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Dissemination of pseudomyxoma peritonei into the thoracic cavity is rare and carries a poor prognosis. Optimal treatment has not been defined. In our institution, patients have received cytoreductive surgery with hyperthermic intrathoracic chemotherapy, which demonstrated a good prognosis. A 51-year-old woman was referred to our hospital with right intrathoracic dissemination of pseudomyxoma peritonei. We performed parietal and mediastinal pleurectomy and simple resection of all visible tumors on the diaphragm and visceral pleura, followed by hyperthermic intrathoracic chemotherapy with 20 mg mitomycin at 42°C to 43°C. The patient had no evidence of disease progression in the thoracic cavity 1 year after surgery.

Introduction A gastrointestinal stromal tumor (GIST) often arises in the stomach and small intestine, while esophageal GIST is rare. The first-choice treatment is surgical resection, but there is no standard technique. Herein, we describe our experience in the treatment of esophageal GIST and discuss the usefulness of robotic esophagectomy. Presentation of case The patient was a 60-year-old woman, who was diagnosed with a 30 mm GIST in the middle thoracic esophagus. We underwent robot-assisted thoracoscopic esophagectomy in the prone position. The duration of the thoracoscopic part was 69 min and the total operation time was 319 min. Total blood loss was 135 ml. The patient's postoperative course was uneventful after surgery and the patient was discharged home in good condition on the 18th postoperative day. Discussion The prognosis of esophageal GIST was less favorable compared with gastric GIST, and due to the anatomical peculiarities of the esophagus, which surgical procedure should be performed is still under debate. Robotic surgery has several technological advantages as it provides a three-dimensional view, ten times magnification, tremor control, and ambidexterity. Therefore, Robotic-assisted minimally invasive esophagectomy (RAMIE) allows achieving for safe R0 resection of esophageal GIST. Conclusion RAMIE may be useful for esophageal GIST because it facilitates safe and minimally invasive surgery in a limited space of the thoracic cavity., Highlights • There is no standard technique due to the anatomical peculiarities of the esophagus. • We think McKeown's procedure in the prone position has some advantages from others. • Robot surgery has a three-dimensional view, tremor control, and ambidexterity. • RAMIE would be useful techniques in a limited space of the thoracic cavity.

BACKGROUND The optimal preemptive analgesia for thoracoscopic surgery remains unclear. We evaluated the utility of intraoperative intravenous analgesia on postoperative pain and the postoperative course in patients who underwent thoracoscopic lobectomy. METHODS We retrospectively reviewed 228 consecutive patients who underwent single-lobe thoracoscopic lobectomy for malignant pulmonary tumors between October 2017 and December 2019. Instead of epidural anesthesia, intercostal nerve blocks were performed from the thoracic cavity. We assessed the differences in the clinical and perioperative parameters including postoperative pain among the following: (1) N group (nonintraoperative intravenous analgesia), (2) A group (1000 mg acetaminophen), and (3) AF group (1000 mg acetaminophen with 50 mg flurbiprofen axetil). The numerical rating scale (NRS) was used to assess pain. RESULTS Receiver operating characteristic curve analysis revealed that the optimal cutoff pain score for the additional analgesic within 12 h postsurgery was 3.5 (area under the curve = 0.771; sensitivity = 63%; specificity = 19.4%; 95% confidence interval [CI] = 0.703-0.839; p

Background Solitary fibrous tumors of the pleura are rare diseases of the thoracic cavity. They frequently grow unnoticed until they exert compressive effects on adjacent organs. Treatment of solitary fibrous tumors of the pleura is surgical resection. Post-operative surveillance is recommended to identify early recurrent disease. Case presentation We present a rare case of a 76-year-old female patient with no previous pulmonary history who presented with progressive dyspnea, fatigue, and involuntary weight loss. On chest X-ray and computed chest tomography scan, she was found to have a 16.7 cm × 12.8 cm × 10.1 cm bulky mass occupying the left hemithorax with associated compressive atelectasis of the lung. She underwent a computed tomography guided biopsy that revealed the mass to be a solitary fibrous tumor. The patient underwent left muscle sparing lateral thoracotomy with complete resection of the tumor. Post procedure, the left lung fully expanded. 18 months post-resection, she developed a 3.3 cm × 1.7 cm tumor along the left internal thoracic artery lymph node chain which was histologically identical to the resected tumor. The patient is currently being treated with bevacizumab and temozolomide. Conclusion Solitary fibrous tumors are very rare pleural tumors. Surgical resection is the treatment of choice followed by close post-operative surveillance.

On radiographic imaging, the finding of a right-sided heart location can be due to multiple etiologies and may be congenital or acquired. We present the case of a 71-year-old male with a self-reported past medical history of hiatal hernia and previously diagnosed dextrocardia. The patient experienced cardiovascular intervention following an ST-elevation myocardial infarction. In the cardiac workup, a low-voltage normal electrocardiogram confirmed dextroposition of the heart due to significant herniation of gastric contents into the thoracic cavity. This gentleman had presumably been diagnosed with dextrocardia, a right-left reversal of heart anatomy and electrophysiology, based on imaging and incomplete workup. Dextroposition refers to a rightward shift of the mediastinum with no changes in orientation of cardiac anatomy, and therefore unchanged directional orientation of conduction. This is an important distinction from dextrocardia, a mirror-image reversal of the cardiac chambers and heart location in the chest wall, such as that due to congenital ciliary dysfunction. A sliding hernia is an uncommon cause of the rightward mediastinal shift, with few such cases documented in the literature, and cardiovascular manifestations of hiatal hernias are discussed. This case exemplifies the role of an electrocardiogram in distinguishing between dextrocardia and dextroposition for accurate diagnosis and management.

Medical imaging and a patient's medical history are great resource for predicting the degree of adhesions developing in the thoracic cavity. However, we would encounter a strong, total adhesion unexpectedly. Although the degree of adhesions varies in each, individual case, there are common theories and techniques to apply for the total adhesion. We hope this article would be helpful to minimize any risk, such as the amount of blood loss, the surgery duration, the degree of lung injury, and postoperative complications, if you encounter the total adhesiolysis.

Congenital diaphragmatic hernia (CDH) is a severe defect with an estimated incidence of 1:3000 live births (). This anomalous condition is characterized by an absence of separation between the thoracic and abdominal cavities during fetal development. Some of the first hypotheses about this congenital defect postulated that the presence of abdominal viscera in the thoracic cavity caused pulmonary hypoplasia by pushing the abdominal contents into the developing lungs (,). After several studies in animal models, a new theory was presented [...]

