Mediastinotomy

Abstract: Most hyperfunctioning parathyroid tumors situated in the mediastinum can be removed by means of a cervical approach. However, a few tumors, because of their location deep in the chest, require mediastinotomy for removal. These tumors are probably derived from parathyroid glands that have developed from the third branchial pouch. Between 1942 and 1980, 38 such tumors were removed at the Mayo Clinic, using a sternum-splitting procedure. With one exception, the patients had undergone previous parathyroid exploration, Almost all of the patients had significant complications of primary hyperparathyroidism (HPT). Thirty-seven patients (97%) were cured after removal of their mediastinal parathyroid tumors, but postoperative chest complications were encountered in eight patients (21%), and eight have permanent hypoparathyroidism. Six patients had selective arteriography, two had selective thyroid venous sampling and parathyroid hormone assay, and 13 had mediastinal computed tomography in an attempt to localize tumors before operation. The anatomic locations of the tumors at operation were variable, but the vast majority (68%) were in or near the thymus.

Abstract: Background and Study Aims: The use of endoscopic ultrasonography (EUS) guidance for fine-needle aspiration (FNA) of mediastinal lymph nodes has become an important aid in the staging of bronchogenic carcinoma. In many cases, it may be an alternative to mediastinoscopy/mediastinotomy (MED), but the cost-effectiveness of the two techniques has not been compared. The aim of this study was to apply a decision-analysis model to compare the cost-effectiveness of EUS and MED in the preoperative staging of patients with non-small-cell lung cancer. Patients and Methods: A decision-analysis model was designed, taking as entry criteria lung cancer and abnormal mediastinal lymph nodes verified by computerized tomography (CT). Performance characteristics of MED and EUS were retrieved from the published literature, as were life expectancy data. Direct actual costs of the relevant procedures were retrieved from the billing system of our hospital. Results: The cost per year of expected survival is US$ 1.729 with the EUS strategy, and US$ 2.411 with the MED strategy. The advantage conferred by EUS remains even when the negative predictive value of EUS is as low as 0.22. Conclusion: Because of its low cost and high yield, EUS-guided FNA is a cost-effective aid assessing mediastinal lymphadenopathy.

Abstract: Mosthyperfunctioning parathyroid tumorssituated inthe mediastinum canberemoved bymeansofacervical approach. However, afewtumors, because oftheir location deepinthe chest, require mediastinotomy forremoval. Thesetumorsare probably derived fromparathyroid glands that havedeveloped fromthethird branchial pouch. Between 1942and1980,38 suchtumors wereremoved attheMayoClinic, using asternumsplitting procedure. Withoneexception, thepatients had undergone previous parathyroid exploration. Almost allofthe patients hadsignificant complications ofprimary hyperparathyroidism (HPI). Thirty-seven patients (97%)werecured after removal oftheir mediastinal parathyroid tumors, but postoperative chest complications wereencountered ineight patients (21%), andeight havepermanent hypoparathyroidism. Sixpatients hadselective arteriography, twohadselective thyroid venous sampling andparathyroid hormone assay, and13 hadmediastinal computed tomography inanattempt tolocalize tumorsbefore operation. Theanatomic locations ofthetumors atoperation werevariable, butthevastmajority (68%) werein ornearthethymus. C HURCHILLWASTHEFIRSTtorecognize that hyperfunctioning parathyroid tumors might belocated within themediastinum.1 In1932, hesuccessfully performed a sternum-splitting procedure toremovea mediastinal parathyroid adenomafroma Captain Charles E.Martell. Thisunfortunate patient hadpreviously undergone sixunsuccessful cervical explorations forprimary hyperparathyroidism, whichwascompli