortic operation due to decreased access to preventative care and elective surgical services. Methods and Results An observational study of the Society of Thoracic Surgeons Database identified 51,282 patients who underwent thoracic aortic surgery between 2007–2011 at 940 North American centers. Patients were stratified by insurance status (private insurance, Medicare, Medicaid, other insurance, or uninsured) as well as age < 65 years or age ≥ 65 years to account for differences in Medicare eligibility. The need for non-elective thoracic aortic operation was highest for uninsured patients (71.7%) and lowest for privately insured patients (36.6%). The adjusted risks of non-elective operation were increased for uninsured patients (adjusted risk ratio [ARR], 1.77; 95% confidence interval [CI], 1.70–1.83 for age < 65 years; ARR, 1.46; 95% CI, 1.29–1.62 for age ≥ 65 years) as well as Medicaid patients age < 65 years (ARR, 1.18; 95% CI, 1.10–1.26) when compared to patients with private insurance. The adjusted odds of major morbidity and/or mortality were further increased for all patients age < 65 years without private insurance (ARRs between 1.13 and 1.27). Conclusions Insurance status was associated with acuity of presentation and major morbidity and mortality for thoracic aortic operations. Efforts to reduce insurance-based disparities in the care of patients with thoracic aortic disease appear warranted and may reduce the incidence of aortic emergencies and improve outcomes after thoracic aortic surgery. PMID:24714600

  7. Pulmonary function tests correlated with thoracic volumes in adolescent idiopathic scoliosis.

    PubMed

    Ledonio, Charles Gerald T; Rosenstein, Benjamin E; Johnston, Charles E; Regelmann, Warren E; Nuckley, David J; Polly, David W

    2017-01-01

    Scoliosis deformity has been linked with deleterious changes in the thoracic cavity that affect pulmonary function. The causal relationship between spinal deformity and pulmonary function has yet to be fully defined. It has been hypothesized that deformity correction improves pulmonary function by restoring both respiratory muscle efficiency and increasing the space available to the lungs. This research aims to correlate pulmonary function and thoracic volume before and after scoliosis correction. Retrospective correlational analysis between thoracic volume modeling from plain x-rays and pulmonary function tests was conducted. Adolescent idiopathic scoliosis patients enrolled in a multicenter database were sorted by pre-operative Total Lung Capacities (TLC) % predicted values from their Pulmonary Function Tests (PFT). Ten patients with the best and ten patients with the worst TLC values were included. Modeled thoracic volume and TLC values were compared before and 2 years after surgery. Scoliosis correction resulted in an increase in the thoracic volume for patients with the worst initial TLCs (11.7%) and those with the best initial TLCs (12.5%). The adolescents with the most severe pulmonary restriction prior to surgery strongly correlated with post-operative change in total lung capacity and thoracic volume (r(2)  = 0.839; p < 0.001). The mean increase in thoracic volume in this group was 373.1 cm(3) (11.7%) which correlated with a 21.2% improvement in TLC. Scoliosis correction in adolescents was found to increase thoracic volume and is strongly correlated with improved TLC in cases with severe restrictive pulmonary function, but no correlation was found in cases with normal pulmonary function. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:175-182, 2017.

  8. Subsequent surgery rates after cervical total disc replacement using a Mobi-C Cervical Disc Prosthesis versus anterior cervical discectomy and fusion: a prospective randomized clinical trial with 5-year follow-up.

    PubMed

    Jackson, Robert J; Davis, Reginald J; Hoffman, Gregory A; Bae, Hyun W; Hisey, Michael S; Kim, Kee D; Gaede, Steven E; Nunley, Pierce Dalton

    2016-05-01

    OBJECTIVE Cervical total disc replacement (TDR) has been shown in a number of prospective clinical studies to be a viable treatment alternative to anterior cervical discectomy and fusion (ACDF) for the treatment of symptomatic degenerative disc disease. In addition to preserving motion, evidence suggests that cervical TDR may result in a lower incidence of subsequent surgical intervention than treatment with fusion. The goal of this study was to evaluate subsequent surgery rates up to 5 years in patients treated with TDR or ACDF at 1 or 2 contiguous levels between C-3 and C-7. METHODS This was a prospective, multicenter, randomized, unblinded clinical trial. Patients with symptomatic degenerative disc disease were enrolled to receive 1- or 2-level treatment with either TDR as the investigational device or ACDF as the control treatment. There were 260 patients in the 1-level study (179 TDR and 81 ACDF patients) and 339 patients in the 2-level study (234 TDR and 105 ACDF patients). RESULTS At 5 years, the occurrence of subsequent surgical intervention was significantly higher among ACDF patients for 1-level (TDR, 4.5% [8/179]; ACDF, 17.3% [14/81]; p = 0.0012) and 2-level (TDR, 7.3% [17/234]; ACDF, 21.0% [22/105], p = 0.0007) treatment. The TDR group demonstrated significantly fewer index- and adjacent-level subsequent surgeries in both the 1- and 2-level cohorts. CONCLUSIONS Five-year results showed treatment with cervical TDR to result in a significantly lower rate of subsequent surgical intervention than treatment with ACDF for both 1 and 2 levels of treatment. Clinical trial registration no.: NCT00389597 ( clinicaltrials.gov ).

  9. Biological performance of a polycaprolactone-based scaffold used as fusion cage device in a large animal model of spinal reconstructive surgery.

    PubMed

    Abbah, Sunny A; Lam, Christopher X L; Hutmacher, Dietmar W; Goh, James C H; Wong, Hee-Kit

    2009-10-01

    A bioactive and bioresorbable scaffold fabricated from medical grade poly (epsilon-caprolactone) and incorporating 20% beta-tricalcium phosphate (mPCL-TCP) was recently developed for bone regeneration at load bearing sites. In the present study, we aimed to evaluate bone ingrowth into mPCL-TCP in a large animal model of lumbar interbody fusion. Six pigs underwent a 2-level (L3/4; L5/6) anterior lumbar interbody fusion (ALIF) implanted with mPCL-TCP + 0.6 mg rhBMP-2 as treatment group while four other pigs implanted with autogenous bone graft served as control. Computed tomographic scanning and histology revealed complete defect bridging in all (100%) specimen from the treatment group as early as 3 months. Histological evidence of continuing bone remodeling and maturation was observed at 6 months. In the control group, only partial bridging was observed at 3 months and only 50% of segments in this group showed complete defect bridging at 6 months. Furthermore, 25% of segments in the control group showed evidence of graft fracture, resorption and pseudoarthrosis. In contrast, no evidence of graft fractures, pseudoarthrosis or foreign body reaction was observed in the treatment group. These results reveal that mPCL-TCP scaffolds could act as bone graft substitutes by providing a suitable environment for bone regeneration in a dynamic load bearing setting such as in a porcine model of interbody spine fusion.

  10. Role of rod diameter in comparison between only screws versus hooks and screws in posterior instrumentation of thoracic curve in idiopathic scoliosis.

    PubMed

    Lamartina, Claudio; Petruzzi, Maria; Macchia, Marcello; Stradiotti, Paola; Zerbi, Alberto

    2011-05-01

    Since the introduction of Cotrel-Dubousset instrumentation in 1984, the correction techniques in scoliosis surgery have changed from Harrington principles of concave distraction to segmental realignment to a variety of possibilities including the rod rotation manoeuvres, and to segmental approximation via cantilever methods. Additionally, pedicle screw utilization in lumbar curves enhanced correction and stabilization of various deformities, and various studies have strongly supported the clinical advantages of lumbar pedicle screws versus conventional hook instrumentation. Pedicle screw constructs have become increasingly popular in the treatment of patients with spinal deformity. When applied to adolescent idiopathic scoliosis patients, pedicle screw fixation has demonstrated increased corrective ability compared with traditional hook/hybrid instrumentation. In our study, we do a retrospective review of idiopathic scoliosis patients (King 2-Lenke 1 B/C) treated with a selective thoracic posterior fusion using an all-screw construct versus a hybrid (pedicle screws and hooks) construct and, compare the percentage of correction of the scoliotic curves obtained with screws alone and screws and hooks. Special attention was given to the rod diameter and correction technique. Our results show that the percentage of correction of idiopathic thoracic scoliosis is similar when treating the scoliosis with rods and screws alone or with rods, screws and hooks; therefore, we and the majority of authors in the literature do not consider the rod section. This can be an important parameter in the evaluation of the superiority of treatment with screws only or screws and hooks. In our study, even if not of statistical significance, the better thoracic curve correction obtained with the hybrid group should be ascribed to the fact that in this group mostly 6 mm rods were used.

  11. 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.

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

    PubMed Central

    Su, I-Chang

    2007-01-01

    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

  13. The History of Sympathetic Surgery.

    PubMed

    Hashmonai, Moshe

    2016-11-01

    At present, primary hyperhidrosis is the main indication for sympathectomy. For upper thoracic sympathetic ablation, excision of the second thoracic ganglion alone or with the first and/or third ganglia was the standard during the open surgery era. With the advent of thoracoscopy, modifications related to the level, extent, and type of ablation were proposed to attenuate compensatory hyperhidrosis. The ideal operation for sympathetic denervation of the face and upper limbs remain to be defined. Controlled double-blind studies with quantitave measurements of sweat production are required.

  14. Aneurysms of the thoracic aorta

    PubMed Central

    Le Roux, B. T.; Rogers, M. A.; Gotsman, M. S.

    1971-01-01

    Selected radiographs from 40 patients with thoracic aortic aneurysm serve to illustrate most of the radiographic features of this disease. Surgical techniques are outlined and were used to modify the natural course of the disease in 14 patients, with three postoperative deaths. The remaining 26 patients were either moribund on admission and died shortly afterwards or declined operations and died later. Images PMID:5144643

  15. A Thoracic Surgical Case Presented at the First Academic Meeting of the Chosun (Korean) Medical Association Held in 1947

    PubMed Central

    Kim, Won-Gon

    2016-01-01

    The late Prof. Kyeok Boo Han (1913–2005) was one of the pioneers in the early stages of the establishment of thoracic surgery in Korea. He was in charge of thoracic surgery at Seoul National University Hospital from 1948 to the outbreak of the Korean War in 1950. He presented a thoracic surgical case entitled “Adhesive (constrictive) pericarditis: one surgical case” at the first academic meeting of the Chosun (an old name for Korea) Medical Association, held in 1947. This presentation is considered to be the first thoracic surgical case presented by a Korean surgeon at a domestic medical meeting after the National Liberation from Japanese colonial rule in 1945. In this regard, this study was intended to analyze the content and the meaning of the case, published in a journal in 1948. PMID:27525248

  16. Emergency Thoracic US: The Essentials.

    PubMed

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

    2016-01-01

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

  17. Hepatopulmonary fusion in a newborn. An uncommon intraoperatory finding during right congenital diaphragmatic hernia surgery: case description and review of literature.

    PubMed

    Olenik, D; Codrich, D; Gobbo, F; Travan, L; Zennaro, F; Dell'Oste, C; Bussani, R; Schleef, J

    2014-06-01

    Hepatic pulmonary fusion is a rare malformation associated with right congenital diaphragmatic hernia (CDH), often only discovered during surgical repair of the defect. Fourteen previous cases have been reported in the literature. We describe a case of a full term male newborn with prenatal ultrasound diagnosis of right CDH who underwent a thoracoscopy converted to a thoracotomy, due to this rare aforementioned intraoperative incidental finding. We reviewed the previous reported literature, especially focusing on the chosen surgical approach, concluding that an early and appropriate preoperative imaging investigation may be crucial for the best management of these kinds of patients.

  18. [Assessing the Current Status of Enhanced Recovery after Surgery in the Usage of Web-based Survey Questionnaires by Thoracic Surgeons and Nurses Attending the Meeting in Mainland China].

    PubMed

    Du, Na; Guo, Chenglin; Yang, Mei; Ji, Yanli; Wang, Wei; Li, Jie; Li, Chuan; Liu, Lunxu; Che, Guowei

    2017-03-20

    背景与目的 虽然加速康复外科(enhanced recovery after surgery, ERAS)理念近年来已逐渐被外科医生所熟悉和应用于临床实践中,但目前关于我国大陆胸外科医师对ERAS理念的认知和应用现状如何仍不清楚。本研究基于对参会胸外科医生和护士进行ERAS相关问题的问卷调查结果,分析加速康复外科在胸外科的应用现状和面临的困难。方法 对参与第一届胸科ERAS华西论坛代表回复的773份有效问卷进行分析,问卷内容主要包括两部分:一是被调查人单位情况及个人基本情况;二是加速康复外科相关的10个问题。结果 ①ERAS的临床应用现状为理念大于实践,69.6%的医生和58.7%的护士认同此观点;88.5%的医生和85.7%护士均认为ERAS理念适用于所有外科。②ERAS临床应用依从性差的主要原因是方案不成熟、无共识和规范(55.6%的医生和69.1%的护士)。③ERAS临床实施的最佳团队组合是外科为主的学科协作及医护一体(62.1%的医生和70.7%的护士)。④73.7%的医生和81.9%的护士认为ERAS的评价标准应为:平均住院日、患者感受和社会满意度进行综合评价。结论 加速康复外科在胸外科应用现状仍然是理念大于实践,主要原因是缺乏临床可用的规范和方案。.

  19. Penetrating thoracic injuries - treatment of two patients after suicide attempts.

    PubMed

    Greberski, Krzysztof; Bugajski, Paweł; Rzymski, Stanisław; Jarząbek, Radosław; Olczak, Bogumił; Kalawski, Ryszard

    2015-03-01

    Thoracic injuries are usually caused by penetrating or blunt trauma. The primary method of treatment is surgery. This study describes two cases of male patients with stab wounds of the chest resulting from suicide attempts. The first case involved a 29-year-old patient transported and admitted to the hospital with a knife still in his chest; its blade extended from the jugular notch to the 5(th) thoracic vertebra but did not damage any important structures. The applied treatment, limited to evacuating the knife, resulted in a satisfactory outcome, and the patient was discharged from the intensive care unit (ICU) in good condition. The second patient reached the hospital on his own. On admission, he did not reveal the real cause of the wound; however, in view of his deteriorating condition, he admitted that the knife penetrated deeply into the mediastinum. In this case, sternotomy was necessary to stop the bleeding of the pulmonary trunk and internal thoracic artery. After completion of treatment, the patient was discharged in good condition. The described management of life-threatening situations conducted by a multidisciplinary team of consultants enabled the choice of optimal treatment methods and resulted in successful outcomes.

  20. 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.

  1. 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

  2. Radioscapholunate Fusions

    PubMed Central

    McGuire, Duncan Thomas; Bain, Gregory Ian

    2012-01-01

    Radiocarpal fusions are performed for a variety of indications, most commonly for debilitating painful arthritis. The goal of a wrist fusion is to fuse the painful, diseased joints and to preserve motion through the healthy joints. Depending on the extent of the disease process, radiocarpal fusions may take the form of radiolunate, radioscapholunate, or total wrist fusions. Surgical techniques and instrumentation have advanced over the last few decades, and consequently the functional outcomes have improved and complications decreased. Techniques for partial carpal fusions have improved and now include distal scaphoid and triquetrum excision, which improves range of motion and fusion rates. In this article we discuss the various surgical techniques and fixation methods available and review the corresponding evidence in the literature. The authors' preferred surgical technique of radioscapholunate fusion with distal scaphoid and triquetrum excision is outlined. New implants and new concepts are also discussed. PMID:24179717

  3. Thoracic and Cardiovascular Surgeons’ Perception of the Concentration of Cardiovascular Operations in Seoul Metropolitan Area’s Hospitals

    PubMed Central

    Jeong, Hyo Seon; Lee, Kun Sei; Chee, Hyun Keun; Ahn, Hye Mi; Sim, Sung Bo

    2016-01-01

    Background The purpose of this study is to evaluate the concentration of cardiovascular surgical procedures in a metropolitan area and investigate the perception of specialists regarding governmental policies to resolve this imbalance. Methods From March to May 2015, surveys were distributed to members of the Thoracic and Cardiovascular Surgery Association. The final pool of research subjects consisted of 75 respondents. Subjects were queried regarding the concentration of cardiovascular operations in metropolitan areas, alternatives to the imbalance, and governmental policies to resolve the inequalities. Results Survey participants responded that South Korea needs governmental policies to alleviate the concentration of cardiovascular surgery patients in large metropolitan hospitals. Participants agreed that the freedom to choose medical institutions and improved accessibility to metropolitan hospitals due to advanced transportation systems were some of the causes for the concentration. A majority (98.7%) of respondents thought establishing thoracic and cardiovascular surgery centers in provinces was an appropriate solution to alleviate the concentration. Thoracic and cardiovascular surgery specialists were ranked as the number one group on which to focus development. Conclusion Developing and carrying out policies to establish thoracic and cardiovascular surgery centers in provinces will alleviate the regional imbalance in available heart surgery services and an overall improvement in cardiovascular disease treatment in South Korea. PMID:28035298

  4. 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 ...

