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Case Reports in Rheumatology 2013A 34-year-old female patient, who had proximal muscle weakness for 8 months, presented with erythema nodosum lesions on the pretibial region in addition to pain,...
A 34-year-old female patient, who had proximal muscle weakness for 8 months, presented with erythema nodosum lesions on the pretibial region in addition to pain, swelling, and movement restriction in both ankles for the last one month. Thoracic CT demonstrated hilar and mediastinal lymphadenopathy. She underwent mediastinoscopic lymph node biopsy; biopsy result was consistent with noncaseating granuloma. Serum angiotensin converting enzyme level and muscle enzymes have been elevated. Muscular MRI and EMG findings were consistent with myositis. Muscle biopsy was done, and myopathy was found. The patient was diagnosed with sarcoidosis, Löfgren's syndrome, and sarcoid myopathy. The patient displayed remarkable clinical and radiological regression after 6-month corticosteroid and MTX therapy.
PubMed: 23691415
DOI: 10.1155/2013/125251 -
JSLS : Journal of the Society of... 2005Primary cysts constitute 25% of all masses in the mediastinum. Because radiological investigations are often inconclusive, many adults require mediastinoscopy,... (Review)
Review
OBJECTIVE
Primary cysts constitute 25% of all masses in the mediastinum. Because radiological investigations are often inconclusive, many adults require mediastinoscopy, thoracotomy, video-assisted thoracic surgery, or computed tomography-guided transbronchial, transesophageal, or transcutaneous aspiration to confirm the cystic nature of these lesions. Minimally invasive procedures fail when the cyst contents are gelatinous and mucoid (failure to aspirate) or when the cyst wall continues to secrete fluid. Though Pursel reported mediastinoscopic extirpation of benign cysts 35 years ago, it remains a "therapeutic curiosity" with sporadic reports of its usage. We report 2 successful mediastinal cyst extirpations performed as outpatient procedures and review the literature with regards to its management.
METHODS
A rigid, 8-mm mediastinoscope was inserted into the anterior mediastinum following the creation of a 2-cm suprasternal incision and dissection along the anterior surface of the trachea. After aspiration, cytology of the contents revealed their benign nature. Right paratracheal cysts in 2 adult males were successfully removed mediastinoscopically by blunt and sharp dissection.
RESULTS
Histopathology revealed benign mesothelial cysts in both instances. Both patients had an uncomplicated procedure and were discharged within 23 hours. No other pathology was detected on mediastinoscopy, and follow-up at 3 months and 6 months has revealed no recurrence.
CONCLUSION
Mediastinoscopic cyst removal is a minimally invasive procedure with a very low morbidity and mortality rate. Morbidity, recovery, and discharge times are much less than those of more invasive procedures (video-assisted thoracic surgery / thoracotomy). We suggest that it should be the first-choice procedure for the excision of appropriately located benign mediastinal cysts.
Topics: Aged; Humans; Male; Mediastinal Cyst; Mediastinoscopy; Middle Aged; Neoplasms, Mesothelial; Tomography, X-Ray Computed
PubMed: 15984700
DOI: No ID Found -
Interactive Cardiovascular and Thoracic... Mar 2012A best evidence topic was written according to a structured protocol. The question addressed was whether video-assisted mediastinoscopy (VAM) has a better lymph node... (Review)
Review
A best evidence topic was written according to a structured protocol. The question addressed was whether video-assisted mediastinoscopy (VAM) has a better lymph node yield and safety profile than the conventional mediastinoscopy (CM). A total of 194 papers were found, using the reported searches, of which five represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two studies to date have directly compared CM and VAM with respect to lymph node yield, calculated diagnostics performance and complication rate. In both of these, lymph node yield is shown to be higher using VAM with better sensitivity, negative predictive value and accuracy rates. The favourable figures of lymph node sampling are found to be statistically significant in the single study providing such analysis. Complication rates using VAM are low, however, in the one instance where it is reported as higher than CM, the extensive lymph node dissection used in this technique may be a reasonable explanation for this finding. All studies described here exemplify VAM as a safe and useful tool in mediastinal staging, lymph node dissection and tissue diagnosis of mediastinal diseases given its superior visualization of surrounding structures and advantage of bimanual dissection. The future scope for diagnostic and therapeutic indications of cervical mediastinscopy is anticipated with recent advances and new techniques, such as video-assisted mediastinoscopic lymphadenectomy and virtual mediastinscopy.
