Preoperative Chest Roentgenograms Research Articles

Risk Factors for Development and Progression of Scoliosis After Pediatric Cardiothoracic Operations

The purpose of this study was to determine the incidence and risk factors for the development and rate of progression of scoliosis and moderate/severe scoliosis inpatients undergoing cardiothoracic operations (CTOs). Included were patients aged younger than 12years who underwent CTOs in 1995 to 2006 with a preoperative chest roentgenogram (CRG) and a CRG at least 8 years after CTOs. Scoliosis and moderate/severe scoliosis were defined as a Cobb angle of 10 degrees or more and an angle of 25 degrees or more or the need forsurgical intervention, respectively. Risk factors were analyzed using nonparametric and parametric survival analyses. For patients that developed scoliosis, progression rate was analyzed using linear regression models for repeated measures using CRG at 6-month intervals. The study included 871 patients (380 girls [44%]). Median CRG follow-up was 11 years (interquartile range, 9 to 13 years). Overall 10-year incidence ofscoliosis and moderate/severe scoliosis was 12% and 3%, respectively. Independent predictors for scoliosis included female sex (hazard ratio [HR], 1.7; 95% confidence interval [CI], 1.2 to 2.5), syndrome (HR, 1.9; 95% CI, 1.3 to 2.8), and isolated developmental delay (HR, 2.4; 95% CI, 1.4 to 4.2). For development of moderate/severe scoliosis, independent risk factors included female sex (HR, 2.8; 95% CI, 1.4 to 5.8), syndrome (HR, 3; 95% CI, 1.5 to 6.1), isolated developmental delay (HR, 3.1; 95% CI, 1 to 9.2]), and prematurity for neonates/infants (HR, 2.3; 95% CI, 1 to 5.2). Rate of angle progression was 0.17 times the current angle per year. Age, syndrome, and developmental delay were risk factors for angle progression. Patients that undergo pediatric CTO, regardless of the operative approach, are at increased risk for development of scoliosis and moderate/severe scoliosis. Long-term follow-up of these patients is warranted, in particular for girls and patients with genetic syndromes or developmental delay.

Operative hysteroscopy intravascular absorption syndrome caused by massive absorption of 0.9% saline as the distention/irrigation medium

Operative hysteroscopy intravascular absorption syndrome caused by massive absorption of 0.9% saline as the distention/irrigation medium

Cystic lymphangioma confined to mediastinum in an adult

Mediastinal lymphangiomas are very rare tumors among the slow-growing mediastinal masses in the literature. We present the successful resection of a 52-year-old woman who was referred to our hospital. Past medical history consisted of surgical treatment for cervical mass and pathological diagnosis of lymphoma nine years earlier. She underwent postoperative radiotherapy. Preoperative chest roentgenogram and computed tomogram of the chest showed a cystic mass in the anterior mediastinum. The tumor was completely resected. The preoperative diagnosis was never questioned until the histopathological examination confirmed that the lesion was a cystic lymphangioma. Cystic lymphangiomas are benign tumors with the evidence of progression in tumor size and invasion into the vital structures. As our case shows, the tumor involvement with the vital structures causes difficulty in removal.

Peripheral nerve injuries during cardiac surgery: risk factors, diagnosis, prognosis, and prevention.

Neuropathies involving the brachial plexus, phrenic, recurrent laryngeal, and saphenous nerves, as well as the sympathetic chain are complications of cardiac surgery. The reported frequency of nerve injuries varies from 1.5% to 24% for the brachial plexus and 10% to 60",,6 for the phrenic nerve (1-5). Neuropathies of the recurrent laryngeal, lower limb (saphenous) nerves, and the sympathetic chain are less frequent.

Bronchostenosis Due to Childhood Tuberculosis and Manifested as an Asymptomatic Mass

We report a case of bronchostenosis manifested as an asymptomatic mass on preoperative chest roentgenogram. Bronchoscopic biopsy inadvertently led to drainage of the obstructed bronchus. The various pathogenic origins of bronchostenosis are discussed, with the most likely cause in this case being previous tuberculosis.

Bronchostenosis Due to Childhood Tuberculosis and Manifested as an Asymptomatic Mass

We report a case of bronchostenosis manifested as an asymptomatic mass on preoperative chest roentgenogram. Bronchoscopic biopsy inadvertently led to drainage of the obstructed bronchus. The various pathogenic origins of bronchostenosis are discussed, with the most likely cause in this case being previous tuberculosis.

Tumor doubling time: a selection factor for pulmonary resection of metastatic melanoma.