  5. Total Spinal Block after Thoracic Paravertebral Block

    PubMed Central

    Beyaz, Serbülent Gökhan; Özocak, Hande; Ergönenç, Tolga; Erdem, Ali Fuat; Palabıyık, Onur

    2014-01-01

    Thoracic paravertebral block (TPVB) can be performed with or without general anaesthesia for various surgical procedures. TPVB is a popular anaesthetic technique due to its low side effect profile and high analgesic potency. We used 20 mL of 0.5% levobupivacaine for a single injection of unilateral TPVB at the T7 level with neurostimulator in a 63 year old patient with co-morbid disease who underwent cholecystectomy. Following the application patient lost consciousness, and was intubated. Haemodynamic instability was normalised with rapid volume replacement and vasopressors. Anaesthetic drugs were stopped at the end of the surgery and muscle relaxant was antagonised. Return of mucle strenght was shown with neuromuscular block monitoring. Approximately three hours after TPVB, spontaneous breathing started and consciousness returned. A total spinal block is a rare and life-threatening complication. A total spinal block is a complication of spinal anaesthesia, and it can also occur after peripheral blocks. Clinical presentation is characterised by hypotension, bradicardia, apnea, and cardiac arrest. An early diagnosis and appropriate treatment is life saving. In this case report, we want to present total spinal block after TPVB. PMID:27366387

  6. 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.

  7. Thoracic aorta aneurysm open repair in heart transplant recipient; the anesthesiologist's perspective

    PubMed Central

    Monaco, Fabrizio; Oriani, Alessandro; De Luca, Monica; Bignami, Elena; Sala, Alessandra; Chiesa, Roberto; Melissano, Germano; Zangrillo, Alberto

    2016-01-01

    Many years following transplantation, heart transplant recipients may require noncardiac major surgeries. Anesthesia in such patients may be challenging due to physiological and pharmacological problems regarding allograft denervation and difficult immunosuppressive management. Massive hemorrhage, hypoperfusion, renal, respiratory failure, and infections are some of the most frequent complications related to thoracic aorta aneurysm repair. Understanding how to optimize hemodynamic and infectious risks may have a substantial impact on the outcome. This case report aims at discussing risk stratification and anesthetic management of a 54-year-old heart transplant female recipient, affected by Marfan syndrome, undergoing thoracic aorta aneurysm repair. PMID:26750703

  8. Study of 433 Operated Cases of Thoracic Trauma.

    PubMed

    Çakmak, Muharrem; Nail Kandemir, Mehmet

    2016-12-01

    Patients with thoracic trauma constitute one third of all the trauma cases. Of traumatic patients, 20-25 % die because of thoracic trauma. Our aim was to compare our clinical experience and the results with the related literature. Four hundred thirty-three patients, who underwent surgical interventions due to thoracic trauma, were evaluated. The latest form of treatment applied were taken as the criteria for the quantitative detection of patients. Continuous variables were expressed as mean ± standard deviation, while categorical variables were explained as number and percentage. The significance of the analysis results was evaluated using Fisher's exact test. p values <0.05 were considered as significant. Penetrating injuries were found in 258 (59 %) of the patients, and blunt trauma was identified in 175 (41 %). Depending on the trauma, pneumothorax was discovered in 130 patients (30.02 %), hemothorax in 117 (27.02 %), hemopneumothorax in 61 (14.08 %), pulmonary contusion in 110 (45 %), pneumomediastinum in 14 (3.23 %), and pericardial tamponade in 1 patient (0.23 %). It was demonstrated that 385 of 433 patients examined in the study underwent tube thoracostomy, 41 were treated with thoracotomy, while 6 of them underwent video-assisted thoracoscopic surgery (VATS), and 1 underwent sternotomy. No correlation was observed between mortality, morbidity, and gender and type of trauma and location of trauma (p > 0.05). However, statistically significant correlation was found between mortaxlity, morbidity, and the presence of concomitant injuries, the duration between injury and admission being more than 1 h (p < 0.05). Urgent intervention, early diagnosis, and fast transport are vital for patients with thoracic injuries.

  9. Spinal neuromodulation as a novel surgical option for failed back surgery syndrome following rhBMP exuberant bony growth in instrumented lumbar fusion: A case report and literature review

    PubMed Central

    Ghaly, Ramsis F.; Lissounov, Alexei; Tverdohleb, Tatiana; Kohanchi, David; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2016-01-01

    Background: Bone morphogenic protein (BMP) for instrumented lumbar fusion was approved in 2002, and since then has led to an increasing incidence of BMP-related neuropathic pain. These patients are usually resistant to conventional medical therapy and frequently undergo multiple surgical revisions without any pain relief. Case Description: A 58-year-old male was referred to the author's outpatient clinic after four lumbar surgeries did not provide satisfactory pain relief. During his 10 years of suffering from low back pain after an injury, the patient was resistant to conventional and interventional treatment options. He was experiencing severe back pain rated 10/10, as well as right lower extremity pain, numbness, tingling, and motor deficits. Outside spine specialists had performed revision surgeries for BMP-related exuberant bone formation at L5–S1, which included the removal of the ipsilateral hardware and debridement of intradiscal and intraforamina heterotrophic exuberant bony formation. The author implanted the patient with a permanent continuous spinal cord stimulator, after which he achieved complete pain relief (0/10) and restoration of motor, sensory, autonomic, and sphincter functions. Conclusion: This is the first reported case of restorative function with neuromodulation therapy in a BMP-induced postoperative complication, which is considered as a primarily inflammatory process, rather than nerve root compression due to exuberant bony formation. We hypothesize that neuromodulation may enhance blood flow and interfere with inflammatory processes, in addition to functioning by the accepted gate control theory mechanism. The neuromodulation therapy should be strongly considered as a therapeutic approach, even with confirmed BMP-induced postoperative radiculitis, rather than proposing multiple surgical revisions. PMID:27843683

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

    PubMed

    Meneses-Quintero, David; Alvarado-Gómez, Fernando; Alcalá-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.

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

    PubMed Central

    Meneses-Quintero, David; Alvarado-Gómez, Fernando; Alcalá-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

  12. Splenogonadal Fusion – Not Just Another Hydrocoele

    PubMed Central

    Kennedy, KP; Barnard, S; Speakman, MJ

    2006-01-01

    Splenogonadal fusion is a rare congenital abnormality. In this case report, the diagnosis of splenogonadal fusion was made after the removal of an abnormal mass at ‘routine’ left herniotomy. A cautious approach at surgery resulted in no apparent damage to the testicle. A short review of the literature is included. PMID:16551409

  13. 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.

  14. 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.

  15. 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.

  16. 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

  17. Cervical lordotic alignment following posterior spinal fusion for adolescent idiopathic scoliosis: reciprocal changes and risk factors for malalignment.

    PubMed

    Hayashi, Kazunori; Toyoda, Hiromitsu; Terai, Hidetomi; Suzuki, Akinobu; Hoshino, Masatoshi; Tamai, Koji; Ohyama, Shoichiro; Nakamura, Hiroaki

    2017-01-27

    OBJECTIVE Numerous reports have been published on the effectiveness and safety of correction of the coronal Cobb angle and thoracolumbar sagittal alignment in patients with adolescent idiopathic scoliosis (AIS). Suboptimal sagittal alignment, such as decreased thoracic kyphosis (TK), after corrective surgery, is a possible cause of lumbar or cervical spinal degeneration and junctional malalignment; however, few reports are available on reciprocal changes outside of the fused segments, such as the cervical lordotic angle (CLA). This study aimed to investigate the relationship between the perioperative CLA and other radiographic factors or clinical results in AIS, and to identify independent risk factors of postoperative cervical hyperkyphosis. METHODS A total of 51 AIS patients who underwent posterior spinal fusion with the placement of pedicle screw (PS) constructs at thoracic levels were included in the study. Clinical and radiographic follow-up of patients was conducted for a minimum of 2 years, and the postoperative course was evaluated. The authors measured and identified the changes in the CLA and other radiographic parameters using whole-spine radiography, with the patient in the standing position, performed immediately before surgery, 2 weeks after surgery, and 2 years after surgery. The postoperative cervical hyperkyphosis group included patients whose CLA at 2-year follow-up was smaller than -10°. The reciprocal changes of the CLA and other parameters were also investigated. Univariate and multivariate analyses were conducted to determine the associated risk factors for postoperative cervical hyperkyphosis. RESULTS This study comprised 48 females and 3 males (mean age 16.0 years). The mean follow-up period was 47 months (range 24-90 months). The main coronal thoracic curve was corrected from 54.6° to 16.4°, and the mean correction rate was 69.8% at 2 years. The CLA significantly increased from the mean preoperative measurement (-5.4° ± 14°) to the 2

  18. History of Cardiothoracic Surgery at Washington University in Saint Louis.

    PubMed

    Moon, Marc R

    2016-01-01

    The Division of Cardiothoracic Surgery at Washington University evolved a century ago to address what many considered to be the last surgical frontier, diseases of the chest. In addition, as one of the first training programs in thoracic surgery, Washington University has been responsible for educating more thoracic surgeons than nearly any other program in the world. Beginning with Evarts A. Graham and continuing through to Ralph J. Damiano Jr., the leaders of the division have had a profound impact on the field of cardiothoracic surgery.

  19. Distraction Osteogenesis of Multiple Ribs for the Treatment of Acquired Thoracic Dystrophy.

    PubMed

    Piper, Merisa L; Delrosario, Lawrence; Hoffman, William Y

    2016-03-01

    Acquired thoracic dystrophy is a complication associated with early open repair of pectus excavatum resulting from extensive cartilage resection. The condition can cause serious functional and physiologic impairments, including cardiac compression and restrictive pulmonary function. We describe a 17-year-old boy with acquired thoracic dystrophy after Ravitch repair of pectus excavatum during infancy, whom we treated with distraction osteogenesis. The patient had a marked deformity of the chest wall and general hypoplasia of the central portion of the ribcage, with resultant symptomatic dyspnea on exertion and reduced pulmonary function. After osteotomies and distraction osteogenesis of bilateral ribs 4-8 using customized distraction devices, he had improved thoracic contour, resolution of dyspnea, and decreased restrictive pulmonary symptoms. This case suggests that distraction osteogenesis, already used extensively in craniomaxillofacial and orthopedic surgery, may be a novel method for management of this condition.

  20. Spirometry. Spanish Society of Pulmonology and Thoracic Surgery (SEPAR).

    PubMed

    García-Río, Francisco; Calle, Myriam; Burgos, Felip; Casan, Pere; Del Campo, Félix; Galdiz, Juan B; Giner, Jordi; González-Mangado, Nicolás; Ortega, Francisco; Puente Maestu, Luis

    2013-09-01

    Spirometry is the main pulmonary function test and is essential for the evaluation and monitoring of respiratory diseases. Its utility transcends the field of Respiratory Medicine, is becoming increasingly important in primary care and applications have even been described outside the field of respiratory diseases. This document is therefore intended to serve as support for all health professionals who use spirometry, providing recommendations based on the best scientific evidence available. An update of the indications and contraindications of the test is proposed. The document sets out recommendations on the requirements necessary for conventional spirometers and portable office equipment, as well as on spirometer hygiene and quality control measures. Spirometric parameters that must be considered, performance of manoeuvres, criteria for acceptability and repeatability of measurements and their quality control are defined. A proposal is also established for presentation of the results and an evaluation and interpretation is proposed according to information generated in recent years. Finally, lines of adaptation and integration of spirometry in the field of new technologies are considered.

  1. Neural networks and artificial intelligence in thoracic surgery.

    PubMed

    Esteva, Hugo; Núñez, Tomás G; Rodríguez, Ricardo O

    2007-08-01

    The human brain has billions of neurons and connections that cannot be emulated by computers. This structure could explain the anatomical basis of typically human psychological activities like intuition or artistic creation. On the other hand, the computer-organized way of "reasoning" binary problems through systematic comparison of a large number of data-as AIM does--is impossible to be emulated by humans. At the same time, AIM, through the use of different methods like ANN or DM systems, is able to give individualized answers to otherwise probabilistic population problems. Hence, that is the reason for its application in the assessment of surgical risk in lung resection candidates. With regard to AIM methodology, many issues could be addressed and argued, especially on the data collection because of the retrospective nature of the data on which the available contributions from the literature are based. In the larger studies, patients from different centers treated by different surgical teams were included. Both circumstances could have caused heterogeneity of the study groups, which, in turn, can lead to less-reliable conclusions. Even if limited, our experience became an appealing one because AIM seems to be a potentially useful complementary tool to the nonreplaceable clinical judgment.

  2. Medical teleconference about thoracic surgery using free Internet software.

    PubMed

    Obuchi, Toshiro; Shiono, Hiroyuki; Shimada, Junichi; Kaga, Kichizo; Kurihara, Masatoshi; Iwasaki, Akinori

    2011-11-01

    Surgical teleconferences using advanced academic networks are becoming common; however, reports regarding Internet teleconferencing using free software packages such as Skype, USTREAM, and Dropbox are very rare. Teleconferences concerning mainly surgical techniques were held five times between Fukuoka University Hospital and other institutions from April to September 2010. These teleconferences used Skype and USTREAM as videophones to establish communication. Both PowerPoint presentations and surgical videos were made. These presentation files were previously sent to all stations via mail, e-mail, or Dropbox, and shared. A slide-show was simultaneously performed following the presenter's cue in each station. All teleconferences were successfully completed, even though there were minor instances of the Skype link being broken for unknown reasons during the telecommunication. Internet surgical teleconferences using ordinary software are therefore considered to be sufficiently feasible. This method will become more convenient and common as the Internet environments advance.

  3. Reconstructive Surgery in the Thermally Injured Patient

    DTIC Science & Technology

    2012-01-01

    lateral thoracic, lower abdom- inal, or groin areas are chosen. Since harvesting includes removal of all regenerative dermal layers down to adipose tissue...Understanding and managing burn pain : part 1. Am J Nursing 2009;109:4. 113Reconstructive Surgery in the Thermally Injured Patient

  4. Sacroiliac joint pain after lumbar/lumbosacral fusion: current knowledge.

    PubMed

    Yoshihara, Hiroyuki

    2012-09-01

    Recently, the sacroiliac joint (SIJ) has gained increased attention as a source of persistent or new pain after lumbar/lumbosacral fusion. The underlying pathophysiology of SIJ pain may be increased mechanical load, iliac crest bone grafting, or a misdiagnosis of SIJ syndrome. Imaging studies show more frequent degeneration of the SIJ in patients with lumbar/lumbosacral fusion than in patients without such fusion. Using injection tests, it has been shown that SIJ pain is the cause of persistent symptoms in a considerable number of patients after fusion surgery. Recent articles reporting on surgical outcomes of SIJ fusion include a high percentage of patients who had lumbar/lumbosacral fusion or surgery before, although well-controlled clinical studies are necessary to assess the efficacy of surgical treatment. Taking these findings into consideration, the possibility that the SIJ is the source of pain should be considered in patients with failed back surgery syndrome after lumbar/lumbosacral fusion.