Topics: Carcinoma, Non-Small-Cell Lung; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Mediastinoscopy; Predictive Value of Tests; Video-Assisted Surgery
PubMed: 22159246
DOI: 10.1093/icvts/ivr052 -
Respirology (Carlton, Vic.) Feb 2024To evaluate the diagnostic accuracy and clinical usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging of...
BACKGROUND AND OBJECTIVE
To evaluate the diagnostic accuracy and clinical usefulness of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal staging of centrally located T1N0M0 non-small cell lung cancer (NSCLC) clinically staged with positron emission tomography/computed tomography (PET/CT).
METHODS
We conducted a study that included patients with centrally located T1N0M0 NSCLC, clinically staged with PET/CT who underwent EBUS-TBNA for mediastinal staging. Patients with negative EBUS-TBNA underwent mediastinoscopy, video-assisted mediastinoscopic lymphadenectomy (VAMLA) and/or lung resection with systematic nodal dissection, that were considered the gold standard. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), overall accuracy of EBUS-TBNA for diagnosing mediastinal metastases (N2 disease) and the number needed to treat (NNT: number of patients needed to undergo EBUS-TBNA to avoid a case of pathologic N2 disease after resection) were calculated.
RESULTS
One-hundred eighteen patients were included. EBUS-TBNA proved N2 disease in four patients. In the remaining 114 patients who underwent mediastinoscopy, VAMLA and/or resection there were two cases of N2 (N2 prevalence 5.1%). The sensitivity, specificity, NPV, PPV and overall accuracy for diagnosing mediastinal metastases (N2 disease) were of 66%, 100%, 98%, 100% and 98%, respectively. The NNT was 31 (95% CI: 15-119).
CONCLUSION
EBUS-TBNA in patients with central clinically staged T1N0M0 NSCLC presents a good diagnostic accuracy for mediastinal staging, even in a population with low prevalence of N2 disease. Therefore, its indication should be considered in the management of even these early lung cancers.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Lung Neoplasms; Positron Emission Tomography Computed Tomography; Mediastinum; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Neoplasm Staging; Lymph Nodes; Retrospective Studies; Endosonography
PubMed: 37885329
DOI: 10.1111/resp.14613 -
Journal of Thoracic Disease Jan 2021Esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy as a safe and feasible minimally invasive technique has gained...
BACKGROUND
Esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy as a safe and feasible minimally invasive technique has gained attention recently. But the occurrence of Intraoperative events is inevitable. It's necessary to investigate and discuss the intraoperative events and countermeasures during operation.
METHODS
Intraoperative events were retrospectively reviewed in 60 patients who underwent esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy in the recent 3 years.
RESULTS
There was no perioperative death and no aortic or bronchial injury. Bronchial artery injury occurred in 2 cases (3.34%), bronchial artery combined with azygos vein hemorrhage occurred in 1 case (1.67%). The pleura were injured in 3 cases (5%). Recurrent laryngeal nerve injury was noticed in 7 cases (11.67%). Thoracic duct injury occurred in 1 case (1.67%).
CONCLUSIONS
As a new surgical method, esophagectomy via transcervical incision inflatable single-port mediastinoscope combined with laparoscopy is considered safe and feasible, but requires improvement when compared with traditional surgical methods. Due to the influence of surgical space and with experienced surgeons, the incidence of intraoperative events such as intraoperative bleeding and thoracic duct injury is not dominant when compared with the traditional surgical methods. Thoracic surgeons should continuously improve their clinical knowledge as well as skills. Careful preoperative examination and evaluation of the patients, being familiar with the anatomical structure and various methods, wise selection of energy devices and calmly dealing with all kinds of events are the key factors for successful surgeries with fewer intraoperative events.
PubMed: 33569193
DOI: 10.21037/jtd-20-2331 -
Journal of Medical Economics 2021Dynamic changes in the payer landscape have resulted in increasing out-of-pocket costs (OOPCs). Little is known about OOPC for patients undergoing biopsy for suspicious...
AIMS
Dynamic changes in the payer landscape have resulted in increasing out-of-pocket costs (OOPCs). Little is known about OOPC for patients undergoing biopsy for suspicious pulmonary nodules in the United States. This study seeks to describe the spectrum of OOPC for diagnostic tissue sampling for suspicious pulmonary nodule with an ultimate diagnosis of lung cancer.
METHODS
Retrospective cohort study of adult patients with a primary lung cancer diagnosis and treatment who underwent diagnostic biopsy for suspicious pulmonary nodule utilizing IBM Marketscan Databases (2013-2017). Claims data included both total hospital and physician billed costs, insurer reimbursement and OOPC. OOPCs were further stratified by type of biopsy, whether the patient underwent a single or multiple biopsies, and year of biopsy.
