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Khirurgiia 2022To optimize therapeutic and tactical algorithm in patients with mediastinal tumors.
OBJECTIVE
To optimize therapeutic and tactical algorithm in patients with mediastinal tumors.
MATERIAL AND METHODS
The study included 300 patients with mediastinal tumors examined and treated in the Thoracic Surgery Department of the Hertzen Moscow Cancer Research Center between 2008 and 2019. Patients were stratified into 2 groups. The diagnostic group consisted of 160 patients including 80 ones after 89 ultrasound-assisted transthoracic biopsies and 80 patients after open biopsy through parasternal mediastinotomy. The treatment group consisted of 140 patients who underwent 145 resections of mediastinal tumors. We analyzed the results of diagnosis and treatment in both groups, mistakes, risk factors of non-informative biopsies and complicated course of the postoperative period. Subsequently, a clinical algorithm was developed. Its effectiveness in 50 patients was compared with 90 patients who constituted the historical control group.
RESULTS
The final histological diagnosis after transthoracic ultrasound-assisted biopsy of the mediastinum was established in 71 out of 89 cases (80%). Informative value of ultrasound-assisted biopsy for thymic tumors was 100%, for metastatic mediastinal lesions - 92%. Repeated ultrasound-assisted biopsies were performed in 7 (9%) patients that made it possible to establish the final diagnosis in 5 (71%) cases. In the parasternal mediastinotomy group, the final correct histological diagnosis was made in 79 out of 80 (99%) patients. Analyzing thoracoscopic approach and traditional sternotomy or thoracotomy, we found surgery time decrease from 187 (150-215) to 140 (122-165) min (<0.01), blood loss from 300 (200-350) to 50 (35-150) ml (<0.01), postoperative hospital-day from 12 (9-14.5) to 7 (6-8) days (<0.01). Mean dimension of tumor was 5 (4-6) cm in the thoracoscopy group and 7.5 (6-10) cm in the open surgery group (<0.01). Postoperative complications occurred in 19 (13%) patients, mortality rate was 2.8%. Multivariate analysis revealed superior vena cava syndrome (OR=5.1, 95% CI=1.246-21.343; =0.024) and invasion of the right pleural cavity (OR 4.2, 95% CI 1.12-7.69; =0.006) as the most significant predictors of postoperative complications. The proposed algorithms made it possible to reduce the incidence of non-informative biopsy from 12% to 0% (<0.05), misdiagnosis from 9% to 1% (<0.05), exploratory surgeries from 23% to 0% (<0.05).
CONCLUSION
The developed algorithm is valuable to avoid the errors and improve the results of diagnosis and treatment of patients with mediastinal tumors.
Topics: Algorithms; Humans; Mediastinal Neoplasms; Mediastinum; Postoperative Complications; Retrospective Studies; Superior Vena Cava Syndrome
PubMed: 35593627
DOI: 10.17116/hirurgia202205143 -
The American Journal of the Medical... May 2017
Topics: Adenoma; Adolescent; Calcium; Female; Humans; Hypercalcemia; Hyperparathyroidism; Mediastinum; Parathyroid Hormone; Parathyroid Neoplasms; Radiography, Thoracic; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed
PubMed: 28502343
DOI: 10.1016/j.amjms.2016.08.009 -
The Annals of Thoracic Surgery Feb 2023Angiomyolipomas are benign mesenchymal tumors classified as PEComas, consisting of blood vessels, smooth muscle, and fat, and generally found in renal tissue. Extrarenal...
Angiomyolipomas are benign mesenchymal tumors classified as PEComas, consisting of blood vessels, smooth muscle, and fat, and generally found in renal tissue. Extrarenal cases are uncommon, and those of the mediastinum are rare, with only 23 reports in the literature. We present a successful surgically managed case of a symptomatic 44-year-old woman with a large heart-shaped mediastinal angiomyolipoma in the right hemithorax associated with chylopericardium.
Topics: Female; Humans; Adult; Angiomyolipoma; Mediastinum; Pericardial Effusion; Hamartoma; Kidney Neoplasms
PubMed: 35314157
DOI: 10.1016/j.athoracsur.2022.03.006 -
BMJ Case Reports Oct 2016
Topics: Adult; Contrast Media; Hematoma; Humans; Male; Mediastinum; Tomography, X-Ray Computed
PubMed: 27793874
DOI: 10.1136/bcr-2016-217799 -
BMC Endocrine Disorders Jun 2023Parathyroid carcinoma (PC) is an uncommon cause of primary hyperparathyroidism (PHPT) and particularly rare in the mediastinum. Herein, we present a case of mediastinal... (Review)
Review
BACKGROUND
Parathyroid carcinoma (PC) is an uncommon cause of primary hyperparathyroidism (PHPT) and particularly rare in the mediastinum. Herein, we present a case of mediastinal PC and conduct a related literature review.
