The thorax is a division of an animal's body that lies between the head and the abdomen.

In humans, the thorax is the region of the chest formed by the sternum, the thoracic vertebrae and the ribs. It extends from the neck to the diaphragm, not including the upper limbs. The heart and the lungs reside in the thoracic cavity, as well as many blood vessels. The inner organs are protected by the rib cage and the sternum.

In insects and the extinct trilobites, the thorax is one of the three main divisions (or tagmata) of the creature's body, each of which is in turn composed of multiple segments. It is the area where the wings and legs attach in insects, or an area of multiple articulating plates in trilobites. In most insects, the thorax itself is composed of three segments; the prothorax, the mesothorax, and the metathorax. In extant insects, the prothorax never has wings, though legs are always present in adults; wings (when present) are restricted to at least the mesothorax, and typically also the metathorax, though the wings may be reduced or modified on either or both segments (as in the fly shown, where the metathoracic wings have been reduced to tiny balancing organs called halteres). In the Apocritan Hymenoptera, the first abdominal segment is fused to the metathorax, where it forms a structure known as the propodeum. Accordingly, in these insects, the functional thorax is composed of four segments, and is therefore typically called the mesosoma to distinguish it from the "thorax" of other insects.

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ScienceDirect Publication: Thoracic Surgery Clinics

Chemotherapy in the Older Patient with Operable Non–Small Cell Lung Cancer: Neoadjuvant and Adjuvant Regimens
Sat, 31 Oct 2009 23:48:54 -0000
Publication year: 2009Source: Thoracic Surgery Clinics, Volume 19, Issue 3, August 2009, Pages 377-389Ilene, Browner , Michael, Purtell
Thoracic Irradiation in the Elderly
Sat, 31 Oct 2009 23:48:54 -0000
Publication year: 2009Source: Thoracic Surgery Clinics, Volume 19, Issue 3, August 2009, Pages 391-400Kristin J., Redmond , Danny Y., Song
Quality of Life and Ethical Concerns in the Elderly Thoracic Surgery Patient
Sat, 31 Oct 2009 23:48:54 -0000
Publication year: 2009Source: Thoracic Surgery Clinics, Volume 19, Issue 3, August 2009, Pages 401-407Holly M., Holmes
Thoracic Surgery in the Elderly: Areas of Future Research and Studies
Sat, 31 Oct 2009 23:48:54 -0000
Publication year: 2009Source: Thoracic Surgery Clinics, Volume 19, Issue 3, August 2009, Pages 409-413Joseph, LoCicero III , Jason Philip, Shaw
Index
Sat, 31 Oct 2009 23:48:54 -0000
Publication year: 2009Source: Thoracic Surgery Clinics, Volume 19, Issue 3, August 2009, Pages 415-418[No author name available]
Contents
Sat, 31 Oct 2009 23:48:54 -0000
Publication year: 2009Source: Thoracic Surgery Clinics, Volume 19, Issue 3, August 2009, Pages v-vii[No author name available]

