Clinical case of angiosarcoma of pericardium and pleura

Primary heart tumors are an extremely rare pathology, previously detected only by autopsy data and detected in 0.001%-0.03% of cases. Primary angiosarcomas of the pericardium are even more rare and are presented in the literature with isolated descriptions. The article describes a clinical case of epithelioid angiosarcoma of the pericardium and pleura of high malignancy in a 57-year-old man. The diagnosis was confirmed by immunohistochemical examination and positron emission tomography. For today, chemotherapeutic treatment of angiosarcomas localized in the chest cavity is a palliative treatment method. In this patient, the most effective scheme was the one containing anthracyclines (doxorubicin). Despite the ongoing therapy, the patient died 15 months after the diagnosis was made, with increasing signs of respiratory and heart failure. Thus, when patients, especially young and middle-aged men, show signs of hydropericardium without established etiological prerequisites, it is necessary to remember about the possibility of developing a primary malignant tumor of the heart and / or pericardium as the cause of this condition and include it in the standard diagnostic search.

A mechanism of abnormal motility of the esophagus and stomach and associated sound phenomenon

The aim of the article is to update the pathophysiological mechanisms that cause the appearance and activation of pathological peristalsis of the esophagus and stomach and associated esophageal-gastrointestinal-diaphragmatic noise, described earlier, designed to expand the diagnostic capabilities of physical methods for diagnosing hiatal hernia and to facilitate the differential diagnosis of this disease with other diseases of the chest. The result of the study is to describe 5 the pathophysiological mechanisms of developing hernia hiatal and lead to the emergence of pathological motility of the esophagus and stomach in the form of the strengthening or emergence of antiperistaltic waves. The resulting acoustic phenomenon is the essence of a new physical symptom in this disease - esophageal-gastrointestinal-diaphragmatic noise. The first mechanism that determines the pathological motor activity of the smooth muscle cells of the esophageal wall is the so-called esophageal “cleansing” peristalsis, which prevents the regurgitation of the acidic contents of the stomach into the esophagus, where the environment is normally neutral. The second mechanism that causes the appearance and strengthening of pathological peristalsis of the stomach is the deformation during the passage of its part through the esophageal opening of the diaphragm into the chest cavity. The third mechanism that determines the occurrence of pathological peristalsis of the esophagus and stomach is a violation of the secretion and metabolism of nitric oxide in diaphragmatic hernias. The fourth mechanism that leads to the appearance of esophageal-diaphragmatic noise is the pathological peristalsis of the esophagus and stomach in patients with hiatal hernia, which causes the appearance of antiperistaltic waves accompanied by gastro-esophageal reflux and manifests itself in clinically pathological belching. The fifth mechanism that causes pathological peristalsis of the esophagus is the phenomenon of hydrodynamic cavitation, which occurs as a result of regurgitation of the contents of the stomach into the esophagus. Understanding the pathophysiological mechanisms that cause the appearance of pathological peristalsis and antiperistalsis of the esophagus and stomach in patients with diaphragmatic hernia allows us to understand the causes of the sound phenomenon and the associated physical symptom in this disease.

Puncture biopsy of bifurcation lymph nodes in the diagnosis of lung cancer

Clinical, radiological and pathological data of a number of authors testify to the frequent defeat of the lymph nodes of the mediastinum with cancer metastases (MN Goryunova, 1951; Ya. G. Dillon, 1947; BK Osipov, 1959, etc.). Anatomical works of Ruvier (1932), DA Zhdanov (1947) and others testify to broad afferent connections of bifurcation lymph nodes in normal conditions with the organs of the chest cavity. These factors create the possibility of lymphogenous metastasis of cancer of the lung and esophagus in the mediastinal lymph nodes, in particular, in the bifurcation.

Thoracoscopic resection of bilateral multiple superior mediastinal neurofibromas

Background The indications for surgical resection concerning multiple bilateral neurofibromas in the superior mediastinum remain controversial, because vascular injury or development of postoperative Horne syndrome are concerned. Case presentation A 60-year-old woman presented with multiple nodules in her right neck and bilateral chest cavity tops which indicated neurofibromatosis. The thoracic masses grew slowly over 9 years, and she then underwent a 2-stage resection starting with the left to right side. Bilateral tumors were completely removed via video-assisted thoracic surgery. The patient’s postoperative course was uneventful, without postoperative Horner syndrome. Conclusions To the best of our knowledge, this is the first case of multiple bilateral superior mediastinal neurofibromas resected from the pulmonary apices via thoracoscopy. We selected a minimally invasive pure video-assisted thoracoscopic surgery approach and enucleated some tumors to avoid nerve injury. This approach may be safe and useful for multiple neurofibromas in patients with neurofibromatosis.