  5. 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

  6. Thoracic organ transplantation: laboratory methods.

    PubMed

    Patel, Jignesh K; Kobashigawa, Jon A

    2013-01-01

    Although great progress has been achieved in thoracic organ transplantation through the development of effective immunosuppression, there is still significant risk of rejection during the early post-transplant period, creating a need for routine monitoring for both acute antibody and cellular mediated rejection. The currently available multiplexed, microbead assays utilizing solubilized HLA antigens afford the capability of sensitive detection and identification of HLA and non-HLA specific antibodies. These assays are being used to assess the relative strength of donor specific antibodies; to permit performance of virtual crossmatches which can reduce the waiting time to transplantation; to monitor antibody levels during desensitization; and for heart transplants to monitor antibodies post-transplant. For cell mediated immune responses, the recent development of gene expression profiling has allowed noninvasive monitoring of heart transplant recipients yielding predictive values for acute cellular rejection. T cell immune monitoring in heart and lung transplant recipients has allowed individual tailoring of immunosuppression, particularly to minimize risk of infection. While the current antibody and cellular laboratory techniques have enhanced the ability to manage thoracic organ transplant recipients, future developments from improved understanding of microchimerism and graft tolerance may allow more refined allograft monitoring techniques.

  7. Image fusion

    NASA Technical Reports Server (NTRS)

    Pavel, M.

    1993-01-01

    The topics covered include the following: a system overview of the basic components of a system designed to improve the ability of a pilot to fly through low-visibility conditions such as fog; the role of visual sciences; fusion issues; sensor characterization; sources of information; image processing; and image fusion.

  8. Thoracic outlet syndrome in whiplash injury.

    PubMed Central

    Capistrant, T D

    1977-01-01

    Thirty-five cases of thoracic outlet syndrome complicating whiplash or cervical strain injury were studied. Thirty cases had confirmation by the demonstration of slowed ulnar nerve conduction velocity (UNCV) through the thoracic outlet. Two distinct groups of patients were found. An acute group, seen an average of 3 1/2 months post injury, had severe neck pain with often mild or incidental thoracic outlet syndrome. A chronic group, with symptoms persisting more than 2 years after cervical injury, often had thoracic outlet symptoms as the predominant complaint. This study suggests that the arm aches and parethesias seen in association with both acute and chronic cervical strain injury are most often secondary to thoracic outlet syndrome. PMID:836089

  9. Plastic Surgery

    MedlinePlus

    ... Loss Surgery? A Week of Healthy Breakfasts Shyness Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A ... her forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word " ...

  10. Outpatient Surgery

    MedlinePlus

    ... Outpatient Surgery Share this Page Preparing For Surgery Effects of Anesthesia Children and Anesthesia Pregnancy and Anesthesia Seniors and Anesthesia Surgery Risks Anesthesia Awareness Obesity and Anesthesia Sleep Apnea and Anesthesia Smoking and Anesthesia Outpatient Surgery ...

  11. 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

  12. Rib Composite Flap With Intercostal Nerve and Internal Thoracic Vessels for Mandibular Reconstruction

    PubMed Central

    Zhang, Bin; Li, Ke-Yi; Jiang, Li-Cheng; Meng, Zhen; Wang, Xiu-Mei; Cui, Fu-Zhai; Zhu, Ying-Nan; Wu, Ya-Ping

    2016-01-01

    Purpose: The purpose of this study was to present the outcome and discuss the feasibility of rib composite flap with intercostal nerve and internal thoracic vessels for reconstructing mandibular defect. Methods: Rib composite flaps have been used in 82 patients for reconstructing benign tumor-caused large mandibular defects: 66 of the 82 patients were reconstructed using rib composite flap with intercostal nerve and internal thoracic vessels, whereas the other 16 patients were reconstructed using rib composite flap with internal thoracic vessels, without intercostal nerve. After operation, clinical observation, imageological examination, and sensory detection were used to evaluate the effect of reconstruction. Results: All rib composite flaps with intercostal nerve and internal thoracic vessels were successfully harvested and transplanted. Both immediate and long-term examination showed good appearance reconstruction. All followed-up patients conveyed good satisfaction degree with function and appearance reconstruction. Postoperative panoramic x-ray examination showed new bone formation between the transplanted rib and mandibular stump. Good recoveries of mandibular nerve sensory were observed when followed up after reconstruction surgery. Conclusions: Rib composite flap with intercostal nerve and internal thoracic vessels could be a promising method for reconstruction of mandibular defects. PMID:27564074

  13. Prenatal presentation and postnatal management of congenital thoracic malformations.

    PubMed

    Bush, Andrew

    2009-11-01

    The antenatal finding of a congenital thoracic malformation (CTM) leads to anxiety in the parents and uncertainty as to the optimal management. The antenatal spectrum of CTM includes congenital cystic adenomatoid malformation, sequestration, congenital lobar emphysema, enteric and bronchogenic cysts, and bronchial atresia. Most lesions require no antenatal intervention, and shrink substantially in the third trimester, but if fetal hydrops develops, then antenatal intervention is required, occasionally medical but more usually surgical, because mortality is high. If the baby is symptomatic in the newborn period, then some form of surgical intervention is clearly required. The asymptomatic baby presents a therapeutic dilemma. Advocates of early surgery point to the complications of CTM, which include infection, pneumothorax, bleeding and malignant transformation. Those who are proponents of conservative management retort that some CTM disappear postnatally, and that the complication rate is unknown; many children appear never to need surgery. Furthermore, there is clearcut evidence that excision of a CTM does not totally eliminate the risk of a subsequent malignancy. It is clear that, both antenatally and postnatally, counselling of the family on a case by case basis is needed. The limitations of present evidence should be stressed. Different families will make different decisions about postnatal surgery in an asymptomatic baby. If surgery is performed, morbidity is low, particularly with a video-assisted thoracoscopic (VATS) procedure.

  14. National trends in gastroesophageal reflux surgery

    PubMed Central

    McMahon, Ross L.; Mercer, C. Dale

    2000-01-01

    Objectives To assess the surgical technique and the frequency of different types of antireflux surgery used in Canada after the introduction of laparoscopic antireflux surgery. Design Gastroesophageal reflux (GER) surgery and population data in fiscal years 1992 through 1996. were accessed through the Canadian Institute of Health Information, provincial health ministries, MED ECHO and Statistics Canada databases. Data were also analysed by province and nationally for type of surgery (e.g., open abdominal, thoracic, thoracoscopic and laparoscopic). Results National data showed a slight increase in GER surgery in the last 5 years. Laparoscopic surgery increased 2.8 fold in 1993 and 1.6 fold in 1995 over the previous years. Open abdominal cases decreased 1.1 fold from 1992 to 1996. Thoracic cases remained essentially unchanged. Provincial and regional disparities in procedures per 100 000 population exist (Ontario 7.1 versus Nova Scotia 20.7). Areas in which little or no laparoscopic surgery was done had an average increase of 3%, whereas areas in which laparoscopic surgery was done had an average increase of 16% in GER surgery during the course of the study. In provinces west of Quebec (with the exception of Manitoba) more than 50% of GER surgery is laparoscopic; in areas east of Ontario less than 25% of GER surgery is performed laparoscopically. Five provinces (Manitoba, Quebec, Nova Scotia, Prince Edward Island and Newfoundland) performed significantly fewer laparoscopic procedures than the national average. Conclusions The frequency of GER surgery is increasing modestly in Canada and is performed most often by the open abdominal route. Regional disparities in open and laparoscopic techniques are apparent. Laparoscopic surgery for GER is increasing rapidly and accounts for the decrease in open GER surgery. PMID:10714258

  15. [Thoracic nocardiosis - a clinical report].

    PubMed

    Vale, Artur; Guerra, Miguel; Martins, Daniel; Lameiras, Angelina; Miranda, José; Vouga, Luís

    2014-01-01

    Nocardia genus microorganisms are ubiquitous, Gram positive aerobic bacterias, responsible for disease mainly in immunocompromised hosts, with cellular immune response commitment. Inhalation is the main form of transmition and pulmonary disease is the most frequent presentation. Dissemination may occur by contiguity and also via hematogenous. The clinical and imaging presentation is not specific, and diagnosis is obtained after identification of Nocardia bacteria in biological samples. Since there are no reliable studies that indicate the best therapeutic option, treatment should be individualized and based on antimicrobial susceptibility testing. Surgical drainage should also be considered in all patients. The authors present a clinical case of a patient with thoracic nocardiosis, and make a short literature review on the theme.

  16. 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.

  17. 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)

  18. PET-Based Thoracic Radiation Oncology.

    PubMed

    Simone, Charles B; Houshmand, Sina; Kalbasi, Anusha; Salavati, Ali; Alavi, Abass

    2016-07-01

    Fluorodeoxyglucose-PET is increasingly being integrated into multiple aspects of oncology. PET/computed tomography (PET/CT) has become especially important in radiation oncology. With the increasing use of advanced techniques like intensity-modulated radiation therapy and proton therapy, PET/CT scans have played critical roles in the target delineation of tumors for radiation oncologists delivering conformal treatment techniques. Use of PET/CT is well established in lung cancer and several other thoracic malignancies. This article details the current uses of PET/CT in thoracic radiation oncology with a focus on lung cancer and describes expected future roles of PET/CT for thoracic tumors.

  19. 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; Goodwin, C Rory; 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 <12 months compared to >12 months 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.

  20. Mycotic Abdominal Aortic Aneurysm Secondary to Septic Embolism of a Thoracic Aorta Graft Infection.

    PubMed

    Blanco Amil, Carla Lorena; Vidal Rey, Jorge; López Arquillo, Irene; Pérez Rodríguez, María Teresa; Encisa de Sá, José Manuel

    2016-05-01

    Mycotic aneurysms account for 1% of abdominal aortic aneurysms. There are very few cases published that describe the formation of mycotic aneurysms after septic embolism due to graft infection. We present the first case to our knowledge to be described in the literature of a mycotic aneurysm caused by septic embolism derived from a thoracic aorta graft infection, treated with conventional surgery leading to a successful outcome and evolution.

  1. 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.

  2. [Results of surgical treatment for the intervertebral disc protrusion within thoracic spine].

    PubMed

    Malawski, S; Lukawski, S

    1998-01-01

    Results of surgical treatment for intervertebral disc protrusion within thoracic spine in 4 cases are presented. Protrusion had caused spinal compression resulting in neurological impairment (plegia). There were 3 females and 1 male, all in their forties or fifties. Two cases are presented in details, with radiological investigations included. Lateral approach was used at surgery. Neurological deficits subsided completely in all cases. Follow-up ranged from 1-15 years, mean 8 years.

  3. History of surgery for ruptured disk.

    PubMed

    Patwardhan, R V; Hadley, M N

    2001-01-01

    The history of surgery for ruptured disk of the human spine began approximately a century ago. Advances in the understanding of symptoms and signs of root or cord compression, their relationship to the pathology, and the refinement in imaging techniques have contributed to the present surgical management of rupture disk disease. Historical findings relevant to the cervical, thoracic, and lumbosacral regions of the spine, with relevant pathophysiology, imaging, and surgical treatment, including the evolution of various surgical approaches are discussed. Surgeons and other contributors in the medical field are cited for their respective contributions to the evolution of the present operative approaches for disk ruptures in the cervical, thoracic, and lumbar spinal regions.

  4. Late failure of posterior fixation without bone fusion for vertebral metastases

    PubMed Central

    Bellato, Renato Tavares; Teixeira, William Gemio Jacobsen; Torelli, Alessandro Gonzalez; Cristante, Alexandre Fogaça; de Barros, Tarcísio Eloy Pessoa; de Camargo, Olavo Pires

    2015-01-01

    ABSTRACT OBJECTIVE : To verify the frequency of late radiological com-plications in spinal fixation surgeries performed without fu-sion in oncological patients METHODS : This is a retrospective analysis analysing failure in cases of non-fused vertebral fixation in an oncology reference hospital between 2009 and 2014. Failure was defined as implant loosening or bre-akage, as well as new angular or translation deformities RESULTS : One hundred and five cases were analyzed. The most common site of primary tumor was the breast and the most common place of metastasis was the thoracic spine. The average follow-up was 22.7 months. Nine cases (8%) of failure were reported, with an average time until failure of 9.5 months. The most common failure was implant loosening. No case required further surgery CONCLUSION : The occurrence of failure was not different than that reported for fused cases. The time interval until failure was higher than the median of survival of the majority (88%) of cases. Level of Evidence IV, Therapeutic Study. PMID:27057142

  5. Surgery for spinal tuberculosis: a multi-center experience of 582 cases

    PubMed Central

    Phan, Kevin; Karim, Rezaul; Jonayed, Sharif Ahmed; Munir, Hasan Khalid Md.; Chakraborty, Shubhendu; Alam, Tashfique

    2015-01-01

    Background Tuberculosis (TB) of the spine is a common site of osseous TB, accounting for 50%-60% of cases. Spinal TB still occurs in both developed and developing countries. The diagnosis of spinal TB is difficult and it commonly presents at an advanced stage. Delays in establishing diagnosis and management result in complications such as spinal cord compression and spinal deformity. Methods A total of 582 patients with TB of the cervical, thoracic and lumbar spine with moderate to severe cord compression were studied. Variable degrees of neurological deficit with deformity were treated from January, 2003 to July, 2014. Thoracotomy along with anterolateral decompression and autogenous strut bone grafting with simultaneous fixation by screws and rods were performed in 113 cases. Posterior decompression, posterior interbody and posterolateral fusion by bone graft with stabilization by transpedicular screws and rods were done in the remaining 469 cases. Appropriate anti-TB drugs were given to all patients for 18-24 months. The follow-up period was 3 months to 10 years. Results The average age was 32.5 years. All patients survived surgery. There were 7 cases of superficial infections (1.2%) whilst there were 4 cases (0.7%) of deep infections. Revision surgery was performed in 6 patients (1.0%). Implant failure occurred in 4 cases (0.7%) whilst malposition of screws occurred in 12 cases (2.1%). Perioperative bleeding complications were reported for 4 patients (0.7%). Neurological improvement occurred in all patients except for 2 cases (0.3%). Preoperatively, the majority of patients (n=221, 38%) were classified with Class A on the American Spinal Injury Association (ASIS) neurological impairment scale. This was significantly reduced postoperatively to 0.4%. Conclusions For patients with spinal TB anterior debridement, auto graft bone fusion, anterior or posterior fixation appears to be effective in arresting disease, correcting kyphotic deformity and maintaining

  6. Methods of evaluating lumbar and cervical fusion.

    PubMed

    Gruskay, Jordan A; Webb, Matthew L; Grauer, Jonathan N

    2014-03-01

    Introduced in 1911, spinal fusion is now widely used to stabilize the cervical, thoracic, and lumbar spine. Despite advancements in surgical techniques, including the use of instrumentation and optimizing bone graft options, pseudarthrosis remains one of the most significant causes of clinical failure following attempted fusion. Diagnosis of this common complication is based on a focused clinical assessment and imaging studies. Pseudarthrosis classically presents with the onset of or return of axial or radicular symptoms during the first postoperative year. However, this diagnosis is complicated because other diagnoses can mimic these symptoms (such as infection or adjacent segment degeneration) and because many cases of pseudarthrosis are asymptomatic. Computed tomography and assessment of motion on flexion/extension radiographs are the two preferred imaging modalities for establishing the diagnosis of pseudarthrosis. The purpose of this article was to review the current status of imaging and clinical practices for assessing fusion following spinal arthrodesis.

  7. 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

  8. Fractures of the Thoracic and Lumbar Spine

    MedlinePlus

    .org Fractures of the Thoracic and Lumbar Spine Page ( 1 ) Spinal fractures can vary widely in severity. While some fractures are very serious injuries that require emergency treatment, other fractures can ...

  9. Percutaneous Hindfoot and Midfoot Fusion.

    PubMed

    Bauer, Thomas

    2016-09-01

    Hindfoot and midfoot fusions can be performed with percutaneous techniques. Preliminary results of these procedures are encouraging because they provide similar results than those obtained with open techniques with less morbidity and quick recovery. The best indications are probably fusions for mild-to-moderate reducible hindfoot and midfoot deformities in fragile patients with general or local bad conditions. The main limit is linked to the surgeon's experience in percutaneous foot surgery because a learning curve with the specific tools is necessary before doing these procedures.