Interactive CardioVascular and Thoracic Surgery current issue

Primary sternal plating to prevent sternal wound complications after cardiac surgery: early experience and patterns of failure [Work in progress report - Cardiac general]
Snyder, C. W., Graham, L. A., Byers, R. E., Holman, W. L. Sternal closure with rigid titanium plates (primary sternal plating) may reduce sternal wound complications in high-risk patients. We began performing primary sternal plating for the following indications: obesity, manual laborer, osteoporotic sternum, or intraoperative transverse sternal fracture. Patients receiving plate closure were compared to a risk-matched control group receiving wire closure. Outcomes of interest were postoperative length of stay and sternal wound complications [sterile dehiscence or deep sternal wound infection (DSWI)]. Wound complications were classified by time of occurrence as early (≤30 days postoperation) or late (>30 days postoperation). Of 445 total cardiac cases during the 5-year study period, 129 (29%) met inclusion criteria. The plate group (n=30) and wire group (n=99) were generally well-matched in terms of risk factors. Postoperative length of stay was significantly shorter in the plate group (median 7 vs. 8 days, P=0.023). No early sternal wound complications occurred in the plate group, compared to 12 (12%) in the wire group (P=0.067). The incidence of late sternal wound complications was 10% in both groups (P=1.0). Primary sternal plating appears to provide benefits over wire closure during the early postoperative period, but may not prevent late wound complications in patients with osteoporosis or extreme obesity.
Efficacy of SOFT COAG for intraoperative bleeding in thoracic surgery [Work in progress report - Thoracic non-oncologic]
Sakuragi, T., Ohma, H., Ohteki, H. We present and examine two cases of the dramatic hemostasis with SOFT COAG in general thoracic surgery. SOFT COAG is a coagulation mode unique to VIO electrosurgical units (ERBE Elektromedizin GmbH, Germany). This system regulates the temperature rise below boiling point without generating sparks, which is high enough to denature protein. In addition to clinical applications, this coagulation system makes use of a reusable device, Slim line hand switch®, which has economically and ecologically major advantages for ecosurgery.
The heart of patients with aortic aneurysms: evidence from cardiac computed tomography [Institutional report - Cardiac general]
Stolzmann, P., Phan, C., Desbiolles, L., Lachat, M., Pfammatter, T., Marincek, B., Prokop, M., Alkadhi, H. To determine in patients with abdominal aortic aneurysm (AAA) the coronary calcium burden and prevalence of coronary artery disease (CAD) in relation to cardiovascular risk factors, and to assess the left ventricular (LV) function using cardiac computed tomography (CT). Sixty consecutive patients (six females; 72.2±9.0 years) with AAA underwent dual-source CT calcium scoring and coronary angiography prior to AAA repair. In the 60 patients, the Framingham risk score (FRS) ranged from 5–43%. Twenty patients (33%) were at low, 16 (27%) at intermediate, and 24 (40%) at high risk for cardiovascular disease. The median Agatston score (AS) was 393 (0–3538). No significant correlation was found between AS and FRS (P=0.76). 846/851 coronary segments (99%) in 57/60 patients (95%) were depicted with a diagnostic image quality. Significant stenoses were found in 132/846 segments (16%) in 33/60 patients (55%). Five patients (8%) with significant coronary artery stenosis showed reduced LV function [ejection fraction (EF)<50%]. The extent of CAD was significantly correlated with AS (r=0.43, P<0.01), whereas no correlation was found for FRS (P=0.55). Cardiac CT is feasible in patients with AAA and allows for the assessment of coronary calcium, coronary stenoses, and LV function. The calcium burden and coronary stenoses assessment with cardiac CT provides incremental information beyond traditional cardiovascular risk factors alone.
eComment: Re: The heart of patients with aortic aneurysms: evidence from cardiac computed tomography [eComment]
Bockeria, L. A., Makarenko, V. N.
Reconstruction of atrioventricular valves with photo-oxidized bovine pericardium [Institutional report - Valves]
Verbrugghe, P., Meuris, B., Flameng, W., Herijgers, P. Repair of complex valve pathological processes often requires the use of leaflet tissue or pericardium. The use of bovine photo-oxidized pericardium may be an alternative, a tissue less prone to calcification. The aim of this study is to evaluate the use of photo-oxidized bovine pericardial tissue in the reconstruction of atrioventricular valves in humans. Between July 2001 and September 2006, 21 patients with complex valve pathology underwent a reconstruction with photo-oxidized pericardium. The pericardial patch was used for the reconstruction of a tricuspid valve leaflet in two patients, the reconstruction of a mitral valve leaflet in six patients, the reconstruction of the tricuspid annulus in one patient and the reconstruction of the mitral annulus in 12 patients. The follow-up ranged from 13.9 to 43.2 months. There were five perioperative deaths. Four patients developed failure of the reconstruction, in one patient there was thinning and perforation of the pericardial patch without signs of infection or abrasion. The other patients were free from thromboembolism, endocarditis, hemorrhagic complications or echocardiographic signs of failure of the reconstruction. Photo-oxidized bovine pericardium is a versatile material for complex reconstruction of the atrioventricular valvular structures. Its durability should, however, be investigated in comparison with alternative tissues in a randomized trial.
Temporary cardiac support with a mini-circuit system consisting of a centrifugal pump and a membrane ventilator [Institutional report - Assisted circulation]
Meyer, A. L., Strueber, M., Tomaszek, S., Goerler, A., Simon, A. R., Haverich, A., Fischer, S. Commonly used extracorporeal membrane oxygenation (ECMO) systems for cardiac support are limited by bleeding complications, especially after surgery in the adult patient. Recently, we have switched from the use of a conventional ECMO system to a miniature-circuit including a centrifugal pump and the Novalung® membrane ventilator (iLA). This system allows us to administer less heparin compared to the conventional system. Between January and August 2007, 1469 patients underwent cardiac surgery at our center, of which 18 patients (1.2%) required temporary postoperative ECMO system support. Surgical procedures in these patients included coronary artery bypass grafting (CABG) surgery (n=5), valvular replacement (n=2), aortic surgery (n=2), cardiac transplantation (n=5), and other procedures (n=3). The mean age of the 18 patients was 50±15 years (n=13 male) with a mean duration of ECMO system support of 4.3 days (range: <1 to 14 days). Twelve patients (67%) were successfully weaned from ECMO system. The 30-day survival was 44% with a hospital mortality of 61%. Re-thoracotomy for bleeding was necessary in six patients (33%) under ECMO system support. In summary, the miniature ECMO system circuit seems to be suitable for middle-term cardiac support and is associated with a low rate of bleeding complications.

