935 results on '"Thoracic Diseases surgery"'
Search Results
2. Giant thoracic calcinosis.
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Chermat A, Begueret H, Tricard J, Jougon J, Belaroussi Y, and Thumerel M
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- Humans, Thoracic Diseases surgery, Thoracic Diseases diagnostic imaging, Thoracic Diseases diagnosis, Calcinosis diagnostic imaging, Calcinosis surgery, Calcinosis pathology, Tomography, X-Ray Computed
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- 2024
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3. In endometriosis-related pneumothorax surgery, presence of endometriotic nodules increases postoperative air leaks and long-term relapse.
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Issard J, Vaudelin C, Imberton D, Vayssette A, Leroux M, Giol M, Khalife T, Camuset J, Debrosse D, Assouad J, and Etienne H
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- Female, Humans, Menstruation, Recurrence, Diaphragm surgery, Pneumothorax surgery, Endometriosis surgery, Thoracic Diseases surgery
- Abstract
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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- 2024
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4. Application of pedicled greater omentum flap tamponade combined with laparoscopic fenestration in diaphragmatic hepatic cyst.
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Wu Z, Chen Y, Jin Y, Liu C, Liu Y, and Zhang B
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- Humans, Omentum surgery, Liver, Cysts surgery, Liver Diseases surgery, Laparoscopy methods, Thoracic Diseases surgery
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Objective: To investigate the efficacy and clinical application advantage of omental tamponade with vascular pedicle combined with Laparoscopic fenestration for the treatment of diaphragmatic hepatic cyst., Methods: A total of 56 patients with diaphragmatic hepatic cysts underwent laparoscopic surgery in a single tertiary academic medical center from January 2010 to October 2020, including 21 patients (non-omental group) underwent laparoscopic fenestration of liver cysts, and 36 patients underwent laparoscopic liver cyst fenestration combined with vascular pedicle omentum tamponade (omental group). The general conditions and follow-up results of the two groups were compared and annalyzed., Results: The operation time of the omental group was longer than that of the non-omental group (P = 1.358E-4). There was no significant difference in postoperative complications, postoperative laboratory values and hospital costs (P>0.05). The length of hospital stay in omental group was shorter than that in non-omental group (P = 0.034). In the omental group, recurrence occurred in 1 of 35 patients (4.65%) who were followeded up 12 months after surgery. In the non-omental group, of the 21 patients followed, 3 patients (14.28%) recurred 6 months after surgery, and 8 patients (38.10%) recurred 12 months after surgery., Conclusion: It is an effective method to prevent the recurrence of diaphragmatic hepatic cyst after laparoscopic fenestration by packing the cyst with vascularized omentum., (© 2022. The Author(s).)
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- 2022
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5. Surgical management of diaphragmatic and thoracic endometriosis': A French multicentric descriptive study.
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Wetzel A, Philip CA, Golfier F, Bonnot PE, Cotte E, Brichon PY, Darnis B, Chene G, Michy T, Hoffmann P, Tronc F, and Dubernard G
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- Adult, Diaphragm abnormalities, Endometriosis epidemiology, Endometriosis surgery, Female, France epidemiology, Hospitals, University organization & administration, Hospitals, University statistics & numerical data, Humans, Middle Aged, Recurrence, Retrospective Studies, Thoracic Diseases epidemiology, Diaphragm surgery, Endometriosis complications, Thoracic Diseases surgery
- Abstract
Introduction: Surgical management of Diaphragmatic and thoracic endometriosis (DTE) is still controversial, a thoracic or an abdominal approach can be proposed., Methods: We conducted a multicentric retrospective study in 8 thoracic, gynecology or digestive surgery units in 5 French university hospitals. The main objective was to review the current management of DTE., Results: 50 patients operated for DTE from 2010 to 2017 were included: 26 with a thoracic approach and 24 with an abdominal approach. Preoperative pelvic endometriosis (PE) concerned 25 patients. In 38 patients, DTE diagnosis was made on clinical symptoms (pneumothorax (n = 19), chronic or catamenial chest pain (n = 18) or hemopneumothorax (n = 1)). Median time from onset of symptoms to diagnosis was 47 months (0-212). PE surgery concurrently occurred in 22 patients. We report diaphragmatic nodules, pleuropulmonary nodules and diaphragmatic perforations in 42, 5 and 22 women respectively. Lesions were right-sided in 45 patients. Nodules were destructed in 12 cases and resected in 38 cases. When a diaphragmatic reconstruction was needed (n = 31), a simple suture was performed in 26 patients, while 5 patients needed a mesh repair. Pleural symphysis was performed for all patients who received a thoracic approach. DTE resection was considered complete in 46 patients. Three patients had severe 30-days complications of DTE surgery. Median follow-up was 20 months (range 1-69). Recurrence occurred in 10 patients., Conclusion: The results emphasize the importance of systematically looking for chest pain in patients suffering from PE and underline the lack of a standardized procedure and treatment in DTE., Competing Interests: Declaration of Competing Interest none, (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)
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- 2021
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6. Cardiothoracic Surgical Volume Within the Military Health System: Fiscal Years 2007 to 2017.
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Johnson JC, Morey BL, Carroll AM, Strevig MA, Ramirez AR, Mullenix PS, Wozniak CJ, and Ricca RL
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- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Retrospective Studies, United States, Young Adult, Cardiac Surgical Procedures statistics & numerical data, Military Health Services statistics & numerical data, Patient Acceptance of Health Care statistics & numerical data, Surgeons statistics & numerical data, Thoracic Diseases surgery
- Abstract
Background: Cardiothoracic surgical services have been provided at 7 military treatment facilities over the past decade. Accurate case volume data for adult cardiac and general thoracic surgical service lines in the Military Health System is unknown., Methods: We queried the Military Health System Data Repository for adult cardiac and general thoracic cases performed at military treatment facilities in the Military Health System and surrounding purchased care markets for fiscal years 2007 to 2017. Cases were filtered and classified into major cardiac and major general thoracic categories. Five military treatment facility markets had sufficient cardiac case data to perform cost analysis., Results: Institutional major cardiac case volume was low across the Military Health System with less than 100 cardiopulmonary bypass cases per year (range, 17-151 cases per year) performed most years at each military treatment facility. Similarly, general thoracic surgical case volume was universally low, with less than 30 anatomic lung resections (range, 0-26) and fewer than 5 esophageal resections (range, 0-4) performed at each military treatment facility annually. Cost analysis revealed that provision of cardiac surgical services is significantly more expensive at most military treatment facilities compared with their surrounding purchased care markets., Conclusions: Adult cardiac and general thoracic surgical volume within the Military Health System is low across all institutions and inadequate to provide clinical readiness for active-duty surgeons. Recapture of major cases from the purchased care market is unlikely and would not significantly increase military treatment facility or individual surgeon case volume., (Published by Elsevier Inc.)
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- 2021
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7. Reducing Unnecessary Chest X-Ray Films After Thoracic Surgery: A Quality Improvement Initiative.
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Porter ED, Kelly JL, Fay KA, Hasson RM, Millington TM, Finley DJ, and Phillips JD
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- Aged, Female, Humans, Inpatients, Male, Postoperative Period, Retrospective Studies, Thoracic Diseases diagnosis, Quality Improvement, Radiography, Thoracic statistics & numerical data, Thoracic Diseases surgery, Thoracic Surgical Procedures, Unnecessary Procedures statistics & numerical data
- Abstract
Background: Previous work has identified that inpatient post-thoracic surgery chest x-ray films (CXR) are overutilized., Methods: A three-phase rapid cycle quality improvement initiative was performed to reduce empiric post-thoracic surgery CXR use by 25% over 1 year. We adapted evidence-based guidelines and implemented "plan-do-study-act" (PDSA) cycle methodology. The PDSA cycles included (1) education with literature and preintervention statistics; (2) electronic medical record order-set modification; and (3) audit and feedback with monthly status reports. Each cycle lasted 3 months. Use of CXR was tracked in the post-anesthesia care unit and as a daily rate of non-post-anesthesia care unit CXRs. Cost data were estimated from Centers for Medicare & Medicaid Services fees., Results: During the initiative, 292 thoracic surgery inpatients were monitored. Before intervention, 99% of patients (69 of 70) received a post-anesthesia care unit CXR, and the daily rate of other CXRs was 1.6. Overall, there was a significant reduction in CXR utilization (P < .001). Post-anesthesia care unit CXRs decreased by 42%, lowering to 89% (68 of 76) to 68% (50 of 74) to 57% (41 of 72) in PDSA cycles 1 through 3, respectively. The daily rate of other CXRs decreased by 38%, lowering to 1.4 to 1.3 to 1.0. Patient perioperative characteristics and health care quality measures were not different between cycles. After quality improvement implementation, cost savings were estimated to be at least $73,292 per year., Conclusions: Implementation of our quality improvement initiative safely and systematically reduced empiric CXR use after inpatient thoracic surgery. Results will be used in future quality improvement initiatives to reduce unnecessary postoperative testing., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2021
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8. The Man Behind the Clagett Procedure: Dr Oscar Theron "Jim" Clagett.