Damage control has well-defined steps. However, there are still controversies regarding whom, when, and how re-interventions should be performed. This article summarizes the Trauma and Emergency Surgery Group (CTE) Cali-Colombia recommendations about the specific situations concerning second interventions of patients undergoing damage control surgery. We suggest packing as the preferred bleeding control strategy, followed by unpacking within the next 48-72 hours. In addition, a deferred anastomosis is recommended for correction of intestinal lesions, and patients treated with vascular shunts should be re-intervened within 24 hours for definitive management. Furthermore, abdominal or thoracic wall closure should be attempted within eight days. These strategies aim to decrease complications, morbidity, and mortality. Resumen El control de daños es uno de los pilares de la cirugía de trauma. Sin embargo, la reintervención aún genera controversias en cuanto a quién, cuándo y cómo debe realizarse. El presente artículo presenta las recomendaciones del grupo de Cirugía de Trauma y Emergencias (CTE) de Cali, Colombia, respecto a las reintervenciones después de una cirugía de control de daños. Se recomienda el empaquetamiento como la estrategia de control de sangrado y se debe desempaquetar en un lapso entre 48 y 72 horas. La anastomosis diferida debe ser la opción de reparo en las lesiones intestinales. La reintervención vascular en los pacientes manejados con shunt vascular debe ser antes de las 24 horas para dar el manejo definitivo. En un lapso de 8 días se debe intentar realizar el cierre de la pared abdominal o torácica. Estas estrategias buscan disminuir la frecuencia de complicaciones y de morbimortalidad.

BackgroundThe cardiovascular system is significantly agitated by loss of gravity. In microgravity, the body fluids shift toward the thoracic cavity, induced the heart becomes more spherical. This further increased the cardiac preload with an increasing of transmural central venous pressure, affects the right heart ventricles to tolerating the enhanced preload on the right ventricular wall.MethodIn this study we investigated the rat right ventricle remodeling in simulating persistent microgravity by using tail-suspension model, examined the remolding of the heart and the specific STAT3 expression in right heart myocardium.ResultThe results indicated that microgravity induced heart remodeling included a significant increasing of the ventricular weight in the left. However, the right ventricle was not increased significantly in the microgravity simulation rats. The histological study demonstrated that the outstanding development on right ventricular wall which included the gap junction remodeling and STAT3 signaling protein specific accumulation in the right ventricles.ConclusionThe results existed that the right cardiac ventricle has a distinctive remodeling process during microgravity simulation which was not the muscular hypertrophy and relative weight increasing, but manifested the STAT3 accumulation and the electrical gap junction remodeling. The effect of microgravity induced right ventricle remodeling and the STAT3 specific accumulation can be used for multi-purpose research.

OBJECTIVES The cervicothoracic junction is a special section that connects the neck, thoracic cavity, mediastinum and axilla. Tumours in the region often invade or compress surrounding tissues and organs, which makes the surgical treatment difficult. METHODS A retrospective analysis involving 69 patients with tumours at the cervicothoracic junction. Clinical data with regard to manifestation, surgical approach, resection degree, outcome and pathological types were collected. RESULTS A total of 48 cases of asymptomatic patients and 21 cases of patients with ≥1 clinical manifestation were enrolled in the study. Twenty-seven patients received radical resection with video-assisted thoracoscopic surgery. Anterior approach was the predominant treatment method in open surgery (25 cases, 36.2%), while the anterolateral approach was used in 8 cases (6 cases of hemiclamshell incisions and 2 cases of trap-door incisions). In addition, we observed 1 case of posterior approach, 2 cases of posterolateral approach and 1 case of supraclavicular approach combined with posterolateral approach. Pathological examination results revealed 67 cases of radical resection and 2 cases of microscopic residual. Neurilemmoma was the most widespread pathological type (30 cases, 43.5%), followed by tumour originating from fibrous tissues (5 cases, 7.2%). A 3-year overall survival rate of the 69 patients was 89.9%, while a 5-year overall survival rate was 85.5%. CONCLUSIONS Tumours associated with the cervicothoracic junction are characterized by their unique location, complex anatomy and various histopathological subtypes. An individualized approach during surgery enhances safety and standardized of treatments for patients with tumours located at the cervicothoracic junction.

Pneumothorax or fluidopneumothorax is a critical condition when there is some air or/and fluid in the plural cavity. The symptoms may include shortness of breath, chest pain, blue discoloration of the skin or lips, increased heart rate, and loss of consciousness. Pleural cavity drainage is management therapy with the concept of Water Seal Drainage (WSD), which requires a long hospital stay. Heimlich valve is a non-return valve that allows fluid and air to exit the thoracic cavity (on inspiration) and prevents fluid and air from re-entering (during expiration). Heimlich valve is a viable, inexpensive, convenient, safe, effective, and efficient alternative in the management of ambulation of patients requiring prolonged pleural cavity drainage. The use of Heimlich valve is an alternative option for patients with persistent pneumothorax or fluidopneumothorax. It can shorten the time of treatment in the hospital, lowering treatment costs, and minimize the presence of nosocomial infections. Relative contraindications include fluidopneumothorax with massive pleural effusion or empyema. The risks and complications are dislodgement or improper reattachment, leaking valve, adhesion, and blockage, thus becoming tension pneumothorax or pleural cavity infection. Currently the latest innovation also improves the patient’s convenience, like Thoracic Vent, Pneumostat, or Mini Mobile Dry Seal Drain.

Published risk stratification models of solitary fibrous tumor (SFT) have been associated with distant metastases outside the central nervous system (CNS), but have not been studied for tumors occurring in the CNS. In a retrospective review, we identified 72 cases of solitary fibrous tumor or hemangiopericytoma (HPC) diagnosed between January 2011 and December 2020 at our institution. The tumors involved the central nervous system (N = 17), thoracic cavity (N = 28), and extrathoracic sites (N = 27). The risk of local recurrence, distant metastasis, or death at 5 years was 57% (95% CI 23%, 76%) in the CNS, 24% (95% CI 2%, 41%) in the thoracic cavity, and 13% (95% CI 0%, 25%) in extrathoracic sites. By contrast, the risk of distant metastasis or death at 5 years was 13% (95% CI 0%, 29%) in CNS primaries, 5% (95% CI 0%, 14%) in thoracic primaries, and 14% (95% CI 0%, 27%) in extrathoracic primaries. Using the published 3- and 4-variable risk stratification models by Demicco et al., we retrospectively assessed our cases for risk of local recurrence, distant metastasis, and death. For tumors outside the CNS, we show that three- and four-variable risk stratification models were associated with recurrence-free survival in addition to the previously known association with distant metastasis (all P 0.05). In contrast, inside the CNS, we show that neither risk model is a significantly associated with clinical behavior, and that WHO grade is likely the best available prognostic tool, though none of the differences were significant. The lack of significant differences can be likely explained by the younger median age (47 years vs 61 years) and smaller median tumor size (3.5 cm vs 5.6 cm), downgrading the risk stratification scores in CNS compared to non-CNS primaries. In conclusion, existing risk stratification models of SFT are not associated with clinical behavior for tumors arising inside the CNS, but are associated with local recurrence in addition to distant metastasis outside the CNS.

