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Cases Journal Dec 2009Several lesions have been described as post-intubation complications. Most frequent are injuries of the pharynx/larynx or trachea. Cranial nerve injury following routine...
INTRODUCTION
Several lesions have been described as post-intubation complications. Most frequent are injuries of the pharynx/larynx or trachea. Cranial nerve injury following routine endo-tracheal intubation appears to be rare, and most reports describe Tapia's syndrome with hypoglossus/recurrent laryngeal nerve paralysis; cases that describe only bilateral hypoglossus palsy are infrequent. The cause is attributed to neuropathy of the nerve, provoked by compression following inflation of the cuff within the larynx or damage after neck hyperextension during a difficult intubation. However, similar cases after non-traumatic intubation have not been reported.
CASE PRESENTATION
We report here a case of bilateral hypoglossus palsy in a young man undergoing a diagnostic anterior mediastinotomy that was attributed to prolonged non-complicated oro-tracheal intubation. Progressive recovery of function by the patient supports neuropraxic damage as the cause.
CONCLUSION
To avoid such problems, special attention should be paid to the correct positioning of the head during surgery or during rapidly performed tracheostomy if prolonged intubation is anticipated.
PubMed: 20062625
DOI: 10.1186/1757-1626-2-9301 -
Zhonghua Zhong Liu Za Zhi [Chinese... Oct 2009To explore the clinical indication of N3 lymph node biopsy during mediastinoscopy for non-small cell lung cancer (NSCLC).
OBJECTIVE
To explore the clinical indication of N3 lymph node biopsy during mediastinoscopy for non-small cell lung cancer (NSCLC).
METHODS
Cervical mediastinoscopy was performed in 89 patients with clinical stage I-IIIA non-small cell lung cancer prior to thoracotomy. Of those, 12 underwent cervical medistinoscopy combined with right scalene lymph node biopsy and 10 with anterior mediastinotomy.
RESULTS
Nine patients were found to have lymph node metastasis (N3 disease) during mediastinosopy. Of those, 6 had contralateral mediastinal lymph node metastasis and 3 cases with right scalene lymph node metastasis. The incidence of N3 disease in the patients with adenocarcinoma, serum CEA > 5 ng/ml and multi-station mediastinal lymph node metastasis was significantly higher than that in those with non-adenocarcinoma, CEA < 5 ng/ml and ipsilateral uni-station mediastinal lymph nodes metastasis (P < 0.05).
CONCLUSION
Biopsy of scalene lymph node or contralateral mediastinal lymph node should be performed during mediastinoscopy in order to exclude N3 disease for potentially operable NSCLC patients with adenocarcinoma, serum CEA >5 ng/ml and ipsilateral multi-station mediastinal lymph nodes metastasis.
Topics: Adenocarcinoma; Adult; Aged; Biopsy; Carcinoembryonic Antigen; Carcinoma, Non-Small-Cell Lung; Female; Follow-Up Studies; Humans; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Male; Mediastinoscopy; Mediastinum; Middle Aged; Neck Muscles; Neoplasm Staging
PubMed: 20021834
DOI: No ID Found -
The Annals of Thoracic Surgery Oct 2009Previous mediastinal surgery may be considered a contraindication to minimally invasive resection of anterior mediastinal masses. We have found video-assisted...
Previous mediastinal surgery may be considered a contraindication to minimally invasive resection of anterior mediastinal masses. We have found video-assisted thoracoscopic resection of anterior mediastinal masses to be technically feasible after sternotomy or chamberlain procedures. Changes in positioning and port location may facilitate these procedures.
Topics: Aged; Humans; Male; Mediastinum; Middle Aged; Sternum; Thoracoscopy; Thoracotomy; Thymectomy; Thymoma; Thymus Neoplasms; Thyroid Neoplasms; Thyroidectomy; Tomography, X-Ray Computed
PubMed: 19766853
DOI: 10.1016/j.athoracsur.2009.01.032 -
The Annals of Thoracic Surgery Jul 2009Intrathoracic hilar or mediastinal lymph node metastases (HMLNMs) of extrathoracic carcinomas are infrequent. Their treatment strategy is not established and their...
BACKGROUND
Intrathoracic hilar or mediastinal lymph node metastases (HMLNMs) of extrathoracic carcinomas are infrequent. Their treatment strategy is not established and their prognosis poorly known. We reviewed the place of surgical intervention in their management.
METHODS
Among 565 patients with mediastinal lymph node enlargement, 37 had a history of extrathoracic carcinoma. The enlargement consisted in HMLNMs in 26 (15 men, 11 women), with a mean age of 57.6 (range 19-78) years. Surgical procedures were reviewed.
RESULTS
Diagnostic procedures, comprising mediastinoscopy in 9, anterior mediastinotomy in 2, and video-assisted thoracic surgery (VATS) in 4, were performed mainly because of unresectability due to diffuse and bilateral HMLNMs. Cancer location was breast in 6, kidney or prostate in 2 each, and bladder, rectum, testis, melanoma, and larynx in 1 each. Median survival was 21 months. Resection was performed in 11 patients, comprising posterolateral thoracotomy in 6, muscle sparing thoracotomy in 2, and VATS in 3. Seventeen involved LN stations were removed; of these, primary were kidney in 3, testis or thyroid in 2 each, and larynx, nasopharynx, and intestinum in 1 each. Five-year survival was 41.6% (median, 45 months).
