Rupture Of Great Vessels Research Articles

Tolerance of the aorta using intraoperative iodine-125 interstitial brachytherapy in cancer of the lung

Purpose A retrospective review to assess the efficacy and morbidity of surgical resection and 125I interstitial lung brachytherapy placed in approximation to the aorta. Methods and materials The records and postoperative films of 278 patients who had undergone intrathoracic 125I brachytherapy at our institution were reviewed. All patients had undergone a gross total resection of a non–small-cell lung cancer using segmental resection, wedge resection, or sublobar resection. Frozen section margins of resection were required to be negative before the intraoperative delivery of the implant. Of those reviewed, 29 patients were implanted with 125I impregnated Vicryl mesh that contacted greater than 50% with the aorta. Implants consisted of 125I seeds sewn into a nomographically guided geometric array. Only implants where 50% or greater of the implant volume directly approximated the aorta were selected for inclusion into this study. The mean aortic volume receiving the entire prescribed dose was 17.2 cc (mean surface area = 34.4 cm 2) and the mean prescribed dose was 114 Gy (range, 85–120) over the permanent life of the implant calculated by isodose curve distribution at a depth of 0.5 cm from the plane of the implant. Five patients have received postoperative mediastinal dose supplementation with external beam irradiation to further address occult mediastinal nodal disease not revealed during the intraoperative frozen section analysis. Results All patients tolerated the surgery and brachytherapy well with no perioperative mortality. With a median followup of 45.3 months (range, 1–117), 1 of the 29 patients suffered a fatal hemorrhage from suspected great vessel rupture. A review of this case demonstrated that the interstitial therapy had been supplemented with 4500 cGy of external irradiation, which overlapped a small portion of the implant volume overlying the aorta. No other patients suffered even minor events referable to the implant and have continued to do well without symptomatic evidence of chronic sequelae as of the publication of this article or the time of their death. Local control has been achieved in all patients still living and had been achieved in all patients who died from subsequent progression of metastatic disease or other cause. Conclusions Interstitial 125I intrathoracic brachytherapy is a safe and effective method when used with sublobar resection in high-risk stage I non–small-cell lung cancer patients and may be used even in situations that require placement of the sources in close approximation to the aorta. The tolerance of the aorta seems to be greater than previously thought, and may well exceed 12,000 cGy over the permanent life of the interstitial implant. Interstitial 125I brachytherapy can safely be used to deliver significant radiation dose in direct contact with the aorta but supplemental, overlapping external beam irradiation should be avoided.

Reconstruction following total laryngopharyngoesophagectomy and extensive resection of the superior mediastinum: an update.

Our experience with four patients who underwent immediate reconstruction following total laryngopharyngoesophagectomy and extensive resection of the superior mediastinum is presented. The reconstructive procedures included free jejunal graft or microvascularly augmented gastric pedicle for esophageal reconstruction, pectoral fasciocutaneous or myocutaneous flap for tracheal reconstruction, and mesenteric flap connected with jejunal graft omental flap, or pectoral flap for protection of the great vessels and obliteration of the dead space in the cervical and superior mediastinal region. The reconstructive procedures were successful, and no pharyngocutaneous fistula, mediastinitis, or great vessel rupture was noted in any patient. There was one patient who developed lung edema and liver dysfunction postoperatively. Combinations of reconstructive procedures using well-vascularized soft tissues can be expected to provide well-tolerated reconstruction following extensive cervical and superior mediastinal resection.

Traumatic haemorrhage into the thyroid simulating major vessel damage from deceleration injury.

Lawton, G. (1974).Thorax, 29, 607-608. Traumatic haemorrhage into the thyroid simulating major vessel damage from deceleration injury. Haemorrhage into the thyroid gland is a well recognized condition but there are few cases in the literature of severe haemorrhage associated with trauma. A case is described of a patient involved in a road traffic accident where the clinical features strongly suggested a diagnosis of great vessel rupture associated with deceleration injury. The importance of considering the possibility of haemorrhage into a retrosternal thyroid gland in a closed chest injury is stressed, as is the importance of arch aortography in management.