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Hemmati P, Arghami A, Dearani JA, Schaff HV, Daly RC, and Nichols FC
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- History, 20th Century, Humans, Male, Thoracic Diseases surgery, Thoracic Surgical Procedures methods, United States, Thoracic Diseases history, Thoracic Surgical Procedures history
- Abstract
Dr O.T. "Jim" Clagett was a pioneer in surgery of the great vessels and thorax. The procedure that bears his name for treatment of postpneumonectomy empyema was only one of his many innovations in aortic, lung, and esophageal surgery. He performed over 35,000 operations and trained over 115 residents during his tenure at Mayo Clinic. His distinguished career highlights include: helping develop the field of cardiothoracic surgery during its infancy, starting the Thoracic Surgery Residency Program at Mayo Clinic, serving in numerous institutional and national leadership roles, and countless awards., (Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
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- 2021
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9. Thoracic endometriosis syndrome in Nigeria: a single-centre experience.
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Ezemba N, Okafor OC, Emeruem NU, and Adiri CO
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- Adult, Diaphragm, Female, Humans, Lung pathology, Middle Aged, Nigeria, Pleura pathology, Pneumothorax surgery, Young Adult, Endometriosis complications, Endometriosis surgery, Hemothorax etiology, Pneumothorax etiology, Thoracic Diseases complications, Thoracic Diseases surgery
- Abstract
Objectives: Thoracic endometriosis syndrome (TES) is the presence of functional endometrial tissue in or around the lung. There seem to be differences in the clinical presentation of this condition among Nigerian patients. We aim to study the clinical presentation and management outcome of TES in our centre., Methods: This is an analysis of consecutive patients with TES treated over a 5-year period and followed up for 6 months to 5 years. Information collected included the gynaecological history, clinical presentation, causes of misdiagnosis, modalities of treatment and outcome., Results: Twenty-three patients with TES aged between 24 and 45 years (median 32 years) were treated. Severe dysmenorrhoea was a prominent symptom in 91.3% of cases (median dysmenorrhoea score 8) and was uninfluenced by the marital status (P = 0.522). The patients usually presented with massive or recurrent haemothorax associated with massive ascites [16/23 (69.5%) of cases (P = 0.0006)]. The right side alone was involved in 21 cases and 1 patient had catamenial haemoptysis as a part of her symptoms, even though there was bronchial bleed at bronchoscopy in 6 patients. In 40%, tuberculosis was the misdiagnosis. Diagnosis was established histologically in 18/23 (78.3%) of the cases. Treatment was multimodal and multidisciplinary with notable macroscopic lesions in 77.8% of the patients that had surgery., Conclusions: TES is not an uncommon lesion. Presentation with massive haemothorax is usually associated with massive ascites. A large percentage of such have pleural and diaphragmatic lesions that require surgical treatment. The ascites may be refractory to treatment requiring repeated paracentesis., (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2021
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10. [Haemothorax revealing thoracic endometriosis].
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Barzilai M, Roriz M, Guyard A, Debray MP, Pellenc Q, Papo T, and Sacre K
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- Adult, Endometriosis complications, Endometriosis surgery, Female, Hemothorax etiology, Hemothorax surgery, Humans, Pleural Diseases complications, Pleural Diseases diagnosis, Pleural Diseases surgery, Pneumothorax diagnosis, Pneumothorax etiology, Pneumothorax surgery, Recurrence, Thoracic Diseases complications, Thoracic Diseases surgery, Endometriosis diagnosis, Hemothorax diagnosis, Thoracic Diseases diagnosis
- Abstract
Introduction: Thoracic endometriosis (TE) is a rare disorder affecting women during their reproductive years. Manifestations of TE include pneumothorax and haemothorax. Treatment is based on surgical and hormonal therapy that aims at eradicating existing endometrial thoracic plaques and to prevent reseeding from pelvic endometriosis., Case Report: We report the case of a 36 year-old young woman presenting thoracic endometriosis revealed by a recurring spontaneous, large and isolated right haemothorax. Diagnosis, pathogeny and treatment are discussed., Conclusion: Thoracic endometriosis needs to be considered as a cause of haemothorax in women of childbearing age., (Copyright © 2020. Published by Elsevier Masson SAS.)
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- 2020
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11. Choice between video-assisted thoracic surgery and thoracotomy: importance of required operative time and blood transfusion.
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Lang ZP and Bao MW
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- Female, Humans, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Blood Transfusion, Operative Time, Thoracic Diseases surgery, Thoracic Surgery, Video-Assisted, Thoracotomy
- Abstract
Objective: The current evidence in support of Video-assisted thoracic surgery (VATS) over conventional open thoracotomy is based upon outcomes related to perioperative complications. The aim of the current study was to compare the mean operative time and amount of blood transfusion required for VATS and thoracotomy., Patients and Methods: A retrospective data analysis was carried out of all patients undergoing pulmonary surgery in the year 2017 for either for benign or malignant conditions at our institute. The primary outcomes were mean operative times and amounts of blood transfusion required during the procedure. Adjusted regression models were used to draw an association between the type of surgical modality (VATS or thoracotomy) and the outcomes considered., Results: There were 278 subjects that underwent VATS and 237 that had thoracotomy. The mean operating time for the VATS group (2.58 ± 0.98 hours) was significantly less than that of the thoracotomy group (2.99 ± 1.18 hours). Similarly, the amounts of combined blood and plasma transfused were significantly less with VATS (5.81±6.3 units) as compared to the thoracotomy group (9.9 ± 15.1 units). VATS also required significantly fewer blood units as compared to thoracotomy (3.79 ± 3.1 vs. 7.15 ± 12.3). Our analysis indicated that, with VATS, the requirement of blood and plasma transfusion was reduced by nearly 4 units (b=-4.09; 95% CI: -6.04, -2.14) and the mean operative time was reduced by around 40 minutes (b=-0.41; 95% CI: -0.60, -0.22)., Conclusions: Both VATS and thoracotomy are acceptable surgical techniques for the management of lung pathology. However, VATS technique is associated with lower need for blood transfusion and reduced operating time. The decision of the surgical technique should be guided by the availability of resources and the skills of the surgeon.
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- 2020
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12. Thoracic endometriosis-related non-catamenial pneumothorax with peculiar histological findings.
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Scarnecchia E, Inzirillo F, Declich P, and Della Pona C
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- Biopsy, Diagnostic Errors, Endometriosis complications, Endometriosis diagnosis, Female, Humans, Middle Aged, Pneumothorax diagnosis, Pneumothorax etiology, Recurrence, Thoracic Diseases complications, Thoracic Diseases diagnosis, Endometriosis surgery, Lung diagnostic imaging, Pneumothorax surgery, Thoracic Diseases surgery, Thoracic Surgery, Video-Assisted methods
- Abstract
Thoracic endometriosis-related non-catamenial pneumothorax is a rare entity whose pathogenesis is still less unclear than catamenial pneumothorax one. Hormonal therapy and/or talc pleurodesis are not sufficient for successful management. Surgical videothoracoscopic resection has a central role in the treatment. We displace a case of thoracic endometriosis-related non-catamenial pneumothorax presenting with recurrent right pneumothorax, surgically treated three times and misdiagnosed at first two interventions. At third operation, unusual histological findings on diaphragmatic and pulmonary specimens were disclosed. These results could partially clarify the presentation of some complicated misdiagnosed cases. More has to be investigated about pathogenesis of the disease and influence of the hormonal balance on it.
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- 2020
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13. Complete resections of giant thorax masses and experienced difficulties.
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Yenigün BM, Yüksel C, İbrahimov F, Yücemen U, Gürsoy Çoruh A, Kahya Y, Kocaman G, Özkan M, Enön S, and Kayı Cangır A
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- Adult, Aged, Female, Humans, Male, Middle Aged, Thoracic Diseases pathology, Thoracic Neoplasms diagnostic imaging, Thoracic Neoplasms surgery, Tomography, X-Ray Computed, Young Adult, Neurosurgical Procedures, Thoracic Diseases diagnostic imaging, Thoracic Diseases surgery, Thorax diagnostic imaging
- Abstract
Introduction: Thoracic giant masses do not have a clear definition. In some publications, giant thoracic mass definition is used in tumors whose long axis is> 10 cm and in other publications covering more than 50% of the hemithorax. In this study, demographic data of patients with a massive resectable giant thoracic mass and the difficulties and experiences experienced in the peroperative process were reviewed with a general perspective., Materials and Methods: 14 giant intrathoracic masses operated at the department of Thoracic Surgery, School of Medicine, Ankara University were included in the study. The masses occupying more than half of the hemithorax and mediastinal lesions with a long axis of 15 cm or larger radiologically were included and evaluated., Result: 9 (64.3%) of our patients were male and 9 (35.7%) were female. The average age was 49.2 ± 17.1(between18-68). The tumor localizations of our patients were determined as 9 (64.2%) hemithorax and 5 (35.8%) mediastinal. When the radiological and intraoperative dimensions were examined separately, it was observed that the mean of long axis of CT image is average 18 ± 3.8 cm (between 12 cm and 26 cm), and the mean of long axis of specimen is average 18.14 ± 3.6 cm (between 15 cm and 23 cm). The heaviest mass was average 844 ± 473 g (350 g-2204 g)., Conclusions: The surgical maneuvers and hence the excision of giant masses become difficult to operate due to the narrow localization of the masses and the frequent invasions of adjacent vascular structures and nerve tissues. However, complete resection of these slowly growing and generally encapsulated masses can provide the cure.
