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Thoracic expansion techniques

Binshan Zha, Geliang Xu, Huagang Zhu, Wentao Xie, Zhigong Zhang, Yongsheng Li, Peng Qiu
Purpose: The aim of this study was to present our experience and assess the morphologic changes of the descending aorta after the restrictive bare stent (RBS) technique in the treatment of type B aortic dissection (TBAD). Patients and methods: A retrospective study was conducted of 22 consecutive patients with TBAD who underwent RBS treatment between February 2012 and June 2016. Indications for the RBS procedure included radiological evidence of true lumen (TL) compression or collapse and/or tortuosity index (TI) of the descending aorta >1...
2018: Therapeutics and Clinical Risk Management
Rodney Laing, Ivan Timofeev, Roberto Colasanti, Andrew Dean, Alessandro Di Rienzo
OBJECTIVE: Surgical treatment of ventrally located intradural cysts is difficult and controversial. Laminectomy with division of the denticulate ligaments and gentle cord mobilization remains the standard approach but risks further neurologic deterioration secondary to cord manipulation. Our purpose is to evaluate the safety and effectiveness of a midline cord-splitting approach as an alternative for treating ventral thoracic intradural cysts. METHODS: We describe 2 patients who were treated for ventral intradural cysts causing progressive and severe myelopathy...
October 5, 2018: World Neurosurgery
F Fernández-Méndez, R Barcala-Furelos, M Otero-Agra, M Fernández-Méndez, M Santos-Folgar, A Rodríguez-Núñez
OBJECTIVE: To evaluate the quality of cardiopulmonary resuscitation (CPR) by lay people when guided by a mobile phone application with real-time feedback, with the comparison of three different mobile phone applications (APPs). DESIGN: A cross-sectional quasi-experimental study was carried out. PARTICIPANTS: A sample of 113 nursing students participated in the study. INTERVENTIONS: Three hands-only CPR tests with continuous compressions were performed: (i)without external help; (ii)with the mobile phone turned off; and (iii)guided by APP...
September 27, 2018: Medicina Intensiva
A Claire Watkins, Bella Huasen, Andrew Hill, Parma Nand, Andrew Holden
Described by Kato et al1 , the frozen elephant technique (FET) has simplified aortic arch surgery. As with thoracic endovascular aortic repair (TEVAR), FET reconstructions often require re-intervention. Skilled endovascular management of FET complications is imperative as novel devices emerge. We describe two cases of early intervention for severe foreshortening and incomplete expansion of the Thoraflex TM (Vascutek, Inchinnan, UK) stent-graft.
September 25, 2018: Annals of Thoracic Surgery
Shun Wu, Ke Guo, Peng Xiao, Jie Yang, Jiaming Sun
BACKGROUND: Conjoined twinning is a rare congenital malformation, and the resultant huge body wall defects after separation of conjoined twins represent a real challenge to surgeons. METHODS: From 2004 to 2009, authors performed body wall reconstruction for 2 pairs of thoraco-omphalopagus twins and 1 pair of ischiopagus tetrapus twins. Before separation, the techniques of tissue expansion and tractive training were adopted to acquire sufficient skin for final coverage...
September 20, 2018: Annals of Plastic Surgery
Vicente Orozco-Sevilla, Richard Whitlock, Ourania Preventza, Kim I de la Cruz, Joseph S Coselli
Aortic root aneurysm is the most common cardiovascular manifestation requiring surgical intervention in patients with Marfan syndrome (MFS), a heritable thoracic aortic disease. Elective replacement of the aortic root is the treatment of choice for patients with aneurysmal complications of the aortic root and ascending aorta. There are two basic approaches to aortic root replacement: valve-sparing (VS) and valve-replacing (VR) techniques. After successful aortic root replacement surgery, several patients with MFS may develop a late complication related to their aortic disease process, such as developing a pseudoaneurysm of the coronary artery reattachment buttons, aneurysmal expansion, or aortic dissection in the remaining native aorta...
June 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Carol C Hasler
Early-onset scoliosis (EOS) describes a wide array of diagnoses and deformities exposed to growth. This potentially life-threatening condition is still 1 of the biggest challenges in pediatric orthopaedics. The enlightenment of Bob Campbell's thoracic insufficiency syndrome concept and the negative impact of the earlier short and straight spine fusion approach on respiratory function and survival have fueled the evolution of EOS care. Despite all the progress made, growth-friendly spine surgery remains to be a burden to patients and caregivers...