Melanoma patients have a 20-27% rate of 5-year survival after surgical resection of pulmonary metastases. We evaluated tumor doubling time (TDT) and other prognostic factors in an attempt to identify candidates for pulmonary metastasectomy. Review of our large melanoma database identified 129 patients who underwent complete or partial resection of pulmonary metastases. At least two preoperative chest roentgenograms were available for 45 patients; these images were used by a single examiner to measure tumor width and length. The mean of the diameters was plotted against time on semilogarithmic paper: the slope of the line approximated tumor growth rate, and TDT was proportional to the inverse of the tumor growth rate. For the 45 patients with a calculated TDT, median survival was 23.1 months and 5-year survival rate was 15.6% (7/45). By multivariate analysis, the only prognostically significant factors were TDT (P=0.006) and type of pulmonary resection (P=0.022). When TDT was <60 days, median survival was 16.0 months, and 5-year survival rate was zero; when TDT was > or = 60 days, median survival was 29.2 months (log-rank test; significant at P < 0.0001) and 5-year survival rate was 20.7% (6/29) (P < 0.0001). TDT is the most significant preoperative prognostic factor for patients undergoing pulmonary resection of metastatic melanoma. If TDT is <60 days, a preoperative neoadjuvant regimen of chemotherapy and biologic therapy is recommended. Pulmonary metastasectomy should not be attempted if TDT cannot be increased to > or = 60 days by systemic therapy.

ELEVATED HEMIDIAPHRAGM AFTER CARDIAC SURGERY WITH MYOCARDIAL PROTECTION USING TOPICAL ICE SLUSH, INCIDENCE AND PROGNOSIS

Chest roentgenograms of 163 consecutive cardiac surgical procedures were serially reviewed to determine the incidence and prognosis of elevated hemidiaphragm (ED), and any relationship with the use of topical ice slush in myocardial preservation. Diagnosis was based on radiographic criteria, comparing preoperative chest roentgenograms with postoperative ones. All patients were treated with similar myocardial preservation techniques including moderate hypothermia. Subjects were 59 child patients, 73 adult patients with acquired valve disease, and 31 adult patients treated with coronary artery bypass grafting (CABG). Of the 163 patients ED occurred in 20 (12.3%), which all located in the left side. The 20 patients included one (1.6%) out of 59 children, 10 (13.6%) out of 73 adults with acquired valve disease, and 9 (29%) out of 31 treated with CABG. When the ED cases were compared with normal cases for various operative factors, a significant difference (p<0.05) was noted in the lowest myocardial temperature. Nineteen cases could be followed on an ambulant basis. Of the 19 cases 5 (26%) recovered within 3 months, 14 (70%) within 12 months, and 18 (94%) within 2 years. Only one case still revealed ED 5 years after surgery. Phrenic nerve palsy was transient and was of no clinical significance except when bilateral. Recovery of ED on a chest roentgenography demanded a considerable period, however, early recovery in pulmonary function could be observed.

Main bronchial sleeve resection with pulmonary conservation

Twenty-seven main bronchial resections (19 left, 8 right) were performed without pulmonary resection between 1975 and 1991. The patients were 17 men and 9 women with an average age of 35 years (range, 20 to 65 years). Tumors comprised 55% of the lesions, including 9 carcinoid tumors (33%), 2 mucoepidermoid tumors, 2 fibrous histiocytomas, 1 hemangiopericytoma, and 1 large cell carcinoma. Scarring and stenosis secondary to multiple causes occurred in 10 patients (37%). Two patients had miscellaneous lesions. Presenting symptoms included dyspnea (52%), wheezing or stridor (44%), cough (41%), hemoptysis (37%), and pneumonia (18%). Preoperative chest roentgenogram was abnormal in 60% of patients, whereas tomograms delineated the lesion in 94%. All patients had bronchoscopy for lesion evaluation. Anesthesia was accomplished through a long single-lumen endotracheal tube in 19 cases and a double-lumen tube in 8 cases. Mobilization and exposure techniques to create a tension-free anastomosis were critical for left main bronchial resections and included pretracheal mobilization (100%), neck flexion (100%), tracheal and main bronchial retraction (85%), aortic and pulmonary artery retraction (44%), and intrapericardial hilar release (33%). All resections were for cure; there was no operative mortality. Morbidity in 4 patients (15%) included an anastomotic stenosis (successfully reresected), prolonged air leak and pneumonia, transient recurrent nerve palsy, and atelectasis. Median 5-year follow-up revealed 92% of patients alive, with only one of two late deaths being diseaserelated. Main bronchial resection is an ideal technique for selected benign and malignant lesions, allowing complete pulmonary parenchymal preservation.