The sensation of pain perturbs both psychological and physiological processes that comprise human existence. While both acute and chronic pain cause emotional distress, pain also interferes with biological homeostasis, quality of life, and disease recovery. Over the past few decades, medical practice has devoted more attention towards researching and addressing pain. However, the opioid epidemic has revealed the difficulty in striking a balance between successful and ethical pain management. In 2019, the National Institutes of Health launched the HEAL Initiative to focus specifically on creating and researching non-opioid-based therapies. Although the federal government has directed more funding towards alternative pain management techniques, multi-billion-dollar pharmaceutical companies have such a tight grasp on the market that it remains virtually impossible for new competitors – with effective products – to break into the field. The following technical thesis seeks to deepen the understanding of pain associated with the chest tube and to create a virtual model of the thoracic cavity for in silico modeling. Since the difficulty of studying pain lies in its highly variable nature, the first part of the project revealed underlying consensuses about pain from the healthcare provider’s (HCP) view. In the second part of the thesis, we conducted finite element analysis on a computer model of the chest in order to simulate stress concentrations and strain deformations under external loads. The simulation results – coupled with our survey finding that 85 percent of HCPs believed that the chest tube needs improvement – indicate that a true clinical need exists and must be addressed. The Science, Technology, and Society (STS) thesis focuses largely on the ethical and societal implications of privatizing prescription data and using it to inform pharmaceutical marketing decisions. The process of prescription “datafication” has successfully increased the revenues of brand-name pharmaceuticals at the expense of doctor’s privacy and patient’s livelihoods. When this controversial practice came before the Supreme Court, the Court held that exchanging prescriber-identifiable pharmaceutical data was tantamount to corporate expression and must be protected under the First Amendment. The STS research analyzes the prescription data mining system as one manifestation of neoliberalism within biopower, where a free-market mentality drives nation-state practices towards prioritizing the business, rather than the individual. The technical research revealed that that medical field has neither sufficiently nor successfully addressed pain management, while the STS research focuses on how one highly-defended business practice creates a barrier to pharmaceutical market entry. Although the technical project was unable to provide a chest tube dressing that reduced pain, the creation of an anatomically-correct thoracic cavity model has wide-reaching applications for in silico modeling. The STS thesis successfully analyzed the prescription data mining system as an engrained corporate practice, leading to the rise of the corporate Frankenstein monster. Lastly, I wish to express my profound gratitude for William Guilford, Ph.D., and Sean Ferguson, Ph.D., for guiding my technical project and STS thesis. I would also like to thank Maeve Isabella Coleman, my technical project partner, for her countless hours of work dedicated to this research.

Research Areas: Veterinary Sciences Clinical, pathological, and immunohistochemical findings related to a feline mammary tumor with similar features to canine anaplastic mammary carcinoma are herein described for the first time. A female cat was presented for clinical evaluation with gastrointestinal signs, oedema, erythema, and painful lesion in the right inguinal region. Three weeks later, the mass had doubled in size and radiographic revaluation of the thoracic cavity revealed a metastatic pattern. Due to the poor prognosis and decline of the clinical status the owners decided for euthanasia. Post-mortem examination exposed a mammary tumoral mass with subcutaneous oedema, an enlargement of the right inguinal lymph node, and nodules in several organs. Histological analysis confirmed the presence of large pleomorphic epithelial cells, often grouped in small clusters with bizarre nuclei. Immunohistochemical study of the different lesions was performed and both primary tumor and regional metastasis showed tumor cells to be negative estrogen receptor alpha, positive progesterone receptor, positive HER-2, and positive pan-cytokeratin. Given that the clinical history was compatible with an inflammatory mammary carcinoma, the cyclooxygenase-2 expression levels were evaluated and presented a weak immunoreactivity. Regarding the distant metastatic lesions, tumor cells were negative for ER-α and PR and, positive both for HER-2 and pan-cytokeratin. info:eu-repo/semantics/publishedVersion

Introduction: Thoracic endometriosis syndrome (TES) is a rare phenomenon that affects 6-10% of women of reproductive age. It is characterized by presence of ectopic endometrial tissue within the thoracic cavity, mainly the lung parenchyma and pleura. TES presents as catamenial pneumothorax (CP), catamenial hemothorax (CH), pulmonary nodules or hemoptysis. Hormonal therapy is considered first line treatment followed by operative thoracoscopy for removal of ectopic endometrial implants. Our case highlights the limited number of treatment options in a young patient with recurrent catamenial disease.Description: A 37-year-old G4P0040 female presented to the emergency department (ED) with worsening shortness of breath (SOB) for 5 days. Her SOB was sudden in onset, progressively worsening, and associated with cough and right-sided chest pain. Patient was admitted 5 months ago for similar symptoms. She has a past medical history significant for hypertension, obesity, iron deficiency anemia, severe endometriosis and TES manifesting as recurrent, right sided pleural effusions, CPs and CHs requiring surgical treatment. Previous biopsies of the ectopic endometrial tissue revealed dense fibroconnective tissue with focal endometriosis and no indication for malignancy. In the ED, she appeared in distress and had a BP of 166/102. Physical examination revealed tachypnea, accessory muscle usage, respiratory distress and retractions. Breath sounds were decreased in the right lung. EKG revealed normal sinus rhythm, and a COVID-19 test yielded negative results. Chest x-ray and CT were consistent with findings for right tension hemothorax. She was started on BiPAP initially and thoracic surgery was consulted. A tube thoracostomy was performed in the ED and a chest tube was placed. Moreover, a CBC revealed Hb of 5.7g/dl. She was transfused 4 units pRBC and admitted to the ICU for further monitoring. Ob/gyn was consulted and leuprolide was administered to prevent recurrence of a hemothorax. She remained in the hospital for 3 days and was subsequently discharged after resolution of symptoms confirmed by imaging.Conclusion: Catamenial hemothoraces are a late finding of TES. There is mixed data regarding the effectiveness of GnRH agonists on recurrence rates of CH, however subsequent surgery has shown to be preventative in resistant cases. This unique case illustrates the insufficiency in both mainstay treatments. Despite the fact the patient had previous lobectomies using VATS, lysis of adhesions and hormonal therapy, she continued to have recurrent manifestations of TES. Novel treatments in conjunction with a multidisciplinary team approach should be used to effectively treat TES and prevent disease relapse.

Background An intracardiac foreign body causing recurrent fungemia is a rare clinical situation. Clinicians should be that aware of rare sources of sepsis despite a thorough history and examination. Results The authors describe a 63 year-old man, with unremarkable past medical history, who presented with a fever for 2 weeks. Blood cultures persistently grew Candida albicans and Streptococcus constellatus. Echocardiogram assessment showed a suspected vegetation over the tricuspid valve. Surgical exploration with median sternotomy and cardiopulmonary bypass revealed a tooth-pick impacted within the right atrium surrounded by vegetation. The authors postulate accidental ingestion of the foreign body and translocation into the right atrium via the esophagus and thoracic cavity. Conclusion Surgical removal of symptomatic intracardiac foreign bodies is highly recommended.

Background Thoracic endometriosis syndrome (TES) is a rare condition that occurs in women when endometriosis implants into the thoracic cavity. Catamenial hemoptysis, the occurrence of hemoptysis with menstruation, is a recognized clinical manifestation of TES commonly treated with hormonal therapy. Case summary We present the first documented case describing the recrudescence of catamenial hemoptysis in the setting of Lumacaftor/Ivacaftor administration in a 25-year-old woman with cystic fibrosis (CF). Discussion We review the literature on TES, pharmacologic management, and reported cystic fibrosis transmembrane conductance regulator (CFTR) modulator drug interactions. We propose that our patient's recrudescence of catamenial hemoptysis was secondary to a drug-drug interaction between Lumacaftor/Ivacaftor and oral contraceptive therapy. Conclusion Our case suggests that women with CF who have catamenial hemoptysis and a genetic mutation approved for Tezacaftor/Ivacaftor or Elexacaftor/Tezacaftor/Ivacaftor can be managed effectively with either CFTR modulator and hormonal contraceptive therapy.

