1/12. Delayed intrathoracic rupture of herniated Nissen fundoplication: report of two cases.We report 2 patients who presented with rupture of a laparoscopic Nissen fundoplication in the left chest. These were successfully managed by closure of the perforation over a tube drainage that was brought under the diaphragm as a controlled fistula.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/12. Closure of fenestra in Clagett procedure: use of rectus abdominis musculocutaneous flap.empyema developed in a 62-year-old man after right pneumonectomy for lung cancer. According to the Clagett procedure, an open window thoracostomy was made with two ribs removed. After 5 weeks, primary closure of the fenestra was attempted. Because the fenestra was too large to be primarily closed, a rectus abdominis musculocutaneous flap was successfully transposed to cover the chest wall. There was no evidence of recurrence of empyema during 11 months' observation after closure. In patients with a large fenestra and with little tissue left for closure, the rectus abdominis musculocutaneous flap could be of great help in completing the Clagett procedure.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
3/12. Macromastia as a factor in sternal wound dehiscence following cardiac surgery: management combining chest wall reconstruction and reduction mammoplasty.Major sternal wound infection occurs in nearly 2% of patients following coronary artery bypass graft surgery. The relationship of this complication to gender has not been reported in detail, nor has female breast size previously been implicated as a factor increasing the risk of sternotomy dehiscence. We report two cases of sternotomy wound dehiscence in women with large, pendulous breasts undergoing myocardial revascularization surgery and postulate that the weight of large, unsupported breasts produced inferolateral tension on the midline sternotomy incisions, contributing to dehiscence of the wounds. Chest wall reconstruction was accomplished using pectoralis muscle flaps, and the procedures were combined with amputative reduction of the size of the breasts, with subsequently successful healing in each case. Combining sternal reconstruction with breast reduction surgery may lead to improved secondary outcome, and postoperative use of supportive brassieres may reduce the frequency of this complication.- - - - - - - - - - ranking = 4keywords = chest (Clic here for more details about this article) |
4/12. Streptococcal infection and necrotizing fasciitis--implications for rehabilitation: a report of 5 cases and review of the literature.Five cases are presented of patients who were diagnosed with necrotizing fasciitis secondary to (1) hip disarticulation (in a paraplegic patient); (2) tooth abscess with extensive neck dissection, complicated by sepsis and hypotension with resultant dysphagia and ischemic encephalopathy; (3) below-knee amputation, anoxia, and severe debility; (4) emergent above-knee amputation; and (5) percutaneous endoscopic gastrostomy placement. The latter patient developed abdominal and chest wall necrotizing fasciitis that required skin grafting. Four patients were treated in an acute rehabilitation setting and returned home, and the fifth was rehabilitated in a subacute facility. This report emphasizes the importance of carefully monitoring rehabilitation patients, especially those with impaired sensation.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
5/12. Dehiscence of a valved conduit in the ascending aorta following low-velocity blunt chest trauma: case report.We report a case of a 56-year old man presenting with dehiscence of a valved conduit in the ascending aorta following low-velocity blunt thoracic trauma. The patient had a history of a Bentall procedure in 1994. Two weeks before referral to our hospital, the patient fell during a bicycle ride and hit the handlebars of the bicycle with his chest. During the days following the accident, the patient developed progressively worsening fatigue, shortness of breath, and intolerance for even minor physical effort. The presence of an enlarged ascending aorta surrounding the implanted valved graft was confirmed, and the patient was referred to our department for surgical repair, after which the patient had an uneventful recovery and was discharged home on postoperative day 12.- - - - - - - - - - ranking = 5keywords = chest (Clic here for more details about this article) |
6/12. When is a pneumothorax not a pneumothorax?The authors report on a 13-year-old boy who, after exercise, had respiratory distress and left upper quadrant abdominal pain. Initially, a mistaken diagnosis of pneumothorax was made, and a chest tube was inserted. A nasogastric tube was then visualized on chest x-ray in the left hemithorax. He underwent a laparotomy and had herniation of spleen, stomach, and large and small bowel in the left pleural space passing through a traumatic defect in the hemidiaphragm. The laparoscopic Nissen fundoplication 3 years prior was felt to have contributed. A timely and correct diagnosis is essential to avoid the sequelae associated with these injuries and with inappropriate tube thoracostomy.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
7/12. Major anastomotic dehiscence after repair of esophageal atresia: conservative management or reoperation?SUMMARY. The authors report a case of recurrent anastomotic dehiscence following surgical repair of type C esophageal atresia according to the Gross classification. Surgical repair was followed by a recurrence, which was successfully managed with conservative treatment. esophageal atresia with fistulization of the lower pouch in a male newborn with the VACTER association was repaired with a high-tension single-layer anastomosis. On the fifth postoperative day, major anastomotic dehiscence (> 4 mm) was diagnosed. The breach was re-sutured and the anastomosis reinforced with fibrin glue, but dehiscence recurred again 4 days later. Surgery was deferred and the infant was treated conservatively with continued chest-tube drainage and total parenteral nutrition. After 43 days, complete closure of the anastomosis was documented. Even major anastomotic dehiscence can be successfully managed with conservative treatment (chest-tube drainage, suspension of oral feedings, total parenteral nutrition). If the patient is otherwise stable, we feel that this approach should be attempted even when major leakage is present.- - - - - - - - - - ranking = 2keywords = chest (Clic here for more details about this article) |
8/12. Intrathoracic xanthoma mimicking lung cancer in a patient with familial hypercholesterolemia type II: a case report.Xanthomas are benign soft-tissue lesions commonly occurring on the skin, subcutis, or tendon sheaths of patients. The lung and thoracic cavity is a rare location for xanthomas. We present a 39-year-old woman who was admitted to our hospital with complaints of dyspnea, cough, and chest pain. She had a prior diagnosis of type II familial hypercholesterolemia. Chest x-ray film and computed tomography scans revealed a large tumor-like mass in the right hemithorax. Thoracal mass and narrowed tracheal segments were removed using cardiopulmonary bypass. Histopathologic findings were consistent with xanthoma.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
9/12. rectus abdominis myocutaneous flap used to close a median sternotomy chest defect. A case report.A 55-year-old white man presented with an infected median sternotomy wound after coronary artery bypass grafting, with subsequent dehiscence and exposure of the heart and great vessels. A left-sided rectus abdominis myocutaneous transposition flap was used for closure.- - - - - - - - - - ranking = 4keywords = chest (Clic here for more details about this article) |
10/12. Reconstruction after median sternotomy infection.Reconstruction after median sternotomy infections is a difficult problem. We have presented ten consecutive patients with a wide variety of underlying cardiac illnesses who have had this dreaded complication develop. All of these patients have undergone successful reconstruction after adequate debridement and elimination of the mediastinal dead space using a combination of well vascularized omentum and pectoralis major muscle flaps. Stability of the chest wall has been accomplished primarily with pectoralis major muscle flaps. Complications have been few, morbidity has been significantly reduced and mortality, thus far, has been eliminated, although we certainly have no expectations that it will remain so.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
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