ABSTRACT
Objective To study the local recurrent pattern of postoperative middle thoracic esophageal squamous cell carcinoma( ESCC) and provide the evidence for designing the radiation target in postoperative radiotherapy. Methods From May 2007 to December 2015, a total of 752 patients with local recurrence of postoperative middle thoracic ESCC were included in this retrospective analysis. χ2 test was used to analyze the recurrent pattern of mediastinum, anastomotic, abdominal cavity and primary tumor bed. Results The median interval between surgery and recurrence was 14. 6 months (1-106 months). The highest risk of recurrent site was mediastinum (79. 7%), followed by supraclavicular and anastomotic (29. 1%and 7. 4%, respectively), but rarely occurred at the abdominal cavity and primary tumor bed (4. 1%and 0. 7%, respectively). The relapse rate differed significantly among the five sites (χ2 =925. 8, P<0. 05). Furthermore, the relative metastatic rate in upper mediastinum was 74. 2%, 19. 8%in middle mediastinum and 4. 8%in the lower. There was statistically significant difference in the relative metastatic rate among the three sites(χ2 =791. 6, P <0. 05). Recurrences occurred highly at the 7th, 1st -5th regions, but rarely at 6th, 8th -10th regions. There was significant difference among these 10 regions from the mediastinum(χ2 =486. 9, P<0. 05). The lymphatic metastasis of superior mediastinum was mainly distributed at paratracheal lymph nodes. The metastatic rate of right paratracheal lymph nodes was 47. 1% including 1R,2R and 4R regions and the left paratracheal lymph nodes was 29. 4%including 1L, 2L and 4L regions. The metastatic rate of right supraclavicular paratracheal lymph nodes was significantly higher than that of left ones(χ2 =31. 5, P <0. 05). Conclusions Local recurrence mainly occurred in the bilateral supraclavicular areas, upper/middle mediastinum and anastomosis in patients with middle thoracic ESCC. The bilateral supraclavicular areas, 1st -5th regions of superior mediastinum, 7th region of middle mediastinum and anastomosis should be included in the postoperative prophylactic irradiation target volume.
ABSTRACT
Objective To study the local recurrent pattern of postoperative middle thoracic esophageal squamous cell carcinoma( ESCC) and provide the evidence for designing the radiation target in postoperative radiotherapy. Methods From May 2007 to December 2015, a total of 752 patients with local recurrence of postoperative middle thoracic ESCC were included in this retrospective analysis. χ2 test was used to analyze the recurrent pattern of mediastinum, anastomotic, abdominal cavity and primary tumor bed. Results The median interval between surgery and recurrence was 14. 6 months (1-106 months). The highest risk of recurrent site was mediastinum (79. 7%), followed by supraclavicular and anastomotic (29. 1%and 7. 4%, respectively), but rarely occurred at the abdominal cavity and primary tumor bed (4. 1%and 0. 7%, respectively). The relapse rate differed significantly among the five sites (χ2 =925. 8, P<0. 05). Furthermore, the relative metastatic rate in upper mediastinum was 74. 2%, 19. 8%in middle mediastinum and 4. 8%in the lower. There was statistically significant difference in the relative metastatic rate among the three sites(χ2 =791. 6, P <0. 05). Recurrences occurred highly at the 7th, 1st -5th regions, but rarely at 6th, 8th -10th regions. There was significant difference among these 10 regions from the mediastinum(χ2 =486. 9, P<0. 05). The lymphatic metastasis of superior mediastinum was mainly distributed at paratracheal lymph nodes. The metastatic rate of right paratracheal lymph nodes was 47. 1% including 1R,2R and 4R regions and the left paratracheal lymph nodes was 29. 4%including 1L, 2L and 4L regions. The metastatic rate of right supraclavicular paratracheal lymph nodes was significantly higher than that of left ones(χ2 =31. 5, P <0. 05). Conclusions Local recurrence mainly occurred in the bilateral supraclavicular areas, upper/middle mediastinum and anastomosis in patients with middle thoracic ESCC. The bilateral supraclavicular areas, 1st -5th regions of superior mediastinum, 7th region of middle mediastinum and anastomosis should be included in the postoperative prophylactic irradiation target volume.
ABSTRACT
A 22-year-old man shot himself with a nail gun. He was admitted to a local hospital with chest pain. Chest x-ray film and chest computed tomography showed 5 nails penetrating the left thorax and some of these nails were considered to reach the pericardium. He was transferred to our hospital for intervention. Left thoracotomy was performed. Three nails reached the left ventricle and one nail was embedded the left lung. The last nail was found by transesophageal echocardiography to be completely buried in the left ventricle wall. All nails were removed and the left ventricular wounds were repaired with felt 4-0 surgipro mattress sutures. He made an uneventful postoperative recovery with a normal postoperative echocardiography and he was discharged on postoperative day 12 in good condition.
ABSTRACT
Pericardial tamponade limits diastolic filling of the heart; therefore, a high venous pressure is required to fill the ventricle. In presence of cardiac tamponade, therapeutic agents and manoeuvres that results in venodilation or vasodilation can severely compromise diastolic filling of the heart and might result in rapid cardiac decompensation. Equalization of central venous pressure and pulmonary artery diastolic pressure or equalization of pressures in all four chambers during diastole confirms cardiac tamponade. Transthoracic echocardiography can detect the site of tamponade and assist in pericardiocentesis. We describe acute pericardial tamponade in a young man who underwent left posterolateral thoracotomy for left upper lobectomy. Intraoperatively, mobilization of the left upper lobe was frequently associated with hypotension. Postoperatively, the patient suffered two more episodes of hypotension. The episodes of hypotension were attributed to surgical manipulation and epidural blockade. Hemodynamics normalized after discontinuing epidural infusion, volume resuscitation and lobectomy. On third postoperative day, the patient developed cardiovascular collapse; arterial blood pressure and central venous pressure were 70/50 and 12 mmHg. Investigations showed haziness of left lung, and severe respiratory acidosis. On opening of the left thoracotomy wound, pericardial tamponade was diagnosed. A pericardial window was created and tamponade was released with that the hemodynamics normalized. Episodes of unexplained hypotension after left upper lobectomy suggest a cardiac etiology and acute pericardial tamponade is a possibility which should be released immediately otherwise it can result in fatal outcome.
Subject(s)
Anesthesia, General , Aspergillosis/surgery , Cardiac Tamponade/diagnosis , Cardiac Tamponade/etiology , Cardiac Tamponade/therapy , Hemodynamics/physiology , Humans , Critical Care , Lung/surgery , Lung Diseases, Fungal/surgery , Male , Postoperative Complications/etiology , Postoperative Complications/therapy , Pulmonary Surgical Procedures/methods , Shock/complications , Thoracotomy/adverse effectsABSTRACT
Since 1998, as a method of operating on descending thoracic aortic disease, especially distal aortic disease, a simple circulatory support technique, which uses the axillary artery or the ascending aorta as the aortic inflow, and the inferior vena cava for total body retrograde perfusion of cold oxygenated blood during circulatory arrest for open proximal anastomosis has been applied. This technique has been used in 25 consecutive cases over 10 years. In this report, we evaluate the efficacy of this support technique. From our experience, an atherosclerotic lesion in the ascending aorta required selection of the femoral artery as an aortic inflow site in 7 patients. Prolonged ventilatory support was unnecessary postoperatively unless neurological sequelae supervened, and no heart or visceral organ complications were occurred recognized. The hospital mortality rate was 16%. These results suggest our technique will continue to play an important role in operations on descending thoracic aortic diseases.