Pulmonary resection combined with cardiac operations

Surgical management of patients with concomitant critical cardiac disease and resectable lung lesions is controversial. During a 7-year period (1982 to 1988), 21 patients underwent combined cardiac and pulmonary operations. Patients had cardiac symptoms only; the lung lesions were found on preoperative chest roentgenograms. The pathological diagnosis was established in only 2 of the patients before operation. All underwent concurrent pulmonary resection during cardiac operations requiring extracorporeal circulation. The pulmonary operations included 17 wedge resections and four lobectomies. The final diagnoses in 8 patients with stage I non-small cell lung cancer included epidermoid carcinoma (4), adenocarcinoma (3), and bronchoalveolar carcinoma (1). Postoperatively, 1 patient required a permanent pacemaker and 1 patient died. The actuarial survival at 5 years for all patients who underwent combined procedures was 95%. The 5-year survival for the 8 patients with lung cancer was 88% compared with 100% for those with benign pulmonary pathology ( p = 0.172). This experience suggests that combining pulmonary resection with cardiac operations is safe and offers a favorable prognosis to a select group of patients.

Truth Is Stranger Than Fiction Department: The Surgeon, the Radiologist, the Authors, and JAMA Got it Right-Reply

ABSTRACT In Reply.— Figure 2, left and right, are of the same female patient. As a matter of fact, this was the first patient in whom we established the diagnosis of reperfusion pulmonary edema with all its typical components. The patient was a 60year-old woman. The preoperative chest roentgenogram was taken on Septmiber 1,1987, in the erect position and the postoperative chest film was taken on September 3, 1987, at 6:05 PM in the supine position in the surgical intensive care unit. Luckily enough, I have retained copies of the negatives, both indicating the patient's name.Changes in proportions and position lead to the impression that the postoperative film (Fig 2, right) is of a different, male patient. In fact, the breasts are clearly seen on the negative (mastectomy was not performed as Dr Najarian suggests), but this is not clear enough in the printed version.

Postoperative Pleural Effusion Following Upper Abdominal Surgery

Of 128 patients who underwent upper abdominal surgery, examined by standard preoperative and postoperative chest roentgenograms for the formation of postoperative pleural effusions, 89 had postoperative pleural effusions. Their presence was not related to the type of operation, infection, serum amylases, sex, smoking habits, or weight. There was no correlation between the localization of the pleural effusions and that of the abdominal incisions. There was a positive correlation between atelectasis and pleural effusion, but no evidence of a causal relationship. Pleural effusions might be related to postoperative sodium and water retention, and aggravated by an age-related relative cardiac decompensation. Early postoperative pleural effusions are common and do not require specific treatment.

Traumatic perforation of the diaphragm.

To ascertain our experience with traumatic perforations of the diaphragm, we reviewed the charts of 72 patients treated over a ten-year period. From January 1975 through June 1984, 58 male patients and 14 female patients, ranging in age from 6 to 72 years, were treated for traumatic perforations of the diaphragm. These injuries resulted from gunshot wounds in 44 patients (61%), stab wounds in 13 (18%), blunt trauma in 11 (15%), and shotgun wounds in four (6%). Seventy-three percent of the injuries were to the left hemidiaphragm, 26% to the right, and 1% to both. Signs and symptoms were unreliable for making the diagnosis of perforation. Diagnosis depended mainly on preoperative chest roentgenograms (especially for those caused by blunt trauma), thorough intraoperative exploration, and a high index of suspicion. Overall mortality was 7%, but death was usually more readily attributable to associated injuries than to the diaphragmatic injuries.

Usefulness of routine preoperative chest roentgenograms in elderly patients.

One hundred thirty-six charts of preoperative patients over the age of 59 years were reviewed to determine whether clinical criteria alone are sufficient to identify patients who would not benefit from preoperative chest roentgenograms. Thirty-four percent of the patients without risk factors and 62% of those in the high-risk group were found to have significant abnormalities on chest roentgenograms (P less than 0.05). Postoperative complications occurred in 20% of patients in the high-risk group compared to 11% complication-rate in patients without clinical risk factors. The difference is not statistically significant. The prevalence of abnormal preoperative chest roentgenograms among those over the age of 70 years (49%) was not significantly different from the prevalence in those between the ages of 60 and 70 years (59%); however, the incidence of major postoperative complications was significantly higher in the older group (17 v 4%, P less than 0.01). Because of the substantial prevalence of abnormal chest roentgenograms and postoperative complications, it is concluded that in the elderly preoperative patients, in particular those over the age of 70 years, chest roentgenograms should be done on all patients regardless of clinical history.

