Prenatal Therapy for Obstructive Uropathy

The increasing use of routine prenatal imaging and diagnosis has provided a better understanding of the natural history of obstructive uropathy. Fortunately, most disorders portend little clinical significance prenatally, although a select subset can incur irreversible renal injury and pulmonary hypoplasia depending on the onset, duration, severity, and level of obstruction. In these cases, timely antenatal evaluation and prenatal intervention can provide an optimal postnatal outcome. The natural history, evaluation, and management of fetal obstructive uropathies are discussed.     

Transaxillary Minithoracotomy: The Optimal Approach for Certain Pulmonary and Mediastinal Lesions

This report concerns the use of trans-axillary thoracotomy for a variety of pulmonary, pleural, and mediastinal conditions in 50 patients. Primary and metastatic carcinomas, pneumothoraces, and benign lesions such as bronchogenic cysts and neurogenic tumors can be identified, evaluated, and treated with confidence. Reduced postoperative pain and morbidity, rapid return of arm and shoulder movements, reduced hospital stay, and excellent cosmetic result are among the advantages of this approach when compared with the usual posterolateral thoracotomy.     

Aspiration Needle Biopsy of Thoracic Lesions

We reviewed our experience with 2,114 percutaneous aspiration needle biopsies of intrathoracic lesions. Aspiration was performed for cytological diagnosis employing biplane fluoroscopy and a 20 gauge needle, 0.9 mm in outside diameter. A satisfactory specimen was obtained in 88% of biopsies, and the chance of obtaining a correct diagnosis of a malignant lesion was 81.5%. The false positive rate was 2.2%, and the cytologists could always distinguish between primary and secondary neoplasms. A false negative rate of 13.6% (36 patients) resulted in only three delayed thoracotomies and two instances of interval metastases discovered at mediastinoscopy. Cellular specificity in primary tumors was not sufficiently accurate to affect therapy. Pneumothoraces occurred frequently (31.9% of patients) but were generally small; 10.4% of patients required chest drainage. There were no recorded instances of tumor implantation in needle tracts. We conclude that a rapid and accurate diagnosis of intrathoracic pathology can be obtained by this technique. It is associated with an acceptable morbidity and may greatly expedite both patient care and investigation.     

胸段食管癌颈部及上纵隔淋巴结转移

探讨胸段食管癌颈部及上纵隔淋结转移规律。方法采用颈,胸,腹三切口施行胸段食管癌手术６１６例,同时施行三区域淋巴洁清扫。结果：中及上纵隔淋巴结转移率和转移度分别为５７．１％和２１．５％。结论胸段食管癌必须重颈部及上纵隔淋巴结清扫。     

CT引导下行胸部病变穿刺活检术病人的护理

总结23例胸部病变CT引导下行穿刺活检术病人的护理.提出注重术前准备、术中配合及术后健康教育,可提高穿刺的成功率,减少并发症的发生.     

Intraoperative Fine Needle Aspiration Biopsy of Thoracic Lesions

Forty-one intraoperative fine needle aspiration biopsies were performed on 35 patients during exploratory thoracotomy (33 patients) or mediastinoscopy (2 patients). Each biopsy was done with a 22 gauge needle. Smears were prepared at the operating table, air-dried, sent directly to the laboratory, stained, and interpreted immediately by the pathologist. Preparation and reporting time averaged ten minutes. Surgical decisions were made on the basis of the pathologist's reports.Intraoperative fine needle aspiration biopsy was 100% accurate in differentiating inflammatory from neoplastic lesions. Ninety-five percent diagnostic accuracy for malignancy (39 out of 41 specimens) was obtained. It permitted quick biopsy of lesions deep within the lung parenchyma without the need to cut across uninvolved tissue, thus permitting appropriate resection in each patient. There were no deaths related to the procedure.     

一期后路全脊椎切除并内固定矫形治疗胸腰椎疾患

目的 观察一期后路全脊椎切除并内固定矫形治疗胸腰椎疾患的疗效.方法 对17例胸腰椎疾患(6例陈旧性脊柱骨折脱位,4例全脊椎结核,5例脊柱侧后凸畸形,2例全脊椎肿瘤)全脊柱切除的疗效进行回顾性分析.其中14例伴有后凸或侧后凸成角畸形,12例病变节段以下完全或不完全性瘫痪.对所有患者一期经后路行病椎全脊椎切除,环脊髓减压、...     

Mediastinoscopy: Its Application in Central Versus Peripheral Thoracic Lesions

In an attempt to ascertain the value of mediastinoscopy in peripheral lung lesions, records of 157 patients undergoing cervicomediastinal exploration (CME) at Wilford Hall USAF Medical Center were reviewed. Among patients with benign lesions, CME was positive in 90.6% of those who had central lesions and 58.3% of those with peripheral lesions. It was positive in all 7 patients who had peripheral lesions with associated mediastinal nodes on roentgenogram and negative in all 5 who had peripheral lesions without nodes. In the patients with malignant lesions, CME was positive in 72.9% of those who had central lesions and 58.1% of those with peripheral lesions. It was positive in 24 of 27 patients who had peripheral lesions with associated mediastinal nodes and negative in 15 of 16 patients with peripheral lesions without nodes.Although we recognize this to be a selected series, CME does appear to be valuable in patients with central lesions and peripheral lesions with mediastinal nodal involvement on roentgenogram. It does not appear to be as useful in those with peripheral lesions who do not have central nodal involvement.     

Mediastinal Adiposity Influences the Technical Difficulty of Thoracic Procedure in Minimally Invasive Esophagectomy

Background

Obesity is considered to influence the difficulty of surgery. However, whether mediastinal adiposity influences the difficulty of the thoracic procedure in minimally invasive esophagectomy (MIE) remains unclear.

Methods

Computed tomography volumetry was performed in 142 patients who underwent MIE between 2012 and 2014. We measured abdominal visceral fat area (AVFA) at the umbilicus level and mediastinal fat area (MFA) at the tracheal carina level. The influence of MFA on the difficulty of the thoracic procedure was assessed using the thoracic procedure duration as a parameter, and the effect of MFA on morbidity after MIE was assessed.

Results

MFA was significantly smaller than AVFA (p < 0.01). There was a positive correlation between them (p < 0.01). A significant positive correlation was observed between MFA and thoracic procedure duration (p < 0.01). Multivariate analysis revealed that MFA was independently correlated with prolonged thoracic procedure duration (p < 0.01). Regarding postoperative complications associated with the thoracic procedure, there were no significant differences in MFA between patients with or without pneumonia and those with or without chylothorax. Patients who experienced recurrent laryngeal nerve palsy (RLNP) had greater MFA than those who did not (p = 0.04). Multivariate analysis revealed that MFA was a significant predictor of the occurrence of RLNP (p = 0.04).

Conclusions

Although the extent of mediastinal adiposity was much lesser than that of abdominal visceral adiposity, it could be a predictor of the difficulty of the thoracic procedure as well as the risk of RLNP in MIE.