News - Part 10

Clinical Spectrum of Mediastinal Cysts: Symptomatology and Diagnosis

In any case, local disruption of thymic tissue can induce the formation or growth of cysts. In the current series, they mainly encompassed thymic cysts of congenital origin, and we excluded the cystic masses of neoplastic origin such as cystic thymomas or degeneration after surgery. Of note, Suster and Rosai reported 18 cases of multiocular thymic cysts, in addition to uniocular cysts. Read more »

Clinical Spectrum of Mediastinal Cysts: Pleural cysts

Clinical Spectrum of Mediastinal Cysts: Pleural cystsIn this sense, bronchogenic cysts and esophageal cysts (duplications) share a similar developmental background, namely foregut budding errors, rather than being separate disease entities., A distinction is made between bronchogenic and esophageal cysts when cartilage is present, which suggests the cyst is bronchogenic in origin. However, Nobuhara et al advocated naming both types as “foregut cysts” because of their common embryological origin, anatomic proximity and histologic similarities. Read more »

Clinical Spectrum of Mediastinal Cysts: Bronchogenic cysts

Bronchogenic cysts were more common than esophageal cysts. The prevalence of bronchogenic cysts was reported to be 1:42,00 and 1:68,000 of admissions to two hospitals; however, it is difficult to appreciate the prevalence of the cysts exactly, since some aged patients have lesions that remain forever silent.
Bronchogenic and esophageal cysts originate from the ventral primitive foregut as an anomalous budding of the laryngotracheal groove during embryonic development around the time when cleavage occurs between the respiratory tract and digestive tube. Read more »

Clinical Spectrum of Mediastinal Cysts: Discussion

Clinical Spectrum of Mediastinal Cysts: DiscussionThree patients with bronchogenic cysts were converted to standard thoracotomy because of severe adhesions around the cysts, particularly into the esophageal muscle layers. Three patients with pericardial cysts had a communication with the pericardial cavity, which were found during surgery, thoracoscopic fenestration was performed. One female patient with a thymic cyst had a concurrent neurogenic tumor in the posterior mediastinum; therefore, the thymic tumor was resected via a median sternotomy as an initial diagnosis of thymoma, and a neurogenic tumor was removed via a posterolateral approach concurrently. Read more »

Clinical Spectrum of Mediastinal Cysts: Surgical Treatment

Overall, 38 patients (36.2%) with mediastinal cysts were symptomatic: 39.2% of bronchogenic/esophageal foregut cysts, 40% of thymic cysts, and 15.8% of pericardial/pleural cysts. These symptoms usually appeared in progressive fashion in most patients. Overall common symptoms were retrosternal chest pain (14.3%), followed by dyspnea (7.6%), cough (6.7%), fever (5.7%), and hoarseness (4.8%). Of particular interest, 4 of 30 patients with benign thymic cysts presented with hoarseness despite the benign nature of this disease. Read more »

Clinical Spectrum of Mediastinal Cysts: Symptoms

Clinical Spectrum of Mediastinal Cysts: SymptomsSmall subcarinal or hilar bronchogenic cysts, and small thymic cysts were found as homogenous water density masses on chest CT. Barium swallow studies and/or esophagoscopy were performed mainly for patients for suspected esophageal and bronchogenic cysts. CT was performed in patients after 1980, which revealed round, well-circumscribed masses of water density or a little higher. In the early series when CT was not available, induced pneumomediastinum was a diagnostic tool used to demonstrate the size, shape, and extent of the mediastinal masses. Read more »

Clinical Spectrum of Mediastinal Cysts: Results

Between 1951 and 2000, 806 patients (451 male and 355 female) were referred to our institution for treatment of mediastinal tumors. There were 105 mediastinal cysts (50 male and 55 female patients), comprising 13.0% of total mediastinal tumors. There were 10 pediatric patients < 15 years of age and 95 adult patients (age range, 6 months to 74 years; average age, 37.3 years). The prevalence of cysts in all mediastinal tumors of the adult population was slightly higher than that in the pediatric population (14.1% vs 7.7%, p < 0.05). The details of mediastinal cysts are listed in Table 1. Read more »

Clinical Spectrum of Mediastinal Cysts

Clinical Spectrum of Mediastinal CystsCysts of the mediastinum, which are benign masses, constitute a small but important diagnostic group, representing 12 to 18% of all primary mediastinal tumors; however, the individual physician has little chance to know the clinical characteristics and total disease entities because of their relative rarity. Read more »

Left Ventricular Mechanics and Myocardial Blood Flow: Study Limitations

Besides, the fact that the observed functional abnormalities during ventricular pacing, like reduced regional myocardial work, reduced oxygen uptake, and free fatty metabolism, are found in regions supplied by the dominant artery further reinforces our results. Read more »

Left Ventricular Mechanics and Myocardial Blood Flow: Coronary Flow and CFR

Left Ventricular Mechanics and Myocardial Blood Flow: Coronary Flow and CFROur results are relevant to those of Nelson et al, who found that cardiac resynchronization in patients with dilated cardiomyopathy and left bundle branch block improved LV contractile function with a modest decline in oxygen utilization. Read more »

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