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- 2020
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14. Single massive thoracolithiasis.
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Ladegaard PBJ, Ladegaard L, Carter-Storch R, and Christensen NL
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- Aged, Calculi surgery, Humans, Lithiasis surgery, Male, Positron Emission Tomography Computed Tomography, Thoracic Diseases surgery, Thoracic Surgery, Video-Assisted, Tomography, X-Ray Computed, Calculi diagnostic imaging, Lithiasis diagnostic imaging, Thoracic Diseases diagnostic imaging
- Abstract
Competing Interests: Competing interests: None declared.
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- 2020
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15. Innovations - The COVID-19 Pandemic.
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Ad N
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- COVID-19, Coronavirus Infections complications, Humans, Pneumonia, Viral complications, SARS-CoV-2, Thoracic Diseases surgery, Betacoronavirus, Coronavirus Infections epidemiology, Pandemics, Pneumonia, Viral epidemiology, Thoracic Diseases complications, Thoracic Surgical Procedures standards
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- 2020
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16. Video-assisted thoracoscopic surgery is a safe and effective method to treat intrathoracic unicentric Castleman's disease.
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Wang YQ, Li SQ, and Guo F
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- Adolescent, Adult, Aged, Female, Humans, Male, Middle Aged, Retrospective Studies, Thoracotomy, Vena Cava, Superior, Young Adult, Castleman Disease diagnosis, Castleman Disease diagnostic imaging, Castleman Disease surgery, Thoracic Diseases diagnosis, Thoracic Diseases diagnostic imaging, Thoracic Diseases surgery, Thoracic Surgery, Video-Assisted
- Abstract
Background: Castleman's disease (CD) is a rare non-clonal lymphadenopathy. Application of video-assisted thoracoscopic surgery (VATs) in intrathoracic unicentric Castleman's disease (UCD) is rarely reported. This study is aimed to clarify the role of VATs for diagnosis and treatment in intrathoracic UCD., Methods: The authors reviewed and identified patients who had received a histologic diagnosis of CD through VATs at our hospital from January2010 to June 2018. Clinical and radiologic variables, histopathology, type of approach, complications, and long-term effect were analyzed to evaluate the safety and efficacy of VATs., Results: A total of 10 patients were included in this study, with 8 hyaline vascular type and 2 plasma cell type. The mean maximum diameter of the lesions was 4.66 cm. Nine cases underwent complete surgical excision by VATs, and 1 case was converted to thoracotomy. All patients had no postoperative complications. With a median follow-up of 5 years (range: 1-9 years), no tumor recurrence was found in 9 patients receiving complete tumor resection, and 1 patient with incomplete tumor resection remained symptom free without clinical or radiographic progression., Conclusions: VATs is an alternative, minimally invasive technique for the diagnosis and treatment in patients with intrathoracic UCD.
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- 2020
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17. General thoracic surgery services across Asia during the 2020 COVID-19 pandemic.
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Jheon S, Ahmed AD, Fang VW, Jung W, Khan AZ, Lee JM, Nakajima J, Sihoe AD, Thongcharoen P, Tsuboi M, and Turna A
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- Asia epidemiology, COVID-19, Comorbidity, Humans, Lung Neoplasms epidemiology, SARS-CoV-2, Thoracic Diseases epidemiology, Betacoronavirus, Coronavirus Infections epidemiology, Delivery of Health Care statistics & numerical data, Lung Neoplasms surgery, Pandemics, Pneumonia, Viral epidemiology, Thoracic Diseases surgery, Thoracic Surgical Procedures statistics & numerical data
- Abstract
The COVID-19 pandemic of 2020 posed an historic challenge to healthcare systems around the world. Besides mounting a massive response to the viral outbreak, healthcare systems needed to consider provision of clinical services to other patients in need. Surgical services for patients with thoracic disease were maintained to different degrees across various regions of Asia, ranging from significant reductions to near-normal service. Key determinants of robust thoracic surgery service provision included: preexisting plans for an epidemic response, aggressive early action to "flatten the curve", ability to dedicate resources separately to COVID-19 and routine clinical services, prioritization of thoracic surgery, and the volume of COVID-19 cases in that region. The lessons learned can apply to other regions during this pandemic, and to the world, in preparation for the next one.
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- 2020
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18. Thoracic splenosis: Case report of a symptomatic case.
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Le Bars F, Pascot R, Ricordel C, Corbineau H, Verhoye JP, Richard De Latour B, and Rouzé S
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- Adult, Humans, Male, Splenectomy, Splenosis pathology, Splenosis surgery, Thoracic Diseases pathology, Thoracic Diseases surgery, Thoracotomy, Abdominal Injuries complications, Asymptomatic Diseases, Spleen injuries, Splenosis diagnosis, Splenosis etiology, Thoracic Diseases diagnosis, Thoracic Diseases etiology, Thoracic Injuries complications, Unnecessary Procedures
- Abstract
Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy., Competing Interests: Declaration of Competing Interest The authors declared no competing interest., (Copyright © 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. All rights reserved.)
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- 2020
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19. Chondromesenchymal hamartomas in a 24-year-old male mimicking a posterior mediastinal tumor and a 5-month-old boy with postoperative disseminated intravascular coagulation: two case reports.
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Li Y, Zheng D, Zuo M, Li Y, and Zhang H
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- Diagnosis, Differential, Hamartoma diagnosis, Humans, Infant, Male, Mediastinal Neoplasms diagnosis, Ribs pathology, Ribs surgery, Thoracic Diseases diagnosis, Young Adult, Disseminated Intravascular Coagulation etiology, Hamartoma pathology, Hamartoma surgery, Thoracic Diseases pathology, Thoracic Diseases surgery, Thoracic Surgical Procedures adverse effects
- Abstract
Background: Chondromesenchymal hamartoma of the chest wall is a rare, benign disease that usually presents at birth or in early infancy. It typically involves one or more ribs, forming a unilateral or bilateral extrapleural mass. Patients may be asymptomatic or complain of mild respiratory distress depending on tumor size and location. To the best of our knowledge, only two of the approximately 100 cases reported so far are adults., Case Presentation: We present two cases of chondromesenchymal hamartoma. The first case involved the left fifth rib in a 24-year-old male, in close proximity to the fifth vertebral body in the left posterior mediastinum, mimicking a posterior mediastinal tumor on imaging. The tumor was excised via thoracoscopy and the patient had an uneventful postoperative course. The second case was that of a 5-month-old boy, who had a tumor involving the left fifth and sixth ribs which caused thoracic cage collapse. Following en bloc resection of the tumor and the involved rib segments, the patient was transferred to the intensive care unit for treatment of pulmonary infection and disseminated intravascular coagulation (DIC). He was discharged from the hospital in stable condition 11 days later. On histopathology, the tumor was found to be a chondromesenchymal hamartoma with immature spindle-shaped mesenchymal cells, plate-like hyaline cartilage, areas of woven bone formation, endochondral ossification and calcification, osteoclastic giant cells, and secondary aneurysmal bone cysts., Conclusions: Although the presently reported cases have morphological characteristics similar to previously reported ones, they had distinct radiological and clinical characteristics. Patient 1 is only the third report of an adult with chondromesenchymal hamartoma. His case was characterized by its radiological appearance mimicking a posterior mediastinal tumor. Patient 2 represents the first documentation of DIC as a postoperative complication following excision of a chondromesenchymal hamartoma. We present these two cases to provide clinicopathological insights regarding this extremely rare tumor that are relevant to both pathologists and clinicians.
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- 2020
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20. Paravertebral Block Versus Intercostal Nerve Block in Non-Intubated Uniportal Video-Assisted Thoracoscopic Surgery: A Randomised Controlled Trial.
