Thoracic Puncture Research Articles

Thoracic epidural puncture guided by an acoustic signal: clinical results

Thoracic epidural puncture guided by an acoustic signal: clinical results

Sources of pathogens causing pleuropulmonary infections after lung cancer resection.

The source of pathogens responsible for pleuropulmonary complications after lung resection is not yet completely understood, yet knowing this source is very important for proper perioperative use of antibiotics in lung surgery. We studied prospectively the value of sputum samples -- collected 3 days before and 3 days after surgery -- and of intraoperative bronchial swabs in the diagnosis of infective pulmonary complications following lung cancer resection. In a prospective trial, we studied 194 patients (18 women and 176 men, age range 34-79 years, mean 57 years) who were operated on for lung cancer. The infection screen consisted of intraoperative bronchial swabs, and sputum samples obtained prior to and 3 days after surgery. Before the operation, all patients were free of clinical signs of respiratory infection. In patients with postoperative infection, causative pathogens were identified from sputum, tracheal aspirate, thoracic puncture and thoracic drainage fluids. Thirty-four patients suffered from 32 pleuropulmonary infections, and two from wound infection. Pathogenic organisms were isolated from preoperative and postoperative sputum samples and from intraoperative bronchial swabs in 50, 64 and 27% of patients, respectively. Postoperative infective complications were caused by gram-negative bacteria and Candida albicans in 75% of patients. These potential pathogens were recovered from preoperative sputum samples and from intraoperative bronchial swabs in only 18 and 13% of cases, but from postoperative sputum samples in 63% of cases. A strong correlation in identified pathogens was found between the postoperative sputum samples and the samples collected for microbiological diagnosis of subsequent postoperative infective complications (P<0.01). Our results indicate that pathogens that cause pleuropulmonary infective complications are probably acquired postoperatively from the patient's oral cavity, pharynx and hypopharynx. Appropriate antibiotic prophylaxis is discussed.

Observation on curative effect of compound Salviae miltiorrhizae injection in treating tuberculous exudative pleurisy

From Feb. 1994 to Oct. 1997, 67 cases with tuberculous exudative pleurisy were treated with chemotherapy and fluid aspiration by thoracic puncture, combined with compound Salviae miltiorrhizae injection (CSMI) through intravenous and thoracic cavity injection, and a good clinical effect was obtained.

Thoracic Surgery Techniques of Şerefeddi̇n Sabuncuoğlu in the Fifteenth Century

Şerefeddin Sabuncuoğlu (1385 to 1470?) is known to be the author of the first surgery textbook, namely Cerrahiyyet’ül Haniyye (Imperial Surgery), written in Turkish in 1465. It is the first book to contain colored illustrations of surgical procedures, incisions, and instruments in the Turkish-Islamic medical literature. He was the first man to illustrate and mention introduction of a tube into the pharynx and upper esophagus, removal of foreign bodies in the esophagus by special instruments of his own design, and use of a silver ringlet in a man after tracheotomy. He also described and illustrated reduction of sternal fractures, thoracic puncture through the intercostal space for drainage of empyema cavities, and treatment of rib fractures that have severed the diaphragm. He was a humble, curious, and intelligent surgeon, and also a calligrapher and a miniature artist.(Ann Thorac Surg 1997;63:575–7)

Incidence of neurologic complications related to thoracic epidural catheterization.