CASE PRESENTATION
We described a case of a 50-year-old female patient with PHPT due to mediastinal PC. She was initially admitted to a local hospital in her hometown with hypercalcemia and high blood concentrations of PTH (parathyroid hormone). The patient underwent neck parathyroidectomy and pathological examination suggested parathyroid adenoma. Although the overproduction of serum calcium and PTH declined after the surgery, calcium and PTH increased again one month later, so the patient was transferred to our hospital. A 99Tc-sestamibi scan revealed an ectopic finding in the mediastinum, which was also indicated on the CT image. After removing the mediastinal mass, the metabolism of calcium and PTH quickly reverted to normal and the pathologic features of the mass were consistent with PC. By reviewing the related literature, we noticed that only scattered reports were published before 1982, and those were not included in the present review due to their differences with current radiological examination and treatment methods. After excluding outdated studies, we summarized and analyzed 20 reports of isolated mediastinal PC and concluded that. Parathyroidectomy remains the only curative treatment for the disease. Furthermore, the success of treatment directly depends on accurate preoperative localization.
CONCLUSION
With this study, we emphasize the importance of accurate preoperative diagnosis of mediastinal PC and improve clinicians' understanding of the disease.
Topics: Humans; Female; Middle Aged; Parathyroid Neoplasms; Mediastinum; Calcium; Parathyroid Hormone; Parathyroidectomy; Hyperparathyroidism, Primary
PubMed: 37280629
DOI: 10.1186/s12902-023-01363-w -
Seminars in Thoracic and Cardiovascular... 2022To evaluate the diagnostic accuracy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Endoscopic Ultrasound-guided Fine Needle...
To evaluate the diagnostic accuracy of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration (EBUS-TBNA) and Endoscopic Ultrasound-guided Fine Needle Aspiration (EUS-FNA) in the diagnosis of lymphoma. A retrospective analysis of patients with suspected mediastinal lymphoproliferative disorders who underwent EBUS-TBNA, EUS-FNA or combined procedures from 2009 to 2019 was conducted using a prospectively maintained interventional thoracic endoscopy database. Demographic data, imaging, needle size, surgical biopsy, complications rate and pathology reports were reviewed. Over a 10-year period, a total of 444 patients were investigated with endosonography as the first diagnostic procedure for mediastinal adenopathy suspicious for lymphoma. Lymphoma was diagnosed in 77 patients (17.3%). In total, 68 patients (88.3%) were diagnosed using endosonographic mediastinal tissue sampling. Four patients had both lymphoproliferative disorders and lung cancer. Nine patients (11.7%) required a surgical biopsy to confirm the lymphoma diagnosis (6 non-diagnostic; 3 inadequate samples from endosonographic biopsies). In patients with adequate biopsies via endosonography, the sensitivity for the diagnosis of lymphoma, was 91.9% (n = 68/74). The histopathologic subtype of lymphoma was determined by endosonographic biopsies in 61 patients (89.7%) with an increased sensitivity (92.6%) for low grade Non-Hodgkin lymphoma (NHL). No acute complication related to endosonography was observed. Endosonographic biopsy (EBUS and/or EUS) of mediastinal adenopathy in patients with suspected lymphoma is a highly sensitive and safe diagnostic test. Endosonography should be the first test in the diagnosis of suspicious mediastinal lymphoma and should be followed by surgical biopsy in cases of insufficient sampling or indefinite diagnosis.
Topics: Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Lung Neoplasms; Lymph Nodes; Lymphadenopathy; Lymphoma; Mediastinum; Neoplasm Staging; Retrospective Studies; Sensitivity and Specificity; Treatment Outcome
PubMed: 34157382
DOI: 10.1053/j.semtcvs.2021.06.010 -
The Indian Journal of Chest Diseases &... Jul 2016We report the case of a 28-year-old resident doctor with no past history of having taken rifampicin, who presented with thrombocytoapaenic purpura occurring after the...
We report the case of a 28-year-old resident doctor with no past history of having taken rifampicin, who presented with thrombocytoapaenic purpura occurring after the initiation of anti-tuberculosis therapy (isoniazid, rifampicin, pyrazinamide and ethambutol) for tubercular lymphadenopathy.