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Mogahed MM and Elkahwagy MS
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- Adult, Female, Humans, Intercostal Nerves, Male, Postoperative Period, Anesthesia, Conduction methods, Nerve Block methods, Pain, Postoperative prevention & control, Thoracic Diseases surgery, Thoracic Surgery, Video-Assisted methods
- Abstract
Background: Non-intubated uniportal video-assisted thoracoscopic surgery (VATS) has been reported to be safe and feasible for patients with various thoracic diseases, including those who have respiratory dysfunction. This study examined the anaesthetic and analgesic sparing effects of either paravertebral block or intercostal nerve block on the non-intubated technique with spontaneous ventilation in patients under general anaesthesia (GA) using a supraglottic airway device. The primary aim was to compare the anaesthetic sparing effect of paravertebral block versus intercostal nerve block in non-intubated GA with airway support via a supraglottic airway device during VATS surgery. The secondary aim was to compare the recovery characters and postoperative outcomes of the patients., Methods: The study included 105 patients with American Society of Anesthesiologists (ASA) physical status II-III who had video-assisted thoracoscopy without endotracheal intubation and using a laryngeal airway. The patients were divided into three groups; each group consisted of 35 patients. Group I (35 patients): control group received only GA. Group 2 (35 patients): received a single-shot paravertebral block before induction of the GA. Group 3 (35 patients): received thoracoscopic intercostal block infiltration after induction of anaesthesia from the third to the eighth intercostal nerve block, in addition to intrathoracic vagal block. Heart rate, mean arterial pressure (MAP), and oxygen saturation were recorded before induction of GA (T0), after induction of GA (T1), 20 minutes later (T2), and before the end of the surgical procedure (T3)., Results: Heart rate was significantly lower in Groups 2 and 3 compared with Group 1, and lower in Group 2 compared with Group 3. The MAP was significantly lower in Groups 2 and 3 compared with Group 1, and there was no significant difference between Groups 2 and 3. Oxygen saturation was significantly higher in Group 2 and in Group 3 compared with Group 1 and there was no significance difference between Groups 2 and 3. Expiratory fraction of sevoflurane (Ef sevo) was significantly lower in Groups 2 and 3 compared with Group 1, with no difference between Group 2 and 3. Groups 2 and 3 had lower fentanyl requirements, time to spontaneous eye movement, time to spontaneous arm movement, time to purposeful movement, and time to laryngeal mask removal than Group 1., Conclusions: Regional anaesthesia by either preoperative paravertebral block or thoracoscopic intercostal nerve block with ipsilateral vagal block provided an anaesthetic sparing effect, guided by lower Ef sevo concentration, with comparable bi-spectral index in patients undergoing uniportal thoracoscopic surgery., (Copyright © 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)
- Published
- 2020
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21. Understanding Respiratory Restrictions as a Function of the Scoliotic Spinal Curve in Thoracic Insufficiency Syndrome: A 4D Dynamic MR Imaging Study.
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Udupa JK, Tong Y, Capraro A, McDonough JM, Mayer OH, Ho S, Wileyto P, Torigian DA, and Campbell RM Jr
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- Adolescent, Child, Female, Humans, Male, Orthopedic Equipment, Retrospective Studies, Thoracic Wall diagnostic imaging, Thoracic Wall pathology, Treatment Outcome, Magnetic Resonance Imaging methods, Prosthesis Implantation adverse effects, Prosthesis Implantation instrumentation, Prosthesis Implantation methods, Respiratory Insufficiency diagnosis, Respiratory Insufficiency etiology, Respiratory Insufficiency physiopathology, Respiratory Insufficiency prevention & control, Ribs surgery, Scoliosis complications, Scoliosis diagnosis, Scoliosis physiopathology, Scoliosis surgery, Thoracic Diseases diagnosis, Thoracic Diseases etiology, Thoracic Diseases physiopathology, Thoracic Diseases surgery
- Abstract
Background: Over the past 100 years, many procedures have been developed for correcting restrictive thoracic deformities which cause thoracic insufficiency syndrome. However, none of them have been assessed by a robust metric incorporating thoracic dynamics. In this paper, we investigate the relationship between radiographic spinal curve and lung volumes derived from thoracic dynamic magnetic resonance imaging (dMRI). Our central hypothesis is that different anteroposterior major spinal curve types induce different restrictions on the left and right lungs and their dynamics., Methods: Retrospectively, we included 25 consecutive patients with thoracic insufficiency syndrome (14 neuromuscular, 7 congenital, 4 other) who underwent vertical expandable prosthetic titanium rib surgery and received preimplantation and postimplantation thoracic dMRI for clinical care. We measured thoracic and lumbar major curves by the Cobb measurement method from anteroposterior radiographs and classified the curves as per Scoliosis Research Society (SRS)-defined curve types. From 4D dMRI images, we derived static volumes and tidal volumes of left and right lung, along with left and right chest wall and left and right diaphragm tidal volumes (excursions), and analyzed their association with curve type and major curve angles., Results: Thoracic and lumbar major curve angles ranged from 0 to 136 and 0 to 116 degrees, respectively. A dramatic postoperative increase in chest wall and diaphragmatic excursion was seen qualitatively. All components of volume increased postoperatively by up to 533%, with a mean of 70%. As the major curve, main thoracic curve (MTC) was associated with higher tidal volumes (effect size range: 0.7 to 1.0) than thoracolumbar curve (TLC) in preoperative and postoperative situation. Neither MTC nor TLC showed any meaningful correlation between volumes and major curve angles preoperatively or postoperatively. Moderate correlations (0.65) were observed for specific conditions like volumes at end-inspiration or end-expiration., Conclusions: The relationships between component tidal volumes and the spinal curve type are complex and are beyond intuitive reasoning and guessing. TLC has a much greater influence on restricting chest wall and diaphragm tidal volumes than MTC. Major curve angles are not indicative of passive resting volumes or tidal volumes., Level of Evidence: Level II-diagnostic.
- Published
- 2020
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22. Intrathoracic Splenosis Without Clinical Evidence of Diaphragmatic Rupture.
- Author
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Buttar SN and Ravn J
- Subjects
- Humans, Male, Middle Aged, Splenosis etiology, Thoracic Diseases etiology, Thoracic Surgery, Video-Assisted, Tomography, X-Ray Computed, Splenosis diagnosis, Splenosis surgery, Thoracic Diseases diagnosis, Thoracic Diseases surgery
- Abstract
Intrathoracic splenosis is a rare diagnosis that is usually made after an invasive procedure. Most cases report concomitant rupture of the spleen and left hemidiaphragm with autotransplantation of splenic tissue into the left hemithorax. We report a case of intrathoracic splenosis with no evidence of diaphragmatic rupture. The mechanism may be explained by hematogenous spread. The patient underwent video-assisted thoracoscopic surgery for diagnosis, which could have been avoided if splenosis was suspected., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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23. Site-specific Surgical Site Infection Rates for Rib-based Distraction.
- Author
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Striano BM, Refakis CA, Anari JB, Campbell RM, and Flynn JM
- Subjects
- Child, Child, Preschool, Cohort Studies, Databases, Factual, Humans, Philadelphia epidemiology, Prostheses and Implants adverse effects, Quality Improvement, Reoperation, Retrospective Studies, Risk Factors, Surgical Wound Infection etiology, Thoracic Diseases surgery, Osteogenesis, Distraction adverse effects, Ribs surgery, Scoliosis surgery, Surgical Wound Infection epidemiology
- Abstract
Background: Implantable rib-based distraction devices have revolutionized the treatment of children with early onset scoliosis and thoracic insufficiency syndrome. Unfortunately, the need for multiple skin incisions and repeated surgeries in a fragile patient population creates considerable infection risk. In order to assess rates of infection for different incision locations and potential risk factors, we generated a prospectively collected database of patients treated with rib-based distraction devices., Methods: We analyzed a cohort of patients with thoracic insufficiency syndrome from various etiologies that our institution treated with rib-based distraction devices from 2013 to 2016. Surgery type (implantation, expansion, revision/removal), and surgeon adjudicated surgical site infection (SSI) were collected. For this study, we developed a novel, rib-based distraction device surgical site labeling system in which incisions could be labeled as either proximal or distal surgical exposure areas. Treating surgeons documented the operative site, procedure, and SSI site in real-time., Results: A total of 166 unique patients underwent 670 procedures during the study period, producing 1537 evaluable surgical sites; 1299 proximal and 238 distal. Patients were 6.81±4.0 years of age on average. Forty-seven procedures documented SSIs (7.0%), while 40 (24.1%) patients experienced an infection. Analysis showed significant variation in the rate of infection between implantation, and expansion, and revision procedures, with implantation procedures having the highest infection rate at 13.1% (P<0.01). Infections occurred more frequently at distal sites than proximal ones (P=0.02)., Conclusions: Our novel, surgeon-entered, prospective quality improvement database has identified distal surgical sites as being at higher risk for SSI than proximal ones. Further, rib-based distraction device implantation procedures were identified as being at a greater risk for SSI than expansion or revision procedures. We believe this data can lead to improved prevention measures, anticipatory guidance, and patient care., Level of Evidence: Level II-prognostic study.
- Published
- 2019
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24. Cyriax syndrome: a misdiagnosed condition of the chest wall.