Pneumomediastinum is a clinical and radiographic finding that is associated with a wide range of acute processes that allow gas to disseminate through the tissues of mediastinum that often necessitates prompt consideration for thoracic intervention. In some circumstances, pneumomediastinum may arise from processes extrinsic to the thoracic cavity and is a secondary process arising from a primary retropharyngeal or retroperitoneal etiology. Acute emphysematous pyelonephritis is a rare and severe infectious disease of the kidney associated with a very high mortality rate. We report a case of advanced emphysematous pyelonephritis presenting with pneumomediastinum successfully treated with simple nephrectomy in the absence of any direct mediastinal intervention.

Highlights • Bochdalek Hernia is most commonly found in young age. • Bochdalek Hernia may present in old age with non-specific symptoms. • ER Physicians and surgeons should be critical in thinking keeping such unusual pathology in mind while dealing with patients. • New ER Physicians commonly miss such rare and unusual cause of abdominal and thoracic symptoms., Introduction Physicians working as first-level responders in emergency departments (ED) often encounter patients, of any age group with shortness of breath (SOB). Definitive diagnosis is quite challenging once the underlying pathology is rare and unusual and/or the ED physicians recommend and rely on non-specific investigations. Presentation of case A 29-year-old female presented to the emergency department with sudden onset of shortness of breath and upper abdominal pain radiating to the left shoulder. Diagnosis of Bochdalek hernia was made clinically coupled with radiological findings of CXR and computed tomography (CT) by the surgeon on-call, while it was missed by an emergency care physician on her first visit. Discussion Herniation of the abdominal contents into the thoracic cavity via the Bochdalek opening, commonly known as Bochdalek hernia is seen and diagnosed most commonly accidentally in early life. Adult cases of symptomatic Bochdalek hernia has been reported in the literature. These patients usually present with non-specific symptoms, thus pose a diagnostic challenge for an emergency care physician. Conclusion The report of this case highlights the notion that such rare causes of acute onset dyspnea and upper abdominal pain pose a diagnostic challenge for novice emergency care physicians especially in situations where he/she does not ask for second-line help in general and recommend and rely on a non-specific investigation in specific.

The term aspergillosis describes the disease caused by Aspergillus species. The most common pathogen in this genus is Aspergillus fumigatus. Anatomic pulmonary resection is the preferred treatment modality in most of cases especially the presence of the localized disease, but sometimes patients complicate by prolonged air leakage, pleural space problems, and infection of this residual space. We reported a patient who undergone left upper lobectomy because of aspergilloma in the left upper lobe. After the operation, the patient’s condition became complicated because of expansion failure of the lung and space problems. After the period of conservative treatment, urgent re-operation was needed because of acute hemorrhage from the chest tube. Hemorrhage was controlled, but disseminated pleural aspergillosis and infection in the pulmonary arterial stump were seen in the thoracic cavity. Completion pneumonectomy and pleural decortication were applied, and the antifungal therapy was arranged. With this report, we aim to evaluate the relation between disseminated pleural aspergillosis and inflammatory erosion of pulmonary arterial stump. It is also important to consider possibility of dissemination of the Aspergillus infection especially in patients with expansion failure after lung resection.

We present a case of 5 year-old female with funnel chest, by which cardiovascular structures were displaced into the left chest cavity. This caused left bronchial compression by the pulmonary artery and the descending aorta, for which an external stenting was successfully performed. The patient had features suggestive of skeletal dysplasia with tracheobronchial malacia. One possible mechanism of vascular compression could be an association of fragility of the thoracic cavity and inspiratory dyspnea, causing thoracic deformity.

Diaphragmatic hernia is protrusion of the abdominal contents into the thoracic cavity. It is a congenital defect of the diaphragm. It is most commonly encountered in infancy but rarely in adults. Here, we would like to present a rare case of 75-year-old male with Bochdalek's hernia. The patient had presented for the first time in his life for his symptoms. This case report emphasises the rare presentation of Bochdalek's hernia in an elderly male. The patient was treated using minimal access surgery i.e., laparoscopic approach and hence had a better post-operative outcome.

Situs inversus totalis (SIT) is a rare congenital anomaly with a thoracic cavity, and abdominal structures are reversed. The most suitable approach and surgical technique in a patient with SIT and organ variation remain unclear. We report our experience with a case of situs inversus totalis diagnosed with the esophagogastric tumour. We report a 77 years old female diagnosed with locally advanced esophagogastric tumour classified as Siewert Type II. Preoperative CT scan shows a complete mirror image of the thoracic cavity and abdominal viscera and no vascular anomalies. She underwent distal esophagectomy and total gastrectomy with Roux-en-y anastomosis and D2 lymph node dissection. Distal esophagectomy was done via transhiatal approach for adequate proximal margin resection. There were no intra-operative problems, and the postoperative course was uneventful. Till present, we believe that this is the first case of Transhiatal distal esophagectomy and total gastrectomy in situs inversus totalis patient reported in Malaysia.

Background Bleeding of the subclavian artery is a fatal condition. Adhesion between the pleura and staple line may develop after surgical treatment of pneumothorax, and collateral arteries often develop from the subclavian artery toward the adhesion at the lung apex; however, atraumatic tearing and bleeding of these collateral arteries into the extrapleural and intrathoracic cavities is rare. Case presentation A 70-year-old man visited the hospital for evaluation of left chest pain. Contrast-enhanced chest computed tomography showed a huge tumor in the left apex of the lung. It was suspected to be an extrapleural huge hematoma, and it ruptured into the thoracic cavity. Bleeding from the left subclavian artery was suspected; therefore, emergency angiography was performed. Angiography showed some collateral circulation from the left subclavian artery to the apex of the left lung. Distal and proximal bleeding points were identified. The distal bleeding point was embolized using coils. The proximal bleeding point was blown out, and stents were placed in the left subclavian artery. He had undergone pneumothorax surgery 20 years previously, and the present bleeding episode was strongly suspected to be associated with that surgery. The collateral circulation from the subclavian artery could have developed because of post-pneumothorax inflammation, eventually rupturing and bleeding into the extrapleural space. Conclusions This report described an important case of atraumatic subclavian artery bleeding considered to have been caused by surgical treatment of pneumothorax 20 years previously. Emergency angiography and percutaneous stent placement or coil embolization should be considered first in such cases.

A six-year-old cross bred Jersey cow was presented for necropsy. On examination of thoracic cavity, pericardium over the base of the heart revealed dark reddish, firm, tortuous mass embedded in thoracic part of thymus surrounded by adipose tissue. Histopathological of the tissue revealed thymus with involution changes. Lobes were shrunken. Capsule was thin and was surrounded and infiltrated by adipocytes. Thymic lobules were shrunken, follicles were atrophied. Cortex and medulla were non-de- lineated containing condensed area composed of epithelial cells, Hassall’s corpuscles and thymocytes. Cystic degenerations were noticed in Hassel’s Corpuscles, epithelial cells and stromal tissue. Thymocytes were arranged to form acinar pattern. Atrophic thymus showed variable sized vascular channels filled with blood. The vascular channels were lined by endothelial cells. The stroma composed of fat and fibrous tissues admixed with remnant of thymic tissue and follicles. Based on the location, gross and histopathological features of the tissue, the case was diagnosed as cavernous haemangioma of thymus in a cross bred Jersey cow.

