1/155. Treatment for empyema with bronchopleural fistulas using endobronchial occlusion coils: report of a case.We report herein the case of a woman with bronchopleural fistulas treated with the endobronchial placement of vascular embolization coils. She was referred to our hospital to undergo lavage of a postoperative empyema. She had undergone an air plombage operation for pulmonary tuberculosis 9 years previously. However, bronchopleural fistulas occurred postoperatively and she had to continue the use of a chest drainage tube since then. Lavage of her empyema space with 5kE of OK-432 (picibanil: Chugai) plus 100 mg minocycline was performed once every 2 weeks for 3 months, and the purulent discharge from the empyema remarkably decreased. Thereafter, the bronchopleural fistulas were occluded endobronchially by the placement of vascular embolization coils. Soon after the procedure, air leakage from the fistulas was stopped and the drainage tube was removed 2 days later. The patient remains well without any additional treatment at 20 months after this treatment. As treatment for empyema with bronchopleural fistulas, it would be worth trying to lavage the empyema space with OK-432 until it is cleaned out and to plug the fistulas by the endobronchial placement of embolization coils, before such radical operations as thoracoplasty and space-filling of the empyema are considered.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/155. case reports: pleural melioidosis.We report herein a patient with pulmonary melioidosis, whose initial chest roentgenogram revealed only a pleural mass. The patient had not been in a zone endemic for melioidosis during the previous 15 months. We stress the importance of including melioidosis in the differential diagnosis of pleural lesions, and of considering this diagnosis in any patient who has been in an endemic zone at any time in the past.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
3/155. Minimally invasive direct coronary artery bypass using H graft for pleural symphysis.In November 1995, video-assisted minimally invasive direct coronary artery bypass procedure, which is defined as a combination of the thoracoscopic internal mammary artery (IMA) harvest and direct coronary bypass grafting, was introduced for patients who need minimally invasive direct coronary artery bypass (MIDCAB) using IMA. In the thoracoscopic IMA harvest, the pleural adhesions or symphysis present an obstacle. We present a case where a redo patient who had complete pleural symphysis of left chest cavity precluded the thoracoscopic IMA harvest, and MIDCAB with the H graft procedure was performed.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
4/155. Pleural incarceration of the gastric graft after trans-hiatal esophagectomy.We report on a 73-year-old man who underwent a transhiatal esophagectomy for a T2N1M0 adenocarcinoma of the distal esophagus and developed an incarcerated herniation of the gastric graft through a defect in the right mediastinal pleura. The patient experienced delayed gastric emptying postoperatively, which was initially suggested by barium swallow. The gastric herniation was unidentified by early postoperative swallowing studies and endoscopies. After diagnosis by a later computed tomographic scan and barium study, the herniation was reduced by incising the mediastinal pleura from the diaphragm to the apex of the chest and by plication of the stomach longitudinally in order to reduce its intrathoracic diameter.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/155. Transsternal approach to closure of bronchopleural fistulas after pneumonectomy. A fifteen cases report.A treatment method for main bronchus fistula after pneumonectomy via median sternotomy was described by P. Abruzzini in 1961. This operation is performed in an area not involved with infection. Fifteen patients underwent the procedure in our surgical department; one of them died of myocardial infarction while all the others survived for different periods of time, closely associated with the original disease; seven were long-term survivors. The transmediastinal approach seems an effective means of managing such a difficult complication.- - - - - - - - - - ranking = 0.0026656767311222keywords = area (Clic here for more details about this article) |
