Mediastinal coelomic cyst.

Coelomic cysts are rare cysts of mesothelial origin. This is a case report of a thoracic coelomic cyst presenting as atypical chest pain.

Low mortality after treatment for esophageal perforation: a single-center experience.

Background: Historically, esophageal perforation has been associated with significant mortality. Improvements in diagnosis, critical care, and surgical and endoscopic techniques may lead to lower mortality rates in the modern era. We reviewed our experience with the management of esophageal perforation to determine whether outcomes have improved.

Effect of sympathectomy level on the incidence of compensatory hyperhidrosis after sympathectomy for palmar hyperhidrosis.

Objective: Palmar hyperhidrosis can be psychosocially devastating. Sympathectomy provides effective treatment. The most common side effect after sympathectomy is compensatory hyperhidrosis, which can be debilitating.

The risk of esophageal resection after esophagomyotomy for achalasia.

Background: Esophagomyotomy is the mainstay of treatment for achalasia with proven long-term success. However, in patients with a significantly dilated esophagus, many advocate esophageal resection thus forgoing an esophagomyotomy. The purpose of this study is to determine the esophagomyotomy failure rate in patients with achalasia.

Characteristics of second primary lung malignancy in patients with known breast cancer.

Background: As breast cancer survival improves, the incidence of additional malignancies will likely rise. Identification of a lung nodule in a patient with known breast cancer poses a challenging diagnostic problem. This study outlines the management of such patients and identifies factors that correlate with survival.

Neoadjuvant chemoradiation versus chemotherapy for patients undergoing esophagectomy for esophageal cancer.

Background: Neoadjuvant chemoradiation followed by esophagectomy is currently the standard of care for locally advanced esophageal cancer. This intense preoperative regimen delays definitive resection and increases perioperative risks. With the improvement of chemotherapy agents, chemotherapy alone may be better suited for patients awaiting esophagectomy because of shorter preoperative treatment time and less associated perioperative complications.

Muscles of the chest wall.

The extrathoracic muscle flaps can be used in a number of different situations such as in sternal reconstruction, for filling many types of defects, and in chest wall reconstruction. The extrathoracic flaps can be utilized in the treatment of postpneumonectomy empyema and bronchopleural fistula after lobectomy. Another use for these flaps is in tracheal resection as coverage of an anastomotic area and in the gastrointestinal tract as wrapping for an anastomoses.

Modified Nissen fundoplication combined with Ivor Lewis esophagogastrectomy.

Esophageal carcinoma is a difficult neoplasm to treat, with a reported overall 5-year survival of about 15%. The role of chemotherapy and radiation has yet to be defined, making surgical resection the standard treatment. Postoperative esophageal leak remains a significant contributor to morbidity and mortality, especially after an intrathoracic anastomosis.

Clues to cardiovascular risk: an office-based approach.

Current tools for predicting coronary heart disease risk in the asymptomatic patient fall into 2 major categories: traditional population-based models and noninvasive imaging techniques. Population-based models that estimate cardiovascular risk are powerful clinical tools but do not utilize a large volume of patient-specific data that are readily available to the clinician and may help to identify at-risk patients. The use of high-technology noninvasive imaging has not been consistently validated and clinicians or patients often lack the resources for such testing.

Partial sleeve right pneumonectomy with carinal flap closure.

We describe a technique used in 2 patients for resection of carcinoid tumor arising from the right main bronchus and extending along the lateral wall of the lower trachea. A flap was mobilized from the non-involved membranous posterior wall of the right main bronchus, which was left attached to the carina. This was used to close the defect in the lower trachea.

Physicians assistants in cardiothoracic surgery: a 30-year experience in a university center.

Background: The purpose of this study was to evaluate our 30 years of experience with the use of physician assistants (PAs) on a cardiothoracic surgery (CTS) service.

Methods: A retrospective review of the utilization of CTS PAs was performed at a university center from 1973 to 2003.

Results: The number of PAs has increased from 2 (1973) to 23 (2003), corresponding to the increased clinical service demands with a constant resident number for the past decade.

Intrathoracic splenosis.

Intrathoracic splenosis is a rare condition involving autotransplantation of the splenic tissue into the pleural cavity. It is typically a result of diaphragmatic and splenic rupture after blunt or penetrating abdominal trauma. The diagnosis is usually determined by surgical biopsy of an incidental asymptomatic mass on a radiograph or computed tomography.

Intrathoracic gastrojejunostomy for gastric outlet obstruction after Ivor Lewis esophagogastrectomy.