CONCLUSIONS
HMLNMs of extrathoracic carcinoma may be isolated, probably in the context of a particular lymphatic mode of spread. Our experience demonstrates that operation is mainly diagnostic but resection may safely achieve local control of the disease and deserves being advocated in patients with isolated and resectable HMLNMs.
Topics: Adult; Aged; Cause of Death; Cohort Studies; Female; Humans; Kaplan-Meier Estimate; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Mediastinal Neoplasms; Mediastinoscopy; Middle Aged; Minimally Invasive Surgical Procedures; Neoplasm Invasiveness; Neoplasm Staging; Neoplasms; Prognosis; Risk Assessment; Sensitivity and Specificity; Survival Analysis; Thoracic Surgery, Video-Assisted; Treatment Outcome; Young Adult
PubMed: 19559225
DOI: 10.1016/j.athoracsur.2009.04.005 -
Annali Italiani Di Chirurgia 2009To point out the actual possibilities to apply surgical treatments (diagnostic and therapeutics) for the cure of neoplastic disease of the lungs into an outpatient...
AIM OF THE STUDY
To point out the actual possibilities to apply surgical treatments (diagnostic and therapeutics) for the cure of neoplastic disease of the lungs into an outpatient procedure. After a review of the recent literature, the authors show problems and limits of such a program. The analysis of the invasive diagnostic procedures (video-mediastinoscopy, anterior mediastinotomy, and thoracoscopy) shows that in most cases, a part from the kind of anesthesia, could be done in a short-term hospitalization. On the contrary, for pulmonary resection, all the experiences prove the practicability of the program, but only after careful selection of the patient, deep information of the patient and of his family and mostly, a proved integration between hospital and territory to warranty the continuation of the cures.
CONCLUSION
The Authors believe that, mostly in their country, it is too early for a wide diffusion of new form of hospitalization different from the traditional one for the treatment of neoplastic disease of the lung.
Topics: Ambulatory Surgical Procedures; Humans; Lung Neoplasms; Mediastinoscopy; Patient Selection; Pneumonectomy; Program Evaluation; Thoracic Surgery, Video-Assisted; Thoracoscopy; Treatment Outcome
PubMed: 19537117
DOI: No ID Found -
Revue de Pneumologie Clinique Apr 2009Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is a rare pathology, often associated with autoimmune diseases. The authors report the case of an Asian woman...
INTRODUCTION
Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is a rare pathology, often associated with autoimmune diseases. The authors report the case of an Asian woman with Sjögren's syndrome.
OBSERVATION
A 48-year-old Chinese woman, without past medical history and a non-smoker, presented an alteration in her overall condition, dyspnoea at exercise, inflammatory polyarthralgia, and a dry eye and mouth syndrome over the last few months. Thoracic tomodensitometry detected an anterior heterogenic cystic mediastinal mass. A mediastinotomy was performed. The diagnosis of the surgical biopsy was thymic MALT lymphoma. The authors also diagnosed Sjögren's syndrome with the presence of four diagnostic criteria. Chemotherapy by rituximab, cyclophosphamide, vincristine, prednisone induced major tumoral regression. The patient declined surgery and will be monitored.
CONCLUSION
Thymic MALT lymphoma is a rare pathology. There is a high correlation with autoimmune diseases, like Sjögren's syndrome. Its appearance is that of an anterior mediastinal mass with a cystic component. The treatment is not well codified and is most often based on surgical resection, eventually followed by chemotherapy or radiotherapy. As far as the authors know, this is the second case of thymic MALT lymphoma treated by exclusive chemotherapy.
Topics: Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Lymphoma, B-Cell, Marginal Zone; Middle Aged; Sjogren's Syndrome; Thymus Neoplasms
PubMed: 19375051
DOI: 10.1016/j.pneumo.2008.12.006 -
Proceedings of the American Thoracic... Apr 2009The diagnosis of indeterminate mediastinal lymph nodes, masses, and peripheral pulmonary nodules constitutes a significant challenge. Options for tissue diagnoses... (Review)
Review
The diagnosis of indeterminate mediastinal lymph nodes, masses, and peripheral pulmonary nodules constitutes a significant challenge. Options for tissue diagnoses include computed tomography-guided percutaneous biopsy, transbronchial fine-needle aspiration, mediastinoscopy, left anterior mediastinotomy, or video-assisted thoracoscopic surgery; however, these approaches have both advantages and limitations in terms of tissue yield, safety profile, and cost. Endobronchial ultrasound (EBUS) is a new minimally invasive technique that expands the view of the bronchoscopist beyond the lumen of the airway. There are two EBUS systems currently available. The radial probe EBUS allows for evaluation of central airways, accurate definition of airway invasion, and facilitates the diagnosis of peripheral lung lesions. Linear EBUS guides transbronchial needle aspiration of hilar and mediastinal lymph nodes, improving diagnostic yield. This article will review the principles and clinical applications of EBUS, and will highlight the role of this new technology in the diagnosis and staging of lung cancer.