RESULTS
A total of 22,870 patients aged 18-95 who underwent diagnostic lung biopsy were identified. The gender ratio was 49:51 for female:male and 50% of patients were aged 65 or above. 78% of patients had a co-morbidity. The median OOPC for a patient receiving a single biopsy (any type) was $600, two biopsies: $706, three biopsies: $811, and four biopsies: $1,177. By biopsy type, the median OOPC for a patient requiring a single biopsy was $604 for percutaneous biopsy, $316 for surgical biopsy, $674 for bronchoscopic biopsy, and $545 for mediastinoscopic biopsy.
LIMITATIONS
Under-estimation of OOP expenses from costs of transportation, job loss, and loss of productivity. Over-estimation of OOPC from lack of individual claims adjudication.
CONCLUSIONS
The median OOPC for lung cancer patient requiring a single diagnostic lung biopsy is $600. Prior research indicates that almost 50% of the lung cancer patient population undergoes multiple biopsies increasing costs anywhere between 20% and 100% resulting in further patient financial burden for each episodic biopsy attempt. Further cost-effectiveness research is needed to differentiate various diagnostic technologies for lung biopsy.
Topics: Adult; Biopsy; Female; Health Expenditures; Humans; Lung; Lung Neoplasms; Male; Retrospective Studies; United States
PubMed: 34596001
DOI: 10.1080/13696998.2021.1988282 -
Thoracic Surgical Science Nov 2005Accurate mediastinal lymph node dissection during thoracotomy is mandatory for staging and for adjuvant therapy in lung cancer. Pre-therapeutic staging for neoadjuvant...
Accurate mediastinal lymph node dissection during thoracotomy is mandatory for staging and for adjuvant therapy in lung cancer. Pre-therapeutic staging for neoadjuvant therapy or for video assisted thoracoscopic resection of lung cancer is achieved usually by CT-scan and mediastinoscopy. However, these methods do not reach the accuracy of open nodal dissection. Therefore we developed a technique of radical video-assisted mediastinoscopic lymphadenectomy (VAMLA). This study was designed to show that VAMLA is feasible and that radicality of lymphadenectomy is comparable to the open procedure.In a prospective study all VAMLA procedures were registered and followed up in a database. Specimens of VAMLA were analysed by a single pathologist. Lymph nodes were counted and compared to open lymphadenectomy. The weight of the dissected tissue was documented. In patients receiving tumour resection subsequently to VAMLA, radicality of the previous mediastinoscopic dissection was controlled during thoracotomy.37 patients underwent video-assisted mediastinoscopy from June 1999 to April 2000. Mean duration of anaesthesia was 84.6 (SD 35.8) minutes.In 7 patients radical lymphadenectomy was not intended because of bulky nodal disease or benign disease. The remaining 30 patients underwent complete systematic nodal dissection as VAMLA.18 patients received tumour resection subsequently (12 right- and 6 left-sided thoracotomies). These thoracotomies allowed open re-dissection of 12 paratracheal regions, 10 of which were found free of lymphatic tissue. In two patients, 1 and 2 left over paratracheal nodes were counted respectively. 10/18 re-dissected subcarinal regions were found to be radically dissected by VAMLA. In 6 patients one single node and in the remaining 2 cases 5 and 8 nodes were found, respectively. However these counts also included nodes from the ipsilateral main bronchus. None of these nodes was positive for tumour.Average weight of the tissue that was harvested by VAMLA was 10.1 g (2.2-23.7, SD 6.3). An average number of 20.5 (6-60, SD 12.5) nodes per patient were counted in the specimens. This is comparable to our historical data from open lymphadenectomy.One palsy of the recurrent nerve in a patient with extensive preparation of the nerve and resection of 11 left-sided enlarged nodes was the only severe complication in this series.VAMLA seems to accomplish mediastinal nodal dissection comparable to open lymphadenectomy and supports video assisted surgery for lung cancer. In neoadjuvant setting a correct mediastinal N-staging is achieved.
PubMed: 21289921
DOI: No ID Found -
Surgical Case Reports Sep 2022Mediastinal foreign bodies might cause mediastinal organ injury or mediastinal abscess. The prompt removal surgery of mediastinal foreign bodies is needed to prevent...
BACKGROUND
Mediastinal foreign bodies might cause mediastinal organ injury or mediastinal abscess. The prompt removal surgery of mediastinal foreign bodies is needed to prevent those complications. We report a case in which a mediastinal foreign body was removed by video-mediastinoscopy.