Topics: Adult; Antibiotics, Antitubercular; Humans; Lymph Nodes; Male; Mediastinum; Purpura, Thrombocytopenic; Radiography, Thoracic; Rifampin; Treatment Outcome; Tuberculosis, Pulmonary; Withholding Treatment
PubMed: 30152654
DOI: No ID Found -
Chest Sep 2021A 74-year-old man, in excellent physical condition and doing regular intense cycling, was evaluated for transient episodes of thoracic discomfort over a period of...
A 74-year-old man, in excellent physical condition and doing regular intense cycling, was evaluated for transient episodes of thoracic discomfort over a period of several months. His medical history only included a right inguinal hernia, surgically treated, and an abdominal aortic aneurysm measured at 46 mm and treated medically. Physical examination did not reveal much information. The patient did not report gastroesophageal reflux, dysphagia, or history of digestive occlusion. The patient had normal weight and had no trauma history. He had no nicotine or alcohol-dependent behaviors. Vital signs were within normal values. Laboratory test results were normal. Functional status was normal, without anomalies of pulmonary function tests or arterial blood gases. The ECG did not reveal any anomaly.
Topics: Abdominal Cavity; Aged; Chest Pain; Colon; Diagnosis, Differential; Hernias, Diaphragmatic, Congenital; Herniorrhaphy; Humans; Laparotomy; Male; Mediastinum; Radiography, Thoracic; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 34488972
DOI: 10.1016/j.chest.2021.04.021 -
BMJ Case Reports Jun 2022Functional mediastinal paragangliomas (PGs) are rare, catecholamine-secreting tumours. Surgical resection is the preferred treatment, but it can be complicated by...
Functional mediastinal paragangliomas (PGs) are rare, catecholamine-secreting tumours. Surgical resection is the preferred treatment, but it can be complicated by catecholamine-related symptoms, involvement of cardiac structures and/or tumour supply from major blood vessels. We report a case of a man in his 30s with a subcarinal functional PG complicated by all three factors. The PG had arterial supplies from the right coronary and bronchial arteries, with mass effect on the left atrium. Given the high risk of intraoperative bleeding, catecholamine surges and injury to right coronary artery, we attempted a minimally invasive strategy that incorporates best practices from the few published cases on functional PGs. We show that a multidisciplinary approach involving alpha/beta blockade, preoperative embolisation of tumour blood supply, robotic-assisted tumour mobilisation and, if needed, open resection with cardiopulmonary bypass can be a safe strategy in the treatment of functional mediastinal paragangliomas adherent to cardiac structures.
Topics: Catecholamines; Humans; Male; Mediastinal Neoplasms; Mediastinum; Paraganglioma; Paraganglioma, Extra-Adrenal
PubMed: 35672059
DOI: 10.1136/bcr-2022-250500 -
The Annals of Thoracic Surgery Jan 2018Prevention strategies have long been sought to reduce the incidence and burden of postoperative atrial fibrillation (POAF) after heart surgery. However, none has emerged... (Review)
Review
BACKGROUND
Prevention strategies have long been sought to reduce the incidence and burden of postoperative atrial fibrillation (POAF) after heart surgery. However, none has emerged as a dominant and widely applicable prophylactic measure. The purpose of this review is to consider the biological mechanisms by which shed mediastinal blood leads to oxidation and inflammation within the postoperative pericardial environment and how this might trigger POAF in susceptible persons, as well as how it could represent a new target for prevention of POAF.
METHODS
We conducted a structured research of literature using PubMed and MEDLINE databases to May 2016. Biomolecular and clinical articles focused on assessing the contribution of pericardial blood, or the resulting inflammation within the pericardial space and its potential role in triggering POAF, were included in this review.
RESULTS
Evidence suggests that shed mediastinal blood through breakdown products, activation of coagulation cascade, and oxidative burst contributes to a highly pro-oxidant and proinflammatory milieu found within the pericardial space that can trigger postoperative atrial fibrillation in susceptible persons. The extent of this reaction could be blunted by reducing the exposition of pericardium to blood either through posterior pericardiotomy or improved chest drainage.
CONCLUSIONS
Shed mediastinal blood undergoing transformation within the pericardium appears to be an important contributing factor to POAF. Strategies to prevent shed mediastinal blood from pooling around the heart might be considered in developing future paradigms for prevention of POAF.
Topics: Atrial Fibrillation; Blood; Blood Physiological Phenomena; Cardiac Surgical Procedures; Humans; Mediastinum; Pericardium; Postoperative Complications
PubMed: 29174782
DOI: 10.1016/j.athoracsur.2017.07.045