Ectopy of the thymus is a rare anomaly arising during fetal development, where the thymus does not make a complete decent into the thoracic cavity where it should involute in adolescence. The most common complications of an ectopic thymus include tracheal or esophageal compression presenting in childhood. This is a report of a single case of ectopic cervical thymus identified in a 2-month-old infant presenting with Horner's syndrome. Thymic ectopy should be on the differential when performing a radiologic evaluation of a neck mass when imaging characteristics are similar to thymic tissue. Keywords: Horner's syndrome, Ectopic, Thymus, Pediatrics

An 11-year-old (44.5-kg [97.9-lb]) sexually intact male Weimaraner was evaluated at the Veterinary Teaching Hospital of the University of Georgia because of a 2-day history of weakness and difficulty rising from a lying position associated with all 4 limbs. Several years earlier, the dog had bilateral cranial cruciate ligament disease and tibial plateau leveling osteotomies were performed bilaterally. Three months prior to evaluation at the hospital, the right tibial plateau leveling osteotomy plate was removed because of lameness and suspected infection. Electrocardiographic abnormalities were not detected during any of the dog’s previous anesthetic episodes. The dog had no other pertinent medical history. Initial physical examination findings were unre markable, and the dog’s heart rate was 112 beats/min. During auscultation of the thoracic cavity, no murmur or arrhythmia was detected and lung sounds were apparently normal bilaterally. Results of a neurologic examination were consistent with a lesion affecting C6 through T2 spinal cord segments. Abnormalities detected via a CBC and serum biochemical analyses included mild leukocytosis characterized by a mature neutrophilia (12.5 X 10 3 cells/M L; reference range, 2.9 X 10 3 cells/M L to 12 X 10 3 cells/M L), monocytosis (2.0 X 10 3 cells/M L; reference range, 0.1 X 10 3 cells/M L to 1.4 X 10 3 cells/M L), and mild hyperglycemia (124 mg/dL; reference range, 77 to 120 mg/dL). Results of a urinalysis were also within reference limits. Radiography of the thorax and cervical portion of the vertebral column revealed no abnormalities, with the exception of a narrow intervertebral disk space at C6-7.

Background and objectives Intraoperative photodynamic therapy (IO-PDT) is typically administered by a handheld light source. This can result in uncontrolled distribution of light irradiance that impacts tissue and tumor response to photodynamic therapy. The objective of this work was to characterize a novel optical surface applicator (OSA) designed to administer controlled light irradiance in IO-PDT. Study design/materials and methods An OSA was constructed from a flexible silicone mesh applicator with multiple cylindrically diffusing optical fibers (CDF) placed into channels of the silicone. Light irradiance distribution, at 665 nm, was evaluated on the OSA surface and after passage through solid tissue-mimicking optical phantoms by measurements from a multi-channel dosimetry system. As a proof of concept, the light administration of the OSA was tested in a pilot study by conducting a feasibility and performance test with 665-nm laser light to activate 2-(1'-hexyloxyethyl) pyropheophorbide-a (HPPH) in the thoracic cavity of adult swine. Results At the OSA surface, the irradiance distribution was non-uniform, ranging from 128 to 346 mW/cm2 . However, in the tissue-mimicking phantoms, beam uniformity improved markedly, with irradiance ranges of 39-153, 33-87, and 12-28 mW/cm2 measured at phantom thicknesses of 3, 5, and 10 mm, respectively. The OSA safely delivered the prescribed light dose to the thoracic cavities of four swine. Conclusions The OSA can provide predictable light irradiances for administering a well-defined and potentially effective therapeutic light in IO-PDT. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

Background In 2009, the Japan Esophageal Society (JES) established a system for certification of qualified surgeons as “Board Certified Esophageal Surgeons” (BCESs) or institutes as “Authorized Institutes for Board Certified Esophageal Surgeons” (AIBCESs). We examined the short-term outcomes after esophagectomy, taking into consideration the certifications statuses of the institutes and surgeons. Methods This study investigated patients who underwent esophagectomy for thoracic esophageal cancer and who were registered in the Japanese National Clinical Database (NCD) between 2015 and 2017. Using hierarchical multivariable logistic regression analysis adjusted for patient-level risk factors, we determined whether the institute’s or surgeon’s certification status had greater influence on surgery-related mortality or postoperative complications. Results Enrolled were 16,752 patients operated on at 854 institutes by 1879 surgeons. There were significant differences in the backgrounds and incidences of postoperative complications and surgery-related mortality rates between the 11,162 patients treated at AIBCESs and the 5590 treated at Non–AIBCESs (surgery-related mortality rates: 1.6% vs 2.8%). There were also differences between the 6854 patients operated on by a BCES and the 9898 treated by a Non-BCES (1.7% vs 2.2%). Hierarchical logistic regression analysis revealed that surgery-related mortality was significantly lower among patients treated at AIBCESs. The institute’s certification had greater influence on short-term surgical outcomes than the operating surgeon’s certification. Conclusions The certification system for surgeons and institutes established by the JES appears to be appropriate, as indicated by the improved surgery-related mortality rate. It also appears that the JES certification system contributes to a more appropriate medical delivery system for thoracic esophageal cancer in Japan.

Background Spontaneous esophageal rupture is a rare but serious disease with high mortality. Conservative treatment and endoscopic therapy have been reported, but surgical treatment is still a basic modality of therapy. In addition to thoracotomy, recent studies have reported treatment with thoracoscopic surgery and laparoscopic transhiatal repair. In this study, we report a patient who underwent laparoscopic transhiatal suture closure for spontaneous esophageal rupture with favorable postoperative course. We also discuss indication for laparoscopic surgery for spontaneous esophageal rupture. Case presentation A 70-year-old man visited our hospital with chief complaints of epigastric pain and vomitus niger. He was diagnosed with spontaneous esophageal rupture in the left wall of the lower esophagus by computed tomography and upper gastrointestinal (GI) series. At 11 h after the onset of symptoms, we performed laparoscopic transhiatal suture closure and lavage drainage. We performed transhiatal esophageal replacement using the 5-hole approach. We observed a perforation of 2 cm in diameter at the site of the rostral portion approximately 4 cm from the esophageal hiatus. All layers were closed with three stitches using 3–0 absorbable sutures. No perforation was observed in the thoracic cavity. The total operative time was 178 min, and total bleeding was 2 ml. He had no postoperative complications and was discharged on day 15 after the procedure. He received continuous proton pump inhibitor therapy as an outpatient. Healing cicatrization was found at the site of rupture by esophagogastroscopy. The patient was advised to improve his lifestyle and has shown no signs of recurrence over 2 years from the date of surgery. Conclusions Simple closure of all the layers using laparoscopic transhiatal simple closure was useful in the treatment of esophageal rupture as a less invasive approach for patients who meet the following conditions: stable general condition, intrathoracic perforation, and the perforation site is identified as the lower esophagus by pre-operative examination.