CASE PRESENTATION
The patient, a 74-year-old man with a chief complaint of hoarseness, was referred to our department for surgical management of a wooden foreign body that had traumatically migrated into the superior mediastinum. During the surgery, the video-mediastinoscopy was introduced under the pneumomediastinal pressure. We could dissect the scar tissue and remove the azalea tree branch safely and carefully, without damaging the other mediastinal organs. He was discharged on postoperative day 5, with no complications.
CONCLUSIONS
Video-mediastinoscopic approach under pneumomediastinal pressure is minimally invasive and could provide wide surgical view. Therefore, we consider it useful and effective for removal of foreign bodies in the mediastinum.
PubMed: 36138272
DOI: 10.1186/s40792-022-01525-3 -
Journal of Thoracic Oncology : Official... Apr 2007The development of a two-bladed spreadable videomediastinoscope in 1992 allowed increased exposure and bimanual dissection of mediastinal structures. Concurrent with...
BACKGROUND
The development of a two-bladed spreadable videomediastinoscope in 1992 allowed increased exposure and bimanual dissection of mediastinal structures. Concurrent with technical progress in mediastinoscopy, neoadjuvant treatment of stage III lung cancer was introduced, and accuracy of pretreatment mediastinal staging became a topic at issue. In this setting, development of a videomediastinoscopic technique for complete mediastinal lymphadenectomy was the obvious thing to do.
METHODS
Video-assisted mediastinoscopic lymphadenectomy (VAMLA) dissection is guided by anatomical landmarks, very similar to open lymphadenectomy. It includes en bloc resection of the right and central compartments and dissection and lymphadenectomy of the left-sided compartments. In a preliminary case-control study of 40 patients, VAMLA technique was standardized and evaluated against open lymphadenectomy. A second study investigated 130 patients with resectable lung cancer and radiographically normal mediastinum who underwent VAMLA and consecutive lung resection with mediastinal reexploration.
RESULTS
VAMLA harvested significantly more nodes than open lymphadenectomy. With a mean duration of 54 minutes and a complication rate of 4.6%, VAMLA appeared applicable to clinical routine. We noted a sensitivity of 93.8%, a specificity of 100%, and a false-negative rate of 0.9%.
CONCLUSIONS
In our experience, VAMLA is a feasible method of mediastinal staging. Its accuracy and radicality can equal open lymphadenectomy. However, VAMLA is minimally invasive and therefore pretherapeutically available. Its advantages might be of interest with neoadjuvant strategies, trials, involved field radiation, video-assisted thoroscopic lobectomy, and left-sided tumors.
Topics: Carcinoma, Non-Small-Cell Lung; Cohort Studies; Female; Humans; Lung Neoplasms; Lymph Node Excision; Lymph Nodes; Male; Mediastinoscopy; Neoplasm Staging; Predictive Value of Tests; Retrospective Studies; Sensitivity and Specificity; Thoracic Surgery, Video-Assisted
PubMed: 17409814
DOI: 10.1097/01.JTO.0000263725.89512.d7 -
Mediastinum (Hong Kong, China) 2019To determine the value of mediastinoscopy in N staging of lung cancer with clinical N2 disease.
BACKGROUND
To determine the value of mediastinoscopy in N staging of lung cancer with clinical N2 disease.
METHODS
We retrospectively reviewed 87 patients who received mediastinoscopy for known or suspected lung cancer, including 83 cervical mediastinoscopies and 4 parasternal mediastinoscopies. All patients were clinically staged N2 for enlarged ipsilateral mediastinal and/or subcarinal lymph nodes (short axis >1.0 cm) on computed tomography scan.
RESULTS
Of the 87 patients, 61 cases proved to be N2 disease by mediastinoscopy; the other 26 mediastinoscopy-negative patients underwent thoracotomy for lung resection and mediastinal lymph node dissection in the same operation. Final pathologic N staging was consistent with mediastinoscopic sampling and surgical dissection in 24 patients, and N2 disease was found in 2 patients (false-negative by mediastinoscopy). The sensitivity, specificity, and accuracy of mediastinoscopy were 96.8%, 100%, and 97.7%, respectively. Among all 87 mediastinoscopic procedures, there was no mortality and only 1 complication (1.1%).
CONCLUSIONS
Mediastinoscopy is a highly effective and safe procedure for the mediastinal staging of lung cancer with clinical N2 disease.
PubMed: 35118251
DOI: 10.21037/med.2019.05.03