Topics: Carcinoma, Non-Small-Cell Lung; Endosonography; Equipment Design; Humans; Lung Neoplasms; Lymphatic Metastasis; Neoplasm Staging; Predictive Value of Tests; Sensitivity and Specificity
PubMed: 19349486
DOI: 10.1513/pats.200808-081LC -
Thoracic Surgery Clinics Feb 2009Many histologically different tumors and cysts that affect people of all ages arise from the multiple anatomic structures present in the mediastinum. The number of... (Review)
Review
Many histologically different tumors and cysts that affect people of all ages arise from the multiple anatomic structures present in the mediastinum. The number of diagnostic possibilities can be narrowed by considering the patient's age, tumor location, the presence or absence of symptoms and signs, the association of a specific systemic disease, radiographic findings, and biochemical markers. Pathologic diagnosis is often required to confirm a presumed diagnosis and to select the optimal treatment modality. A variety of biopsy techniques for obtaining tissue from the mediastinum have been described, including ultrasound-guided endoscopic biopsy, percutaneous image-guided needle biopsy, parasternal anterior mediastinotomy, cervical mediastinoscopy, and video-assisted thoracoscopic surgery. The choice of biopsy technique depends on the localization of the lesion, clinical factors such as the age and the condition of the patient, and the availability of special techniques with the required expert and the equipment.
Topics: Biopsy; Decision Making; Diagnostic Imaging; Endoscopy; Humans; Mediastinal Cyst; Mediastinal Neoplasms; Mediastinoscopy; Mediastinum; Radiography, Interventional; Thoracic Surgery, Video-Assisted; Ultrasonography, Interventional
PubMed: 19288818
DOI: 10.1016/j.thorsurg.2008.09.001 -
American Journal of Surgery Jun 2008Approximately 2% of ectopic parathyroid glands reside within the mediastinum in a location that requires a thoracic approach.
BACKGROUND
Approximately 2% of ectopic parathyroid glands reside within the mediastinum in a location that requires a thoracic approach.
METHODS
All patients with mediastinal parathyroid tumors who underwent anterior mediastinotomy were included in this review.
RESULTS
Over the course of 16 years, 10 patients with primary hyperparathyroidism underwent anterior mediastinotomy. There were 6 men and 4 women with a median age of 65. Seven patients had undergone at least one previous cervical exploration. Preoperative calcium levels were 11.3 +/- .8 mg/dL. Nine patients had preoperative localization with radionuclide scans and 9 patients also had preoperative computerized tomography or magnetic resonance imaging scans. An abnormal gland was removed in all cases. Nine of 10 patients had normalization of their calcium levels.
CONCLUSIONS
Anterior mediastinotomy after preoperative imaging has proven to be a technically feasible, safe, and effective method for the surgical management of patients with sporadic primary hyperparathyroidism and mediastinal parathyroid tumors.
Topics: Aged; Aged, 80 and over; Female; Humans; Hyperparathyroidism, Primary; Male; Mediastinum; Middle Aged; Parathyroid Glands; Parathyroid Neoplasms; Parathyroidectomy
PubMed: 18436184
DOI: 10.1016/j.amjsurg.2007.09.036 -
Der Chirurg; Zeitschrift Fur Alle... Jan 2008For patients with lung cancer preoperative evaluation of the mediastinal lymph nodes is important to estimate local operability and/or to consider the necessity of... (Comparative Study)
Comparative Study Review
For patients with lung cancer preoperative evaluation of the mediastinal lymph nodes is important to estimate local operability and/or to consider the necessity of neoadjuvant treatment. Cervical mediastinoscopy is generally accepted as a safe and highly accurate procedure in the staging of lung cancer. Nodes accessible to CM are the levels of the superior (level 2R and 2L) and inferior (level 4R and 4L) paratracheal and subcarinal (level 7) nodal stations. Additionally extended CM and left parasternal mediastinotomy allow the exploration of the aortopulmonary window (level 5) and anterior mediastinal nodes (level 6). In locally advanced lung cancer repeat mediastinoscopy was used after induction chemotherapy or chemoradiation to reexplore the upper mediastinum in order to select patients with a higher probability to undergo complete resection. Operative mortality of both investigations is less than 0.5%; the preoperative complication rate is very low (less than 4%). Because of the higher sensitivity, specificity, and accuracy, mediastinoscopy and repeat mediastinoscopy are superior to new methods like FDG-PET, FDG-PET/CT, EBUS-FNA, and EUS-FNA.
Topics: Biopsy, Fine-Needle; Carcinoma, Non-Small-Cell Lung; Fluorodeoxyglucose F18; Humans; Lung; Lung Neoplasms; Lymph Nodes; Lymphatic Metastasis; Mediastinoscopy; Neoplasm Staging; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity
PubMed: 18209980
DOI: 10.1007/s00104-007-1447-9