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Surgical and Radiologic Anatomy : SRA Mar 2022The primary objective of the present study was to use CT angiography and 3D reconstruction to assess and to classify the mediastinal pulmonary basal segmental arteries.
PURPOSE
The primary objective of the present study was to use CT angiography and 3D reconstruction to assess and to classify the mediastinal pulmonary basal segmental arteries.
METHODS
We report a particular type of bifurcated left lower pulmonary artery, namely, the "mediastinal basal pulmonary artery" type, which is the first branch from the proximal the left pulmonary artery (LPA) between the left main bronchus (LMB) and the left superior pulmonary vein (LSPV) and proceeding directly into the lower lobe. There are many types of mediastinal basal pulmonary arteries, and these can be classified worldwide in a unified way and format, which will be beneficial for clinical records, annotation and academic exchange.
RESULTS
The mediastinal basal pulmonary arteries are described either as "supernumerary" when duplicating or "displaced" when replacing the normal arterial branching pattern of the lower lobe. The displaced type is more frequent than the supernumerary type. There are 12 types of left mediastinal basilar arteries.
CONCLUSION
This is the first report to categorize the mediastinal basal pulmonary artery, is the first to suggest a system for mediastinal basal pulmonary artery nomenclature, and creates simplified models for use when planning anatomical segmentectomy. Knowledge and recognition of this rare and special condition may facilitate better diagnosis and treatment of these patients.
Topics: Bronchi; Humans; Imaging, Three-Dimensional; Lung; Mediastinum; Pulmonary Artery
PubMed: 35092478
DOI: 10.1007/s00276-022-02889-9 -
Radiographics : a Review Publication of... 2022Acute aortic syndrome (AAS) is classically attributed to three underlying pathologic conditions-aortic dissection (AD), intramural hematoma (IMH), and penetrating...
Acute aortic syndrome (AAS) is classically attributed to three underlying pathologic conditions-aortic dissection (AD), intramural hematoma (IMH), and penetrating atherosclerotic ulcer (PAU). In the majority of cases, the basics of image interpretation are not difficult and have been extensively reviewed in the literature. In this article, the authors extend existing imaging overviews of AAS by highlighting additional factors related to the diagnosis, classification, and characterization of difficult AAS cases. It has been well documented that AAS is caused not only by an AD but by a spectrum of lesions that often have overlap in imaging features and are not clearly distinguishable. Specifically, phase of contrast enhancement, flow artifacts, and flapless AD equivalents can complicate diagnosis and are discussed. While the A/B dichotomy of the Stanford system is still used, the authors subsequently emphasize the Society for Vascular Surgery's new guidelines for the description of acute aortic pathologic conditions given the expanded use of endovascular techniques used in aortic repair. In the final section, atypical aortic rupture and pitfalls are described. As examples of pericardial and shared sheath rupture become more prevalent in the literature, it is important to recognize contrast material third-spacing and mediastinal blood as potential mimics. By understanding these factors related to difficult cases of AAS, the diagnostic radiologist will be able to accurately refine CT interpretation and thus provide information that is best suited to directing management. RSNA, 2021.
Topics: Aortic Dissection; Aorta; Aortic Diseases; Hematoma; Humans; Tomography, X-Ray Computed; Ulcer
PubMed: 34951836
DOI: 10.1148/rg.210098 -
The Thoracic and Cardiovascular Surgeon Jan 2023Omental flap (OF) is a traditional surgical option to counteract severe postcardiotomy mediastinal infection and to cover extensive sternal defects. We reviewed our... (Review)
Review
INTRODUCTION
Omental flap (OF) is a traditional surgical option to counteract severe postcardiotomy mediastinal infection and to cover extensive sternal defects. We reviewed our experience with omental flap transfer (OFT) in various clinical circumstances, in which omentoplasty may be considered by cardiac surgeons.
METHODS
Twenty-one patients, who underwent OFT from January 2012 to December 2021, were studied. The main indication was treatment of infected foreign material implants including vascular grafts and ventricular assist devices or prevention of its infection (16 patients). In five patients, an OFT was used to cure mediastinitis following deep sternal wound infection after median sternotomy.
RESULTS
All patients had a high surgical risk with 3 ± 1.9 previous sternotomies and a mean Euro Score II of 55.0 ± 20.1. OF was successful in its prophylactic or therapeutic purpose in all patients, no complications related to the operative procedure were noted, that is, no early or late flap failure and no herniation of abdominal organs occurred. In-hospital mortality was six patients as three patients each died from multiple organ dysfunction syndrome and cerebral hemorrhage. All fifteen patients discharged demonstrated rapid recovery, complete wound healing without fistula, and no late gastrointestinal complications. The mean follow-up of 18 months was uneventful.
CONCLUSION
OFT seems to be an excellent solution for extensive mediastinal and deep sternal wound infections.