- Author
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Zairi S, Hadj Dahmane M, Attia M, Dridi A, Mestiri T, and Marghli A
- Subjects
- Adult, Diagnostic Errors, Humans, Male, Musculoskeletal Diseases complications, Musculoskeletal Diseases surgery, Orthopedic Procedures, Predictive Value of Tests, Thoracic Diseases complications, Thoracic Diseases surgery, Treatment Outcome, Abdominal Pain etiology, Musculoskeletal Diseases diagnosis, Ribs diagnostic imaging, Ribs surgery, Thoracic Diseases diagnosis
- Published
- 2019
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25. Sternal allograft transplantation for anterior chest wall reconstruction after sternectomy.
- Author
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Dell'Amore A, Comacchio G, Ferrigno P, Pangoni A, Schiavon M, and Rea F
- Subjects
- Allografts, Humans, Male, Middle Aged, Bone Neoplasms surgery, Chondrosarcoma surgery, Sternum transplantation, Thoracic Diseases surgery, Thoracic Wall surgery, Thoracoplasty methods
- Abstract
The reconstruction of the anterior chest wall after sternectomy for cancer or after mediastinitis is still a challenging procedure for the thoracic surgeon. Different surgical techniques and materials have been used for anterior chest wall reconstruction, but none of them is yet considered to be the gold standard. In this video tutorial, we report on our experience of using a sternal allograft for reconstruction of the anterior chest wall. Sternal allografts offer the same advantages as bone autografts and obviously are perfectly shaped for sternal replacement. They are simple to trim and to fix to the chest wall and, unlike autografts, do not require the patient to undergo an additional incision and procedure for harvesting the bone., (© The Author 2016. Published by MMCTS on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
- Published
- 2019
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26. Thoracic Endometriosis Syndrome: A Review of Diagnosis and Management.
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Nezhat C, Lindheim SR, Backhus L, Vu M, Vang N, Nezhat A, and Nezhat C
- Subjects
- Adult, Diaphragm surgery, Endometriosis diagnosis, Female, Hemothorax diagnosis, Humans, Laparoscopy, Pleural Diseases diagnosis, Pleural Diseases surgery, Pneumothorax diagnosis, Recurrence, Thoracic Diseases diagnosis, Endometriosis surgery, Hemothorax surgery, Pneumothorax surgery, Thoracic Diseases surgery, Thoracic Surgery, Video-Assisted
- Abstract
Background: Endometriosis is characterized by the presence of endometrial-like glands and stroma outside the uterine cavity and is believed to affect 6%-10% of reproductive-age women. Endometriosis within the lung parenchyma or on the diaphragm and pleural surfaces produces a range of clinical and radiological manifestations. This includes catamenial pneumothorax, hemothorax, hemoptysis, and pulmonary nodules, resulting in an entity known as thoracic endometriosis syndrome (TES)., Database: Computerized searches of MEDLINE and PubMed were conducted using the key words "thoracic endometriosis," "catamenial pneumothorax," "catamenial hemothorax," and "catamenial hemoptysis." References from identified sources were manually searched to allow for a thorough review., Conclusion: TES can produce incapacitating symptoms for some patients. Symptoms of TES are nonspecific, so a high degree of clinical suspicion is warranted. Medical management represents the first-line treatment approach. When this fails or is contraindicated, definitive surgical treatment for cases of suspected TES uses a combined video laparoscopy performed by a gynecologic surgeon and video-assisted thoracoscopic surgery performed by a thoracic surgeon. Postoperative hormonal suppression may further reduce disease recurrence., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest directly relevant to the content of this article.
- Published
- 2019
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27. Intrathoracic renal ectopia with congenital diaphragmatic hernia.
- Author
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Peterson JLH, Riggs H, Nedungadi S, Lansdale N, and Kamupira S
- Subjects
- Choristoma surgery, Female, Hernias, Diaphragmatic, Congenital surgery, Humans, Infant, Newborn, Radiography, Thoracic Diseases surgery, Tomography, X-Ray Computed, Choristoma diagnostic imaging, Hernias, Diaphragmatic, Congenital diagnostic imaging, Kidney diagnostic imaging, Thoracic Diseases diagnostic imaging
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2019
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28. Mesenchymal hamartoma of the chest wall in a 10-year-old girl mimicking malignancy: a case report.
- Author
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Tanaka T, Fumino S, Shirai T, Konishi E, and Tajiri T
- Subjects
- Biopsy, Large-Core Needle, Child, Contrast Media, Diagnosis, Differential, Female, Humans, Magnetic Resonance Imaging, Ribs diagnostic imaging, Ribs surgery, Thoracoscopy, Tomography, X-Ray Computed, Hamartoma diagnostic imaging, Hamartoma surgery, Thoracic Diseases diagnostic imaging, Thoracic Diseases surgery
- Abstract
We herein report a rare case of mesenchymal hamartoma of the chest wall in a 10-year-old girl. She complained of chest pain and was diagnosed with a large chest wall tumor originating from the left fourth rib. Malignancy such as osteosarcoma or chondrosarcoma could not be ruled out with imaging studies. Therefore, we performed a core needle biopsy assisted by thoracoscopy, which revealed no malignancy. Therefore, extended resection with chest wall reconstruction was unnecessary, and thoracoscopy-assisted tumor excision with only the removal of the involved fourth rib was performed without chest wall reconstruction. The postoperative course was satisfactory with no thoracic deformity and no recurrence.
- Published
- 2019
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29. Spine Deformity With Fused Ribs Treated With Proximal Rib- Versus Spine-Based Growing Constructs.
- Author
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Larson AN, Baky FJ, St Hilaire T, Pawelek J, Skaggs DL, Emans JB, and Pahys JM
- Subjects
- Age Factors, Age of Onset, Child, Preschool, Female, Humans, Male, Prospective Studies, Prosthesis Design, Retrospective Studies, Scoliosis complications, Spinal Fusion methods, Spine abnormalities, Thoracic Diseases complications, Thoracic Vertebrae surgery, Thoracoplasty instrumentation, Thoracoplasty methods, Treatment Outcome, Ribs surgery, Scoliosis surgery, Spinal Fusion instrumentation, Spine surgery, Suture Anchors, Thoracic Diseases surgery
- Abstract
Study Design: Retrospective review of prospectively collected data., Objective: To compare the use of spine-based versus rib-based implants for the treatment of early-onset scoliosis (EOS) in the setting of rib fusions., Summary of Background Data: Treatment for severe early-onset spinal deformity with rib fusions includes growing spine devices with proximal rib or spine anchors. The results of treatment, however, have not been compared between spine-based versus rib-based proximal anchors., Methods: 169 patients with rib fusions treated with rib-based or spine-based constructs and minimum two-year follow-up were included. Sixteen patients were treated with proximal spine-based anchors and 153 with proximal rib-based devices (VEPTRs). Overall, 104 of the patients with rib-based fixation underwent thoracoplasty at the index surgery. We evaluated change in T1-T12 and T1-S1 height, coronal Cobb angle, kyphosis, and number of lengthening/revision surgeries., Results: Kyphosis increased a mean of 7° in the rib-based group and decreased a mean of 20 degrees in the spine-based group (p = .002). Major Cobb angle decreased in both groups (p < .0001); however, the spine-based group had greater Cobb angle improvement (24 vs. 11 degrees, p = .04). From implant and lengthening of distraction devices, there was a mean 3.3-cm (22%) increase in T1-T12 height and a mean of 8.0 lengthenings in the rib-based group compared with a 5.7-cm increase and 6.3 lengthening surgeries in the spine-based group. Patients with rib-based constructs had a mean of 11 total procedures, whereas spine-based patients had a mean of 8., Conclusions: Patients underwent a mean of eight lengthening surgeries before final fusion or cessation of lengthening with a modest 2.3-cm increase in T1-T12 height. Compared with proximal rib anchors, proximal spine anchors controlled kyphosis and improved Cobb angle correction for early-onset scoliosis with rib fusions., (Copyright © 2018 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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30. Surgery for Giant Calcified Herniated Thoracic Discs: A Systematic Review.
- Author
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Gong M, Liu G, Guan Q, Li L, Xing F, and Xiang Z
- Subjects
- Humans, Reoperation, Calcinosis surgery, Intervertebral Disc Displacement surgery, Spinal Cord Diseases surgery, Thoracic Diseases surgery, Thoracic Vertebrae surgery
- Abstract
Objective: The giant calcified herniated thoracic disc (HTD), a rare disease, is a challenge for surgeons because of its complications. This review aimed to confirm the surgical treatment, including surgical approach, results, and complications of HTDs., Methods: This systematic review of the literature complies with the PRISMA guidelines and involves a search of PubMed, Embase, and the Cochrane Library for all papers describing surgical treatment of giant calcified HTDs in ≥3 patients. Data on the surgical approach, change in neurologic impairment, and complications were extracted from the search results., Results: A total of 11 studies, including 164 patients with giant calcified HTDs that met the inclusion criteria, were included in this systematic review. Of the 164 patients, 145 had myelopathy in giant calcified HTDs, and 8 surgical approaches were included. After the surgical treatment, the neurologic grades were improved in 69% of patients, remained unchanged in 22% of patients, and worsened further in 3% of patients at the final follow-up. Also, of the total patients analyzed, 3% had permanent neurologic deterioration, 4% patients had subarachnoid-pleural cerebrospinal fluid fistula complications, 30% had other complications, 4% had reoperation via transthoracic approach, 13% had permanent neurologic deterioration via the posterolateral approach, and 25% had permanent neurologic deterioration via the thoracoscopy approach., Conclusions: Surgical treatment can improve or stabilize neurologic impairment for most patients with giant calcified HTDs. We thus recommend the anterior thoracotomy approach for giant calcified HTDs because of the theoretical advantages over other approaches and the low rate of neurologic deterioration, subarachnoid-pleural cerebrospinal fluid fistula, and reoperation., (Copyright © 2018 Elsevier Inc. All rights reserved.)
