1/57. Stomal recurrence invading the cervicothoracic esophagus and upper mediastinum: resectability and the creation of a safe anterior mediastinal tracheostoma.Surgical salvage for stomal recurrence is a for midable problem for head and neck surgeons. The two factors of considerable significance are resectability and establishment of a safe anterior mediastinal tracheostoma. A case of stomal recurrence invading the cervicothoracic esophagus and upper mediastinum is presented. Total esophagectomy and upper mediastinal dissection was performed. The esophagus was reconstructed immediately with a pedicled gastric flap. The omentum on the gastric pedicle was wrapped around the trachea to reduce the likelihood of erosion into the great vessels and to supplement the lateral blood supply to the trachea. No serious postoperative complications were observed. We believe that the total esophagectomy improved the resectability, and that the bulk of the gastric pedicle and the use of the omentum prevented significant postoperative complications associated with an anterior mediastinal tracheostoma.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/57. Anterior mediastinal masses: an anaesthetic challenge.A patient with a large anterior mediastinal mass with minimal respiratory symptoms presented for a diagnostic biopsy of the mass. A pre-operative thoracic computed tomographic scan demonstrated narrowing of the distal trachea, and right and left main stem bronchi. An awake intubation was done. Thiopentone and muscle relaxant were given and surgery commenced. High airway pressure developed and ventilation became difficult, although oxygenation remained satisfactory throughout. Anaesthetic implications are discussed. We recommend that patients with more than 50% obstruction of the airway at the level of the lower trachea and main bronchi have their femoral vessels cannulated in readiness for cardiopulmonary bypass.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/57. Upper posterior mediastinal tumor supplied by an atrial branch of the left circumflex artery.We report a case of a 39-year-old woman with an upper posterior mediastinal tumor. The tumor was demonstrated by echocardiography and further defined by computerized tomography and magnetic resonance imaging. The tumor was fed by a large atrial branch of the left circumflex artery. Because of its location (adjacent to large vessels), it could not be resected by surgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/57. Primary malignant melanoma of the anterior mediastinum in a child.Primary malignant melanoma of the mediastinum is extremely rare. We report a case not previously reported of primary malignant melanoma located in the mediastinum in a 11-year-old boy. The tumor could not be completely resected as a result of extensive invasion of the large blood vessels. Histologically, the tumor was heavily pigmented and composed of vague fascicles of spindle cells intermingled with epithelioid cells. Immunohistochemical analysis showed vimentin, S-100 protein, Melan-A, and HMB-45 immunoreactivity in most of the tumor cells. Nearly 50% of the tumor cells were also positive for p53. It is suggested that primary malignant melanoma of the anterior mediastinum may have a histogenetic relationship to the recently described aggregates of nevus cells in the thymus or mediastinal lymph nodes.- - - - - - - - - - ranking = 3.9448254839201keywords = blood vessel, vessel (Clic here for more details about this article) |
5/57. Phosphaturic mesenchymal tumor, mixed connective tissue variant (oncogenic osteomalacia).A case of tumor-induced phosphaturic osteomalacia in a 54 year old man is reported. The patient was admitted because of progressive muscle spasms with pain and weakness in the bilateral thighs. Laboratory data showed hypophosphatemia, decreased tubular resorption of phosphate (TRP), a low 1,25-dihydroxyvitamin D level, and a high serum alkaline phosphatase level. Radiologic examinations revealed multiple lesions of osteomalacia in the ribs, and a small mass in the lower posterior mediastinum. After removal of the tumor, clinical symptoms disappeared and hypophosphatemia, decreased TRP, and the 1,25-dihydroxyvitamin D level were corrected. Microscopical examination revealed that the tumor was composed of mature adipose tissues, osseous tissues, and primitive stromal zones including osteoclast-like giant cells, non-mineralized woven bone, and various sized blood vessels. Patho-physiologic observations suggested that the tumor secreted some humoral substances inhibiting 25-hydroxyvitamin D-1 alpha-hydroxylase activity, renal phosphate resorption, and parathyroid hormone production.- - - - - - - - - - ranking = 3.9448254839201keywords = blood vessel, vessel (Clic here for more details about this article) |
6/57. Thymohemangiolipoma, a rare histologic variant of thymolipoma: a case report and review of the literature.We report a case of a thymic neoplasm in an 18-year-old woman who presented with chest discomfort and an anterior mediastinal mass. The surgically resected tumor showed abundant adipose tissue admixed with thymic tissue and numerous medium-caliber blood vessels. We consider this tumor a rare variant of thymolipoma and designate it as thymohemangiolipoma. Because of its benign nature, it should be distinguished from other mediastinal lesions.- - - - - - - - - - ranking = 3.9448254839201keywords = blood vessel, vessel (Clic here for more details about this article) |
7/57. Extended left pneumonectomy combined with off-pump coronary revascularization (CABG).Here, we will report on a 63-year-old patient with a centrally located squamous cell carcinoma of the left lung with complete atelectasis and tumor infiltration into mediastinal pleura and fat. A known coronary two-vessel disease, which became highly symptomatic during the operation made a change of the planned surgical strategy necessary.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/57. Aortico-pulmonary paraganglioma associated with bilateral carotid body tumors. Diagnostic presentation and clinical implications.A case of mediastinal paraganglioma in association with bilateral carotid body tumors is presented. Characteristic radiological findings included a hypointense signal in T1-weighted, a hyperintense signal in T2-weighted magnetic resonance (MR) images and a vascular enhancement pattern in dynamic contrast enhanced MR imaging. Thus, feeding vessels could be depicted noninvasively. The importance of family screening in affected individuals is stressed, as a hereditary form of the disease exists in which multiple paragangliomas are common.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/57. Dynamic CT features of mediastinal hemangioma: more information for evaluation.Dynamic enhancing feature in mediastinal hemangioma was rarely reported. Slow, gradually increasing and prolonged contrast stains are the diagnostic hints in our case that avoid the hemorrhagic catastrophe from transthoracic core needle biopsy. A rare finding of an aberrant vessel entering into the tumor was valuable for operative planning. Dynamic computed tomography (CT) can provide more information for evaluation in such cases.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/57. Effective therapy of a vascular tumor of infancy with vincristine.Vascular tumors are common in infancy, affecting as many as 10% of children. These lesions often follow a benign course, with an initial proliferative phase followed by spontaneous involution, and require no therapy. Others manifest explosive early growth and Kasabach-Merritt phenomenon, requiring therapeutic intervention. Occasionally, some bulky tumors threaten life or vision because of mass effect, also mandating intervention. steroids are the mainstay of therapy, but often are ineffective. Interferon alpha (2a and 2b) has been used as second-line therapy in cases of steroid failure. However, interferon therapy has been associated with a significant incidence of spastic diplegia. The authors present the case of a 3-month-old girl in whom respiratory distress secondary to tracheal compression developed. magnetic resonance imaging and magnetic resonance angiography showed a large cervicothoracic lesion encasing the great vessels and displacing the airway. She did not display associated Kasabach-Merritt phenomenon. The lesion proved refractory to standard steroid therapy, but responded dramatically to 4 cycles of vincristine (0.05 mg/kg). Although this agent has been used in children with life-threatening Kasabach-Merritt phenomenon, this is the first time it has been described in the setting of compromised vital function. vinca alkaloids recently have been shown to have potent antiangiogenic activities in experimental models. Given the low predicted incidence of side effects at this dose, vincristine used as an antiangiogenic agent may prove an attractive alternative therapy for patients with life-threatening vascular tumors of infancy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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