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Hepato-gastroenterology 2014To determine the anatomic distribution of mesentery-like appearance around the thyroid and explore a potential mesothyroid excision for thyroid cancer patients....
BACKGROUND/AIMS
To determine the anatomic distribution of mesentery-like appearance around the thyroid and explore a potential mesothyroid excision for thyroid cancer patients. According to the concept of total mesorectal excision (TME) for rectal cancer, we perform a concept of complete mesothyroid excision for thyroid cancer. Most digestive organs have mesentery. In-depth understanding of mesentery has changed the conceptual framework of surgical treatment and improved management and better outcomes of digestive tumors.
METHODOLOGY
The anatomic distribution of the fascia and fascial spaces was studied by dissection of ten specimen fixed in 10% formalin. Thyroid cancer patients (n=5) were included to verify the fascia and fascial spaces during the operation.
RESULTS
The paratracheal fat tissue was found to connect to the pretracheal fat tissue with a structure embedded in two layers of fascia. The two layers of fascia combined with carotid sheath from the outside, while the inside component was connected to the thyroid and considered mesentery.
CONCLUSION
The thyroid has mesentery which is located in pretracheal and paratracheal area. An adequate treatment for the patients is the systematic en bloc removal of the tumor and lymph nodes while performing mesothyroid excision.
Topics: Fascia; Fasciotomy; Humans; Lymph Node Excision; Mesentery; Thyroid Gland; Thyroid Neoplasms
PubMed: 25699346
DOI: No ID Found -
Journal of Visualized Experiments : JoVE Dec 2014Thymectomy in neonatal rodents is an established and reliable procedure for immunological studies. However, in adult rats, complications of hemorrhage and pneumothorax...
Thymectomy in neonatal rodents is an established and reliable procedure for immunological studies. However, in adult rats, complications of hemorrhage and pneumothorax from pleural disruption can result in a significant mortality rate. This protocol is a simple method of rat thymectomy that utilizes a mini-sternotomy and endotracheal intubation. Intubation is accomplished with a non-invasive and easily reproducible method and allows for positive pressure ventilation to prevent pneumothorax and a controlled airway that allows sufficient time for careful thymus dissection to minimize pleural disruption. A 1.5 cm sternal incision decreases contact with mediastinal vessels and pleura, while still providing full visualization of the thymus. Following exposure of the mediastinum, the thymus is removed by blunt dissection under magnification. The pleural space is then sealed by suture closure of the pre-tracheal muscles followed by the application of surgical glue. The thorax is then closed by suture closure of the sternum, followed by suture closure of the skin. All thymectomies were complete as evidenced by immunohistochemical (IHC) staining of mediastinal tissue, and absence of naïve T-cells by flow cytometry, and the procedure had a 96% survival rate. This method is suitable when complete thymectomy with minimal complications is desired for further immunological studies in athymic adult rats.
Topics: Animals; Intubation, Intratracheal; Rats; Thymectomy
PubMed: 25590868
DOI: 10.3791/52152 -
Zhonghua Jie He He Hu Xi Za Zhi =... Aug 2014To explore the shape and the location of mediastinal spaces (mediastinal lymph node locations) associated with conventional transbronchial needle aspiration technique...
OBJECTIVE
To explore the shape and the location of mediastinal spaces (mediastinal lymph node locations) associated with conventional transbronchial needle aspiration technique (C-TBNA), and to determine the relationship between the mediastinal spaces and physiological and anatomical marks in trachea-bronchial lumen for choosing the puncture points of C-TBNA.
METHODS
The chest HRCT images of 1 000 consecutive patients preparing for bronchoscopic examination were analyzed to determine the shape and the location of the mediastinal gap, and which physiological and anatomic markers in the airway were suitable for locating the mediastinal spaces and lymph nodes. Eighty-one groups of lymph nodes from 52 patients were punctured by endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to verify the locating of puncture points by these markers for the mediastinal lymph nodes under general anesthesia. The needle was punctured into the wall of the airway first, and then the ultrasound was used to confirm if the needle was in the lymph nodes.
RESULTS
Pretracheal space, aortic-left pulmonary window space, superior-carinal space and subcarinal space showed close relationship with C-TBNA biopsy for mediastinal lymph nodes. The pretracheal space could be located by the physiological and anatomic marks of aortic impression and aortic pulse points. The superior-carinal space was like a triangle and locating in 12 o'clock of the first ring of trachea. The 9-10 o'clock of the first ring of the trachea was the aortic-left pulmonary window. The 8-9 o'clock of the right main bronchus and middle bronchus was for subcarinal space. Eighty-one groups of lymph nodes from 52 patients were punctured by EBUS-TBNA according to the physiological and anatomic markers, and it showed that only 3 groups were missed by C-TBNA. No mediastinal bleeding and pneumomediastinum occurred.
CONCLUSION
Mediastinal spaces(mediastianl lymph nodes) and physiological and anatomical marks within the airway had a relatively fixed relationship. These marks could be used for locating the mediastinal lymph nodes when C-TBNA was performed.
Topics: Biopsy, Fine-Needle; Bronchi; Humans; Lymph Nodes; Mediastinum
PubMed: 25351265
DOI: No ID Found