- Published
- 2018
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31. [Welcome to SPCCTV 4D Visions18].
- Author
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Cabral G
- Subjects
- Humans, Imaging, Three-Dimensional methods, Time, Cardiovascular Diseases diagnostic imaging, Cardiovascular Diseases surgery, Thoracic Diseases diagnostic imaging, Thoracic Diseases surgery
- Published
- 2018
32. [The doctor, the boss and the innovation! The good, the bad and the ugly!]
- Author
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Guerra M
- Subjects
- Humans, Inventions, Cardiovascular Diseases surgery, Thoracic Diseases surgery
- Published
- 2018
33. Thoracic endometriosis syndrome: Comparison between catamenial pneumothorax or endometriosis-related pneumothorax and catamenial hemoptysis.
- Author
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Fukuda S, Hirata T, Neriishi K, Nakazawa A, Takamura M, Izumi G, Harada M, Hirota Y, Koga K, Wada-Hiraike O, Fujii T, and Osuga Y
- Subjects
- Adolescent, Adult, Endometriosis surgery, Female, Humans, Middle Aged, Pneumothorax surgery, Thoracic Diseases surgery, Young Adult, Endometriosis diagnosis, Pneumothorax diagnosis, Thoracic Diseases diagnosis
- Abstract
Objectives: To evaluate the clinical features of thoracic endometriosis syndrome (TES) represented by catamenial pneumothorax (CP), endometriosis-related pneumothorax (ERP), and catamenial hemoptysis (CH)., Study Design: In this retrospective study, we enrolled 25 patients with TES, 18 of whom had CP/ERP and 7 had CH, to investigate the clinical presentation, effectiveness of treatment, and recurrence rates in these disorders., Results: The age at onset was significantly lower in patients with CH than in patients with CP/ERP (P < 0.05). In 94.4% of patients with CP/ERP, pneumothorax was observed on either the right side or bilaterally, however there was no tendency toward laterality of CH among our cases. In our study, patients with CP/ERP predominantly underwent surgical management and the recurrence rate during treatment was higher in patients with CP/ERP than in those with CH. We found that the recurrence frequency of CP/ERP was lowest under the combination therapy with thoracic surgery and postoperative hormonal therapy., Conclusion: Our findings suggest that CP/ERP and CH are different pathological conditions and CP/ERP is more difficult to manage than CH., (Copyright © 2018 Elsevier B.V. All rights reserved.)
- Published
- 2018
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34. Thoracolithiasis: A Rare Cause of Multiple Nodules.
- Author
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Hochhegger B, Camargo SM, Nascimento D, Zanetti G, and Marchiori E
- Subjects
- Humans, Male, Middle Aged, Multiple Pulmonary Nodules physiopathology, Rare Diseases complications, Rare Diseases physiopathology, Rare Diseases surgery, Thoracic Diseases physiopathology, Treatment Outcome, Multiple Pulmonary Nodules etiology, Multiple Pulmonary Nodules surgery, Thoracic Diseases complications, Thoracic Diseases surgery
- Published
- 2018
- Full Text
- View/download PDF
35. [Application of VSD in 6 Cases of Postoperative Infection -A Clinical Experience Sharing].
- Author
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Ma J, Zhao J, Bai Q, He S, Yu J, and Gou Y
- Subjects
- Adult, Drainage instrumentation, Esophageal Neoplasms complications, Female, Humans, Lung Neoplasms, Male, Middle Aged, Postoperative Complications etiology, Retrospective Studies, Thoracic Diseases complications, Drainage methods, Esophageal Neoplasms surgery, Postoperative Complications surgery, Thoracic Diseases surgery
- Abstract
Background: Surgical site infection is one of the common postoperative complications of thoracic surgery, and its harm is related to infection degree and location. Light causes local pain, prolonged hospitalization and increased cost. Severe infection can lead to severe infection, even septic shock and life-threatening. Therefore, proper treatment of incision infection can help to promote recovery, reduce the burden of disease and lay a good foundation for further treatment. The traditional surgical treatment of wound infection includes thorough drainage, intensive dressing change and antibiotic use. There are many shortcomings such as long treatment process, ineffective treatment effect and so on. The experience of using vacuum sealing drainage (VSD) in 6 cases of postoperative infection patients in our department is summarized in order to improve the traditional treatment of postoperative infection in patients after thoracic surgery., Methods: The clinical data of patients with postoperative incision infection or fistula after thoracic surgery in our department were reviewed and summarized. 6 patients treated with VSD material for postoperative infection. The process and final clinical results of them were summarized and discussed., Results: In this study, fever and wound exudation disappeared within 6 h-10 h after VSD use, 5 cases of wound infection were obviously improved, the secretion disappeared and the granulation tissue grew well at the cutting edge of the operation, the second stage operation was performed to close the chest and skin. One patient was seriously infected, and the secretion was still more after VSD removal, reposition VSD device next time, the VSD device was removed 7 d later. The wound infection were obviously improved, the secretion disappeared and the granulation tissue grew well, close the chest and skin second stage. In all 6 patients, the symptoms were relieved, the symptoms improved and the surgical incision healed well. In 2 patients with esophageal cancer, the average operation time was 427.5 min, the average hospitalization time was 40 d, the average number of times of dressing change was 8.5, the average total cost during hospitalization was 111,893.47 yuan patients with chronic empyema, the average operation time was 192.5 min. The average hospital stay was 27.75 days, the average number of times of dressing change was 5.5, and the average total expenditure during hospitalization was 48,237.71 yuan., Conclusions: VSD has a good effect on the treatment of postoperative incision infection patients in thoracic surgery. It can reduce the pain and burden of patients and ensure the quality of life of postoperative infected patients.
- Published
- 2018
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36. [Application of Thoracic Surgery Structured Electronic Medical Record Based on Standard Vocabulary].
- Author
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Jiang J and Yu X
- Subjects
- Electronic Health Records statistics & numerical data, Electronic Health Records trends, Humans, Thoracic Diseases diagnosis, Thoracic Surgical Procedures methods, Thoracic Surgical Procedures standards, Electronic Health Records standards, Thoracic Diseases surgery
- Abstract
As an important carrier in the information construction of modern hospitals, electronic medical record is becoming more and more refined and intelligent. This paper introduces the standardized and structured electronic medical record system of thoracic surgecal department and puts forward the effect evaluation and prospect. .
- Published
- 2018
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37. Thoracic skeletal anomalies following surgical treatment of esophageal atresia. Lessons from a national cohort.
- Author
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Bastard F, Bonnard A, Rousseau V, Gelas T, Michaud L, Irtan S, Piolat C, Ranke-Chrétien A, Becmeur F, Dariel A, Lamireau T, Petit T, Fouquet V, Le Mandat A, Lefebvre F, Allal H, Borgnon J, Boubnova J, Habonimana E, Panait N, Buisson P, Margaryan M, Michel JL, Gaudin J, Lardy H, Auber F, Borderon C, De Vries P, Jaby O, Fourcade L, Lecompte JF, Tolg C, Delorme B, Schmitt F, and Podevin G
- Subjects
- Child, Digestive System Surgical Procedures methods, Esophageal Atresia diagnostic imaging, Female, Humans, Male, Musculoskeletal Abnormalities etiology, Radiography, Radiography, Thoracic, Retrospective Studies, Thoracic Diseases diagnostic imaging, Thoracoscopy methods, Thoracotomy methods, Treatment Outcome, Esophageal Atresia surgery, Musculoskeletal Abnormalities diagnostic imaging, Musculoskeletal Abnormalities surgery, Thoracic Diseases surgery
- Abstract
Introduction: Thoracotomy as surgical approach for esophageal atresia treatment entails the risk of deformation of the rib cage and consequently secondary thoracogenic scoliosis. The aim of our study was to assess these thoracic wall anomalies on a large national cohort and search for factors influencing this morbidity., Materials and Methods: Pediatric surgery departments from our national network were asked to send recent thoracic X-ray and operative reports for patients born between 2008 and 2010 with esophageal atresia. The X-rays were read in a double-blind manner to detect costal and vertebral anomalies., Results: Among 322 inclusions from 32 centers, 110 (34.2%) X-rays were normal and 25 (7.7%) displayed thoracic malformations, including 14 hemivertebrae. We found 187 (58.1%) sequelae of surgery, including 85 costal hypoplasia, 47 other types of costal anomalies, 46 intercostal space anomalies, 21 costal fusions and 12 scoliosis, with some patients suffering from several lesions. The rate of patients with these sequelae was not influenced by age at intervention, weight at birth, type of atresia, number of thoracotomy or size of the center. The rate of sequelae was higher following a classical thoracotomy (59.1%), whatever the way that thoracotomy was performed, compared to nonconverted thoracoscopy (22.2%; p=0.04)., Conclusion: About 60 % of the patients suffered from a thoracic wall morbidity caused by the thoracotomy performed as part of surgical treatment of esophageal atresia. Minimally invasive techniques reduced thoracic wall morbidity. Further studies should be carried out to assess the potential benefit of minimally invasive approaches to patient pulmonary functions and on the occurrence of thoracogenic scoliosis in adulthood., Levels of Evidence: Level III retrospective comparative treatment study., (Copyright © 2017 Elsevier Inc. All rights reserved.)