July 2018: Journal of Pediatric Orthopedics
Nishant Saran, Chaim Locker, Sameh M Said, Richard C Daly, Simon Maltais, John M Stulak, Kevin L Greason, Alberto Pochettino, Hartzell V Schaff, Joseph A Dearani, Lyle D Joyce, Brian D Lahr, David L Joyce
BACKGROUND: We sought to identify the trends in bilateral internal thoracic artery use and determine the degree to which the survival advantage of bilateral internal thoracic artery revascularization persists among perceived "high-risk" patients, compared with the use of left internal thoracic artery alone. METHODS: A retrospective review was conducted of patients who underwent isolated coronary artery bypass grafting for multivessel coronary artery disease at the Mayo Clinic between January 2000 and December 2015...
June 2018: Journal of Thoracic and Cardiovascular Surgery
Tim Berger, Maximilian Kreibich, Julia Morlock, Stoyan Kondov, Johannes Scheumann, Fabian A Kari, Bartosz Rylski, Matthias Siepe, Friedhelm Beyersdorf, Martin Czerny
OBJECTIVES: To evaluate early and mid-term clinical outcomes and to assess the potential of the frozen elephant trunk technique to induce remodelling of downstream aortic segments in acute and chronic thoracic aortic dissections. METHODS: Over a 4-year period, 65 patients (48 men, aged 61 ± 12 years) underwent total aortic arch replacement using the frozen elephant trunk technique for acute (n = 31) and chronic (n = 34) thoracic aortic dissections at our institution...
August 1, 2018: European Journal of Cardio-thoracic Surgery
William J Quinones-Baldrich, Taimur Saleem, Adam Oskowitz
OBJECTIVE: Aortic dissection (AD) often involves the infrarenal aorta. We review our experience with open infrarenal aortic repair with or without false lumen intentional placement (FLIP) of endografts in the proximal dissected aorta as part of a hybrid strategy to treat complex AD. METHODS: A prospectively maintained database of patients undergoing intervention for AD was reviewed. Data regarding diagnosis, imaging features, nature of the infrarenal repair (one- vs two-stage procedure), endoleaks, need for additional interventions, morbidity, and mortality were collected...
July 2018: Journal of Vascular Surgery
A Langenbach, Pascal Oppel, Sina Grupp, Sebastian Krinner, Milena Pachowsky, Thomas Buder, Melanie Schulz-Drost, Friedrich F Hennig, Stefan Schulz-Drost
PURPOSE: Stabilizing techniques for flail chest injuries are described through wide surgical approaches to the chest wall, especially in the most affected posterior and lateral regions. Severe morbidity due to these invasive approaches needs to be considered due to dissection of the scapular guiding muscles and the risk of injuries to neurovascular bundles. This study discusses possibilities for minimized approaches to the posterior and lateral regions. METHOD: Ten fresh-frozen cadavers in lateral decubitus position were observed on both sides...
June 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
Pierluigi Vergara, Damiano Giuseppe Barone
OBJECTIVE: Arachnoid webs are rare intradural lesions that can cause direct spinal cord compression or alteration of the cerebrospinal fluid flow with syringomyelia. Surgery has been historically performed through wide-open laminectomies. The aim of this study is to prove the feasibility of minimally invasive techniques for the excision of arachnoid webs. METHODS: A retrospective review of two cases of minimally invasive excision of thoracic arachnoid webs was performed...
January 2018: World Neurosurgery
Yang Zhao, Henghui Yin, Yitian Chen, Mian Wang, Liang Zheng, Zilun Li, Guangqi Chang
OBJECTIVE: Distal stent graft-induced new entry (SINE) can occur after thoracic endovascular aortic repair (TEVAR) of type B aortic dissection. This study investigated the mechanism of distal SINE and its prevention using a restrictive bare stent (RBS) technique. METHODS: From January 2013 to December 2014, 68 consecutive type B aortic dissection patients received endovascular repair at our center. The RBS technique was used with distal oversizing (between the diameter of the thoracic stent graft and the descending aorta true lumen diameter at the level of the intended distal edge of the thoracic stent graft) >20%...
January 2018: Journal of Vascular Surgery
David J Mener, Fray Dylan Stewart, David E Tunkel
We describe the management of posterior trachea tears after blunt neck trauma in two children. The first, a 5 year-old boy who fell off his scooter, causing a 1.0cm tear in the membranous cervical trachea, was managed conservatively with 5 days of intubation. The second, a 12 year-old girl who fell on her bicycle, causing a 4.0cm tear in the membranous thoracic trachea, was repaired with thoracoscopic techniques. The presumed mechanism may be expansion of the U-shaped cartilage with tear of the membranous trachea...
