-
Interactive Cardiovascular and Thoracic... Jun 2022Isolated Chylopericardium (without chylothorax) is a rare clinical disorder that may happen idiopathically or secondary to trauma, radiotherapy, lymphatic anomalies,...
Isolated Chylopericardium (without chylothorax) is a rare clinical disorder that may happen idiopathically or secondary to trauma, radiotherapy, lymphatic anomalies, infections or mediastinal neoplasm. We present a case of middle-aged male with no past medical history of note prior to developing heavy sweating, loss of weight and cough. A series of investigations were done including chest computed tomography which showed enlarged mediastinal lymph nodes leading to uncomplicated mediastinoscopy and lymph node biopsy. Six days after being discharged, he developed dyspnoea and chest pain. Echocardiography revealed massive pericardial effusion. Pericardiocentesis was done and surprisingly revealed milky white chylous fluid. The patient was then successfully managed without the need for further intervention.
Topics: Chylothorax; Humans; Lymph Nodes; Male; Mediastinum; Middle Aged; Pericardial Effusion; Pericardiocentesis
PubMed: 34964452
DOI: 10.1093/icvts/ivab365 -
Turk Gogus Kalp Damar Cerrahisi Dergisi Jan 2024Mediastinal tumors are the most common thoracic tumor in the pediatric population. They include a spectrum of tumors, and most are malignant. These lesions can be... (Review)
Review
Mediastinal tumors are the most common thoracic tumor in the pediatric population. They include a spectrum of tumors, and most are malignant. These lesions can be anatomically and radiologically classified by means of compartments; anterior, middle, and posterior. Symptoms, signs, localization of the tumor, age of the child, and tumor markers are key points of diagnosis. Surgical approaches are typically needed for diagnosis, but sometimes tru-cut needle biopsies may be sufficient. Mediastinoscopy, mediastinotomy, and video-assisted thoracoscopic surgery may be used in the diagnostic workup of mediastinal tumors in children as they are used in adults. Frequently, diagnosis and treatment are both established by means of surgery. Surgery remains the mainstay of treatment of most benign and malignant nonlymphoid tumors. Combined modality of treatment incorporating chemotherapy and radiotherapy is often required in malignant tumors and is associated with high survival rates in these patients.
PubMed: 38584788
DOI: 10.5606/tgkdc.dergisi.2024.25799 -
Journal of Clinical Oncology : Official... Aug 2023Resectable non-small-cell lung cancer (NSCLC) with a high probability of mediastinal nodal involvement requires mediastinal staging by endosonography and, in the absence... (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
Resectable non-small-cell lung cancer (NSCLC) with a high probability of mediastinal nodal involvement requires mediastinal staging by endosonography and, in the absence of nodal metastases, confirmatory mediastinoscopy according to current guidelines. However, randomized data regarding immediate lung tumor resection after systematic endosonography versus additional confirmatory mediastinoscopy before resection are lacking.
METHODS
Patients with (suspected) resectable NSCLC and an indication for mediastinal staging after negative systematic endosonography were randomly assigned to immediate lung tumor resection or confirmatory mediastinoscopy followed by tumor resection. The primary outcome in this noninferiority trial (noninferiority margin of 8% that previously showed to not compromise survival, < .0250) was the presence of unforeseen N2 disease after tumor resection with lymph node dissection. Secondary outcomes were 30-day major morbidity and mortality.
RESULTS
Between July 17, 2017, and October 5, 2020, 360 patients were randomly assigned, 178 to immediate lung tumor resection (seven dropouts) and 182 to confirmatory mediastinoscopy first (seven dropouts before and six after mediastinoscopy). Mediastinoscopy detected metastases in 8.0% (14/175; 95% CI, 4.8 to 13.0) of patients. Unforeseen N2 rate after immediate resection (8.8%) was noninferior compared with mediastinoscopy first (7.7%) in both intention-to-treat (Δ, 1.03%; UL 95% CIΔ, 7.2%; = .0144) and per-protocol analyses (Δ, 0.83%; UL 95% CIΔ, 7.3%; = .0157). Major morbidity and 30-day mortality was 12.9% after immediate resection versus 15.4% after mediastinoscopy first ( = .4940).
