Esophageal hiatus hernia after fundoplication.

The cases of three patients who underwent fundoplication to correct gastroesophageal reflux and who subsequently had herniation above the diaphragm of abdominal contents through the esophageal hiatus are described. In two patients, the fundoplication was performed through a transabdominal approach, and in one patient through a transthoracic approach. The main symptoms were vague but persistent (48 hours) abdominal pain in three, associated with nausea and vomiting in one.

Treatment of achalasia: the best of both worlds.

Objective: To conduct a retrospective analysis of one center's experience with treating achalasia over 4 yr with skilled gastroenterologists using primarily the Rigiflex balloon dilator and with a senior surgeon performing Heller myotomies.

Methods: Newly diagnosed cases of achalasia were identified by a computer search of hospital records. Charts were reviewed for the presence/severity of dysphagia, regurgitation, heartburn, and chest pain.

CT manifestation of non-Hodgkin's lymphoma as a solitary pulmonary nodule in a patient with acquired immunodeficiency syndrome.

We present a case of acquired immunodeficiency syndrome with primary pulmonary non-Hodgkin's lymphoma that manifested as a solitary pleura-based mass lesion. Its differentiation from an infectious process imposed a diagnostic dilemma. The importance of awareness of such an entity for earlier diagnosis is stressed.

Intrapulmonary teratoma: a case report and review of the literature.

Intrapulmonary teratomas are rare; only 30 cases have been reported in the world literature. These tumors are thought to originate from the third pharyngeal pouch. They occur equally in men and women and usually are diagnosed in the second to fourth decade of life.

Radiographic evidence of calcification in pulmonary hamartomas.

Eight cases of solitary intrapulmonary hamartomas are presented to show the unusually high frequency of calcification (75%, six of eight cases) in this series. Possible contributory factors were high percentage of chondromatous variant (seven of eight cases), large size of the tumors, and use of computed tomography.

Procedures in the evaluation of chest disease.

The evaluation of chest disease may require one or more procedures. Bronchoscopy, both rigid and flexible, mediastinoscopy, mediastinotomy, chest tube drainage, lung biopsy, thoracoscopy, and pleural biopsy are described, with indications, contraindications, and results detailed.

Percutaneous fine needle aspiration in the diagnosis and management of mediastinal cysts in adults.

Management of asymptomatic mediastinal cysts in adults is controversial. In the past, these cysts were excised primarily to establish a diagnosis. Presently, computerized tomography (CT) of the chest can diagnose the majority of mediastinal cysts, based on their smooth contour and low density; however, CT diagnosis of a mediastinal cyst based on density can be erroneous.

Computed tomography evaluation of pathologic processes in the potential spaces of the mediastinum.

The potential spaces of the mediastinum can be involved in a variety of disease processes and become evident by computed tomography study. The potential spaces may be distended with air, blood, inflammatory exudate, excessive fat, or tumor which separates and displaces the normal mediastinal structures. Seven cases with various pathologic processes are selected to demonstrate the computed tomography characteristics of such lesions.

Transthoracic exposure for anterior spinal surgery.

The anterior approach to the vertebral column is used to treat fractures, spinal deformities, and destructive lesions secondary to tumor or infection. The thoracic surgeon, working with orthopedic surgeons and neurosurgeons, is uniquely qualified to provide surgical exposure expediently and assist in postoperative care. Forty-five patients with spinal deformities secondary to trauma (18 patients), congenital anomalies (16 patients), neoplastic disease (7 patients), and inflammation (4 patients) were treated by a transthoracic (37 patients) or thoracoabdominal (10 patients) anterior approach to the vertebral column.

Solitary neurofibroma of the vagus nerve in the aortopulmonary window masquerading as a developmental cyst.

A rare case of solitary neurofibroma of the vagus nerve in the aortopulmonary window masquerading as a developmental cyst is reported. Its computed tomographic characteristics and magnetic resonance imaging are described and correlated with pathologic findings. Although the features of such imaging modalities are quite characteristic for a neurofibroma, its differentiation from "atypical" developmental cysts may be difficult.

Nonbronchial systemic collateral arteries: significance in percutaneous embolotherapy for hemoptysis.

Twenty patients with massive or recurrent hemoptysis underwent percutaneous transcatheter embolotherapy between 1979 and 1986 for the following diseases: cavitary aspergillosis (n = 4); cystic fibrosis (n = 4); tuberculosis (n = 3); bronchogenic carcinoma (n = 3); bronchiectasis (n = 3); small cell lung carcinoma 6 years after irradiation (n = 1); congenital heart disease, after Glenn and Blalock anastomoses (n = 1); and unknown interstitial disease (n = 1). Bronchial arteries were embolized in all but one patient. In nine patients (45%) nonbronchial systemic collateral arteries contributed significantly to areas of pathologic pulmonary tissue and frequently were the major arterial supply.

Concatenations.

Concatenations, linkings of events and ideas, are demonstrated to show the progress of thoracic surgery. The development of our knowledge of pulmonary anatomy, pleural drainage, and thoracic anesthesia, independently and collectively, has proven invaluable in the current successful surgical treatment of many pulmonary diseases.

Surgery as palliative treatment for distant metastases of melanoma.

Sixty-five patients with distant metastatic melanoma amenable to surgical treatment had excision of 94 metastatic lesions from the brain, lung, abdomen, distant subcutaneous sites, and distant lymph nodes. Relief of symptoms, if present, was obtained after excision of 77% of brain metastases, 100% of lung metastases, 88% of distant lymph node and subcutaneous metastases, and 100% of abdominal metastases. Median survival after excision of brain metastases was 8 months, lung metastases 9 months, abdominal metastases 8 months, and distant subcutaneous and lymph node metastases 15 months.

Potential value of digital radiography. Preliminary observations on the use of dual-energy subtraction in the evaluation of pulmonary nodules.

The radiographic demonstration of calcification in a solitary pulmonary nodule renders the possibility of malignancy extremely unlikely, although rare exceptions have been reported. Conventional roentgenograms and tomograms sometimes provide inconclusive evidence although CT can be highly accurate in both identifying and quantifying calcium content. An alternative method is dual-energy subtraction utilizing scanned projection digital radiography.