May 2017: International Journal of Pediatric Otorhinolaryngology
C S Wang, J Li, H Lai
The strategy of root reconstruction for Stanford type A aortic dissection (AAD) includes resection of the intimal tear site, correction of concomitant aortic valve dysfunction and amendment of coronary lesion. Supracommissural tube graft replacement is a well-adopted and convenient procedure for most patients, although its application is limited when distinct sinus expansion and severe intimal damage is present. Composite valve conduit replacement (Bentall procedure) is suitable for patients with overt sinus damage...
April 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
H Fujiwara, A Shiozaki, H Konishi, S Komatsu, T Kubota, D Ichikawa, K Okamoto, R Morimura, Y Murayama, Y Kuriu, H Ikoma, M Nakanishi, C Sakakura, E Otsuji
Laparoscopic transhiatal esophagectomy is a minimally invasive approach for esophageal cancer. However, a transhiatal procedure has not yet been established for en bloc mediastinal dissection. The purpose of this study was to present our novel procedure, hand-assisted laparoscopic transhiatal esophagectomy, with a systematic procedure for en bloc mediastinal dissection. The perioperative outcomes of patients who underwent this procedure were retrospectively analyzed. Transhiatal subtotal mobilization of the thoracic esophagus with en bloc lymph node dissection distally from the carina was performed according to a standardized procedure using a hand-assisted laparoscopic technique, in which the operator used a long sealing device under appropriate expansion of the operative field by hand assistance and long retractors...
March 1, 2016: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
Michele Antonello, Francesco Squizzato, Chiara Colacchio, Jacopo Taglialavoro, Franco Grego, Michele Piazza
BACKGROUND: Provisional Extension To Induce Complete Attachment (PETTICOAT) technique has shown good results in the treatment of acute type B aortic dissections (ABAD). Usually, uncovered tubular stainless steel stents are used to promote distal true lumen reattachment. METHODS: We describe the Petticoat technique using a conic self-expanding nitinol device as distal uncovered stent in five cases of complicated ABAD. We used as distal uncovered stent the single-flared E-XL (Jotec-GmbH)...
July 2017: Annals of Vascular Surgery
Thomas A Treibel, Marianna Fontana, Jennifer A Steeden, Arthur Nasis, Jason Yeung, Steven K White, Sri Sivarajan, Shonit Punwani, Francesca Pugliese, Stuart A Taylor, James C Moon, Steve Bandula
BACKGROUND: The quantification of extracellular volume fraction (ECV) by Cardiac Computed Tomography (CCT) can identify changes in the myocardial interstitium due to fibrosis or infiltration. Current methodologies require laboratory blood hematocrit (Hct) measurement - which complicates the technique. The attenuation of blood (HUblood ) is known to change with anemia. We hypothesized that the relationship between Hct and HUblood could be calibrated to rapidly generate a synthetic ECV without formally measuring Hct...
May 2017: Journal of Cardiovascular Computed Tomography
David Pérez-Alonso, Norberto Santana-Rodríguez, José Ramón Cano, Adil Ayub, Wissam Raad, Khalid Alshehri, César Calderón-Murgas, Francisco Hernández, Gara Torrent, Faiz Y Bhora
BACKGROUND: Uncontrollable chest wall bleeding secondary to thoracic trauma has been a challenging problem faced by surgeons. Thoracic packing has been described as a good alternative although most thoracic surgeons avoid it because of the potential deleterious effects on cardiopulmonary function. METHODS: We describe a selective gauze packing technique of the thoracic wall preserving cardiopulmonary function in 3 patients with uncontrollable bleeding, where gauze packs were placed on bleeding areas holding them in a "sandwich-like" arrangement between the skin and the pleura and tightly fixed with coated wire stitches using internal and external-thoracic Ventrofil® devices...
September 2017: American Journal of Surgery
Yalcin Kulahci, Cihan Sahin, Huseyin Karagoz, Fatih Zor
The size of the thoracodorsal artery perforator (TDAP) flap or pedicle, in general, may be found to be inadequate. Pre-expansion of the flap before harvest can be a solution to increase the size of the TDAP flap in such instances. The pre-expanded TDAP flap can be used to reconstruct large-sized defects with the advantage of primary closure of the donor site. This article presents details on the surgical technique and provides discussion of the authors' experiences.
January 2017: Clinics in Plastic Surgery
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