- Published
- 2018
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38. [Robotic-assisted Thoracic Surgery is Expected to be Feasible for Widely Utility in Thoracic Disease].
- Author
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Yu Z
- Subjects
- Feasibility Studies, Humans, Pneumonectomy, Robotic Surgical Procedures, Thoracic Diseases surgery
- Published
- 2018
- Full Text
- View/download PDF
39. [Extragenital endometriosis: Parietal, thoracic, diaphragmatic and nervous lesions. CNGOF-HAS Endometriosis Guidelines].
- Author
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Merlot B, Ploteau S, Abergel A, Rubob C, Hocke C, Canis M, Fritel X, Roman H, and Collinet P
- Subjects
- Endometriosis complications, Endometriosis diagnosis, Female, Humans, Laparoscopy, Peripheral Nervous System Diseases etiology, Thoracic Diseases etiology, Abdomen surgery, Diaphragm surgery, Endometriosis therapy, Peripheral Nervous System Diseases therapy, Thoracic Diseases surgery
- Abstract
According to some studies, extragenital endometriosis represents 5% of the localisations. Its prevalence seems to be underestimated. The extra pelvic localisation can make the diagnosis more difficult. Nevertheless, the recurrent and catamenial symptomatology can evoke this pathology. Surgery seems to be the unique efficient treatment for parietal lesions. Pain linked to nervous lesions (peripheric and sacral roots) seems to be underestimated and difficult to diagnose because of various localisations. Neurolysis seems to have encouraging results. Diaphragmatic lesions are often discovered either incidentally during laparoscopy, or by pulmonary symptomatology as recurrent catamenial pneumothorax or cyclic thoracic pain. Surgical treatment seems as well to be efficient., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)
- Published
- 2018
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40. Single Versus Multi-Incisional Video-Assisted Thoracic Surgery: A Systematic Review and Meta-analysis.
- Author
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Abouarab AA, Rahouma M, Kamel M, Ghaly G, and Mohamed A
- Subjects
- Chest Tubes statistics & numerical data, Drainage adverse effects, Humans, Length of Stay statistics & numerical data, Lymph Node Excision statistics & numerical data, Operative Time, Postoperative Complications epidemiology, Thoracic Surgery, Video-Assisted adverse effects, Treatment Outcome, Thoracic Diseases surgery, Thoracic Surgery, Video-Assisted methods
- Abstract
Background: Video-Assisted Thoracic Surgery (VATS) is conventionally performed through multiple small incisions (C-VATS). Recent studies have reported encouraging results with the single-incision VATS (S-VATS) over the conventional technique. However, these studies were either small in size, unfocused, nonuniform, retrospective, lacking follow-up information, or focused on pain. We aim to validate previously reported results in a single large meta-analysis, including only the best evidence studies available., Methods: Systematic review of the PubMed archive was conducted to include only full English articles with Newcastle Ottawa Scale score ≥7. The primary outcome was the complications rate while secondary outcomes were operative time, resected lymph nodes (LNs), chest tube duration, estimated blood loss, length of postoperative stay (LOS), and postoperative pain on day 1 after surgery. Odds ratio and standard mean difference were used as effect estimates. Random model and leave-one-out analysis were used., Results: A total of 39 studies were included with 4635 patients (1686 S-VATS versus 2949 C-VATS). S-VATS has resulted in significantly less postoperative pain (P < .001), blood loss (P = .006), LOS (P < .001), and chest tube duration (P < .001). In lung cancer patients, the number of retrieved LNs was similar to that of C-VATS (P > .05). Subgroup comparison of the rate of complications between lung resections versus other intrathoracic procedures, lung cancer versus pneumothorax, and lung cancer versus other lung-only lesions did not show any significant differences between the groups., Conclusion: Performing S-VATS technique has shown superior postoperative outcomes over the C-VATS technique in the treatment of thoracic disorders. Substantial benefit was confirmed in terms of less postoperative pain, blood loss, drainage time, and postoperative hospital stay.
- Published
- 2018
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41. Five Hundred Seventy-Six Cases of Video-Assisted Thoracic Surgery Using Local Anesthesia and Sedation: Lessons Learned.
- Author
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Katlic MR
- Subjects
- Adult, Aged, Aged, 80 and over, Humans, Middle Aged, Pericardium surgery, Respiratory Tract Diseases pathology, Respiratory Tract Diseases surgery, Retrospective Studies, Thoracic Diseases surgery, Young Adult, Anesthesia, Local, Conscious Sedation, Thoracic Surgery, Video-Assisted methods
- Abstract
Background: General anesthesia and endotracheal intubation are a luxury rather than a necessity for many video-assisted thoracic surgery (VATS) operations. Twenty-three years ago, I began using local anesthesia and sedation for pleural disease and subsequently, for pericardial and lung disease., Study Design: The records of all patients undergoing VATS using local anesthesia and sedation at hospitals of the Geisinger Health System (Danville and Wilkes-Barre, PA), from June 1, 2002 to June 30, 2011, and the Lifebridge Health System (Baltimore, MD) from July 1, 2011 to March 1, 2017, were retrospectively reviewed. There was 1 unsuccessful attempt at this technique, and it was eligible for inclusion. No patient was excluded based on age, BMI, or comorbidities. No patient had endotracheal intubation, laryngeal mask airway, or epidural or nerve block analgesia; all patients breathed spontaneously., Results: Five hundred twenty-nine patients ranging in age from 21 to 104 years (mean 67 years) underwent 576 procedures: pleural biopsy-drainage with or without talc (n = 368); drainage of empyema (n = 112); lung biopsy (n = 56); evacuation of chronic hemothorax (n = 23); pericardial window (n = 10); treatment of chylothorax (n = 2); lung abscess draining (n = 2); treatment of pneumothorax (n = 2); and mediastinal mass biopsy (n = 1). No patient required intubation or conversion to thoracotomy. There were 12 complications (2%). There were no deaths due to operation., Conclusions: Video-assisted thoracic surgery using local anesthesia and sedation is safe and effective for many indications. A review of the lessons learned caring for 529 patients will allow any thoracic surgeon and any anesthesiologist to practice this technique., (Copyright © 2017 American College of Surgeons. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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42. [The change is here, the future is now].
- Author
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Cabral G
- Subjects
- Forecasting, Humans, Cardiovascular Diseases surgery, Cardiovascular Surgical Procedures trends, Thoracic Diseases surgery, Thoracic Surgical Procedures trends
- Published
- 2018
43. Three-dimensional versus two-dimensional video-assisted thoracic surgery for thoracic disease: a meta-analysis.
- Author
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Xu Y, Chen N, Ma A, Wang Z, Zhang Y, Liu C, and Liu L
- Subjects
- Humans, Imaging, Three-Dimensional, Thoracic Diseases surgery, Thoracic Surgery, Video-Assisted methods
- Abstract
Objectives: It remains unclear whether 3D systems are manoeuvrable in video-assisted thoracic surgery (VATS) for patients with thoracic diseases. The objective of this systematic review and meta-analysis was to evaluate the efficacy and safety of 3D VATS compared with 2D VATS., Methods: A systemic research of the literature was performed using the PubMed, Embase, the Cochrane library, China National Knowledge Infrastructure, Wanfang and CQVIP databases through December 2016. Studies investigating the efficacy and safety of 3D VATS compared with 2D VATS were eligible for our meta-analysis. Odds ratios and mean differences or standard mean differences with 95% confidence intervals (95% CI) as well as a P-value were applied to compare continuous and dichotomous variables, respectively., Results: Seven studies with 1080 patients (525 patients for 3D VATS and 555 patients for 2D VATS) were included. There were significant differences in the 3D group with regard to shorter operation times (standard mean difference = -0.66, 95% CI: -0.98 to - 0.34; P < 0.001), less blood loss (mean difference = -12.12, 95% CI: -19.07 to - 5.16; P < 0.001) and shorter postoperative drainage times (standard mean difference = -0.53, 95% CI: -0.92 to - 0.14; P = 0.008) compared with the 2D group. However, no statistical difference was found for postoperative hospital stay, total postoperative drainage volume, postoperative drainage volume in 24 h, number of lymph nodes dissected and postoperative complications., Conclusions: The results of this systematic review and meta-analysis suggest that 3D VATS might be an acceptable method for treating thoracic diseases in the future., (© The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
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- 2017
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44. [The surgery of diaphragmatic hydatidosis and their complications].