  10. Outcome of surgical management of the thoracic outlet compression syndrome in a district general hospital.

    PubMed Central

    Baker, D. M.; Lamerton, A. J.

    1993-01-01

    The 5-year experience of one surgeon in treating 50 consecutive patients (57 limbs) with the thoracic outlet compression syndrome (TOCS) is described. A predominance of neurological symptoms presented; each was treated in a similar fashion with extensive resection of the first rib and excision of fibrous bands and cervical ribs. Results of surgery (84% complete resolution or improvement of symptoms) compare favourably with others. This series demonstrates that although the technicality of the surgery demands a surgeon very familiar with the operation, this need not be undertaken in a regional centre. PMID:8323211

  11. A Case of Patent Ductus Arteriosus in an Elderly Patient Treated by Thoracic Endovascular Aortic Repair

    PubMed Central

    Ishibashi, Hiroyuki; Sugimoto, Ikuo; Yamada, Tetsuya; Maruyama, Yuki; Hagihara, Makiyo; Ishiguchi, Tsuneo

    2016-01-01

    The patient described herein was a 75-year-old female. Echocardiography showed patent ductus arteriosus (PDA). Heart failure symptoms gradually appeared, and she was referred to our department for treatment. Contrast-enhanced computed tomography (CT) revealed a tubular structure communicating between the aortic arch and pulmonary artery trunk, suggesting adult PDA. Thoracic endovascular aortic repair (TEVAR) was performed to close PDA. Completion angiography confirmed the disappearance of PDA. Post-TEVAR CT revealed no endoleak. The patient was discharged from the hospital on the 11th day after surgery. TEVAR is more useful and less invasive for adult PDA than conventional open surgery. PMID:28018507

  12. Commentary on: A randomized controlled trial of fusion surgery for lumbar spinal stenosis (Forsth P, Ólafsson G, Carlsson T, Frost A, Borgström F, Fritzell P, et al. N Eng J Med 2016;374:1414-23)

    PubMed Central

    Epstein, Nancy E.

    2016-01-01

    Background: This article by Forsth et al. published in the New England Journal of Medicine entitled A randomized controlled trial of fusion surgery for lumbar spinal stenosis determined that decompressions alone vs. decompressions/fusions were equally effective in treating 1-2 level spinal stensois with/without degenerative spondylolisthesis (DS). Additionally, decompression alone reduced the perioperative morbidity, while reducuing the length of hospital stay (LOS), operative time, and surgical costs. Methods: Utilizing a randomized controlled design, the efficacy of 1-2 level decompressions alone vs. decompressions with fusions for lumbar spinal stenosis with/without DS (135 patients) was assessed in 247 patients between the ages of 50–80. Outcomes were analyzed at 2 and 5 postoperative years utilizing the 6-minute walk test, and the Oswestry disability index (ODI). Results: At 2 and 5 postoperative years, there were no significant clinical differences between the two groups (e.g., on the average ODI or 6-minute walk test). In addition, with decompressions alone, the LOS (averaging 7.4 days for fusion vs. 4.1 days for decompression alone), surgical time, and operative costs were markedly reduced. Furthermore, at 6.5 postoperative years, reoperation rates were comparable for both groups; 22% for decompression/fusion vs. 21% for decompression alone. Conclusions: The authors concluded that at 2 and 5 postoperative years, patients with 1-2 level spinal stenosis did equally well with decompressions alone vs. decompressions with fusions with/without degenerative spondylolisthesis. This article offers a clear message for spinal surgeons; for older patients with 1-2 level spinal stenosis with/without DS, decompresions alone will typically suffice. This reduces patient morbidity along with LOS, operative time, and surgical costs. PMID:27843676

  13. Spontaneous intracranial hypotension resulting from a thoracic osteophyte.

    PubMed

    Hung, Ling-Chien; Hsu, Yung-Chu

    2015-06-01

    We report a 34-year-old woman who presented with progressive postural headache and neck tightness over 1week. We confirmed the diagnosis of spontaneous intracranial hypotension (SIH) and spinal images showed a thoracic osteophyte caused the cerebrospinal fluid (CSF) leak. SIH caused by spinal CSF leak is generally thought to be a consequence of deficiency of the spinal meninges in conjunction with trivial trauma. Less commonly, spinal bony pathology can lead to SIH. We reviewed 13 reported patients with bony structural pathology related SIH. After two to three epidural blood patches, eight patients underwent surgery. They generally had good outcomes. In conclusion, even though surgical repair confers specific risks, it should be considered after repetitive failures of epidural blood patches. The long-term prognoses of surgical versus non-surgical patients warrants further investigation.

  14. Robotic surgery

    MedlinePlus

    Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance ... computer station and directs the movements of a robot. Small surgical tools are attached to the robot's ...

  15. Effect of magnesium infusion on thoracic epidural analgesia

    PubMed Central

    Gupta, Sampa Dutta; Mitra, Koel; Mukherjee, Maitreyee; Roy, Suddhadeb; Sarkar, Aniruddha; Kundu, Sudeshna; Goswami, Anupam; Sarkar, Uday Narayan; Sanki, Prakash; Mitra, Ritabrata

    2011-01-01

    Introduction: Patients of lung volume reduction surgery (LVRS) having an ASA status III or more are likely to be further downgraded by surgery to critical levels of pulmonary function. Aim: To compare the efficacy of thoracic epidural block with (0.125%) bupivacaine, fentanyl combination and (0.125%) bupivacaine, fentanyl combination with adjunctive intravenous magnesium infusion for the relief of postoperative pain in patients undergoing LVRS. Methods: Patients were operated under general anesthesia. Thirty minutes before the anticipated completion of skin closure in both groups, (Group A and Group B) 7 ml of (0.125%) bupivacaine calculated as 1.5 ml/thoracic segment space for achieving analgesia in dermatomes of T4, T5, T6, T7, and T8 segments, along with fentanyl 50 μg (0.5 ml), was administered through the catheter, activating the epidural block, and the time was noted. Thereafter, in patients of Group A, magnesium sulfate injection 30 mg/kg i.v. bolus was followed by infusion of magnesium sulfate at 10 mg/kg/hr and continued up to 24 hours. Group B was treated as control. Results and Analysis: A significant increase in the mean and maximum duration of analgesia in Group A in comparison with Group B (P<0.05) was observed. Total epidural dose of fentanyl and bupivacaine required in Group A was significantly lower in comparison with Group B in 24 hours. Discussion: Requirement of total doses of local anesthetics along with opioids could be minimized by magnesium infusion; therefore, the further downgradation of patients of LVRS may be prevented. Conclusion: Intravenous magnesium can prolong opioid-induced analgesia while minimizing nausea, pruritus, and somnolence. PMID:21655018

  16. 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)

  17. Prevalence, Distribution, and Significance of Incidental Thoracic Ossification of the Ligamentum Flavum in Korean Patients with Back or Leg Pain : MR-Based Cross Sectional Study

    PubMed Central

    Moon, Bong Ju; Kuh, Sung Uk; Kim, Sungjun; Kim, Keun Su; Cho, Yong Eun

    2015-01-01

    Objective Thoracic ossification of the ligamentum flavum (OLF) is a relatively rare disease. Because of ambiguous clinical symptom, it is difficult for early diagnosis of OLF and subsequent treatment can be delayed or missed. Therefore, the purpose of this study is to comprehensively assess the prevalence and distribution of thoracic OLF by magnetic resonance imaging (MRI) and coexisting spinal disease in Korean patients with back pain or leg pain. Methods The sample included 2134 Korean patients who underwent MRI evaluation for back pain. The prevalence and distribution of thoracic OLF were assessed using lumbar MRI with whole spine sagittal images. Additionally, we examined the presence of coexisting lumbar and cervical diseases. The presence of thoracic OLF as well as clinical parameters such as age, sex, and surgery were retrospectively reviewed. Results The prevalence of thoracic OLF in total patients was 16.9% (360/2134). The prevalence tended to increase with aging and was higher in women than in men. The lower thoracic segment of T10-11 was the most frequently affected segment. Of the 360 patients with OLF, 31.9% had coexisting herniated thoracic discs at the same level. Approximately 74% of the patients with OLF had coexisting lumbar and cervical disease. Nine (2.5%) of 360 OLF patients underwent surgery for thoracic lesion. Conclusion The prevalenceof thoracic OLF was relatively higher than those of previous reports. And coexisting lumbar and cervical disease were very frequent. Therefore, we should check coexisting spinal diseases and the exact diagnostic localization of ossification besides lumbar disease. PMID:26361526

  18. Modified uniportal video-assisted thoracoscopic surgery (VATS)

    PubMed Central

    Balderson, Stafford S.; D’Amico, Thomas A.

    2016-01-01

    Video-assisted thoracoscopic surgery (VATS) for resectable lung cancer patients has been frequently used in the past decades. The potential beneficial advantages and safety of VATS has been shown in large patient series and meta-analyses. The strategy of limiting access to one incision in one intercostal space (uniportal VATS) has been adopted by some thoracic surgeons in recent years. We have described a modified uniportal VATS technique with its potential advantages. Modified uniportal VATS potentially offers better exposure, beneficial opportunities for education and improved comfort for the thoracic surgery team in clinical usage. PMID:27134839

  19. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    MedlinePlus

    ... 1- to 2-Year-Old Weight Loss Surgery (Bariatric Surgery) KidsHealth > For Parents > Weight Loss Surgery (Bariatric Surgery) ... or bariatric surgery might be an option. About Bariatric Surgery Bariatric surgery had its beginnings in the 1960s, ...

  20. The non-intubated anesthesia for airway surgery

    PubMed Central

    Nakanishi, Ryoichi

    2016-01-01

    Surgical treatment for lung cancer including airway resection following reconstruction is typically performed under general anesthesia with single-lung ventilation because it is necessary to maintain a sufficient working space and to adjust the airway pressure for the leak test. However, non-intubated thoracic surgery has been gradually developed in recent years for thoracoscopic surgery, due to its lower rate of postoperative complications, shorter hospitalization duration, and lower invasiveness than the usual single-lung anesthesia. Initially, only minor thoracoscopic surgery, including wedge resection for pneumothorax and the diagnosis of solitary pulmonary nodules, was performed under waking anesthesia. However, major thoracoscopic surgery, including segmentectomy and lobectomy, has also been performed under these conditions in some institutions due to its advantages with respect to the postoperative recovery and in-operating room time. In addition, non-intubated thoracic surgery has been performed for tracheal resection followed by reconstruction to fully explore the advantages of this surgical modality. In this article, the merits and demerits of non-intubated thoracoscopic surgery and the postoperative complications, perioperative problems and optimum selection criteria for patients for thoracic surgery (mainly airway surgery) are discussed. PMID:28066621

  1. The non-intubated anesthesia for airway surgery.

    PubMed

    Okuda, Katsuhiro; Nakanishi, Ryoichi

    2016-11-01

    Surgical treatment for lung cancer including airway resection following reconstruction is typically performed under general anesthesia with single-lung ventilation because it is necessary to maintain a sufficient working space and to adjust the airway pressure for the leak test. However, non-intubated thoracic surgery has been gradually developed in recent years for thoracoscopic surgery, due to its lower rate of postoperative complications, shorter hospitalization duration, and lower invasiveness than the usual single-lung anesthesia. Initially, only minor thoracoscopic surgery, including wedge resection for pneumothorax and the diagnosis of solitary pulmonary nodules, was performed under waking anesthesia. However, major thoracoscopic surgery, including segmentectomy and lobectomy, has also been performed under these conditions in some institutions due to its advantages with respect to the postoperative recovery and in-operating room time. In addition, non-intubated thoracic surgery has been performed for tracheal resection followed by reconstruction to fully explore the advantages of this surgical modality. In this article, the merits and demerits of non-intubated thoracoscopic surgery and the postoperative complications, perioperative problems and optimum selection criteria for patients for thoracic surgery (mainly airway surgery) are discussed.

  2. Treatment of Spinal Tuberculosis by Debridement, Interbody Fusion and Internal Fixation via Posterior Approach Only.

    PubMed

    Tang, Ming-xing; Zhang, Hong-qi; Wang, Yu-xiang; Guo, Chao-feng; Liu, Jin-yang

    2016-02-01

    Surgical treatment for spinal tuberculosis includes focal tuberculosis debridement, segmental stability reconstruction, neural decompression and kyphotic deformity correction. For the lesions mainly involved anterior and middle column of the spine, anterior operation of debridement and fusion with internal fixation has been becoming the most frequently used surgical technique for the spinal tuberculosis. However, high risk of structural damage might relate with anterior surgery, such as damage in lungs, heart, kidney, ureter and bowel, and the deformity correction is also limited. Due to the organs are in the front of spine, there are less complications in posterior approach. Spinal pedicle screw passes through the spinal three-column structure, which provides more powerful orthopedic forces compared with the vertebral body screw, and the kyphotic deformity correction effect is better in posterior approach. In this paper, we report a 68-year-old male patient with thoracic tuberculosis who underwent surgical treatment by debridement, interbody fusion and internal fixation via posterior approach only. The patient was placed in prone position under general anesthesia. Posterior midline incision was performed, and the posterior spinal construction was exposed. Then place pedicle screw, and fix one side rod temporarily. Make the side of more bone destruction and larger abscess as lesion debridement side. Resect the unilateral facet joint, and retain contralateral structure integrity. Protect the spinal cord, nerve root. Clear sequestrum, necrotic tissue, abscess of paravertebral and intervertebral space. Specially designed titanium mesh cages or bone blocks were implanted into interbody. Fix both side rods and compress both sides to make the mesh cages and bone blocks tight. Reconstruct posterior column structure with allogeneic bone and autologous bone. Using this technique, the procedures of debridement, spinal cord decompression, deformity correction, bone grafting

  3. Surgical management for upper thoracic spine tumors by a transmanubrium approach and a new space

    PubMed Central

    Xiao, Zeng Ming; Gong, De Feng; De Li, Shi

    2006-01-01

    The anterior aspect of the upper thoracic spine is a difficult region to approach in spinal surgery. Many vital structures including osseus, articular, vascular and nervous ones hinder the exposure. With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal tumors .The traditional exposure is between the esophagus and trachea medially and the left common carotid or the brachiocephalic artery (BCA) laterally, and the disadvantages were that the ligation and section of the left innominate vein is proposed to reach T4 and the injury of the thoracic duct could occur. The right space of the BCA or the ascending aorta (AA) (the exposure between the right brachiocephalic vein and the BCA or between the AA and superior caval vein) is recommended in exposing the upper thoracic vertebrae; this new space is technically feasible; the exposure is sufficient for vertebral body resection and reconstruction and fixation. Twenty-eight patients with upper thoracic spine tumors underwent surgery by the use of this new space between June 2000 and October 2005. A strut graft was fixed anteriorly after decompression of the spinal cord. Levels C7–T5 can be well exposed through this new space, allowing complete vertebral body removal at level T1–T4. After body removal, the posterior longitudinal ligament is well exposed, allowing complete release of the spinal cord. Curettage was performed in one case of aneurysmal bone cyst and three cases of bone giant cell tumors. For other tumors, vertebrectomies or sagittal resections were performed. Four patients underwent surgery by a combination of anterior and posterior approach. PMID:17043896

  4. Surgical management for upper thoracic spine tumors by a transmanubrium approach and a new space.

    PubMed

    Xiao, Zeng Ming; Zhan, Xin Li; Gong, De Feng; De Li, Shi

    2007-03-01

    The anterior aspect of the upper thoracic spine is a difficult region to approach in spinal surgery. Many vital structures including osseus, articular, vascular and nervous ones hinder the exposure. With increasing frequency, spine surgeons are being asked to provide decompression and stabilization in patients with spinal tumors. The traditional exposure is between the esophagus and trachea medially and the left common carotid or the brachiocephalic artery (BCA) laterally, and the disadvantages were that the ligation and section of the left innominate vein is proposed to reach T4 and the injury of the thoracic duct could occur. The right space of the BCA or the ascending aorta (AA) (the exposure between the right brachiocephalic vein and the BCA or between the AA and superior caval vein) is recommended in exposing the upper thoracic vertebrae; this new space is technically feasible; the exposure is sufficient for vertebral body resection and reconstruction and fixation. Twenty-eight patients with upper thoracic spine tumors underwent surgery by the use of this new space between June 2000 and October 2005. A strut graft was fixed anteriorly after decompression of the spinal cord. Levels C7-T5 can be well exposed through this new space, allowing complete vertebral body removal at level T1-T4. After body removal, the posterior longitudinal ligament is well exposed, allowing complete release of the spinal cord. Curettage was performed in one case of aneurysmal bone cyst and three cases of bone giant cell tumors. For other tumors, vertebrectomies or sagittal resections were performed. Four patients underwent surgery by a combination of anterior and posterior approach.