Introduction Lung herniation is defined as a protrusion of the lung parenchyma with its pleura through the intercostal space. It is a rare condition and usually occurs after thoracic trauma and surgical interventions. A few cases of lung herniations have been reported after video-assisted thoracoscopic surgery (VATS) but only two cases have been reported after VATS lobectomy. Aim The VATS procedure has become the dominant method of lung cancer surgery, but there is no case series about the complications of lung herniation in the literature. We aim to define some risk factors and possible ways of prevention of lung herniation after VATS resection. Material and methods This study retrospectively analyses 650 (550 anatomic, 100 non-anatomic sublobar resections) patients who underwent lung resections for lung cancer in our department between 2012 and 2018. We detected lung herniation in 3 patients after VATS resection. Results Asymptomatic lung hernias may be managed by close observation but because of the risk of incarceration of the pulmonary parenchyma, surgery is often necessary. The main steps of treatment involve: identification of the hernia, freeing of all adhesions, reduction of the lung tissue back into the thoracic cavity and repairing the defect of the chest wall. Conclusions By this retrospective case series, we defined some patient-related and surgeon-related risk factors and some basic recommendations for prevention of this complication.

Mediastinal abscess is a rare yet emergent infectious complication of the thoracic cavity following balloon dilatation of the esophagus. Early diagnosis and management could avoid its poor outcome. A 20-year-old man with esophageal stricture underwent balloon dilatation. A mediastinal abscess developed 2 weeks after procedure. Computed tomographic chest helped in diagnosis and guiding approach of management. Surgical drainage and debridement of the abscess were performed. Surgical treatment combined with systemic antibiotics was effective, leading to remission of the abscess. Mediastinal abscess should be considered as a possible infectious complication after upper endoscopy. Computed tomographic scan is a mandatory imaging modality to enable early diagnosis. Aggressive treatment including surgical drainage combined with medical management is the treatment of choice that may prevent catastrophic outcome.

A detailed Clinico-pathological profile of clinically diseased cattle and buffaloes with Theileriosis located in Al-Ghaniem region, Assiut Governorate, was aimed. Theileria annulata was confirmed by the presence of T. annulata piroplasms in blood smears and/or lymph smears followed by polymerase chain reaction (PCR). During the period of investigation (April 2015 to August 2018), out of the clinically inspected cattle (n= 300) and buffaloes (n= 100), 80 (26.67%) and 15 (15 %) cases were clinically suspected to have Theileriosis, respectively. The positive cases were molecularly identified (PCR). The general observed signs were anorexia, fever, swelling of superficial lymph nodes. ocular lesions were white cloudiness were more obvious in the center of cornea rather than the borders (yellowish colored corneoscleral opacity surrounded by hyperemic band). a watery discharge from the eyes. Serous ocular discharge (watery lacrimation) was remarkable, however in severe cases the ocular discharges was accumulated in the medial canthus. Some newly born calves of less than one month exposed to ocular symptoms mainly protruding of eye ball with ictric conjunctiva. The clinical examination of conjunctivae of the clinically suspected cases with Theileriosis indicated that icteric appearance of conjunctivae in some cases. Three cases showed petechiated conjunctivae. In our study some animals showed up--word visible bulging of temporal fossa. visible protrusion of hemorrhagic conjunctiva with apparently exophthalmia (ocular edema) were observed. Bloody diarrhea and tarry like diarrhea, change in feeding behavior or habit like depraved appetite by eating mud ,soil were noticed. On the other side, the most prominent necropsy features the recently succumbed animals: Gross changes in various organs including heart lungs, trachea, stomach, liver, spleen, kidneys superficial lymph nodes, mesenteric lymph nodes, small and large intestine. All mucous membranes and conjunctivae, peritoneum and abdominal fatty tissues were icteric. On external observation. Jaundice, petechial hemorrhages involving mucosal and serosal surfaces of many organs as well as body fat. In the thoracic cavity, the most prominent autopsy findings were obviously extra edematous swelling of all lobes of the lung, hydrothorax and the lung was distended, discolored, solid in texture, and filled with exudate by palpation, The liver was friable, yellowish, and larger than normal, with the gall bladder being markedly distended with dark olive-green or brownish green bile. The abomasum was the most severely affected organ in the alimentary canal, it contains numerous ulcers about 3 mm. in diameter .a few linear ulcers were present on the leaves. There were prominent hemorrhagic ulcers and petechial hemorrhages were seen in the abomasum of the most cases. There were remarkable enlargement of spleen (splenomegaly) were also recorded. The kidneys were congested or dark brown in color and their perirenal fat were yellowish in color. The heart had petechial and hemorrhages on the outer and inner surface of the auricles.

Human echinococcosis is a rare zoonotic infection caused by larvae of the tapeworm species Echinococcus. The most relevant two species to humans are Echinococcus multilocularis and the dog tapeworm Echinococcus granulosus. The latter causes cystic echinococcosis, which plays a dominant role in thoracic surgery due to its pulmonal involvement. The parasite develops characteristic hydatic cysts mostly in liver and lung. In 2016 a rise in cases of cystic echinococcosis in Germany was recorded, a probable cause could have been the refugee wave. The infection and advanced stages of the disease does not always cause symptoms and stays asymptomatic. Dry cough, thoracic pain and hemoptysis are uncharacteristic symptoms. Cysts may rupture and void into the bronchial system or thoracic cavity, which can result in empyema. Surgery remains the main therapeutic approach for pulmonary cystic echinococcosis. Surgical therapy includes peri- or endocystectomy, wedge and anatomic resections. Depending on size and localization of hydatid cysts the appropriate surgical technique should be chosen aiming on minimal loss of lung parenchyma. The treatment strategies need to be discussed in an interdisciplinary setting including infectiologists and thoracic or general surgeons. The respective treatment should be carried out in specialized centers due to the low incidence of the disease.

Background This study aimed to determine the usefulness and limitations of videoassisted thoracoscopic (VATS) lobectomy using one-window and puncture method (1WPM). Methods This study involved 14 patients who underwent lobectomy using the 1WPM at our institute from 2008 to 2017. Results The study patients comprised of 3 men and 11 women with a median age of 10.5 years (range, 0-72 years). There were eight cases in children younger than 18 years old and the youngest patient was 9 days old. The diagnoses were congenital pulmonary cystic disease (n = 7), primary lung cancer (n = 4), metastatic lung tumor (n = 1), and others (n = 2). The 1WPM was successful in 9 of 14 patients (64.3%) and, in 5 cases (35.7%), needed conversion to either two-window method (TWM) using additional port (n = 3) or open thoracotomy (n = 2). The causes for conversion were need for additional bronchoplasty or lymph node dissection (n = 3), failure of one-lung ventilation (n = 1), and presence of a small thoracic cavity that made the procedure extremely difficult (n = 1). In the group that was successfully treated with 1WPM, the median values were as follows: operation time, 193 min (range, 112-480 min); blood loss, 0 ml (range, 0-90 ml); drainage duration, 1 day (range, 1-4 days); and postoperative hospital stay, 7 days (range, 4-13 days). Conclusions Lobectomy by 1WPM can be safely performed and has good postoperative course and this procedure can be applicable and effective in small infants., Highlights • This study describes the novel VATS lobectomy method: the one-window and puncture method (1WPM). • 1WPM is performed using 2–3 cm single incisions and a needle scope for intrathoracic access from other points. • This retrospective study involved 14 patients who underwent lobectomy using the 1WPM. • VATS lobectomy using 1WPM can be safely applied from adult cases to new born cases.