Topics: Humans; Surgical Flaps; Surgical Wound Infection; Debridement; Treatment Outcome; Cardiac Surgical Procedures; Sternum; Sternotomy; Mediastinitis; Retrospective Studies
PubMed: 36257544
DOI: 10.1055/s-0042-1757892 -
Clinical Rheumatology Aug 2022It is now well established that Th17 lymphocytes associate with myriad immune-mediated inflammatory diseases. Over the past one and a half decades, a subset of Th17... (Review)
Review
It is now well established that Th17 lymphocytes associate with myriad immune-mediated inflammatory diseases. Over the past one and a half decades, a subset of Th17 lymphocytes viz. Th17.1 lymphocytes has been identified in pre-clinical and clinical models of inflammatory rheumatic diseases. These lymphocytes secrete IL-17A (signature cytokine of Th17 lymphocytes) as well as IFN-γ (the signature cytokine of Th1 lymphocytes). They express the chemokine markers for Th1 (CXCR3) as well as Th17 (CCR6) lymphocytes. Th17.1 lymphocytes also express the drug efflux protein p-glycoprotein, which associates with resistance to corticosteroids and other immunosuppressive drugs. This narrative review overviews the evidence regarding Th17.1 lymphocytes in different inflammatory rheumatic diseases. It is now recognized that Th17.1 lymphocytes are increased in the synovial fluid of affected joints in rheumatoid arthritis (RA) and associate with poor treatment response to abatacept. Th17.1 lymphocytes from synovial fluid of RA are less responsive to immunosuppression than those from the peripheral blood. In sarcoidosis, Th17.1 lymphocytes are concentrated in mediastinal lymph nodes and alveolar lining. Such Th17.1 lymphocytes in sarcoidosis are the predominant source of IFN-γ in the sarcoid lung. Th17.1 lymphocytes are elevated in lupus and Takayasu arteritis and associate with disease activity. Future studies should evaluate isolated Th17.1 lymphocytes from peripheral blood or sites of pathology such as synovial fluid and assess their modulation with immunosuppressive therapy in vitro. The analysis of gene expression signature of isolated Th17.1 lymphocytes might enable the identification of newer therapeutic strategies specifically targeting these cell populations in inflammatory rheumatic diseases. Key Points • Th17.1 lymphocytes are a subset of Th17 lymphocytes secreting both IFN-γ and IL-17 • Th17.1 lymphocytes drive neutrophilic inflammation, granuloma formation, and corticosteroid resistance • Th17.1 lymphocytes are elevated in rheumatoid arthritis and sarcoidosis at sites of inflammation • Increased circulating Th17.1 lymphocytes have been identified in lupus and Takayasu arteritis and associate with active disease.
Topics: Arthritis, Rheumatoid; Cytokines; Humans; Inflammation; Sarcoidosis; Takayasu Arteritis; Th1 Cells; Th17 Cells
PubMed: 35546376
DOI: 10.1007/s10067-022-06202-2 -
Scientific Reports Mar 2021In this work, we sought to delineate the prevalence of cardiothoracic imaging findings of Proteus syndrome in a large cohort at our institution. Of 53 individuals with a...
In this work, we sought to delineate the prevalence of cardiothoracic imaging findings of Proteus syndrome in a large cohort at our institution. Of 53 individuals with a confirmed diagnosis of Proteus syndrome at our institution from 10/2001 to 10/2019, 38 individuals (men, n = 23; average age = 24 years) underwent cardiothoracic imaging (routine chest CT, CT pulmonary angiography and/or cardiac MRI). All studies were retrospectively and independently reviewed by two fellowship-trained cardiothoracic readers. Disagreements were resolved by consensus. Differences between variables were analyzed via parametric and nonparametric tests based on the normality of the distribution. The cardiothoracic findings of Proteus syndrome were diverse, but several were much more common and included: scoliosis from bony overgrowth (94%), pulmonary venous dilation (62%), band-like areas of lung scarring (56%), and hyperlucent lung parenchyma (50%). In addition, of 20 individuals who underwent cardiac MRI, 9/20 (45%) had intramyocardial fat, mostly involving the endocardial surface of the left ventricular septal wall. There was no statistically significant difference among the functional cardiac parameters between individuals with and without intramyocardial fat. Only one individual with intramyocardial fat had mildly decreased function (LVEF = 53%), while all others had normal ejection fraction.
Topics: Adolescent; Adult; Child; Diagnostic Imaging; Female; Heart Defects, Congenital; Humans; Lung; Magnetic Resonance Imaging; Male; Mediastinum; Middle Aged; Proteus Syndrome; Thoracic Wall; Thorax; Tomography, X-Ray Computed; Young Adult
PubMed: 33753828
DOI: 10.1038/s41598-021-86029-0 -
Kyobu Geka. the Japanese Journal of... Jul 2023We have been performing multiport thoracoscopic surgery as a minimally invasive procedure for mediastinal tumors. The criteria for thoracoscopic surgery are as...