  5. Spinal fusion

    MedlinePlus

    Liu G, Wong HK. Laminectomy and fusion. In: Shen FH, Samartzis D, Fessler RG, eds. Textbook of the Cervical Spine . Philadelphia, PA: Elsevier Saunders; 2015:chap 34. Wood GW. Arthrodesis of the spine. In: Canale ST, Beaty JH, eds. Campbell's Operative ...

  6. Ruptured Thoracic Aortic Aneurysm Infected with Listeria Monocytogenes: A Case Report and a Review of Literature

    PubMed Central

    Masuda, Shigeki; Takeuchi, Nobuhiro; Takada, Masanori; Fujita, Koichi; Nishibori, Yoshiharu; Maruyama, Takao

    2013-01-01

    A 75-year-old male with a history of alcoholic liver cirrhosis, sigmoid colon cancer, and metastatic liver cancer was admitted to our institution with a complaint of a prickly feeling in his chest. On admission, a chest radiograph revealed a normal cardio-thoracic ratio of 47%. Echocardiography revealed pericardial effusion and blood chemical analyses revealed elevated C-reactive protein levels (14.7 mg/dL). On day 3, chest radiography revealed cardiomegaly with a cardio-thoracic ratio of 58% and protrusion of the left first arch. Contrast-enhanced chest computed tomography revealed a saccular aneurysm in the aortic arch with surrounding hematoma; thus, a ruptured thoracic aortic aneurysm was suspected. Emergency surgery was performed, which revealed a ruptured aortic aneurysm with extensive local inflammation. The diagnosis of an infected aortic rupture was therefore confirmed. The aneurysm and abscess were resected, followed by prosthetic graft replacement and omental packing. Histopathology of the resected aneurysm revealed gram-positive bacilli; and Listeria monocytogenes was confirmed as the causative organism by culture. Postoperative course was uneventful; on postoperative day 60, the patient was ambulatory and was discharged. Here we report the case of a male with a ruptured thoracic aortic aneurysm infected with L. monocytogenes. PMID:25512697

  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. Surgical treatment of thoracic disc herniations using a modified transfacet approach

    PubMed Central

    Yang, Xizhong; Liu, Xinyu; Zheng, Yanping

    2014-01-01

    Background: Ideal surgical treatment for thoracic disc herniation (TDH) is controversial due to variations in patient presentation, pathology, and possible surgical approach. Althougth discectomy may lead to improvements in neurologic function, it can be complicated by approach related morbidity. Various posterior surgical approaches have been developed to treate TDH, but the gold standard remains transthoracic decompression. Certain patients have comorbidities and herniation that are not optimally treated with an anterior approach. A transfacet pedicle approach was first described in 1995, but outcomes and complications have not been well described. The aim of this work was to evaluate the clinical effect and complications in a consecutive series of patients with symptomatic thoracic disc herniations undergoing thoracic discectomy using a modified transfacet approach. Materials and Methods: 33 patients with thoracic disc herniation were included in this study. Duration of the disease was from 12 days to 36 months, with less than 1 month in 13 patients. Of these, 15 patients were diagnosed with simple thoracic disc herniation, 6 were associated with ossified posterior longitudinal ligament, and 12 with ossified or hypertrophied yellow ligament. A total of 45 discs were involved. All the herniated discs and the ossified posterior longitudinal ligaments were excised using a modified transfacet approach. Laminectomy and replantation were performed for patients with ossified or hypertrophied yellow ligament. The screw–rod system was used on both sides in 14 patients and on one side in l9 patients. Results: 29 patients were followed up for an average of 37 months (range 12-63 months) and 4 patients were lost to followup. Evaluation was based on Epstein and Schwall criteria.5 15 were classified as excellent and 10 as good, accounting for 86.21% (25/29); 2 patients were classified as improved and 2 as poor. All the patients recovered neurologically after surgery. A

  9. Lung surgery

    MedlinePlus

    ... are thoracotomy and video-assisted thoracoscopic surgery (VATS). Robotic surgery may also be used. Lung surgery using a ... clot from the pulmonary artery ( pulmonary embolism ) Treat complications of tuberculosis Video-assisted thoracoscopic surgery can be used to treat many of these ...

  10. 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

  11. Surgery in 2013 and beyond

    PubMed Central

    Windsor, Morgan N.; Goldstraw, Peter

    2013-01-01

    Lung cancer is a leading cause of cancer related mortality. The role of surgery continues to evolve and in the last ten years there have been a number of significant changes in the surgical management of lung cancer. These changes extend across the entire surgical spectrum of lung cancer management including diagnosis, staging, treatment and pathology. Positron Emission Tomography (PET) scanning and ultrasound (EBUS) have redefined traditional staging paradigms, and surgical techniques, including video-assisted thoracoscopy (VATS), robotic surgery and uniportal surgery, are now accepted as standard of care in many centers. The changing pathology of lung cancer, with more peripheral tumours and an increase in adenocarcinomas has important implications for the Thoracic surgeon. Screening, using Low-Dose CT scanning, is having an impact, with not only a higher percentage of lower stage cancers detected, but also redefining the role of sublobar resection. The incidence of pneumonectomy has reduced as have the rates of “exploratory thoracotomy”. In general, lung resection is considered for stage I and II patients with a selected role in more advanced stage disease as part of a multimodality approach. This paper will look at these issues and how they impact on Thoracic Surgical practice in 2013 and beyond. PMID:24163751

  12. Giant thoracic osteophyte: a distinct clinical entity.

    PubMed

    Coumans, Jean-Valery C E; Neal, Jonathan B; Grottkau, Brian E; Nahed, Brian V; Shin, John H; Walcott, Brian P

    2014-09-01

    Calcified lesions described within the neural axis are classified as either an ossification of the posterior longitudinal ligament, diffuse idiopathic skeletal hyperostosis, or ossification of the ligamentum flavum. We aim to describe a unique pathologic entity: the giant thoracic osteophyte. We identified four patients who were surgically treated at the Massachusetts General Hospital from 2006 to 2012 with unusual calcified lesions in the ventral aspect of the spinal canal. In order to differentiate giant thoracic osteophytes from calcified extruded disc material, disc volumetrics were performed on actual and simulated disc spaces. All patients underwent operative resection of the calcific lesion as they had signs and/or symptoms of spinal cord compression. The lesions were found to be isolated, large calcific masses that originated from the posterior aspect of adjacent thoracic vertebral bodies. Pathological examination was negative for tumor. Adjacent disc volumes were not significantly different from the index disc (p=0.91). A simulated calculation hypothesizing that the calcific mass was extruded disc material demonstrated a significant difference (p=0.01), making this scenario unlikely. In conclusion, giant thoracic osteophyte is a unique and rare entity that can be found in the thoracic spine. The central tenant of surgical treatment is resection to relieve spinal cord compression.

  13. 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

  14. Successful Treatment of a Three-Column Thoracic Extension Injury with Recumbency

    PubMed Central

    Choy, Winward; Smith, Zachary A; Viljoen, Stephanus V; Lindley, Timothy E

    2016-01-01

    We report a unique instance of a 66-year-old male patient with an unstable three-column thoracic extension injury at the level of T4/5 who was treated with recumbency and bracing without surgery. A posterior long segment fixation was attempted three times on two separate occasions over the course of a week with failure due to difficulty in ventilating the patient during prone positioning, cardiopulmonary arrest, and hemodynamic instability during prone positioning for surgery. The decision then was to treat this fracture with recumbency. He was fitted with a thoracolumbosacral orthosis (TLSO), and was kept on bed rest for eight weeks. The patient’s activity was advanced to head of bed for 45 degrees for four weeks and then to 90 degrees for four other weeks. At his 16th week visit, the patient was asymptomatic, and a computer tomography (CT) scan and magnetic resonance imaging (MRI) of the thoracic spine demonstrated evidence of osteophyte bridging and restoration of normal alignment. Three-column thoracic extension injuries can be successfully treated with recumbency in poor surgical candidates. PMID:27335719

  15. Thoracic myoepithelial tumors: a pathologic and molecular study of 8 cases with review of the literature

    PubMed Central

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

    2016-01-01

    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 S-100 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 0–6 mitoses/2 mm2 (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 one case each, and one case having EWSR1 rearrangement with no partner identified. No cases were found to have HMGA2 or PLAG1 abnormalities. Compared to fusion negative tumors, fusion positive tumors tended to occur in patients who were younger (50 vs 58 yrs), female (1:3 vs 3:1 male:female ratio), and demonstrated predominantly spindle and clear cell morphology. Using a combined dataset 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 per 2mm2/10 HPF (p=0.005). In summary, we identify a subset of thoracic MTs harboring rearrangements in EWSR1 or FUS, and our data suggests that necrosis and increased mitotic activity correlate with aggressive clinical behavior. PMID:26645726

  16. Nonintubated Transareolar Endoscopic Thoracic Sympathectomy with a Flexible Endoscope: Experience of 58 Cases

    PubMed Central

    Chen, Jianfeng; Lin, Jianbo; Lin, Min; Li, Xu; Lai, Fancai

    2015-01-01

    Objective: Natural orifice transluminal endoscopic surgery (NOTES) has recently become a hot spot in the field of minimally invasive surgery. But, most of the procedures are still in the early stages of development and limited to animal experiments. Transareolar endoscopic surgery could work as a viable intermediate step before thoracic NOTES. Under intravenous anesthesia without endotracheal intubation, transareolar endoscopic thoracic sympathectomy (ETS) with a flexible endoscope has rarely been attempted. The objective of this study is to evaluate the feasibility and safety of this novel minimally invasive technique in managing primary palmar hyperhidrosis (PPH). Methods: From June 2012 to July 2014, a total of 58 male patients with severe PPH underwent transareolar ETS by use of a flexible endoscope. Under intravenous anesthesia without endotracheal intubation, a flexible endoscope was introduced through the incision on the edge of the areola into the thoracic cavity. The thoracic sympathetic chain was ablated at the level of the fourth rib. Results: All procedures were successfully performed with a mean operating time of 33.6 ± 8.3 min. All patients regained consciousness rapidly and none of them complained about sore throat after surgery. There were no operative mortality and conversion to open procedure. The symptoms of all patients disappeared as soon as the sympathetic chain was cut off. Fifty six patients (96.6%) were discharged from the hospital on the first postoperative day. The postoperative complications were minor, and no patients developed Horner’s syndrome. At 3 months postoperatively, there was no obvious surgical scar on the chest wall, and none of the patients complained about postoperative pain. Compensatory hyperhidrosis (CH) appeared in 19 patients. No recurrent symptoms were observed in our study. One year follow-up revealed an excellent cosmetic result and degree of satisfaction. Conclusion: Nonintubated transareolar ETS with a flexible

  17. Cold fusion, Alchemist's dream

    SciTech Connect

    Clayton, E.D.

    1989-09-01

    In this report the following topics relating to cold fusion are discussed: muon catalysed cold fusion; piezonuclear fusion; sundry explanations pertaining to cold fusion; cosmic ray muon catalysed cold fusion; vibrational mechanisms in excited states of D{sub 2} molecules; barrier penetration probabilities within the hydrogenated metal lattice/piezonuclear fusion; branching ratios of D{sub 2} fusion at low energies; fusion of deuterons into {sup 4}He; secondary D+T fusion within the hydrogenated metal lattice; {sup 3}He to {sup 4}He ratio within the metal lattice; shock induced fusion; and anomalously high isotopic ratios of {sup 3}He/{sup 4}He.

  18. Long thoracic neuropathy from athletic activity.

    PubMed

    Schultz, J S; Leonard, J A

    1992-01-01

    Four cases of long thoracic mononeuropathy associated with sports participation are presented. Each patient developed shoulder pain or dysfunction after an acute event or vigorous activity, and demonstrated scapular winging consistent with serratus anterior weakness. The diagnosis was confirmed with electromyography in each case. It is suggested that the athletic activity caused a stretch injury to the long thoracic nerve. Conservative management, consisting of range of motion exercises for the shoulder and strengthening of the serratus anterior muscle, resulted in a favorable outcome in all patients.

  19. Thoracic pain in a collegiate runner.

    PubMed

    Austin, G P; Benesky, W T

    2002-08-01

    This case study describes the process of examination, re-examination, and intervention for a collegiate runner with mechanical thoracic pain preventing athletic participation and limiting daily function. Unimpaired function fully returned in less than 3 weeks with biweekly sessions to re-establish normal and painfree thoracic mechanics via postural hygiene, exercise, mobilization, and manipulation. The outcome of this case study supports the original hypothesis that the pattern of impairments was in fact responsible for the functional limitations and disability in this athlete. At the time of publication the athlete was without functional limitations and had fully returned to competitive sprinting for the university track team.

  20. MR imaging of the thoracic aorta.

    PubMed

    Lohan, Derek G; Krishnam, Mayil; Saleh, Roya; Tomasian, Anderanik; Finn, J Paul

    2008-05-01

    MR imaging has been incorporated into the diagnostic algorithm for suspected thoracic aortic pathology, challenging CT and invasive catheter angiography as investigations of choice. Techniques, including spin echo, 3-D steady-state free precession, cardiac cine imaging, phase-contrast flow quantification, and high-resolution contrast-enhanced magnetic resonance angiography, are poised to trump other single competitive modalities. The proliferation of 3-tesla systems has advanced the performance of magnetic resonance, aided by parallel imaging techniques, multiarray surface coils, and powerful gradient coils. This article considers the current status of MR imaging in evaluation of the thoracic aorta, with reference to common clinical indications in clinical practice.

  1. The renal disease of thoracic asphyxiant dystrophy.

    PubMed

    Gruskin, A B; Baluarte, H J; Cote, M L; Elfenbein, I B

    1974-01-01

    In those children with thoracic asphyxiant dystrophy, a genetically determined disorder, who survive infancy, the development of renal disease may be life-threatening. This report will present data obtained in six patients from three families which deals with the renal abnormalities in thoracic asphyxiant dystrophy. Both functional and anatomic abnormalities are described. Abnormalities in solute transport in the proximal tubule may be the earliest sign of renal dysfunction in this syndrome. Early glomerular changes may be more important than previously recognized. Finally, the various phenotypic expressions of this disorder are considered.