Radiation-induced lung injury to normal airway epithelium is a frequent side-effect and dose-limiting factor in radiotherapy of tumors in the thoracic cavity. NOTCH signaling plays key roles in self-renewal and differentiation of upper airway basal lung stem cells during development, and the NOTCH pathway is frequently deregulated in lung cancer. In preclinical lung cancer models, NOTCH inhibition was shown to improve the radiotherapy response by targeting tumor stem cells, but the effects in combination with irradiation on normal lung stem cells are unknown. NOTCH/γ-secretase inhibitors are potent clinical candidates to block NOTCH function in tumors, but their clinical implementation has been hampered by normal tissue side-effects. Here we show that NOTCH signaling is active in primary human- and murine-derived airway epithelial stem cell models and when combined with radiation NOTCH inhibition provokes a decrease in S-phase and increase in G1-phase arrest. We show that NOTCH inhibition in irradiated lung basal stem cells leads to a more potent activation of the DNA damage checkpoint kinases pATM and pCHK2 and results in an increased level of residual 53BP1 foci in irradiated lung basal stem cells reducing their capacity for self-renewal. The effects are recapitulated in ex vivo cultured lung basal stem cells after in vivo whole thorax irradiation and NOTCH inhibition. These results highlight the importance of studying normal tissue effects that may counteract the therapeutic benefit in the use of NOTCH/γ-secretase inhibitors in combination with radiation for antitumor treatment.

Although esophagectomy is the standard treatment for resectable esophageal cancer, chemoradiotherapy or radiotherapy alone is also selected for some cases. However, there have been very few detailed studies conducted on a large scale on the efficacy of these treatments in Japan. Of the patients enrolled in the Comprehensive Registry of Esophageal Cancer in Japan by the Japan Esophageal Society for the 2015–2017 surveys (patients treated between 2009 and 2011), the data of 388 patients treated by definitive radiotherapy alone (RTx) and 1964 patients treated by definitive chemoradiotherapy (CRTx) were analyzed. The median age of the patients was 78 years in the RTx group and 69 years in the CRTx group; thus, the proportion of elderly patients was significantly higher in the RTx group than in the CRTx group (p

Objective The right anterior lateral thoracotomy (RALT) approach for aortic valve replacement provides excellent outcomes in expert hands while avoiding sternal disruption. It, however, remains a technically demanding niche operation. Instrument trajectories via this access are influenced by patient anatomy, the intercostal space chosen, and surgical retraction maneuvers. Methods To simulate the typical surgical maneuvers, on an anatomically accurate model, and to measure the instrument trajectories, we generated a 3-dimensional (3D) printed model of the heart and chest cavity. A simulated approach to the base of the right coronary sinus via the medial-second intercostal, the lateral-second intercostal, or third intercostal space was made. Keeping the instrument in place, 3D scans of the models and geometrical measurements of the instrument trajectories were performed. Results The 3D scans of the 3D printed model showed a high fidelity when compared to the original computed tomographic scan image geometry (mean deviation of 1.26 ± 1.27mm). The instrument intrathoracic distance was 75 mm via the medial-second, 115 mm via the lateral-second, and 80 mm via the third intercostal space. The 3D angulation of the instrument to the incision was 33.77o, 55.93o, and 38.4o respectively. The distance of the instrument to the lateral margin was 12, 26, and 5 mm respectively. The cranial margin of the incision was always a limiting margin for the instrument. Conclusions Three-dimensional printing and 3D scanning facilitated a realistic simulation of the instrument trajectory during RALT approach. The lateral-second intercostal approach showed the most favorable approach angle and distance from the lateral margin, although it also had the longest intrathoracic distance.

Variants of the course of tuberculosis infection in 54 children from two to 14 years old, negatively reacting to a sample with an allergen tuberculosis recombinant (Diaskintest) were analyzed. There were 3 groups: 1st – 27 children infected with Mycobacterium tuberculosis (MBT), 50. 0% of cases; 2nd – 16 children with newly diagnosed residual post-tuberculosis changes (OPTI), 29. 6% of cases; 3rd group – 11 patients with active tuberculosis, 20. 4% of cases. Methods of examination: intradermal Mantoux test with 2TE and Diaskintest, according to the testimony of a number of patients in vitro tests: QuantiFERON test (QFT), – SPOT test.TV, multispiral computed tomography, bacteriological, molecular genetic methods of investigation on MBT. The method of mass tuberculin diagnostics revealed 70. 4 ± 8. 8% of children of the 1st group, 93. 8 ± 4. 7% of the 2nd group and 54. 6 ± 15. 0% of children of the 3rd group. The duration of infection with MBT in children was different and was less than 1 year in children of the 1st and 2nd groups – 51. 9 ± 9. 6% and 43. 8 ± 12. 4% of cases, respectively, which was significantly more frequent than in patients of the 3rd group (18. 2 ± 11. 6% of cases). Tuberculosis disease occurred in the form of complicated forms of the primary period-in 45. 5 ± 15. 0 % of cases, uncomplicated forms – in 27. 3 ± 3. 4% of cases, generalized lesions – in 27. 3 ± 13. 4% of cases. Diagnosis of a specific lesion occurred equally in the manifest phases of inflammation: infiltration, infiltration and decay (45. 5 ± 15. 0% of cases), and in the phase of ongoing reverse development (incomplete calcination – in 45. 5 ± 15. 0% of cases), one child had a combination of infiltration and calcination phases (9. 1 ± 8. 7% of cases). Residual posttuberculosis changes in children of group 2 were more often formed in the form of calcifications in the organs of the thoracic cavity – in 87. 5% of cases, in 12. 5 ± 8. 3% of patients OPTI was formed by the formation of seals. Conclusion: in children with negative reactions to the Diaskintest requires individual comprehensive diagnosis of tuberculosis infection.

Summary A 2-year-old neutered female Shiba dog exhibited laboured breathing for 1 month. Computed tomography of the thoracic cavity revealed multiple nodules (2–5 mm diameter) in the lungs. Grossly, the lungs were firm and normal in shape. The nodules were grey–white in colour. Microscopically, the nodules were non-encapsulated and exhibited an irregular shape. They were composed of polygonal or spindle cells with indistinct cell borders arranged in sheets. The cells had large, round, hyperchromatic nuclei and abundant pale eosinophilic cytoplasm with no atypia. Intrapulmonary arterial emboli and infiltration into the bronchioles were observed. Immunohistochemically, the cells were positive for vimentin and negative for cytokeratin, glial fibrillary acidic protein and α-smooth muscle actin. Ultrastructurally, the cells displayed cytoplasmic processes, desmosomes and intermediate filaments. These findings led to a diagnosis of diffuse pulmonary meningotheliomatosis with sarcomatous transformation. To the best of our knowledge, this is the first report of diffuse pulmonary meningotheliomatosis in a dog.

Background Mediastinal lipoma/liposarcoma is a rare tumor of the mediastinum. Case presentation This article reported one case of giant anterior superior mediastinum well-differentiated liposarcoma involving the left thoracic cavity with symptom of dysphagia. The mediastinum liposarcoma was completely resected through a left thoracotomy. Histologic examination and molecular pathological test clarified the diagnosis as well-differentiated mediastinal liposarcoma. There has been no evidence of recurrence during the 8 months follow-up. Conclusion Molecular pathological examination of the MDM2, CDK4 and p16 gene in tumors provides the diagnostic gold standard in distinguishing well-differentiated liposarcoma from lipoma. Complete surgical resection is the first-line treatment choice for mediastinal lipoma/ liposarcoma.