Gastric outlet obstruction after esophagogastrectomy with a drainage procedure is unusual, but when encountered, its management can be formidable. A Rous-en-Y intrathoracic gastrojejunostomy was created in a 74-year-old woman 2 years after Ivor Lewis esophagogastrectomy for benign disease to treat severe gastric outlet obstruction at the native pylorus.

Incidence of deep sternal wound infections after tracheostomy in cardiac surgery patients.

Background: Tracheostomy after median sternotomy is associated with an increased risk of deep sternal wound infection (DSWI). However, associated comorbidities in these patients make the exact risk of tracheostomy difficult to discern. Therefore, we performed a retrospective review to determine the risk of DSWI in our cardiac surgery patients who underwent postoperative tracheostomy.

Role of thoracic surgeons in the diagnosis of idiopathic interstitial lung disease.

The interstitial lung disorders are a heterogenous group of pulmonary disorders in which the interstitium is the predominant tissue type involved in the disease process. The idiopathic interstitial pneumonias represent a subgroup of these disorders that can be distinguished by unique clinical, radiologic, and pathologic features. Recent changes have been made in the classification system, with important distinctions between idiopathic pulmonary fibrosis and the other idiopathic interstitial pneumonias.

Diets and cardiovascular disease: an evidence-based assessment.

With rising obesity, despite low-fat diet recommendations, there is an increased interest in weight loss and alternative dietary approaches for cardiovascular health. Physicians must have an understanding of the literature to better counsel their patients about diets and cardiovascular disease. This review examines several dietary approaches to cardiovascular health and evaluates the available scientific evidence regarding these diets.

Thoracic presentations of posttransplant lymphoproliferative disorders.

Background: Posttransplant lymphoproliferative disorders (PTLDs) are rare complications following transplantation. Although organ-specific cases have been reported, primary presentation in the thoracic cavity has not been fully characterized.

Methods: Eleven cases of PTLD with a primary thoracic presentation were identified among 3,085 solid-organ transplant patients and 1,662 bone marrow transplant patients from 1990 to 2001.

Primary solitary endobronchial plasmacytoma.

Twenty-two cases of pulmonary plasmacytoma have been reported in the literature and verified by immunohistochemistry or other diagnostic tests. The treatment for this rare tumor has included various combinations of surgical resection, chemotherapy, and radiation therapy. We report a case of a middle-age man who underwent endoscopic debulking followed by laser ablation for a pulmonary plasmacytoma, which showed a prominent endobronchial location with clinical and histopathologic verification.

Preoperative risk assessment for marginal patients requiring pulmonary resection.

Surgical resection remains the mainstay of treatment for pulmonary malignancy. The ability of patients to undergo resection is dependent on the anatomic characteristics of the tumor, and the respiratory and cardiovascular status of the patient. There have been recent advances in our understanding of respiratory function in the patient with marginal lung function that have allowed surgical therapy of lung cancer in patients previously deemed inoperable.

A brief history of the Southern Thoracic Surgical Association and a synopsis of the Presidential addresses.

This article contains a brief history of the Southern Thoracic Surgical Association since it was founded in 1953, and a synopsis of each Presidential Address that was available for review. Not all Addresses were available or could be obtained.

Twenty-six years of experience with the modified eloesser flap.

Background: Empyema thoracis is a common thoracic problem with a multitude of therapeutic options. The modified Eloesser flap (MEF) is one means of dealing with this problem in selected complicated patients. The purpose of this study is to report our 26-year experience with the MEF.

Thirty-year experience with repair of pectus deformities in adults.

Background: A plethora of studies have described repair of pectus deformities in children, but only few reports have described this repair in adults. The purpose of this study was to review our 30-year experience with surgical repair of pectus deformities in adults.

Methods: A retrospective review of all adult patients (> 16 years old) who underwent repair of congenital pectus deformities from 1971 through 2001.

High dose rate brachytherapy in the management of lung transplant airway stenosis.

Background: Airway complications after lung transplantation remain a major cause of postoperative morbidity and mortality. Interventional bronchoscopic management continues to be the main modality in the management of these problems.

Methods: Four patients with airway stenoses after lung transplantation received high dose rate brachytherapy for management of recurrent stenosis.

Preservation of the lima pedicle after cardiac surgery in left upper lobectomy.

Left internal mammary artery (LIMA) harvesting for coronary artery bypass grafting often complicates future thoracic procedures because of adhesion formation in the left chest and to the left upper lobe. We describe an adjuvant approach to left upper lobectomy for bronchogenic carcinoma in a patient with previous LIMA harvesting and grafting in which we preserved the LIMA pedicle, while still providing near complete lobe resection.