We have been performing multiport thoracoscopic surgery as a minimally invasive procedure for mediastinal tumors. The criteria for thoracoscopic surgery are as follow;tumor under 6 cm without invasion of great vessels, chest wall, or lung. We started one port surgery since 2017 and robot-assisted thoracoscopic surgery since 2018. We retrospectively reviewed these three approaches for mediastinal tumor for 12 years. 269 patients underwent surgery for mediastinal tumor, 141 patients by multiport surgery, 21 patients by one port surgery, and 38 patients by robot-assisted thoracoscopic surgery. Of 203 patients with anterior mediastinal tumors, 141 patients underwent thymectomy for thymic tumors (72 patients by multiport surgery, 9 patients by one port surgery, 17 patients by robot-assisted thoracoscopic surgery, and 43 patients by open surgery). There was no difference in tumor size, but the operating time and blood loss were significantly less in one port surgery than in multiport surgery or robot-assisted thoracoscopic surgery. The approaches have become more diverse, with a wider choice of surgical techniques, allowing us to offer more radical minimally invasive surgeries.
Topics: Humans; Mediastinal Neoplasms; Retrospective Studies; Thoracic Surgery, Video-Assisted; Thymus Neoplasms; Mediastinum
PubMed: 37475097
DOI: No ID Found -
Cancer Epidemiology Apr 2022Neuroendocrine neoplasms (NENs) are rare and can originate from any body part. However, there are only few epidemiological studies, especially on lung and mediastinal...
BACKGROUND
Neuroendocrine neoplasms (NENs) are rare and can originate from any body part. However, there are only few epidemiological studies, especially on lung and mediastinal NENs. This study investigated the epidemiological trends and differences between lung and mediastinal NENs in Japan.
METHODS
Patients with lung and mediastinal NENs were identified in a national hospital-based cancer registry between 2009 and 2015 in Japan. NENs were subclassified into neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs). NECs were further subdivided into large neuroendocrine carcinomas (LCNECs) and small cell carcinomas (SCCs). We examined the patient characteristics: sex, age, histology, year of diagnosis, diagnostic opportunity, and initial treatment.
RESULTS
We identified 48,433 patients with 47,888 lung (98.9%) and 545 mediastinal (1.1%) NENs. The commonest subtype of lung NENs was SCCs (87%), followed by LCNECs (10%) and NETs (3%). In the mediastinum, SCCs were also the commonest (48%), followed by NETs (38%) and LCNECs (14%). The number of lung NEN annually increased; however, that of mediastinal NENs did not change over time. The mean age of patients with lung NETs was lower than that of patients with lung LCNECs and SCCs (NETs, 62 ± 14 years; LCNECs, 70 ± 9 years; SCCs, 71 ± 9 years; p < .001). The lung and mediastinal NENs were mainly detected based on symptoms, except for lung NETs. Surgical intervention, including multimodal therapy, was performed for 89.3% of lung NETs (surgery alone: 83.6%), while only 15.6% of lung NECs were treated with surgery. For the mediastinum, 75.9% of NETs were treated with surgery, with 27.1% of cases treated with surgery plus multimodal therapy. Surgery was performed more frequently for mediastinal NECs (37%) than for lung NECs (15.6%).
CONCLUSIONS
This study highlights differences in trends of lung and mediastinal NENs. This study's findings support the importance of epidemiological evaluations based on the primary sites and histological subtypes.
Topics: Aged; Carcinoma, Neuroendocrine; Humans; Japan; Lung; Lung Neoplasms; Middle Aged; Neuroendocrine Tumors; Pancreatic Neoplasms
PubMed: 35144127
DOI: 10.1016/j.canep.2022.102116 -
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 -
Clinical Immunology (Orlando, Fla.) May 2022Potential etiologies of TBNK SCID include both hematopoietic defects and thymic aplasia. The management of patients with this phenotype, identified by newborn screen,...
Potential etiologies of TBNK SCID include both hematopoietic defects and thymic aplasia. The management of patients with this phenotype, identified by newborn screen, may be unclear in the absence of a genetic diagnosis. We report an infant with lymphocyte flow cytometry consistent with TBNK SCID and reduced proliferative response to phytohemagglutinin. The patient had no genetic diagnosis after targeted panel and exome sequencing. The decision to trend laboratory values rather than move immediately to hematopoietic cell transplant was made given the absence of a genetic defect and the finding of a normal thymus on ultrasound. During the course of evaluation for transplant, the patient unexpectedly had normalization of T cell number and function. This case demonstrates a role for mediastinal ultrasound and the utility of trending laboratory values in patients with severe T cell lymphopenia but no genetic diagnosis, given the small but important possibility of spontaneous resolution.
Topics: Hematopoietic Stem Cell Transplantation; Humans; Infant, Newborn; Lymphopenia; Neonatal Screening; Severe Combined Immunodeficiency; T-Lymphocytes
PubMed: 35447312
DOI: 10.1016/j.clim.2022.109014 -
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