CONCLUSION
On the basis of our chosen noninferiority margin in the rate of unforeseen N2, confirmatory mediastinoscopy after negative systematic endosonography can be omitted in patients with resectable NSCLC and an indication for mediastinal staging.
Topics: Humans; Lung Neoplasms; Carcinoma, Non-Small-Cell Lung; Mediastinoscopy; Endosonography; Neoplasm Staging; Lymph Nodes
PubMed: 37018653
DOI: 10.1200/JCO.22.01728 -
Saudi Journal of Anaesthesia 2021The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications... (Review)
Review
The management of infants and children presenting for thoracic surgery poses a variety of challenges for anesthesiologists. A thorough understanding of the implications of developmental changes in cardiopulmonary anatomy and physiology, associated comorbid conditions, and the proposed surgical intervention is essential in order to provide safe and effective clinical care. This narrative review discusses the perioperative anesthetic management of pediatric patients undergoing noncardiac thoracic surgery, beginning with the preoperative assessment. The considerations for the implementation and management of one-lung ventilation (OLV) will be reviewed, and as will the anesthetic implications of different surgical procedures including bronchoscopy, mediastinoscopy, thoracotomy, and thoracoscopy. We will also discuss pediatric-specific disease processes presenting in neonates, infants, and children, with an emphasis on those with unique impact on anesthetic management.
PubMed: 34764836
DOI: 10.4103/sja.SJA_350_20 -
Chest Mar 2020There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to...
BACKGROUND
There remains debate over the best invasive diagnostic modality for mediastinal nodal evaluation. Prior studies have limited generalizability and insufficient power to detect differences in rare adverse events. We compared the risks and costs of endobronchial ultrasound (EBUS)-guided nodal aspiration and mediastinoscopy performed for any indication in a large national cohort.
METHODS
We conducted a retrospective study (2007-2015) with MarketScan, a claims database of individuals with employer-provided insurance in the United States. Patients who underwent multimodality mediastinal evaluation (n = 1,396) or same-day pulmonary resection (n = 2,130) were excluded. Regression models were used to evaluate associations between diagnostic modalities and risks and costs while adjusting for patient characteristics, year, concomitant bronchoscopic procedures, and lung cancer diagnosis.
RESULTS
Among 30,570 patients, 49% underwent EBUS. Severe adverse events-pneumothorax, hemothorax, airway/vascular injuries, or death-were rare and invariant between EBUS and mediastinoscopy (0.3% vs 0.4%; P = .189). The rate of vocal cord paralysis was lower for EBUS (1.4% vs 2.2%; P < .001). EBUS was associated with a lower adjusted risk of severe adverse events (OR, 0.42; 95% CI, 0.32-0.55) and vocal cord paralysis (OR, 0.57; 95% CI, 0.54-0.60). The mean cost of EBUS was $2,211 less than mediastinoscopy ($6,816 vs $9,023; P < .001). After adjustment this difference decreased to $1,650 (95% CI, $1,525-$1,776).
CONCLUSIONS
When performed as isolated procedures, EBUS is associated with lower risks and costs compared with mediastinoscopy. Future studies comparing the effectiveness of EBUS vs mediastinoscopy in the community at large will help determine which procedure is superior or if trade-offs exist.
Topics: Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Female; Health Care Costs; Health Expenditures; Hemothorax; Humans; Lung Neoplasms; Lymph Nodes; Male; Mediastinoscopy; Middle Aged; Mortality; Neoplasm Staging; Pneumothorax; Postoperative Complications; Respiratory System; Retrospective Studies; Vascular System Injuries; Vocal Cord Paralysis
PubMed: 31605700
DOI: 10.1016/j.chest.2019.09.021 -
World Journal of Surgical Oncology Aug 2021To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a...
BACKGROUND
To avoid the inconvenience of triangulation among various rigid operating instruments in mediastinoscopy-assisted esophagectomy, we invented a new technique: used a flexible endoscope to mobilize thoracic esophagus and dissected mediastinal lymph nodes through the left cervical incision. This technology has not been reported so far. In this study, we introduce our long-term experience and demonstrate this new technique.
METHODS
Twenty-nine patients with early esophageal cancer underwent mediastinoscopy-assisted esophagectomy in our hospital from June 2018 to September 2020. Among them, 12 patients used flexible mediastinoscopy, and 17 patients used conventional rigid mediastinoscopy and instruments to observe their therapeutic effect.