  2. Transforaminal Approach in Thoracal Disc Pathologies: Transforaminal Microdiscectomy Technique

    PubMed Central

    Dalbayrak, Sedat; Öztürk, Kadir; Yılmaz, Mesut; Gökdağ, Mahmut; Ayten, Murat

    2014-01-01

    Objective. Many surgical approaches have been defined and implemented in the last few decades for thoracic disc herniations. The endoscopic foraminal approach in foraminal, lateral, and far lateral disc hernias is a contemporary minimal invasive approach. This study was performed to show that the approach is possible using the microscope without an endoscope, and even the intervention on the discs within the spinal canal is possible by having access through the foramen. Methods. Forty-two cases with disc hernias in the medial of the pedicle were included in this study; surgeries were performed with transforaminal approach and microsurgically. Extraforaminal disc hernias were not included in the study. Access was made through the Kambin triangle, foramen was enlarged, and spinal canal was entered. Results. The procedure took 65 minutes in the average, and the mean bleeding amount was about 100cc. They were mobilized within the same day postoperatively. No complications were seen. Follow-up periods range between 5 and 84 months, and the mean follow-up period is 30.2 months. Conclusion. Transforaminal microdiscectomy is a method that can be performed in any clinic with standard spinal surgery equipment. It does not require additional equipment or high costs. PMID:24839557

  3. A survey among Brazilian thoracic surgeons about the use of preoperative 2D and 3D images

    PubMed Central

    Cipriano, Federico Enrique Garcia; Arcêncio, Livia; Dessotte, Lycio Umeda; Rodrigues, Alfredo José; Vicente, Walter Villela de Andrade

    2016-01-01

    Background Describe the characteristics of how the thoracic surgeon uses the 2D/3D medical imaging to perform surgical planning, clinical practice and teaching in thoracic surgery and check the initial choice and the final choice of the Brazilian Thoracic surgeon as the 2D and 3D models pictures before and after acquiring theoretical knowledge on the generation, manipulation and interactive 3D views. Methods A descriptive research type Survey cross to data provided by the Brazilian Thoracic Surgeons (members of the Brazilian Society of Thoracic Surgery) who responded to the online questionnaire via the internet on their computers or personal devices. Results Of the 395 invitations visualized distributed by email, 107 surgeons completed the survey. There was no statically difference when comparing the 2D vs. 3D models pictures for the following purposes: diagnosis, assessment of the extent of disease, preoperative surgical planning, and communication among physicians, resident training, and undergraduate medical education. Regarding the type of tomographic image display routinely used in clinical practice (2D or 3D or 2D–3D model image) and the one preferred by the surgeon at the end of the questionnaire. Answers surgeons for exclusive use of 2D images: initial choice =50.47% and preferably end =14.02%. Responses surgeons to use 3D models in combination with 2D images: initial choice =48.60% and preferably end =85.05%. There was a significant change in the final selection of 3D models used together with the 2D images (P<0.0001). Conclusions There is a lack of knowledge of the 3D imaging, as well as the use and interactive manipulation in dedicated 3D applications, with consequent lack of uniformity in the surgical planning based on CT images. These findings certainly confirm in changing the preference of thoracic surgeons of 2D views of technologies for 3D images. PMID:27621874

  4. Comparative analysis of the patency of the internal thoracic artery in the CABG of left anterior descending artery: 6-month postoperative coronary CT angiography evaluation

    PubMed Central

    Deininger, Maurilio Onofre; Moreira, Luiz Felipe Pinho; Dallan, Luiz Alberto Oliveira; de Oliveira, Orlando Gomes; Magalhães, Daniel Marcelo Silva; Coelho, José Reinaldo de Moura; Deininger, Eugênia di Giuseppe; Lopes, Norland de Souza; Queiroga, Ricardo Wanderley; Belmont, Elizabeth Ferreira

    2014-01-01

    Objective To assess the patency of the pedicled right internal thoracic artery with an anteroaortic course and compare it to the patency of the left internal thoracic artery , in anastomosis to the left anterior descending artery in coronary artery bypass grafting by using coronary CT angiography at 6 months postoperatively. Methods Between December 2008 and December 2011, 100 patients were selected to undergo a prospective coronary artery bypass grafting procedure without cardiopulmonary bypass. The patients were randomly divided by a computer-generated list into Group-1 (G-1) and Group-2 (G-2), comprising 50 patients each, the technique used was known at the beginning of the surgery. In G-1, coronary artery bypass grafting was performed using the left internal thoracic artery for the left anterior descending and the free right internal thoracic artery for the circumflex, and in G-2, coronary artery bypass grafting was performed using the right internal thoracic artery pedicled to the left anterior descending and the left internal thoracic artery pedicled to the circumflex territory. Results The groups were similar with regard to the preoperative clinical data. A male predominance of 75.6% and 88% was observed in G-1 and G-2, respectively. Five patients migrated from G-1 to G-2 because of atheromatous disease in the ascending aorta. The average number of distal anastomoses was 3.48 (SD=0.72) in G-1 and 3.20 (SD=0.76) in G-2. Coronary CT angiography in 96 re-evaluated patients showed that all ITAs, right or left, used in situ for the left anterior descending were patent. There were no deaths in either group. Conclusion Coronary artery bypass grafting surgery involving anastomosis of the anteroaortic right internal thoracic artery to the left anterior descending artery has an outcome similar to that obtained using the left internal thoracic artery for the same coronary site. PMID:25140469

  5. A case of painless acute Type-A thoracic aortic dissection.

    PubMed

    Catlow, Jamie; Cross, Tarquin

    2015-01-01

    We describe the case of an 83-year-old lady with a known aneurysmal thoracic aorta, developing acute breathlessness and hypoxia, with no pain and unremarkable cardiovascular examination. As D-dimers were raised, she was treated with low-molecular-weight heparin (LMWH) for suspected pulmonary embolism. CT pulmonary angiography showed acutely dissecting, Type-A, thoracic aortic aneurysm. The patient was treated medically with β-blockers. Despite a poor prognosis, she remains well 2 months later. Observational studies of patients over 70 with Type-A dissection show only 75.3% experience pain, are offered surgery less and have higher mortality. d-Dimers are almost always elevated in aortic dissection. No previous studies document breathlessness as the only presenting symptom. This case emphasises the need, in older populations, for a low suspicion threshold for aortic dissection.

  6. Delayed neurological deficits induced by an epidural hematoma associated with a thoracic osteoporotic compression fracture.

    PubMed

    Kang, Min-Soo; Shin, Yong-Hwan; Lee, Choon-Dae; Lee, Sang-Ho

    2012-01-01

    A 79-year-old woman developed neurological deficits 6 weeks after the onset of a thoracic osteoporotic compression fracture. Magnetic resonance (MR) imaging of the thoracic spine revealed an epidural hematoma at the T10-L2 levels. Acute decompressive laminectomy and percutaneous vertebroplasty were performed. Following the surgery, the patient's neurologic deficits improved and follow-up MR imaging showed complete resolution of the hematoma. Spinal epidural hematomas are rare and associated delayed neurological deficits are extremely rare. Conservative treatment may be effective for epidural hematomas in neurologically intact patients, but epidural hematomas can be a cause of neural compression and symptomatic deterioration resulting in delayed neurological deficits during the follow-up period.

  7. [A case of true neurogenic thoracic outlet syndrome accompanied by an aberrant right subclavian artery].

    PubMed

    Sekiguchi, Kenji; Saito, Takanori; Yokota, Ichiro; Kowa, Hisatomo; Kanda, Fumio; Toda, Tatsushi

    2015-01-01

    A 65-year-old woman experienced progressive intrinsic muscle wasting on the right hand over a period of 7 years. The distribution of muscular atrophy and weakness was consistent with the area innervated by the right C8 and Th1 nerve roots. Neurophysiological examination suggested a right lower trunk lesion. An elongated right transverse process of the C7 vertebra and an aberrant subclavian artery were detected on computed tomography images, and the right lower trunk of the brachial plexus appeared to be lifted upward on magnetic resonance images. The patient was diagnosed with true neurogenic thoracic outlet syndrome. A fibrous band extending from the elongated transverse process was found during surgery, and symptoms did not progress further after resection of the band. True neurogenic thoracic outlet syndrome can cause monomelic amyotrophy, and localized neuroimaging and detailed neurophysiological examination were useful for diagnosis.

  8. Botulinum toxin in the management of acquired motor fusion deficiency

    PubMed Central

    Murthy, Ramesh; Kesarwani, Siddharth

    2009-01-01

    Acquired disruption of motor fusion is a rare condition characterized by intractable diplopia. Management of these patients is extremely difficult. Prisms in any combination or even surgery may not help relieve their symptoms. We describe a longstanding case of acquired motor fusion disruption which was managed successfully with botulinum toxin injection. PMID:19861751

  9. Aortobronchial Fistula after Thoracic Endovascular Aortic Repair (TEVAR) for Descending Thoracic Aortic Aneurysm.

    PubMed

    Melvan, John Nicholas; DeLaRosa, Jacob; Vasquez, Julio C

    2017-03-07

    Continued enlargement of the aneurysm sac after thoracic endovascular aortic repair (TEVAR) is a known risk after endovascular treatment of thoracic aortic aneurysms. For this reason, periodic outpatient follow-up is required to identify situations that require repair. Here, we describe an aortobronchial fistula (ABF) in a patient lost to follow-up, that presented 3 years after an elective TEVAR done for a primary, descending thoracic aortic aneurysm. Our patient arrived in extremis and suffered massive hemoptysis leading to her demise. Computed tomography (CT) angiogram near the time of her death demonstrated a bleeding ABF immediately distal to her previous TEVAR repair. Aortic aneurysmal disease remains life threatening even after repair. Improved endovascular techniques and devices have resulted in decreased need for reintervention. However, this case demonstrates the risk of thoracic aortic disease progression and highlights the importance of establishing consistent, long-term follow-up after TEVAR.

  10. Ketamine in adult cardiac surgery and the cardiac surgery Intensive Care Unit: An evidence-based clinical review

    PubMed Central

    Mazzeffi, Michael; Johnson, Kyle; Paciullo, Christopher

    2015-01-01

    Ketamine is a unique anesthetic drug that provides analgesia, hypnosis, and amnesia with minimal respiratory and cardiovascular depression. Because of its sympathomimetic properties it would seem to be an excellent choice for patients with depressed ventricular function in cardiac surgery. However, its use has not gained widespread acceptance in adult cardiac surgery patients, perhaps due to its perceived negative psychotropic effects. Despite this limitation, it is receiving renewed interest in the United States as a sedative and analgesic drug for critically ill-patients. In this manuscript, the authors provide an evidence-based clinical review of ketamine use in cardiac surgery patients for intensive care physicians, cardio-thoracic anesthesiologists, and cardio-thoracic surgeons. All MEDLINE indexed clinical trials performed during the last 20 years in adult cardiac surgery patients were included in the review. PMID:25849690

  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. Maze Surgery

    MedlinePlus

    ... surgery to treat an arrhythmia called chronic atrial fibrillation (AF). AF is a fast, irregular heart rhythm ... Surgeons http://www.sts.org/node/2275 Atrial Fibrillation Surgery – Maze Procedure Updated August 2016 Please contact ...

  13. 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 ...

  14. 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 ...

  15. Thoracic empyema caused by Campylobacter rectus.

    PubMed

    Ogata, Tomoyuki; Urata, Teruo; Nemoto, Daisuke; Hitomi, Shigemi

    2017-03-01

    We report a case of thoracic empyema caused by Campylobacter rectus, an organism considered as a periodontal pathogen but rarely recovered from extraoral specimens. The patient fully recovered through drainage of purulent pleural fluid and administration of antibiotics. The present case illustrates that C. rectus can be a cause of not only periodontal disease but also pulmonary infection.

  16. Thoracic empyema due to migrated gallstones.

    PubMed

    Flores-Franco, René Agustín

    2013-01-01

    Hepatobiliary conditions should be considered in the differential diagnosis of right pleural effusion. Here we present the illustrative images of thoracic empyema due to migrated gallstones in a woman who was treated for laparoscopic cholecystectomy one year before. The gallstones were obtained unexpectedly during a thoracentesis with aid of an Abrams needle. This rare complication is discussed under current literature review.

  17. Thoracic outlet syndromes and magnetic resonance imaging.

    PubMed

    Panegyres, P K; Moore, N; Gibson, R; Rushworth, G; Donaghy, M

    1993-08-01

    The thoracic outlet syndromes encompass the diverse clinical entities affecting the branchial plexus or subclavian artery including cervical ribs or bands. Thoracic outlet syndrome are often difficult to diagnose on existing clinical and electrophysiological criteria and new diagnostic methods are necessary. This study reports our experience with magnetic resonance imaging (MRI) of the brachial plexus in 20 patients with suspected thoracic outlet syndrome. The distribution of pain and sensory disturbance varied widely, weakness and wasting usually affected C8/T1 innervated muscles, and electrophysiology showed combinations of reduced sensory nerve action potentials from the fourth and fifth digits, and prolonged F-responses or tendon reflex latencies. The MRI study was interpreted blind. Deviation of the brachial plexus was recorded in 19 out of the 24 symptomatic sides (sensitivity 79%). Absence of distortion was correctly identified in 14 out of 16 asymptomatic sides (specificity 87.5%). The false positive rate was 9.5%. Magnetic resonance imaging demonstrated all seven cervical ribs visible on plain cervical spine radiographs. Magnetic resonance imaging also showed a band-like structure extending from the C7 transverse process in 25 out of 33 sides; similar structures were detected in three out of 18 sides in control subjects. These MRI bands often underlay the brachial plexus distortion observed in our patients. We also observed instances of plexus distortion by post-traumatic callus of the first rib, and by a hypertrophied serratus anterior muscle. If they did not demonstrate a cervical rib, plain cervical spine radiographs had no value in predicting brachial plexus distortion. We believe MRI to be of potential value in the diagnosis of thoracic outlet syndrome by: (i) demonstrating deviation or distortion of nerves or blood vessels; (ii) suggesting the presence of radiographically invisible bands; (iii) disclosing other causes of thoracic outlet syndrome

  18. Chronic pain and the thoracic spine

    PubMed Central

    Louw, Adriaan; Schmidt, Stephen G.

    2015-01-01

    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

  19. 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

  20. 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.

  1. [Minimally invasive thymus surgery].

    PubMed

    Rückert, J C; Ismail, M; Swierzy, M; Braumann, C; Badakhshi, H; Rogalla, P; Meisel, A; Rückert, R I; Müller, J M

    2008-01-01

    There are absolute and relative indications for complete removal of the thymus gland. In the complex therapy of autoimmune-related myasthenia gravis, thymectomy plays a central role and is performed with relative indication. In case of thymoma with or without myasthenia, thymectomy is absolutely indicated. Thymus resection is further necessary for cases of hyperparathyroidism with ectopic intrathymic parathyroids or with certain forms of multiple endocrine neoplasia. The transcervical operation technique traditionally reflected the well-founded desire for minimal invasiveness for thymectomy. Due to the requirement of radicality however, most of these operations were performed using sternotomy. With the evolution of therapeutic thoracoscopy in thoracic surgery, several pure or extended minimally invasive operation techniques for thymectomy have been developed. At present uni- or bilateral, subxiphoid, and modified transcervical single or combination thoracoscopic techniques are in use. Recently a very precise new level of thoracoscopic operation technique was developed using robotic-assisted surgery. There are special advantages of this technique for thymectomy. An overview of the development and experiences with minimally invasive thymectomy is presented, including data from the largest series published so far.

  2. Successful surgical repair of an infectious thoracic aortic pseudoaneurysm accompanied by aortobronchopulmonary fistula and advanced hepatic dysfunction without assisted circulation.

    PubMed

    Masuhara, Hiroshi; Watanabe, Yoshinori; Fujii, Takeshiro; Shiono, Noritsugu; Hamada, Satoshi; Hara, Masanori; Teramoto, Chikao; Yoshihara, Katsunori; Koyama, Nobuya

    2010-08-01

    The patient was a 59-year-old female. Because of massive hemoptysis, she was brought to our emergency center by ambulance. Thoracic computed tomography led to a diagnosis of an infectious thoracic aortic pseudoaneurysm accompanied by an aortobronchopulmonary fistula. Emergency surgery followed. Also noted was an advanced hepatic dysfunction, assessed as Child-Pugh score B, caused by an alcoholic liver disease. A localized affected area made it possible for us to perform an aneurysmectomy using a temporary bypass rather than assisted circulation. A patch plasty using expanded polytetrafluoroethylene completed the procedure. Streptococcus agalactiae (GBS) was detected in a sample obtained during the surgery from an abscess located in the aneurysm. The patient made satisfactory postoperative progress and left the hospital walking unaided on the 36th postoperative day.

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

    PubMed

    Fernández-de-Las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-07-01

    Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars.