Facilitating mental health on college campuses: consultation between university counseling centers and offices of residence life.

Abstract “Usefulness of Screening Chest Roentgenograms in Preoperative Patients,” Lloyd Rucker, Elizabeth B. Frye, Myrlene A. Staten. We proposed that clinical criteria could define a group of patients very unlikely to have abnormal preoperative chest roentgenograms. Nine hundred five surgical admissions were screened for the presence of clinical factors we thought would make those patients more likely to have abnormal preoperative chest roentgenograms. Of these, 368 had no risk factors. One patient (0.3%) of the 368 had an abnormal x-ray film, which did not affect the surgery. No material abnormalities were found in the remainder of the group without risk factors. Five hundred four patients had identifiable risk factors. Of these, 114 (22%) were found to have serious abnormalities on preoperative chest roentgenograms. (Journal of the American Medical Association 1983;250:3209–3211) “Effect of Treatment Regimens for Neisseria Gonorrhoeae on Simultaneous Infection With Chlamydia Trachomatis,” Walter E. Sta...

Kaolin pneumoconiosis. Radiologic, pathologic, and mineralogic findings.

Pulmonary tissue obtained at thoracotomy or autopsy from 5 kaolin workers with complicated pneumoconiosis was studied by optical light and scanning electron microscopy. Premortem or preoperative chest roentgenograms demonstrated small irregular shadows and large opacities typical of kaolin pneumoconiosis. On gross examination, there were firm, grey-brown nodules and masses in the parenchyma and in the hilar lymph nodes. Histologically, there was extensive pulmonary kaolinite deposition associated with formation of peribronchiolar macules and nodules. The latter were comprised of kaolinite aggregates traversed by bands of fibrous tissue rather than dense whorled collagen, as seen in silicosis. Crystallographic studies confirmed the presence of kaolinite in the lungs, but silica was not demonstrable by either analytical scanning electron microscopy or X-ray diffractometry. These findings illustrate the pathology of human kaolin pneumoconiosis, confirm the fibrogenic potential of kaolinite, and emphasize differences in pulmonary responses to kaolinite and to silica.

Usefulness of Screening Chest Roentgenograms in Preoperative Patients

We proposed that clinical criteria could define a group of patients very unlikely to have abnormal preoperative chest roentgenograms. Nine hundred five surgical admissions were screened for the presence of clinical factors we thought would make those patients more likely to have abnormal preoperative chest roentgenograms. Of these, 368 had no risk factors. One patient (0.3%) of the 368 had an abnormal x-ray film, which did not affect the surgery. No material abnormalities were found in the remainder of the group without risk factors. Five hundred four patients had identifiable risk factors. Of these, 114 (22%) were found to have serious abnormalities on preoperative chest roentgenogram.

Transcervical thymectomy for thymoma in myasthenia gravis

The results of thymectomy performed through a transcervical approach in 37 myasthenic patients with thymomas is reported and compared with results in 97 patients who had thymomas removed through a transsternal approach. In 29 of the former patients the thymomas were unsuspected and found at the time of thymectomy, and in 8 a preoperative chest roentgenogram was suspicious for the presence of a tumor. In the transcervical group there were only 4 invasive thymomas, while in the transsternal group there were 32. In the transcervical group there was no evidence of recurrence in the patients with unsuspected thymomas, and one recurrence in the group with suspected thymomas. In the transsternal group eight patients had known recurrence or persistent disease. The transcervical approach seems appropriate for the removal of small thymomas discovered at the time of thymectomy or suspected from the preoperative work-up.

Patent Ductus Arteriosus

Twenty-four of 230 patients with patent ductus arteriosus had hypovascularity and hyperlucency in the left lung on preoperative chest roentgenograms. Two of the 24 patients died shortly after operation, and one was unavailable for follow-up. During the postoperative course (mean, three years), roentgenograms of eight of the remaining 21 patients showed persistent, unequal pulmonary vascularity and hyperlucent left lung, with no evidence of air trapping, and two patients had diminished volume of the hyperlucent left lung compared with that of the right lung.

The Value of Routine Preoperative Chest Roentgenograms in Infants and Children

FARNSWORTH, P. B.; STEINER, E.; KLEIN, R. M.; SANFILIPPO, J. A.; Moffitt, Emerson A. M.D. Author Information