RESULTS
There were no significant differences between the two groups in gender, average age, body mass index, incidence of adverse reactions, bleeding volume, and postoperative hospital stay. The operation time of flexible mediastinoscopy group was significantly shorter than that of rigid mediastinoscopy group (192.9 ± 13.0 vs 246.8 ± 6.9 min, p < 0.01). The number of lymph nodes removed by flexible endoscopy was significantly more than that of rigid endoscopy (8.5 ± 0.6 vs 6.0 ± 0.3, P < 0.01). Postoperative follow-up was completed for all patients, and the average follow-up time was 11.6 ± 7.2 months. During the follow-up period, no recurrence or death was observed.
CONCLUSIONS
Mediastinoscopy-assisted esophagectomy is an effective way to treat early esophageal cancer. The application of flexible mediastinoscopy provides more convenience and better stability. It can facilitate the operation of the surgeon and lymph node dissection, which proved to be a feasible technology.
Topics: Esophageal Neoplasms; Esophagectomy; Humans; Lymph Node Excision; Mediastinoscopy; Neoplasm Recurrence, Local; Prognosis; Technology
PubMed: 34364369
DOI: 10.1186/s12957-021-02352-w -
The Thoracic and Cardiovascular Surgeon Jan 2023The coexistence of pleural and pericardial effusions in frail patients with or without confirmed neoplasia necessitates the use of a minimally invasive technique that...
The coexistence of pleural and pericardial effusions in frail patients with or without confirmed neoplasia necessitates the use of a minimally invasive technique that has a minor impact on the patient's general status and allows for fast fluid evacuation and biopsy sampling if necessary. We present a subxiphoid mediastinoscopic autonomous (simultaneous noncommunicating) double fenestration approach for these patients with both diagnostic and therapeutic advantages in selected cases. Using the mediastinoscope alone through the subxiphoid incision can considerably reduce the duration of operation, allow for fluid evacuation, and significantly alleviate the patient's symptoms. This method enables the sampling of pleural and pericardial fluids and targeted tissue, if necessary.
Topics: Humans; Mediastinoscopes; Treatment Outcome; Pericardial Effusion; Mediastinoscopy; Biopsy
PubMed: 36216329
DOI: 10.1055/s-0042-1757177 -
Indian Journal of Surgical Oncology Dec 2022Northeast India, a region of geographic, cultural, and ethnic diversity comprises of Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Tripura, and Sikkim....
Northeast India, a region of geographic, cultural, and ethnic diversity comprises of Assam, Arunachal Pradesh, Manipur, Meghalaya, Mizoram, Tripura, and Sikkim. Geographically, two-thirds of the area is hilly terrain. The North Eastern Region (NER) shows marked diversity in customs, cultures, cuisines, traditions, and languages. The Aizawl district of Mizoram (269.4) and the Papumpare district of Arunachal Pradesh (219.8) have the highest age-adjusted incidence rates (AAR) of cancer among males and females, respectively. Meghalaya has the highest relative proportion of cancers associated with tobacco use, with 70.4% in men and 46.5% in women. This correlates with the high prevalence of tobacco use. The Dr Bhubaneswar Borooah Cancer Institute, Guwahati, was inaugurated in 1973. The Institute currently conducts M.Ch. Surgical Oncology, Head and Neck Oncology and Gynaecologic Oncology, and DM courses in Medical Oncology and Onco-pathology. The year 2019 saw the creation of a high-dose radioisotope therapy ward. Allogenic Bone Marrow Transplantation (BMT) was started in 2021-2022. State Cancer Institute (SCI), Guwahati, houses a medical cyclotron, which is the only one in Northeast India. Assam Cancer Care Foundation (ACCF) is a joint venture between the Government of Assam and the Tata Trusts, with a three-level cancer grid. The Cachar Cancer Hospital and Research Centre (CCHRC) offers holistic, subsidised cancer care to over 4000 new patients every year. North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS) offers endobronchial ultrasound (EBUS) and mediastinoscopy services, enabling accurate staging of lung cancers. While the cancer care facilities in NER have grown over the years, it is not commensurate with the high incidence of cancers in the region.
PubMed: 36691507
DOI: 10.1007/s13193-022-01557-z