Objective: To explore the prognostic value of simple renal cyst (SRC) for adverse events in patients receiving thoracic endovascular aortic repair (TEVAR) for Stanford B aortic dissection (TBAD). Methods: This study is a retrospective cohort study. Consecutive patients receiving TEVAR for TBAD between January 2010 and December 2015 were enrolled in this study. The patients were divided into SRC group and non-SRC group. With sex and age ±2 years old as matching factors, SRC group and non-SRC group were matched by 1∶1. Collect and compare the differences of clinical data between the two groups. Adverse events were recorded through outpatient, telephone follow-up and in-hospital review. After adjusting for confounding factors, multivariate Cox regression was used to analyze the risk factors of aortic adverse events. Kaplan-Meier method was used to analyze the survival curve of SRC group and non-SRC group. Results: A total of 692 consecutive patients were recruited. Patients were divided into SRC group (n=235) and non-SRC group (n=457). After 1∶1 matching, there were 229 cases in SRC group and no SRC group respectively. The age of SRC group was (62.3±10.4) years old, 209 cases were male (91.3%), and the age of no SRC group was (62.0±10.2) years old, 209 cases were male (91.3%). Cox regression analysis showed that, after adjusting for confounding factors, comorbid SRC (HR=1.991, 95%CI: 1.090-3.673, P=0.025), TEVAR in the acute phase (HR=13.635, 95%CI: 5.969-31.147, P=0.001), general anesthesia (HR=2.012, 95%CI: 1.066-3.799, P=0.031) are independent factors of aortic-adverse events after TEVAR for TBAD. Kaplan-Meier analysis showed that the cumulative survival rate of SRC group was significantly lower than non-SRC group (log-rank P=0.031, 0.005). Conclusion: SRC is an independent predictor of aortic-related adverse events in patients following TEVAR for TBAD.
Aged ; Aortic Dissection/surgery* ; Aortic Aneurysm, Thoracic/surgery* ; Blood Vessel Prosthesis Implantation/methods* ; Endovascular Procedures/methods* ; Female ; Humans ; Kidney Diseases, Cystic/complications* ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome

Thoracic splenosis is the autotransplantation of splenic tissue in the left thoracic cavity as a result of a splenic injury. This rare pathology is usually asymptomatic and may be discovered on incidental imaging, but the diagnosis often requires invasive procedures such as surgery in order to eliminate a neoplasic origin. We report a rare symptomatic case of a 39-year-old man presenting with chest pain and multiple nodules revealed on a computed tomography scan. The patient underwent a surgical exploration and the pathological studies concluded to a thoracic splenosis. Indeed, the previous medical history of the patient revealed a left thoraco-abdominal traumatism during childhood. The aim of this paper is to emphasize that the diagnosis can now be performed using only imaging techniques such as technetium-99 sulfur colloid or labelled heat-denatured red blood cell scintigraphy to avoid unnecessary invasive procedures including thoracotomy.
Abdominal Injuries ; complications ; Adult ; Asymptomatic Diseases ; Humans ; Male ; Spleen ; injuries ; Splenectomy ; Splenosis ; diagnosis ; etiology ; pathology ; surgery ; Thoracic Diseases ; diagnosis ; etiology ; pathology ; surgery ; Thoracic Injuries ; complications ; Thoracotomy ; Unnecessary Procedures

BACKGROUND: The endovascular approach to aortic disease treatment has been increasingly utilized in the past 2 decades. This study aimed to determine the long-term results of using the Seal thoracic stent graft. METHODS: We retrospectively reviewed the outcomes of patients who underwent thoracic endovascular aortic repair or a hybrid procedure using the Seal thoracic stent graft (S&G Biotech, Seongnam, Korea) from January 2008 to July 2018 at a single institution. We investigated in-hospital mortality and the incidence of postoperative complications. We also investigated the mid-term survival rate and incidence of aorta-related complications. RESULTS: Among 72 patients with stent grafts, 15 patients underwent the hybrid procedure and 21 underwent emergency surgery. The mean follow-up period was 37.86±30.73 months (range, 0–124 months). Five patients (6.9%) died within 30 days. Two patients developed cerebrovascular accidents. Spinal cord injury occurred in 2 patients. Postoperative renal failure, postoperative extracorporeal membrane oxygenation support, and pneumonia were reported in 3, 1, and 6 patients, respectively. Stent-related aortic complications were observed in 5 patients (6.8%). The 1- and 5-year survival and freedom from stent-induced aortic event rates were 81.5% and 58.7%, and 97.0% and 89.1%, respectively. CONCLUSION: The use of the Seal thoracic stent graft yielded good mid-term results. Further studies are needed to examine the long-term outcomes of this device.
Aorta, Thoracic ; Aortic Diseases ; Aortic Rupture ; Blood Vessel Prosthesis ; Emergencies ; Endoleak ; Extracorporeal Membrane Oxygenation ; Follow-Up Studies ; Freedom ; Gyeonggi-do ; Hospital Mortality ; Humans ; Incidence ; Pneumonia ; Postoperative Complications ; Renal Insufficiency ; Retrospective Studies ; Spinal Cord Injuries ; Stents ; Stroke ; Survival Rate