A Nano-Silver Loaded PVA/Keratin Hydrogel With Strong Mechanical Properties Provides Excellent Antibacterial Effect for Delayed Sternal Closure

Delayed chest closure (DSC) is widely performed during the treatment of congenital heart diseases. However, the high prevalence of surgical site infection (SSI) in patients undergoing DSC affects prognosis negatively. Herein, we designed a suturable poly (vinyl alcohol)/keratin film loaded with silver nanoparticles (AgNPs) as an alternative material for DSC, which was named PVA/Keratin/AgNPs. The PVA/Keratin/AgNPs films exhibited significantly enhanced mechanical strength after crosslinking by sodium trimetaphosphate (STMP). These films were non-toxic, and cells proliferated with good morphology after 1 week of culture. In addition, PVA/Keratin/AgNPs films provided superior antibacterial ability, as evidenced by the eradication and lower growth rate of Staphylococcus aureus and Escherichia coli. Finally, the PVA/Keratin/AgNPs films were demonstrated to successfully cover the chest cavity temporarily and protect the chest cavity from bacterial infection. These results indicated that the PVA/Keratin/AgNPs films have great prospects to be further exploited for clinical applications in DSC.

Modern concepts of constitutional and X-ray anatomy of the chest in adolescents and adults

The review presents the analysis of domestic and foreign literature, selecting the available scientific data on the features of constitutional and X-ray anatomy of the chest in adolescents and adults. The size and shape of the chest depends on age, sex and anthropometric parameters: height, body mass index, and also the presence of concomitant pathology. These patterns are characteristic of individual anatomical structures of the chest: sternum, ribs, spine and diaphragm. The study of constitutional anatomy is necessary for the development of morphological foundations for the interpretation of the results of intravital imaging of the chest and organs, justification of various methods of surgical access to the organ and structures of the chest and chest cavity.

COMBINED INJURY OF THE BREAST AND ABDOMINAL IN PEDESTRIANS INJURED BY AUTOMOTIVE INJURY

Purpose of the study. Revealing the features of the formation of damage to the structure of the chest and abdominal organs in pedestrians during their collisions with moving cars. Materials and methods. A forensic medical examination of 215 corpses of persons killed in collisions with moving cars was carried out. Among the dead there were 173 men and 42 women. The victims were between 14 and 75 years old. Research results and their discussion. It was found that among pedestrians who died in collisions with cars, injuries of two or more parts of the body with fractures of the limb bones (55.8%) and сombined injury (CI) of the head, chest, abdomen (23.3%) prevail. In the composition of CI, damage to the structure of the chest and organs of the chest cavity was noted in 85.6% of cases. Rib fractures were detected in 57.7% of cases; fractures in the midclavicular and axillary lines predominated in localization. Damage to the structure of organs and tissues of the abdominal cavity in the composition of the abdominal CI in pedestrians was -71.0%. At the same time, 80.8% of the dead pedestrians show signs of injury to organs and tissues with pronounced hemorrhages in the suspension apparatuses, walls and parenchyma of organs. In 23.2% of cases, along with hemorrhages, there is a violation of the anatomical integrity of organs, mainly the liver and spleen. The outlined nature of damage to the structure of the chest, organs of the chest and abdominal cavity made it possible to establish the possibility of their formation in the 3rd phase of car injury - the fall of the injured on the road surface. Traumatic (pleuropulmonary), hemorrhagic shock and hemorrhagic pneumothorax were the main causes of injuries at the prehospital stage.

On postoperative reflex cardiac disorders of mechanical origin Sauerbruch (Zentr. F. Chir . 1925, no. 16)

According to Sauerbruch (Zentr. F. Chir . 1925, No. 16) during operations in the thoracic cavity, the operator must be accurately aware of the reflex pathways coming from the chest cavity, and of reflex disorders that sometimes accompany intrathoracic interventions.

N. D. Guardian. Fundamentals of physical diagnosis of abdominal diseases. Hands. for students and doctors. Page 195 page 60 image 1924.

As far as the physical diagnosis of the organs of the chest cavity is systematically (although still far from perfect) set out in various manuals for medical diagnosis and has been widely used in the daily practice of doctors, the situation is just as bad with the physical methods of studying diseases of the abdominal cavity.

Defective mesothelium and limited physical space are drivers of dysregulated lung development in a genetic model of congenital diaphragmatic hernia

ABSTRACT Congenital diaphragmatic hernia (CDH) is a developmental disorder associated with diaphragm defects and lung hypoplasia. The etiology of CDH is complex and its clinical presentation is variable. We investigated the role of the pulmonary mesothelium in dysregulated lung growth noted in the Wt1 knockout mouse model of CDH. Loss of WT1 leads to intrafetal effusions, altered lung growth, and branching defects prior to normal closure of the diaphragm. We found significant differences in key genes; however, when Wt1 null lungs were cultured ex vivo, growth and branching were indistinguishable from wild-type littermates. Micro-CT imaging of embryos in situ within the uterus revealed a near absence of space in the dorsal chest cavity, but no difference in total chest cavity volume in Wt1 null embryos, indicating a redistribution of pleural space. The altered space and normal ex vivo growth suggest that physical constraints are contributing to the CDH lung phenotype observed in this mouse model. These studies emphasize the importance of examining the mesothelium and chest cavity as a whole, rather than focusing on single organs in isolation to understand early CDH etiology.