- Author
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Issoufou I, Harmouchi H, Rabiou S, Belliraj L, Ammor FZ, Diarra AS, Lakranbi M, Sani R, Ouadnouni Y, and Smahi M
- Subjects
- Adult, Diaphragm diagnostic imaging, Diaphragm pathology, Echinococcosis complications, Echinococcosis diagnosis, Female, Humans, Male, Middle Aged, Prognosis, Thoracic Diseases complications, Thoracic Diseases diagnosis, Thoracic Surgical Procedures, Tomography, X-Ray Computed, Diaphragm parasitology, Echinococcosis surgery, Thoracic Diseases surgery
- Abstract
Primary or secondary diaphragmatic echinococcosis is rare, accounting for 1% of the thoracic locations. They may be operative discovery or by their complication, hence a variable symptomatology making this localization a particular entity. The thoracic and abdominal CT allows a complete assessment. Surgery remains the only therapeutic approach. In complicated forms an additional surgery is required for complete care. The prognosis is generally good apart from the risk of recurrence. Through a series of 4 operated patients, we focus on the clinical and therapeutic features of this pathology and its complications., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)
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- 2017
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45. Perioperative implications of thoracic decortications: a retrospective cohort study.
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Gorman J, Funk D, Srinathan S, Embil J, Girling L, and Kowalski S
- Subjects
- Adult, Aged, Anesthesiology methods, Cohort Studies, Female, Humans, Male, Manitoba, Middle Aged, Retrospective Studies, Thoracic Diseases epidemiology, Thoracic Diseases physiopathology, Treatment Outcome, Perioperative Care methods, Postoperative Complications epidemiology, Thoracic Diseases surgery, Thoracic Surgical Procedures methods
- Abstract
Purpose: An increasing number of thoracic decortications have been performed in Manitoba, from five in 2007 to 45 in 2014. The primary objective of this study was to define the epidemiology of decortications in Manitoba. The secondary objective was to compare patients who underwent decortication due to primary infectious vs non-infectious etiology with respect to their perioperative outcomes., Methods: Data for this cohort study were extracted from consecutive charts of all adult patients who underwent a decortication in Manitoba from 2007-2014 inclusive., Results: One hundred ninety-two patients underwent a decortication. The most frequent disease processes resulting in a decortication were pneumonia (60%), trauma (13%), malignancy (8%), and procedural complications (5%). The number of decortications due to complications of pneumonia rose at the greatest rate, from three cases in 2007 to 29 cases in 2014. Performing a decortication for an infectious vs a non-infectious etiology was associated with a higher rate of the composite postoperative outcome of myocardial infarction, acute kidney injury, need of vasopressors for > 12 hr, and mechanical ventilation for > 48 hr (44.4% vs 24.2%, respectively; relative risk, 1.83; 95% confidence interval, 1.1 to 2.9; P = 0.01)., Conclusion: There has been a ninefold increase in decortications over an eight-year period. Potential causes include an increase in the incidence of pneumonia, increased organism virulence, host changes, and changes in practice patterns. Patients undergoing decortication for infectious causes had an increased risk for adverse perioperative outcomes. Anesthesiologists need to be aware of the high perioperative morbidity of these patients and the potential need for postoperative admission to an intensive care unit.
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- 2017
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46. Cardiothoracic Critical Care.
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Lobdell KW, Haden DW, and Mistry KP
- Subjects
- Critical Care organization & administration, Humans, Heart Diseases surgery, Thoracic Diseases surgery
- Abstract
High-value CCC is rapidly evolving to meet the demands of increased patient acuity and to incorporate advances in technology. The high-performing CCC system and culture should aim to learn quickly and continuously improve. CCC demands a proactive, interactive, precise, an expert team, and continuity., (Copyright © 2017 Elsevier Inc. All rights reserved.)
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- 2017
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47. The Role of Plastic Surgery at an Academic Medical Center in the United States.
- Author
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Pu LL and Mirmanesh M
- Subjects
- Aged, Aged, 80 and over, California, Female, Head and Neck Neoplasms surgery, Humans, Kentucky, Leg Injuries surgery, Male, Middle Aged, Peripheral Vascular Diseases surgery, Retrospective Studies, Surgical Flaps, Thoracic Diseases surgery, United States, Academic Medical Centers, Physician's Role, Practice Patterns, Physicians' statistics & numerical data, Surgery, Plastic
- Abstract
Background: Plastic surgery may have traditionally been labelled as a "less essential" service at many academic medical centers in the United States. The purpose of this study is to evaluate the role of the plastic surgery team as a valuable service at an academic medical center., Methods: We performed a 10-year retrospective case review of a single plastic surgeon's case log at 2 academic medical institutions, each with an active plastic surgery training program. Plastic surgical procedures performed in combination with other services and surgical management of complications from nonplastic surgical procedures was evaluated. Plastic surgical procedures performed for all types of reconstruction as a primary service, including breast reconstruction were excluded. The role of the plastic surgery service was evaluated to identify the types of assistance provided, which primary services were involved and what the most common procedures performed were for each service., Results: The type of assistance provided by the plastic surgery service was divided into 2 common categories. The first type involved a concurrent or combined surgical case where the procedure required plastic surgery's participation. The second group included management of complications that occurred on another service, which then required assistance by the plastic surgery team. A total of thirteen primary services were identified as benefitting from involvement with plastic surgery. The most commonly performed reconstructive procedures provided for each service were identified., Conclusions: The plastic surgery team provides invaluable support to other services in a tertiary teaching hospital. Its input allows for more complex surgical procedures to be performed safely and for complications of surgery to be managed successfully. Clearly, plastic surgery plays a critical role at academic medical centers in the United States.
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- 2017
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48. Left-Sided Catamenial Pneumothorax with Thoracic Endometriosis and Bullae in the Alveolar Wall.
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Takahashi R, Kurihara M, Mizobuchi T, Ebana H, and Yamanaka S
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- Adult, Biopsy, Blister diagnostic imaging, Blister surgery, Endometriosis diagnostic imaging, Endometriosis surgery, Female, Humans, Immunohistochemistry, Pneumonectomy, Pneumothorax diagnostic imaging, Pneumothorax surgery, Thoracic Diseases diagnostic imaging, Thoracic Diseases surgery, Tomography, X-Ray Computed, Treatment Outcome, Blister complications, Endometriosis complications, Pneumothorax complications, Pneumothorax etiology, Pulmonary Alveoli diagnostic imaging, Pulmonary Alveoli surgery, Thoracic Diseases complications
- Abstract
Catamenial pneumothorax (CP) is generally caused by intraperitoneal air leaking from the uterus into the thoracic cavity via a defect in the endometrial tissue of the diaphragm and is usually detected in the right thorax. We report a case of left-sided CP caused by endometriosis in the visceral pleura and with no abnormal findings in the diaphragm. A 33-year-old female patient presented at the end of a course of low-dose contraceptive pills for pelvic endometriosis, with spontaneous pneumothorax in the left chest. Chest CT revealed a bulla in the left upper lung lobe. The patient underwent partial resection of the lung. Immunohistochemistry confirmed the presence of endometrial stromal tissue in the visceral pleura and confirmed this as the cause of pneumothorax since there were no observable abnormalities in the diaphragm. This case suggests that immunohistochemical examination of patients with spontaneous pneumothorax can detect alternative endometrial lesions.
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- 2017
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49. [What's new in thoracic imaging?]
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Chabi ML
- Subjects
- Diagnostic Imaging classification, Diagnostic Imaging statistics & numerical data, Early Detection of Cancer methods, Early Detection of Cancer trends, France, Humans, Lung Neoplasms diagnosis, Radiography, Thoracic methods, Radiography, Thoracic trends, Thoracic Diseases surgery, Thoracic Surgical Procedures methods, Thoracic Surgical Procedures trends, Diagnostic Imaging methods, Diagnostic Imaging trends, Thoracic Diseases diagnosis
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- 2017
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50. Thoracic splenosis masquerading as advanced lung cancer.
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Remtulla M, Drury NE, Kaushal NA, Trotter SE, and Kalkat MS
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- Adult, Diagnosis, Differential, Humans, Male, Splenosis etiology, Splenosis surgery, Thoracic Diseases etiology, Thoracic Diseases surgery, Lung Neoplasms diagnosis, Splenosis diagnosis, Thoracic Diseases diagnosis
- Published
- 2017
- Full Text
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