BACKGROUND: Surgical site infection is one of the common postoperative complications of thoracic surgery, and its harm is related to infection degree and location. Light causes local pain, prolonged hospitalization and increased cost. Severe infection can lead to severe infection, even septic shock and life-threatening. Therefore, proper treatment of incision infection can help to promote recovery, reduce the burden of disease and lay a good foundation for further treatment. The traditional surgical treatment of wound infection includes thorough drainage, intensive dressing change and antibiotic use. There are many shortcomings such as long treatment process, ineffective treatment effect and so on. The experience of using vacuum sealing drainage (VSD) in 6 cases of postoperative infection patients in our department is summarized in order to improve the traditional treatment of postoperative infection in patients after thoracic surgery. METHODS: The clinical data of patients with postoperative incision infection or fistula after thoracic surgery in our department were reviewed and summarized. 6 patients treated with VSD material for postoperative infection. The process and final clinical results of them were summarized and discussed. RESULTS: In this study, fever and wound exudation disappeared within 6 h-10 h after VSD use, 5 cases of wound infection were obviously improved, the secretion disappeared and the granulation tissue grew well at the cutting edge of the operation, the second stage operation was performed to close the chest and skin. One patient was seriously infected, and the secretion was still more after VSD removal, reposition VSD device next time, the VSD device was removed 7 d later. The wound infection were obviously improved, the secretion disappeared and the granulation tissue grew well, close the chest and skin second stage. In all 6 patients, the symptoms were relieved, the symptoms improved and the surgical incision healed well. In 2 patients with esophageal cancer, the average operation time was 427.5 min, the average hospitalization time was 40 d, the average number of times of dressing change was 8.5, the average total cost during hospitalization was 111,893.47 yuan patients with chronic empyema, the average operation time was 192.5 min. The average hospital stay was 27.75 days, the average number of times of dressing change was 5.5, and the average total expenditure during hospitalization was 48,237.71 yuan. CONCLUSIONS VSD has a good effect on the treatment of postoperative incision infection patients in thoracic surgery. It can reduce the pain and burden of patients and ensure the quality of life of postoperative infected patients.
Adult ; Drainage ; instrumentation ; methods ; Esophageal Neoplasms ; complications ; surgery ; Female ; Humans ; Lung Neoplasms ; Male ; Middle Aged ; Postoperative Complications ; etiology ; surgery ; Retrospective Studies ; Thoracic Diseases ; complications ; surgery

OBJECTIVE: To investigate the treatment strategy for subcutaneous fistula secondary to cerebrospinal fluid leakage (CSFL) in thoracic spinal stenosis (TSS) cases. METHODS: In the study, 186 CSFL cases diagnosed with TSS and operated in general spine group of Department of Orthopedics, Peking University Third Hospital from January 2005 to December 2014 were retrospectively reviewed, of which eleven had subcutaneous fistula secondary to CSFL and were regularly followed up. Treatment strategy for subcutaneous fistula depended on the severity of CSFL and the recovery rate of thoracic myelopathy. Japanese Orthopedic Association (JOA) score was utilized to evaluate the neurologic status of these patients preoperatively and postoperatively. Statistical analysis was conducted between preoperative and postoperative JOA scores. RESULTS: All of the 11 patients were regularly followed up for at least 24 months. Six of them had ossification of the posterior longitudinal ligament (OPLL) combined with ossification of ligamentum flavum (OLF), all of them undertook "cave-in" 360° circumferential decompression of the spinal cord with instrumentation. Five cases had OLF only, and received En bloc resection of lamina and OLF and fixation. The follow-up period ranged from 30 months to 131 months, and averaged at (85±34) months. Preoperative symptoms lasted from 3 months to 8 years, and the median was 18 months. Drainages were placed for 2-6 days, and averaged at (4.2±1.1) days. Ten cases appeared with fever during the perioperative period, the maximum body temperature was (37.3-39.7) °C. Prolonged antibiotics were applied in two cases with high fever. Ten cases were treated with conservative methods, CSFL were completely absorbed during the follow-up time, of which compressive dressing was utilized in 8 cases, and punctures combined with compressive dressing were used in 2 cases. For only 1 case, conservative therapy failed and reoperation was required because of neurological deterioration arising from CSF pseudocyst. For these 11 cases, preoperative JOA score arose from (3.8±1.6) preoperatively to (8.9±1.2) at the end of the final follow-up, the recovery rate was 70.8%. No infection of wound or central nerve system were noticed, and neither were unhealing wound. CONCLUSION Most TSS cases with subcutaneous fistula secondary to CSFL could be cured by conservative methods, and reoperation is required only if myelopathy caused by cerebrospinal fluid pseudocyst is identified.
Cerebrospinal Fluid Leak/complications* ; Decompression, Surgical ; Fistula/etiology* ; Humans ; Retrospective Studies ; Spinal Cord Diseases ; Spinal Stenosis/complications* ; Thoracic Vertebrae ; Treatment Outcome

Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
Abdominal Injuries ; complications ; Anti-Infective Agents ; therapeutic use ; Decompression, Surgical ; Digestive System Surgical Procedures ; adverse effects ; methods ; Drainage ; Duodenal Diseases ; diagnosis ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; injuries ; surgery ; Enteral Nutrition ; Humans ; Hypoproteinemia ; therapy ; Intestinal Fistula ; diagnosis ; etiology ; prevention & control ; therapy ; Ischemia ; prevention & control ; Nutritional Support ; Parenteral Nutrition ; Postoperative Complications ; prevention & control ; therapy ; Suture Techniques ; Thoracic Injuries ; complications

Patients in traffic accidents are usually presented with pain and bleeding due to fractures or soft tissue injury. On some occasions, more severe complications may be triggered by the trauma. A review of the published English language literature reveals no survival case once the traumatic mediastinal hematoma is ruptured. In our case, a 54-year-old man suffering motorcycle accident was admitted to emergency department. Computed tomography scan revealed subdural hematoma combined with posterior mediastinal hematoma. The patient was saved and discharged with a satisfactory outcome. Here we hope to share our treatment experience in dealing with the patient with severe multiple trauma.
Hematoma ; complications ; Hemorrhage ; therapy ; Humans ; Male ; Mediastinal Diseases ; complications ; Middle Aged ; Rupture ; Thoracic Diseases ; therapy

No abstract available.
Acute Disease ; Adult ; Anti-Bacterial Agents/therapeutic use ; Choristoma/*complications/radiography ; Escherichia coli Infections/diagnosis/drug therapy/*microbiology ; Female ; Hernias, Diaphragmatic, Congenital/*complications/radiography ; Humans ; *Kidney ; Predictive Value of Tests ; Pyelonephritis/diagnosis/drug therapy/*microbiology ; Thoracic Diseases/*complications/radiography ; Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures.

METHODSIt was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching.

RESULTSTechnical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was successfully treated with a tapered stent-graft, there was no new endoleak during follow up period, 3 type I endoleak disappeared spontaneously, and 1 type II endoleak disappeared after secondary intervention.

CONCLUSIONSEndovascular repair of aortic arch disease hybrid with supra-arch debranching procedure is low invasive with favorable long-term outcomes. It is suitable for high risk patients of poor general condition with little tolerance to aortic arch replacement. The in-hospital mortality is higher in the ascending aorta based debranching group than in the non-ascending aorta based debranching group. Stroke is a critical fatal complication and should be attached attention.

Adult ; Aged ; Aged, 80 and over ; Aneurysm, Dissecting ; surgery ; Aorta ; pathology ; surgery ; Aortic Aneurysm, Thoracic ; surgery ; Aortic Diseases ; surgery ; Blood Vessel Prosthesis Implantation ; Endoleak ; complications ; Endovascular Procedures ; Female ; Hospital Mortality ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Stents ; Stroke ; complications ; Survival Rate ; Tomography, X-Ray Computed

No abstract available.
*Aorta, Thoracic/ultrasonography ; Aortic Diseases/*complications/diagnosis ; Catheterization, Peripheral/*adverse effects ; Cerebral Angiography/*adverse effects ; Electrocardiography ; Fatal Outcome ; *Femoral Artery ; Heart Arrest/diagnosis/etiology ; Humans ; Male ; Middle Aged ; Myocardial Infarction/diagnosis/*etiology ; Punctures ; *Sinus of Valsalva/ultrasonography ; Thrombosis/diagnosis/*etiology