The Annals of Thoracic Surgery current issue

Left Ventricular Assist Devices: Psychosocial Challenges in the Elderly [CASE REPORTS]
Marcus, P. As the baby boom generation ages, the number of people with heart failure is expected to rise exponentially. A rapid increase in the demand for heart transplants will result in an increased use of left ventricular assist devices. This case illustrates the challenges facing transplant teams in evaluating elderly heart failure patients as candidates for assist devices. The critical elements of a psychosocial assessment are described.
Percutaneous Implantation of CoreValve Aortic Prostheses in Patients With a Mechanical Mitral Valve [CASE REPORTS]
Bruschi, G., De Marco, F., Oreglia, J., Colombo, P., Fratto, P., Lullo, F., Paino, R., Frigerio, M., Martinelli, L., Klugmann, S. Concerns exist in the field of transcatheter aortic valve implantation regarding the treatment of patients with mechanical mitral valve for possible interference between the percutaneous aortic valve and the mechanical mitral prosthesis. We report our experience with percutaneous aortic valve implantation in 4 patients with severe aortic stenosis, previously operated on for mitral valve replacement with a mechanical prosthesis. All patients underwent uneventful percutaneous retrograde CoreValve implantation (CoreValve Inc, Irvine, CA). No deformation of the nitinol tubing of the prostheses (ie, neither distortion nor malfunction of the mechanical valve in the mitral position) occurred in any of the patients. All patients are alive and asymptomatic at a mean follow-up of 171 days.
Cardiac Tamponade: Chylopericardium Presenting 2 Weeks After Mechanical Aortic Valve Replacement Through a Median Sternotomy [CASE REPORTS]
Nwaejike, N., El-Amin, W. O., Kuo, J. Chylopericardium is a rare disorder that can be secondary to thoracic duct injury. Consequences include nutritional, metabolic, and immunologic abnormalities, as well as cardiac complications, such as pericarditis and cardiac tamponade. We present a case of chylopericardium presenting as cardiac tamponade after a median sternotomy for mechanical aortic valve replacement.

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