  4. Dry needling for the management of thoracic spine pain

    PubMed Central

    Fernández-de-las-Peñas, César; Layton, Michelle; Dommerholt, Jan

    2015-01-01

    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

  5. Management of adjacent segment disease after cervical spinal fusion.

    PubMed

    Kepler, Christopher K; Hilibrand, Alan S

    2012-01-01

    Adjacent segment disease (ASD) was described after long-term follow-up of patients treated with cervical fusion. The term describes new-onset radiculopathy or myelopathy referable to a motion segment adjacent to previous arthrodesis and often attributed to alterations in the biomechanical environment after fusion. Evidence suggests that ASD affects between 2% and 3% of patients per year. Although prevention of ASD was one major impetus behind the development of motion-sparing surgery, the literature does not yet clearly distinguish a difference in the rate of ASD between fusion and disk replacement. Surgical techniques during index surgery may reduce the rate of ASD.

  6. Mediastinal migration of distal occipito-thoracic instrumentation

    PubMed Central

    Joseph, Vivek; Al Jahwari, Ahmed S.

    2007-01-01

    We present the occurrence and management of mediastinal migration of the distal aspect of a posterior occipito-thoracic screw–rod construct. No similar occurrence was found in the literature. This event occurred following an emergency tracheotomy (requiring neck hyperextension) in a patient with severe rheumatoid arthritis, who had previously undergone decompression and an Occiput-T2 instrumented fusion for cranio-cervical and sub-axial cervical spine instability. Imaging showed fracture-subluxation of T1/2 and T2/3 with the bilateral C7, T1 and T2 screws in the mediastinum causing tracheal and esophageal compression. Removal of the instrumentation, decompression (T2 corpectomy) and construct revision down to T10 was safely performed from a posterior approach. Severe osteoporosis, some pre-existing screw loosening and hyperextension of the neck were the predisposing factors of this near catastrophic event. By staying directly posterior to the rod and following the fibrous tract already created, the instrumentation was safely removed from the mediastinum. PMID:18000689

  7. [Minimally invasive operations in vascular surgery].

    PubMed

    Stádler, Petr; Sedivý, Petr; Dvorácek, Libor; Slais, Marek; Vitásek, Petr; El Samman, Khaled; Matous, Pavel

    2011-01-01

    Minimally invasive surgery provides an attractive alternative compared with conventional surgical approaches and is popular with patients, particularly because of its favourable cosmetic results. Vascular surgery has taken its inspiration from general surgery and, over the past few years, has also been reducing the invasiveness of its operating methods. In addition to traditional laparoscopic techniques, we most frequently encounter the endovascular treatment of aneurysms of the thoracic and abdominal aorta and, most recently, robot-assisted surgery in the area of the abdominal aorta and pelvic arteries. Minimally invasive surgical interventions also have other advantages, including less operative trauma, a reduction in post-operative pain, shorter periods spent in the intensive care unit and overall hospitalization times, an earlier return to normal life and, finally, a reduction in total treatment costs.

  8. The Fusion Energy Option

    NASA Astrophysics Data System (ADS)

    Dean, Stephen O.

    2004-06-01

    Presentations from a Fusion Power Associates symposium, The Fusion Energy Option, are summarized. The topics include perspectives on fossil fuel reserves, fusion as a source for hydrogen production, status and plans for the development of inertial fusion, planning for the construction of the International Thermonuclear Experimental Reactor, status and promise of alternate approaches to fusion and the need for R&D now on fusion technologies.

  9. Improved Surgery Planning Using 3-D Printing: a Case Study.

    PubMed

    Singhal, A J; Shetty, V; Bhagavan, K R; Ragothaman, Ananthan; Shetty, V; Koneru, Ganesh; Agarwala, M

    2016-04-01

    The role of 3-D printing is presented for improved patient-specific surgery planning. Key benefits are time saved and surgery outcome. Two hard-tissue surgery models were 3-D printed, for orthopedic, pelvic surgery, and craniofacial surgery. We discuss software data conversion in computed tomography (CT)/magnetic resonance (MR) medical image for 3-D printing. 3-D printed models save time in surgery planning and help visualize complex pre-operative anatomy. Time saved in surgery planning can be as much as two thirds. In addition to improved surgery accuracy, 3-D printing presents opportunity in materials research. Other hard-tissue and soft-tissue cases in maxillofacial, abdominal, thoracic, cardiac, orthodontics, and neurosurgery are considered. We recommend using 3-D printing as standard protocol for surgery planning and for teaching surgery practices. A quick turnaround time of a 3-D printed surgery model, in improved accuracy in surgery planning, is helpful for the surgery team. It is recommended that these costs be within 20 % of the total surgery budget.

  10. Influence of ultra-low dose Aprotinin on thoracic surgical operations: a prospective randomized trial

    PubMed Central

    Apostolakis, Efstratios; Panagopoulos, Nikolaos; Koletsis, Efstratios N; Crockett, James; Stamou-Kouki, Helen; Sourgiadaki, Efrosini; Filos, Kriton; Dougenis, Dimitrios

    2008-01-01

    Background The blood saving effect of aprotinin has been well documented in cardiac surgery. In thoracic surgery, very few recent studies, using rather high doses of aprotinin, have shown a similar result. In a randomized prospective trial, we have tested the influence of aprotinin using an ultra-low dose drug regime. Methods Fifty-nine patients, mean age 58 ± 13.25 years (mean ± SD) undergoing general thoracic procedures were randomized into placebo (Group A) and treatment group (Group B). The group B (n = 29) received 500.000 IU of aprotinin after induction to anesthesia and a repeat dose immediately after chest closure. A detailed protocol with several laboratory parameters was recorded. Patients were transfused when perioperative Ht was less than 26%. Results The two groups were similar in terms of age, gender, diagnosis, pathology, co-morbidity and operations performed. The mean drainage of the first and second postoperative day in group B was significantly reduced (412.6 ± 199.2 vs. 764.3 ± 213.9 ml, p < 0.000, and 248.3 ± 178.5 vs. 455.0 ± 274.6, p < 0.001). Similarly, the need for fresh frozen plasma transfusion was lower in group B, p < 0.035. Both the operation time and the hospital stay were also less for group B but without reaching statistical significance (84.6 ± 35.2 vs 101.2 ± 52.45 min. and 5.8 ± 1.6 vs 7.2 ± 3.6 days respectively, p < 0.064). The overall transfusion rate did not differ significantly. No side effects of aprotinin were noted. Conclusion The perioperative ultra-low dose aprotinin administration was associated with a reduction of total blood losses and blood product requirements. We therefore consider the use of aprotinin safe and effective in major thoracic surgery. PMID:18361800

  11. [Current status and future prospects of robotic surgery for lung cancer].

    PubMed

    Nakamura, Hiroshige; Taniguchi, Yuji; Miwa, Ken; Haruki, Tomohiro

    2014-11-01

    As the use of robotic surgery has widely spread, its usefulness in the field of general thoracic surgery needs to be verified. The biggest advantage of robotic surgery is the remarkably free movement of joint-equipped robotic forceps under 3-dimensional high vision. An accurate operation makes complex procedures straightforward and may overcome the disadvantages of previous thoracoscopic surgery. Robotic surgery for lung cancer has been safely introduced, and the initial results have been favorable. While still at the stage of clinical research, it is expected to be useful in hilar exposure, lymph node dissection, and suturing of lung parenchyma or bronchus. We considered robotic surgery for lung cancer surgery because of its ability to facilitate both thoracotomy and minimally invasive video-assisted thoracic surgery. Robotic thoracic surgery has not been sufficiently examined for its usefulness, and other major issues such as safety management, education, and significant cost need to be addressed. However, it may become an extension of thoracoscopic surgery, and studies showing its usefulness for primary lung cancer have been increasing. Two urgent issues are its use in advanced medical care and national heal th insurance coverage.

  12. Revitalizing Fusion via Fission Fusion

    NASA Astrophysics Data System (ADS)

    Manheimer, Wallace

    2001-10-01

    Existing tokamaks could generate significant nuclear fuel. TFTR, operating steady state with DT might generate enough fuel for a 300 MW nuclear reactor. The immediate goals of the magnetic fusion program would necessarily shift from a study of advanced plasma regimes in larger sized devices, to mostly known plasmas regimes, but at steady state or high duty cycle operation in DT plasmas. The science and engineering of breeding blankets would be equally important. Follow on projects could possibly produce nuclear fuel in large quantity at low price. Although today there is strong opposition to nuclear power in the United States, in a 21st century world of 10 billion people, all of whom will demand a middle class life style, nuclear energy will be important. Concern over greenhouse gases will also drive the world toward nuclear power. There are studies indicating that the world will need 10 TW of carbon free energy by 2050. It is difficult to see how this can be achieved without the breeding of nuclear fuel. By using the thorium cycle, proliferation risks are minimized. [1], [2]. 1 W. Manheimer, Fusion Technology, 36, 1, 1999, 2.W. Manheimer, Physics and Society, v 29, #3, p5, July, 2000

  13. Prevention and management of perioperative arrhythmias in the thoracic surgical population.

    PubMed

    Amar, David

    2008-06-01

    Although bradyarrhythmias or malignant ventricular tachyarrhythmias have been reported in less than 1% of patients following noncardiac surgery, rapid atrial arrhythmias more frequently affect the elderly who undergo thoracic operations. This article focuses on new issues leading to the improved understanding of the pathophysiology and mechanisms of postoperative atrial arrhythmias. It discusses new risk factors and a prediction rule for postthoracotomy atrial fibrillation (AF), reviews prophylaxis and acute therapeutic interventions for postthoracotomy AF, and highlights the most recent recommendations of the American Heart Association Task Force on the management of patients who have AF with emphasis on preventing thromboembolic events.

  14. Syndrome of fascial incarceration of the long thoracic nerve: winged scapula☆

    PubMed Central

    Silva, Jefferson Braga; Gerhardt, Samanta; Pacheco, Ivan

    2015-01-01

    Objective To analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula. Methods Six patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up. Results The patients achieved improvement of their symptoms 6–20 months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders. Conclusion The approach of early surgical release seems to be a better predictor for recovery from non-traumatic paralysis of the anterior serratus muscle. PMID:26535205

  15. Hemorrhagic thoracic schwannoma presenting with intradural hematoma and acute paraplegia after spinal manipulation therapy

    PubMed Central

    Goodwin, C. Rory; Sciubba, Daniel; Bydon, Ali; Wolinsky, Jean-Paul; Witham, Timothy; Gokaslan, Ziya L.

    2016-01-01

    Hemorrhagic conversion of spinal schwannomas represents a rare occurrence; also rare is the development of a spinal intradural hematoma after spinal manipulation therapy. We report a unique presentation of paraplegia in a patient who underwent spinal manipulation therapy and was found to have a hemorrhagic thoracic schwannoma at time of surgery in the setting of anti-platelet therapy use. In patients with spinal schwannomas, tumor hemorrhage is a rare occasion, which can be considered in the setting of additive effects of spinal manipulation therapy and antiplatelet therapy. PMID:28377856

  16. Fishbone penetration of the thoracic esophagus with prolonged asymptomatic impaction within the aorta.

    PubMed

    Ko, Sheung-Fat; Lu, Hung-I; Ng, Shu-Hang; Kung, Chia-Te

    2013-02-01

    A 54-year-old man with fishbone penetration of the thoracic esophagus and mediastinal hematoma was successfully managed with conservative treatment. Six-month follow-up computed tomography (CT) revealed migration of the fishbone into the aorta; however, the patient was asymptomatic and refused surgery. Six years later, CT showed persistent impaction of the fishbone within the aorta, but the patient was healthy. To our knowledge, this is the first reported case of serial CT documentation of fishbone penetration of the esophagus with migration into and prolonged asymptomatic impaction within the aorta.

  17. Myelopathy with syringomyelia following thoracic epidural anaesthesia.

    PubMed

    Aldrete, J A; Ferrari, H

    2004-02-01

    Under general anaesthesia and muscle relaxation, a thoracic epidural catheter was inserted at the T8-T9 level in a 7-year-old boy scheduled to have a Nissen fundoplication to provide postoperative analgesia. After 4 ml of lignocaine 1.5% was injected through the catheter, hypotension resulted. Fifty-five minutes later 5 ml of bupivacaine 0.25% produced the same effect. In the recovery room a similar injection resulted in lower blood pressure and temporary apnoea. Sensory and motor deficits were noted the next day and four days later magnetic resonance imaging demonstrated spinal cord syringomyelia extending from T5 to T10. Four years later, dysaesthesia from T6 to T10 weakness of the left lower extremity and bladder and bowel dysfunction persist. The risks of inserting thoracic epidural catheters in patients under general anaesthesia and muscle relaxation are discussed, emphasising the possibility of spinal cord injury with disastrous consequences.

  18. 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

  19. [Thoracic ectopia cordis with tetralogy of fallot].

    PubMed

    Ben Khalfallah, A; Annabi, N; Ousji, M; Hadrich, M; Najai, A

    2003-01-01

    Ectopia cordis; very rare congenital malformation, characterized by an evisceration of the heart through a parietal defect. The thoracic localization is most frequent. We report the case of a full term baby girl without follow-up of the pregnancy, presenting a beating mass in thoracic position, expansive to the effort, covered by a translucent membrane corresponding to an ectopique position of the heart. Transthoracic echocardiography shows cardiac malformation: Fallot tetralogy. The precocious diagnosis is possible by prenatal ultrasound examination after 12th week of pregnancy. The surgical treatment remain the only hope for these neonates. It's results depends on the associated malformations and the neonatal complications especially the infections. The prognosis remains poor in spite of the progress of surgical techniques.

  20. Thoracic radiology in kidney and liver transplantation.

    PubMed

    Fishman, Joel E; Rabkin, John M

    2002-04-01

    Renal transplantation accounts for more than half of all solid organ transplants performed in the U.S., and the liver is the second most commonly transplanted solid organ. Although abdominal imaging procedures are commonplace in these patients, there has been relatively little attention paid to thoracic imaging applications. Preoperative imaging is crucial to aid in the exclusion of infectious or malignant disease. In the perioperative time period, thoracic imaging focuses both on standard intensive care unit care, including monitoring devices and their complications, and on the early infections that can occur. Postoperative management is divided into three time periods, and the principles governing the occurrence of infections and malignancies are reviewed. Anatomic and pathologic aspects unique to kidney and liver transplantation patients are also discussed.

  1. [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.

  2. Delayed Esophageal Perforation Secondary to Thoracic Aortic Aneurysm Rupture in a Patient with Human Immunodeficiency Virus Infection

    PubMed Central

    2014-01-01

    A 65-year-old man infected with human immunodeficiency virus underwent emergency surgery for rupture of a mycotic descending thoracic aneurysm. The aneurysm was replaced with a prosthetic graft wrapped with omentum. Esophageal perforation occurred 3 weeks after surgery. The patient’s condition remained stable, and we adopted a conservative treatment. The esophageal fistula had not healed completely and a biopsy of the scar revealed gastric cancer. We performed a distal gastrectomy, Roux-Y reconstruction, and enterostomy for enteral feeding. Follow-up endoscopy revealed healing of the fistula, and the patient was eventually discharged. We managed this potentially fatal complication with minimally invasive treatment. PMID:24995070

  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: 54±19 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

  4. Thoracic Aortic Aneurysm from Chronic Antiestrogen Therapy.

    PubMed

    Tripathi, Rishi; Sainathan, Sandeep; Ziganshin, Bulat A; Elefteriades, John A

    2017-03-01

    Aortic aneurysms are a common but often undetected pathology prevalent in the population. They are often detected as incidental findings on imaging studies performed for unrelated pathologies. Estrogens have been shown to exert a protective influence on aortic tissue. Pharmacological agents blocking the actions of estrogens may thus be implicated in causing aortic pathologies. We present the case of an elderly woman with breast carcinoma treated for 18 years with antiestrogen therapy who subsequently developed acute thoracic aortic deterioration (enlargement and wall disruption).

  5. Transesophageal echocardiography evaluation of the thoracic aorta

    PubMed Central

    Patil, T. A.; Nierich, Arno

    2016-01-01

    Transesophageal echocardiography (TEE) can be used to identify risk factors such as aortic atherosclerosis[2] before any sort of surgical manipulations involving aorta and its related structures. TEE has become an important noninvasive tool to diagnose acute thoracic aortic pathologies. TEE evaluation of endoleaks helps early detection and immediate corrective interventions. TEE is an invaluable imaging modality in the management of aortic pathology. TEE has to a large extent improved the patient outcomes. PMID:27762248

  6. Managing Dissections of the Thoracic Aorta

    PubMed Central

    WONG, DANIEL R.; LEMAIRE, SCOTT A.; COSELLI, JOSEPH S.