Due to potential neurologic sequelae, the risk:benefit ratio of thoracic epidural analgesia is controversial. Surprisingly, however, few available data address neurologic complications. The incidence of neurologic complications occurring after thoracic epidural catheterization was studied in patients scheduled for abdominal or abdominothoracic surgery. A total of 4,185 patients were studied, including 2,059 during the prospective phase of the study and 2,126 during the retrospective phase. After thoracic epidural catheterization, all patients received general anesthesia. Patients' neurologic status was assessed by an anesthesiologist using clinical criteria after operation and after epidural catheter removal. If neurologic complications were suspected, a neurologist was consulted. The incidence of specific complications was compared for different thoracic puncture sites: upper (T3/4-6/7), mid (T7/8-8/9), and lower (T9/10-11/12) catheter insertion levels. The overall incidence of complications after thoracic epidural catheterization was 3.1% (n = 128). This included dural perforation (0.7%; n = 30); unsuccessful catheter placement (1.1%; n = 45); postoperative radicular type pain (0.2%; n = 9), responsive to catheter withdrawal in all cases; and peripheral nerve lesions (0.6%; n = 24), 0.3% (n = 14) of which were peroneal nerve palsies probably related to surgical positioning or other transient peripheral nerve lesions (0.2%; n = 10). No signs suggesting epidural hematoma were recognized, and there were no permanent sensory or motor defects attributable to epidural catheterization. Unintentional dural perforation was observed significantly more often in the lower (3.4%) than in the mid (0.9%), or upper (0.4%) thoracic region. A single patient experienced severe respiratory depression after receiving epidural buprenorphine but recovered without sequelae. Thoracic epidural catheterization for abdominal and thoracoabdominal surgery is not associated with a high incidence of serious neurologic complications. In fact, the incidence of puncture- and catheter-related complications is less in the mid and upper than in lower thoracic region, and the predicted maximum risk for permanent neurologic complications (upper bound of the 95% confidence interval) is 0.07%.

Extensive application of epidural anesthesia and analgesia in a university hospital: incidence of complications related to technique.

The authors report the role of epidural anesthesia and analgesia (EAA) and the incidence of epidural puncture-related complications in a university hospital in Japan. Epidural anesthesia and analgesia was the major (39.7%) technique when administering 40,010 anesthetics. For the upper and the lower abdominal procedures, EAA was the major anesthetic technique in 79.5%, and 71.1% of these were carried out without potent inhaled anesthetics or long-acting muscle relaxants, and without endotracheal intubation. Epidural anesthesia and analgesia-related complications included failure to produce anesthesia on the first attempt (4.1%), bleeding/intravascular cannulation (0.67%), unintentional dural puncture (0.61%), paresthesia (0.16%), and local anesthetic toxicity (0.12%). The incidence of EAA-related complications was greater with lumbar than with thoracic puncture. Four patients had transient neuropathy related to epidural puncture, but no serious neurologic complications occurred.

Compsocryptus of the Northern Caribbean with Description of a New Species from Hispaniola (Hymenoptera: Ichneumonidae)

Compsocryptus (Ichneumonidae: Mesostenini) is centered in the Sonoran Region of western North America and Middle America but has disjunct species in southern South America, in Florida, and on some of the northern Antilles. Compsocryptus stangei n. sp. is the 1st Compsocryptus reported from Hispaniola. It differs from other Caribbean and south Floridian congeners by the following combination of characters: body shining black, wings dark wih yellow blotches, gaster red, and thorax generally shining with narrow but prominent smooth intervals among the punctures. Compsocryptus fasciipennis (Brulle) of Florida and Cuba has yellow wing markings but a uniformly blue-black ground color on the gaster, mesosoma, and head. Compsocryptus orientalis Alayo & Tzankov (described from Cuba and here cited also from the Bahamas) has the wings almost uniformly dark and a subdued bluish-purple ground color. In both the foregoing species the thoracic punctures are dense with inconspicuous smooth interspaces.

ネコの胸腔カテーテル法における吸引洗浄の一手技

Catheterization after thoracic puncture was more useful for drainage and washing every or every other day when performed on both sides than when conducted on the right side alone. A silicon catheter was efficient enough to drain almost perfectly, although it came off in a week or two. A balloon catheter remained in a fixed position for a long time, although it removed only 70-80% of the effused fluid. This technique was applicable to hydrothorax and pyothorax in cats with success.

Fetal complications of amniocentesis

2 cases of complications which arose as a result of diagnostic amniocentesis are presented here. In the first case the fetus suffered a fatal tension pneumothorax from a thoracic puncture which occurred during amniocentesis. In the second case the infant suffered a cord hematoma during amniocentesis which produced increased tension on the cord that was knotted and twisted tightly around the neck. This mother was sectioned immediately and the baby lived.

The Clinical Pathology of Thoracic Puncture Fluids

The Clinical Pathology of Thoracic Puncture Fluids