6/155. Gastric seromuscular and omental pedicle flap for bronchopleural fistula after pneumonectomy.We report a case of postpneumonectomy bronchopleural fistula treated using a gastric seromuscular and omental pedicle flap and maintaining good postoperative respiratory function. A 76-year-old man underwent right pneumonectomy with regional lymph node dissection for squamous cell carcimoma of the lung. Five weeks later, a bronchopleural fistula occurred. empyema with the bronchopleural fistula was diagnosed and chest tube drainage implemented immediately. Despite the drainage, signs of inflammation persisted and the patient's nutrition did not improve leading to surgery, on August 18, 1997. The bronchopleural fistula was closed by horizontal suture proximal to the stapling sutured line. A gastric seromuscular and omental pedicle flap was sutured as a cover over the bronchial stump. Postoperative analysis of respiratory function and arterial blood gas showed good results.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
7/155. churg-strauss syndrome with pleural involvement.A 51-year-old Japanese man with churg-strauss syndrome (CSS) diagnosed by pleural biopsy is described. He was hospitalized because of high fever and bilateral knee, elbow and shoulder joint pain. Chest roentgenogram and chest computed tomography (CT) scan revealed bilateral massive pleural effusion. Pleural biopsy revealed eosinophilic infiltration and necrotizing granulomas. He was treated with oral prednisolone and his symptoms improved. This is the first report of CSS diagnosed by pleural biopsy.- - - - - - - - - - ranking = 1.0125271981267keywords = chest, pain (Clic here for more details about this article) |
8/155. Systemic-to-pulmonary artery fistula following actinomycosis.We report a case of pleuropulmonary actinomycosis in a child followed by a most unusual complication: the appearance of a systemic-to-pulmonary artery fistula in the area where the abscess was drained. Fifteen months after successful treatment with penicillin and surgical drainage, a continuous murmur was heard over the scar. Aortic angiography showed multiple connections between the intercostal arteries and the left pulmonary artery through an angiomatous lesion in the left lower lobe. This resulted in a considerable left-to-right shunt. Possible pathogenic mechanisms are discussed.- - - - - - - - - - ranking = 0.0026656767311222keywords = area (Clic here for more details about this article) |
9/155. Tension pneumocephalus resulting from iatrogenic subarachnoid-pleural fistulae: report of three cases.BACKGROUND: Symptomatic pneumocephalus may result from a cerebrospinal fluid leak communicating with extradural air. However, it is a rare event after thoracic surgical procedures, and its management and physiology are not widely recognized. methods: During the past 2 years, we have identified 3 patients who developed pneumocephalus after thoracotomy for tumor resection. Only 1 patient had a discernible spinal fluid leak identified intraoperatively. Two patients experienced delayed spinal fluid drainage from their chest tubes and subsequently developed profound lethargy, confusion, and focal neurologic signs. The third patient was readmitted to the hospital with a delayed pneumothorax and altered mental status. Radiographic imaging in all patients showed significant pneumocephalus of the basilar cisterns and ventricles. RESULTS: The first 2 patients were managed by discontinuation of the chest tube suction and bedrest. The third patient underwent surgical reexploration and nerve root ligation. All 3 patients had resolution of their symptoms within 72 hours. CONCLUSIONS: pneumocephalus is a rare, but serious, complication of thoracotomy. Previous patients reported in the literature have been managed with reoperation to ligate the nerve roots. However, the condition resolved nonoperatively in 2 of our patients. Discontinuation of chest tube suction may be definitive treatment and is always the important initial management to decrease cerebrospinal fluid extravasation into the pleural space and allow normalization of neurologic symptoms.- - - - - - - - - - ranking = 3keywords = chest (Clic here for more details about this article) |
10/155. Cutaneous nocardiosis of the chest wall and pleura--10-year consequences of a hand actinomycetoma.We report an unusual case of primary cutaneous nocardiosis due to nocardia otitidiscaviarum presenting first as a mycetoma of the right hand and wrist. The patient refused treatment and was lost to follow-up until he showed up 10 years later with numerous discharging large sinuses and abscesses on the upper right quadrant of the chest wall and in the right armpit. Roentgenograms revealed pleural masses. histology was in keeping with the diagnosis of mycetoma. Treatment with amikacin, rifampicin and co-trimaxole proved to be successful.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
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