Management of extensive surgical emphysema with subcutaneous drain: A case report

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Quoc Tran

Full Text Available Introduction: Subcutaneous emphysema (SE is a frequent and often self-limiting complication of tube thoracostomy or other cardiothoracic procedures. On rare occasions, severe and extensive surgical emphysema marked by palpable cutaneous tension, dysphagia, dysphonia, palpebral closure or associated with pneumoperitoneum, airway compromise, “tension phenomenon” and respiratory failure require treatment. Presentation of case: A 67 year old lady presented with a large spontaneous pneumothorax on the background of end-stage chronic obstructive pulmonary disease (COPD and newly diagnosed lung cancer, developed extensive surgical emphysema following insertion of a chest drain. Immediate improvement was observed after insertion of a large-bore, 26 French (Fr. intercostal catheter, subcutaneous drain which was maintained under low suction (−5 cm H2O for a further 24 h. Discussion: Several methods have been described in the literature for the treatment of extensive subcutaneous emphysema, including: emergency tracheostomy, multisite subcutaneous drainage, infraclavicular “blow holes” incisions and subcutaneous drains or simply increasing suction on an in situ chest drain. Here a large-bore, fenestrated, subcutaneous drain maintained on low negative pressure also provided the necessary decompression. Conclusion: In the absence of a comparative study to identify the most effective method to manage extensive subcutaneous emphysema, this case highlights an effective, simple and safe management option. Keywords: Pneumothorax, Subcutaneous emphysema, Drain, Low suction, Intercostal catheter, Case report

Use of a Nasal Speculum for Chest-Drain Insertion: A Simple Technique

OpenAIRE

Saxena, Pankaj; Konstantinov, Igor E.; Newman, Mark A.J.

2006-01-01

Tube thoracostomy is a very commonly performed procedure in cardiothoracic surgery. Insertion of a chest drain requires expertise to minimize complications. We describe a simple technique of using a nasal speculum to perform this procedure.

Effect of Needle Aspiration of Pneumothorax on Subsequent Chest Drain Insertion in Newborns

DEFF Research Database (Denmark)

Murphy, Madeleine C; Heiring, Christian; Doglioni, Nicoletta

2018-01-01

Importance: Treatment options for a symptomatic pneumothorax in newborns include needle aspiration (NA) and chest drain (CD) insertion. There is little consensus as to the preferred treatment, reflecting a lack of evidence from clinical trials. Objective: To investigate whether treating pneumotho......Importance: Treatment options for a symptomatic pneumothorax in newborns include needle aspiration (NA) and chest drain (CD) insertion. There is little consensus as to the preferred treatment, reflecting a lack of evidence from clinical trials. Objective: To investigate whether treating...... was 5 tertiary European neonatal intensive care units. Infants receiving respiratory support (endotracheal ventilation, continuous positive airway pressure, or supplemental oxygen >40%) who had a pneumothorax on CR that clinicians deemed needed treatment were eligible for inclusion. Interventions...... was inserted if clinicians deemed that the response was inadequate. For CD insertion, a drain was inserted between the ribs and was left in situ. Main Outcomes and Measures: The primary outcome was whether a CD was inserted on the side of the pneumothorax within 6 hours of diagnosis. Results: A total of 76...

Tube thorocostomy: management and outcome in patients with penetrating chest trauma.

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Muslim, Muhammad; Bilal, Amer; Salim, Muhammad; Khan, Muhammad Abid; Baseer, Abdul; Ahmed, Manzoor

2008-01-01

Penetrating chest trauma is common in this part of the world due to present situation in tribal areas. The first line of management after resuscitation in these patients is tube thoracostomy combined with analgesia and incentive spirometry. After tube thoracostomy following surgery or trauma there are two schools of thought one favours application of continuous low pressure suction to the chest tubes beyond the water seal while other are against it. We studied the application of continuous low pressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial was conducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading Hospital Peshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness of continuous low pressure suction in patients with penetrating chest trauma for evacuation of blood, expansion of lung and prevention of clotted Haemothorax. One hundred patients who underwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds were included in the study. Patients with multiple trauma, blunt chest trauma and those intubated for any pulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination and necessary investigations patients were randomized to two groups. Group I included patients who had continuous low pressure suction applied to their chest drains. Group II included those patients whose chest drains were placed on water seal only. Lung expansion development of pneumothorax or clotted Haemothorax, time to removal of chest drain and hospital stay was noted in each group. There were fifty patients in each group. The two groups were not significantly different from each other regarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansion was achieved in forty six (92%) patients in group I and thirty seven (74%) in group II. Partial lung

Reduce chest pain using modified silicone fluted drain tube for chest drainage after video-assisted thoracic surgery (VATS) lung resection.

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Li, Xin; Hu, Bin; Miao, Jinbai; Li, Hui

2016-02-01

The aim of this study was to assess the feasibility, efficacy and safety of a modified silicone fluted drain tube after video-assisted thoracic surgery (VATS) lung resection. The prospective randomized study included 50 patients who underwent VATS lung resection between March 2015 and June 2015. Eligible patients were randomized into two groups: experimental group (using the silicone fluted drain tubes for chest drainage) and control group (using standard drain tubes for chest drainage). The volume and characteristics of drainage, postoperative (PO) pain scores and hospital stay were recorded. All patients received standard care during hospital admission. In accordance with the exit criteria, three patients were excluded from study. The remaining 47 patients included in the final analysis were divided into two groups: experiment group (N=24) and control group (N=23). There was no significant difference between the two groups in terms of age, sex, height, weight, clinical diagnosis and type of surgical procedure. There was a trend toward less PO pain in experimental group on postoperative day (POD) 1, with a statistically significant difference. Patients in experimental group had a reduced occurrence of fever [temperature (T) >37.4 °C] compared to the control group. The silicone fluted drain tube is feasible and safe and may relieve patient PO pain and reduce occurrence of fever without the added risk of PO complications.

Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná

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Amanda Carina Coelho de Morais

2016-09-01

Full Text Available The purpose of chest drainage is to allow lung re-expansion and the reestablishment of the subatmospheric pressure in the pleural space. Properly managing the drainage system minimizes procedure-related complications. This prospective observational study evaluated adult patients undergoing water-seal chest drainage, admitted to our hospital and accompanied by residents and tutors, aiming to check their care. One hundred chest drainages were monitored. The average age was 38.8 years old. The average drainage time was 6.7 days. Trauma was the prevalent cause (72% for the indication of pleural drainage. The obstruction of the system occurred in 6% of the cases; 5% subcutaneous emphysema, 1% infection around the drain; 5% accidental dislodgement of the drain, and in 5% of the patients, there were some complications when removing the drain. Failures in chest drainage technique and management were present, and reflected in some complications that are inherent to the procedure, although it is known that there are intrinsic complications. This study aimed to assess the management of closed chest drainage systems and standardize the care provided in such procedure.

Management of Chest Drains: A National Survey on Surgeons‑in ...

African Journals Online (AJOL)

triangle of safety [Figure 1]. Just above a quarter of respondents (27.2%) always utilized different sizes of tubes for different pathologies and the same proportion of respondents always positioned the tip of the tube apically to drain pneumothorax and basally to drain pleural effusion. In contrast, 9.9% and 6.2% of respondents.

Comparison of a large and small-calibre tube drain for managing spontaneous pneumothoraces.

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Benton, Ian J; Benfield, Grant F A

2009-10-01

To compare treatment success of large- and small-bore chest drains in the treatment of spontaneous pneumothoraces the case-notes were reviewed of those admitted to our hospital with a total of 73 pneumothoraces and who were treated by trainee doctors of varying experience. Both a large- and a small-bore intercostal tube drain system were in use during the two-year period reviewed. Similar pneumothorax profile and numbers treated with both drains were recorded, resulting in a similar drain time and numbers of successful and failed re-expansion of pneumothoraces. Successful pneumothorax resolution was the same for both drain types and the negligible tube drain complications observed with the small-bore drain reflected previously reported experiences. However the large-bore drain was associated with a high complication rate (32%) with more infectious complications (24%). The small-bore drain was prone to displacement (21%). There was generally no evidence of an increased failure and morbidity, reflecting poorer expertise, in the non-specialist trainees managing the pneumothoraces. A practical finding however was that in those large pneumothoraces where re-expansion failed, the tip of the drain had not been sited at the apex of the pleural cavity irrespective of the drain type inserted.

Subxyphoid pleural drain confers lesser impairment in respiratory muscle strength, oxygenation and lower chest pain after off-pump coronary artery bypass grafting: a randomized controlled trial.

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Cancio, Andreia S A; Guizilini, Solange; Bolzan, Douglas W; Dauar, Renato B; Succi, José E; de Paola, Angelo A V; Carvalho, Antonio C de Camargo; Gomes, Walter J

2012-01-01

To evaluate respiratory muscle strength, oxygenation and chest pain in patients undergoing off-pump coronary artery bypass (OPCAB) using internal thoracic artery grafts comparing pleural drain insertion site at the subxyphoid region versus the lateral region. Forty patients were randomized into two groups in accordance with the pleural drain site. Group II (n = 19) -pleural drain exteriorized in the intercostal space; group (SI) (n = 21) chest tube exteriorized at the subxyphoid region. All patients underwent assessment of respiratory muscle strength (inspiratory and expiratory) on the pre, 1, 3 and 5 postoperative days (POD). Arterial blood gas analysis was collected on the pre and POD1. The chest pain sensation was measured 1, 3 and 5 POD. A significant decrease in respiratory muscle strength (inspiratory and expiratory) was seen in both groups until POD5 (P pleural drainage showed less decrease in respiratory muscle strength, better preservation of blood oxygenation and reduced thoracic pain compared to patients with intercostal drain on early OPCAB postoperative.

Thoracic Trauma: Which Chest Tube When and Where?

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Molnar, Tamas F

2017-02-01

Clinical suspicion of hemo/pneumothorax: when in doubt, drain the chest. Stable chest trauma with hemo/pneumothorax: drain and wait. Unstable patient with dislocated trachea must be approached with drain in hand and scalpel ready. Massive hemo/pneumothorax may be controlled by drainage alone. The surgeon should not hesitate to open the chest if too much blood drains over a short period. The chest drainage procedure does not end with the last stitch; the second half of the match is still ahead. The drained patient is in need of physiotherapy and proper pain relief with an extended pleural space: control the suction system. Copyright © 2016 Elsevier Inc. All rights reserved.

Necessity of suction drains in gynecomastia surgery.

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Keskin, Mustafa; Sutcu, Mustafa; Cigsar, Bulent; Karacaoglan, Naci

2014-05-01

The aim of gynecomastia surgery is to restore a normal chest contour with minimal signs of breast surgery. The authors examine the rate of complications in gynecomastia surgery when no closed-suction drains are placed. One hundred thirty-eight consecutive male patients who underwent gynecomastia surgery without drains were retrospectively analyzed to determine whether the absence of drains adversely affected patient outcomes. Patients were managed by ultrasonic-assisted liposuction both with and without the pull-through technique. The mean age of the patients was 29 years, and the mean volume of breast tissue aspirated was 350 mL per beast. Pull-through was needed in 23 cases. There was only 1 postoperative hematoma. These results are comparable with previously published data for gynecomastia surgery in which drains were placed, suggesting that the absence of drains does not adversely affect postoperative recovery. Routine closed-suction drainage after gynecomastia surgery is unnecessary, and it may be appropriate to omit drains after gynecomastia surgery.

MINIMALLY-INVASIVE TUBE THORACOSTOMY MADE EASY WITH A COMBINATION OF THORACIC ULTRASOUND AND SMALL BORE CHEST DRAIN KITS (12F TO 16F USING GUIDEWIRE TECHNIQUE

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Venkateswararao

2017-11-01

Full Text Available BACKGROUND Minimally-invasive tube thoracostomy made easy with a combination of thoracic ultrasound and small bore chest drain kits (12F to16F using guidewire technique. The present study is aimed at easy and safe insertion of small bore chest drains (12F to 16F using Seldinger technique under ultrasound guidance with least discomfort to the patient. Large bore chest drains of size >20F using blunt dissection technique is painful, difficult to place in thick chest walls and technically more demanding. Placing the drains blindly basing on chest x-ray image may sometimes injure the underlying lung. MATERIALS AND METHODS Present study included 21 cases, of which 12 cases (57.1% were of pleural effusion and 9 cases (42.8% were of pneumothorax. Thoracic ultrasound was utilised by the operator for all pleural effusions and for those cases of pneumothorax who were on ventilator before tube insertion. Small bore chest drains (12F to 16F designed for guidewire technique were used in the present study. RESULTS Complete and sustainable lung expansion was seen in 19 of 21 cases (90.4%. It failed in remaining 2 cases (9.5% who had complex empyemas and hepatic hydrothorax. Pleurodesis was attempted in 6 cases (28.5% using tetracycline injectable form with success rate of 90%. Patient tolerance was good with numeric pain rating score of 1 to 3 (range 0 to 10; 0 = no pain; 5 = moderate pain; 10 = worst possible pain. CONCLUSION Using small bore chest tubes of sizes 12F to 16F designed for guidewire technique of insertion and utilising thoracic ultrasound, while insertion made the procedure easy and safe, less painful and good tolerance from patient’s point of view. Complete and sustainable lung expansion was seen in 90.4% of cases and highly efficacious for spontaneous and iatrogenic pneumothorax and in noncomplex and malignant pleural effusions. The technique is less demanding and thoracic ultrasound knowledge can be easily learnt and a combination of this

Chest tube insertion

Science.gov (United States)

Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain ... Be careful there are no kinks in your tube. The drainage system should always sit upright and be placed ...

Measurement of hemothorax amount in patients with non-penetrating chest trauma by supine chest AP radiograph

International Nuclear Information System (INIS)

Han, Heon; Yang, Joo Hyun; Na, Myung Hoon; Baik, Hee Jong

1994-01-01

To evaluate the predictability of amount of hemothorax in the patients with blunt chest trauma, supine chest AP radiographs of 66 patients were reviewed and statistically analyzed. In 66 patients, rib fractures were present in 53 patients, hemothorax in 46 patients, pneumothorax in 25 patients, and pulmonary contusions in 18 patients. Width and length of hemothorax were measured on supine chest AP radiograph, and were correlated with known drained amount of hemothorax. The presence and number of rib fracture, pulmonary contusion, subcutaneous emphysema, fracture of scapula and clavicle, and total opacification of hemithorax were also correlated with the drained amount of hemothorax. In multiple logistic regression analysis, width of hemothorax had the highest correlation with drained amount of hemothorax(regression coeffcient 0.718, p value 0.00005). The presence and number of rib fracture, scapular fracture, subcutaneous emphysema were also correlated with drained amount of hemothorax. But length of hemothorax, pulmonary contusion, clavicular fracture, total opacification of hemithorax were not correlated with drained amount of hemothorax. Measured width of hemothorax in supine chest AP radiograph is the most reliable predictor for estimation of the amount of hemothorax, and may also be used as an indication for the application of closed thoracostomy in the treatment of hemothorax

Measurement of hemothorax amount in patients with non-penetrating chest trauma by supine chest AP radiograph

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Han, Heon; Yang, Joo Hyun; Na, Myung Hoon; Baik, Hee Jong [Chung-Ang Gil Hospital, Incheon (Korea, Republic of)

1994-10-15

To evaluate the predictability of amount of hemothorax in the patients with blunt chest trauma, supine chest AP radiographs of 66 patients were reviewed and statistically analyzed. In 66 patients, rib fractures were present in 53 patients, hemothorax in 46 patients, pneumothorax in 25 patients, and pulmonary contusions in 18 patients. Width and length of hemothorax were measured on supine chest AP radiograph, and were correlated with known drained amount of hemothorax. The presence and number of rib fracture, pulmonary contusion, subcutaneous emphysema, fracture of scapula and clavicle, and total opacification of hemithorax were also correlated with the drained amount of hemothorax. In multiple logistic regression analysis, width of hemothorax had the highest correlation with drained amount of hemothorax(regression coeffcient 0.718, p value 0.00005). The presence and number of rib fracture, scapular fracture, subcutaneous emphysema were also correlated with drained amount of hemothorax. But length of hemothorax, pulmonary contusion, clavicular fracture, total opacification of hemithorax were not correlated with drained amount of hemothorax. Measured width of hemothorax in supine chest AP radiograph is the most reliable predictor for estimation of the amount of hemothorax, and may also be used as an indication for the application of closed thoracostomy in the treatment of hemothorax.

Indwelling pleural drain for mobile management of malignant pleural effusion-combining benefits of both methods

OpenAIRE

Dinesh Mehta; Anshu Gupta; Sameer Singhal; Sachin Bansal

2015-01-01

Malignant pleural effusion is a leading cause of morbidity in lung cancer patients requiring repeated pleural aspirations or persistent intercostal drainage tube. Using an indigenous method of putting icd tube of smaller size with subcutaneous tunneling would allow draining fluid from lungs easily and painlessly when needed and avoid the need for repeated injections and chest tube insertion every time the fluid is to be drained.

Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report

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Baig M. Idris

2016-01-01

Conclusion: Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy.

Indwelling pleural drain for mobile management of malignant pleural effusion-combining benefits of both methods

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Dinesh Mehta

2015-01-01

Full Text Available Malignant pleural effusion is a leading cause of morbidity in lung cancer patients requiring repeated pleural aspirations or persistent intercostal drainage tube. Using an indigenous method of putting icd tube of smaller size with subcutaneous tunneling would allow draining fluid from lungs easily and painlessly when needed and avoid the need for repeated injections and chest tube insertion every time the fluid is to be drained.

Horner's syndrome caused by an intercostal chest drain.

OpenAIRE

Campbell, P; Neil, T; Wake, P N

1989-01-01

Horner's syndrome occurred in a young woman as a complication of the treatment of a traumatic pneumothorax with an intercostal drain. The nerve damage probably occurred when the lung had fully re-expanded, pressing the tip of the intercostal drain, lying at the apex of the pleural cavity, on to the sympathetic chain.

Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

Energy Technology Data Exchange (ETDEWEB)

Nahum, E.; Ben-Ari, J.; Schonfeld, T. [Pediatric Intensive Care Unit, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Horev, G. [Dept. of Diagnostic Radiology, Schneider Children' s Medical Center of Israel, Petah Tiqva (Israel); Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel)

2001-06-01

A 3{sup 1}/{sub 2}-year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

Acute diaphragmatic paralysis caused by chest-tube trauma to phrenic nerve

International Nuclear Information System (INIS)

Nahum, E.; Ben-Ari, J.; Schonfeld, T.; Horev, G.

2001-01-01

A 3 1 / 2 -year-old child developed unilateral diaphragmatic paralysis after chest drain insertion. Plain chest X-ray demonstrated paravertebral positioning of the chest-tube tip, and magnetic resonance imaging revealed hematomas in the region of the chest-tube tip and the phrenic nerve fibers. The trauma to the phrenic nerve was apparently secondary to malposition of the chest tube. This is a rare complication and has been reported mainly in neonates. Radiologists should notify the treating physicians that the correct position of a chest drain tip is at least 2 cm distant from the vertebrae. (orig.)

Chest tube insertion - series (image)

Science.gov (United States)

Chest tubes are inserted to drain blood, fluid, or air and allow full expansion of the lungs. The tube is placed in the pleural space. The area where the tube will be inserted is numbed (local anesthesia). The patient may also be sedated. The chest ...

A pilot study of chest tube versus pigtail catheter drainage of acute hemothorax in swine.

Science.gov (United States)

Russo, Rachel M; Zakaluzny, Scott A; Neff, Lucas P; Grayson, J Kevin; Hight, Rachel A; Galante, Joseph M; Shatz, David V

2015-12-01

Evacuation of traumatic hemothorax (HTx) is typically accomplished with large-bore (28-40 Fr) chest tubes, often resulting in patient discomfort. Management of HTx with smaller (14 Fr) pigtail catheters has not been widely adopted because of concerns about tube occlusion and blood evacuation rates. We compared pigtail catheters with chest tubes for the drainage of acute HTx in a swine model. Six Yorkshire cross-bred swine (44-54 kg) were anesthetized, instrumented, and mechanically ventilated. A 32 Fr chest tube was placed in one randomly assigned hemithorax; a 14 Fr pigtail catheter was placed in the other. Each was connected to a chest drainage system at -20 cm H2O suction and clamped. Over 15 minutes, 1,500 mL of arterial blood was withdrawn via femoral artery catheters. Seven hundred fifty milliliters of the withdrawn blood was instilled into each pleural space, and fluid resuscitation with colloid was initiated. The chest drains were then unclamped. Output from each drain was measured every minute for 5 minutes and then every 5 minutes for 40 minutes. The swine were euthanized, and thoracotomies were performed to quantify the volume of blood remaining in each pleural space and to examine the position of each tube. Blood drainage was more rapid from the chest tube during the first 3 minutes compared with the pigtail catheter (348 ± 109 mL/min vs. 176 ± 53 mL/min), but this difference was not statistically significant (p = 0.19). Thereafter, the rates of drainage between the two tubes were not substantially different. The chest tube drained a higher total percentage of the blood from the chest (87.3% vs. 70.3%), but this difference did not reach statistical significance (p = 0.21). We found no statistically significant difference in the volume of blood drained by a 14 Fr pigtail catheter compared with a 32 Fr chest tube.

Contemporary management of flail chest.

Science.gov (United States)

Vana, P Geoff; Neubauer, Daniel C; Luchette, Fred A

2014-06-01

Thoracic injury is currently the second leading cause of trauma-related death and rib fractures are the most common of these injuries. Flail chest, as defined by fracture of three or more ribs in two or more places, continues to be a clinically challenging problem. The underlying pulmonary contusion with subsequent inflammatory reaction and right-to-left shunting leading to hypoxia continues to result in high mortality for these patients. Surgical stabilization of the fractured ribs remains controversial. We review the history of management for flail chest alone and when combined with pulmonary contusion. Finally, we propose an algorithm for nonoperative and surgical management.

Chest tube care in critically ill patient: A comprehensive review

Directory of Open Access Journals (Sweden)

Hanan Mohammed Mohammed

2015-10-01

Full Text Available Breathing is automatic. We don’t usually think too much about it unless we develop a problem. Lack of adequate ventilation and impairment of our respiratory system can quickly become life-threatening. There are many clinical conditions that may necessitate the use of chest tubes. When there is an accumulation of positive pressure in the chest cavity (where it should normally be negative pressure between pleurae, a patient will require chest drainage. Chest tubes may be inserted to drain body fluids or to facilitate the re-expansion of a lung. It is important for the clinician to determine the most appropriate tube size to use prior to intubation. The position of the chest tube is related to the function that the chest tube performs. When managing the care of patients who have chest tubes it is important to fully understand what to do in case problems arise. It is also important to be able to assess when the chest tube is ready to be discontinued. Nurses and other healthcare professionals who are responsible for the safe delivery of care should be knowledgeable about respiratory pathophysiology, signs of respiratory compromise, and the care and management of interventions that may be utilized to ensure adequate respiration.

Chest Wall tumor: combined management

International Nuclear Information System (INIS)

Rao Bhaskar, N.

1997-01-01

Cancer is relatively rare disease among children and adolescents. The incidence of solid tumors other than CNS is less than 2/100,000. Tumors of the chest wall can arise either from the somatic tissue or ribs. These are rare, so either institutional reviews or multi institutional studies should determine optimal therapeutic management. Of the bony chest wall, Ewing's sarcoma or the family of tumor (peripheral neuro epithelioma, Askin tumor), are the most common. These lesions are lytic and have associated large extra pleural component. This large extra pleural component often necessitates major chest wall resection (3 or more ribs), and when lower ribs are involved, this entails resection of portion of diaphragm. Despite this resection, survival in the early 1970 was 10-20%. Since 1970 multi agent chemotherapy has increased survival rates. of importance, however, is these regimens have caused significant reduction of these extra pleural components so that major chest wall resections have become a rarity. With improved survival and decreased morbidity preoperative chemotherapy followed by surgery is now the accepted modality of treatment. Another major advantage of this regimen is that potential radiation therapy may be obviated. The most common chest wall lesion is rhabdomyosarcoma. In the IRS study of 1620 RMS patients, in 141 (9%) the primary lesion was in the chest wall. these are primarily alveolar histology. when lesions were superficial, wide local excision with supplemental radiation therapy was associated with low morbidity and good overall survival. however, a majority have significant intra- thoracic components. in these circumstances the resectability rate is less than 30% and the survival poor. Other lesions include non rhabdomyosarcomas, eosinophilic granuloma, chondrosarcoma, and osteomyelitis. The management of these lesions varies according to extent, histology, and patient characteristics

The management of vacuum neck drains in head and neck surgery and the comparison of two different practice protocols for drain removal.

Science.gov (United States)

Kasbekar, A V; Davies, F; Upile, N; Ho, M W; Roland, N J

2016-01-01

Introduction The management of vacuum neck drains in head and neck surgery is varied. We aimed to improve early drain removal and therefore patient discharge in a safe and effective manner. Methods The postoperative management of head and neck surgical patients with vacuum neck drains was reviewed retrospectively. A new policy was then implemented to measure drainage three times daily (midnight, 6am, midday). The decision for drain removal was based on the most recent drainage period (at Measuring drainage volumes three times daily allows for more accurate assessment of wound drainage, and this can lead to earlier removal of neck drains and safe discharge.

Chest closure without drainage after open patent ductus arteriosus ligation in Ugandan children: A non blinded randomized controlled trial.

Science.gov (United States)

Kebba, Naomi; Mwambu, Tom; Oketcho, Michael; Izudi, Jonathan; Obuku, Ekwaro A

2016-09-29

There is clinical equipoise regarding post-operative management of patients with patent ductus arteriosus (PDA) without insertion of a chest drain. This study evaluated post operative outcomes of chest closure with or without a drain following Patent Ductus Arteriosus ligation among childen at Uganda Heart Instritute (UHI). This was an open label randomized controlled trial of 62 children 12 years of age and below diagnosed with patent ductus arteriosus at Mulago National Teaching and Referral Hospital, Uganda. Participants were randomized in the ratio of 1:1 with surgical ligation of patent ductus arteriosus to either thoracotomy closure with a chest tube or without a chest tube. All participants received standard care and were monitored hourly for 24 hours then until hospital discharge. The combined primary endpoint consisted of significant pleural space accumulation of fluid or air, higher oxygen need or infection of the surgical site. Analysis was conducted by multivariable logistic regression analysis at 5 % significance level. We enrolled 62 participants, 46 (74 %) of whom were females. Their median age was 12 months (IQR: 8-36). Participants in the no-drain arm significantly had less post-operative complications compared to the drain arm (Unadjusted odds ratio [uOR]: 0.21, 95 % CI: 0.06-0.73, p = 0.015). This "protective effect" remained without statistical significance in the multivariable regression model (Adjusted odds ratio [aOR]: 0.07, 95 % CI: 0.00-2.50, p = 0.144). Children aged below 6 years with patent ductus arterious can safely and effectively have thoracotomy closure without using a drain in uncomplicated surgical ligation of the PDA. Chest drain was associated with post-operative complications. The trial was registered in the Pan African Clinical Trials registry on 1st/July/2012, retrospectively registered. Identifier number PACTR201207000395469 .

Novel Split Chest Tube Improves Post-Surgical Thoracic Drainage

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Olivencia-Yurvati, Albert H; Cherry, Brandon H; Gurji, Hunaid A; White, Daniel W; Newton, J Tyler; Scott, Gary F; Hoxha, Besim; Gourlay, Terence; Mallet, Robert T

2014-01-01

Objective Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. Description We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. Methods After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costo-diaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at −20 cm H2O for 30 min. Results When D5W was infused, the split drain left a residual volume of 53 ± 99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P=0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, Pdrain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. Conclusion The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications. PMID:25478289

Novel Split Chest Tube Improves Post-Surgical Thoracic Drainage.

Science.gov (United States)

Olivencia-Yurvati, Albert H; Cherry, Brandon H; Gurji, Hunaid A; White, Daniel W; Newton, J Tyler; Scott, Gary F; Hoxha, Besim; Gourlay, Terence; Mallet, Robert T

2014-01-01

Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costo-diaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at -20 cm H2O for 30 min. When D5W was infused, the split drain left a residual volume of 53 ± 99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P=0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, Pdrain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications.

Percutaneous drainage of chest abscesses in children

International Nuclear Information System (INIS)

Ball, W.S. Jr.; Towbin, R.B.; Bisset, G.S. III.

1987-01-01

Similar techniques for draining abdominal abscesses are now being applied to abscesses within the chest. This report describes the authors' experience in percutaneous drainage of seven chest abscesses in six children aged 3-13 years (mean, 7.3 years). Four pleural/extrapleural loculations were drained in three patients. Abscess location included right apex (one), right minor fissure (one), and left supradiaphragmatic (two). Collections resulted from esophageal perforation (two) or esophageal anastomotic leak (two). Three lung abscesses were drained in three patients. Abscess location included right lower, left lower, and right middle lobes. All lay adjacent to a pleural surface and were localized by CT or US before drainage. There were no complications. Complete resolution occurred in all six patients without the need for surgical intervention

Pediatric chest CT after trauma: impact on surgical and clinical management

International Nuclear Information System (INIS)

Patel, Rina P.; Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H.; Yu, Chang; Ray, Jackie

2010-01-01

Chest CT after pediatric trauma is frequently performed but its clinical impact, particularly with respect to surgical intervention, has not been adequately evaluated. To assess the impact of chest CT compared with chest radiography on pediatric trauma management. Two hundred thirty-five consecutive pediatric trauma patients who had both chest CT and radiography were identified. Images were reviewed and findings were categorized and correlated with subsequent chest interventions, blinded to final outcome and management. Of the 235 children, 38.3% (90/235) had an abnormal chest radiograph and 63.8% (150/235) had an abnormal chest CT (P < 0.0001). Chest interventions followed in 4.7% (11/235); of these, the findings could be made 1 cm above the dome of the liver in 91% (10/11). Findings requiring chest intervention included pneumothorax (PTX) and vertebral fractures. PTX was found on 2.1% (5/235) of chest radiographs and 20.0% (47/235) of chest CTs (P < 0.0001); 1.7% (4/235) of the children received a chest tube for PTX, 0.85% (2/235) seen on chest CT only. Vertebral fractures were present in 3.8% of the children (9/235) and 66.7% (6/9) of those cases were treated with spinal fusion or brace. There were no instances of mediastinal vascular injury. Most intrathoracic findings requiring surgical management in our population were identified in the lower chest and would be included in routine abdominopelvic CT exams; this information needs to be taken into consideration in the diagnostic algorithm of pediatric trauma patients. (orig.)

Pediatric chest CT after trauma: impact on surgical and clinical management

Energy Technology Data Exchange (ETDEWEB)

Patel, Rina P. [Vanderbilt University School of Medicine, Nashville, TN (United States); Hernanz-Schulman, Marta; Hilmes, Melissa A.; Kan, J.H. [Vanderbilt University, Department of Radiology and Radiological Sciences, Vanderbilt Children' s Hospital, Nashville, TN (United States); Yu, Chang [Vanderbilt University, Department of Biostatistics, Nashville, TN (United States); Ray, Jackie [Vanderbilt University, Department of Pediatric Surgery, Vanderbilt Children' s Hospital, Nashville, TN (United States)

2010-07-15

Chest CT after pediatric trauma is frequently performed but its clinical impact, particularly with respect to surgical intervention, has not been adequately evaluated. To assess the impact of chest CT compared with chest radiography on pediatric trauma management. Two hundred thirty-five consecutive pediatric trauma patients who had both chest CT and radiography were identified. Images were reviewed and findings were categorized and correlated with subsequent chest interventions, blinded to final outcome and management. Of the 235 children, 38.3% (90/235) had an abnormal chest radiograph and 63.8% (150/235) had an abnormal chest CT (P < 0.0001). Chest interventions followed in 4.7% (11/235); of these, the findings could be made 1 cm above the dome of the liver in 91% (10/11). Findings requiring chest intervention included pneumothorax (PTX) and vertebral fractures. PTX was found on 2.1% (5/235) of chest radiographs and 20.0% (47/235) of chest CTs (P < 0.0001); 1.7% (4/235) of the children received a chest tube for PTX, 0.85% (2/235) seen on chest CT only. Vertebral fractures were present in 3.8% of the children (9/235) and 66.7% (6/9) of those cases were treated with spinal fusion or brace. There were no instances of mediastinal vascular injury. Most intrathoracic findings requiring surgical management in our population were identified in the lower chest and would be included in routine abdominopelvic CT exams; this information needs to be taken into consideration in the diagnostic algorithm of pediatric trauma patients. (orig.)

Catheters, wires, tubes and drains on postoperative radiographs of pediatric cardiac patients: the whys and wherefores

Energy Technology Data Exchange (ETDEWEB)

Teele, Sarah A.; Thiagarajan, Ravi R. [Children' s Hospital Boston, Department of Cardiology, Boston, MA (United States); Harvard Medical School, Department of Pediatrics, Boston, MA (United States); Emani, Sitaram M. [Children' s Hospital Boston, Department of Cardiac Surgery, Boston, MA (United States); Harvard Medical School, Department of Surgery, Boston, MA (United States); Teele, Rita L. [Harvard Medical School, Department of Radiology, Boston, MA (United States); Starship Children' s Hospital, Department of Radiology, Grafton (New Zealand)

2008-10-15

Surgical treatment of congenital heart disease has advanced dramatically since the first intracardiac repairs in the mid-20th century. Previously inoperable lesions have become the focus of routine surgery and patients are managed successfully in intensive care units around the world. As a result, increasing numbers of postoperative images are processed by departments of radiology in children's hospitals. It is important that the radiologist accurately documents and describes the catheters, wires, tubes and drains that are present on the chest radiograph. This article reviews the reasons for the placement and positioning of perioperative equipment in children who have surgical repair of atrial septal defect, ventricular septal defect or transposition of the great arteries. Also included are a brief synopsis of each cardiac anomaly, the surgical procedure for its correction, and an in-depth discussion of the postoperative chest radiograph including illustrations of catheters, wires, tubes and drains. (orig.)

Catheters, wires, tubes and drains on postoperative radiographs of pediatric cardiac patients: the whys and wherefores

International Nuclear Information System (INIS)

Teele, Sarah A.; Thiagarajan, Ravi R.; Emani, Sitaram M.; Teele, Rita L.

2008-01-01

Surgical treatment of congenital heart disease has advanced dramatically since the first intracardiac repairs in the mid-20th century. Previously inoperable lesions have become the focus of routine surgery and patients are managed successfully in intensive care units around the world. As a result, increasing numbers of postoperative images are processed by departments of radiology in children's hospitals. It is important that the radiologist accurately documents and describes the catheters, wires, tubes and drains that are present on the chest radiograph. This article reviews the reasons for the placement and positioning of perioperative equipment in children who have surgical repair of atrial septal defect, ventricular septal defect or transposition of the great arteries. Also included are a brief synopsis of each cardiac anomaly, the surgical procedure for its correction, and an in-depth discussion of the postoperative chest radiograph including illustrations of catheters, wires, tubes and drains. (orig.)

Chest tube drainage of pleural effusions--an audit of current practice and complications at Hutt Hospital.

Science.gov (United States)

Epstein, Erica; Jayathissa, Sisira; Dee, Stephen

2012-05-11

The aims of the study were to review small-bore chest tube insertion practices for drainage of pleural fluid at Hutt Valley District Health Board (HVDHB), to assess complications, and compare the findings with international data. Retrospective analysis of clinical records was completed on all chest tube insertions for drainage of pleural fluid at HVDHB from December 2008 to November 2009. Descriptive statistics were used to present demographics and tube-associated complications. Comparison was made to available similar international data. Small-bore tubes comprised 59/65 (91%) chest tube insertions and 23/25 (92%) complications. Available comparative data was limited. Ultrasound was used in 36% of insertions. Nearly half of chest drains placed for empyema required subsequent cardiothoracic surgical intervention. Chest drain complication rates at HVDHB were comparable to those seen internationally. Referral rates to cardiothoracic surgery for empyema were within described ranges. The importance of procedural training for junior medical staff, optimising safety of drain insertions with ultrasound guidance, and clear clinical governance for chest tube insertions are important in minimising harm from this procedure. Specialist societies need to take a leadership in providing guidance on chest drain insertions to secondary and tertiary hospitals in Australia and New Zealand.

ORIGINAL ARTICLES Complications of tube thoracostomy for chest ...

African Journals Online (AJOL)

2009-02-01

Feb 1, 2009 ... Intercostal chest drains (ICDs) are commonly used in South. African emergency centres (ECs), with ... blunt dissection of the muscles and pleura (without trocar) for inserting ICDs. Because of increasing ... drain ward; 24 patients were identified with 26 complications relating to the insertion and positioning of ...

Chest Tube Drainage of the Pleural Space: A Concise Review for Pulmonologists.

Science.gov (United States)

Porcel, José M

2018-04-01

Chest tube insertion is a common procedure usually done for the purpose of draining accumulated air or fluid in the pleural cavity. Small-bore chest tubes (≤14F) are generally recommended as the first-line therapy for spontaneous pneumothorax in non-ventilated patients and pleural effusions in general, with the possible exception of hemothoraces and malignant effusions (for which an immediate pleurodesis is planned). Large-bore chest drains may be useful for very large air leaks, as well as post-ineffective trial with small-bore drains. Chest tube insertion should be guided by imaging, either bedside ultrasonography or, less commonly, computed tomography. The so-called trocar technique must be avoided. Instead, blunt dissection (for tubes >24F) or the Seldinger technique should be used. All chest tubes are connected to a drainage system device: flutter valve, underwater seal, electronic systems or, for indwelling pleural catheters (IPC), vacuum bottles. The classic, three-bottle drainage system requires either (external) wall suction or gravity ("water seal") drainage (the former not being routinely recommended unless the latter is not effective). The optimal timing for tube removal is still a matter of controversy; however, the use of digital drainage systems facilitates informed and prudent decision-making in that area. A drain-clamping test before tube withdrawal is generally not advocated. Pain, drain blockage and accidental dislodgment are common complications of small-bore drains; the most dreaded complications include organ injury, hemothorax, infections, and re-expansion pulmonary edema. IPC represent a first-line palliative therapy of malignant pleural effusions in many centers. The optimal frequency of drainage, for IPC, has not been formally agreed upon or otherwise officially established. Copyright©2018. The Korean Academy of Tuberculosis and Respiratory Diseases.

14 French pigtail catheters placed by surgeons to drain blood on trauma patients: is 14-Fr too small?

Science.gov (United States)

Kulvatunyou, Narong; Joseph, Bellal; Friese, Randall S; Green, Donald; Gries, Lynn; O'Keeffe, Terence; Tang, Andy L; Wynne, Julie L; Rhee, Peter

2012-12-01

Small 14F pigtail catheters (PCs) have been shown to drain air quite well in patients with traumatic pneumothorax (PTX). But their effectiveness in draining blood in patients with traumatic hemothorax (HTX) or hemopneumothorax (HPTX) is unknown. We hypothesized that 14F PCs can drain blood as well as large-bore 32F to 40F chest tubes. We herein report our early case series experience with PCs in the management of traumatic HTX and HPTX. We prospectively collected data on all bedside-inserted PCs in patients with traumatic HTX or HPTX during a 30-month period (July 2009 through December 2011) at our Level I trauma center. We then compared our PC prospective data with our trauma registry-derived retrospective chest tube data (January 2008 through December 2010) at our center. Our primary outcome of interest was the initial drainage output. Our secondary outcomes were tube duration, insertion-related complications, and failure rate. For our statistical analysis, we used the unpaired Student's t-test, χ test, and Wilcoxon rank-sum test; we defined significance by a value of p tubes. Our PC group had a higher rate of blunt mechanism injuries than our chest tube group did (83 vs. 62%; p = 0.01). The mean initial output was similar between our PC group (560 ± 81 mL) and our chest tube group (426 ± 37 mL) (p = 0.13). In the PC group, the tube was inserted later (median, Day 1; interquartile range, Days 0-3) than the tube inserted in our chest tube group (median, Day 0; interquartile range, Days 0-0) (p Tube duration, rate of insertion-related complications, and failure rate were all similar. In our early experience, 14F PCs seemed to drain blood as well as large-bore chest tubes based on initial drainage output and other outcomes studied. In this early phase, we were being selective in inserting PCs in only stable blunt trauma patients, and PCs were inserted at a later day from the time of the initial evaluation. In the future, we will need a larger sample size and

Chest Tube Management after Surgery for Pneumothorax.

Science.gov (United States)

Pompili, Cecilia; Salati, Michele; Brunelli, Alessandro

2017-02-01

There is scant evidence on the management of chest tubes after surgery for pneumothorax. Most of the current knowledge is extrapolated from studies performed on subjects with lung cancer. This article reviews the existing literature with particular focus on the effect of suction and no suction on the duration of air leak after lung resection and surgery for pneumothorax. Moreover, the role of regulated suction, which seems to provide some benefit in reducing pneumothorax recurrence after bullectomy and pleurodesis, is discussed. Finally, a personal view on the management of chest tubes after surgery for pneumothorax is provided. Copyright © 2016 Elsevier Inc. All rights reserved.

Experience With The Management Of unusual Penetrating Chest ...

African Journals Online (AJOL)

The presentation shows how a victim of fall from height in the bush can sustain a penetrating chest injury on a dry stick of a shrub. Applications on the principles of management of penetrating chest injury is needed despite the grotesque clinical appearance. [Jnl College of Medicine Vol.7(1) 2002: 40-42] ...

Effectiveness of chest physiotherapy in the management of bronchiectasis

International Nuclear Information System (INIS)

Arif, M.; Bashir, M.S.

2014-01-01

Bronchiectasis is a chronic disease in which clearance of sputum is disturbed because bronchi dilated permanently. So for the clearance of sputum we have to use physiotherapy techniques such as postural drainage percussion and vibration (PDPY), active cycle of breathing technique (ACBT), autogenic drainage, positive expiratory pressure, high frequency chest wall oscillation. Objective: To determine the role of Chest Physical therapy intervention in the management of Bronchi ectasis. To compare the prognosis of bronchiectasis with and without chest physiotherapy. Methodology: Data was collected from Gulab Devi Chest Hospital, Lahore. A Randomized Control Trial (RCT) study method was used and 60 patients are studied. In this study, they were divided into 03 groups 1- Antibiotics Therapy 2-Chest Physical therapy 3-Antibiotics and Chest Physical therapy. Each group consistant. (author)

Diagnostic modalities x-ray and CT chest differ in the management of thoracic injury

Directory of Open Access Journals (Sweden)

D Chapagain

2015-06-01

Full Text Available Objective: To observe difference in the management of blunt trauma to the chest on the basis of conventional xray and computerised tomography of the chest. Methods: This prospective study was conducted between December 2011 to October 2012 in COMS in Bharatpur,a tertiary referral centre in central Nepal . Clinically stable thoracic injury patients were first evaluated with chest x-ray and the management on this basis was recorded. The findings of the CT chest were assessed and the type of management on the basis of CT was also recorded. Outcome was assessed in terms of mortality, morbidity, hospital and ICU stay with respect to the management on the basis of chest x-ray and CT scan. Results: Of the 129 patients, 74.4% were male and 25.6% were female with the patients ranging in age from 7 to 87 years (mean = 40.41 years. The most common mechanism of trauma to the chest was as a result of a motor vehicle accident (69.8%, followed by fall injury (20.2%. X-ray chest diagnosed rib fracture in 62%, haemothorax in 37%, pneumothorax in 27%, lung contusion in 10% and haemopneumothorax in 21% patients. Similarly CT chest diagnosed rib fracture in 86%, haemothorax in 54%, pneumothorax in 36%, lung contusion in 30% and haemopneumothorax in 30% patients. Mean hospital stay was 9.5 days in the group of patients having management on the basis of x-ray chest relative to mean stay of 10.2 days in the CT- chest group. In the management on the basis of xray group, there was a mean ICU stay of 2.8days compared to mean stays of 3.2 days in CT chest group. Conclusion: Though CT scan of the chest is more informative and differs the management of the blunt chest trauma, one should not forget to advise the cost effective, easily available and initial guiding agent, xray chest for early management of the chest injury patient. DOI: http://dx.doi.org/10.3126/jcmsn.v10i1.12764 Journal of College of Medical Sciences-Nepal, 2014, Vol.10(1; 22-31

Classification and management of chest trauma

International Nuclear Information System (INIS)

Farooq, U.; Raza, W.; Zia, N.; Hanif, M.; Khan, M.M.

2006-01-01

Objective: To classify the predominant pattern of injuries following blunt and penetrating chest trauma and to assess the adequacy of treatment strategies, complications and mortality associated with such injuries. Design: Descriptive study. Place and Duration of Study: Surgical Unit I, Holy Family Hospital, Rawalpindi, from December 2000 to December 2003. Patients and Methods: One hundred consecutive patients with thoracic trauma either blunt or penetrating, admitted in the ward were evaluated. Their injuries were classified, treatment strategies outlined and complications and mortality were documented on a specially-designed proforma. Results: Out of the 100 patients presenting in emergency, 44% presented with blunt and 56% with penetrating trauma. Pneumothorax was detected in 39% of the patients, hemopneumothorax in 29%, hemothorax in 12%, flail chest in 9%. Two had involvement of the heart and major vessels, 4% had injury to the diaphragm and 5% had multiple trauma. During treatment, 3% of all the patients were managed conservatively, 83% of patients required chest intubations, 6% needed ventilatory support and 8 % required thoracotomy. Complications were experienced in 28% of the patients of which 9% had pneumonias, 14% empyema and 5% suffered from wound infections. The overall mortality was 7%. Conclusion: This series showed the pattern of injuries following blunt and penetrating chest trauma. Furthermore, it was found that chest incubation and simple resuscitation was adequate for majority of the cases. (author)

Challenges in management of pediatric life-threatening neck and chest trauma

Directory of Open Access Journals (Sweden)

Shilpa Sharma

2018-01-01

Full Text Available Introduction: Neck and thoracic trauma in children pose unforeseen challenges requiring variable management strategies. Here, we describe some unusual cases. Patients and Methods: Pediatric cases of unusual neck and thoracic trauma prospectively managed from April 2012 to March 2014 at a Level 1 trauma center were studied for management strategies, outcome, and follow-up. Results: Six children with a median age of 5.5 (range 2–10 years were managed. Mechanism of injury was road traffic accident, fall from height and other accidental injury in 2, 3 and 1 patient respectively. The presentation was respiratory distress and quadriplegia, exposed heart, penetrating injury in neck, dysphagia and dyspnea, and swelling over the chest wall in 1, 1, 1, 2 and 1 cases respectively. Injuries included lung laceration, open chest wall, vascular injury of the neck, tracheoesophageal fistula (2, and chest wall posttraumatic pyomyositis. One patient had a flare of miliary tuberculosis. Immediate management included chest wall repair; neck exploration and repair, esophagostomy, gastroesophageal stapling, and feeding jejunostomy (followed by gastric pull-up 8 months later. Chest tube insertion and total parenteral nutrition was required in one each. 2 and 4 patients required tracheostomy and mechanical ventilation. The patient with gastric pull-up developed a stricture of the esophagogastric anastomosis that was revised at 26-month follow-up. At follow-up of 40–61 months, five patients are well. One patient with penetrating neck injury suffered from blindness due to massive hemorrhage from the vascular injury in the neck and brain ischemia with only peripheral vision recovery. Conclusion: Successful management of neck and chest wall trauma requires timely appropriate decisions with a team effort.

Single chest tube drainage is superior to double chest tube drainage after lobectomy: a meta-analysis.

Science.gov (United States)

Zhou, Dong; Deng, Xu-Feng; Liu, Quan-Xing; Chen, Qian; Min, Jia-Xin; Dai, Ji-Gang

2016-05-27

In this meta-analysis, we conducted a pooled analysis of clinical studies comparing the efficacy of single chest tube versus double chest tube after a lobectomy. According to the recommendations of the Cochrane Collaboration, we established a rigorous study protocol. We performed a systematic electronic search of the PubMed, Embase, Cochrane Library and Web of Science databases to identify articles to include in our meta-analysis. A literature search was performed using relevant keywords. A meta-analysis was performed using RevMan© software. Five studies, published between 2003 and 2014, including 630 patients (314 patients with a single chest tube and 316 patients with a double chest tube), met the selection criteria. From the available data, the patients using a single tube demonstrated significantly decreased postoperative pain [weighted mean difference [WMD] -0.60; 95 % confidence intervals [CIs] -0.68-- 0.52; P tube after a pulmonary lobectomy. However, there were no significant differences in postoperative complications [OR 0.91; 95 % CIs 0.57-1.44; P = 0.67] and re-drainage rates [OR 0.81; 95 % CIs 0.42-1.58; P = 0.54]. Our results showed that a single-drain method is effective, reducing postoperative pain, hospitalization times and duration of drainage in patients who undergo a lobectomy. Moreover, the single-drain method does not increase the occurrence of postoperative complications and re-drainage rates.

[How to do - the chest tube drainage].

Science.gov (United States)

Klopp, Michael; Hoffmann, Hans; Dienemann, Hendrik

2015-03-01

A chest tube is used to drain the contents of the pleural space to reconstitute the physiologic pressures within the pleural space and to allow the lungs to fully expand. Indications for chest tube placement include pneumothorax, hemothorax, pleural effusion, pleural empyema, and major thoracic surgery. The most appropriate site for chest tube placement is the 4th or 5th intercostal space in the mid- or anterior- axillary line. Attention to technique in placing the chest tube is vital to avoid complications from the procedure. Applying the step-by-step technique presented, placement of a chest tube is a quick and safe procedure. Complications - frequently occurring when the tube is inserted with a steel trocar - include hemothorax, dislocation, lung lacerations, and injury to organs in the thoracic or abdominal cavity." © Georg Thieme Verlag KG Stuttgart · New York.

Effects of Drains on Pain, Comfort and Anxiety in Patients Undergone Surgery

Directory of Open Access Journals (Sweden)

Ummu Yildiz Findik

2013-01-01

Full Text Available Backround: Surgical drains negatively affect patients’ comfort, cause anxiety along with pain, as they are used to promote healing after surgery.Purpose: This study aimed to determine pain, comfort and anxiety levels of patients with drains postoperatively.Methodology: Research was performed with 192 patients undergone abdominal, neck, breast and open heart surgery and had surgical and underwater chest drains at the postoperative period. Patient Information Form, Numerical Pain Scale, General Comfort Questionnaire and Trait Anxiety Scale was used for collection of data. In evaluating the data, we used the t-test, variance and correlation analysis, mean, percentage and frequency.Results: The patients’ mean score of pain was 4.67±2.93, comfort was 2.75±0.29 and anxiety was 39.31±9.21. It was found statistically significant that the comfort level decreases as the pain level increases and that the patients undergone open heart surgery and with underwater chest drains have higher pain levels. It was found statistically significant that, comfort level in patients undergone abdominal or cardiac surgery is lower than patients undergone breast or neck surgery, and that the comfort level decreases as the duration of drains increases. The increasing state anxiety while pain increases and comfort decreases was found statistically significant.Conclusions: Surgeries and drains applied after these procedures decrease the comfort level of the patients as increases the pain level. Also, pain and discomfort increase the patients’ anxiety. Nurses who providing care to these patients are suggested to improve measures about pain and anxiety reduction for maintaining of comfort.

Reverse airflow in certain chest drains may be misinterpreted as prolonged air leakage

DEFF Research Database (Denmark)

Stouby, Anna; Neckelmann, Kirsten; Licht, Peter B

2011-01-01

Prolonged air leakage is common after lung resection. We observed that during deep inspiration some patients were able to empty the water-seal of commercial chest drainage systems and retract air back into the chest tube, which subsequently escaped during the following expiration, mimicking "true...

The Validation of a No-Drain Policy After Thoracoscopic Major Lung Resection.

Science.gov (United States)

Murakami, Junichi; Ueda, Kazuhiro; Tanaka, Toshiki; Kobayashi, Taiga; Kunihiro, Yoshie; Hamano, Kimikazu

2017-09-01

The omission of postoperative chest tube drainage may contribute to early recovery after thoracoscopic major lung resection; however, a validation study is necessary before the dissemination of a selective drain policy. A total of 162 patients who underwent thoracoscopic anatomical lung resection for lung tumors were enrolled in this study. Alveolar air leaks were sealed with a combination of bioabsorbable mesh and fibrin glue. The chest tube was removed just after the removal of the tracheal tube in selected patients in whom complete pneumostasis was obtained. Alveolar air leaks were identified in 112 (69%) of the 162 patients in an intraoperative water-seal test performed just after anatomical lung resection. The chest tube could be removed in the operating room in 102 (63%) of the 162 patients. There were no cases of 30-day postoperative mortality or in-hospital death. None of the 102 patients who did not undergo postoperative chest tube placement required redrainage for a subsequent air leak or subcutaneous emphysema. The mean length of postoperative hospitalization was shorter in patients who had not undergone postoperative chest tube placement than in those who had. The omission of chest tube placement was associated with a reduction in the visual analog scale for pain from postoperative day 0 until postoperative day 3, in comparison with patients who underwent chest tube placement. The outcome of our validation cohort revealed that a no-drain policy is safe in selected patients undergoing thoracoscopic major lung resection and that it may contribute to an early recovery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Operative management versus non-operative management of rib fractures in flail chest injuries: a systematic review

NARCIS (Netherlands)

Schuurmans, Jaap; Goslings, J. C.; Schepers, T.

2017-01-01

Flail chest is a life-threatening complication of severe chest trauma with a mortality rate of up to 15 %. The standard non-operative management has high comorbidities with pneumonia and often leads to extended Intensive Care Unit (ICU) stay, due to insufficient respiratory function and

Improved drainage with active chest tube clearance.

Science.gov (United States)

Shiose, Akira; Takaseya, Tohru; Fumoto, Hideyuki; Arakawa, Yoko; Horai, Tetsuya; Boyle, Edward M; Gillinov, A Marc; Fukamachi, Kiyotaka

2010-05-01

This study was performed to evaluate the efficacy of a novel chest drainage system. This system employs guide wire-based active chest tube clearance to improve drainage and maintain patency. A 32 Fr chest tube was inserted into pleural cavities of five pigs. On the left, a tube was connected to the chest canister, and on the right, the new system was inserted between the chest tube and chest canister. Acute bleeding was mimicked by periodic infusion of blood. The amount of blood drained from each chest cavity was recorded every 15 min for 2 h. After completion of the procedure, all residual blood and clots in each chest cavity were assessed. The new system remained widely patent, and the amount of drainage achieved with this system (670+/-105 ml) was significantly (P=0.01) higher than that with the standard tube (239+/-131 ml). The amount of retained pleural blood and clots with this system (150+/-107 ml) was significantly (P=0.04) lower than that with the standard tube (571+/-248 ml). In conclusion, a novel chest drainage system with active tube clearance significantly improved drainage without tube manipulations. 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.

Managing erosion, sediment transport and water quality in drained peatland catchments

Energy Technology Data Exchange (ETDEWEB)

Marttila, H.

2010-07-01

Peatland drainage changes catchment conditions and increases the transport of suspended solids (SS) and nutrients. New knowledge and management methods are needed to reduce SS loading from these areas. This thesis examines sediment delivery and erosion processes in a number of peatland drainage areas and catchments in order to determine the effects of drainage on sediment and erosion dynamics and mechanics. Results from studies performed in peat mining, peatland forestry and disturbed headwater catchments in Finland are presented and potential sediment load management methods are discussed for drainage areas and headwater brooks. Particular attention is devoted to erosion of organic peat, sediment transport and methods to reduce the impacts of peatland drainage in boreal headwaters. This thesis consists of six articles. The first and second papers focus on the erosion and sediment transport processes at peat harvesting and peatland forestry drainage networks. The results indicate that in-channel processes are important in drained peatland, since the drainage network often constitutes temporary inter-storm storage for eroding and transporting material. Sediment properties determine the bed sediment erosion sensitivity, as fluffy organic peat sediment consolidates over time. As flashiness and peak runoff control sediment entrainment and transport from drained peatland areas, water quality management should include peak runoff management. The third, fourth and fifth papers studies use and application of peak runoff control (PRC) method to the peat harvesting and peatland forestry conditions for water protection. Results indicate that effective water quality management in drained peatland areas can be achieved using this method. Installation of the PRC structures is a useful and cost-effective way of storing storm runoff waters temporarily in the ditch system and providing a retention time for eroded sediment to settle to the ditch bed and drainage network. The main

Does a chest x-ray alter the management of new patients attending a geriatric day hospital?

Science.gov (United States)

Logan, J A; Vallance, R; Williams, B O; Paul, H

1997-01-01

Studies have suggested that routine chest x-ray is never indicated but all new attenders at our day hospitals have a chest x-ray carried out. Our aim was to determine if this investigation altered the clinical management of patients and to try to select those patients in whom a chest x-ray is indicated. A prospective study was carried out over a 7 month period from February to September 1995. All new patients had cardiorespiratory symptoms/signs documented and a management plan made. A chest x-ray was then carried out and change in management as a result of the x-ray report noted. Knightswood and Drumchapel Geriatric Day Hospitals, West Glasgow University NHS Trust. All new Day Hospital attenders. Of 207 new Day Hospital attenders, 53 had no clinical indication for a chest x-ray and although 70% had an abnormal film in no case was patient management changed as a result of this. A chest x-ray was indicated in 154 patients and of these 114 (74%) had an abnormal film with a resultant change in management in 23 patients (this comprised either a change in drug treatment or a further investigation.) Of those whose management was changed as a result of the x-ray report 61% had respiratory symptoms. We would recommend that chest x-ray should be performed in those patients who have a clear clinical indication and that the diagnostic yield is highest in the presence of respiratory symptoms or signs.

Managing Artificially Drained Low-Gradient Agricultural Headwaters for Enhanced Ecosystem Functions

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Pierce, Samuel C.; Kröger, Robert; Pezeshki, Reza

2012-01-01

Large tracts of lowlands have been drained to expand extensive agriculture into areas that were historically categorized as wasteland. This expansion in agriculture necessarily coincided with changes in ecosystem structure, biodiversity, and nutrient cycling. These changes have impacted not only the landscapes in which they occurred, but also larger water bodies receiving runoff from drained land. New approaches must append current efforts toward land conservation and restoration, as the continuing impacts to receiving waters is an issue of major environmental concern. One of these approaches is agricultural drainage management. This article reviews how this approach differs from traditional conservation efforts, the specific practices of drainage management and the current state of knowledge on the ecology of drainage ditches. A bottom-up approach is utilized, examining the effects of stochastic hydrology and anthropogenic disturbance on primary production and diversity of primary producers, with special regard given to how management can affect establishment of macrophytes and how macrophytes in agricultural landscapes alter their environment in ways that can serve to mitigate non-point source pollution and promote biodiversity in receiving waters. PMID:24832519

Managing Artificially Drained Low-Gradient Agricultural Headwaters for Enhanced Ecosystem Functions

Directory of Open Access Journals (Sweden)

Reza Pezeshki

2012-12-01

Full Text Available Large tracts of lowlands have been drained to expand extensive agriculture into areas that were historically categorized as wasteland. This expansion in agriculture necessarily coincided with changes in ecosystem structure, biodiversity, and nutrient cycling. These changes have impacted not only the landscapes in which they occurred, but also larger water bodies receiving runoff from drained land. New approaches must append current efforts toward land conservation and restoration, as the continuing impacts to receiving waters is an issue of major environmental concern. One of these approaches is agricultural drainage management. This article reviews how this approach differs from traditional conservation efforts, the specific practices of drainage management and the current state of knowledge on the ecology of drainage ditches. A bottom-up approach is utilized, examining the effects of stochastic hydrology and anthropogenic disturbance on primary production and diversity of primary producers, with special regard given to how management can affect establishment of macrophytes and how macrophytes in agricultural landscapes alter their environment in ways that can serve to mitigate non-point source pollution and promote biodiversity in receiving waters.

Chest tube drainage of transudative pleural effusions hastens liberation from mechanical ventilation.

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Kupfer, Yizhak; Seneviratne, Chanaka; Chawla, Kabu; Ramachandran, Kavan; Tessler, Sidney

2011-03-01

Pleural effusions occur frequently in patients requiring mechanical ventilatory support. Treatment of the precipitating cause and resolution of the pleural effusion may take considerable time. We retrospectively studied the effect of chest tube drainage of transudative pleural effusions on the liberation of patients from mechanical ventilatory support. Patients in the medical ICU (MICU) at Maimonides Medical Center between January 1, 2009, and October 31, 2009, requiring mechanical ventilatory support with a transudative pleural effusion, were studied retrospectively. They were divided into two groups: standard care and standard care plus chest tube drainage. Chest tubes were placed under ultrasound guidance by trained intensivists. Duration of mechanical ventilatory support was the primary end point. Secondary end points included measures of oxygenation, amount of fluid drained, and complications associated with the chest tube. A total of 168 patients were studied; 88 were treated with standard care and 80 underwent chest tube drainage. Total duration of mechanical ventilatory support was significantly shorter for patients who had chest tube drainage: 3.8±0.5 days vs 6.5±1.1 days for the standard group (P=.03). No differences in oxygenation were noted between the two groups. The average amount of fluid drained was 1,220 mL. No significant complications were caused by chest tube drainage. Chest tube drainage of transudative pleural effusions resulted in more rapid liberation from mechanical ventilatory support. It is a very safe procedure when performed under ultrasound guidance by experienced personnel. ClinicalTrials.gov; Identifier: NCT0114285; URL: www.clinicaltrials.gov.

A prospective randomized, controlled trial deems a drainage of 300 ml/day safe before removal of the last chest drain after video-assisted thoracoscopic surgery lobectomy.

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Xie, Hong-Ya; Xu, Kai; Tang, Jin-Xing; Bian, Wen; Ma, Hai-Tao; Zhao, Jun; Ni, Bin

2015-08-01

To study the feasible and safe volume threshold for chest tube removal following video-assisted thoracoscopic surgical lobectomy. One hundred and sixty-eight consecutive patients (18 were excluded) who underwent video-assisted thoracoscopic surgery lobectomy or bilobectomy with two incisions between August 2012 and February 2014 were included. Eligible patients were randomized into three groups: Group A (chest tube was removed at a drainage volume of 150 ml/day or less. n = 49); Group B (chest tube was removed when the drainage volume was less than 300 ml/day. n = 50); Group C (chest tube was removed when the drainage volume was less than 450 ml/day. n = 51). The postoperative care of all patients was consistent. The time of extracting the drainage tube, postoperative hospital stay, postoperative visual analogue scale grades, dosage of analgesic, and the incidence of complications and thoracocentesis were measured. Group B and C had a much shorter drainage time and postoperative hospital stay than Group A (P 0.05). The mean dosage of pethidine hydrochloride was 248.9 ± 33.3 mg in Group B and 226.1 ± 32.7 mg in Group C (P > 0.05). The dosage of pethidine hydrochloride of Group A was significantly higher than that of Group B and C (P 0.05), Group A had a significantly higher total VAS score than Group B and C (P drains among the three groups (P > 0.05). A 300-ml/day volume threshold for chest tube removal after video-assisted thoracoscopic surgery lobectomy is feasible and safe, demonstating more advantages than the 150-ml/day volume threshold. However, a 450-ml/day volume threshold for chest tube removal may increase the risk of thoracentesis compared with the 300- and the 150-ml/day volume threshold. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Chest compression quality management and return of spontaneous circulation: a matched-pair registry study.

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Lukas, Roman-Patrik; Gräsner, Jan Thorsten; Seewald, Stephan; Lefering, Rolf; Weber, Thomas Peter; Van Aken, Hugo; Fischer, Matthias; Bohn, Andreas

2012-10-01

Investigating the effects of any intervention during cardiac arrest remains difficult. The ROSC after cardiac arrest score was introduced to facilitate comparison of rates of return of spontaneous circulation (ROSC) between different ambulance services. To study the influence of chest compression quality management (including training, real-time feedback devices, and debriefing) in comparison with conventional cardiopulmonary resuscitation (CPR), a matched-pair analysis was conducted using data from the German Resuscitation Registry, with the calculated ROSC after cardiac arrest score as the baseline. Matching for independent ROSC after cardiac arrest score variables yielded 319 matched cases from the study period (January 2007-March 2011). The score predicted a 45% ROSC rate for the matched pairs. The observed ROSC increased significantly with chest compression quality management, to 52% (P=0.013; 95% CI, 46-57%). No significant differences were seen in the conventional CPR group (47%; 95% CI, 42-53%). The difference between the observed ROSC rates was not statistically significant. Chest compression quality management leads to significantly higher ROSC rates than those predicted by the prognostic score (ROSC after cardiac arrest score). Matched-pair analysis shows that with conventional CPR, the observed ROSC rate was not significantly different from the predicted rate. Analysis shows a trend toward a higher ROSC rate for chest compression quality management in comparison with conventional CPR. It is unclear whether a single aspect of chest compression quality management or the combination of training, real-time feedback, and debriefing contributed to this result. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Noncardiac chest pain: diagnosis and management.

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Yamasaki, Takahisa; Fass, Ronnie

2017-07-01

Noncardiac chest pain (NCCP) has been defined as recurrent chest pain that is indistinguishable from ischemic heart pain after excluding a cardiac cause. NCCP is a common and highly challenging clinical problem in Gastrointestinal practice that requires targeted diagnostic assessment to identify the underlying cause of the symptoms. Treatment is tailored according to the cause of NCCP: gastroesophageal reflux disease (GERD), esophageal dysmotility or functional chest pain. The purpose of this review is to discuss the current diagnosis and treatment of NCCP. Utilization of new diagnostic techniques such as pH-impedance and high-resolution esophageal manometry, and the introduction of a new definition for functional chest pain have helped to better diagnose the underlying mechanisms of NCCP. A better therapeutic approach toward GERD-related NCCP, the introduction of new interventions for symptoms due to esophageal spastic motor disorders and the expansion of the neuromodulator armamentarium for functional chest pain have changed the treatment landscape of NCCP. GERD is the most common esophageal cause of NCCP, followed by functional chest pain and esophageal dysmotility. The proton pump inhibitor test, upper endoscopy, wireless pH capsule and pH-impedance are used to identify GERD-induced NCCP. High-resolution esophageal manometry is the main tool to identify esophageal motor disorder in non-GERD-related NCCP. Negative diagnostic assessment suggests functional chest pain. Potent antireflux treatment is offered to patients with GERD-related NCCP; medical, endoscopic or surgical interventions are considered in esophageal dysmotility; and neuromodulators are prescribed for functional chest pain. Assessment and treatment of psychological comorbidity should be considered in all NCCP patients.

Implementation of a chest pain management service improves patient care and reduces length of stay.

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Scott, Adam C; O'Dwyer, Kristina M; Cullen, Louise; Brown, Anthony; Denaro, Charles; Parsonage, William

2014-03-01

Chest pain is one of the most common complaints in patients presenting to an emergency department. Delays in management due to a lack of readily available objective tests to risk stratify patients with possible acute coronary syndromes can lead to an unnecessarily lengthy admission placing pressure on hospital beds or inappropriate discharge. The need for a co-ordinated system of clinical management based on enhanced communication between departments, timely and appropriate triage, clinical investigation, diagnosis, and treatment was identified. An evidence-based Chest Pain Management Service and clinical pathway were developed and implemented, including the introduction of after-hours exercise stress testing. Between November 2005 and March 2013, 5662 patients were managed according to a Chest Pain Management pathway resulting in a reduction of 5181 admission nights by more timely identification of patients at low risk who could then be discharged. In addition, 1360 days were avoided in high-risk patients who received earlier diagnosis and treatment. The creation of a Chest Pain Management pathway and the extended exercise stress testing service resulted in earlier discharge for low-risk patients; and timely treatment for patients with positive and equivocal exercise stress test results. This service demonstrated a significant saving in overnight admissions.

Low protein content of drainage fluid is a good predictor for earlier chest tube removal after lobectomy.

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Olgac, Guven; Cosgun, Tugba; Vayvada, Mustafa; Ozdemir, Atilla; Kutlu, Cemal Asim

2014-10-01

Owing to the great absorption capability of the pleura for transudates, the protein content of draining pleural fluid may be considered as a more adequate determinant than its daily draining amount in the decision-making for earlier chest tube removal. In an a priori pilot study, we observed that the initially draining protein-rich exudate converts to a transudate quickly in most patients after lobectomies. Thus, chest tubes draining high-volume but low-protein fluids can safely be removed earlier in the absence of an air leak. This randomized study aims to investigate the validity and clinical applicability of this hypothesis as well as its influence on the timing for chest tube removal and earlier discharge after lobectomy. Seventy-two consecutive patients undergoing straightforward lobectomy were randomized into two groups. Patients with conditions affecting postoperative drainage and with persisting air leaks beyond the third postoperative day were excluded. Drains were removed if the pleural fluid to blood protein ratio (PrRPl/B) was ≤0.5, regardless of its daily draining amount in the study arm (Group S; n = 38), and patients in the control arm (Group C; n = 34) had their tubes removed if daily drainage was ≤250 ml regardless of its protein content. Patients were discharged home immediately or the following morning after removal of the last drain. All cases were followed up regarding the development of symptomatic pleural effusions and hospital readmissions for a redrainage procedure. Demographic and clinical characteristics as well as the pattern of decrease in PrRPl/B were the same between groups. The mean PrRPl/B was 0.65 and 0.67 (95% CI = 0.60-0.69 and 0.62-0.72) on the first postoperative day, and it remarkably dropped down to 0.39 and 0.33 (95% CI = 0.33-0.45 and 0.27-0.39) on the second day in Groups S and C, respectively, and remained below 0.5 on the third day (repeated-measures of ANOVA design, post hoc 'within-group' comparison of the first

A questionnaire about radiation safety management of the draining-water system at nuclear medicine facilities

International Nuclear Information System (INIS)

Shizukuishi, Kazuya; Narita, Hiroto

2004-01-01

We conducted a questionnaire survey about radiation-safety management condition in Japanese nuclear medicine facilities to make materials of proposition for more reasonable management of medical radioactive waste. We distributed a questionnaire to institutions equipped with Nuclear Medicine facilities. Of 1,125 institutions, 642 institutes (52.8%) returned effective answers. The questionnaire covered the following areas: scale of an institution, presence of enforcement of radiotherapy, system of a tank, size and number of each tank, a form of draining-water system, a displacement in a radioactive rays management area, a measurement method of the concentration of medical radioactive waste in draining water system, planned and used quantity of radioisotopes for medical examination and treatment, an average displacement of hospital for one month. In most institutions, a ratio of dose limitation of radioisotope in draining-water system was less than 1.0, defined as an upper limitation in ordinance. In 499 hospitals without facilities of hospitalization for unsealed radioisotope therapy, 473 hospitals reported that sum of ratios of dose limits in a draining-water system was less than 1.0. It was calculated by used dose of radioisotope and monthly displacement from hospital, on the premise that all used radioisotope entered in the general draining-water system. When a drainage including radioactivity from a controlled area join with that from other area before it flows out of a institution, it may be diluted and its radioactive concentration should be less than its upper limitation defined in the rule. Especially, in all institutions with a monthly displacement of more than 25,000 m 3 , the sum of ratio of the concentration of each radionuclide to the concentration limit dose calculated by used dose of radioisotope, indicated less than 1.0. (author)

Cross-chest liposuction in gynaecomastia

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Biju Murali

2011-01-01

Full Text Available Background: Gynaecomastia is usually treated with liposuction or liposuction with excision of the glandular tissue. The type of surgery chosen depends on the grade of the condition. Objective: Because gynaecomastia is treated primarily as a cosmetic procedure, we aimed at reducing the invasiveness of the surgery. Materials and Methods: The technique complies with all recommended protocols for different grades of gynaecomastia. It uses liposuction, gland excision, or both, leaving only minimal post-operative scars. The use of cross-chest liposuction through incisions on the edge of the areola helps to get rid of all the fat under the areola without an additional scar as in the conventional method. Results: This is a short series of 20 patients, all with bilateral gynaecomastia (i.e., 40 breasts, belonging to Simon′s Stage 1 and 2, studied over a period of 2 years. The average period of follow-up was 15 months. Post-operative complications were reported in only two cases, with none showing long-term complications or issues specifically due to the procedure. Conclusions : Cross-chest liposuction for gynaecomastia is a simple yet effective surgical tool in bilateral gynaecomastia treatment to decrease the post-operative scars. The use of techniques like incision line drain placement and post-drain removal suturing of wounds aid in decreasing the scar.

A chest drainage system with a real-time pressure monitoring device.

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Chen, Chih-Hao; Liu, Tsang-Pai; Chang, Ho; Huang, Tung-Sung; Liu, Hung-Chang; Chen, Chao-Hung

2015-07-01

Tube thoracostomy is a common procedure. A chest bottle may be used to both collect fluids and monitor the recovery of the chest condition. The presence of the "tidaling phenomenon" in the bottle can be reflective of the extent of patient's recovery. However, current practice essentially depends on gross observation of the bottle. The device used here is designed for a real-time monitoring of change in pleural pressure to allow clinicians to objectively determine when the lung has recovered, which is crucially important in order to judge when to remove the chest tube. The device is made of a pressure sensor with an operating range between -100 to +100 cmH2O and an amplifying using the "Wheatstone bridge" concept. Recording and analysis was performed with LABview software. The data can be shown in real-time on screen and also be checked retrospectively. The device was connected to the second part of a three-bottle drain system by a three-way connector. The test animals were two 40-kg pigs. We used a thoracoscopic procedure to create an artificial lung laceration with endoscopic scissors. Active air leaks could result in vigorous tidaling phenomenon up to 20 cmH2O. In the absence of gross tidaling phenomenon, the pressure changes were around 0.25 cmH2O. This real-time pleural pressure monitoring device can help clinicians objectively judge the extent of recovery of the chest condition. It can be used as an effective adjunct with the current chest drain system.

Digital luminescent radiography: A substitute for conventional chest radiography?

International Nuclear Information System (INIS)

Neufang, K.F.R.; Krug, B.; Lorenz, R.; Steinbrich, W.

1990-01-01

The image quality of digital luminescent radiography (DLR) is sufficient for routine biplane chest radiography and for follow-up studies of heart size, pulmonary congestion, coin lesions, infiltrations, atelectasis, pleural effusions, and mediastinal and hilar lymph node enlargement. Chest radiography in the intensive care unit may in most cases be performed using the DLR technique. there is no need for repeat shots because of incorrect exposure, and the position of catheters, tubes, pacemakers, drains and artificial heart valves, the mediastinum, and the retrocardiac areas of the left lung are more confidently assessed on the edge-enhanced DLR films than on conventional films. Nevertheless, DLR is somewhat inferior to conventional film-screen radiography of the chest as it can demonstrate or rule out subtle pulmonary interstitial disease less confidently. There is no reduction of radiation exposure of the chest in DLR compared with modern film-screen systems. As a consequence, DLR is presently not in a position to replace traditional film-screen radiography of the chest completely. (orig.) [de

Monitoring the monitors: tubes and lines on chest radiographs

International Nuclear Information System (INIS)

Wunderbaldinger, P. . patrick.wunderbaldinger@univie.ac.at

2001-01-01

Chest radiography is essential to evaluate the placement and position of tubes and lines in patients treated in intensive care units, such as central venous and arterial catheters, endotracheal and nasogastric tubes, thorax drains, cardiac pacemakers and defibrillators. Radiologic findings with respect to normal positioning, wrong positioning, and complications are described and illustrated. (author)

Gender bias revisited: new insights on the differential management of chest pain

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Karatolios Konstantinos

2011-06-01

Full Text Available Abstract Background Chest pain is a common complaint and reason for consultation in primary care. Few data exist from a primary care setting whether male patients are treated differently than female patients. We examined whether there are gender differences in general physicians' (GPs initial assessment and subsequent management of patients with chest pain, and how these differences can be explained Methods We conducted a prospective study with 1212 consecutive chest pain patients. The study was conducted in 74 primary care offices in Germany from October 2005 to July 2006. After a follow up period of 6 months, an independent interdisciplinary reference panel reviewed clinical data of every patient and decided about the etiology of chest pain at the time of patient recruitment (delayed type-reference standard. We adjusted gender differences of six process indicators for different models. Results GPs tended to assume that CHD is the cause of chest pain more often in male patients and referred more men for an exercise test (women 4.1%, men 7.3%, p = 0.02 and to the hospital (women 2.9%, men 6.6%, p Conclusions While observed gender differences can not be explained by differences in age, CHD prevalence, and underlying risk factors, the less typical symptom presentation in women might be an underlying factor. However this does not seem to result in suboptimal management in women but rather in overuse of services for men. We consider our conclusions rather hypothesis generating and larger studies will be necessary to prove our proposed model.

Ward-based, nurse-led, outpatient chest tube management: analysis of impact, cost-effectiveness and patient safety.

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Tcherveniakov, Peter; De Siqueira, Jonathan; Milton, Richard; Papagiannopoulos, Kostas

2012-06-01

Prolonged drainage and air leaks are recognized complications of elective and acute thoracic surgery and carry significant burden on inpatient stay and outpatient resources. Since 2007, we have run a ward-based, nurse-led clinic for patients discharged with a chest drain in situ. The aim of this study is to assess its cost-effectiveness and safety. We present a retrospective review of the activity of the clinic for a period of 12 months (November 2009-10). An analysis of the gathered data is performed, focusing specifically on the duration of chest tube indwelling, the indications, complications and cost efficiency. The nurse-led clinic was housed in the thoracic ward with no additional fixed costs. Seventy-four patients were reviewed (53 males, 21 females, mean age of 59) and subsequently discharged from the clinic in this time period, accounting for 149 care episodes. Thirty-three (45%) of the patients underwent a video-assisted thoracoscopic surgery procedure, 35 (47%) of them a thoracotomy and 7 (9%) had a bedside chest tube insertion. Following hospital discharge, the chest tubes were removed after a median of 14 days (range 1-82 days). Fifty-eight percent of the patients were reviewed because of a prolonged air leak, 26% for persistent fluid drainage and 16% due to prolonged drainage following evacuation of empyemas. For the care episodes analysed, we estimate that the clinic has generated an income of €24,899 for the department. Hourly staffing costs for the service are significantly lower compared with those of the traditional outpatient clinic: €15 vs. €114. Our results show that a dedicated chest tube monitoring clinic is a safe and efficient alternative to formal outpatient clinic review. It can lead to shorter hospital stays and is cost effective.

High negative pressure subcutaneous suction drain for managing debilitating subcutaneous emphysema secondary to tube thoracostomy for an iatrogenic post computed tomography guided transthoracic needle biopsy pneumothorax: Case report and review of literature.

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Ahmed, Zeeshan; Patel, Pinakin; Singh, Suresh; Sharma, Raj Govind; Somani, Pankaj; Gouri, Abdul Rauf; Singh, Shiv

2016-01-01

Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient. A 72year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx. 3×3cm) at the right hilar region on Chest X-ray. Within 24h of an urgent tube thoracostomy, patient developed intractable subcutaneous emphysema with closure of palpebral fissure and dyspnea unresponsive to increasing suction on chest tube. A subcutaneous fenestrated drain was placed mid-way between the nipple and clavicle in the mid-clavicular line bilaterally. Continuous negative suction (-150mmHg) resulted in immediate, sustained relief and complete resolution within 5days. Extensive and debilitating SE (subcutaneous emphysema) has to be treated promptly to relieve patient discomfort, dysphagia or imminent respiratory compromise. A variety of treatment have been tried including infraclavicular blow-hole incisions, subcutaneous drains +/- negative pressure suction, fenestrated angiocatheters, Vacuum assisted dressings and increasing suction on a pre-existing chest tube. We describe a high negative pressure subcutaneous suction drain which provides immediate and sustained relief in debilitating SE. Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drain provides immediate and sustained relief in extensive and debilitating SE. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Efficacy of short-term versus long-term chest tube drainage following talc slurry pleurodesis in patients with malignant pleural effusions: a randomised trial.

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Goodman, Anna; Davies, Christopher W H

2006-10-01

Talc pleurodesis is commonly used in the palliative treatment of malignant pleural effusions but the shortest and most effective regime has not been determined. In particular, it is not clear when the intercostal drain should be removed following the insertion of sclerosant. We conducted a single-centre, randomised, open trial of drain removal at 24 h versus 72 h following talc slurry pleurodesis. The primary outcome measure was success of pleurodesis (no recurrence of effusion on chest radiograph at 1-month follow-up) and secondary outcome measures included length of hospital stay and mortality. We found no difference between recurrence of pleural effusion in those randomised to drain removal at 24 h and those randomised to drain removal at 72 h (p>0.5). However, length of stay was significantly reduced when the chest drain was removed at 24 h (4 days versus 8 days; p<0.01). Mortality did not differ between the two groups. We conclude that this shorter pleurodesis regime is safe and effective.

Multi-Institutional Evaluation of Digital Tomosynthesis, Dual-Energy Radiography, and Conventional Chest Radiography for the Detection and Management of Pulmonary Nodules.

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Dobbins, James T; McAdams, H Page; Sabol, John M; Chakraborty, Dev P; Kazerooni, Ella A; Reddy, Gautham P; Vikgren, Jenny; Båth, Magnus

2017-01-01

Purpose To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods In this binational, institutional review board-approved, HIPAA-compliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device. Three experienced thoracic radiologists identified true locations of nodules (n = 516, 3-20-mm diameters) with CT and recommended case management by using Fleischner Society guidelines. Five other radiologists marked nodules and indicated case management by using images from conventional chest radiography, conventional chest radiography plus DE imaging, tomosynthesis, and tomosynthesis plus DE imaging. Sensitivity, specificity, and overall accuracy were measured by using the free-response receiver operating characteristic method and the receiver operating characteristic method for nodule detection and case management, respectively. Results were further analyzed according to nodule diameter categories (3-4 mm, >4 mm to 6 mm, >6 mm to 8 mm, and >8 mm to 20 mm). Results Maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography in all nodule size categories (3.55-fold for all nodules, P chest radiography for all nodules (1.49-fold, P chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P chest radiography or tomosynthesis. Conclusion Tomosynthesis outperformed conventional chest radiography for lung nodule detection and determination of case management; DE imaging did not show significant differences over conventional chest

Surgical management for the first 48 h following blunt chest trauma: state of the art (excluding vascular injuries).

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de Lesquen, Henri; Avaro, Jean-Philippe; Gust, Lucile; Ford, Robert Michael; Beranger, Fabien; Natale, Claudia; Bonnet, Pierre-Mathieu; D'Journo, Xavier-Benoît

2015-03-01

This review aims to answer the most common questions in routine surgical practice during the first 48 h of blunt chest trauma (BCT) management. Two authors identified relevant manuscripts published since January 1994 to January 2014. Using preferred reporting items for systematic reviews and meta-analyses statement, they focused on the surgical management of BCT, excluded both child and vascular injuries and selected 80 studies. Tension pneumothorax should be promptly diagnosed and treated by needle decompression closely followed with chest tube insertion (Grade D). All traumatic pneumothoraces are considered for chest tube insertion. However, observation is possible for selected patients with small unilateral pneumothoraces without respiratory disease or need for positive pressure ventilation (Grade C). Symptomatic traumatic haemothoraces or haemothoraces >500 ml should be treated by chest tube insertion (Grade D). Occult pneumothoraces and occult haemothoraces are managed by observation with daily chest X-rays (Grades B and C). Periprocedural antibiotics are used to prevent chest-tube-related infectious complications (Grade B). No sign of life at the initial assessment and cardiopulmonary resuscitation duration >10 min are considered as contraindications of Emergency Department Thoracotomy (Grade C). Damage Control Thoracotomy is performed for either massive air leakage or refractive shock or ongoing bleeding enhanced by chest tube output >1500 ml initially or >200 ml/h for 3 h (Grade D). In the case of haemodynamically stable patients, early video-assisted thoracic surgery is performed for retained haemothoraces (Grade B). Fixation of flail chest can be considered if mechanical ventilation for 48 h is probably required (Grade B). Fixation of sternal fractures is performed for displaced fractures with overlap or comminution, intractable pain or respiratory insufficiency (Grade D). Lung herniation, traumatic diaphragmatic rupture and pericardial rupture are life

Operative intercostal chest drain is not required following extrapleural or transpleural esophageal atresia repair.

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Paramalingam, Saravanakumar; Burge, David M; Stanton, Michael P

2013-08-01

Approximately half of the United Kingdom patients undergoing esophageal atresia (OA) repair have an operative intercostal chest drain (ICD) placed (2008 British Association of Pediatric Surgeons Congenital Anomalies Surveillance Study data). We reviewed our experience of OA repairs to evaluate if an ICD placement is necessary. Patients with OA/distal tracheoesophageal fistula (TOF), treated between January 1990 and January 2010, were identified by retrospective review of a prospectively maintained electronic database and patient case notes. A total of 112 consecutive patients were identified, of whom 107 were included (73 male). Five were excluded as no case notes were available. Median birth weight was 2,597 g (range 924 to 4,245 g) and median gestational age was 38 weeks (27 to 41 weeks). Median age at discharge was 22 days (3 to 440 days) and median follow-up was 3.5 years (0 to 18 years). Patients were analyzed in two groups-group 1 (n = 73) had an extrapleural (EP) repair, of which 23 had a pleural breach and group 2 (n = 34) had a purposeful transpleural (TP) approach (surgeon preference). Eleven patients (10%) had an operative ICD, of which six patients were in group 1 and five in group 2. These 11 patients had an uncomplicated postoperative course and all operative ICD were removed within 48 hours of surgery. Of the 96 patients that did not have an operative ICD, only 2 (2%) required postoperative intervention. One patient, in group 2, had a postoperative ICD inserted for a simple pneumothorax at 12 hours and removed at 48 hours. The other patient, in group 1, had a clinically detected anastomotic leak after 48 hours and required operative repair. An operative ICD is not required following OA/distal TOF repair, whether the approach is EP or TP. ICD that were electively placed (in 10%) served no clinical purpose. Georg Thieme Verlag KG Stuttgart · New York.

Descending Necrotising Mediastinitis: A Case Report Illustrating a Trend in Conservative Management

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B. A. P. Jayasekera

2012-01-01

Full Text Available The mortality rate from descending necrotising mediastinitis (DNM has declined since its first description in 1938. The decline in mortality has been attributed to earlier diagnosis by way of contrast-enhanced computed tomographic (CT scanning and aggressive surgical intervention in the form of transthoracic drainage. We describe a case of DNM with involvement of anterior and posterior mediastinum down to the diaphragm, managed by cervicotomy and transverse cervical drainage with placement of corrugated drains and a pleural chest drain, with a delayed mediastinoscopy and mediastinal drain placement. We advocate a conservative approach with limited debridement and emphasis on drainage of infection in line with published case series.

Pleural Drainage and its Role in Management of the Isolated Penetrating Chest Injuries During the War Time in Sarajevo, 1992.-1995.

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Ademir Hadžismajlović

2007-05-01

Full Text Available Penetrating chest injuries are the most frequent causes of serious demage and death in wounded indivisuals. In reports from the last wars where wounds caused by high velocity projectiles predominated, thoracotomies were perfomed in about 15% of the wounded individuals, mostly encompassing injuries of the heart and great vessels, accomanied by massive bleeding that could not be resolved by chest tube insertion. This retrospective analysis was performed on the medical records of 477 patients tretaed for isolated penetrating chest injuries in Department of Thoracic Surgery Clinical Center of the University in Sarajevo between april 1992 - june 1995. We analised the ways of their menagement with special view on pleural drainage, indication for this method and results of treatment. 398 (83,4% wounded individuals have been treated with pleural tube inserting as definitive mesaure and for the urgent thoracotomy there were 79 (16,6% patients left. Average hospital treatment in wounded drained patients was 7,68 days. With shrapnels there were 357 (74,84% wounded individuals, and with bullet 120 (25,16% wounded individuals. The complications of plaural tube inserting were - empyema in 34 (7,13% patients and there were no other complications. Chest tube inserting as definitive mesaure was used in 398 (83,44% patients. Chest tube inserting as preoperative measure (urgent thoracotomy was used in 79 (16,56% patients. There were 460 (96,44% healed patients. Death occurred in 17 (3,56% patients.

Pleural drainage and its role in management of the isolated penetrating chest injuries during the war time in Sarajevo, 1992.-1995.

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Hadzismajlović, Ademir; Pilav, Alen

2007-05-01

Penetrating chest injuries are the most frequent causes of serious demage and death in wounded indivisuals. In reports from the last wars where wounds caused by high velocity projectiles predominated, thoracotomies were perfomed in about 15% of the wounded individuals, mostly encompassing injuries of the heart and great vessels, accomanied by massive bleeding that could not be resolved by chest tube insertion. This retrospective analysis was performed on the medical records of 477 patients tretaed for isolated penetrating chest injuries in Department of Thoracic Surgery Clinical Center of the University in Sarajevo between april 1992 - june 1995. We analised the ways of their menagement with special view on pleural drainage, indication for this method and results of treatment. 398 (83,4%) wounded individuals have been treated with pleural tube inserting as definitive mesaure and for the urgent thoracotomy there were 79 (16,6%) patients left. Average hospital treatment in wounded drained patients was 7,68 days. With shrapnels there were 357 (74,84%) wounded individuals, and with bullet 120 (25,16%) wounded individuals. The complications of plaural tube inserting were - empyema in 34 (7,13%) patients and there were no other complications. Chest tube inserting as definitive mesaure was used in 398 (83,44%) patients. Chest tube inserting as preoperative measure (urgent thoracotomy) was used in 79 (16,56%) patients. There were 460 (96,44%) healed patients. Death occurred in 17 (3,56%) patients.

Influence of pleural drain insertion in lung function of patients undergoing coronary artery bypass grafting.

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Ozelami Vieira, Irinea Beatriz Carvalho; Vieira, Fabiano F; Abrão, João; Gastaldi, Ada Clarice

2012-01-01

Longitudinal, prospective, randomized, blinded Trial to assess the influence of pleural drain (non-toxic PVC) site of insertion on lung function and postoperative pain of patients undergoing coronary artery bypass grafting in the first three days post-surgery and immediately after chest tube removal. Thirty six patients scheduled for elective myocardial revascularization with cardiopulmonary bypass (CPB) were randomly allocated into two groups: SX group (subxiphoid) and IC group (intercostal drain). Spirometry, arterial blood gases, and pain tests were recorded. Thirty one patients were selected, 16 in SX group and 15 in IC group. Postoperative (PO) spirometric values were higher in SX than in IC group (ppleural drain location on breathing. PaO(2) on the second PO increased significantly in SX group compared with IC group (pDrain with insertion in the subxiphoid region causes less change in lung function and discomfort, allowing better recovery of respiratory parameters. Copyright © 2012 Elsevier Editora Ltda. All rights reserved.

Enfisema subcutâneo maciço - Tratamento com drenos subcutâneos Massive subcutaneous emphysema - Management using subcutaneous drains

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Maria Sucena

2010-04-01

Full Text Available O enfisema subcutâneo é uma complicação relativamente comum na sequência de técnicas invasivas, procedimentos cirúrgicos e algumas patologias médicas. Na maior parte dos casos apenas causa sintomatologia minor e o tratamento é habitualmente conservador. Mesmo quando grave, raramente tem consequências patofisiológicas significativas, apesar de ser extremamente desconfortável para o doente. Os autores descrevem um caso clínico de enfisema subcutâneo maciço, de rápida instalação, após saída acidental de tubo de drenagem torácica, em doente com pneumotórax espontâneo secundário e fístula broncopleural. O enfisema foi tratado através da colocação, sob anestesia local, de dois drenos subcutâneos na parede anterossuperior do tórax, conectados a sacos de drenagem. Após a colocação dos drenos subcutâneos verificou-se uma franca melhoria clínica do doente, com descompressão eficaz do enfisema subcutâneo. No presente caso clínico, a técnica de drenagem do enfisema maciço mostrou-se simples, segura e eficaz, permitindo o alívio sintomático imediato.Massive subcutaneous emphysema is a relatively common complication in invasive techniques, surgical practice and some medical conditions. Subcutaneous emphysema is usually treated conservatively and may only cause minimal symptoms. Even when it is severe, subcutaneous emphysema rarely has pathophysiologic consequences, but it is extremely uncomfortable for the patient. The authors report a case of massive and rapid developing subcutaneous emphysema following chest tube displacement in a patient with spontaneous secondary pneumothorax and large air leak. The emphysema was treated with two subcutaneous drains, inserted using local anesthesia, on both sides of the chest (antero-superior thoracic wall, connected to drainage bags. The drains produced a dramatic clinical improvement and provided effective decompression of the subcutaneous emphysema. In this clinical case, the

Resource reduction in pediatric chest pain: Standardized clinical assessment and management plan.

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Saleeb, Susan F; McLaughlin, Sarah R; Graham, Dionne A; Friedman, Kevin G; Fulton, David R

2018-01-01

Using a Standardized Clinical Assessment and Management Plan (SCAMP) for pediatric patients presenting to clinic with chest pain, we evaluated the cost impact associated with implementation of the care algorithm. Prior to introduction of the SCAMP, we analyzed charges for 406 patients with chest pain, seen in 2009, and predicted 21% reduction of overall charges had the SCAMP methodology been used. The SCAMP recommended an echocardiogram for history, examination, or ECG findings suggestive of a cardiac etiology for chest pain. Resource utilization was reviewed for 1517 patients (7-21 years) enrolled in the SCAMP from July 2010 to April 2014. Compared to the 2009 historic cohort, patients evaluated by the SCAMP had higher rates of exertional chest pain (45% vs 37%) and positive family history (5% vs 1%). The SCAMP cohort had fewer abnormal physical examination findings (1% vs 6%) and abnormal electrocardiograms (3% vs 5%). Echocardiogram use increased in the SCAMP cohort compared to the 2009 historic cohort (45% vs 41%), whereas all other ancillary testing was reduced: exercise stress testing (4% SCAMP vs 28% historic), Holter (4% vs 7%), event monitors (3% vs 10%), and MRI (1% vs 2%). Total charges were reduced by 22% ($822 625) by use of the Chest Pain SCAMP, despite a higher percentage of patients for whom echocardiogram was recommended compared to the historic cohort. The Chest Pain SCAMP effectively streamlines cardiac testing and reduces resource utilization. Further reductions can be made by algorithm refinement regarding echocardiograms for exertional symptoms. © 2017 Wiley Periodicals, Inc.

AIRFIX: the first digital postoperative chest tube airflowmetry--a novel method to quantify air leakage after lung resection.

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Anegg, Udo; Lindenmann, Jorg; Matzi, Veronika; Mujkic, Dzenana; Maier, Alfred; Fritz, Lukas; Smolle-Jüttner, Freyja Maria

2006-06-01

Prolonged air leak after pulmonary resection is a common complication and a major limiting factor for early discharge from hospital. Currently there is little consensus on its management. The aim of this study was to develop and evaluate a measuring device which allows a simple digital bed-side quantification of air-leaks compatible to standard thoracic drainage systems. The measuring device (AIRFIX) is based upon a 'mass airflow' sensor with a specially designed software package that is connected to a thoracic suction drainage system. Its efficacy in detecting pulmonary air-leaks was evaluated in a series of 204 patients; all postoperative measurements were done under standardized conditions; the patients were asked to cough, to take a deep breath, to breathe out against the resistance of a flutter valve, to keep breath and to breathe normally. As standard parameters, the leakage per breath or cough (ml/b) as well as the leakage per minute (ml/min) were displayed and recorded on the computer. Air-leaks within a range of 0.25-45 ml/b and 5-900 ml/min were found. Removal of the chest tubes was done when leakage volume on Heimlich valve was less than 1.0 ml/b or 20 ml/min. After drain removal based upon the data from chest tube airflowmetry none of the patients needed re-drainage due to pneumothorax. The AIRFIX device for bed-side quantification of air-leaks has proved to be very simple and helpful in diagnosis and management of air-leaks after lung surgery, permitting drain removal without tentative clamping.

Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy

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Nirmala Jonnavithula

2015-01-01

Full Text Available Background and Aims: Modified Radical Mastectomy (MRM is the commonly used surgical procedure for operable breast cancer, which involves extensive tissue dissection. Therefore, wound instillation with local anaesthetic may provide better postoperative analgesia than infiltration along the line of incision. We hypothesised that instillation of bupivacaine through chest and axillary drains into the wound may provide postoperative analgesia. Methods: In this prospective randomised controlled study 60 patients aged 45-60 years were divided into three groups. All patients were administered general anaesthesia. At the end of the surgical procedure, axillary and chest wall drains were placed before closure. Group C was the control with no instillation; Group S received 40 ml normal saline, 20 ml through each drain; and Group B received 40 ml of 0.25% bupivacaine and the drains were clamped for 10 min. After extubation, pain score for both static and dynamic pain was evaluated using visual analog scale and then 4 th hourly till 24 h. Rescue analgesia was injection tramadol, if the pain score exceeds 4. Statistical analysis was performed using SPSS version 13. Results : There was a significant difference in the cumulative analgesic requirement and the number of analgesic demands between the groups (P: 0.000. The mean duration of analgesia in the bupivacaine group was 14.6 h, 10.3 in the saline group and 4.3 h in the control group. Conclusion : Wound instillation with local anaesthetics is a simple and effective means of providing good analgesia without any major side-effects.

Management of Septated Malignant Pleural Effusions

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Banka, Radhika; Terrington, Dayle; Mishra, Eleanor K.

2018-01-01

Purpose of Review: We review recent studies of patients with septated malignant pleural effusions, to understand what the clinical implications for patients are and what evidence-based methods should be used to manage these effusions. Recent Findings: Fibrinolytics improve effusion size assessed radiologically in patients with a chest drain inserted for septated malignant pleural effusions but this does not translate into an improvement in breathlessness relief or pleurodesis success. Fibrino...

Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft

OpenAIRE

Guizilini, Solange; Bolzan, Douglas W; Faresin, Sonia M; Ferraz, Raquel F; Tavolaro, Kelly; Cancio, Andrea A; Gomes, Walter J

2012-01-01

Abstract Background Exacerbation of pulmonary dysfunction has been reported in patients receiving a pleural drain inserted through the intercostal space in comparison to patients with an intact pleura undergoing coronary artery bypass grafting (CABG). Evidence suggests that shifting the site of pleural drain insertion to the subxyphoid position minimizes chest wall trauma and preserves respiratory function in the early postoperative period. The aim of this study was to compare the pulmonary f...

Application of the coaxial smart drain in patients with a large air leak following anatomic lung resection: a prospective multicenter phase II analysis of efficacy and safety.

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Guerrera, Francesco; Filosso, Pier Luigi; Pompili, Cecilia; Olivetti, Stefania; Roffinella, Matteo; Imperatori, Andrea; Brunelli, Alessandro

2018-01-01

The presence of air leak following lung resection remains a frequent problem, which may prolong hospital stay and increase hospital costs. In the past, some studies documented the efficacy of soft and flexible chest tube in patients who underwent thoracic surgery. Nevertheless, safety in case of post-operative large air or liquid leak remains questionable. The objective of this study was to verify through a multicentre study the safety and the effectiveness of the coaxial chest tube in a consecutive series of selected patients who underwent anatomical pulmonary resection and with an active and large air leak. Between October 2016 and September 2017, data from patients submitted to anatomical lung resection with curative intent and operated in two Department of Thoracic Surgery of two different were prospectively collected. The inclusion criteria consisted in the presence of an air leak greater than 50 mL/min measured with a digital drainage system during the 3 postoperative hours. A descriptive statistic was used to report the incidence of complications assumed to be associated with the use of the coaxial drain. Forty-eight consecutive patients (27 males) submitted to lobectomy (37 patients: 77%) or anatomic segmentectomies (11 patients) were included in the analyses. Thirty-four operations (71%) were performed by video-assisted thoracic surgery (VATS). The median duration of chest tubes was 13 days [interquartile range (IQR), 4-19] and the median duration of air leak was 9 days (IQR, 2-17.5). No patient had undrained postoperative pleural effusion judged to require an additional chest tube placement. There were 12 (25%) cases of clinically or radiologically significant surgical emphysema; in none of these patients any additional procedure or re-operation was required, and they were treated conservatively by increasing the level of suction. Our experience with this novel Coaxial Drain was satisfactory with no clinically relevant complication caused using this drain

Application of the coaxial smart drain in patients with a large air leak following anatomic lung resection: a prospective multicenter phase II analysis of efficacy and safety

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Filosso, Pier Luigi; Pompili, Cecilia; Olivetti, Stefania; Roffinella, Matteo; Imperatori, Andrea; Brunelli, Alessandro

2018-01-01

Background The presence of air leak following lung resection remains a frequent problem, which may prolong hospital stay and increase hospital costs. In the past, some studies documented the efficacy of soft and flexible chest tube in patients who underwent thoracic surgery. Nevertheless, safety in case of post-operative large air or liquid leak remains questionable. The objective of this study was to verify through a multicentre study the safety and the effectiveness of the coaxial chest tube in a consecutive series of selected patients who underwent anatomical pulmonary resection and with an active and large air leak. Methods Between October 2016 and September 2017, data from patients submitted to anatomical lung resection with curative intent and operated in two Department of Thoracic Surgery of two different were prospectively collected. The inclusion criteria consisted in the presence of an air leak greater than 50 mL/min measured with a digital drainage system during the 3 postoperative hours. A descriptive statistic was used to report the incidence of complications assumed to be associated with the use of the coaxial drain. Results Forty-eight consecutive patients (27 males) submitted to lobectomy (37 patients: 77%) or anatomic segmentectomies (11 patients) were included in the analyses. Thirty-four operations (71%) were performed by video-assisted thoracic surgery (VATS). The median duration of chest tubes was 13 days [interquartile range (IQR), 4–19] and the median duration of air leak was 9 days (IQR, 2–17.5). No patient had undrained postoperative pleural effusion judged to require an additional chest tube placement. There were 12 (25%) cases of clinically or radiologically significant surgical emphysema; in none of these patients any additional procedure or re-operation was required, and they were treated conservatively by increasing the level of suction. Conclusions Our experience with this novel Coaxial Drain was satisfactory with no clinically

Investigation of radiation safety management at nuclear medicine facilities in Japan. Contamination of radioactivity in the draining-water system

International Nuclear Information System (INIS)

Endo, Keigo; Koizumi, Mitsuru; Kinoshita, Fujimi; Nakazawa, Keiji

1999-01-01

Radiation-safety management condition in Japanese nuclear medicine facilities were investigated by the questionnaire method. The first questionnaire was asked in all Japanese 1,401 Nuclear Medicine facilities. Answers from 624 institutes (44.5%) were received and analyzed. The radiation-safety management in nuclear medicine institutes was considered to be very well performed everyday. Opinion for the present legal control of nuclear medicine institutes was that the regulation in Japan was too strict for the clinical use of radionuclides. The current regulation is based on the assumption that 1% of all radioactivity used in nuclear medicine institutes contaminates into the draining-water system. The second questionnaire detailing the contamination of radioactivity in the draining-water system was sent to 128 institutes, and 64 answers were received. Of them, 42 institutes were considered to be enough to evaluate the contamination of radioactivity in the draining-water system. There was no difference between 624 institutes answered to the first questionnaire and 42 institutes, where the radioactivity in the draining-water system measured, in the distribution of the institute size, draining-water system equipment and the radioactivity measuring method, and these 42 institutes seemed to be representative of Japanese nuclear medicine institutes. Contamination rate of radioactivity into the draining system was calculated by the value of radioactivity in the collecting tank divided by the amount of radionuclides used daily in each institute. The institutes were divided into two categories on the basis of nuclear medicine practice pattern; type A: in-vivo use only and type B: both in-vivo and in-vitro use. The contamination rate in 27 type A institutes did not exceed 0.01%, whereas in 15 type B institutes the contamination rate distributed widely from undetectable to above 1%. These results indicated that the present regulation for the draining-water system, which assumed

Greenhouse gas balances in low-productive drained boreal peatlands - is climate-friendly management possible?

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Ojanen, Paavo; Minkkinen, Kari; Heikkinen, Tiina; Penttilä, Timo

2016-04-01

Five million hectares of peatland has been drained for forestry in Finland. About 20% of that, i.e. one million hectares, has been estimated to be so low-productive that the profitability of keeping them in forestry is questionable. At the same time, drainage has introduced changes in the ecosystem functions of these peatlands, including fluxes of greenhouse gases. Options to manage such peatlands include for example 1) no measures, i.e. leaving the drained peatlands as they are 2) increasing intensity by e.g. repetitive fertilisations and 3) restoration back to functional peatlands. Here we estimate the greenhouse gas impacts of these three management options. We collected GHG and organic carbon flux data from 50 low-productive peatlands under these management options over two years 2014-2015. Gas fluxes (CO2, CH4, N2O) were measured with closed chambers. Litter production rates of different plants above and below ground were estimated using litter traps (trees), biomass sampling (roots), through-grow nets (mosses), allometric biomass models (other vasculars) and published turnover rates (roots, other vasculars). Characteristics for estimating tree stand biomass increment were measured at each site from circular sample plots. In this presentation we will estimate the GHG impacts for the different management options, and aim to find the most climate-friendly options for the management of low-productive peatlands in the short and long term. This work was funded by Life+ LIFE12/ENV/FI/150.

Management of rib fractures in traumatic flail chest: a meta-analysis of randomised controlled trials.

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Coughlin, T A; Ng, J W G; Rollins, K E; Forward, D P; Ollivere, B J

2016-08-01

Flail chest from a blunt injury to the thorax is associated with significant morbidity and mortality. Its management globally is predominantly non-operative; however, there are an increasing number of centres which undertake surgical stabilisation. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management. A systematic search of the literature was carried out to identify randomised controlled trials (RCTs) which compared the clinical outcome of patients with a traumatic flail chest treated by surgical stabilisation of any kind with that of non-operative management. Of 1273 papers identified, three RCTs reported the results of 123 patients with a flail chest. Surgical stabilisation was associated with a two thirds reduction in the incidence of pneumonia when compared with non-operative management (risk ratio 0.36, 95% confidence interval (CI) 0.15 to 0.85, p = 0.02). The duration of mechanical ventilation (mean difference -6.30 days, 95% CI -12.16 to -0.43, p = 0.04) and length of stay in an intensive care unit (mean difference -6.46 days, 95% CI 9.73 to -3.19, p = 0.0001) were significantly shorter in the operative group, as was the overall length of stay in hospital (mean difference -11.39, 95% CI -12.39 to -10.38, p < 0.0001). Surgical stabilisation for a traumatic flail chest is associated with significant clinical benefits in this meta-analysis of three relatively small RCTs. Cite this article: Bone Joint J 2016;98-B:1119-25. ©2016 The British Editorial Society of Bone & Joint Surgery.

Laparoscopic primary repair and isoperistaltic endoluminal drain for Boerhaave's Syndrome.

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Prete, Francesco; Pezzolla, Angela; Nitti, Paolo; Prete, Fernando

2015-01-01

Spontaneous oesophageal rupture, also known as Boerhaave syndrome (BS), is a rare and potentially lethal pathological condition. BS recognition is difficult, while rapidity of diagnosis, along with extension of the lesion, affects type and outcome of treatment. BS was classically treated by thoracotomy, but laparoscopic (LS), thoracoscopic (TS) surgery, and nonsurgical procedures as endoscopic stent positioning or use of glues have been described. Still, there is no model treatment, and selection of the most appropriate therapeutic procedure is complex in the absence of standardised criteria. We successfully managed a patient affected with BS by LS approach and present our experience along with a review of treatment options so far described. Our treatment integrated positioning of an oesophageal isoperistaltic endoluminal drain (IED), that we routinely use in oesophageal sutures at risk of leakage, and of which there is no previous report in the setting of BS. A 68 year old man presented to our attention with true BS, suspected on chest-abdominal CT scan and confirmed by upper GI contrast swallow test, showing leakage of hydro-soluble contrast from the lower third of the oesophagus. Of note, pleural cavities appeared intact. We performed an urgent laparoscopy 12 hours after the onset of symptoms. Laparoscopic toilet of the inferior mediastinum and dual layer oesophageal repair with pedicled omental flap were complemented by positioning of IED, feeding jejunostomy and two tubular drains. The patient had a slow but consistent recovery where IED played as a means of oesophageal suture protection, until he could be discharged home. We think that, when integrity of the pleura is documented, LS should be priority choice to avoid contamination of the pleural cavities. We have to consider every type of oesophageal repair in BS at risk of failure, and every means of protection of the suture is opportune. In our patient the oesophageal suture, covered with a flap of omentum

The impact of a chest tube management protocol on the outcome of trauma patients with tube thoracostomy.

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de Abreu, Emanuelle Maria Sávio; Machado, Carla Jorge; Pastore Neto, Mario; de Rezende Neto, João Baptista; Sanches, Marcelo Dias

2015-01-01

to investigate the effect of standardized interventions in the management of tube thoracostomy patients and to assess the independent effect of each intervention. A chest tube management protocol was assessed in a retrospective cohort study. The tube thoracostomy protocol (TTP) was implemented in August 2012, and consisted of: antimicrobial prophylaxis, chest tube insertion in the operating room (OR), admission post chest tube thoracostomy (CTT) in a hospital floor separate from the emergency department (ED), and daily respiratory therapy (RT) sessions post-CTT. The inclusion criteria were, hemodynamic stability, patients between the ages of 15 and 59 years, and injury severity score (ISS) chest wall, lung, and pleura. During the study period 92 patients were managed according to the standardized protocol. The outcomes of those patients were compared to 99 patients treated before the TTP. Multivariate logistic regression analysis was performed to assess the independent effect of each variable of the protocol on selected outcomes. Demographics, injury severity, and trauma mechanisms were similar among the groups. As expected, protocol compliance increased after the implementation of the TTP. There was a significant reduction (pchest tube days. Respiratory therapy was independently linked to significant reduction (pchest tube insertion was associated with significant (ptrauma patients.

Occult pneumothorax in Chinese patients with significant blunt chest trauma: incidence and management.

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Lee, Ka L; Graham, Colin A; Yeung, Janice H H; Ahuja, Anil T; Rainer, Timothy H

2010-05-01

Occult pneumothorax (OP) is a pneumothorax not visualised on a supine chest X-ray (CXR) but detected on computed tomography (CT) scanning. With increasing CT use for trauma, more OP may be detected. Management of OP remains controversial, especially for patients undergoing mechanical ventilation. This study aimed to identify the incidence of OP using thoracic CT as the gold standard and describe its management amongst Hong Kong Chinese trauma patients. Analysis of prospectively collected trauma registry data. Consecutive significantly injured trauma patients admitted through the emergency department (ED) suffering from blunt chest trauma who underwent thoracic computed tomography (TCT) between in calendar years 2007 and 2008 were included. An OP was defined as the identification (by a specialist radiologist) of a pneumothorax on TCT that had not been previously detected on supine CXR. 119 significantly injured patients were included. 56 patients had a pneumothorax on CXR and a further 36 patients had at least one OP [OP incidence 30% (36/119)]. Bilateral OP was present in 8/36 patients, so total OP numbers were 44. Tube thoracostomy was performed for 8/44 OP, all were mechanically ventilated in the ED. The remaining 36 OP were managed expectantly. No patients in the expectant group had pneumothorax progression, even though 8 patients required subsequent ventilation in the operating room for extrathoracic surgery. The incidence of OP (seen on TCT) in Chinese patients in Hong Kong after blunt chest trauma is higher than that typically reported in Caucasians. Most OP were managed expectantly without significant complications; no pneumothorax progressed even though some patients were mechanically ventilated. (c) 2010 Elsevier Ltd. All rights reserved.

Does reporting of plain chest radiographs affect the immediate management of patients admitted to a medical assessment unit?

International Nuclear Information System (INIS)

Grosvenor, L.J.; Verma, R.; O'Brien, R.; Entwisle, J.J.; Finlay, D.

2003-01-01

AIM: The purpose of our study was to investigate whether reporting of plain chest radiographs affects immediate management of patients admitted to a medical assessment unit. MATERIALS AND METHODS: During a 3 month period we prospectively evaluated 200 patients who had a plain chest radiograph on admission. After the post on-call ward round, an independent medical specialist registrar reviewed the notes, retrieving relevant clinical details. The plain chest films were reported independently by a trainee radiologist and consultant, reaching a consensus report. RESULTS: There was 93% agreement between trainee and consultant radiologists (95% CI=89-96%). Seventy percent had documented reports by the on-call medical team. There was disagreement between radiology and medical reports in 49% of reported films (95% CI=40-57%). The radiologist's report led to a direct change in the immediate management of 22 patients (11%). CONCLUSION: Only 70% of films had documented reports in the clinical notes despite this being a legal requirement. Radiology reporting does cause a direct change in patient management. Chest radiographs of patients admitted to a medical admissions unit should be reported by a radiologist with the minimum of delay

Chest X-Ray (Chest Radiography)

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... Resources Professions Site Index A-Z X-ray (Radiography) - Chest Chest x-ray uses a very small dose ... Radiography? What is a Chest X-ray (Chest Radiography)? The chest x-ray is the most commonly performed diagnostic ...

New Guidelines for the Management of Chest Pain: Lessons From a Recent Audit in Tauranga, New Zealand

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Chapman, Andrew R; Leslie, Stephen J; Sage, Derek K

2012-01-01

Background Protocol based care is known to improve the outcomes of patients admitted with recent onset chest pain. The aim of this clinical review was to investigate chest pain management, using newly published guidance from NICE, in the emergency department of a regional hospital in New Zealand. Methods All admissions with chest pain during the period of September-October 2010 were identified retrospectively (n = 599), and a sufficiently powered random sample (n = 120) taken. Relevant data was identified from patient notes, including basic demographics and specific management details. Results One hundred and eighteen patients were analysed (M = 65, F = 53), 99.2% received an ECG on admission, yet only 59.3% of patients had documented evidence of a repeat ECG, with admissions during the day less likely to receive one compared to those admitted overnight (51.5% vs 69.2%, P = 0.04). Younger patients (< 39 years) appeared less likely to receive aspirin than older patients (38.9% vs 80.0%, P = 0.06), 21.3% of patients failed to receive 300 mg aspirin, and 45.6% of patients received oxygen despite normal saturations. Conclusions Despite good performance in a number of areas, this clinical review has highlighted that some standards, such as repeat ECGs, administration of aspirin therapy and appropriate use of oxygen are not being met in all patients with chest pain. A chest pain management pathway is to be implemented for all relevant admissions, to ensure that essential aspects of care are not missed. Timely dissemination and implementation of new clinical guidelines remains a challenge in clinical practice. PMID:28357018

Effects of pond draining on biodiversity and water quality of farm ponds.

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Usio, Nisikawa; Imada, Miho; Nakagawa, Megumi; Akasaka, Munemitsu; Takamura, Noriko

2013-12-01

Farm ponds have high conservation value because they contribute significantly to regional biodiversity and ecosystem services. In Japan pond draining is a traditional management method that is widely believed to improve water quality and eradicate invasive fish. In addition, fishing by means of pond draining has significant cultural value for local people, serving as a social event. However, there is a widespread belief that pond draining reduces freshwater biodiversity through the extirpation of aquatic animals, but scientific evaluation of the effectiveness of pond draining is lacking. We conducted a large-scale field study to evaluate the effects of pond draining on invasive animal control, water quality, and aquatic biodiversity relative to different pond-management practices, pond physicochemistry, and surrounding land use. The results of boosted regression-tree models and analyses of similarity showed that pond draining had little effect on invasive fish control, water quality, or aquatic biodiversity. Draining even facilitated the colonization of farm ponds by invasive red swamp crayfish (Procambarus clarkii), which in turn may have detrimental effects on the biodiversity and water quality of farm ponds. Our results highlight the need for reconsidering current pond management and developing management plans with respect to multifunctionality of such ponds. Efectos del Drenado de Estanques sobre la Biodiversidad y la Calidad del Agua en Estanques de Cultivo. © 2013 Society for Conservation Biology.

What are the Advantages? A Prospective Analysis of 16 versus 28 French Chest Tube Sizes in Video-assisted Thoracoscopic Surgery Lobectomy of Lung Cancer

Directory of Open Access Journals (Sweden)

Mei YANG

2015-08-01

Full Text Available Background and objective Post-operation management of minimally invasive thoracic surgery is similar to that of open surgery, especially on the drainage tube of the chest. The aim of this study is to compare the advantages of using 16 F versus 28 F chest tubes in video-assisted thoracoscopic surgery (VATS lobectomy of lung cancer. Methods Data from 163 patients (February-May 2014 who underwent VATS lobectomy of lung cancer with insertion of one chest drain (16 F or 28 F were analyzed. The following post-operative data were evaluated: primary healing of tube incision, CXR abnormalities (pneumothorax, fluid, atelectasis, subcutaneous emphysema, and hematoma, drainage time, new drain insertion, and wound healing at the site of insertion. Results A total of 75 patients received 28 F chest tubes, and 88 patients received 16 F chest tubes. Both groups were similar in age, gender, comorbidities, and pathological evaluation of resection specimens. After adjustment, no statistically significant difference was found between the two groups in relation to tube-related complications including residual pneumothoraces (4.00% vs 4.44%; P=0.999, subcutaneous emphysema (8.00% vs 6.67%; P=0.789, retained hemothorax (0 vs 41%, P=0.253, and drainage time [(28.4±16.12 h vs (22.1±11.8 h; P=0.120] The average total drainage volume and rrhythmia rates of the 16 F group [(365±106 mL, 14.67%] was less than that of the 28 F group [(665±217 mL, 4.5%; P=0.030, P=0.047]. The rates of primary healing at the site of insertion in the 16 F group (95.45% was higher than that in the 28 F group (77.73%, P=0.039. A significant difference was found on the post-operative length of stay of the two groups [(4.23±0.05 d vs (4.57±0.16 d, P=0.078]. Conclusion The use of 16 F chest tube for VATS lobectomy of patients with lung cancer did not affect the clinically relevant outcomes tested. However, 16 F chest tube facilitated faster wound healing at the site of insertion.

Chest pain in daily practice: occurrence, causes and management.

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Verdon, François; Herzig, Lilli; Burnand, Bernard; Bischoff, Thomas; Pécoud, Alain; Junod, Michel; Mühlemann, Nicole; Favrat, Bernard

2008-06-14

We assessed the occurrence and aetiology of chest pain in primary care practice. These features differ between primary and emergency care settings, where most previous studies have been performed. 59 GPs in western Switzerland recorded all consecutive cases presenting with chest pain. Clinical characteristics, laboratory tests and other investigations as well as the diagnoses remaining after 12 months of follow-up were systematically registered. Among 24,620 patients examined during a total duration of 300 weeks of observation, 672 (2.7%) presented with chest pain (52% female, mean age 55 +/- 19(SD)). Most cases, 442 (1.8%), presented new symptoms and in 356 (1.4%) it was the reason for consulting. Over 40 ailments were diagnosed: musculoskeletal chest pain (including chest wall syndrome) (49%), cardiovascular (16%), psychogenic (11%), respiratory (10%), digestive (8%), miscellaneous (2%) and without diagnosis (3%). The three most prevalent diseases were: chest wall syndrome (43%), coronary artery disease (12%) and anxiety (7%). Unstable angina (6), myocardial infarction (4) and pulmonary embolism (2) were uncommon (1.8%). Potentially serious conditions including cardiac, respiratory and neoplasic diseases accounted for 20% of cases. A large number of laboratory tests (42%), referral to a specialist (16%) or hospitalisation (5%) were performed. Twentyfive patients died during follow-up, of which twelve were for a reason directly associated with thoracic pain [cancer (7) and cardiac causes (5)]. Thoracic pain was present in 2.7% of primary care consultations. Chest wall syndrome pain was the main aetiology. Cardio - vascular emergencies were uncommon. However chest pain deserves full consideration because of the occurrence of potentially serious conditions.

Drains and Drainage Capabilities: Quantitative Analysis of Drain Efficiencies

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Andaç Aykan

2016-03-01

Full Text Available Objective: In this study, it was aimed to compare the efficiency of the same type of but different-sized silicone drains at different surgical procedures. Material and Methods: Twenty-four patients, who had different diagnoses and were operated between 2011 and 2013, were included. In all patients, 7- and 10-mm silicone-ended, Jackson–Pratt drains were used. Drains that were under 30 cc/day removed. The connection tube and perforated silicone end were examined due to the clot content. All drain efficiencies were calculated, and the results were statistically analyzed. Results: Seven of the 24 patients (29.2% were males and 17 (70.8% were females; the mean age was 39.0±11.4 years. Totally, 49 drains were used, of which 25 (51% were 7 mm and 24 (49% were 10 mm in size. Median removal time was the 5th day (2–12 for the 7-mm drains and the 6th day (3–14 for the 10-mm drains. There was no statistically significant difference between the groups for drain removal time (p=0.268. Further, there was no difference at the connection tube and silicone end for clot content between the 7- and 10-mm drains (p=0.58. For the drainage volume and efficiency, no difference was observed between the groups (p=0.146. Conclusion: In this study it was observed that there is no difference in the drainage volume and efficiency between different-sized Jackson–Pratt drains.

Chest Trauma in Athletic Medicine.

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Phillips, Nicholas R; Kunz, Derek E

2018-03-01

While overall sports participation continues at high rates, chest injuries occur relatively infrequently. Many conditions of chest injury are benign, related to simple contusions and strains, but the more rare, severe injuries carry a much higher risk of morbidity and mortality than the typical issues encountered in athletic medicine. Missed or delayed diagnosis can prove to be catastrophic. Sports medicine providers must be prepared to encounter a wide range of traumatic conditions relating to the torso, varying from the benign chest wall contusion to the life-threatening tension pneumothorax. Basic field-side management should be rapid and focused, using the standardized approach of Advanced Traumatic Life Support protocol. Early and appropriate diagnosis and management can help allow safe and enjoyable sports participation.

To drain or not to drain? Predictors of tube thoracostomy insertion and outcomes associated with drainage of traumatic hemothoraces.

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Wells, Bryan J; Roberts, Derek J; Grondin, Sean; Navsaria, Pradeep H; Kirkpatrick, Andrew W; Dunham, Michael B; Ball, Chad G

2015-09-01

Historical data suggests that many traumatic hemothoraces (HTX) can be managed expectantly without tube thoracostomy (TT) drainage. The purpose of this study was to identify predictors of TT, including whether the quantity of pleural blood predicted tube placement, and to evaluate outcomes associated with TT versus expected management (EM) of traumatic HTXs. A retrospective cohort study of all trauma patients with HTXs and an Injury Severity Score (ISS) ≥12 managed at a level I trauma centre between April 1, 2005 and December 31, 2012 was completed. Mixed-effects models with a subject-specific random intercept were used to identify independent risk factors for TT. Logistic and log-linear regression were used to compute odds ratios (ORs) for mortality and empyema and percent increases in length of hospital and intensive care unit stay between patients managed with TT versus EM, respectively. A total of 635 patients with 749 HTXs were included in the study. Overall, 491 (66%) HTXs were drained while 258 (34%) were managed expectantly. Independent predictors of TT placement included concomitant ipsilateral flail chest [OR 3.03; 95% confidence interval (CI) 1.04-8.80; p=0.04] or pneumothorax (OR 6.19; 95% CI 1.79-21.5; p<0.01) and the size of the HTX (OR per 10cc increase 1.12; 95% CI 1.04-1.21; p<0.01). Although the adjusted odds of mortality were not significantly different between groups (OR 3.99; 95% CI 0.87-18.30; p=0.08), TT was associated with a 47.14% (95% CI, 25.57-69.71%; p<0.01) adjusted increase in hospital length of stay. Empyemas (n=29) only occurred among TT patients. Expectant management of traumatic HTX was associated with a shorter length of hospital stay, no empyemas, and no increase in mortality. Although EM of smaller HTXs may be safe, these findings must be confirmed by a large multi-centre cohort study and randomized controlled trials before they are used to guide practice. Copyright © 2015 Elsevier Ltd. All rights reserved.

Accuracy of chest radiography versus chest computed tomography in hemodynamically stable patients with blunt chest trauma

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Chardoli Mojtaba

2013-12-01

Full Text Available 【Abstract】 Objective: Thoracic injuries are respon- sible for 25% of deaths of blunt traumas. Chest X-ray (CXR is the first diagnostic method in patients with blunt trauma. The aim of this study was to detect the accuracy of CXR versus chest computed tomograpgy (CT in hemodynami- cally stable patients with blunt chest trauma. Methods: Study was conducted at the emergency department of Sina Hospital from March 2011 to March 2012. Hemodynamically stable patients with at least 16 years of age who had blunt chest trauma were included. All patients underwent the same diagnostic protocol which consisted of physical examination, CXR and CT scan respectively. Results: Two hundreds patients (84% male and 16% female were included with a mean age of (37.9±13.7 years. Chin J Traumatol 2013;16(6:351-354 Rib fracture was the most common finding of CXR (12.5% and CT scan (25.5%. The sensitivity of CXR for hemothorax, thoracolumbar vertebra fractures and rib fractures were 20%, 49% and 49%, respectively. Pneumothorax, foreign body, emphysema, pulmonary contusion, liver hematoma and ster- num fracture were not diagnosed with CXR alone. Conclusion: Applying CT scan as the first-line diag- nostic modality in hemodynamically stable patients with blunt chest trauma can detect pathologies which may change management and outcome. Key words: Radiography; Thoracic injuries; Tomography, X-ray computed

Efficacy of the addition of positive airway pressure to conventional chest physiotherapy in resolution of pleural effusion after drainage: protocol for a randomised controlled trial.

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da Conceição Dos Santos, Elinaldo; Lunardi, Adriana Claudia

2015-04-01

Chest drainage for pleural effusion can cause pain and changes in respiratory function. It can also increase the risk of pulmonary complications and impair functional ability, which may increase length of hospital stay and the associated costs. For these reasons, surgical and clinical strategies have been adopted to reduce the duration of chest drainage. To evaluate the efficacy of the addition of intermittent positive airway pressure applied by the Muller reanimator via a rubber facial mask versus conventional physiotherapy on the duration of chest drainage (primary objective), and its effect on the recovery of respiratory function, length of hospital stay and incidence of pulmonary complications (secondary objectives). Randomised, controlled trial. Inpatients with pleural effusion, aged over 18 years, who have had chest drainage in situ for drain will be a transudate output ≤ 200ml over 24hours and full lung expansion on chest radiography, as assessed by a blinded physician. Duration of chest drainage, length of hospital stay, and any pulmonary complications diagnosed during hospitalisation will be recorded. Intention to treat using: survival analysis for duration of chest drainage, and length of hospital stay; analysis of variance for chest-tube output, lung function and peripheral oxygen saturation; and chi-square tests for comparing the incidence of pulmonary complications between groups. Conventional chest physiotherapy and intermittent positive airway pressure breathing are widely indicated for people with pleural effusion and chest drains; however, no studies have evaluated the real benefit of this type of treatment. Our hypothesis is that optimised lung expansion achieved through the application of intermittent positive airway pressure will accelerate the reabsorption of pleural effusion, decrease the duration of chest drainage and respiratory system impairment, reduce the length of hospital stay, and reduce the incidence of pulmonary complications

Non-operative management of right side thoracoabdominal penetrating injuries--the value of testing chest tube effluent for bile.

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De Rezende Neto, João Baptista; Guimarães, Tiago Nunes; Madureira, João Lopo; Drumond, Domingos André Fernandes; Leal, Juliana Campos; Rocha, Aroldo; Oliveira, Rodrigo Guimarães; Rizoli, Sandro B

2009-05-01

While mandatory surgery for all thoracoabdominal penetrating injuries is advocated by some, the high rate of unnecessary operations challenges this approach. However, the consequences of intrathoracic bile remains poorly investigated. We sought to evaluate the outcome of patients who underwent non-operative management of right side thoracoabdominal (RST) penetrating trauma, and the levels of bilirubin obtained from those patients' chest tube effluent. We managed non-operatively all stable patients with a single RST penetrating injury. Chest tube effluent samples were obtained six times within (4-8 h; 12-16 h; 20-24 h; 28-32 h; 36-40 h; 48 h and 72 h) of admission for bilirubin measurement and blood for complete blood count, bilirubin, alanine (ALT) and aspartate aminotransferases (AST) assays. For comparison we studied patients with single left thoracic penetrating injury. Forty-two patients with RST injuries were included. All had liver and lung injuries confirmed by CT scans. Only one patient failed non-operative management. Chest tube bilirubin peaked at 48 h post-trauma (mean 3.3+/-4.1 mg/dL) and was always higher than both serum bilirubin (pchest tube effluent from control group (27 patients with left side thoracic trauma). Serum ALT and AST were higher in RST injury patients (ptrauma appears to be safe. Bile originating from the liver injury reaches the right thoracic cavity but does not reflect the severity of that injury. The highest concentration was found in the patient failing non-operative management. The presence of intrathoracic bile in selected patients who sustain RST penetrating trauma, with liver injury, does not preclude non-operative management. Our study suggests that monitoring chest tube effluent bilirubin may provide helpful information when managing a patient non-operatively.

Efficacy of the addition of positive airway pressure to conventional chest physiotherapy in resolution of pleural effusion after drainage: protocol for a randomised controlled trial

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Elinaldo da Conceição dos Santos

2015-04-01

Discussion: Conventional chest physiotherapy and intermittent positive airway pressure breathing are widely indicated for people with pleural effusion and chest drains; however, no studies have evaluated the real benefit of this type of treatment. Our hypothesis is that optimised lung expansion achieved through the application of intermittent positive airway pressure will accelerate the reabsorption of pleural effusion, decrease the duration of chest drainage and respiratory system impairment, reduce the length of hospital stay, and reduce the incidence of pulmonary complications.

No benefit to surgical fixation of flail chest injuries compared with modern comprehensive management: results of a retrospective cohort study.

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Farquhar, Jaclyn; Almarhabi, Yahya; Slobogean, Gerard; Slobogean, Bronwyn; Garraway, Naisan; Simons, Richard K; Hameed, S Morad

2016-09-01

Chest wall trauma is a common cause of morbidity and mortality. Recent technological advances and scientific publications have created a renewed interest in surgical fixation of flail chest. However, definitive data supporting surgical fixation are lacking, and its virtues have not been evaluated against modern, comprehensive management protocols. Consecutive patients undergoing rib fracture fixation with rib-specific locking plates at 2 regional trauma centres between July 2010 and August 2012 were matched to historical controls with similar injury patterns and severity who were managed nonoperatively with modern, multidisciplinary protocols. We compared short- and long-term outcomes between these cohorts. Our patient cohorts were well matched for age, sex, injury severity scores and abbreviated injury scores. The nonoperatively managed group had significantly better outcomes than the surgical group in terms of ventilator days (3.1 v. 6.1, p = 0.012), length of stay in the intensive care unit (3.7 v. 7.4 d, p = 0.009), total hospital length of stay (16.0 v. 21.9 d, p = 0.044) and rates of pneumonia (22% v. 63%, p = 0.004). There were no significant differences in long-term outcomes, such as chest pain or dyspnea. Although considerable enthusiasm surrounds surgical fixation of flail chest injuries, our analysis does not immediately validate its universal implementation, but rather encourages the use of modern, multidisciplinary, nonoperative strategies. The role of rib fracture fixation in the modern era of chest wall trauma management should ultimately be defined by prospective, randomized trials.

Coronary artery dissection following chest trauma

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Manoj K Agarwala

2016-01-01

Full Text Available Chest trauma has a high rate of mortality. Coronary dissection causing myocardial infarction (MI following blunt chest trauma is rare. We describe the case of an anterior MI following blunt chest trauma. A 39-year-old male was received in our hospital following a motorcycle accident. The patient was asymptomatic before the accident. The patient underwent craniotomy for evacuation of hematoma. He developed severe chest pain and an electrocardiogram (ECG revealed anterior ST segment elevation following surgery. Acute coronary event was medically managed; subsequently, coronary angiogram was performed that showed dissection in the left anterior coronary artery, which was stented.

Calibration and Validation of the Precision Nitrogen Management Tool for Artificially Drained Fields Under Maize

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Marjerison, R.; Hutson, J.; Melkonian, J.; van Es, H.; Sela, S.

2015-12-01

Organic and inorganic fertilizer additions to agricultural fields can lead to soil nitrogen (N) levels in excess of those required for optimal crop growth. The primary loss pathways for this excess N are leaching and denitrification. Nitrate leaching from agricultural sources contributes to the formation of hypoxic zones in critical estuarine systems including the Chesapeake Bay and Gulf of Mexico. Denitrification can lead to the production of nitrous oxide (N2O), a potent greenhouse gas. Agricultural practices such as controlling the timing and location of fertilizer application can help reduce these losses. The Precision Nitrogen Management (PNM) model was developed to simulate water transport, nitrogen transformations and transport, and crop growth and nutrient uptake from agricultural fields. The PNM model allows for the prediction of N losses under a variety of crop and management scenarios. Recent improvements to the model include the option to simulate artificially drained fields. The model performs well in simulating drainage and nitrate leaching when compared to measured data from field studies in artificially drained soils in New York and Minnesota. A simulated N budget was compared to available data. The improved model will be used to assess different management options for reducing N losses in maize production under different climate projections for key maize production locations/systems in the U.S.

Nurse managers' strategies for feeling less drained by their work: an action research and reflection project for developing emotional intelligence.

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Taylor, Bev; Roberts, Sue; Smyth, Therese; Tulloch, Moira

2015-10-01

To raise nurse managers' critical awareness of practice problems; uncover practice constraints and improve work effectiveness. Nurse management requires skills and knowledge, underscored by emotional intelligence. The research improved participants' practice and personal insights. Purposive sampling targeted nurse managers interested in improving their practice. Three experienced female nurse managers met fortnightly in a group, for 1 hour, for 10 meetings. The methods included: writing and sharing de-identified journal reflections; critically analysing practice stories; identifying a thematic concern; generating action strategies; and instituting and revising the action plan. Phase One resulted in the identification of the issue of 'being drained by the intensity of nurse managers' work'. The participants adopted five strategies: debriefing problematic situations; deflecting multiple requests; diffusing issues; naming dysfunctional behaviours; and regrouping. In Phase Two, participants implemented and revised the action plan strategies, which resulted in them feeling less drained by their work. Strategies can lessen nurse managers' sense of personal depletion. However, strategies cannot guarantee success every time because the emotional intelligence is integral to nurse management. Action research and reflection assist nurse managers to improve their practice and develop their emotional intelligence. © 2014 John Wiley & Sons Ltd.

Chest radiography practice in critically ill patients: a postal survey in the Netherlands

International Nuclear Information System (INIS)

Graat, Marleen E; Hendrikse, Karin A; Spronk, Peter E; Korevaar, Johanna C; Stoker, Jaap; Schultz, Marcus J

2006-01-01

To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a 'daily-routine chest radiography' ICU. From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy

Chest Injuries Associated with Head Injury

African Journals Online (AJOL)

Traumatic brain injury (TBI) is a common cause of mortality and severe morbidity. Although there have been significant advances in management, associated severe injuries, in particular chest injuries, remain a major challenge. Extracranial injuries, especially chest injuries increase mortality in patients with TBI in both short.

An audit of the complications of intercostal chest drain insertion in a high volume trauma service in South Africa.

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Kong, V Y; Oosthuizen, G V; Sartorius, B; Keene, C; Clarke, D L

2014-11-01

Intercostal chest drain (ICD) insertion is a commonly performed procedure in trauma and may be associated with significant morbidity. This was a retrospective review of ICD complications in a major trauma service in South Africa over a four-year period from January 2010 to December 2013. A total of 1,050 ICDs were inserted in 1,006 patients, of which 91% were male. The median patient age was 24 years (interquartile range [IQR]: 20-29 years). There were 962 patients with unilateral ICDs and 44 with bilateral ICDs. Seventy-five per cent (758/1,006) sustained penetrating trauma and the remaining 25% (248/1006) sustained blunt trauma. Indications for ICD insertion were: haemopneumothorax (n=338), haemothorax (n=314), simple pneumothorax (n=265), tension pneumothorax (n=79) and open pneumothorax (n=54). Overall, 203 ICDs (19%) were associated with complications: 18% (36/203) were kinked, 18% (36/203) were inserted subcutaneously, 13% (27/203) were too shallow and in 7% (14/203) there was inadequate fixation resulting in dislodgement. Four patients (2%) sustained visceral injuries and two sustained vascular injuries. Forty-one per cent (83/203) were inserted outside the 'triangle of safety' but without visceral or vascular injuries. One patient had the ICD inserted on the wrong side. Junior doctors inserted 798 ICDs (76%) while senior doctors inserted 252 (24%). Junior doctors had a significantly higher complication rate (24%) compared with senior doctors (5%) (p Conclusions ICD insertion is associated with a high rate of complications. These complications are significantly higher when junior doctors perform the procedure. A multifaceted quality improvement programme is needed to improve the situation.

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

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Omar Hesham R

2011-09-01

Full Text Available Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients.

Science.gov (United States)

Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

2011-09-27

Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

Penetrating chest injury: A miraculous life salvage

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Santosh B Dalavi

2013-01-01

Full Text Available An unusual penetrating chest injury was caused by high velocity road traffic accident. An 18-year-old had a four wheeler accident and was brought in emergency department with a ′bamboo′ stick on the left side chest exiting through back. After the stabilization of vital parameters, an inter-costal tube drainage was done on the left side. Except the minor brochopleural fistula which healed by 10 th day, his recovery was uneventful. The outcome was consistent with current aggressive management of penetrating chest injuries. Management of penetrating chest injury involving pulmonary trauma is based on three principles. One is stabilization of hemodynamics of patient with proper clinical evaluation. Second, a mere intercostal tube drainage sufficient for majority of the cases. Third, post-operative active as well as passive physiotherapy is necessary for speedy recovery.

Primary chest wall Hydatid cyst: Review of literature with report of a new case

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Abdulwahid M. Salih

Full Text Available Introduction: Hydatid cyst is a parasitic disease caused by Echinococci. The most commonly affected organ is liver, followed by lungs. Hydatid disease of the chest wall is extremely rare. The aim of this study is to report a case of chest wall Hydatid cyst with literature review. A 20-year-old pregnant lady presented with left hypochondrial and lower chest painful swelling. There was 10 × 15 centimeters, tender mass with features suggestive of abscess. The patient refused every sort of radiological examination. Under general anesthesia, oblique incision was done, on opening, clear fluid came out, with deep incision pus-like fluid and many daughter cysts drained. Complete evacuation of the cyst was done with closure of the residual cavity. The patient refused chemoprophylaxis because of her pregnancy. Conclusion: primary chest wall Hydatid cyst is a very rare disease in endemic areas. Mass and pain are the most common presentation. Excision under general anesthesia is main modality of treatment. Keywords: Hydatid cyst, Pregnancy, Albendazole

Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft.

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Guizilini, Solange; Bolzan, Douglas W; Faresin, Sonia M; Ferraz, Raquel F; Tavolaro, Kelly; Cancio, Andrea A; Gomes, Walter J

2012-01-25

Exacerbation of pulmonary dysfunction has been reported in patients receiving a pleural drain inserted through the intercostal space in comparison to patients with an intact pleura undergoing coronary artery bypass grafting (CABG). Evidence suggests that shifting the site of pleural drain insertion to the subxyphoid position minimizes chest wall trauma and preserves respiratory function in the early postoperative period. The aim of this study was to compare the pulmonary function parameters, clinical outcomes, and pain score between patients undergoing pleurotomy with pleural drain placed in the subxyphoid position and patients with intact pleural cavity after off-pump CABG (OPCAB) using left internal thoracic artery (LITA). Seventy-one patients were allocated into two groups: I (n = 38 open left pleural cavity and pleural drain inserted in the subxyphoid position); II (n = 33 intact pleural cavity). Pulmonary function tests and clinical parameters were recorded preoperatively and on postoperative days (POD) 1, 3 and 5. Arterial blood gas analysis and shunt fraction were evaluated preoperatively and in POD1. Pain score was assessed on POD1. To monitor pleural effusion and atelectasis chest radiography was performed routinely 1 day before operation and until POD5. In both groups a significant impairment was found in lung function parameters until on POD5. However, no significant difference in forced vital capacity and forced expiratory volume in 1 second were seen between groups. A significant decrease in partial pressure of arterial oxygen and an increase in shunt fraction values were observed on POD1 in both groups, but no statistical difference was found when the groups were compared. Pleural effusion and atelectasis until on POD5 were similar in both groups. There were no statistical differences in pain score, duration of mechanical ventilation and postoperative hospital stay between groups. Subxyphoid insertion of pleural drain provides similar effects to

Managing health worker migration: a qualitative study of the Philippine response to nurse brain drain

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Dimaya Roland M

2012-12-01

Full Text Available Abstract Background The emigration of skilled nurses from the Philippines is an ongoing phenomenon that has impacted the quality and quantity of the nursing workforce, while strengthening the domestic economy through remittances. This study examines how the development of brain drain-responsive policies is driven by the effects of nurse migration and how such efforts aim to achieve mind-shifts among nurses, governing and regulatory bodies, and public and private institutions in the Philippines and worldwide. Methods Interviews and focus group discussions were conducted to elicit exploratory perspectives on the policy response to nurse brain drain. Interviews with key informants from the nursing, labour and immigration sectors explored key themes behind the development of policies and programmes that respond to nurse migration. Focus group discussions were held with practising nurses to understand policy recipients’ perspectives on nurse migration and policy. Results Using the qualitative data, a thematic framework was created to conceptualize participants’ perceptions of how nurse migration has driven the policy development process. The framework demonstrates that policymakers have recognised the complexity of the brain drain phenomenon and are crafting dynamic policies and programmes that work to shift domestic and global mindsets on nurse training, employment and recruitment. Conclusions Development of responsive policy to Filipino nurse brain drain offers a glimpse into a domestic response to an increasingly prominent global issue. As a major source of professionals migrating abroad for employment, the Philippines has formalised efforts to manage nurse migration. Accordingly, the Philippine paradigm, summarised by the thematic framework presented in this paper, may act as an example for other countries that are experiencing similar shifts in healthcare worker employment due to migration.

Advanced Technologies in Trauma Critical Care Management

Science.gov (United States)

2012-01-01

largely replaced diagnostic peritoneal lavage for identifying intra-abdominal fluid in trauma patients. Furthermore, with the addition of chest windows...authors use chest ultrasound in the following manner: To identify a pneumothorax or hemothorax that needs to be drained acutely To differentiate...these situations, Technologies in the Trauma ICU 913 the authors first insert 2 or 3 chest tubes and position them as usual. A sterile nonad- herent

Simulation of the hydraulic performance of highway filter drains through laboratory models and stormwater management tools.

Science.gov (United States)

Sañudo-Fontaneda, Luis A; Jato-Espino, Daniel; Lashford, Craig; Coupe, Stephen J

2017-05-23

Road drainage is one of the most relevant assets in transport infrastructure due to its inherent influence on traffic management and road safety. Highway filter drains (HFDs), also known as "French Drains", are the main drainage system currently in use in the UK, throughout 7000 km of its strategic road network. Despite being a widespread technique across the whole country, little research has been completed on their design considerations and their subsequent impact on their hydraulic performance, representing a gap in the field. Laboratory experiments have been proven to be a reliable indicator for the simulation of the hydraulic performance of stormwater best management practices (BMPs). In addition to this, stormwater management tools (SMT) have been preferentially chosen as a design tool for BMPs by practitioners from all over the world. In this context, this research aims to investigate the hydraulic performance of HFDs by comparing the results from laboratory simulation and two widely used SMT such as the US EPA's stormwater management model (SWMM) and MicroDrainage®. Statistical analyses were applied to a series of rainfall scenarios simulated, showing a high level of accuracy between the results obtained in laboratory and using SMT as indicated by the high and low values of the Nash-Sutcliffe and R 2 coefficients and root-mean-square error (RMSE) reached, which validated the usefulness of SMT to determine the hydraulic performance of HFDs.

Chest radiography after minor chest trauma

Energy Technology Data Exchange (ETDEWEB)

Rossen, B.; Laursen, N.O.; Just, S.

The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6(30%) of the 20 patients with hemo/-pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma.

Chest radiography after minor chest trauma

International Nuclear Information System (INIS)

Rossen, B.; Laursen, N.O.; Just, S.

1987-01-01

The results of chest radiography in 581 patients with blunt minor thoracic trauma were reviewed. Frontal and lateral views of the chest indicated pathology in 72 patients (12.4%). Pneumothorax was present in 16 patients; 4 had hemothorax. The physical examination and the results of chest radiography were not in accordance because in 6(30%) of the 20 patients with hemo/-pneumothorax the physical examination was normal. Consequently there is wide indication for chest radiography after minor blunt chest trauma. (orig.)

Evaluation and Management of Patients with Noncardiac Chest Pain

Directory of Open Access Journals (Sweden)

C. Shekhar

2008-01-01

Full Text Available Up to a third of patients undergoing coronary angiography for angina-like chest pain are found to have normal coronary arteries and a substantial proportion of these individuals continue to consult and even attend emergency departments. Initially, these patients are usually seen by cardiologists but with accumulating evidence that the pain might have a gastrointestinal origin, it may be more appropriate for them to be cared for by the gastroenterologist once a cardiological cause has been excluded. This review covers the assessment and management of this challenging condition, which includes a combination of education, reassurance, and pharmacotherapy. For the more refractory cases, behavioral treatments, such as cognitive behavioral therapy or hypnotherapy, may have to be considered.

Intrapulmonary pseudo-malposition of chest tubes on computed tomography (CT)

International Nuclear Information System (INIS)

Flueckiger, F.; Kullnig, P.; Juettner-Smolle, F.; Melzer, G.; Graz Univ.

1991-01-01

The diagnosis of an intrapulmonary malposition of chest tubes on CT may be problematic. We report about 13 chest tubes which were suspected on CT to be in an intrapulmonary malposition. In all cases as well as clinical and radiological follow up ruled out such a malposition. The use of a stiff tube and the presence of a soft lung parenchyma obviously led to a sinking of the tube into a 'channel'. Whereas after removal of the tube in case of such a pseudo-malposition solely a transitory local fluid collection and later a tender scar is seen, real intrapumonary malposition leads to parenchymal injury and concomitant complications. The diagnosis of intrapulmonary malposition should be doubted, if the drain is positioned within the pleural space after having crossed the lung parenchyma in a supposed intrapulmonary rout. The CT criterias of this pseudo-malposition are presented and discussed. (orig.) [de

Improved recognition of ineffective chest compressions after a brief Crew Resource Management (CRM) training: a prospective, randomised simulation study.

Science.gov (United States)

Haffner, Leopold; Mahling, Moritz; Muench, Alexander; Castan, Christoph; Schubert, Paul; Naumann, Aline; Reddersen, Silke; Herrmann-Werner, Anne; Reutershan, Jörg; Riessen, Reimer; Celebi, Nora

2017-03-03

Chest compressions are a core element of cardio-pulmonary resuscitation. Despite periodic training, real-life chest compressions have been reported to be overly shallow and/or fast, very likely affecting patient outcomes. We investigated the effect of a brief Crew Resource Management (CRM) training program on the correction rate of improperly executed chest compressions in a simulated cardiac arrest scenario. Final-year medical students (n = 57) were randomised to receive a 10-min computer-based CRM or a control training on ethics. Acting as team leaders, subjects performed resuscitation in a simulated cardiac arrest scenario before and after the training. Team members performed standardised overly shallow and fast chest compressions. We analysed how often the team leader recognised and corrected improper chest compressions, as well as communication and resuscitation quality. After the CRM training, team leaders corrected improper chest compressions (35.5%) significantly more often compared with those undergoing control training (7.7%, p = 0.03*). Consequently, four students have to be trained (number needed to treat = 3.6) for one improved chest compression scenario. Communication quality assessed by the Leader Behavior Description Questionnaire significantly increased in the intervention group by a mean of 4.5 compared with 2.0 (p = 0.01*) in the control group. A computer-based, 10-min CRM training improved the recognition of ineffective of chest compressions. Furthermore, communication quality increased. As guideline-adherent chest compressions have been linked to improved patient outcomes, our CRM training might represent a brief and affordable approach to increase chest compression quality and potentially improve patient outcomes.

Prenatal ultrasonographic diagnosis and successful management of ...

African Journals Online (AJOL)

with a distended abdomen and 5 cm hepatomegaly. There was bradycardia and the apex beat was displaced to the right. Chest radiography showed opacity of both lung fields (Fig. 3). Chest drains were insened, and 30 ml of straw-eoloured fluid was aspirated from the right pleural space after which some aerated lung was ...

Limiting chest computed tomography in the evaluation of pediatric thoracic trauma.

Science.gov (United States)

Golden, Jamie; Isani, Mubina; Bowling, Jordan; Zagory, Jessica; Goodhue, Catherine J; Burke, Rita V; Upperman, Jeffrey S; Gayer, Christopher P

2016-08-01

Computed tomography (CT) of the chest (chest CT) is overused in blunt pediatric thoracic trauma. Chest CT adds to the diagnosis of thoracic injury but rarely changes patient management. We sought to identify a subset of blunt pediatric trauma patients who would benefit from a screening chest CT based on their admission chest x-ray (CXR) findings. We hypothesize that limiting chest CT to patients with an abnormal mediastinal silhouette identifies intrathoracic vascular injuries not otherwise seen on CXR. All blunt trauma activations that underwent an admission CXR at our Level 1 pediatric trauma center from 2005 to 2013 were retrospectively reviewed. Patients who had a chest CT were evaluated for added diagnoses and change in management after CT. An admission CXR was performed in 1,035 patients. One hundred thirty-nine patients had a CT, and the diagnosis of intra-thoracic injury was added in 42% of patients. Chest CT significantly increased the diagnosis of contusion or atelectasis (30.3% vs 60.4%; p pneumothorax (7.2% vs 18.7%; p chest CT. Chest CT changed the management of only 4 patients (2.9%). Two patients underwent further radiologic evaluation that was negative for injury, one had a chest tube placed for an occult pneumothorax before exploratory laparotomy, and one patient had a thoracotomy for repair of aortic injury. Chest CT for select patients with an abnormal mediastinal silhouette on CXR would have decreased CT scans by 80% yet still identified patients with an intrathoracic vascular injury. The use of chest CT should be limited to the identification of intrathoracic vascular injuries in the setting of an abnormal mediastinal silhouette on CXR. Therapeutic study, level IV; diagnostic study, level III.

Containment vessel drain system

Science.gov (United States)

Harris, Scott G.

2018-01-30

A system for draining a containment vessel may include a drain inlet located in a lower portion of the containment vessel. The containment vessel may be at least partially filled with a liquid, and the drain inlet may be located below a surface of the liquid. The system may further comprise an inlet located in an upper portion of the containment vessel. The inlet may be configured to insert pressurized gas into the containment vessel to form a pressurized region above the surface of the liquid, and the pressurized region may operate to apply a surface pressure that forces the liquid into the drain inlet. Additionally, a fluid separation device may be operatively connected to the drain inlet. The fluid separation device may be configured to separate the liquid from the pressurized gas that enters the drain inlet after the surface of the liquid falls below the drain inlet.

Climate mitigation scenarios of drained peat soils

Science.gov (United States)

Kasimir Klemedtsson, Åsa; Coria, Jessica; He, Hongxing; Liu, Xiangping; Nordén, Anna

2014-05-01

The national inventory reports (NIR) submitted to the UNFCCC show Sweden - which as many other countries has wetlands where parts have been drained for agriculture and forestry purposes, - to annually emit 12 million tonnes carbon dioxide equivalents, which is more GHG'es than industrial energy use release in Sweden. Similar conditions can be found in other northern countries, having cool and wet conditions, naturally promoting peat accumulation, and where land use management over the last centuries have promoted draining activities. These drained peatland, though covering only 2% of the land area, have emissions corresponding to 20% of the total reported NIR emissions. This substantial emission contribution, however, is hidden within the Land Use Land Use Change and Forestry sector (LULUCF) where the forest Carbon uptake is even larger, which causes the peat soil emissions become invisible. The only drained soil emission accounted in the Swedish Kyoto reporting is the N2O emission from agricultural drained organic soils of the size 0.5 million tonnes CO2e yr-1. This lack of visibility has made incentives for land use change and management neither implemented nor suggested, however with large potential. Rewetting has the potential to decrease soil mineralization, why CO2 and N2O emissions are mitigated. However if the soil becomes very wet CH4 emission will increase together with hampered plant growth. By ecological modeling, using the CoupModel the climate change mitigation potential have been estimated for four different land use scenarios; 1, Drained peat soil with Spruce (business as usual scenario), 2, raised ground water level to 20 cm depth and Willow plantation, 3, raised ground water level to 10 cm depth and Reed Canary Grass, and 4, rewetting to an average water level in the soil surface with recolonizing wetland plants and mosses. We calculate the volume of biomass production per year, peat decomposition, N2O emission together with nitrate and DOC

Organic loss in drained wetland: managing the carbon footprint

NARCIS (Netherlands)

Durham, B.; van de Noort, R.; Martens, V.V.; Vorenhout, M.

2012-01-01

The recent installation of land drains at Star Carr, Yorkshire, UK, has been linked with loss of preservation quality in this important Mesolithic buried landscape, challenging the PARIS principle. Historically captured organic carbon, including organic artefacts, is being converted to soluble

Chest radiographic findings in Human Immunodeficiency Virus ...

African Journals Online (AJOL)

This study was carried out to determine findings on chest radiographs in HIV positive/AIDS patients at the University of Benin Teaching Hospital (UBTH) Benin City. All consecutive HIV positive/AIDS patients, managed at the UBTH between 1991 and 2001 were included in the study. Patients had postero-anterior (PA) chest ...

Pleurotomy with subxyphoid pleural drain affords similar effects to pleural integrity in pulmonary function after off-pump coronary artery bypass graft

Directory of Open Access Journals (Sweden)

Guizilini Solange

2012-01-01

Full Text Available Abstract Background Exacerbation of pulmonary dysfunction has been reported in patients receiving a pleural drain inserted through the intercostal space in comparison to patients with an intact pleura undergoing coronary artery bypass grafting (CABG. Evidence suggests that shifting the site of pleural drain insertion to the subxyphoid position minimizes chest wall trauma and preserves respiratory function in the early postoperative period. The aim of this study was to compare the pulmonary function parameters, clinical outcomes, and pain score between patients undergoing pleurotomy with pleural drain placed in the subxyphoid position and patients with intact pleural cavity after off-pump CABG (OPCAB using left internal thoracic artery (LITA. Methods Seventy-one patients were allocated into two groups: I (n = 38 open left pleural cavity and pleural drain inserted in the subxyphoid position; II (n = 33 intact pleural cavity. Pulmonary function tests and clinical parameters were recorded preoperatively and on postoperative days (POD 1, 3 and 5. Arterial blood gas analysis and shunt fraction were evaluated preoperatively and in POD1. Pain score was assessed on POD1. To monitor pleural effusion and atelectasis chest radiography was performed routinely 1 day before operation and until POD5. Results In both groups a significant impairment was found in lung function parameters until on POD5. However, no significant difference in forced vital capacity and forced expiratory volume in 1 second were seen between groups. A significant decrease in partial pressure of arterial oxygen and an increase in shunt fraction values were observed on POD1 in both groups, but no statistical difference was found when the groups were compared. Pleural effusion and atelectasis until on POD5 were similar in both groups. There were no statistical differences in pain score, duration of mechanical ventilation and postoperative hospital stay between groups. Conclusion Subxyphoid

Surgical management of the radiated chest wall

International Nuclear Information System (INIS)

Arnold, P.G.; Pairolero, P.C.

1986-01-01

Fifty consecutive patients with radiation-related problems of the chest wall were treated between 1976 and 1984. There were 40 women and 10 men with an average age of 54 years (range 26 to 78 years). Twenty-three patients had radiation ulcers alone, 20 had recurrent cancer, and 7 had infected median sternotomy wounds. Thirty-six had skeletal resections and 44 had soft-tissue resections. The skeleton was reconstructed with Prolene mesh in 12 patients and with autogenous rib in 3. Sixty-three muscles were transposed in 43 patients. Twelve omental transpositions were performed (8 for primary treatment and 4 for salvage of a failed muscle flap). Hospitalization averaged 20.2 days. There was one operative death (at 29 days). Partial flap necrosis occurred in 10 patients. Mesh was removed in three patients. There were 14 late deaths, most from recurrent tumor. The remaining patients had well-healed wounds and a generally improved quality of life. We conclude that aggressive resection and reliable reconstruction are critical considerations in the surgical management of this perplexing clinical problem

Chiropractic Treatment vs Self-Management in Patients With Acute Chest Pain: A Randomized Controlled Trial of Patients Without Acute Coronary Syndrome

DEFF Research Database (Denmark)

Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner

2012-01-01

minimal intervention in patients without acute coronary syndrome but with musculoskeletal chest pain. Results suggest that chiropractic treatment might be useful; but further research in relation to patient selection, standardization of interventions, and identification of potentially active ingredients......OBJECTIVE: The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of 2 treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation and (2......) self-management as an example of minimal intervention. METHODS: In a nonblinded, randomized, controlled trial set at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were...

Design of an Electronic Chest-Band

Science.gov (United States)

Atakan, R.; Acikgoz Tufan, H.; Baskan, H.; Eryuruk, S. H.; Akalin, N.; Kose, H.; Li, Y.; Kursun Bahadir, S.; Kalaoglu, F.

2017-10-01

In this study, an electronic chest strap prototype was designed for measuring fitness level, performance optimization, mobility and fall detection. Knitting technology is used for production by using highly elastic nylon yarn. In order to evaluate comfort performance of the garment, yarn strength and elongation, air permeability, moisture management and FAST tests (Fabric Assurance Fabric Testing) were carried out, respectively. After testing of textile part of the chest band, IMU sensors were integrated onto the garment by means of conductive yarns. Electrical conductivity of the circuit was also assessed at the end. Results indicated that the weight and the thickness of the product are relatively high for sports uses and it has a negative impact on comfort properties. However, it is highly stretchable and moisture management properties are still in acceptable values. From the perspective of possible application areas, developed smart chest band in this research could be used in sports facilities as well as health care applications for elderly and disabled people.

The use of ultrasonography in the perioperative management of ...

African Journals Online (AJOL)

S Kudsk-Iversen

and minimal fluid in the right pleural space were noted. The rest of the scan was unremarkable, with the inferior ... placed an intercostal drain on the right side. After induction, the patient was placed in the left lateral ... apical intercostal drain was placed, and postoperatively the chest X-ray was commensurate with someone ...

Surgical stabilization of internal pneumatic stabilization? A prospective randomized study of management of severe flail chest patients.

Science.gov (United States)

Tanaka, Hideharu; Yukioka, Tetsuo; Yamaguti, Yoshihiro; Shimizu, Syoichiro; Goto, Hideaki; Matsuda, Hiroharu; Shimazaki, Syuji

2002-04-01

We compared the clinical efficacy of surgical stabilization and internal pneumatic stabilization in severe flail chest patients who required prolonged ventilatory support. Thirty-seven consecutive severe flail chest patients who required mechanical ventilation were enrolled in this study. All the patients received identical respiratory management, including end-tracheal intubation, mechanical ventilation, continuous epidural anesthesia, analgesia, bronchoscopic aspiration, postural drainage, and pulmonary hygiene. At 5 days after injury, surgical stabilization with Judet struts (S group, n = 18) or internal pneumatic stabilization (I group, n = 19) was randomly assigned. Most respiratory management was identical between the two groups except the surgical procedure. Statistical analysis using two-way analysis of variance and Tukey's test was used to compare the groups. Age, sex, Injury Severity Score, chest Abbreviated Injury Score, number of rib fractures, severity of lung contusion, and Pao2/Fio2 ratio at admission were all equivalent in the two groups. The S group showed a shorter ventilatory period (10.8 +/- 3.4 days) than the I group (18.3 +/- 7.4 days) (p < 0.05), shorter intensive care unit stay (S group, 16.5 +/- 7.4 days; I group, 26.8 +/- 13.2 days; p < 0.05), and lower incidence of pneumonia (S group, 24%; I group, 77%; p < 0.05). Percent forced vital capacity was higher in the S group at 1 month and thereafter (p < 0.05). The percentage of patients who had returned to full-time employment at 6 months was significantly higher in the S group (11 of 18) than in the I group (1 of 19). This study proved that in severe flail chest patients, surgical stabilization using Judet struts has beneficial effects with respect to less ventilatory support, lower incidence of pneumonia, shorter trauma intensive care unit stay, and reduced medical cost than internal fixation. Moreover, surgical stabilization with Judet struts improved percent forced vital capacity from the

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures.

Science.gov (United States)

Chapman, Brandon C; Overbey, Douglas M; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T; French, Andrew; Johnson, Jeffrey L; Burlew, Clay C; Barnett, Carlton; Moore, Ernest E; Pieracci, Fredric M

2016-12-01

Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Retrospective cohort study of blunt trauma patients with rib fractures at a level I trauma center that had both a CXR and a CT chest. The CT finding of ≥ 3 additional fractures in patients with ≤ 3 rib fractures on CXR was considered clinically meaningful. Student's t-test and chi-square analysis were used for comparison. We identified 499 patients with rib fractures: 93 (18.6%) had CXR only, 7 (1.4%) had chest CT only, and 399 (79.9%) had both CXR and chest CT. Among these 399 patients, a total of 1,969 rib fractures were identified: 1,467 (74.5%) were missed by CXR. The median number of additional fractures identified by CT was 3 (range, 4 - 15). Of 212 (53.1%) patients with a clinically meaningful increase in the number of fractures, 68 patients underwent one or more clinical interventions: 36 SICU admissions, 20 pain catheter placements, 23 epidural placements, and 3 SSRF. Additionally, 70 patients had a chest tube placed for retained hemothorax or occult pneumothorax. Overall, 138 patients (34.5%) had a change in clinical management based upon CT chest. The chest X-ray missed ~75% of rib fractures seen on chest CT. Although patients with a clinical meaningful increase in the number of rib fractures were more likely to be admitted to the intensive care unit, there was no associated improvement in pulmonary outcomes.

The diagnosis and management of children with blunt injury of the chest.

Science.gov (United States)

Sartorelli, Kennith H; Vane, Dennis W

2004-05-01

Thoracic trauma remains a major source of morbidity and mortality in injured children, and is second only to brain injuries as a cause of death. The presence of a chest injury increases an injured child's mortality by 20-fold. Greater than 80% of chest injuries in children are secondary to blunt trauma. The compliant chest wall in children makes pulmonary contusions and rib fractures the most common chest injuries in children. Injuries to the great vessels, esophagus, and diaphragm are rare. Failure to promptly diagnose and treat these injuries results in increased morbidity and mortality.

Vacuum-assisted closure device for the management of infected postpneumonectomy chest cavities.

Science.gov (United States)

Perentes, Jean Yannis; Abdelnour-Berchtold, Etienne; Blatter, Jeannine; Lovis, Alban; Ris, Hans-Beat; Krueger, Thorsten; Gonzalez, Michel

2015-03-01

Infected postpneumonectomy chest cavities may be related to chronic postpneumonectomy empyema or arise in rare situations of necrotizing pneumonia with complete lung destruction where pneumonectomy and pleural debridement are required. We evaluated the safety and efficacy of an intrathoracic vacuum-assisted closure device (VAC) for the treatment of infected postpneumonectomy chest cavities. A retrospective single institution review of all patients with infected postpneumonectomy chest cavities treated by VAC between 2005 and 2013. Patients underwent surgical debridement of the thoracic cavity, muscle flap closure of the bronchial stump when a fistula was present, and repeated intrathoracic VAC dressings until granulation tissue covered the entire chest cavity. After this, the cavity was obliterated by a Clagett procedure and closed. Twenty-one patients (14 men and 7 women) underwent VAC treatment of their infected postpneumonectomy chest cavity. Twelve patients presented with a chronic postpneumonectomy empyema (10 of them with a bronchopleural fistula) and 9 patients with an empyema occurring in the context of necrotizing pneumonia treated by pneumonectomy. In-hospital mortality was 23%. The median duration of VAC therapy was 23 days (range, 4-61 days) and the median number of VAC changes per patient was 6 (range, 2-14 days). Infection control and successful chest cavity closure was achieved in all surviving patients. One adverse VAC treatment-related event was identified (5%). The intrathoracic VAC application is a safe and efficient treatment of infected postpneumonectomy chest cavities and allows the preservation of chest wall integrity. Copyright © 2015 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Tube Thoracostomy: Complications and Its Management

Directory of Open Access Journals (Sweden)

Emeka B. Kesieme

2012-01-01

Full Text Available Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended.

Tube Thoracostomy: Complications and Its Management

Science.gov (United States)

Kesieme, Emeka B.; Dongo, Andrew; Ezemba, Ndubueze; Irekpita, Eshiobo; Jebbin, Nze; Kesieme, Chinenye

2012-01-01

Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended. PMID:22028963

Spontaneous chylothorax complicating small cell lung cancer – Review of aetiology and diagnosis

Directory of Open Access Journals (Sweden)

S. Hanina

2015-01-01

Full Text Available We report the first case of spontaneous chylothorax complicating small cell lung cancer. A 52 year old female presented with exertional dyspnoea, left-sided chest and neck pain, and dysphagia. The chest X-ray on admission revealed a large left-sided pleural effusion. A subsequent CT chest showed a large anterior mediastinal mass with a left brachiocephalic and jugular vein thrombosis. The patient underwent medical thoracoscopy with chest drain insertion, which drained pleural fluid high in triglycerides, consistent with a chylothorax. Due to its uncommon nature, the management of chylothorax is not well defined. Alongside the case report, we provide a review of aetiology, mechanism and diagnosis with a brief summary of treatment options.

Outpatient Management of Children With World Health Organization Chest Indrawing Pneumonia: Implementation Risks and Proposed Solutions.

Science.gov (United States)

McCollum, Eric D; Ginsburg, Amy Sarah

2017-10-16

This Viewpoints article details our recommendation for the World Health Organization Integrated Management of Childhood Illness guidelines to consider additional referral or daily monitoring criteria for children with chest indrawing pneumonia in low-resource settings. We review chest indrawing physiology in children and relate this to the risk of adverse pneumonia outcomes. We believe there is sufficient evidence to support referring or daily monitoring of children with chest indrawing pneumonia and signs of severe respiratory distress, oxygen saturation <93% (when not at high altitude), moderate malnutrition, or an unknown human immunodeficiency virus (HIV) status in an HIV-endemic setting. Pulse oximetry screening should be routine and performed at the earliest point in the patient care pathway as possible. If outpatient clinics lack capacity to conduct pulse oximetry, nutritional assessment, or HIV testing, then we recommend considering referral to complete the evaluation. When referral is not possible, careful daily monitoring should be performed. © The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America.

The use of Jackson-Pratt silicone flat drains as prolonged pleural catheters for the management of pleural effusions

OpenAIRE

Demirhan, Ozkan; Kasapoglu, Tugce; Ece, Ferah; Toker, Alper

2013-01-01

Introduction: Imbalance between secretion and absorbtion of pleural fluid results in pleural effusion. Emergence of pleural effusion ipsilateral or contralateral to the side drained previously is named recurrent effusion. There is currently no standart approach for the management of recurrent pleural effusions. Materials and methods: Eighteen patients, treated between 2011 and 2012 for recurrent pleural effusions due to various etiologies, not considered for surgical or other treatments, ...

Mechanisms and Clinical Management of Ventricular Arrhythmias following Blunt Chest Trauma

Directory of Open Access Journals (Sweden)

Daniel H. Wolbrom

2016-01-01

Full Text Available Nonpenetrating, blunt chest trauma is a serious medical condition with varied clinical presentations and implications. This can be the result of a dense projectile during competitive and recreational sports but may also include other etiologies such as motor vehicle accidents or traumatic falls. In this setting, the manifestation of ventricular arrhythmias has been observed both acutely and chronically. This is based on two entirely separate mechanisms and etiologies requiring different treatments. Ventricular fibrillation can occur immediately after chest wall injury (commotio cordis and requires rapid defibrillation. Monomorphic ventricular tachycardia can develop in the chronic stage due to underlying structural heart disease long after blunt chest injury. The associated arrhythmogenic tissue may be complex and provides the necessary substrate to form a reentrant VT circuit. Ventricular tachycardia in the absence of overt structural heart disease appears to be focal in nature with rapid termination during ablation. Regardless of the VT mechanism, patients with recurrent episodes, despite antiarrhythmic medication in the chronic stage following blunt chest injury, are likely to require ablation to achieve VT control. This review article will describe the mechanisms, pathophysiology, and treatment of ventricular arrhythmias that occur in both the acute and chronic stages following blunt chest trauma.

Accuracy of the diagnosis of pleural effusion on supine chest X-ray

International Nuclear Information System (INIS)

Emamian, S.A.; Kaasboel, M.A.; Olsen, J.F.; Pedersen, J.F.

1997-01-01

Diagnosis of pleural effusion (PE) on supine chest X-ray (SCXR) is considered difficult. This study aimed at evaluating the accuracy of the diagnosis of PE on SCXR and was performed in two phases. At phase 1, a formula for the sonographic estimation of the volume of PE was established by correlating 24 measurements (in 7 patients in whom complete drainage was achieved) with the drained volumes. At phase two, 112 consecutive SCXRs were supplemented by sonography of the chest. The films were evaluated for the presence of PE and for the presence of different radiologic signs of PE. Sonography showed PE in 41 right and 30 left hemithoraces. The overall accuracy of the diagnosis of PE on SCXR was 82 %. Only one of the undiagnosed PEs had a volume of > 300 ml. The most accurate signs were increased density of the hemithorax, blunted costophrenic angle, and loss of the hemidiaphragm silhouette. (orig.). With 2 figs., 3 tabs

Cost-effectiveness of chiropractic care versus self-management in patients with musculoskeletal chest pain

DEFF Research Database (Denmark)

Stochkendahl, Mette Jensen; Sørensen, Jan; Vach, Werner

2016-01-01

suggested that chiropractic care was cost-effective with a probability of 97%, given a threshold value of €30 000 per QALY gained. In both groups, there was an increase in the health-related quality of life, and the mean increases were similar over the 12-month evaluation period. The mean differences......AIMS: To assess whether primary sector healthcare in the form of chiropractic care is cost-effective compared with self-management in patients with musculoskeletal chest pain, that is, a subgroup of patients with non-specific chest pain. METHODS AND RESULTS: 115 adults aged 18-75 years with acute......-dimension questionnaire (EQ-5D) and Short Form 36-item Health Survey (SF-36)) were compared in cost-effectiveness analyses over 12 months from baseline. Mean costs were €2183 lower for the group with chiropractic care, but not statistically significant (95% CI -4410.5 to 43.0). The incremental cost-effectiveness ratio...

Radiological diagnosis of chest wall tuberculosis: CT versus chest radiograph

International Nuclear Information System (INIS)

Liu Fugeng; Pan Jishu; Chen Qihang; Zhou Cheng; Yu Jingying; Tang Dairong

2006-01-01

Objective: To evaluate the role of CT or Chest radiograph in diagnosis of chest wall tuberculosis. Methods: The study population included 21 patients with chest wall tuberculosis confirmed by operation or biopsy. Chest radiograph and plain CT were performed in all eases, while enhanced CT in 9 cases, and all images were reviewed by 2 radiologists. Results: Single soft tissue mass of the chest wall was detected in all cases on CT, but not on chest radiograph(χ 2 =42.000, P 2 =4.421, P<0.05). Conclusion: CT, especially enhanced CT scan is the first choice in the diagnosis of chest wall tuberculosis. (authors)

Editor's Choice-The organization of chest pain units: Position statement of the Acute Cardiovascular Care Association.

Science.gov (United States)

Claeys, Marc J; Ahrens, Ingo; Sinnaeve, Peter; Diletti, Roberto; Rossini, Roberta; Goldstein, Patrick; Czerwińska, Kasia; Bueno, Héctor; Lettino, Maddalena; Münzel, Thomas; Zeymer, Uwe

2017-04-01

Chest pain units are defined as organizational short stay units with specific management protocols designed to facilitate and optimize the diagnosis of patients presenting with chest pain in the emergency department. The present document is intended to standardize and facilitate the installation of chest pain units nearby to the emergency department or as an integral part of the emergency department. Recommendations on organizational structure, physical and technical requirements and on disease management are presented. More standardized installation and implementation of chest pain units will enhance the quality of chest pain units and improve the quality of care of our chest pain patients.

Drains after Thyroidectomy for Benign Thyroid Disorders; Are ...

African Journals Online (AJOL)

Prophylactic drainage after thyroidectomy has been a regular practice at Kenyatta National Hospital( KNH). This has been ... stay and post-operative pain. Introduction. Prophylactic drains are still regularly used in ..... Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region.

Management and Prevention of Breast Cancer After Radiation to the Chest for Childhood, Adolescent, and Young Adulthood Malignancy.

Science.gov (United States)

Koo, Eva; Henderson, Michael A; Dwyer, Mary; Skandarajah, Anita R

2015-12-01

Women treated with chest irradiation for childhood, adolescent, and young adulthood (CAYA) malignancies, in particular Hodgkin's lymphoma, have an increased risk of developing second cancers of the breast (SCB). However, there are few uniform guidelines regarding surveillance and prevention for this high-risk group. A systematic search using PUBMED and OVID MEDLINE was performed. Publications listed under the terms "breast neoplasm", "neoplasm, radiation-induced", "therapeutic radiation-induced breast cancer", "screening", "surveillance", "prevention", and "prophylaxis" between January 1992 and January 2015 were assessed. A total of 138 publications were reviewed. Factors associated with increased SCB risk include young age at irradiation, prolong duration since irradiation (peak relative risk 13.87 at 15-19 years postradiation), and increased radiation dose and field. Early menopause reduces SCB risk. Annual screening mammography and breast MRI is recommended from age 25 or 8 years posttreatment for women treated with ≥20 Gy chest radiation before age 30 years. Compared with sporadic primary breast cancers (PBC), SCB more often are bilateral (6-34 %), managed with mastectomy (56-100 %), hormone receptor-negative (27-49 %), and high-grade (35 %). Women with SCB have a similar breast cancer event-free survival and breast cancer-specific survival compared to women with PBC. However, their overall survival is worse due to comorbid conditions. There is paucity of information regarding secondary prevention of SCB. Survivors of CAYA malignancy are at risk of many late effects, including iatrogenic breast cancer from chest irradiation. They are best managed in a multidisciplinary late-effects setting where tailored risk management can be provided.

Chest X-Ray

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Full Text Available ... about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed x-ray exams and use a very small dose of ... of the inside of the chest. A chest x-ray is used to evaluate the lungs, heart and ...

Globalization, Brain Drain, and Development

OpenAIRE

Docquier, Frédéric; Rapoport, Hillel

2012-01-01

This paper reviews four decades of economics research on the brain drain, with a focus on recent contributions and on development issues. We first assess the magnitude, intensity, and determinants of the brain drain, showing that brain drain (or high-skill) migration is becoming a dominant pattern of international migration and a major aspect of globalization. We then use a stylized growth model to analyze the various channels through which a brain drain affects the sending countries and revi...

Use of laterally placed vacuum drains for management of aural hematomas in five dogs.

Science.gov (United States)

Pavletic, Michael M

2015-01-01

5 dogs (a Newfoundland, Golden Retriever, Shiba Inu, Staffordshire Terrier, and Vizsla) were referred for evaluation and treatment of unilateral aural hematomas within a week after their formation. Aural hematomas involved the left (3) or right (2) ears. With patients under anesthesia, the aural hematomas were approached surgically from the convex, or lateral, pinnal surface. Two small incisions were used to position a vacuum drain into the incised hematoma cavity. The drain exited at the base of the pinna and adjacent cervical skin. The free end of the drain was attached to a vacuum reservoir for 18 to 21 days. Drains and skin sutures were removed at this time along with the protective Elizabethan collar. All hematomas resolved and surgical sites healed during the minimum 6-month follow-up period. Cosmetic results were considered excellent in 4 of 5 patients. Slight wrinkling of the pinna in 1 patient resulted from asymmetric enlargement of the cartilaginous walls of the hematoma, where vacuum application resulted in a slight folding of the redundant lateral cartilage wall. The described treatment was efficient, economical, and minimally invasive and required no bandaging or wound care. Placement of the drain tubing on the convex (lateral) aspect sheltered the system from displacement by patients with an Elizabethan collar in place. Overall cosmetic results were excellent; asymmetric enlargement of the cartilaginous walls of the hematoma with slight folding of the pinna was seen in 1 patient.

Using Smoke Injection in Drains to Identify Potential Preferential Pathways in a Drained Arable Field

Science.gov (United States)

Nielsen, M. H.; Petersen, C. T.; Hansen, S.

2014-12-01

Macropores forming a continuous pathway between the soil surface and subsurface drains favour the transport of many contaminants from agricultural fields to surface waters. The smoke injection method presented by Shipitalo and Gibbs (2000) used for demonstrating and quantifying such pathways has been further developed and used on a drained Danish sandy loam. In order to identify the preferential pathways to drains, smoke was injected in three 1.15 m deep tile drains (total drain length 93 m), and smoke emitting macropores (SEMP) at the soil surface were counted and characterized as producing either strong or weak plumes compared to reference plumes from 3 and 6 mm wide tubes. In the two situations investigated in the present study - an early spring and an autumn situation, smoke only penetrated the soil surface layer via earthworm burrows located in a 1.0 m wide belt directly above the drain lines. However, it is known from previous studies that desiccation fractures in a dry summer situation also can contribute to the smoke pattern. The distance between SEMP measured along the drain lines was on average 0.46 m whereas the average spacing between SEMP with strong plumes was 2.3 m. Ponded water was applied in 6 cm wide rings placed above 52 burrows including 17 reference burrows which did not emit smoke. Thirteen pathways in the soil were examined using dye tracer and profile excavation. SEMP with strong plumes marked the entrance of highly efficient transport pathways conducting surface applied water and dye tracer into the drain. However, no single burrow was traced all the way from the surface into the drain, the dye patterns branched off in a network of other macropores. Water infiltration rates were significantly higher (P drains and surface waters, pathways being associated primarily with unevenly distributed SEMP producing strong smoke plumes.

Routine chest X-ray in the allergy clinic

International Nuclear Information System (INIS)

Garcia-Barredo, M.R.; Usamentiaga, E.; Fidalgo, I.

1997-01-01

To determine whether routine chest X-ray is indicated in allergy patients when there is no evidence of cardiopulmonary involvement. A retrospective study to analyze the indications and radiologic findings in 515 consecutive patients who underwent chest X-ray: Positive findings were considered to be any radiological sing that led to the performance of additional diagnostic measures or a change in the therapeutic management of the patient. Positive radiologic findings were observed in 39 cases (7.59%). Only two patients (0.38%) were diagnosed as having diseases that were susceptible to proper treatment. In one of them (0.19%), the failure to perform chest X-ray would have impeded the introduction of proper treatment. We do not recommend carrying out routine chest X-ray in this patient population. (Author) 7 refs

Chest X-Ray

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Full Text Available ... talk with you about chest radiography also known as chest x-rays. Chest x-rays are the ... treatment for a variety of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray ...

Blunt chest trauma in a non-specialist centre: Right treatment, right place?

Science.gov (United States)

Maher, Lesley; Jayathissa, Sisira

2016-12-01

To compare patient characteristics, management and outcomes for patients admitted with isolated blunt chest trauma, managed by medical or surgical teams. We reviewed adult patients admitted with blunt chest trauma between 1 September 2006 and 31 August 2011 to a secondary hospital in New Zealand. Inclusion criteria were: blunt chest trauma, with at least one radiologically demonstrated rib fracture. The primary outcome was in-hospital mortality, and secondary outcomes were development of pneumonia, and use of analgesia. Seventy-two patients were included. Thirty-three patients were managed by medical teams and 39 by surgical teams. In-hospital mortality was greater amongst medical patients 5/33 (15%) versus surgical 0/39 (0%); P = 0.012. Pneumonia occurred in 15/33 (45%); medical patients versus surgical 2/39 (5%), P trauma fall compared to surgically managed patients (28/33 [85%] vs 9/39 [27%]; P chest trauma, those managed by medical teams were older, had more comorbidities and were more likely to have become injured with a low trauma fall than those managed by surgical teams. They had less access to analgesic options, developed pneumonia more often and had higher mortality. © 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

Chest X-Ray

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Full Text Available ... by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, ... d like to talk with you about chest radiography also known as chest x-rays. Chest x- ...

FLAIL CHEST

Directory of Open Access Journals (Sweden)

Anton Crnjac

2003-12-01

Full Text Available Background. Major thoracic trauma is consistent with high mortality rate because of associated injuries of vital thoracic organs and dangerous complications. The flail chest occurs after disruption of the skeletal continuity of chest wall and demands because of its pathophysiological complexity rapid and accurate diagnosis and treatment.Conclusions. Basic pathophysiological mechanism of the flail chest is respiratory distress, which is provoked by pulmonary contusions and paradoxical chest wall motion. The treatment should be pointed to improvement and support of respiratory functions and include aggressive pain control, pulmonary physiotherapy and selective mechanical ventilation. Views about operative fixation of the flail chest are still controversial. Neither mortality rate neither long-term disability are improved after operative fixation.

Chest X-Ray

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Full Text Available ... by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, ... you about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed ...

Pleuritic Chest Pain: Sorting Through the Differential Diagnosis.

Science.gov (United States)

Reamy, Brian V; Williams, Pamela M; Odom, Michael Ryan

2017-09-01

Pleuritic chest pain is characterized by sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling. Pulmonary embolism is the most common serious cause, found in 5% to 21% of patients who present to an emergency department with pleuritic chest pain. A validated clinical decision rule for pulmonary embolism should be employed to guide the use of additional tests such as d-dimer assays, ventilation-perfusion scans, or computed tomography angiography. Myocardial infarction, pericarditis, aortic dissection, pneumonia, and pneumothorax are other serious causes that should be ruled out using history and physical examination, electrocardiography, troponin assays, and chest radiography before another diagnosis is made. Validated clinical decision rules are available to help exclude coronary artery disease. Viruses are common causative agents of pleuritic chest pain. Coxsackieviruses, respiratory syncytial virus, influenza, parainfluenza, mumps, adenovirus, cytomegalovirus, and Epstein-Barr virus are likely pathogens. Treatment is guided by the underlying diagnosis. Nonsteroidal anti-inflammatory drugs are appropriate for pain management in those with virally triggered or nonspecific pleuritic chest pain. In patients with persistent symptoms, persons who smoke, and those older than 50 years with pneumonia, it is important to document radiographic resolution with repeat chest radiography six weeks after initial treatment.

Blunt chest trauma: bony injury in the thorax.

Science.gov (United States)

Zreik, Nasri H; Francis, Irene; Ray, Arun; Rogers, Benedict A; Ricketts, David M

2016-02-01

The management of blunt chest trauma is an evolving concept with no clear current guidelines. This article explores the bony injuries associated with this, focusing on rib fractures and flail segments and the themes around investigation and best management.

Clinical Databases for Chest Physicians.

Science.gov (United States)

Courtwright, Andrew M; Gabriel, Peter E

2018-04-01

A clinical database is a repository of patient medical and sociodemographic information focused on one or more specific health condition or exposure. Although clinical databases may be used for research purposes, their primary goal is to collect and track patient data for quality improvement, quality assurance, and/or actual clinical management. This article aims to provide an introduction and practical advice on the development of small-scale clinical databases for chest physicians and practice groups. Through example projects, we discuss the pros and cons of available technical platforms, including Microsoft Excel and Access, relational database management systems such as Oracle and PostgreSQL, and Research Electronic Data Capture. We consider approaches to deciding the base unit of data collection, creating consensus around variable definitions, and structuring routine clinical care to complement database aims. We conclude with an overview of regulatory and security considerations for clinical databases. Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Chest X-Ray

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Full Text Available ... I’d like to talk with you about chest radiography also known as chest x-rays. Chest x-rays are the most ... far outweighs any risk. For more information about chest x-rays, visit Radiology Info dot org. Thank you for your time! ...

A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma.

Science.gov (United States)

Singh, Amit Kumar; Suryanarayanan, Bhaskar; Choudhary, Ajay; Prasad, Akhila; Singh, Sachin; Gupta, Laxmi Narayan

2014-01-01

Chronic subdural hematoma (CSDH) recurs after surgical evacuation in 5-30% of patients. Inserting subdural drain might reduce the recurrence rate, but is not commonly practiced. There are few prospective studies to evaluate the effect of subdural drains. A prospective randomized study to investigate the effect of subdural drains in the on recurrence rates and clinical outcome following burr-hole drainage (BHD) of CSDH was undertaken. During the study period, 246 patients with CSDH were assessed for eligibility. Among 200 patients fulfilling the eligibility criteria, 100 each were assigned to "drain group" (drain inserted into the subdural space following BHD) and "without drain group" (subdural drain was not inserted following BHD) using random allocation software. The primary end point was recurrence needing re-drainage up to a period of 6 months from surgery. Recurrence occurred in 9 of 100 patients with a drain, and 26 of 100 patients in without drain group (P = 0.002). The mortality was 5% in patients with drain and 4% in patients without drain group (P = 0.744). The medical and surgical complications were comparable between the two study groups. Use of a subdural drain after burr-hole evacuation of a CSDH reduces the recurrence rate and is not associated with increased complications.

Americium/curium bushing melter drain tests

International Nuclear Information System (INIS)

Smith, M.E.; Hardy, B.J.; Smith, M.E.

1997-01-01

Americium and curium were produced in the past at the Savannah River Site (SRS) for research, medical, and radiological applications. They have been stored in a nitric acid solution in an SRS reprocessing facility for a number of years. Vitrification of the americium/curium (Am/Cm) solution will allow the material to be safely stored or transported to the DOE Oak Ridge Reservation. Oak Ridge is responsible for marketing radionuclides for research and medical applications. The bushing melter technology being used in the Am/Cm vitrification research work is also under consideration for the stabilization of other actinides such as neptunium and plutonium. A series of melter drain tests were conducted at the Savannah River Technology Center to determine the relationship between the drain tube assembly operating variables and the resulting pour initiation times, glass flowrates, drain tube temperatures, and stop pour times. Performance criteria such as ability to start and stop pours in a controlled manner were also evaluated. The tests were also intended to provide support of oil modeling of drain tube performance predictions and thermal modeling of the drain tube and drain tube heater assembly. These drain tests were instrumental in the design of subsequent melter drain tube and drain tube heaters for the Am/Cm bushing melter, and therefore in the success of the Am/Cm vitrification and plutonium immobilization programs

The efficacy of Jackson drain in the application to be a tunnel pleural catheter (TPC) in the management of malignant pleural effusion.

Science.gov (United States)

Tscheikuna, Jamsak; Thomrongpairoj, Preecha; Disayabutr, Suppareurg

2011-06-01

Malignant pleural effusion (MPE) is a common clinical problem in patients with advanced cancer and portends a poor prognosis, which means survival of less than six months. In June 1997, the US-FDA approved an indwelling TPC with a one-way drainage valve to be used in the management of MPE. Although popularity of this TPC has increased over the past few years, the experience with this device remains limited in Thai patients. One of the reasons is its high cost. Assess the efficacy and the safety of customary indwelling TPC by using Jackson drain in the management of patients with symptomatic MPE. Ten patients with symptomatic MPE were receiving these catheters (18 Fr Silicone catheters with 25 cm fenestrated length) to drain effusion via plastic vacuum bottles (250 ml) every other day or as needed to relieve dyspnea. The patient's dyspnic respiration, quality of life, and comfort during the catheter's application were quantified with a Borg score, the St. George Respiratory Disease Questionnaire (SGRQ), and the comfort's score, respectively. These parameters were recorded at initial (before insertion) and 2-week follow-up visit. Pain after 24 hours of each insertion was quantified by visual pain analogue scale (VPAS). Patients were followed until either death or catheter removal. The Borg score, SGRQ, and comfort's score showed significant improvement at 2-week visit (p drain was effective in the treatment of MPE as a TPC without early complications.

Right-sided superior vena cava draining into the left atrium: a rare anomaly of systemic venous return

International Nuclear Information System (INIS)

Aminololama-Shakeri, Shadi; Wootton-Gorges, Sandra L.; Reyes, Melissa; Moore, Elizabeth H.; Pretzlaff, Robert K.

2007-01-01

The most commonly encountered systemic thoracic venous anomaly is a persistent left superior vena cava that drains into the right atrium via the coronary sinus. A much rarer systemic venous anomaly is that of isolated anomalous drainage of a normally positioned right superior vena cava (RSVC) into the left atrium (LA). This has been reported in approximately 20 patients with the diagnosis usually being made by cardiac catheterization. We report the case of a toddler with asymptomatic hypoxemia resulting from anomalous drainage of a normal RSVC into his LA. This was diagnosed non-invasively by contrast-enhanced chest CT. (orig.)

Diagnostic value of the chest radiograph in asymptomatic neonates with a cardiac murmur

International Nuclear Information System (INIS)

Oeppen, R.S.; Fairhurst, J.J.; Argent, J.D.

2002-01-01

AIM: To establish the diagnostic accuracy and diagnostic usefulness of the chest radiograph in asymptomatic neonates with cardiac murmurs. PATIENTS AND METHODS: The chest radiographs of 68 asymptomatic neonates with cardiac murmurs were analysed retrospectively. The radiographs were anonymized and then evaluated for the presence or absence of cardiac disease by six radiologists, three who regularly interpret neonatal chest radiographs and three who do so infrequently. The eventual diagnosis for each neonate and the impact of the chest radiograph and original report on patient management were established by review of the clinical case notes. RESULTS: The results for each observer were expressed in 2 x 2 contingency tables and statistical analysis was performed using Fisher's exact test. The radiologists who were experienced in reporting neonatal chest radiographs achieved statistically significant results (P = 0.003, P = 0.002 andP = 0.007) compared with those who were less experienced (P = 0.13, P = 0.16 andP = 0.09). Review of the case notes established that the chest radiograph and original report did not influence clinical management in any of the 68 cases studied. CONCLUSIONS: Radiologists who frequently report neonatal chest radiographs achieve high accuracy in differentiating cardiac from non-cardiac disease. However, inaccuracies are unavoidable as radiological evidence of cardiac disease is often not present. A false-positive result could cause undue anxiety while a false-negative report could result in the omission of further investigations. Furthermore, a chest radiograph is unlikely to provide the definitive diagnosis. Chest radiographs did not appear to influence patient management in this study and cannot be recommended in the initial evaluation of the asymptomatic neonate with a heart murmur. Oeppen, R.S. et al. (2002)

A 26-year-old man with dyspnea and chest pain

Directory of Open Access Journals (Sweden)

Saurabh Mittal

2017-01-01

Full Text Available A 26-year-old smoker male presented with a history of sudden onset dyspnea and right-sided chest pain. Chest radiograph revealed large right-sided pneumothorax which was managed with tube thoracostomy. High-resolution computed tomography thorax revealed multiple lung cysts, and for a definite diagnosis, a video-assisted thoracoscopic surgery-guided lung biopsy was performed followed by pleurodesis. This clinicopathologic conference discusses the clinical and radiological differential diagnoses, utility of lung biopsy, and management options for patients with such a clinical presentation.

Navigating the socio-bio-geo-chemistry and engineering of nitrogen management in two illinois tile-drained watersheds.

Science.gov (United States)

David, Mark B; Flint, Courtney G; Gentry, Lowell E; Dolan, Mallory K; Czapar, George F; Cooke, Richard A; Lavaire, Tito

2015-03-01

Reducing nitrate loads from corn and soybean, tile-drained, agricultural production systems in the Upper Mississippi River basin is a major challenge that has not been met. We evaluated a range of possible management practices from biophysical and social science perspectives that could reduce nitrate losses from tile-drained fields in the Upper Salt Fork and Embarras River watersheds of east-central Illinois. Long-term water quality monitoring on these watersheds showed that nitrate losses averaged 30.6 and 23.0 kg nitrate N ha yr (Embarras and Upper Salt Fork watersheds, respectively), with maximum nitrate concentrations between 14 and 18 mg N L. With a series of on-farm studies, we conducted tile monitoring to evaluate several possible nitrate reduction conservation practices. Fertilizer timing and cover crops reduced nitrate losses (30% reduction in a year with large nitrate losses), whereas drainage water management on one tile system demonstrated the problems with possible retrofit designs (water flowed laterally from the drainage water management tile to the free drainage system nearby). Tile woodchip bioreactors had good nitrate removal in 2012 (80% nitrate reduction), and wetlands had previously been shown to remove nitrate (45% reductions) in the Embarras watershed. Interviews and surveys indicated strong environmental concern and stewardship ethics among landowners and farmers, but the many financial and operational constraints that they operate under limited their willingness to adopt conservation practices that targeted nitrate reduction. Under the policy and production systems currently in place, large-scale reductions in nitrate losses from watersheds such as these in east-central Illinois will be difficult. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Emergency management of blunt chest trauma in children: an evidence-based approach.

Science.gov (United States)

Pauzé, Denis R; Pauzé, Daniel K

2013-11-01

Pediatric trauma is commonly encountered in the emergency department, and trauma to the head, chest, and abdomen may be a source of significant morbidity and mortality. As children have unique thoracic anatomical and physiological properties, they may present with diagnostic challenges that the emergency clinician must be aware of. This review examines the effects of blunt trauma to the pediatric chest, as well as its relevant etiologies and associated mortality. Diagnostic and treatment options for commonly encountered injuries such as pulmonary contusions, rib fractures, and pneumothoraces are examined. Additionally, this review discusses rarely encountered--yet highly lethal--chest wall injuries such as blunt cardiac injuries, commotio cordis, nonaccidental trauma, and aortic injuries.

Chest pain related to crack cocaine smoking

International Nuclear Information System (INIS)

Eurman, D.W.; Potash, H.I.; Eyler, W.R.; Beute, G.H.; Paganussi, P.

1988-01-01

The chest radiographs of 80 patients coming to emergency room because of chest pain and/or shortness of breath following the smoking of highly potent crack cocaine were retrospectively reviewed. Four showed intrathoracic free air (pneumomediastinum in two, hemopneumothorax in one, and pneumothorax in one). Four other patients showed subsegmental atelectasis or parenchymal infiltrate. Radiographic detection of these abnormalities was of importance in the clinical management of the patients. This spectrum of findings is presented with a discussion of the pathophysiologic mechanisms and other potential complications of this form of drug abuse

A retrospective study of the use of active suction wound drains in dogs and cats.

Science.gov (United States)

Bristow, P C; Halfacree, Z J; Baines, S J

2015-05-01

To report indications for use and complications associated with commonly used closed active suction wound drains in a large number of clinical cases. Retrospective review of medical case records (from 2004 to 2010) for dogs and cats that had a closed active suction drain placed into a wound. Only the four most common drain types were included: Mini Redovac®, Redovac®, Jackson Pratt® and Wound Evac®. Two hundred and fifty-three drains were placed in 33 cats and 195 dogs. Mini Redovac drains were used most frequently in cats (76 · 5%) and Redovac drains in dogs (54 · 3%). The infection rate for clean surgeries in dogs was 15 · 6% (unattainable in cats). Major complications occurred in four dogs; minor complications occurred in 12 drains in cats (35 · 3%), and in 74 drains in dogs (33 · 8%). There was no statistically significant association between the type of drain and complication rate for either species. Although closed active suction drains can be used with low risk of major complications, they lead to a high rate of infection in clean surgeries in dogs. It is recommended that such drains are kept in place for the shortest time possible and that strict asepsis is adhered to both during placement and management. © 2015 British Small Animal Veterinary Association.

Chest trauma in children: A local experience

International Nuclear Information System (INIS)

Al-Saigh, A.; Fazili, Fiaz M.; Allam, Abdulla R.

1999-01-01

Chest trauma in childhood is relatively uncommon in clinical practice andhas been the subject of few reports in literature. This study was undertakento examine our experience in dealing with chest trauma in children. This wasa retrospective study of 74 children who sustained chest trauma and werereferred to King Fahd Hospital in Medina over a two-year period. The age,cause of injury, severity of injury, associated extrathoracic injuries,treatment and outcome were analyzed. The median age of patients was nineyears. Fifty-nine of them (80%) sustained blunt trauma in 62% of thechildren, gun shot wounds were seen in five and stab wounds in 10 children.Head injury was the most common injury associated with thoracic trauma andwas seen in 14 patients (19%) and associated intra-abdominal injuries wereseen in nine patients. Chest x-ray of the blunt trauma patients revealedfractured ribs in 24 children, pneumothorax in six, hemothorax in four,hemoneumothorax in three, and pulmonary contusions in 22 patients. Fifty onepercent of children were managed conservatively, 37% required tubethoracostomy, 8% were mechanically ventilated and 4% underwent thoractomy.The prevalence of chest trauma in children due to road traffic accidents ishigh in Saudi Arabia. Head injury is thought to be the most common associatedextrathoracic injuries, however, most of these patients can be managedconservatively. (author)

Coronary artery fistulas as a cause of angina: How to manage these patients?

Energy Technology Data Exchange (ETDEWEB)

Buccheri, Dario; Dendramis, Gregory, E-mail: gregorydendramis@libero.it; Piraino, Davide; Chirco, Paola Rosa; Carità, Patrizia; Paleologo, Claudia; Andolina, Giuseppe; Assennato, Pasquale; Novo, Salvatore

2015-07-15

Coronary artery fistulas represent the most common hemodynamically significant congenital defect of the coronary arteries and the clinical presentation is mainly dependent on the severity of the left-to-right shunt. We describe a case of a 55-year-old man with history of chest pain and without history of previous significant chest wall trauma or any invasive cardiac procedures. A coronary multislice computed tomography showed two large coronary fistulas arising from the left anterior descending coronary artery and ending in an angiomatous plexus draining into the common pulmonary trunk. Coronary angiography confirmed the CT finding and showed a third fistulous communication arising from the sinus node artery. Although coronary fistulas are infrequent, they are becoming increasingly important because their management and treatment could prevent serious complications. The latest guidelines of the American College of Cardiology/American Heart Association indicate as Class I recommendation the percutaneous or surgical closure for large fistulas regardless of symptoms. In this manuscript, we provide a detailed review of the literature on this topic, focusing on the clinical management of these patients.

Chest tube placement in thorax trauma - comparison chest X-ray and computed tomography (CT)

International Nuclear Information System (INIS)

Heim, P.; Maas, R.; Buecheler, E.; Tesch, C.

1998-01-01

Estimation of chest tube placement in patients with thoracic trauma with regard to chest tube malposition in chest radiography in the supine position compared to additional computed tomography of the thorax. Material and methods: Apart from compulsory chest radiography after one or multiple chest tube insertions, 31 severely injured patients with thoracic trauma underwent a CT scan of the thorax. These 31 patients with 40 chest tubes constituted the basis for the present analysis. Results: In chest radiography in the supine position there were no chest tube malpositions (n=40); In the CT scans 25 correct positions, 7 pseudo-malpositions, 6 intrafissural and 2 intrapulmonary malpositions were identified. Moreover 16 sufficient, 18 insufficient and 6 indifferent functions of the chest tubes were seen. Conclusion: In case of lasting clinical problems and questionable function of the chest tube, chest radiography should be supplemented by a CT scan of the thorax in order to estimate the position of the chest tube. (orig.) [de

Postoperative intraabdominal fluid collections : a modified percutaneous drainage method using a surgical drain track

International Nuclear Information System (INIS)

Lee, Deok Hee; Kim, Gab Choul; Hwang, Jae Cheol; Yoon, Hyun Ki; Song, Ho Young; Sung, Kyu Bo

2000-01-01

In the management of postoperative fluid collection, the conventional percutaneous drainage method can be employed. Because of abdominal incisions and various types of surgical drains and/or T-tubes, the application of this method is not always easy, however. We inserted a drainage catheter through a pre-existing percutaneous track formed by a surgical drain located adjacent to the site of abnormal fluid collection. There was no need to remove the drain nor make an additional puncture in the abdominal wall. A dilator was inserted along the drain, and a guide wire was used to negotiate its intraperitoneal track and reach the accumulated fluid. The procedure was simple and safe. We briefly describe our experience of this modified percutaneous drainage technique, as used in three cases involving postoperative fluid collection. (author)

Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial.

Science.gov (United States)

Guizilini, Solange; Viceconte, Marcela; Esperança, Gabriel Tavares da M; Bolzan, Douglas W; Vidotto, Milena; Moreira, Rita Simone L; Câncio, Andréia Azevedo; Gomes, Walter J

2014-01-01

To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27) - pleural drain in intercostal space; SI group (n=29) - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second) were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5) was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1. In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second) until POD5 (Ppleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting.

A mathematical model to optimize the drain phase in gravity-based peritoneal dialysis systems.

Science.gov (United States)

Akonur, Alp; Lo, Ying-Cheng; Cizman, Borut

2010-01-01

Use of patient-specific drain-phase parameters has previously been suggested to improve peritoneal dialysis (PD) adequacy. Improving management of the drain period may also help to minimize intraperitoneal volume (IPV). A typical gravity-based drain profile consists of a relatively constant initial fast-flow period, followed by a transition period and a decaying slow-flow period. That profile was modeled using the equation VD(t) = (V(D0) - Q(MAX) x t) xphi + (V(D0) x e(-alphat)) x (1 - phi), where V(D)(t) is the time-dependent dialysate volume; V(D0), the dialysate volume at the start of the drain; Q(MAX), the maximum drain flow rate; alpha, the exponential drain constant; and phi, the unit step function with respect to the flow transition. We simulated the effects of the assumed patient-specific maximum drain flow (Q(MAX)) and transition volume (psi), and the peritoneal volume percentage when transition occurs,for fixed device-specific drain parameters. Average patient transport parameters were assumed during 5-exchange therapy with 10 L of PD solution. Changes in therapy performance strongly depended on the drain parameters. Comparing 400 mL/85% with 200 mL/65% (Q(MAX/psi), drain time (7.5 min vs. 13.5 min) and IPV (2769 mL vs. 2355 mL) increased when the initial drain flow was low and the transition quick. Ultrafiltration and solute clearances remained relatively similar. Such differences were augmented up to a drain time of 22 minutes and an IPV of more than 3 L when Q(MAX) was 100 mL/min. The ability to model individual drain conditions together with water and solute transport may help to prevent patient discomfort with gravity-based PD. However, it is essential to note that practical difficulties such as displaced catheters and obstructed flow paths cause variability in drain characteristics even for the same patient, limiting the clinical applicability of this model.

Indications for chest CT. Retrospective study of cases with normal chest CT

International Nuclear Information System (INIS)

Obata, Shiro

1995-01-01

The usefulness of computed tomography (CT) in thoracic radiology is now well appreciated, and the number of chest CTs has greatly increased. There are, however, many chest CT cases that are completely or almost completely normal. Indications for chest CT should be re-evaluated considering the cost and radiation exposure associated with the examination. Reviewing the reports of 4930 chest CT examinations performed in three hospitals during the period of two years, the author found 620 (12.6%) negative CT examinations. In 312 of the 620, the CT was requested because of 'abnormal shadow' on chest radiograph. When the same chest radiographs were re-evaluated by two radiologists, no abnormality was noted in 257 cases (82.4%). CT examinations were considered justified in only 55 cases (17.6%). There was a significant difference in the frequency of normal chest CT examinations between the university hospital and two other hospitals. The causes of false positive interpretation of chest radiographs were analyzed, and it was felt that fundamental knowledge necessary to interpret chest radiographs was lacking. The importance of close cooperation between clinicians and radiologists should be emphasized. (author)

American College of Chest Physicians

Science.gov (United States)

... Foundation Participate in the e-Community Get Social Career Connection Publications CHEST Journal CHEST SEEK Guidelines & Consensus Statements CHEST Physician CHEST NewsBrief Coding for Chest Medicine Tobacco Dependence Toolkit (3rd Ed.) Mobile Websites and Apps CHEST Journal ...

Functional results after chest wall stabilization with a new screwless fixation device

OpenAIRE

Wiese, Mark Nikolaj; Kawel-Boehm, Nadine; Moreno de la Santa, Pablo; Al-Shahrabani, Feras; Toffel, Melanie; Rosenthal, Rachel; Schäfer, Juliane; Tamm, Michael; Bremerich, Jens; Lardinois, Didier

2017-01-01

OBJECTIVES This is the experience with the Stratos system in two surgical centres for the management of two types of rib fractures: flail chest and multiple dislocated rib fractures with significant chest wall deformity. METHODS From January 2009 to May 2012, 94 consecutive patients were included. Selected indications were extended anterolateral flail chest (n = 68) and dislocated painful rib fractures (n = 26). The open reduction internal fixation (ORIF) system consists of flexible titanium ...

Chest MRI

Science.gov (United States)

... resonance imaging - chest; NMR - chest; MRI of the thorax; Thoracic MRI Patient Instructions ... Gotway MB, Panse PM, Gruden JF, Elicker BM. Thoracic radiology. In: Broaddus VC, Mason RJ, Ernst JD, et ...

Drain Current Modulation of a Single Drain MOSFET by Lorentz Force for Magnetic Sensing Application.

Science.gov (United States)

Chatterjee, Prasenjit; Chow, Hwang-Cherng; Feng, Wu-Shiung

2016-08-30

This paper reports a detailed analysis of the drain current modulation of a single-drain normal-gate n channel metal-oxide semiconductor field effect transistor (n-MOSFET) under an on-chip magnetic field. A single-drain n-MOSFET has been fabricated and placed in the center of a square-shaped metal loop which generates the on-chip magnetic field. The proposed device designed is much smaller in size with respect to the metal loop, which ensures that the generated magnetic field is approximately uniform. The change of drain current and change of bulk current per micron device width has been measured. The result shows that the difference drain current is about 145 µA for the maximum applied magnetic field. Such changes occur from the applied Lorentz force to push out the carriers from the channel. Based on the drain current difference, the change in effective mobility has been detected up to 4.227%. Furthermore, a detailed investigation reveals that the device behavior is quite different in subthreshold and saturation region. A change of 50.24 µA bulk current has also been measured. Finally, the device has been verified for use as a magnetic sensor with sensitivity 4.084% (29.6 T(-1)), which is very effective as compared to other previously reported works for a single device.

Chest Pain: First Aid

Science.gov (United States)

First aid Chest pain: First aid Chest pain: First aid By Mayo Clinic Staff Causes of chest pain can vary from minor problems, such as indigestion ... 26, 2018 Original article: http://www.mayoclinic.org/first-aid/first-aid-chest-pain/basics/ART-20056705 . Mayo ...

Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax

DEFF Research Database (Denmark)

Olesen, Winnie Hedevang; Katballe, Niels; Sindby, Jesper Eske

2018-01-01

OBJECTIVES: Primary spontaneous pneumothorax frequently recurs after chest tube management. Evidence is lacking whether patients may benefit from surgery following their first episode. METHODS: We performed a multicentre, randomized trial and enrolled young, otherwise healthy patients admitted...... with their first episode of primary spontaneous pneumothorax and treated using conventional chest tube drainage. Patients underwent high-resolution computed tomography on fully expanded lungs, and using web-based randomization, we assigned patients to continued conservative chest tube treatment or chest tube...... treatment to prevent recurrence in patients with their first presentation of primary spontaneous pneumothorax and should be the standard of care when high-resolution computed tomography demonstrates bullae ≥2 cm. Clinical trial registration: ClinicalTrial.gov: NCT 02866305....

Pediatric chest imaging. Chest imaging in infants and children. 2. rev. ed.

Energy Technology Data Exchange (ETDEWEB)

Lucaya, Javier [Vall d' Hebron Hospitals, Barcelona (Spain). Dept. of Pediatric Radiology and Inst. of Diagnostic Imaging; Hospital Quiron, Barcelona (Spain). Dept. of Radiology; Strife, Janet L. (eds.) [Cincinnati Univ. Coll. of Medicine, Cincinnati, OH (United States). Dept. of Radiology Cincinnati Children' s Hospital Medical Center

2008-07-01

Imaging of the pediatric chest continues to evolve rapidly. All chapters in this 2nd edition of Pediatric Chest Imaging have been extensively updated, with additional disease-specific information and numerous new illustrations. The book thus presents the state of the art in the diagnosis of pediatric chest disorders, highlighting the role played by advanced technology. As the conventional features of most of these disorders are extremely well known, special attention is devoted to the technical aspects of the modern imaging modalities, their indications, and the diagnostic information that they supply. Individual chapters focus on chest ultrasound, nuclear medicine imaging, high-resolution chest CT, helical CT, and pediatric cardiac CT and pediatric cardiacMRI. Others are directed towards specific disorders, including congenital malformations of the chest, chest tumors, pulmonary infection, trauma, the lung in systemic diseases, the pediatric airway, foreign bodies, the thymus, and the chest wall. Without exception, the authors of this book are internationally known specialists with great expertise in the field. This book will serve as a handy, superbly illustrated reference for all who routinely image children, as well as for those who need access to information on how best to image them. (orig.)

Continuous 'Passive' Registration of Non-Point Contaminant Loads Via Agricultural Subsurface Drain Tubes

Science.gov (United States)

Rozemeijer, J.; Jansen, S.; de Jonge, H.; Lindblad Vendelboe, A.

2014-12-01

Considering their crucial role in water and solute transport, enhanced monitoring and modeling of agricultural subsurface tube drain systems is important for adequate water quality management. For example, previous work in lowland agricultural catchments has shown that subsurface tube drain effluent contributed up to 80% of the annual discharge and 90-92% of the annual NO3 loads from agricultural fields towards the surface water. However, existing monitoring techniques for flow and contaminant loads from tube drains are expensive and labor-intensive. Therefore, despite the unambiguous relevance of this transport route, tube drain monitoring data are scarce. The presented study aimed developing a cheap, simple, and robust method to monitor loads from tube drains. We are now ready to introduce the Flowcap that can be attached to the outlet of tube drains and is capable of registering total flow, contaminant loads, and flow-averaged concentrations. The Flowcap builds on the existing SorbiCells, a modern passive sampling technique that measures average concentrations over longer periods of time (days to months) for various substances. By mounting SorbiCells in our Flowcap, a flow-proportional part of the drain effluent is sampled from the main stream. Laboratory testing yielded good linear relations (R-squared of 0.98) between drainage flow rates and sampling rates. The Flowcap was tested in practice for measuring NO3 loads from two agricultural fields and one glasshouse in the Netherlands. The Flowcap registers contaminant loads from tube drains without any need for housing, electricity, or maintenance. This enables large-scale monitoring of non-point contaminant loads via tube drains, which would facilitate the improvement of contaminant transport models and would yield valuable information for the selection and evaluation of mitigation options to improve water quality.

Quantitative evaluation of changes in pleural effusion using digital images of the chest

International Nuclear Information System (INIS)

Nishiike, Shigeaki; Fujimura, Ichiro; Sagara, Kenji; Sakashita, Keiji

2000-01-01

Exposure data recognition (EDR) is a function of FCR that automatically determines the optimal density of images. This function makes it difficult to evaluate changes in pleural effusion on sequential chest CR. We developed a method to quantify the amount of pleural effusion using the digital value and S value of chest CR. We evaluated the efficacy of the method to quantify the amount of pleural effusion using these values of chest CR in clinical settings. The study period was from December 1996 to January 1999. Study 1: Chest CR was carried out before and after pleural cavity drainage in 70 cases. The volume calculated with the method using the digital value and S value of CR [x(ml)] was compared with the drained volume [y1] on both sides. Study 2: Change in pleural effusion was estimated with a method using CT (y2) and with the method using the digital value and S value of CR (x). The relationship of these two data was investigated. Study 1: The regression equations between x and y1 were y1=1.05x+21.1 (r 2 =0.89) on the right side and y1=0.95x+69.7 (r 2 =0.68) on the left side. Study 2: The regression equations between x and y2 were y2=0.75x-1.88 (r 2 =0.70) on the right side and y2=0.87x-1.27 (r 2 =0.65) on the left side. The method using the digital value and S value of CR was effective for quantifying changes in pleural effusion. (author)

A Rare Complication of Abdominal Drain: Fallopian Tube Herniation Through the Drain Site

OpenAIRE

Dilek Uygur; Seval Erdinç; Hülya Dede; Ümit Taşdemir; Oktay Kaymak; Nuri Danışman

2016-01-01

Prophylactic drainage of the peritoneal cavity after obstetrical and gynecological surgery is widely practiced. The idea of “when in doubt, drain” is accepted and applied clinically by many surgeons. However, surgically placed drains are not without risk. The present case describes herniation of fallopian tube during the removal of a surgical drain placed after a cesarean section.

Radiology of blunt chest trauma

Energy Technology Data Exchange (ETDEWEB)

Shulman, H.S.; Samuels, T.H. (Sunnybrook Medical Centre, Toronto, Ontario (Canada))

1983-09-01

Chest injuries and related complications prove fatal in over half of the victims of multiple trauma. The radiologist's responsibility is twofold: a) to recognize key radiographic signs and b) to guide the clinician in the radiologic investigation and management of the patient. The important diagnoses to be recognized from radiographs are pneumothorax, aortic rupture, bronhcial rupture and diaphragmatic rupture.

Cardiac CT for the assessment of chest pain: Imaging techniques and clinical results

International Nuclear Information System (INIS)

Becker, Hans-Christoph; Johnson, Thorsten

2012-01-01

Immediate and efficient risk stratification and management of patients with acute chest pain in the emergency department is challenging. Traditional management of these patients includes serial ECG, laboratory tests and further on radionuclide perfusion imaging or ECG treadmill testing. Due to the advances of multi-detector CT technology, dedicated coronary CT angiography provides the potential to rapidly and reliably diagnose or exclude acute coronary artery disease. Life-threatening causes of chest pain, such as aortic dissection and pulmonary embolism can simultaneously be assessed with a single scan, sometimes referred to as “triple rule out” scan. With appropriate patient selection, cardiac CT can accurately diagnose heart disease or other sources of chest pain, markedly decrease health care costs, and reliably predict clinical outcomes. This article reviews imaging techniques and clinical results for CT been used to evaluate patients with chest pain entering the emergency department.

Predictors of chest drainage complications in trauma patients

Directory of Open Access Journals (Sweden)

CECÍLIA ARAÚJO MENDES

2018-04-01

Full Text Available ABSTRACT Objective: to identify predictors of chest drainage complications in trauma patients attended at a University Hospital. Methods: we conducted a retrospective study of 68 patients submitted to thoracic drainage after trauma, in a one-year period. We analyzed gender, age, trauma mechanism, trauma indices, thoracic and associated lesions, environment in which the procedure was performed, drainage time, experience of the performer, complications and evolution. Results: the mean age of the patients was 35 years and the male gender was the most prevalent (89%. Blunt trauma was the most frequent, with 67% of cases, and of these, 50% were due to traffic accidents. The mean TRISS (Trauma and Injury Severity Score was 98, with a mortality rate of 1.4%. The most frequent thoracic and associated lesions were, respectively, rib fractures (51% and abdominal trauma (32%. The mean drainage time was 6.93 days, being higher in patients under mechanical ventilation (p=0.0163. The complication rate was 26.5%, mainly poor drain positioning (11.77%. Hospital drainage was performed in 89% of cases by doctors in the first year of specialization. Thoracic drainage performed in prehospital care presented nine times more chances of complications (p=0.0015. Conclusion: the predictors of post-trauma complications for chest drainage were a procedure performed in an adverse site and mechanical ventilation. The high rate of complications demonstrates the importance of protocols of care with the thoracic drainage.

Chest computed tomography

DEFF Research Database (Denmark)

Loeve, Martine; Krestin, Gabriel P.; Rosenfeld, Margaret

2013-01-01

are not suitable to study CF lung disease in young children. Chest computed tomography (CT) holds great promise for use as a sensitive surrogate endpoint in CF. A large body of evidence has been produced to validate the use of chest CT as primary endpoint to study CF lung disease. However, before chest CT can...

Radiological imaging of the neonatal chest. 2. rev. ed.

Energy Technology Data Exchange (ETDEWEB)

Donoghue, Veronica (ed.) [Children' s University Hospital, Dublin (Ireland). Dept. of Radiology; National Maternity Hospital, Dublin (Ireland)

2008-07-01

This second, revised edition of Radiological Imaging of the Neonatal Chest provides a comprehensive and up-to-date discussion of the subject. It is written primarily from the point of view of the paediatric radiologist but will be of particular interest to all antenatal ultrasonographers, neonatologists, paediatric cardiologists, paediatricians and paediatric surgeons. It includes an update on clinical management and appraises the advantages of the various techniques available to image the newborn chest. There is particular emphasis on the impact of recent therapeutic advances on imaging findings. Extensive consideration is given to both antenatal and postnatal imaging of congenital chest malformations, as well as to controversies regarding the postnatal management of asymptomatic infants with these anomalies. There are dedicated chapters on upper airway problems, infection and congenital heart disease, with special emphasis on the current role of magnetic resonance imaging, computed tomography and interventional therapy. There is also a chapter devoted to computed radiography and digital radiography. This book contains important information for all those involved in caring for the neonate. (orig.)

Pre-test probability risk scores and their use in contemporary management of patients with chest pain: One year stress echo cohort study

Science.gov (United States)

Demarco, Daniela Cassar; Papachristidis, Alexandros; Roper, Damian; Tsironis, Ioannis; Byrne, Jonathan; Monaghan, Mark

2015-01-01

Objectives To compare how patients with chest pain would be investigated, based on the two guidelines available for UK cardiologists, on the management of patients with stable chest pain. The UK National Institute of Clinical Excellence (NICE) guideline which was published in 2010 and the European society of cardiology (ESC) guideline published in 2013. Both guidelines utilise pre-test probability risk scores, to guide the choice of investigation. Design We undertook a large retrospective study to investigate the outcomes of stress echocardiography. Setting A large tertiary centre in the UK in a contemporary clinical practice. Participants Two thirds of the patients in the cohort were referred from our rapid access chest pain clinics. Results We found that the NICE risk score overestimates risk by 20% compared to the ESC Risk score. We also found that based on the NICE guidelines, 44% of the patients presenting with chest pain, in this cohort, would have been investigated invasively, with diagnostic coronary angiography. Using the ESC guidelines, only 0.3% of the patients would be investigated invasively. Conclusion The large discrepancy between the two guidelines can be easily reduced if NICE adopted the ESC risk score. PMID:26673458

Diagnostic Yield of Recommendations for Chest CT Examination Prompted by Outpatient Chest Radiographic Findings

Science.gov (United States)

Harvey, H. Benjamin; Gilman, Matthew D.; Wu, Carol C.; Cushing, Matthew S.; Halpern, Elkan F.; Zhao, Jing; Pandharipande, Pari V.; Shepard, Jo-Anne O.

2015-01-01

Purpose To evaluate the diagnostic yield of recommended chest computed tomography (CT) prompted by abnormalities detected on outpatient chest radiographic images. Materials and Methods This HIPAA-compliant study had institutional review board approval; informed consent was waived. Reports of all outpatient chest radiographic examinations performed at a large academic center during 2008 (n = 29 138) were queried to identify studies that included a recommendation for a chest CT imaging. The radiology information system was queried for these patients to determine if a chest CT examination was obtained within 1 year of the index radiographic examination that contained the recommendation. For chest CT examinations obtained within 1 year of the index chest radiographic examination and that met inclusion criteria, chest CT images were reviewed to determine if there was an abnormality that corresponded to the chest radiographic finding that prompted the recommendation. All corresponding abnormalities were categorized as clinically relevant or not clinically relevant, based on whether further work-up or treatment was warranted. Groups were compared by using t test and Fisher exact test with a Bonferroni correction applied for multiple comparisons. Results There were 4.5% (1316 of 29138 [95% confidence interval {CI}: 4.3%, 4.8%]) of outpatient chest radiographic examinations that contained a recommendation for chest CT examination, and increasing patient age (P recommendation for chest CT examination. Of patients within this subset who met inclusion criteria, 65.4% (691 of 1057 [95% CI: 62.4%, 68.2%) underwent a chest CT examination within the year after the index chest radiographic examination. Clinically relevant corresponding abnormalities were present on chest CT images in 41.4% (286 of 691 [95% CI: 37.7%, 45.2%]) of cases, nonclinically relevant corresponding abnormalities in 20.6% (142 of 691 [95% CI: 17.6%, 23.8%]) of cases, and no corresponding abnormalities in 38

A Rare Complication of Abdominal Drain: Fallopian Tube Herniation Through the Drain Site

Directory of Open Access Journals (Sweden)

Dilek Uygur

2016-05-01

Full Text Available Prophylactic drainage of the peritoneal cavity after obstetrical and gynecological surgery is widely practiced. The idea of “when in doubt, drain” is accepted and applied clinically by many surgeons. However, surgically placed drains are not without risk. The present case describes herniation of fallopian tube during the removal of a surgical drain placed after a cesarean section.

Possibilities of CT examinations by chest trauma

International Nuclear Information System (INIS)

Ftacnikova, B.

1994-01-01

Chest trauma represents the most frequent associated injury in multiply injured patients. The success of treatment depends also on prompt and effective diagnosis and extent of the injuries, on quality interdisciplinary approach. Author presents contributions of computed tomography (CT) in the management of 77 critically injured patients. Attention is focused on the efficacy of CT examination routinely employed in the setting of thoracic trauma and its relationship to following rationalization of treatment. CT scans of thorax is modality of choice for evaluating patients with occult pneumothorax, chest wall deformity of rib fractures, early diagnosis of lung contusion and laceration. (author). 13 figs., 1 tab., 7 refs

Transhiatal Chest Drainage After Hybrid Ivor Lewis Esophagectomy: Proof of Concept Study.

Science.gov (United States)

Asti, Emanuele; Sironi, Andrea; Bonitta, Gianluca; Bernardi, Daniele; Bonavina, Luigi

2018-04-01

Intercostal pleural drainage is standard practice after transthoracic esophagectomy but has some drawbacks. We hypothesized that a transhiatal pleural drain introduced through the subxyphoid port site incision at laparoscopy can be as effective as the intercostal drainage and may enhance patient recovery. A proof of concept study was designed to assess a new method of pleural drainage in patients undergoing hybrid Ivor Lewis esophagectomy (laparoscopy and right thoracotomy). The main study aims were safety and efficacy of transhiatal pleural drainage with a 15 Fr Blake tube connected to a portable vacuum system. Pre- and postoperative data, mean duration, and total and daily output of drainage were recorded in an electronic database. Postoperative complications were scored according to the Dindo-Clavien classification. Between June 2015 and December 2016, 50 of 63 consecutive patients met the criteria for inclusion in the study. No conversions from the portable vacuum system to underwater seal and suction occurred. There was no mortality. The overall morbidity rate was 40%. Two patients (4%) required reoperation for hemothorax and chylothorax, respectively. Percutaneous catheter drainage for residual pneumothorax was necessary in 2 patients (4%) on postoperative day 2. The mean duration of drainage was 7 days (interquartile range [IQR] = 2), and the total volume of drain output was 1580 mL (IQR = 880). No pleural effusion on chest X-ray was detected at the 3-month follow-up visit. Transhiatal pleural drainage is safe and effective after hybrid Ivor Lewis esophagectomy and could replace the intercostal drain in selected patients.

Inadvertent chest tube insertion in congenital cystic adenomatoid malformation and congenital lobar emphysema-highlighting an important problem

International Nuclear Information System (INIS)

Prabhu, Shailesh M; Choudhury, Subhasis Roy; Solanki, Ravi S; Shetty, Gurucharan S; Agarwala, Surenderkumar

2013-01-01

Chest tube insertion in congenital cystic lung lesions is an important problem in children with acute respiratory distress having a cystic lucent lesion on chest radiograph. To evaluate the imaging findings and complications in cases of congenital cystic lung lesions with chest tube insertion and suggest the role of appropriate imaging for management of these patients. Chest radiographs and CT scans of children with congenital cystic lung lesions who had inadvertent chest tube insertion preoperatively were retrospectively reviewed for imaging appearances and complications. Fifteen patients comprising 10 cases of congenital cystic adenomatoid malformation (CCAM) and 5 cases of congenital lobar emphysema (CLE) were included. Majority of the cases were infants. CCAM was misdiagnosed as complicated pneumatocele (n = 5) and pneumothorax (n = 5), while CLE was misdiagnosed as tension pneumothorax (n = 5) on the chest radiograph findings. Final diagnosis was made on CT and operative findings with histopathology. Complications noted were pneumothorax, hydropneumothorax, and infection in cases of CCAM, and change in imaging appearance and pneumothorax in cases of CLE. Chest tube insertion in congenital cystic lesions increases the rate of associated complications. Chest CT has a definite role in early diagnosis and deciding appropriate management in these cases

Does the usage of digital chest drainage systems reduce pleural inflammation and volume of pleural effusion following oncologic pulmonary resection?-A prospective randomized trial.

Science.gov (United States)

De Waele, Michèle; Agzarian, John; Hanna, Waël C; Schieman, Colin; Finley, Christian J; Macri, Joseph; Schneider, Laura; Schnurr, Terri; Farrokhyar, Forough; Radford, Katherine; Nair, Parameswaran; Shargall, Yaron

2017-06-01

Prolonged air leak and high-volume pleural drainage are the most common causes for delays in chest tube removal following lung resection. While digital pleural drainage systems have been successfully used in the management of post-operative air leak, their effect on pleural drainage and inflammation has not been studied before. We hypothesized that digital drainage systems (as compared to traditional analog continuous suction), using intermittent balanced suction, are associated with decreased pleural inflammation and postoperative drainage volumes, thus leading to earlier chest tube removal. One hundred and three [103] patients were enrolled and randomized to either analog (n=50) or digital (n=53) drainage systems following oncologic lung resection. Chest tubes were removed according to standardized, pre-defined protocol. Inflammatory mediators [interleukin-1B (IL-1B), 6, 8, tumour necrosis factor-alpha (TNF-α)] in pleural fluid and serum were measured and analysed. The primary outcome of interest was the difference in total volume of postoperative fluid drainage. Secondary outcome measures included duration of chest tube in-situ, prolonged air-leak incidence, length of hospital stay and the correlation between pleural effusion formation, degree of inflammation and type of drainage system used. There was no significant difference in total amount of fluid drained or length of hospital stay between the two groups. A trend for shorter chest tube duration was found with the digital system when compared to the analog (P=0.055). Comparison of inflammatory mediator levels revealed no significant differences between digital and analog drainage systems. The incidence of prolonged post-operative air leak was significantly higher when using the analog system (9 versus 2 patients; P=0.025). Lobectomy was associated with longer chest tube duration (P=0.001) and increased fluid drainage when compared to sub-lobar resection (Pdigital drainage does not appear to decrease pleural

21 CFR 868.5995 - Tee drain (water trap).

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tee drain (water trap). 868.5995 Section 868.5995...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5995 Tee drain (water trap). (a) Identification. A tee drain (water trap) is a device intended to trap and drain water that collects in ventilator...

Development of rationalized system treating floor drain

International Nuclear Information System (INIS)

Nakamura, Yasuyuki; Serizawa, Kenichi; Komatsu, Akihiro; Shimizu, Takayuki

1998-01-01

Radioactive liquid wastes generated at BWR plants are collected and treated as required. These days, however, generation of floor drain has deceased and HFF (Hollow Fiber Filter) has experienced a wide applicability to several kinds of liquid wastes. We should consider that the floor drain can be mixed and diluted with equipment drain and be purified by HFF. That enables some of the sumps and long priming pipes to be combined. From this point of view, we have developed a highly rationalized waste liquid system. We have evaluated the applicability of this system after an investigation into the generation and properties of floor drain and equipment drain at the latest BWR'S and an on-site test at a typical BWR. (author)

Diagnostic value of chest ultrasound after cardiac surgery: a comparison with chest X-ray and auscultation.

Science.gov (United States)

Vezzani, Antonella; Manca, Tullio; Brusasco, Claudia; Santori, Gregorio; Valentino, Massimo; Nicolini, Francesco; Molardi, Alberto; Gherli, Tiziano; Corradi, Francesco

2014-12-01

Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. Diagnostic accuracy of chest auscultation and chest ultrasound were compared in identifying individual abnormalities detected by chest x-ray, considered the reference method. Cardiac surgery intensive care unit. One hundred fifty-one consecutive adult patients undergoing cardiac surgery. All patients included were studied by chest auscultation, ultrasound, and x-ray upon admission to intensive care after cardiac surgery. Six lung pathologic changes and endotracheal tube malposition were found. There was a highly significant correlation between abnormalities detected by chest ultrasound and x-ray (k = 0.90), but a poor correlation between chest auscultation and x-ray abnormalities (k = 0.15). Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements. Copyright © 2014 Elsevier Inc. All rights reserved.

Chest Seal Placement for Penetrating Chest Wounds by Prehospital Ground Forces in Afghanistan.

Science.gov (United States)

Schauer, Steven G; April, Michael D; Naylor, Jason F; Simon, Erica M; Fisher, Andrew D; Cunningham, Cord W; Morissette, Daniel M; Fernandez, Jessie Renee D; Ryan, Kathy L

Thoracic trauma represents 5% of all battlefield injuries. Communicating pneumothoraces resulting in tension physiology remain an important etiology of prehospital mortality. In addressing penetrating chest trauma, current Tactical Combat Casualty Care (TCCC) guidelines advocate the immediate placement of a vented chest seal device. Although the Committee on TCCC (CoTCCC) has approved numerous chest seal devices for battlefield use, few data exist regarding their use in a combat zone setting. To evaluate adherence to TCCC guidelines for chest seal placement among personnel deployed to Afghanistan. We obtained data from the Prehospital Trauma Registry (PHTR). Joint Trauma System personnel linked patients to the Department of Defense Trauma Registry, when available, for outcome data upon reaching a fixed facility. In the PHTR, we identified 62 patients with documented gunshot wound (GSW) or puncture wound trauma to the chest. The majority (74.2%; n = 46) of these were due to GSW, with the remainder either explosive-based puncture wounds (22.6%; n = 14) or a combination of GSW and explosive (3.2%; n = 2). Of the 62 casualties with documented GSW or puncture wounds, 46 (74.2%) underwent chest seal placement. Higher proportions of patients with medical officers in their chain of care underwent chest seal placement than those that did not (63.0% versus 37.0%). The majority of chest seals placed were not vented. Of patients with a GSW or puncture wound to the chest, 74.2% underwent chest seal placement. Most of the chest seals placed were not vented in accordance with guidelines, despite the guideline update midway through the study period. These data suggest the need to improve predeployment training on TCCC guidelines and matching of the Army logistical supply chain to the devices recommended by the CoTCCC. 2017.

MRI of the Chest

Medline Plus

Full Text Available ... gives detailed pictures of structures within the chest cavity, including the mediastinum , chest wall, pleura, heart and ... helpful to assess the vessels of the chest cavity (arteries and veins). MRA can also demonstrate an ...

MRI of the Chest

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Full Text Available ... to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures. MRI ... of the chest. assess disorders of the chest bones (vertebrae, ribs and sternum) and chest wall soft ...

[Chest trauma].

Science.gov (United States)

Freixinet Gilart, Jorge; Ramírez Gil, María Elena; Gallardo Valera, Gregorio; Moreno Casado, Paula

2011-01-01

Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe. Copyright © 2011 Sociedad Española de Neumología y Cirugía Torácica. Published by Elsevier Espana. All rights reserved.

Diagnosis and Treatment of Chest Injury and Emergency Diseases of Chest Organs

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A. M. Khadjibaev

2016-01-01

Full Text Available Goal of research: to evaluate efficiency of videothoracoscopy in diagnosis and treatment of patients with injuries and emergency diseases ща chest organs.Material and methods: Study wasbased on treatment results analysis of 2111 patients with injuries and chest organs emergency diseases, who were treated at Republican Research Centre of Emergency Medicine in 2001-2014. Chest trauma made up 1396 (66,1% victims. There were 477 (22,6% patients with spontaneous pneumothorax. At the stages of initial diagnosis, the radiologic evaluations, CT investigations and videothoracoscopies were performed. In chest trauma patients the videothoracoscopy underwent in 844 cases, in spontaneous pneu#mothorax this method was employed in 290 patients. Complicated forms of lung echinococcosis were observed in 238 (11,3% patients and complicated forms of lung echinococcosis were evident in 72 patients.Results. Videothoracoscopy and video-assisted interventions allowed to eliminate lungs and pleura pathology in 1206 (57,1% patients, whereas the traditional methods were effective only in 905 cases (42,9%.Conclusions. Investigation methods such as multiplanar radioscopy, radiography, chest CT and videothora-coscopy must be included into algorithm of diagnosis and surgical treatment of chest injuries and emergency diseases of chest organs. At chest trauma the videothoracoscopy allows to avoid broad thoracotomy from 9,4% to 4,7% of cases, to reduce the frequency of repeated interventions from 17,4% to 0,5% and diminish a number of early postsurgery complications from 25,4% to 10,9%. Videothoracoscopy of chest traumas allows to reduce frequency of repeated interventions from 19,8 to 1,7%.

The radiology of blunt chest trauma

International Nuclear Information System (INIS)

Shulman, H.S.; Samuels, T.H.

1983-01-01

Chest injuries and related complications prove fatal in over half of the victims of multiple trauma. The radiologist's responsibility is twofold: a) to recognize key radiographic signs and b) to guide the clinician in the radiologic investigation and management of the patient. The important diagnoses to be recognized from radiographs are pneumothorax, aortic rupture, bronhcial rupture and diaphragmatic rupture

216-Z-8 French drain characterization study

International Nuclear Information System (INIS)

Marratt, M.C.; Kasper, R.B.; Van Luik, A.E.

1984-09-01

The 216-Z-8 French drain study is one of a series of studies examining historical transuranic waste facilities no longer in use at the Hanford Site. The 216-Z-8 French drain underground disposal system consisted of a large settling tank that overflowed into a French drain. The French drain consisted of two large-diameter, gravel filled, vitrified clay pipes placed on end, end-to-end, over a gravel-filled excavation. The top of the drain was sealed with concrete to prevent the upward flow of waste solution. The waste solution discharged to the 216-Z-8 waste disposal system was a neutralized, transuranic recovery process, filter cake, backflush slurry. The primary objective of this study was to determine the distribution of plutonium and americium beneath the French drain. Transuranic activity under the French drain did not exceed 5 nCi/g in the soil samples obtained from a well within 1 m of the drain structure. Conservative estimates indicated that 4 to 5 m 3 of radioactive contaminated sediments, 10 nCi/g may lie directly under the 216-Z-8 French drain. The secondary objective of the study was to evaluate the possibility of a leak in the settling tank. Results from the analysis of soil samples from wells drilled around the settling tank indicated the presence of low-level transuranic contamination (on the order of 0.001 nci/g) in the soil surrounding the tank. However, the distribution of the contamination does not support a leak as a plausible mechanism to account for the observed activity surrounding the tank. The bulk of the plutonium was confirmed to be in the sludge that remained in the tank; thus, no significant environmental impact would be expected even if there has been a leak

Drain site evisceration of fallopian tube, another reason to discourage abdominal drain: report of a case and brief review of literature.

Science.gov (United States)

Saini, Pradeep; Faridi, M S; Agarwal, Nitin; Gupta, Arun; Kaur, Navneet

2012-04-01

Placement of a drain following abdominal surgery is common despite a lack of convincing evidence in the current literature to support this practice. The use of intra-abdominal drain is associated with many potential and serious complications. We report a drain site evisceration of the right fallopian tube after the removal of an intra-abdominal drain. The drain was placed in the right iliac fossa in a patient who underwent a lower segment Caesarean section (LSCS) for meconium liquor with fetal distress. The Pfannenstiel incision made for LSCS was reopened and the protruding inflamed fimbrial end of the right fallopian tube was excised. The patient made an uneventful recovery. Routine intra-abdominal prophylactic drain following an abdominal surgery including LSCS should be discouraged.

Carbon balance of rewetted and drained peat soils used for biomass production: A mesocosm study

DEFF Research Database (Denmark)

Karki, Sandhya; Elsgaard, Lars; Kandel, Tanka

2016-01-01

of lower CO2 emissions without losing agricultural land. The present study quantified the carbon balance (CO2, CH4 and harvested biomass C) of rewetted and drained peat soils under intensively managed reed canary grass (RCG) cultivation. Mesocosms were maintained at five different ground water levels (GWL......), i.e., 0, 10, 20 cm below the soil surface, representing rewetted peat soils, and 30 and 40 cm below the soil surface, representing drained peat soils. Net ecosystem exchange (NEE) of CO2 and CH4 emissions were measured during the growing period of RCG (May to September) using transparent and opaque...... closed chamber methods. The average dry biomass yield was significantly lower from rewetted peat soils (12 Mg ha−1) than drained peat soils (15 Mg ha−1). Also, CO2 fluxes of gross primary production (GPP) and ecosystem respiration (ER) from rewetted peat soils were significantly lower than drained peat...

Management of chest tubes after pulmonary resection: a systematic review and meta-analysis.

Science.gov (United States)

Coughlin, Shaun M; Emmerton-Coughlin, Heather M A; Malthaner, Richard

2012-08-01

We performed a systematic review and meta-analysis to determine the effect of suction with water seal, compared with water seal alone, applied to intra pleural chest tubes on the duration of air leaks in patients undergoing pulmonary surgery. We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to find randomized controlled trials (RCTs) comparing the effect of the 2 methods on the duration of air leaks. Trials were systematically assessed for eligibility and validity. Data were extracted in duplicate and pooled across studies using a random-effects model. The search yielded 7 RCTs that met the eligibility criteria. No difference was identified between the 2 methods in duration of air leak (weighted mean difference [WMD] 1.15 days, favours water seal; 95% confidence interval [CI] -0.64 to 2.94), time to discharge (WMD 2.19 d, favours water seal; 95% CI -0.63 to 5.01), duration of chest tubes (WMD 0.96 d, favours water seal; 95% CI -0.12 to 2.05) or incidence of prolonged air leaks (absolute risk reduction [ARR] 0.04, favours water seal; 95% CI -0.01 to 0.09). Water seal was associated with a significantly increased incidence of postoperative pneumothorax (ARR -0.14, 95% CI -0.21 to -0.07). No differences were identified in terms of duration of air leak, incidence of prolonged air leak, duration of chest tubes and duration of hospital stay when chest tubes were placed to suction rather than water seal. Chest tube suction appears to be superior to water seal in reducing the incidence of pneumothorax; however, the clinical significance of this finding is unclear.

Ecografia na patologia torácica Ultrasound in chest disease

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António Bugalho

2010-08-01

Full Text Available Nos últimos anos a ecografia torácica tem vindo a ser reconhecida como um instrumento de extrema importância para os pneumologistas. Actualmente, os equipamentos são práticos, portáteis, de fácil utilização e fidedignos, o que os torna apropriados para utilização no diagnóstico e orientação de procedimentos terapêuticos. Na avaliação de derrame pleural e condução de toracentese são necessárias competências técnicas básicas em ultra-sonografia. Procedimentos mais complexos devem ser realizados perante treino específico e incluem a colocação de dreno torácico e identificação com eventual biopsia de lesões torácicas. Os autores procuram abordar, de um ponto de vista prático, a técnica e os recentes avanços alcançados neste campo. São apresentados alguns casos clínicos no sentido de ilustrar e guiar aqueles que desejam iniciar a realização de ecografia do tórax.In the past few years transthoracic ultrasound has been recognized as an important tool for chest physicians. At present, ultrasound devices are practical, portable, easy to use and reliable, which makes them suited for diagnostic investigations as well as for therapeutic procedures guidance. Basic ultrasound technical expertise is required to assess pleural effusions and perform ultrasound-guided thoracentesis. More complex procedures can be done with specific training and include assistance to chest drain insertion and identification with potential biopsy of thoracic lesions. The authors aim to review, in a practical approach, the technique and recent developments in this field. Clinical cases are presented in order to illustrate and guide the beginner in chest ultrasound.

Developing risk factors for post traumatic empyema in patients with chest trauma

Institute of Scientific and Technical Information of China (English)

Mara del Pilar Quiroga; Jos Daniel Charry; Nicols Becerra; Juan Camilo Garcia; Eliana Karina Muoz; Rodrigo Lara

2015-01-01

Objective:To establish the risk factors associated to development of empyema posttraumatic in patients with chest trauma managed with closed thoracostomy. Methods: It was a descriptive and observational study of patients with chest trauma who were admitted between January 2013 and May 2014. The variables were evaluated and the results according to management with closed thoracostomy in patients with thoracic trauma was determined. Univariate analysis was performed and measures of central tendency were calculated. Results: In total 240 patients were analyzed. Among them, 10.4% (25) developed posttraumatic empyema. In patients who developed empyema, the mean age was 34.2 years, and the mean injury severity score was 20.6. It was identified as a risk factor closed chest trauma in 68%(17) and 84%coagulated hemothorax trauma. Empyema management thoracoscopy was in 100%of cases. Conclusions: The posttraumatic empyema is a complication that occurs in patients with thoracic trauma. One of the most important risk factors is coagulated hemothorax which could be identified and treated in time to avoid comorbidities during hospital stay.

The effect of Tc99m Sestamibi scans during acute chest pain on clinical management

International Nuclear Information System (INIS)

Baldey, A.; Cameron, P.; Grigg, L.; Knott, J.; Better, N.

1998-01-01

Full text: The aim of this study is to assess whether the increased sensitivity and specificity of Tc99m sestamibi scans, during acute chest pain, will lead to alteration in clinical management and potential cost saving in an Australian population. Consecutive patients who presented with acute chest pain were injected 800 MBq of Tc99m sestamibi during pain (Hot MlBI) and SPECT imaging performed 1-6 hours later. The population was those only with a 'intermediate risk' of myocardial ischaemia The patients included in patients, those in the Emergency Department, and those with a previous history of cardiac disease. 25% of patients required a second, pain free study the following day to differentiate acute ischaemia from prior infarction. A question sheet was filled out by the requesting physician prior to the study indicating the likelihood of cardiac disease and the proposed management if no 'Hot MIBI' scan was available. The treatment that the patient subsequently received was ascertained from the patient's medical record. Of the 28 patients, a prediction whether to or not to proceed to coronary angiography was made in 13 patients prior to the MIBI study being performed. Of the 13, 5 would have had coronary angiography performed. and in all 5, the decision to proceed to coronary angiography was averted by the 'Hot MIBI'. Of note, 3 patients were admitted purely because of an abnormal 'Hot MIBI'. The 'Hot MIBI' was able to reduce coronary care admissions by 83% reduce all admissions by 17%, and avert coronary angiography in 38% of patients. In this intermediate risk category patient, this translates to not only admissions saved but potential cost saving

Penrose Drain Migration After Laparoscopic Surgery

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Pazouki AbdolReza

2009-05-01

Full Text Available Laparoscopy has made a revolution in surgical procedures and treatment of various diseases but its complications are still under investigation. Intra-abdominal visceral and vessel injuries, trocar site hernia, and leaving foreign bodies into the peritoneal cavity are among some laparoscopic surgery complications. This is a rare report of Penrose drain migration following incomplete laparoscopic Fundoplication surgery. The patient was a 47- year- old woman, who was a candidate for Touplet Fundoplication via laparoscopic approach due to refractory gastro-esophageal reflux disease (GERD. While wrapping a Penrose drain around the esophagus, the patient had a cardiorespiratory arrest. Attempts to remove the Penrose drain were unsuccessful and the surgical procedure was terminated due to patient's condition. Four months later, after a long period of dysphagia and abdominal pain, the Penrose drain was defecated via rectum.

When the Battle is Lost and Won: Delayed Chest Closure After Bilateral Lung Transplantation.

Science.gov (United States)

Soresi, Simona; Sabashnikov, Anton; Weymann, Alexander; Zeriouh, Mohamed; Simon, André R; Popov, Aron-Frederik

2015-10-12

In this article we summarize benefits of delayed chest closure strategy in lung transplantation, addressing indications, different surgical techniques, and additional perioperative treatment. Delayed chest closure seems to be a valuable and safe strategy in managing patients with various conditions after lung transplantation, such as instable hemodynamics, need for high respiratory pressures, coagulopathy, and size mismatch. Therefore, this approach should be considered in lung transplant centers to give patients time to recover before the chest is closed.

Land Use Impacts on Water Quality of Rivers draining from Mulanje ...

African Journals Online (AJOL)

Land Use Impacts on Water Quality of Rivers draining from Mulanje Mountain: A Case of Ruo River in the Southern Malawi. ... The research recommends an integrated water resources management approach where all users and relevant stakeholders should take an active role in the conservation of Ruo River catchment in ...

Blunt chest trauma.

Science.gov (United States)

Stewart, Daphne J

2014-01-01

Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.

An economic perspective on Malawi's medical "brain drain"

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Mohiddin Abdu

2006-12-01

closer look at the evidence for and against the medical "brain-drain" in Malawi suggests that there are potential gains in managing medical migration to produce outcomes that are beneficial to individuals, households and the country. Finally we present several policy options.

An economic perspective on Malawi's medical "brain drain"

Science.gov (United States)

Record, Richard; Mohiddin, Abdu

2006-01-01

for and against the medical "brain-drain" in Malawi suggests that there are potential gains in managing medical migration to produce outcomes that are beneficial to individuals, households and the country. Finally we present several policy options. PMID:17176457

Prevalence and Clinical Import of Thoracic Injury Identified by Chest Computed Tomography but Not Chest Radiography in Blunt Trauma: Multicenter Prospective Cohort Study.

Science.gov (United States)

Langdorf, Mark I; Medak, Anthony J; Hendey, Gregory W; Nishijima, Daniel K; Mower, William R; Raja, Ali S; Baumann, Brigitte M; Anglin, Deirdre R; Anderson, Craig L; Lotfipour, Shahram; Reed, Karin E; Zuabi, Nadia; Khan, Nooreen A; Bithell, Chelsey A; Rowther, Armaan A; Villar, Julian; Rodriguez, Robert M

2015-12-01

Chest computed tomography (CT) diagnoses more injuries than chest radiography, so-called occult injuries. Wide availability of chest CT has driven substantial increase in emergency department use, although the incidence and clinical significance of chest CT findings have not been fully described. We determine the frequency, severity, and clinical import of occult injury, as determined by changes in management. These data will better inform clinical decisions, need for chest CT, and odds of intervention. Our sample included prospective data (2009 to 2013) on 5,912 patients at 10 Level I trauma center EDs with both chest radiography and chest CT at physician discretion. These patients were 40.6% of 14,553 enrolled in the parent study who had either chest radiography or chest CT. Occult injuries were pneumothorax, hemothorax, sternal or greater than 2 rib fractures, pulmonary contusion, thoracic spine or scapula fracture, and diaphragm or great vessel injury found on chest CT but not on preceding chest radiography. A priori, we categorized thoracic injuries as major (having invasive procedures), minor (observation or inpatient pain control >24 hours), or of no clinical significance. Primary outcome was prevalence and proportion of occult injury with major interventions of chest tube, mechanical ventilation, or surgery. Secondary outcome was minor interventions of admission rate or observation hours because of occult injury. Two thousand forty-eight patients (34.6%) had chest injury on chest radiography or chest CT, whereas 1,454 of these patients (71.0%, 24.6% of all patients) had occult injury. Of these, in 954 patients (46.6% of injured, 16.1% of total), chest CT found injuries not observed on immediately preceding chest radiography. In 500 more patients (24.4% of injured patients, 8.5% of all patients), chest radiography found some injury, but chest CT found occult injury. Chest radiography found all injuries in only 29.0% of injured patients. Two hundred and two

Myocardial perfusion 320-row multidetector computed tomography-guided treatment strategy for the clinical management of patients with recent acute-onset chest pain: Design of the CArdiac cT in the treatment of acute CHest pain (CATCH)-2 randomized controlled trial.

Science.gov (United States)

Sørgaard, Mathias; Linde, Jesper J; Hove, Jens D; Petersen, Jan R; Jørgensen, Tem B S; Abdulla, Jawdat; Heitmann, Merete; Kragelund, Charlotte; Hansen, Thomas Fritz; Udholm, Patricia M; Pihl, Christian; Kühl, J Tobias; Engstrøm, Thomas; Jensen, Jan Skov; Høfsten, Dan E; Kelbæk, Henning; Kofoed, Klaus F

2016-09-01

Patients admitted with chest pain are a diagnostic challenge because the majority does not have coronary artery disease (CAD). Assessment of CAD with coronary computed tomography angiography (CCTA) is safe, cost-effective, and accurate, albeit with a modest specificity. Stress myocardial computed tomography perfusion (CTP) has been shown to increase the specificity when added to CCTA, without lowering the sensitivity. This article describes the design of a randomized controlled trial, CATCH-2, comparing a clinical diagnostic management strategy of CCTA alone against CCTA in combination with CTP. Patients with acute-onset chest pain older than 50 years and with at least one cardiovascular risk factor for CAD are being prospectively enrolled to this study from 6 different clinical sites since October 2013. A total of 600 patients will be included. Patients are randomized 1:1 to clinical management based on CCTA or on CCTA in combination with CTP, determining the need for further testing with invasive coronary angiography including measurement of the fractional flow reserve in vessels with coronary artery lesions. Patients are scanned with a 320-row multidetector computed tomography scanner. Decisions to revascularize the patients are taken by the invasive cardiologist independently of the study allocation. The primary end point is the frequency of revascularization. Secondary end points of clinical outcome are also recorded. The CATCH-2 will determine whether CCTA in combination with CTP is diagnostically superior to CCTA alone in the management of patients with acute-onset chest pain. Copyright © 2015 Elsevier Inc. All rights reserved.

Chest X-Ray

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Full Text Available ... some concerns about chest x-rays. However, it’s important to consider the likelihood of benefit to your health. While a chest x-ray use a ... posted: How to Obtain and Share ...

Cash's textbook of chest, heart and vascular disorders for physiotherapists

Energy Technology Data Exchange (ETDEWEB)

Downie, P.A.; Innocenti, D.M.; Jackson, S.E.

1987-01-01

This book includes a chapter on chest radiographs. A very high proportion of the patients treated by physiotherapy will have had a chest radiograph (x-ray) either because their primary disease is pulmonary or there is some long standing heart or lung illness which should be taken into account during the management of an acute problem. The chapter outlines the principles involved in reading the radiograph.

Thin chest wall is an independent risk factor for the development of pneumothorax after chest tube removal.

Science.gov (United States)

Anand, Rahul J; Whelan, James F; Ferrada, Paula; Duane, Therese M; Malhotra, Ajai K; Aboutanos, Michel B; Ivatury, Rao R

2012-04-01

The factors contributing to the development of pneumothorax after removal of chest tube thoracostomy are not fully understood. We hypothesized that development of post pull pneumothorax (PPP) after chest tube removal would be significantly lower in those patients with thicker chest walls, due to the "protective" layer of adipose tissue. All patients on our trauma service who underwent chest tube thoracostomy from July 2010 to February 2011 were retrospectively reviewed. Patient age, mechanism of trauma, and chest Abbreviated Injury Scale score were analyzed. Thoracic CTs were reviewed to ascertain chest wall thickness (CW). Thickness was measured at the level of the nipple at the midaxillary line, as perpendicular distance between skin and pleural cavity. Chest X-ray reports from immediately prior and after chest tube removal were reviewed for interval development of PPP. Data are presented as average ± standard deviation. Ninety-one chest tubes were inserted into 81 patients. Patients who died before chest tube removal (n = 11), or those without thoracic CT scans (n = 13) were excluded. PPP occurred in 29.9 per cent of chest tube removals (20/67). When PPP was encountered, repeat chest tube was necessary in 20 per cent of cases (4/20). After univariate analysis, younger age, penetrating mechanism, and thin chest wall were found to be significant risk factors for development of PPP. Chest Abbreviated Injury Scale score was similar in both groups. Logistic regression showed only chest wall thickness to be an independent risk factor for development of PPP.

The health workforce crisis: the brain drain scourge.

Science.gov (United States)

Ike, Samuel O

2007-01-01

The magnitude of the health workforce crisis engendered by brain drain particularly in Africa, and nay more especially Nigeria, has been assuming increasingly alarming proportions in the past three decades. The challenge it poses in meeting the manpower needs in the healthcare sector as well as in the larger economy of the sending countries is enormous. This paper thus sets out to highlight the scope of this brain drain, its effects and the reasons sustaining it, as well as makes concrete suggestions to help stern the tide. A review of the literature on brain drain with particular emphasis on the health workforce sector was done, with focus on Africa, and specifically Nigeria. Literature search was done using mainly the Medline, as well as local journals. The historical perspectives, with the scope of external and internal brain drain are explored. The glaring effects of brain drain both in the global workforce terrain and specifically in the health sectors are portrayed. The countries affected most and the reasons for brain drain are outlined. Strategic steps to redress the brain drain crisis are proffered in this paper. The health workforce crisis resulting from brain drain must be brought to the front-burner of strategic policy decisions leading to paradigm shift in political, social and economic conditions that would serve as incentives to curb the scourge.

Long-Term Metal Retention Performance of Media Filter Drains for Stormwater Management

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Agathe Thomas

2015-03-01

Full Text Available Stormwater runoff, a substantial source of nonpoint pollution, can be treated using Best Management Practices (BMPs, such as the Media Filter Drain (MFD. An MFD is a trench filled with an engineered media mix, usually with a grass overlay, that receives runoff from the paved roadway next to it. The MFD was shown to remove dissolved metals (zinc and copper, typical pollutants from vehicles and urban areas, which might negatively impact aquatic species in receiving waters, but its long-term effectiveness was not known. Existing media filter mixes of different ages were collected from two different sites in the Pacific Northwest of the United States. Columns made with these media mixes received concentrated copper and zinc loading to simulate accelerated aging for estimated total lifespans from 14 to 22 years of copper and zinc loading, with little or no decrease in sorption. Throughout the aging process, some columns were subjected to performance testing with higher levels of typical runoff concentrations and average concentration decreases from influent to effluent were found to be greater than 90% for both copper and zinc. Based on this study, the MFD’s lifespan for zinc and copper treatment is significantly greater than the initial ten-year estimate.

Chest X-Ray

Medline Plus

Full Text Available ... and chest wall and may be used to help evaluate shortness of breath, persistent cough, fever, chest ... or injury. It may also be useful to help diagnose and monitor treatment for a variety of ...

Changing pattern and outcome of pediatric chest injuries in urban Syria.

Science.gov (United States)

Darwish, Bassam; Mahfouz, Mohammad Z; Al-Nosairat, Saeed; Izzat, Mohammad Bashar

2018-01-01

Background Pediatric chest injuries were infrequent in our practice, but the outbreak of the Syrian crisis resulted in an increase in number and a change in the pattern of thoracic trauma incidents. We compared our experience of pediatric chest injuries before and during the crisis. Methods We reviewed the records of 256 children aged 12.8 ± 5 years who were admitted to our hospital with the diagnosis of chest trauma over a 12-year period. Collected data included mechanism of injury, associated injuries, method of management, length of hospital stay, complications, and mortality. Results The incidence of pediatric chest injuries increased significantly following the outbreak of the crisis, and penetrating injuries prevailed, mainly due to shrapnel, bullets, and stab wounds. Forty percent of patients with blunt injuries and 20% of those with penetrating injuries were managed conservatively, whereas urgent thoracotomies were indicated in 10%, mostly in patients with penetrating injuries. Associated injuries were more frequent in patients with blunt injuries and resulted in a longer hospital stay and an increased mortality rate. The overall mortality rate was 7.8% and it was higher in children younger than 7 years of age and in patients who had been subjected to blunt injuries. Conclusions There has been a recent substantial upsurge in the incidence of pediatric thoracic trauma, with a predominance of penetrating injuries. Most patients could be managed nonoperatively, but a small subset required an open thoracotomy. The presence of associated injuries constitutes the main determinant of prognosis in this group of patients.

Chest X-Ray

Medline Plus

Full Text Available ... breath, persistent cough, fever, chest pain or injury. It may also be useful to help diagnose and ... have some concerns about chest x-rays. However, it’s important to consider the likelihood of benefit to ...

Pleural fluid drainage: Percutaneous catheter drainage versus surgical chest tube drainage

International Nuclear Information System (INIS)

Illescas, F.F.; Reinhold, C.; Atri, M.; Bret, P.M.

1987-01-01

Over the past 4 years, 55 cases (one transudate, 28 exudates, and 26 empymas) were drained. Surgical chest tubes alone were used in 35 drainages, percutaneous catheters alone in five drainages, and both types in 15 drainages. Percutaneous catheter drainage was successful in 12 of 20 drainages (60%). Surgical tube drainage was successful in 18 of 50 drainages (36%). The success rate for the nonempyema group was 45% with both types of drainage. For the empyema group, the success rate for percutaneous catheter drainage was 66% vs 23% for surgical tube drainage. Seven major complications occurred with surgical tube drainage, but only one major complication occurred with percutaneous catheter drainage. Radiologically guided percutaneous catheter drainage should be the procedure of choice for pleural fluid drainage. It has a higher success rate for empyemas and is associated with less complications

Device for discharging drain in a control rod driving apparatus

International Nuclear Information System (INIS)

Ikeda, Tadasu; Ikuta, Takuzo; Yoshida, Tomiji; Tsukahara, Katsumi.

1975-01-01

Object: To efficiently and safely collect and discharge drain by a simple construction in which a drain cover and a drain tank in a control rod driving apparatus are integrally formed, and an overhauling wrench of said apparatus and a drain hose are mounted on the drain tank. Structure: When a mounting bolt is untightened by a torque wrench so as to be removed from a flange surface of the control rod driving apparatus in a nuclear reactor, axial movement of said apparatus is absorbed by a spring so that drain containing a radioactive material is discharged into a drain tank through the flange surface of said apparatus and is then guided into a collecting tank through a drain hose. (Kamimura, M.)

Does the suction drain diameter matter? Bleeding analysis after total knee replacement comparing different suction drain gauges

Directory of Open Access Journals (Sweden)

Marcos George de Souza Leao

Full Text Available ABSTRACT OBJECTIVES: To evaluate bleeding and the estimated blood loss in patients who underwent total knee replacement (TKR with different closed suction drains (3.2-mm and 4.8-mm gauge. METHODS: This was a randomized controlled trial with 22 patients who underwent TKR and were divided into two groups: Group I, with 11 patients in whom the 3.2-mm suction drain was used, and Group II, with 11 patients in whom the 4.8-mm suction drain was used. The hematocrit was measured after 24, 48 and 72 h after surgery in order to calculate the estimated blood loss. The drained volume was measured 3, 6, 12, 24, and 48 h after TKR, and thereafter both groups were compared. RESULTS: Regarding the hematocrit, there were no differences between groups in measured periods (24, 48, and 72 h after surgery. The total bleeding measured at the suction drains within 48 h was higher in Group II, with a statistically significant difference (p = 0.005; in the first 24 h, there was major bleeding in Group II (mean 893 mL, with a significant difference (p = 0.004. Between 24 and 48 h, there was no statistically significant difference in both groups (p = 0.710. The total estimated bleeding was higher in Group I, with mean of 463 mL, versus 409 mL in Group II, with no statistical significance (p = 0.394. CONCLUSIONS: Bleeding was higher in the group that used the 4.8 mm gauge suction drain, with no differences in hematocrit and estimated blood loss.

Timing of Re-Transfusion Drain Removal Following Total Knee Replacement

Science.gov (United States)

Leeman, MF; Costa, ML; Costello, E; Edwards, D

2006-01-01

INTRODUCTION The use of postoperative drains following total knee replacement (TKR) has recently been modified by the use of re-transfusion drains. The aim of our study was to investigate the optimal time for removal of re-transfusion drains following TKR. PATIENTS AND METHODS The medical records of 66 patients who had a TKR performed between October 2003 and October 2004 were reviewed; blood drained before 6 h and the total volume of blood drained was recorded. RESULTS A total of 56 patients had complete records of postoperative drainage. The mean volume of blood collected in the drain in the first 6 h was 442 ml. The mean total volume of blood in the drain was 595 ml. Therefore, of the blood drained, 78% was available for transfusion. CONCLUSION Re-transfusion drains should be removed after 6 h, when no further re-transfusion is permissible. PMID:16551400

Laparoscopic radical prostatectomy: omitting a pelvic drain

Directory of Open Access Journals (Sweden)

David Canes

2008-03-01

Full Text Available PURPOSE: Our goal was to assess outcomes of a selective drain placement strategy during laparoscopic radical prostatectomy (LRP with a running urethrovesical anastomosis (RUVA using cystographic imaging in all patients. Materials and Methods: A retrospective chart review was performed for all patients undergoing LRP between January 2003 and December 2004. The anastomosis was performed using a modified van Velthoven technique. A drain was placed at the discretion of the senior surgeon when a urinary leak was demonstrated with bladder irrigation, clinical suspicion for a urinary leak was high, or a complex bladder neck reconstruction was performed. Routine postoperative cystograms were obtained. RESULTS: 208 patients underwent LRP with a RUVA. Data including cystogram was available for 206 patients. The overall rate of cystographic urine leak was 5.8%. A drain was placed in 51 patients. Of these, 8 (15.6% had a postoperative leak on cystogram. Of the 157 undrained patients, urine leak was radiographically visible in 4 (2.5%. The higher leak rate in the drained vs. undrained cohort was statistically significant (p = 0.002. Twenty-four patients underwent pelvic lymph node dissection (8 drained, 16 undrained. Three undrained patients developed lymphoceles, which presented clinically on average 3 weeks postoperatively. There were no urinomas or hematomas in either group. CONCLUSIONS: Routine placement of a pelvic drain after LRP with a RUVA is not necessary, unless the anastomotic integrity is suboptimal intraoperatively. Experienced clinical judgment is essential and accurate in identifying patients at risk for postoperative leakage. When suspicion is low, omitting a drain does not increase morbidity.

Development and testing of watershed-scale models for poorly drained soils

Science.gov (United States)

Glenn P. Fernandez; George M. Chescheir; R. Wayne Skaggs; Devendra M. Amatya

2005-01-01

Watershed-scale hydrology and water quality models were used to evaluate the crrmulative impacts of land use and management practices on dowrzstream hydrology and nitrogen loading of poorly drained watersheds. Field-scale hydrology and nutrient dyyrutmics are predicted by DRAINMOD in both models. In the first model (DRAINMOD-DUFLOW), field-scale predictions are coupled...

46 CFR 45.157 - Scuppers and gravity drains.

Science.gov (United States)

2010-10-01

... 46 Shipping 2 2010-10-01 2010-10-01 false Scuppers and gravity drains. 45.157 Section 45.157 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY (CONTINUED) LOAD LINES GREAT LAKES LOAD LINES Conditions of Assignment § 45.157 Scuppers and gravity drains. Scuppers and gravity deck drains from spaces...

Brain drain and health workforce distortions in Mozambique.

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Sherr, Kenneth; Mussa, Antonio; Chilundo, Baltazar; Gimbel, Sarah; Pfeiffer, James; Hagopian, Amy; Gloyd, Stephen

2012-01-01

Trained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain from low and middle-income countries is well described, there is little understanding of the degree of internal brain drain, and how increases in health sector funding through global health initiatives may contribute to the outflow of health workers from the public sector to donor agencies, non-governmental organisations (NGOs), and the private sector. An observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980-2006. Data were collected 26-months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment, and main work duties. Of 723 qualifying physicians between 1980-2006, 95.9% (693) were working full-time, including 71.1% (493) as clinicians, 20.5% (142) as health system managers, and 6.9% (48) as researchers/professors. 25.5% (181) of the sample had left the public sector, of which 62.4% (113) continued working in-country and 37.6% (68) emigrated from Mozambique. Of those cases of internal migration, 66.4% (75) worked for NGOs, 21.2% (24) for donor agencies, and 12.4% (14) in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% (41/113) of internal migration cases had previously held senior-level management positions in the public sector. Internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique. Given the urgent need to strengthen public sector health systems, frank reflection by donors and NGOs is needed to assess how hiring practices may undermine the very systems they seek

Brain drain and health workforce distortions in Mozambique.

Directory of Open Access Journals (Sweden)

Kenneth Sherr

Full Text Available Trained human resources are fundamental for well-functioning health systems, and the lack of health workers undermines public sector capacity to meet population health needs. While external brain drain from low and middle-income countries is well described, there is little understanding of the degree of internal brain drain, and how increases in health sector funding through global health initiatives may contribute to the outflow of health workers from the public sector to donor agencies, non-governmental organisations (NGOs, and the private sector.An observational study was conducted to estimate the degree of internal and external brain drain among Mozambican nationals qualifying from domestic and foreign medical schools between 1980-2006. Data were collected 26-months apart in 2008 and 2010, and included current employment status, employer, geographic location of employment, and main work duties.Of 723 qualifying physicians between 1980-2006, 95.9% (693 were working full-time, including 71.1% (493 as clinicians, 20.5% (142 as health system managers, and 6.9% (48 as researchers/professors. 25.5% (181 of the sample had left the public sector, of which 62.4% (113 continued working in-country and 37.6% (68 emigrated from Mozambique. Of those cases of internal migration, 66.4% (75 worked for NGOs, 21.2% (24 for donor agencies, and 12.4% (14 in the private sector. Annual incidence of physician migration was estimated to be 3.7%, predominately to work in the growing NGO sector. An estimated 36.3% (41/113 of internal migration cases had previously held senior-level management positions in the public sector.Internal migration is an important contributor to capital flight from the public sector, accounting for more cases of physician loss than external migration in Mozambique. Given the urgent need to strengthen public sector health systems, frank reflection by donors and NGOs is needed to assess how hiring practices may undermine the very systems they

Chest tomosynthesis: technical and clinical perspectives.

Science.gov (United States)

Johnsson, Ase Allansdotter; Vikgren, Jenny; Bath, Magnus

2014-02-01

The recent implementation of chest tomosynthesis is built on the availability of large, dose-efficient, high-resolution flat panel detectors, which enable the acquisition of the necessary number of projection radiographs to allow reconstruction of section images of the chest within one breath hold. A chest tomosynthesis examination obtains the increased diagnostic information provided by volumetric imaging at a radiation dose comparable to that of conventional chest radiography. There is evidence that the sensitivity of chest tomosynthesis may be at least three times higher than for conventional chest radiography for detection of pulmonary nodules. The sensitivity increases with increasing nodule size and attenuation and decreases for nodules with subpleural location. Differentiation between pleural and subpleural lesions is a known pitfall due to the limited depth resolution in chest tomosynthesis. Studies on different types of pathology report increased detectability in favor of chest tomosynthesis in comparison to chest radiography. The technique provides improved diagnostic accuracy and confidence in the diagnosis of suspected pulmonary lesions on chest radiography and facilitates the exclusion of pulmonary lesions in a majority of patients, avoiding the need for computed tomography (CT). However, motion artifacts can be a cumbersome limitation and breathing during the tomosynthesis image acquisition may result in severe artifacts significantly affecting the detectability of pathology. In summary, chest tomosynthesis has been shown to be superior to chest conventional radiography for many tasks and to be able to replace CT in selected cases. In our experience chest tomosynthesis is an efficient problem solver in daily clinical work. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center.

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Onat, Serdar; Ulku, Refik; Avci, Alper; Ates, Gungor; Ozcelik, Cemal

2011-09-01

Penetrating injuries to the chest present a frequent and challenging problem, but the majority of these injuries can be managed non-\\operatively. The aim of this study was to describe the incidence of penetrating chest trauma and the ultimate techniques used for operative management, as well as the diagnosis, complications, morbidity and mortality. A retrospective 9-year review of patients who underwent an operative procedure following penetrating chest trauma was performed. The mechanism of injury, gender, age, physiological and outcome parameters, including injury severity score (ISS), chest abbreviated injury scale (AIS) score, lung injury scale score, concomitant injuries, time from admission to operating room, transfusion requirement, indications for thoracotomy, intra-operative findings, operative procedures, length of hospital stay (LOS) and rate of mortality were recorded. A total of 1123 patients who were admitted with penetrating thoracic trauma were investigated. Of these, 158 patients (93 stabbings, 65 gunshots) underwent a thoracotomy within 24 h after the penetrating trauma. There were 146 (92.4%) male and 12 (7.6%) female patients, and their mean age was 25.72 9.33 (range, 15–54) years. The mean LOS was 10.65 8.30 (range, 5–65) days. Patients admitted after a gunshot had a significantly longer LOS than those admitted with a stab wound (gunshot, 13.53 9.92 days; stab wound, 8.76 6.42 days, p chest AIS score (p chest requiring a thoracotomy are uncommon, and lung-sparing techniques have become the most frequently used procedures for lung injuries. The presence of associated abdominal injuries increased the mortality five-fold. Factors that affected mortality were ISS, chest AIS score, SBP, ongoing chest output, blood transfusion volume, diaphragmatic injury and associated abdominal injury.

Surgical Stabilization of Costoclavicular Injuries - A Combination of Flail Chest Injuries and a Clavicula Fracture.

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Langenbach, Andreas; Pinther, Melina; Krinner, Sebastian; Grupp, Sina; Ekkernkamp, Axel; Hennig, Friedrich F; Schulz-Drost, Stefan

2017-01-01

Background: Flail chest injuries (FCI) are associated with a high morbidity and mortality rate. As a concomitant clavicle fracture in FCI even worsens the outcome, the question is how can those costoclavicular injuries (CCI) be managed surgically. Methods: 11 patients with CCI were surgically treated by a locked plate osteosynthesis of the Clavicle and the underlying ribs through limited surgical approaches under general anesthesia. Patients were followed up after 2, 6, 12, 26 and 52 weeks. Results: All patients showed severe chest wall deformity due to severely displaced fractures of the ribs and the clavicle. They were suffering from pain and restriction of respiratory movements. The chest wall could be restored to normal shape in all cases with uneventful bone healing and a high patient convenience. Fractures of the clavicle and the second rib were managed through an innovative clavipectoral approach, the others through standard approaches to the anterolateral and the posterolateral chest wall. Two patients complained about numbness around the lateral approach and lasting periscapular pain. Conclusions: Surgical stabilization might be the appropriate therapy in CCI with dislocated fractures since they would cause severe deformity and loss of function of the chest wall and the shoulder. Celsius.

Current practice patterns of drain usage amongst UK and Irish surgeons performing bilateral breast reductions: Evidence down the drain.

Science.gov (United States)

Sugrue, Conor M; McInerney, Niall; Joyce, Cormac W; Jones, Deidre; Hussey, Alan J; Kelly, Jack L; Kerin, Michael J; Regan, Padraic J

2015-01-01

Bilateral breast reduction (BBR) is one of the most frequently performed female breast operations. Despite no evidence supporting efficacy of drain usage in BBRs, postoperative insertion is common. Recent high quality evidence demonstrating potential harm from drain use has subsequently challenged this traditional practice. The aim of this study is to assess the current practice patterns of drains usage by Plastic & Reconstructive and Breast Surgeons in UK and Ireland performing BBRs. An 18 question survey was created evaluating various aspects of BBR practice. UK and Irish Plastic & Reconstructive and Breast Surgeons were invited to participate by an email containing a link to a web-based survey. Statistical analysis was performed with student t-test and chi-square test. Two hundred and eleven responding surgeons were analysed, including 80.1% (171/211) Plastic Surgeons and 18.9% (40/211) Breast Surgeons. Of the responding surgeons, 71.6% (151/211) routinely inserted postoperative drains, for a mean of 1.32 days. Drains were used significantly less by surgeons performing ≥20 BBRs (p = 0.02). With the majority of BBRs performed as an inpatient procedure, there was a trend towards less drain usage in surgeons performing this procedure as an outpatient; however, this was not statistically significant (p = 0.07). Even with the high level of evidence demonstrating the safety of BBR without drains, they are still routinely utilised. In an era of evidence- based medicine, surgeons performing breast reductions must adopt the results from scientific research into their clinical practice.

QUALIFIED VERSION OF MIGRATION: BRAIN DRAIN

Directory of Open Access Journals (Sweden)

Ayhan GENCLER

2009-07-01

Full Text Available Though globalization suggests an international exchange of people besides goods and capital, developed countries often tended to put forward some restrictions on the migration of workers from developed countries. However, there has been an increase in skilled international migration especially during the last two decades. Skilled international migration or brain drain points out the emigration of educated and highly skilled workers. It seems that, in general, developing or underdeveloped countries experience the negative consequences of the brain drain and suffer from the decreases in their human capital. The paper explains the phenomenon of skilled international migration, or brain drain, and summarizes the main global trends in this area.

PEAT-CO2. Assessment of CO2 emissions from drained peatlands in SE Asia

International Nuclear Information System (INIS)

Hooijer, A.; Silvius, M.; Woesten, H.; Page, S.

2006-12-01

Forested tropical peatlands in SE Asia store at least 42,000 Megatonnes of soil carbon. This carbon is increasingly released to the atmosphere due to drainage and fires associated with plantation development and logging. Peatlands make up 12% of the SE Asian land area but account for 25% of current deforestation. Out of 27 million hectares of peatland, 12 million hectares (45%) are currently deforested and mostly drained. One important crop in drained peatlands is palm oil, which is increasingly used as a biofuel in Europe. In the PEAT-CO2 project, present and future emissions from drained peatlands were quantified using the latest data on peat extent and depth, present and projected land use and water management practice, decomposition rates and fire emissions. It was found that current likely CO2 emissions caused by decomposition of drained peatlands amounts to 632 Mt/y (between 355 and 874 Mt/y). This emission will increase in coming decades unless land management practices and peatland development plans are changed, and will continue well beyond the 21st century. In addition, over 1997-2006 an estimated average of 1400 Mt/y in CO2 emissions was caused by peatland fires that are also associated with drainage and degradation. The current total peatland CO2 emission of 2000 Mt/y equals almost 8% of global emissions from fossil fuel burning. These emissions have been rapidly increasing since 1985 and will further increase unless action is taken. Over 90% of this emission originates from Indonesia, which puts the country in 3rd place (after the USA and China) in the global CO2 emission ranking. It is concluded that deforested and drained peatlands in SE Asia are a globally significant source of CO2 emissions and a major obstacle to meeting the aim of stabilizing greenhouse gas emissions, as expressed by the international community. It is therefore recommended that international action is taken to help SE Asian countries, especially Indonesia, to better conserve

CT of chest trauma

International Nuclear Information System (INIS)

Goodman, P.C.

1986-01-01

There appears to be a limited role for computed tomography in the evaluation of chest trauma. The literature contains few papers specifically addressing the use of CT in the setting of chest trauma. Another series of articles relates anecdotal experiences in this regard. This paucity of reports attests to the remarkable amount of information present on conventional chest radiographs as well as the lack of clear indications for CT in the setting of chest trauma. In this chapter traumatic lesions of various areas of the thorax are discussed. The conventional radiographic findings are briefly described and the potential or proven application of CT is addressed

An experimental study about efficacy of the drain catheters

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Ahn, Bum Gyu; Nho, Joon Young; Woo, Hyo Cheol; Hwang, Woo Cheol; Park, Choong Ki; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of)

1993-09-15

Although percutaneous abscess drainage has become and accepted alternative from of therapy for selected patients with abscess, it is well known that there are several factors in the failure of adequate drainage such as pre- and post-procedural management, technique itself, various features of abscess, and selection and application of catheters. Among these factors, we made an experiment about drainage efficacy of commonly used various catheters with different viscosities of water-glycerin solution under the two different pressure gradients. The experimental values of flow rate were very lower than the calculated values. An efficacy of experimental value was 4-14%. Because the inner diameter of fittings and stopcocks was usually smaller than the inner diameter of catheters, these factors also affected the drain efficacy. Finally, we thought that it will be very helpful to the treatment of patient as well as to study about the catheter drainage, if the drain efficacy of individual catheters has been notified.

Analysis of chest image performance in patients with acute chlorine poisoning

International Nuclear Information System (INIS)

Liu Liangqing; Zheng Jiangang; Yang Keyu; Wu Honglin; Tang Qingfang; Wu Huiming

2012-01-01

Objective: To explore chest image features of patients with acute chlorine poisoning and their clinical values. Methods: A retrospective analysis was performed by chest image features of 117 patients with acute chlorine poisoning. All the patients were classified according to Chinese management of occupational acute chlorine poisoning diagnosis standard. Results: Sixty-five patients presented with stimulus response, and normal or both lungs had a little more white on their chest images. Thirty-one cases presented with minor poisoning, and without or the texture of both lungs was increased, and grew hazy and coarse.seventeen cases were moderate, and small sample vague shadows or single or multiple limitations lamellar shadow. Four cases were serious,and two lungs had extensive and density homogeneous consolidation shadow. Conclusions: It would make the diagnosis and assessment of chlorine poisoning more easier based on the combination of chest image features, the clear history of acute chlorine poisoning and relevant clinical performance. (authors)

What is the clinical significance of chest CT when the chest x-ray result is normal in patients with blunt trauma?

Science.gov (United States)

Kea, Bory; Gamarallage, Ruwan; Vairamuthu, Hemamalini; Fortman, Jonathan; Lunney, Kevin; Hendey, Gregory W; Rodriguez, Robert M

2013-08-01

Computed tomography (CT) has been shown to detect more injuries than plain radiography in patients with blunt trauma, but it is unclear whether these injuries are clinically significant. This study aimed to determine the proportion of patients with normal chest x-ray (CXR) result and injury seen on CT and abnormal initial CXR result and no injury on CT and to characterize the clinical significance of injuries seen on CT as determined by a trauma expert panel. Patients with blunt trauma older than 14 years who received emergency department chest imaging as part of their evaluation at 2 urban level I trauma centers were enrolled. An expert trauma panel a priori classified thoracic injuries and subsequent interventions as major, minor, or no clinical significance. Of 3639 participants, 2848 (78.3%) had CXR alone and 791 (21.7%) had CXR and chest CT. Of 589 patients who had chest CT after a normal CXR result, 483 (82.0% [95% confidence interval [CI], 78.7-84.9%]) had normal CT results, and 106 (18.0% [95% CI, 15.1%-21.3%]) had CTs diagnosing injuries-primarily rib fractures, pulmonary contusion, and incidental pneumothorax. Twelve patients had injuries classified as clinically major (2.0% [95% CI, 1.2%-3.5%]), 78 were clinically minor (13.2% [95% CI, 10.7%-16.2%]), and 16 were clinically insignificant (2.7% (95% CI, 1.7%-4.4%]). Of 202 patients with CXRs suggesting injury, 177 (87.6% [95% CI, 82.4%-91.5%]) had chest CTs confirming injury and 25 (12.4% [95% CI, 8.5%-17.6%]) had no injury on CT. Chest CT after a normal CXR result in patients with blunt trauma detects injuries, but most do not lead to changes in patient management. Copyright © 2013 Elsevier Inc. All rights reserved.

Generation of airborne Listeria innocua from model floor drains.

Science.gov (United States)

Berrang, Mark E; Frank, Joseph F

2012-07-01

Listeria monocytogenes can colonize floor drains in poultry processing and further processing facilities, remaining present even after cleaning and disinfection. Therefore, during wash down, workers exercise caution to avoid spraying hoses directly into drains in an effort to prevent the escape and transfer of drain microflora to food contact surfaces. The objective of this study was to examine the extent to which an inadvertent water spray into a colonized floor drain can cause the spread of airborne Listeria. Listeria innocua was used to inoculate a polyvinyl chloride model floor drain, resulting in approximately 10(8) cells per ml of phosphate-buffered saline and 10(4) attached cells per square centimeter of inner surface. Each model drain was subjected to a 2-s spray of tap water at 68.9 kPa from a distance of 1 m. Drains were sprayed while filled and again after emptying. Airborne cells were collected by using sedimentation plates containing Listeria selective agar which were placed on the floor and walls of a contained room at incremental horizontal and vertical distances of 0.6, 1.2, 2.4, or 4.0 m from the drain. Sedimentation plates were exposed for 10 min. A mechanical sampler was used to also collect air by impaction on the surface of Listeria selective agar to determine the number of cells per liter of air. The experiment was conducted in triplicate rooms for each of four replications. L. innocua was detected on sedimentation plates on the floor as far as 4.0 m from the drain and on walls as high as 2.4 m above the floor and 4 m from the drain. A 2-s spray with a water hose into a contaminated drain can cause airborne spread of Listeria, resulting in the potential for cross-contamination of food contact surfaces, equipment, and exposed product.

The value of cholangiography through Jackson-Pratt drains in the management of postoperative biliary injuries.

Science.gov (United States)

Macedo, Francisco Igor B; Casillas, Victor J; Davis, James S; Levi, Joe U; Sleeman, Danny

2014-01-01

Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution. Mean age was 51.7 ± 18.1 years (range, 19 to 86 years) with 30 (75%) females. Seventeen (42.5%) injuries were detected intraoperatively and in 13 (32.5%) cases, JP drains were placed for biliary drainage. Lesions were classified according to Bismuth grade: I (10 patients [25%]), II (10 patients [25%]), III (six patients [15%]), IV (10 patients [25%]), and V (four patients [10%]). TCC was performed in seven patients with JP drains (53.8%). It fully defined the injury site in three cases of limited magnetic resonance cholangiopancreatography (MRCP) such as common hepatic duct and common bile duct leaks and in four cases (57.1%) that endoscopic retrograde cholangiopancreatography (ERCP) was limited as a result of clipping of the distal common bile duct. TCC showed promising results in cases of limited MRCP and ERCP such as fistulous orifices or leakage. It may represent an alternative adjunct in the diagnostic armamentarium of complex biliary injuries.

Learning chest imaging

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Pedrozo Pupo, John C. (ed.) [Magdalena Univ., Santa Maria (Colombia). Respire - Inst. for Respiratory Care

2013-03-01

Useful learning tool for practitioners and students. Overview of the imaging techniques used in chest radiology. Aid to the correct interpretation of chest X-ray images. Radiology of the thorax forms an indispensable element of the basic diagnostic process for many conditions and is of key importance in a variety of medical disciplines. This user-friendly book provides an overview of the imaging techniques used in chest radiology and presents numerous instructive case-based images with accompanying explanatory text. A wide range of clinical conditions and circumstances are covered with the aim of enabling the reader to confidently interpret chest images by correctly identifying structures of interest and the causes of abnormalities. This book, which will be an invaluable learning tool, forms part of the Learning Imaging series for medical students, residents, less experienced radiologists, and other medical staff. Learning Imaging is a unique case-based series for those in professional education in general and for physicians in prarticular.

Chest radiology

International Nuclear Information System (INIS)

Reed, J.C.

1990-01-01

This book is a reference in plain chest film diagnosis provides a thorough background in the differential diagnosis of 22 of the most common radiologic patterns of chest disease. Each chapter is introduced with problem cases and a set of questions, followed by a tabular listing of the appropriate differential considerations. The book emphasizes plain films, CT and some MR scans are integrated to demonstrate how these modalities enhance the work of a case

Fallopian Tube Herniation through Left Sided Abdominal Drain Site.

Science.gov (United States)

Hussain, Khalid; Masood, Jovaria

2016-06-01

Intra-abdominal drains have been used since long to prevent intra-abdominal collection, and detect any anastomotic leaks. We report a case of left sided fallopian tube herniation from a left lower abdominal drain site in a 27-year female who underwent caesarian section for breach presentation. Several complications related to drain usage has been described but left sided fallopian tube prolapse through drain site has not been reported in literature.

Modeling the long-term effect of winter cover crops on nitrate transport in artificially drained fields across the Midwest U.S.

Science.gov (United States)

A fall-planted cover crop is a management practice with multiple benefits including reducing nitrate losses from artificially drained fields. We used the Root Zone Water Quality Model (RZWQM) to simulate the impact of a cereal rye cover crop on reducing nitrate losses from drained fields across five...

Digital chest radiography

DEFF Research Database (Denmark)

Debess, Jeanne Elisabeth; Johnsen, Karen Kirstine; Thomsen, Henrik

on collimation and dose reduction in digital chest radiography Methods and Materials A retrospective study of digital chest radiography is performed to evaluate the primary x-ray tube collimation of the PA and lateral radiographs. Data from one hundred fifty self-reliant female patients between 15 and 55 years...

Lessons from a large trauma center: impact of blunt chest trauma in polytrauma patients-still a relevant problem?

Science.gov (United States)

Chrysou, Konstantina; Halat, Gabriel; Hoksch, Beatrix; Schmid, Ralph A; Kocher, Gregor J

2017-04-20

Thoracic trauma is the third most common cause of death after abdominal injury and head trauma in polytrauma patients. The purpose of this study was to investigate epidemiological data, treatment and outcome of polytrauma patients with blunt chest trauma in order to help improve management, prevent complications and decrease polytrauma patients' mortality. In this retrospective study we included all polytrauma patients with blunt chest trauma admitted to our tertiary care center emergency department for a 2-year period, from June 2012 until May 2014. Data collection included details of treatment and outcome. Patients with chest trauma and Injury Severity Score (ISS) ≥18 and Abbreviated Injury Scale (AIS) >2 in more than one body region were included. A total of 110 polytrauma patients with blunt chest injury were evaluated. 82 of them were males and median age was 48.5 years. Car accidents, falls from a height and motorbike accidents were the most common causes (>75%) for blunt chest trauma. Rib fractures, pneumothorax and pulmonary contusion were the most common chest injuries. Most patients (64.5%) sustained a serious chest injury (AIS thorax 3), 19.1% a severe chest injury (AIS thorax 4) and 15.5% a moderate chest injury (AIS thorax 2). 90% of patients with blunt chest trauma were treated conservatively. Chest tube insertion was indicated in 54.5% of patients. The need for chest tube was significantly higher among the AIS thorax 4 group in comparison to the AIS groups 3 and 2 (p < 0.001). Also, admission to the ICU was directly related to the severity of the AIS thorax (p < 0.001). The severity of chest trauma did not correlate with ICU length of stay, intubation days, complications or mortality. Although 84.5% of patients suffered from serious or even severe chest injury, neither in the conservative nor in the surgically treated group a significant impact of injury severity on ICU stay, intubation days, complications or mortality was observed. AIS

Does the quality of chest compressions deteriorate when the chest compression rate is above 120/min?

Science.gov (United States)

Lee, Soo Hoon; Kim, Kyuseok; Lee, Jae Hyuk; Kim, Taeyun; Kang, Changwoo; Park, Chanjong; Kim, Joonghee; Jo, You Hwan; Rhee, Joong Eui; Kim, Dong Hoon

2014-08-01

The quality of chest compressions along with defibrillation is the cornerstone of cardiopulmonary resuscitation (CPR), which is known to improve the outcome of cardiac arrest. We aimed to investigate the relationship between the compression rate and other CPR quality parameters including compression depth and recoil. A conventional CPR training for lay rescuers was performed 2 weeks before the 'CPR contest'. CPR anytime training kits were distributed to respective participants for self-training on their own in their own time. The participants were tested for two-person CPR in pairs. The quantitative and qualitative data regarding the quality of CPR were collected from a standardised check list and SkillReporter, and compared by the compression rate. A total of 161 teams consisting of 322 students, which includes 116 men and 206 women, participated in the CPR contest. The mean depth and rate for chest compression were 49.0±8.2 mm and 110.2±10.2/min. Significantly deeper chest compression depths were noted at rates over 120/min than those at any other rates (47.0±7.4, 48.8±8.4, 52.3±6.7, p=0.008). Chest compression depth was proportional to chest compression rate (r=0.206, pcompression including chest compression depth and chest recoil by chest compression rate. Further evaluation regarding the upper limit of the chest compression rate is needed to ensure complete full chest wall recoil while maintaining an adequate chest compression depth. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Effectiveness of embolization for management of hemoptysis pulmonary tuberculosis: comparison of chest radiographic study and angiography

Energy Technology Data Exchange (ETDEWEB)

Shin, Sang Chul; Kim, Yong Ju; Park, Joong Wha; Lee Myeong Sub; Kim Dong Jin; Hong In Soo [Yonsei Univ. College of Medicine, Wonju (Korea, Republic of)

2001-01-01

To compare the effectiveness of embolization of the bronchial artery embolization for the management of hemoptysis in pulmonary tuberculosis cases with the severity of lung parenchymal injury and pleural infiltration, as seen on plain chest radiographs, and with the findings of angiography of the branchial artery. Among 265 patients with hemoptysis due to pulmonary tuberculosis, the findings of plain chest radiography and angiography of the bronchial artery were comparatively analyzed in the 206 for whom the results of follow up were available. The chest radiographin findings were classified as follows: Type I refers to simple pulmonary tuberculosis; Type II includes cases in which pulmonary tuberculosis is complicated by bronchiectasis, aspergillosis, or cavitation; Type III si either Types I or II acompainted by pleural in filtrates limited to the lung apex, and Type IV includes cases in which pleural infiltrates have extended beyond the apex in the whole the lung. Bronchial angiographic findings were divided into four groups: Group I consists of cases which show abnormalities of only the bronchial artery; Group II includes those in which abnormalities are seen in the bronchial artery and either the internal mammary or an intercostal artery; Group III comprises cases which belong to Group I or II and which a bronch of the subclavian artery is abnormal, and Group IV includes those in which abnormalities occur in at least two branches of the subclavian artery, or there is direct visualization of hypervascularity of this vessel. The initial post-embolic hemostatic effect and the results of follow up were studied over a six-month period. As compared with simple pulmonary tuberculosis (Type I), we found that as the severity of pleural infiltration and complications revealed by plain chest radiographs increased (Type II, III, IV), so did the severity of the manifestation of systemic collateral arteries other than the bronchial artery, as depicted by increased on

Effectiveness of embolization for management of hemoptysis pulmonary tuberculosis: comparison of chest radiographic study and angiography

International Nuclear Information System (INIS)

Shin, Sang Chul; Kim, Yong Ju; Park, Joong Wha; Lee Myeong Sub; Kim Dong Jin; Hong In Soo

2001-01-01

To compare the effectiveness of embolization of the bronchial artery embolization for the management of hemoptysis in pulmonary tuberculosis cases with the severity of lung parenchymal injury and pleural infiltration, as seen on plain chest radiographs, and with the findings of angiography of the branchial artery. Among 265 patients with hemoptysis due to pulmonary tuberculosis, the findings of plain chest radiography and angiography of the bronchial artery were comparatively analyzed in the 206 for whom the results of follow up were available. The chest radiographin findings were classified as follows: Type I refers to simple pulmonary tuberculosis; Type II includes cases in which pulmonary tuberculosis is complicated by bronchiectasis, aspergillosis, or cavitation; Type III si either Types I or II acompainted by pleural in filtrates limited to the lung apex, and Type IV includes cases in which pleural infiltrates have extended beyond the apex in the whole the lung. Bronchial angiographic findings were divided into four groups: Group I consists of cases which show abnormalities of only the bronchial artery; Group II includes those in which abnormalities are seen in the bronchial artery and either the internal mammary or an intercostal artery; Group III comprises cases which belong to Group I or II and which a bronch of the subclavian artery is abnormal, and Group IV includes those in which abnormalities occur in at least two branches of the subclavian artery, or there is direct visualization of hypervascularity of this vessel. The initial post-embolic hemostatic effect and the results of follow up were studied over a six-month period. As compared with simple pulmonary tuberculosis (Type I), we found that as the severity of pleural infiltration and complications revealed by plain chest radiographs increased (Type II, III, IV), so did the severity of the manifestation of systemic collateral arteries other than the bronchial artery, as depicted by increased on

Pre-hospital management of patients with chest pain and/or dyspnoea of cardiac origin. A position paper of the Acute Cardiovascular Care Association (ACCA) of the ESC.

Science.gov (United States)

Beygui, Farzin; Castren, Maaret; Brunetti, Natale Daniele; Rosell-Ortiz, Fernando; Christ, Michael; Zeymer, Uwe; Huber, Kurt; Folke, Fredrik; Svensson, Leif; Bueno, Hector; Van't Hof, Arnoud; Nikolaou, Nikolaos; Nibbe, Lutz; Charpentier, Sandrine; Swahn, Eva; Tubaro, Marco; Goldstein, Patrick

2015-08-27

Chest pain and acute dyspnoea are frequent causes of emergency medical services activation. The pre-hospital management of these conditions is heterogeneous across different regions of the world and Europe, as a consequence of the variety of emergency medical services and absence of specific practical guidelines. This position paper focuses on the practical aspects of the pre-hospital treatment on board and transfer of patients taken in charge by emergency medical services for chest pain and dyspnoea of suspected cardiac aetiology after the initial assessment and diagnostic work-up. The objective of the paper is to provide guidance, based on evidence, where available, or on experts' opinions, for all emergency medical services' health providers involved in the pre-hospital management of acute cardiovascular care. © The European Society of Cardiology 2015.

Characterizing subsurface water flow to artificial drain lines using fiber-optic distributed temperature sensing

Science.gov (United States)

Shults, D.; Brooks, E. S.; Heinse, R.; Keller, C. K.

2017-12-01

Over the last several years growers have experienced increasingly wet spring conditions in the Palouse Region located in North Idaho, Eastern Washington and Eastern Oregon. As a result more artificial drain lines are being installed so growers can access their fields earlier in the growing season. Additionally there has been increasing adoption of no-tillage practices among growers in order minimize erosion and runoff in the region. There is a growing body of evidence that suggests long-term no-tillage may lead to the establishment of large macropore networks through increased earthworm activity and the preservation of root channels. These macropore networks, in conjunctions with the presence of artificial drains lines, may create connected preferential flow paths from agricultural fields to receiving streams. This connectivity of flow paths from agricultural fields to receiving water bodies may increase the loading of nutrients and agricultural chemicals as some flow paths may largely bypass soil matrix interaction where materials can be sequestered. Our primary objective for this study was to characterize subsurface flow to two artificial drain lines, one under conventional tillage and the other under no-tillage, using distributed temperature sensing (DTS) technology. During the study (November 2016-April 2017) the near surface soil-water temperature was consistently colder than that of deeper depths. Temperature was thus used as a tracer as snow melt and soil-water moved from the near surface to the drain lines during snowmelt and precipitation events. The spatial and temporal variability of the temperature along the artificial drain line under no-tillage practices was found to be greater than that of the conventional tilled field. It is hypothesized that preferential flow paths are responsible for the increased variability of temperature seen in the drain line under long term no-till management. The temperature along the conventional till drain line showed a

Evaluation of performance of two different chest tubes with either a sharp or a blunt tip for thoracostomy in 100 human cadavers

Directory of Open Access Journals (Sweden)

Ortner Clemens M

2012-02-01

Full Text Available Abstract Background Emergent placement of a chest tube is a potentially life-saving procedure, but rate of misplacement and organ injury is up to 30%. In principle, chest tube insertion can be performed by using Trocar or Non-trocar techniques. If using trocar technique, two different chest tubes (equipped with sharp or blunt tip are currently commercially available. This study was performed to detect any difference with respect to time until tube insertion, to success and to misplacement rate. Methods Twenty emergency physicians performed five tube thoracostomies using both blunt and sharp tipped tube kits in 100 fresh human cadavers (100 thoracostomies with each kit. Time until tube insertion served as primary outcome. Complications and success rate were examined by pathological dissection and served as further outcomes parameters. Results Difference in mean time until tube insertion (63s vs. 59s was statistically not significant. In both groups, time for insertion decreased from the 1st to the 5th attempt and showed dependency on the cadaver's BMI and on the individual physician. Success rate differed between both groups (92% using blunt vs. 86% using sharp tipped kits and injuries and misplacements occurred significantly more frequently using chest tubes with sharp tips (p = 0.04. Conclusion Data suggest that chest drain insertion with trocars is associated with a 6-14% operator-related complication rate. No difference in average time could be found. However, misplacements and organ injuries occurred more frequently using sharp tips. Consequently, if using a trocar technique, the use of blunt tipped kits is recommended.

Fallopian Tube Herniation: An Unusual Complication of Surgical Drain

OpenAIRE

Sharma, Lipi; Singh, Alpana; Bhaskaran, Sruthi; Radhika, A. G.; Radhakrishnan, Gita

2012-01-01

Background. Surgical drains have been used since time immemorial, but their use is not without complications. By presenting this case we aim to describe an uncommon complication of herniation of fallopian tube following the simple procedure of surgical drain removal. Case Presentation. This case describes a 23-year G2P1L1 who underwent an emergency cesarean section for obstructed labor with intraperitoneal drain insertion. The patient had an uneventful postoperative period, drain was removed ...

Imaging of blunt chest trauma

International Nuclear Information System (INIS)

Prosch, H.; Negrin, L.

2014-01-01

Blunt chest trauma is associated with high morbidity and mortality. Consequently, all patients should be evaluated radiologically after blunt chest trauma to allow timely and appropriate treatment. Conventional chest radiographs and computed tomography (CT) are proven modalities with which to evaluate patients after blunt chest trauma. Over the last several years extended focused assessment with sonography for trauma (eFAST) has gained increasing importance for the initial assessment of seriously injured patients. In the acute phase of severely injured patients eFAST examinations are helpful to exclude pneumothorax, hemothorax and hemopericardium. Chest radiographs may also be used to diagnose a pneumothorax or hemothorax; however, the sensitivity is limited and CT is the diagnostic modality of choice to evaluate severely injured patients. (orig.) [de

Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

OpenAIRE

Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

2011-01-01

Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a tru...

Ultrasonic measurements of chest wall thickness and realistic chest phantom for calibration of Pu lung counting facilities

International Nuclear Information System (INIS)

Shirotani, Takashi

1990-01-01

There are four important problems for the measurements of chest wall thickness using ultrasonic device: (1) selection of optimum position of transducer and the number of measured points on the chest covered with detector, (2) estimation of adipose-to-muscle ratio in the chest wall, especially for dispersed adipose like 'marbled beef', (3) determination of regression equations for the prediction of chest wall thickness, derived from groups of different body shape, i.e. corpulent and lean, and (4) estimation of effective chest wall thickness involved self-absorption layer of lung tissue, which changes with distribution of activity in the lungs. This quantity can not be measured with ultrasonic device. Realistic chest phantom was developed. The phantom contains removable model organs (lungs, liver, kidneys and heart), model trachea and artificial rib cage, and also includes chest plates that can be placed over the chest to simulate wide range adipose-to-muscle ratio in the chest wall. Various soft tissue substitutes were made of polyurethane with different concentrations of additive, and the rib cage were made of epoxy resin with calcium carbonate. The experimental data have shown that the phantom can be used as a standard phantom for the calibration. (author)

Thailand and brain drain

Directory of Open Access Journals (Sweden)

Terry Commins

2009-01-01

Full Text Available Brain drain has been the subject of research since the 1960s. This research has been hampered by a lack of accurate data from both source and receiving countries on migration and on the losses and gains to developing economies of skilled migration. However, despite these handicaps, research has been able to clearly show that trends are changing and the effect this is having is usually quite different for individual source countries.Thailand, as a developing economy, could be regarded as a source country. Fortunately, Thailand has never ranked highly in terms of brain drain when compared to other states in Asia and while it may not be a significant problem it nonetheless needs to be monitored. Thailand is also somewhat unique in that the migration that has occurred has been almost equally split between secondary and tertiary educated Thais. Thailand also ranks low in terms of tertiary educated population who have migrated when compared to other countries in the region. Globalisation is having a profound effect on the migration of skilled workers. As trade becomes increasingly free, barriers to the movement of services or people are also freed. As the better educated are encouraged to think globally, so too will they be inclined to move globally into the world community.This paper examines Thailand’s position with respect to brain drain, some of the lessons we have learned and some of the steps that are being taken to minimise the impact of the loss of skilled workers, with a particular focus on science and technology. The conclusion is that brain drain should not be viewed as an entirely negative development and that the positive outcomes should be recognised, encouraged and incorporated into policy.

Imaging of non-cardiac, non-traumatic causes of acute chest pain

Energy Technology Data Exchange (ETDEWEB)

Kienzl, Daniela, E-mail: daniela.kienzl@meduniwien.ac.at [Department of Radiology, Medical University of Vienna (Austria); Prosch, Helmut; Töpker, Michael; Herold, Christian [Department of Radiology, Medical University of Vienna (Austria)

2012-12-15

Non-traumatic chest pain is a common symptom in patients who present in the emergency department. From a clinical point of view, it is important to differentiate cardiac chest pain from non-cardiac chest pain (NCCP). Among the plethora of potential causes of NCCP, life-threatening diseases, such as aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture, must be differentiated from non-life threatening causes. The majority of NCCP, however, is reported to be benign in nature. The presentation of pain plays an important role in narrowing the differential diagnosis and initiating further diagnostic management and treatment. As the benign causes tend to recur, and may lead to patient anxiety and great costs, a meticulous evaluation of the patient is necessary to diagnose the underlying disorder or disease.

Non-Invasive Mechanic Ventilation Using in Flail Chest, Caused By Blunt Chest Trauma

Directory of Open Access Journals (Sweden)

Serdar Onat

2008-01-01

Full Text Available A 75-year-old woman admitted our faculty emergency room with shortness of breath, and chest pain after traffic accident’s second hour. She was diagnosed as bilateral multipl rib fractures, left clavicula fracture, and left flail chest by phsical and radiological examinations. She was transfered to Chest Surgery Depatment’s intensive care unit. The patient was undergone non-invasive mask mechanic ventilation support, because of the decreasing of blood oxygen saturation and increasing of arteriel blood partial carbondioxide pressure. The treatment of non-invasive mechanic ventilation was succesfull for ventilation support. With this report, we would like to attentioned that non-invasive mechanic ventilation for blunt chest trauma patients could be used succesfully and could be used instead of endotracheal invasive mechanic ventilation.

Computer-assisted optimization of chest fluoroscopy

International Nuclear Information System (INIS)

Korolyuk, I.P.; Filippova, N.V.; Kirillov, L.P.; Momsenko, S.F.

1987-01-01

The main trends in the use of computer for the optimization of chest fluorography among employees and workers of a large industrial enterprise are considered. The following directions were determined: automatted sorting of fluorograms, formalization of X-ray signs in describing fluorograms, organization of a special system of fluorographic data management. Four levels of algorithms to solve the problems of fluorography were considered: 1) shops, personnel department, etc.; 2) an automated center for mass screening and a medical unit; 3) a computer center and 4) planning and management service. The results of computer use over a 3-year period were analyzed. The efficacy of computer was shown

Chest wall stabilization in trauma patients: why, when, and how?

Science.gov (United States)

White, Thomas W.

2018-01-01

Blunt trauma to the chest wall and rib fractures are remarkably frequent and are the basis of considerable morbidity and possible mortality. Surgical remedies for highly displaced rib fractures, especially in cases of flail chest, have been undertaken intermittently for more than 50 years. Rib-specific plating systems have started to be used in the last 10 years. These have ushered in the modern era of rib repair with chest wall stabilization (CWS) techniques that are safer, easier to perform, and more efficient. Recent consensus statements have sought to define the indications and contraindications, as well as the when, the how, and the technical details of CWS. Repair should be considered for patients who have three or more displaced rib fractures or a flail chest, whether or not mechanical ventilation is required. Additional candidates include patients who fail non-operative management irrespective of fracture pattern and those with rib fractures who need thoracic procedures for other reasons. Traditionally, unstable spine fracture and severe traumatic brain injury are definite contraindications. Pulmonary contusion’s role in the decision to perform CWS remains controversial. A range of rib-specific plating systems are now commercially available. PMID:29744222

Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice.

Science.gov (United States)

Soleman, Jehuda; Kamenova, Maria; Lutz, Katharina; Guzman, Raphael; Fandino, Javier; Mariani, Luigi

2017-08-01

To investigate whether, after the publication of grade I evidence that it reduces recurrence rates, the practice of drain insertion after burr-hole drainage of chronic subdural hematoma has changed. Further, we aimed to document various practice modalities concerning the insertion of a drain adopted by neurosurgeons internationally. We administered a survey to neurosurgeons worldwide with questions relating to the surgical treatment of chronic subdural hematoma, with an emphasis on their practices concerning the use of a drain. The preferred surgical technique was burr-hole drainage (89%). Most surgeons prefer to place a drain (80%), whereas in 56% of the cases the reason for not placing a drain was brain expansion after evacuation. Subdural drains are placed by 50% and subperiosteal drains by 27% of the responders, whereas 23% place primarily a subdural drain if possible and otherwise a subperiosteal drain. Three quarters of the responders leave the drain for 48 hours and give prophylactic antibiotic treatment, mostly a single-shot dose intraoperatively (70%). Routine postoperative computed tomography is done by 59% mostly within 24-48 hours after surgery (94%). Adjunct treatment to surgery rarely is used (4%). The publication of grade I evidence in favor of drain use influenced positively this practice worldwide. Some surgeons are still reluctant to insert a drain, especially when the subdural space is narrow after drainage of the hematoma. The insertion of a subperiosteal drain could be a good alternative solution. However, its outcome and efficacy must be evaluated in larger studies. Copyright © 2017 Elsevier Inc. All rights reserved.

Differences in Presentation, Management and Outcomes in Women and Men Presenting to an Emergency Department With Possible Cardiac Chest Pain.

Science.gov (United States)

Ruane, Lorcan; H Greenslade, Jaimi; Parsonage, William; Hawkins, Tracey; Hammett, Christopher; Lam, Carolyn Sp; Knowlman, Thomas; Doig, Shaela; Cullen, Louise

2017-12-01

Research suggests that female patients with acute coronary syndrome (ACS) experience delays in emergency department (ED) management and are less likely to receive guideline-based treatments and referrals for follow-up testing. Women are often found to have poorer clinical outcomes in comparison to men. This study aimed to assess current sex differences in the presentation, management and outcomes of patients with undifferentiated chest pain presenting to a tertiary ED. Data were analysed from two prospective studies conducted at a single Australian site between 2007 and 2014. Eligible patients were those of 18 years of age or older presenting with at least 5 minutes of chest pain or other symptoms for which the treating physician planned to investigate for possible ACS. Presenting symptoms, ED time measures, follow-up testing and outcomes, including 30-day ACS and mortality, were measured and compared between male and female patients. Of 2349 (60% men) patients presenting with chest pain, 153 men and 51 women were diagnosed with ACS within 30days . Presenting symptoms were similar in men and women with confirmed ACS. Time from symptom onset to ED presentation, time spent in the ED and total time in hospital were similar between the sexes. Male and female patients had similar rates of follow-up provocative testing. After adjustment for clinical factors, the odds of undergoing angiography were 1.8 (95% CI: 1.36-2.40) times higher for men than women. Of those undergoing coronary angiography within 30 days, a smaller proportion of women, compared to men, received revascularisation. Within 30 days, three (0.2%) male and one (0.1%) female patient died. Minimal sex differences were observed in the contemporary emergency management of patients presenting with suspected ACS. Thirty-day outcomes were similarly low in men and women despite lower rates of coronary angiography and revascularisation in women. Further research is required to replicate these results in different

[Prehospital airway management of laryngeal tubes. Should the laryngeal tube S with gastric drain tube be preferred in emergency medicine?].

Science.gov (United States)

Dengler, V; Wilde, P; Byhahn, C; Mack, M G; Schalk, R

2011-02-01

Laryngeal tubes (LT) are increasingly being used for emergency airway management. This article reports on two patients in whom out-of-hospital intubation with a single-lumen LT was associated with massive pulmonary aspiration in one patient and gastric overinflation in the other. In both cases peak inspiratory pressures exceeded the LT leak pressure of approximately 35 mbar. This resulted in gastric inflation and decreased pulmonary compliance and increased inspiratory pressure further, thereby creating a vicious circle. It is therefore recommended that laryngeal tube suction (LTS) should be used in all cases of emergency airway management and a gastric drain tube be inserted through the dedicated second lumen. Apart from gastric overinflation, incorrect LT/LTS placement must be detected and immediately corrected, e.g. in cases of difficult or impossible gastric tube placement, permanent drainage of air from the gastric tube, decreasing minute ventilation or an ascending capnography curve.

MRI of the Chest

Medline Plus

Full Text Available ... are the limitations of MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging ( ... heart, valves, great vessels, etc.). top of page What are some common uses of the procedure? MR ...

MRI of the Chest

Medline Plus

Full Text Available ... to assess the anatomy and function of the heart and its blood flow. Tell your doctor about ... chest cavity, including the mediastinum , chest wall, pleura, heart and vessels, from almost any angle. MRI also ...

Drain Back, Low Flow Solar Combi Systems

DEFF Research Database (Denmark)

Perers, Bengt; Furbo, Simon; Fan, Jianhua

2014-01-01

Drain Back systems with ETC collectors are tested and analyzed in a Danish - Chinese cooperation project. Experiences from early work at DTU, with drain back, low flow systems, was used to design two systems: 1) One laboratory system at DTU and 2) One demonstration system in a single family house...... in Sorö Denmark. Detailed monitoring and modelling of the system in the DTU lab is done to be able to generalize the results, to other climates and loads and to make design optimizations. The advantage with drain back, low flow systems, is that the system can be made more simple with less components...... and that the performance can be enhanced. A combination of the drain back- and system expansion vessel was tested successfully. Small initial problems with installation and proposals for design improvements to avoid these in practice are described in the paper. Installer education and training is an important step to have...

Conversion to use of digital chest images for surveillance of coal workers' pneumoconiosis (black lung).

Science.gov (United States)

Levine, Betty A; Ingeholm, Mary Lou; Prior, Fred; Mun, Seong K; Freedman, Matthew; Weissman, David; Attfield, Michael; Wolfe, Anita; Petsonk, Edward

2009-01-01

To protect the health of active U.S. underground coal miners, the National Institute for Occupational Safety and Health (NIOSH) has a mandate to carry out surveillance for coal workers' pneumoconiosis, commonly known as Black Lung (PHS 2001). This is accomplished by reviewing chest x-ray films obtained from miners at approximately 5-year intervals in approved x-ray acquisition facilities around the country. Currently, digital chest images are not accepted. Because most chest x-rays are now obtained in digital format, NIOSH is redesigning the surveillance program to accept and manage digital x-rays. This paper highlights the functional and security requirements for a digital image management system for a surveillance program. It also identifies the operational differences between a digital imaging surveillance network and a clinical Picture Archiving Communication Systems (PACS) or teleradiology system.

Imaging of fetal chest masses

Energy Technology Data Exchange (ETDEWEB)

Barth, Richard A. [Lucile Packard Children' s Hospital, Stanford University School of Medicine, Department of Radiology, Stanford, CA (United States)

2012-01-15

Prenatal imaging with high-resolution US and rapid acquisition MRI plays a key role in the accurate diagnosis of congenital chest masses. Imaging has enhanced our understanding of the natural history of fetal lung masses, allowing for accurate prediction of outcome, parental counseling, and planning of pregnancy and newborn management. This paper will focus on congenital bronchopulmonary malformations, which account for the vast majority of primary lung masses in the fetus. In addition, anomalies that mimic masses and less common causes of lung masses will be discussed. (orig.)

The impact of chest compression rates on quality of chest compressions : a manikin study

OpenAIRE

Field, Richard A.; Soar, Jasmeet; Davies, Robin P.; Akhtar, Naheed; Perkins, Gavin D.

2012-01-01

Purpose\\ud Chest compressions are often performed at a variable rate during cardiopulmonary resuscitation (CPR). The effect of compression rate on other chest compression quality variables (compression depth, duty-cycle, leaning, performance decay over time) is unknown. This randomised controlled cross-over manikin study examined the effect of different compression rates on the other chest compression quality variables.\\ud Methods\\ud Twenty healthcare professionals performed two minutes of co...

Endobronchial Tuberculosis and Chest Radiography

Directory of Open Access Journals (Sweden)

Mohammad Reza Sasani

2016-03-01

Full Text Available Endobronchial tuberculosis and chest radiography I read, with interest, the article entitled “Clinical and Para-clinical Presentations of Endobronchial Tuberculosis” by Ahmadi Hoseini H. S. et al. (1 published in this journal. I would like to focus on some details about the chest X-ray of patients as elaborated by the authors in the results section. Accordingly, the findings of chest radiography in the available patients were as follows: pulmonary consolidation (75%, reduced pulmonary volume (20%, and hilar adenopathy (10%. This is an incomplete statement because the authors did not explain whether there was any normal chest radiography in the study population. In addition, it is not clear whether the X-ray examinations of the patients were normal, how many abnormal plain films yielded the presented data. On the other hand, the fact that the studied patients had no normal chest radiography is  controversial since in the literature, 10-20% of the patients with endobronchial tuberculosis are reported to have normal chest X-ray (2, 3. In fact, this is one of the problems in the diagnosis of the disease, as well as a potential cause of delayed diagnosis and treatment of the patients. Therefore, the absence of normal chest radiographs is in contrast to the available literature, and if not an error, it could be a subject of further investigation.

Circuital model for the spherical geodesic waveguide perfect drain

Science.gov (United States)

González, Juan C.; Grabovičkić, Dejan; Benítez, Pablo; Miñano, Juan C.

2012-08-01

The perfect drain for the Maxwell fish eye (MFE) is a non-magnetic dissipative region placed in the focal point to absorb all the incident radiation without reflection or scattering. The perfect drain was recently designed as a material with complex permittivity that depends on frequency. However, this material is only a theoretical material, so it cannot be used in practical devices. The perfect drain has been claimed as necessary for achieving super-resolution (Leonhardt 2009 New J. Phys. 11 093040), which has increased the interest in practical perfect drains suitable for manufacturing. Here, we present a practical perfect drain that is designed using a simple circuit (made of a resistance and a capacitor) connected to the coaxial line. Moreover, we analyze the super-resolution properties of a device equivalent to the MFE, known as a spherical geodesic waveguide, loaded with this perfect drain. The super-resolution analysis for this device is carried out using COMSOL Multiphysics. The results of simulations predict a super-resolution of up to λ/3000.

Circuital model for the spherical geodesic waveguide perfect drain

International Nuclear Information System (INIS)

González, Juan C; