Elastofibroma dorsi is a rare, ill-defined, pseudotumoural lesion of the soft tissues. Surgical treatment can be proposed if the lesion is symptomatic. Furthermore, at the follow-up, the possibility of new occurrences on the contralateral side should be kept in mind.
CONTEXT AND OBJECTIVE: Post-thoracotomy pain is a severe and intense pain caused by trauma to ribs, muscles and peripheral nerves. The current study aimed to compare subpleural analgesia (SPA) with thoracic epidural analgesia (TEA) in patients undergoing thoracotomy. DESIGN AND SETTING: Randomized study at Ankara Numune Education and Research Hospital, in Turkey. METHODS: Thirty patients presenting American Society of Anesthesiologists physical status I-III were scheduled for elective diagnostic thoracotomy. The patients were randomized to receive either patientcontrolled SPA or patient-controlled TEA for post-thoracotomy pain control over a 24-hour period. The two groups received a mixture of 3 µg/ml fentanyl along with 0.05% bupivacaine solution through a patientcontrolled analgesia pump. Rescue analgesia was administered intravenously, consisting of 100 mg tramadol in both groups. A visual analogue scale was used to assess pain at rest and during coughing over the course of 24 hours postoperatively. RESULTS: In the SPA group, all the patients required rescue analgesia, and five patients (33%) required rescue analgesia in the TEA group (P < 0.05). Patients who received subpleural analgesia exhibited higher visual analogue scores at rest and on coughing than patients who received thoracic epidural analgesia. None of the patients had any side-effects postoperatively, such as hypotension or respiratory depression. CONCLUSION: Thoracic epidural analgesia is superior to subpleural analgesia for relieving postthoracotomy pain. We suggest that studies on effective drug dosages for providing subpleural analgesia are necessary.RESUMO CONTEXTO E OBJETIVO: Dor pós-toracotomia é severa e intensa, causada por trauma de nervos periféricos, músculos e costelas. O objetivo foi comparar analgesia subpleural (SPA) com analgesia epidural torácica (TEA) em pacientes submetidos à toracotomia. TIPO DE ESTUDO E LOCAL: Estudo randomizado no Hospital Educação e Pesquisa de Numune, em Ancara, Turquia. MÉTODOS: Trinta pacientes com o estado físico I-III da Sociedade Americana de Anestesiologistas foram agendados para toracotomia diagnóstica eletiva e escolhidos aleatoriamente para receber, num período de 24 horas, SPA ou TEA, ambas controladas pelo próprio paciente, para controle da dor pós-toracotomia. Os dois grupos receberam mistura de 3 ug/ml de fentanil com solução de 0,05% de bupivacaína por meio de bomba de analgesia controlada pelo paciente. Foi administrada analgesia de resgate por via intravenosa, com 100 mg de tramadol, nos dois grupos. No pós-operatório, a escala visual analógica foi utilizada para medir presença de dor durante a tosse ou em repouso, ao longo de 24 horas. RESULTADOS: No grupo SPA, todos os pacientes necessitaram de analgesia de resgate. Cinco pacientes (33%) necessitaram de analgesia de resgate no grupo TEA (P < 0,05). Os pacientes com SPA exibiram pontuações superiores na escala visual analógica, em repouso e ao tossir, em comparação aos que receberam TEA. Nenhum dos pacientes teve quaisquer efeitos...
A 42 year old male patient was admitted to our clinic with complaints of pain, tenderness and mass on the xyphoid process. Radiologic findings indicated benign pathologies. In the follow up, growth in the mass was investigated and surgical exicion was performed. Histopathologic investigation revealed the diagnosis of osteochondroma. Here we report an extremely rare chest wall tumor and different localisation which was an osteochondroma in the xyphoid process. (Tur Toraks Der 2011; 12: 79-80)
ÖZETAmaç: Mediasten, iki torasik kavite arasında yer alan ve içerdiği doku çeşitliliği, kanlanmasının iyi olması, lenfatik doku zenginliği nedeniyle birçok primer ve sekonder kitle, kistin yerleştiği vücut kompartmanıdır. Çalışmamızda mediastinal kitle ve kistlerin tanı, tedavisinde cerrahinin yeri ve önemi araştırıldı. Olgularımızda en sık (% 50) anterior mediastende lezyon saptandı. İncelediğimiz vakaların 37'sinde (%43) semptom yoktu, en çok görülen şikayetler göğüs ağrısı (%26.7), öksürük (%23.5) ve nefes darlığı (%17.6) idi. Hastaların hepsinde cerrahi yöntemlerle; sağ/sol torakotomi(%41.9/%10.5), median sternotomi (%25.6) veya mediastinoskopi (%4.7) ile tanıya ulaşıldı. Tartışma: Mediastinal kitle ve kistlerin tanısında lezyon lokalizasyonu ve klinik bulgular her ne kadar yardımıcı olsa da kesin tanı içi hitopatolojik değerlendirme vazgeçilmezdir. Doğru histopatolojik değerlendirme için yeterli materyal örneklenmesi ve birçok lezyonun spesifik tedavisi için mediastinal kitlelerde cerrahi halen en önemli tanısal ve terapötik modalitedir.
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