    2010-01-01

    Thoracic aortic dissection is associated with substantial morbidity and mortality, and it requires timely and accurate diagnosis and treatment. Long-term antihypertensive therapy remains critical for the treatment of this disease. Surgical intervention, although still a formidable undertaking, has evolved to better address both acute and chronic dissection, and the results have improved. Basic and clinical research, as well as technological advances, have increased our understanding of this challenging disease state. PMID:18481490

  7. Mini Transsternal Approach to the Anterior High Thoracic Spine (T1–T4 Vertebrae)

    PubMed Central

    Thakur, Bhaskar; Tsoti, Sandra Maria; Anichini, Giulio; Vergani, Francesco; Malik, Irfan

    2016-01-01

    Purpose. The anterior high thoracic spine is one of the most complex segments to be accessed surgically due to anatomical constraints and transitional characteristics. We describe in detail the mini transsternal approach to metastatic, infective, traumatic, and degenerative pathologies of T1 to T4 vertebral bodies. We analyse our surgical series, indications, and outcomes. Methods. Over a 5-year period 18 consecutive patients with thoracic myelopathy due to metastatic, infective, traumatic, and degenerative pathologies with T1 to T4 vertebral bodies involvement received a mini transsternal approach with intraoperative monitoring. Frankel scoring system was used to grade the neurological status. Results. Mean follow-up was 40 months. 78% patients improved in Frankel grade after surgery and 22% patients remained unchanged. Average operation time was 210 minutes. There were no intraoperative complications. One patient developed postoperative pneumonia successfully treated with antibiotics. Conclusion. The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca. This approach overcomes the anatomical constraints of this region and provides adequate room for optimal reconstruction and preservation of spinal alignment in the cervicothoracic transition zone with good functional patient outcomes. PMID:27218104

  8. 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

  9. Mini Transsternal Approach to the Anterior High Thoracic Spine (T1-T4 Vertebrae).

    PubMed

    Brogna, Christian; Thakur, Bhaskar; Fiengo, Leslie; Tsoti, Sandra Maria; Landi, Alessandro; Anichini, Giulio; Vergani, Francesco; Malik, Irfan

    2016-01-01

    Purpose. The anterior high thoracic spine is one of the most complex segments to be accessed surgically due to anatomical constraints and transitional characteristics. We describe in detail the mini transsternal approach to metastatic, infective, traumatic, and degenerative pathologies of T1 to T4 vertebral bodies. We analyse our surgical series, indications, and outcomes. Methods. Over a 5-year period 18 consecutive patients with thoracic myelopathy due to metastatic, infective, traumatic, and degenerative pathologies with T1 to T4 vertebral bodies involvement received a mini transsternal approach with intraoperative monitoring. Frankel scoring system was used to grade the neurological status. Results. Mean follow-up was 40 months. 78% patients improved in Frankel grade after surgery and 22% patients remained unchanged. Average operation time was 210 minutes. There were no intraoperative complications. One patient developed postoperative pneumonia successfully treated with antibiotics. Conclusion. The mini transsternal is a safe approach for infective, metastatic, traumatic, and degenerative lesions affecting the anterior high thoracic spine and the only one allowing an early and direct visualisation of the anterior theca. This approach overcomes the anatomical constraints of this region and provides adequate room for optimal reconstruction and preservation of spinal alignment in the cervicothoracic transition zone with good functional patient outcomes.

  10. Cardio-thoracic surgical patients' experience on bedside nursing handovers: Findings from a qualitative study.

    PubMed

    Lupieri, Giulia; Creatti, Chiara; Palese, Alvisa

    2016-08-01

    The purpose of this study was to describe the experiences of postoperative cardio-thoracic surgical patients experiencing nursing bedside handover. A descriptive qualitative approach was undertaken. A purposeful sampling technique was adopted, including 14 patients who went through cardio-thoracic surgery and witnessed at least two bedside handovers. The study was performed in a Cardio-thoracic ICU localised in a Joint Commission International accredited Academic Hospital in north-eastern Italy from August to November 2014. The experience of patients participating at the bedside handover is based on four main themes: (1) 'discovering a new nursing identity', (2) 'being apparently engaged in a bedside handover', (3) 'experiencing the paradox of confidentiality' and (4) 'having the situation under control'. With the handover performed at the bedside in a postoperative setting, two interconnected potential effects may be achieved with regard to patients, nurses and the nursing profession. Nurses have a great opportunity to express their closeness to patients and to promote awareness of the important growth that nursing has achieved over the years as a profession and discipline. Therefore, patients may better perceive nursing competence and feel safer during the postoperative care pathway. They can appreciate nurses' humanity in caring and trust their competence and professionalism.

  11. [Facial surgery].

    PubMed

    Meningaud, Jean-Paul

    2010-11-20

    The patient who has to sustain facial surgery is doubly concerned by the functional issues of his case and his cosmetic appearance. Fortunately, in the recent period of time, huge advancements have been done permitting to offer a solution in more and more difficult situations. The aim of the present article is to give a panorama of facial plastic surgery for non-specialized physicians. The main aspects of the specialty are approached through the surgical techniques born from the progress of technology and biology. This paper treats issues of orthognatic surgery, endoscopic techniques, osteogenic distraction, different types of graft, cosmetic surgery, skin expander-balloons.

  12. A randomized, comparative trial: does pillow type alter cervico-thoracic spinal posture when side lying?

    PubMed Central

    Gordon, Susan J; Grimmer-Somers, Karen A; Trott, Patricia H

    2011-01-01

    Background Many patients ask for advice about choosing a pillow. This research was undertaken to determine if pillow type alters cervico-thoracic spine position when resting in the side-lying position. Aim To investigate the effect of different pillow shape and content on the slope of cervico-thoracic spine segments when side lying. Materials and methods The study was a randomized blinded comparative trial set in a laboratory that replicated a bedroom. The subjects were side sleepers aged over 18 years. Exclusion criteria were history of surgery to the cervico-thoracic spine, an injury or accident to the cervico-thoracic spine in the preceding year, or currently receiving treatment for neck symptoms. Each participant rested in a standardized side-lying position for 10 minutes on each of the trial pillows: regular shaped polyester, foam, feather, and latex pillows, and a contour shaped foam pillow. Reflective markers were placed on external occipital protuberance (EOP), C2, C4, C7, and T3, and digital images were recorded of subjects at 0 and 10 minutes on each pillow. Images were digitized using each reflective marker and the slope of each spinal segment calculated. Univariate analysis of variance models were used to investigate slope differences between pillows at 0 and 10 minutes. Significance was established at P < 0.01 to take account of chance effects from repeated measures and multiple comparisons. Results At 0 and 10 minutes, the EOP-C2, C2-C4, and C4-C7 segmental slopes were significantly different across all pillows. Significant differences were identified when comparing the feather pillow with the latex, regular and contour foam pillows, and when comparing the polyester and foam contour pillows. The regular and contour foam pillows produced similar slopes at all spinal segments. Conclusion Cervico-thoracic spinal segment slope alters significantly when people change from a foam, latex, or polyester pillow to a feather pillow and vice versa. The shape of a

  13. Evaluation of Complications after Surgical Treatment of Thoracic Outlet Syndrome

    PubMed Central

    Hosseinian, Mohammad Ali; Loron, Ali Gharibi; Soleimanifard, Yalda

    2017-01-01

    Background Surgical treatment of thoracic outlet syndrome (TOS) is necessary when non-surgical treatments fail. Complications of surgical procedures vary from short-term post-surgical pain to permanent disability. The outcome of TOS surgery is affected by the visibility during the operation. In this study, we have compared the complications arising during the supraclavicular and the transaxillary approaches to determine the appropriate approach for TOS surgery. Methods In this study, 448 patients with symptoms of TOS were assessed. The male-to-female ratio was approximately 1:4, and the mean age was 34.5 years. Overall, 102 operations were performed, including unilateral, bilateral, and reoperations, and the patients were retrospectively evaluated. Of the 102 patients, 63 underwent the supraclavicular approach, 32 underwent the transaxillary approach, and 7 underwent the transaxillary approach followed by the supraclavicular approach. Complications were evaluated over 24 months. Results The prevalence of pneumothorax, hemothorax, and vessel injuries in the transaxillary and the supraclavicular approaches was equal. We found more permanent and transient brachial plexus injuries in the case of the transaxillary approach than in the case of the supraclavicular approach, but the difference was not statistically significant. Persistent pain and symptoms were significantly more common in patients who underwent the transaxillary approach (p<0.05). Conclusion The supraclavicular approach seems to be the more effective technique of the two because it offers the surgeon better access to the brachial plexus and a direct view. This approach for a TOS operation offers a better surgical outcome and lower reoperation rates than the transaxillary method. Our results showed the supraclavicular approach to be the preferred method for TOS operations. PMID:28180101

  14. Local mechanical properties of human ascending thoracic aneurysms.

    PubMed

    Davis, Frances M; Luo, Yuanming; Avril, Stéphane; Duprey, Ambroise; Lu, Jia

    2016-08-01

    Ascending thoracic aortic aneurysms (ATAAs) are focal, asymmetric dilatations of the aortic wall which are prone to rupture. To identify potential rupture locations in advance, it is necessary to consider the inhomogeneity of the ATAA at the millimeter scale. Towards this end, we have developed a combined experimental and computational approach using bulge inflation tests, digital image correlation (DIC), and an inverse membrane approach to characterize the pointwise stress, strain, and hyperelastic properties of the ATAA. Using this approach, the pointwise hyperelastic material properties were identified on 10 human ATAA samples collected from patients undergoing elective surgery to replace their ATAAs with a graft. Our method was able to capture the varying levels of heterogeneity in the ATAA from regional to local. It was shown for the first time that the material properties in the ATAA are unmistakably heterogeneous at length scales between 1mm and 1cm, which are length scales where vascular tissue is typically treated as homogeneous. The distributions of the material properties for each patient were also examined to study the inter- and intra-patient variability. Large inter-subject variability was observed in the elastic properties.

  15. Laparoscopic surgery - series (image)

    MedlinePlus

    ... performed laparoscopically, including gallbladder removal (laparoscopic cholecystectomy), esophageal surgery (laparoscopic fundoplication), colon surgery (laparoscopic colectomy), and surgery on ...

  16. Single-Stage Repair of Thoracic Aortic Aneurysm through a Median Sternotomy in a Patient with Pseudocoarctation of the Aorta and Severe Aortic Valve Stenosis.

    PubMed

    Yamane, Yoshitaka; Morimoto, Hironobu; Mukai, Shogo

    2015-01-01

    Pseudocoarctation of the aorta is a rare anomaly and considered a benign condition. Pseudocoarctation of the aorta has been associated with aneurysm formation in the thoracic aorta, which may cause sudden rupture or dissection. Thus, the presence of an aneurysm in combination with pseudocoarctation of the aorta is thought to be an indication for surgery. We present a case of pseudocoarctation of the aorta associated with thoracic aortic aneurysm and severe aortic valve stenosis with a bicuspid aortic valve. In our case, single-stage repair was performed through a median sternotomy using our "pleural-window approach."

  17. Fusion energy

    NASA Astrophysics Data System (ADS)

    1990-09-01

    The main purpose of the International Thermonuclear Experimental Reactor (ITER) is to develop an experimental fusion reactor through the united efforts of many technologically advanced countries. The ITER terms of reference, issued jointly by the European Community, Japan, the USSR, and the United States, call for an integrated international design activity and constitute the basis of current activities. Joint work on ITER is carried out under the auspices of the International Atomic Energy Agency (IAEA), according to the terms of quadripartite agreement reached between the European Community, Japan, the USSR, and the United States. The site for joint technical work sessions is at the Max Planck Institute of Plasma Physics. Garching, Federal Republic of Germany. The ITER activities have two phases: a definition phase performed in 1988 and the present design phase (1989 to 1990). During the definition phase, a set of ITER technical characteristics and supporting research and development (R and D) activities were developed and reported. The present conceptual design phase of ITER lasts until the end of 1990. The objectives of this phase are to develop the design of ITER, perform a safety and environmental analysis, develop site requirements, define future R and D needs, and estimate cost, manpower, and schedule for construction and operation. A final report will be submitted at the end of 1990. This paper summarizes progress in the ITER program during the 1989 design phase.

  18. Fusion energy

    SciTech Connect

    Not Available

    1990-09-01

    The main purpose of the International Thermonuclear Experimental Reactor (ITER) is to develop an experimental fusion reactor through the united efforts of many technologically advanced countries. The ITER terms of reference, issued jointly by the European Community, Japan, the USSR, and the United States, call for an integrated international design activity and constitute the basis of current activities. Joint work on ITER is carried out under the auspices of the International Atomic Energy Agency (IAEA), according to the terms of quadripartite agreement reached between the European Community, Japan, the USSR, and the United States. The site for joint technical work sessions is at the MaxPlanck Institute of Plasma Physics. Garching, Federal Republic of Germany. The ITER activities have two phases: a definition phase performed in 1988 and the present design phase (1989--1990). During the definition phase, a set of ITER technical characteristics and supporting research and development (R D) activities were developed and reported. The present conceptual design phase of ITER lasts until the end of 1990. The objectives of this phase are to develop the design of ITER, perform a safety and environmental analysis, develop site requirements, define future R D needs, and estimate cost, manpower, and schedule for construction and operation. A final report will be submitted at the end of 1990. This paper summarizes progress in the ITER program during the 1989 design phase.

  19. 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

  20. [Thoracic involvement in Behçet's vasculitis].

    PubMed

    Zidi, A; Ben Miled Mrad, K; Hantous, S; Nouira, K; Mestiri, I; Mrad, S

    2006-03-01

    Thoracic involvement of Behcet's disease is unusual but serious. It is related to the well known vascular tropism of the disease. It may involve the superior vena cava, pulmonary arteries, aorta and subclavian vessels. Imaging is useful for diagnosis and assess the degree of thoracic involvement. CT scan and MRI are obviously more accurate than angiography. The spectrum of thoracic manifestations of the disease is presented based on a review of 22 cases.

  1. Rhabdomyosarcoma: Surgery

    MedlinePlus

    ... is and what type of operation is done. Physical changes after surgery can range from little more than a scar to changes in appearance or in how some parts of the body function, which may require physical rehabilitation. For more on surgery as a treatment ...

  2. Robert R. Shaw, MD: thoracic surgical hero, Afghanistan medical pioneer, champion for the patient, never a surgical society president.

    PubMed

    Urschel, Harold C; Urschel, Betsey Bradley

    2012-06-01

    Dr Robert R. Shaw arrived in Dallas to practice Thoracic Surgery in 1937, as John Alexander's 7th Thoracic Surgical Resident from Michigan University Medical Center. Dr Shaw's modus operandi was, "You can accomplish almost anything, if you don't care who gets the credit." He was a remarkable individual who cared the most about the patient and very little about getting credit for himself. From 1937 to 1970, Dr Shaw established one of the largest lung cancer surgical centers in the world in Dallas, Texas. It was larger than M.D. Anderson and Memorial Sloan-Kettering Hospitals put together regarding the surgical treatment of lung cancer patients. To accomplish this, he had the help of Dr Donald L. Paulson, who trained at the Mayo Clinic and served as Chief of Thoracic Surgery at Brook Army Hospital during the Second World War. Following the War, because of his love for Texas, he ended up as a partner of Dr Shaw in Dallas. Together, they pursued the development of this very large surgical lung cancer center. Dr Shaw and his wife Ruth went to Afghanistan with Medico multiple times to teach men modern cardiac and thoracic surgery. They also served as consultants on Medico's Ship of Hope in Africa. Dr Shaw initiated multiple new operations including: 1) resection of Pancoast's cancer of the lung after preoperative irradiation; 2) upper lobe of the lung bronchoplasty, r