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Thoracic Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Thoracotomy is an established procedure in the management of life-threatening thoracic trauma, but it is merely an access technique to allow other procedures to be carried out: Evacuation of pericardial tamponadeDirect control of intrathoracic haemorrhageControl of massive air embolism secondary to tracheobronchial disruptionOpen cardiac massageCross-clamping of the descending aorta to limit subdiaphragmatic haemorrhage The indications for its application are specific and evidence based. The procedure is associated with a high mortality and has the best chance of success if performed by an experienced clinician. Pre-hospital thoracotomy is however becoming more common. Survival rates are directly correlated with the patient’s physiological status at presentation. In patients presenting with vital signs after penetrating thoracic trauma, survival from emergency thoracotomy has been quoted to be as high as 40%.42–44
Trauma
Published in Anna Kowalewski, SBAs and EMQs in Surgery for Medical Students, 2021
Cardiac tamponade is an emergency. The pericardium should be drained as soon as possible. This is usually accomplished through pericardiocentesis unless other facilities for direct visualisation are available. If the patient is unstable, thoracotomy may be undertaken.
Principles of lung surgery
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Saleem Islam, James D. Geiger, Steven S. Rothenberg, M. Kunisaki Shaun
Thoracoscopic approaches are now being increasingly employed. Lung biopsies, wedge resections, and lobectomies can be performed using this approach. Improved optics with high-definition cameras and brighter light sources have made visualization excellent, and the development of safe vessel sealing devices for dissection and control of vessels up to 7 mm in diameter has allowed these resections to be performed safely. The clear benefits in cosmesis, decreased pain and length of stay, and less chest wall deformity and scoliosis have been the driving forces. For thoracoscopic resections of any kind, the patient is placed in a lateral decubitus position, as described previously. The table may be rotated to the right or left as needed for exposure. Some surgeons prefer to have the patient in the position described for the anterolateral thoracotomy. It is important to make full use of gravity as a retractor and the surgeon should vary the position accordingly. Single lung ventilation should be used to facilitate exposure for lobectomy, although CO2 insufflation suffices for other procedures. The chest is prepared as for a thoracotomy and a 5 mm incision made in the mid-axillary line in the fourth to sixth interspace. A Veress needle is placed into the chest carefully just above a rib to avoid the neurovascular bundle.
Surgical Treatment of Ectopic Mediastinal Parathyroid Tumors: A 23-Year Clinical Data Study in a Single Center
Published in Journal of Investigative Surgery, 2022
Lei Liu, Jia-qi Zhang, Gui-ge Wang, Ke Zhao, Chao Guo, Cheng Huang, Shan-qing Li, Ye-ye Chen
Although most EMPT can be removed through a neck incision, the thoracic approach is a safer choice because the neck approach provides insufficient exposure and manipulation space. According to literature, the thoracotomy approach is associated with serious complications, including damage to the phrenic nerve and recurrent laryngeal nerve, innominate vein rupture, wound infection, mediastinal infection, and death.1 With the successful implementation of the first VATS approach surgery in 199426 and the first robotic-assisted surgery in 200427 for EMPT, the thoracic approach has increasingly become minimally invasive. In this study, 12 patients underwent thoracotomy and VATS approaches, respectively. Through Mann-Whitney U test, we found that VATS approach had a shorter operation time (P = 0.039) and less intraoperative bleeding (P < 0.001). The above findings are consistent with those of Du et al.28 In addition, this study found that VATS approach surgery has not only a better short-term prognosis after surgery but also a satisfactory long-term prognosis. We suggest that the specific surgical approach can be determined by tumor's location and surgeon's experience. If possible, the VATS surgical approach should be the first choice.
Intrapericardial pneumonectomy for unicentric hilar castleman disease
Published in Acta Chirurgica Belgica, 2021
Murat Kara, Berker Ozkan, Melike Ulker, Deniz Tugcu, Gulcin Yegen
Clinical and radiological findings are not specific to Castleman disease, which made the diagnosis difficult as in our case. A unicentric localized form is a slow-growing, asymptomatic mass lesion; however, a multicentric systemic form may present with generalized lymphadenopathy, fever, fatigue, weight loss, hepatosplenomegaly, and hypergammaglobulinemia [3]. Unicentric Castleman disease manifests as either a solitary, well-circumscribed mediastinal mass or an infiltrative mass with clear contrast enhancement in addition to associated lymphadenopathy on computerized tomography or magnetic resonance imaging. On the other hand, multicentric Castleman disease manifests with diffuse mediastinal lymphadenopathy. All lesions are heterogeneous and have increased signal intensity on T1- and T2-weighted images in the magnetic resonance images [4]. Similarly, PET/CT is not a diagnostic approach because it cannot be adequately differentiated from a malignant tumor. Thus, Castleman disease with intrapulmonary involvement may even mimic lung cancer with false-positive mediastinal lymphadenopathies. A differential diagnosis should include lung tumors, such as carcinoma, carcinoid tumor, hamartoma, lymphoma, and lymphadenopathy. The diagnosis can only be established with a histopathologic examination of the resected lymph nodes. A thoracotomy may also become inevitable for the diagnosis and treatment as in our case.
Phase 2 trial of neoadjuvant toripalimab with chemotherapy for resectable stage III non-small-cell lung cancer
Published in OncoImmunology, 2021
Ze-Rui Zhao, Chao-Pin Yang, Si Chen, Hui Yu, Yong-Bin Lin, Yao-Bin Lin, Han Qi, Jie-Tian Jin, Shan-Shan Lian, Yi-Zhi Wang, Jin-Qi You, Wen-Yu Zhai, Hao Long
Patients received neoadjuvant treatment with intravenous toripalimab (240 mg) on day 1, carboplatin (area under the curve 5) on day 1, and pemetrexed (500 mg/m2 for adenocarcinoma) or nab-paclitaxel (260 mg/m2 for other subtypes) on day 1 of each 21-day cycle for three cycles. Patients who did not progress after treatment by radiographic evaluation underwent surgery, which included resection of the primary tumor and ipsilateral lymph nodes 4–5 weeks following the first day of the third cycle of treatment. Thoracotomy or video-assisted thoracoscopic surgery (VATS) was chosen according to the surgeon’s preference. Adjuvant toripalimab monotherapy commencing 4–8 weeks after surgery and continuing until month 12 was the recommended therapeutic option but other adjuvant modalities may be determined by the multidisciplinary team.