OBJECTIVE: Duchenne muscular dystrophy (DMD) is characterized by damage to muscles including the muscles involved in respiration. Dystrophic muscles become weak and infiltrated with fatty tissue, resulting in progressive respiratory impairment. The objective of this study was to assess respiratory muscle quality and function in DMD using magnetic resonance imaging and to determine the relationship to clinical respiratory function. METHODS: Individuals with DMD (n=36) and unaffected controls (n=12) participated in this cross-sectional magnetic resonance imaging study. Participants underwent dynamic imaging of the thorax to assess diaphragm and chest wall mobility and chemical shift-encoded imaging of the chest and abdomen to determine fatty infiltration of the accessory respiratory muscles. Additionally, clinical pulmonary function measures were obtained. RESULTS: Thoracic cavity area was decreased in individuals with DMD compared to controls during tidal and maximal breathing. Individuals with DMD had reduced chest wall movement in the anterior-posterior direction during maximal inspirations and expirations, but diaphragm descent during maximal inspirations (normalized to height) was only decreased in a subset of individuals with maximal inspiratory pressures less than 60% predicted. Muscle fat fraction was elevated in all three expiratory muscles assessed (p

Intrathoracic organo-axial gastric volvulus is a rare clinical entity associated with paraesophageal hernia. It is characterized by migration of the stomach into the thoracic cavity through an enlarged hiatal defect and rotation around its long axis connecting the cardia and the pylorus. A 72-year-old woman presented with epigastric pain that radiated to the left scapula for 1 week prior to presentation. Computed tomography scan of her thorax and abdomen demonstrated paraoesophageal hernia with organo-axial intrathoracic gastric volvulus. Laparoscopically, the stomach was returned to its abdominal position, the mediastinal sac was excised and after adequate intra-abdominal length of the esophagus was attained, the hiatal defect was closed primarily and reinforced with a composite mesh. An anterior 180° partial fundoplication was performed as both an anti-reflux procedure and also as a form of gastropexy. She had an uneventful recovery and remains well after 2 years.

BACKGROUND: The thoracic cavity was considered as a forbidden area in the past and anyone attempting to meddle with it was expected to be doomed. But the past several decades have seen a marked improvement in the management and reconstruction of complex chest wall defects. This study was undertaken to review our experience in chest wall reconstruction during the past 12 years and to stress upon the importance of a multidisciplinary team approach to this complex problem. METHODS: After obtaining the necessary clearance from institutional ethics committee, we did a retrospective review of all case records of chest wall reconstructions (CWR) performed in our institution during a 12-year period from May 2005 to September 2016. Patient characteristics, co-morbidities, operative data and post-operative complications and outcomes were reviewed. RESULTS: During the study period, a total of 32 patients underwent CWR. All patients were assessed, planned, operated and managed by a team consisting of thoracic surgeons, plastic surgeons, intensivists and pulmonologists. Patients were in the age group of 14–72 with a male:female ratio of 15:17. Indications for CWR were neoplasms (n = 13–40.62%), post-sternotomy wound dehiscence (n = 12–37.5%), osteoradionecrosis (n = 4–12.5%), tuberculosis (n = 2–6.25%) and osteomyelitis rib (1/32–3.125%). Inflammatory defects were mostly closed with soft tissue alone whereas skeletal stabilisation with soft tissue cover was required in tumour resections. All were pedicled flaps, the most common being pectoralis major (PM) muscle flap (n = 12). Others include latissimus dorsi (LD) muscle (n = 9); rectus abdominis (RA) muscle (n = 2); transverse rectus abdominis musculocutaneous flap (TRAM) (n = 2), deltopectoral (DP) (n = 1), omentum (n = 3) and breast flap (n = 3). Post-operative complications include wound dehiscence (12%), wound infection (21%) and recurrent sinus formation (7%). One partial flap failure was recorded. Post-operative mortality was 3%. CONCLUSION: Chest wall reconstruction is a complex procedure and each defect needs an individualised approach for optimum outcome. Extensive chest wall resections can be safely undertaken with the support of the reconstructive surgeon and with good critical care back up.

Background Pulmonary hypoplasia (PH) and congenital lobar emphysema (CLE) are very rare congenital pulmonary anomalies in veterinary medicine. PH refers to the incomplete pulmonary development due to embryologic imbalance of bronchial development between the lung buds, while CLE is defined as alveolar hyperinflation due to bronchial collapse during expiration caused by bronchial cartilage dysplasia, external bronchial compression, and idiopathic etiology. CLE may develop into pulmonary blebs or bullae that may rupture and induce a spontaneous pneumothorax. There are no reports on concurrent PH and CLE in animals. Case presentation A 7-month-old castrated male Italian Greyhound weighing 5.5 kg presented with vomiting and acute onset of severe dyspnea without any previous history of disease. After emergency treatment including oxygen supplementation and thoracocentesis, plain radiology and computed tomography scanning were performed and lobar emphysema with multiple bullae in the left cranial lung lobe associated with tension pneumothorax was identified. Since the pneumothorax was not resolved despite continuous suction of intrathoracic air for 3 days, a complete lobectomy of the left cranial lung lobe was performed. The excised lobe was not grossly divided into cranial and caudal parts, but a tissue mass less than 1 cm in size was present at the hilum and cranial to the excised lobe. Postoperatively, the dog recovered rapidly without air retention in the thoracic cavity. Histopathologically, the mass was identified as a hypoplastic lung tissue with collapsed alveoli, bronchial dysplasia, and pulmonary arterial hypertrophy. Additionally, the excised lung lobe presented CLE with marked ectasia of alveoli, various blebs and bullae, and general bronchial cartilage dysplasia. According to gross and histopathologic findings, the dog was diagnosed with concurrent PH and CLE in the left cranial lung lobe. During 16 months of follow-up, the dog was well and without any respiratory problems. Conclusions This case report confirmed the clinical and histologic features of two different types of rare congenital pulmonary anomalies, PH and CLE, which occurred concurrently in a single lung lobe of a young dog. The condition was successfully managed with lobectomy.

A female English bulldog was gave birth two neonates by cesarean section on the sixty one days after mating, but both neonates were died soon after birth. The bodies of neonates were diagnosed using radiography, ultrasonography, computed tomography and necropsy immediately after death. Both neonates had caudal regression syndrome, butterfly vertebra, hydrocephalus, umbilical hernia, cleft palate and bow-legged hind-limb. At necropsy, neonates had mild fetal anasarca, cleft lip and the skull was remained non-union. At thoracic cavity, only three ribs and thoracic spines were existed and patent ductus arteriosus was found. At abnormal cavity, the renal ectopia was found with abnormal morphology. In the present case, those English bulldog neonates with multiple congenital malformation syndromes seriously suffered vertebral column anomalies and that may induced by neural tube defects in during embryonic period. To prevent congenital malformation occurring in English bulldog, further in depth studies are needed for the breed specific genetic diversity and for the reason of behind genetic abnormality in these breed.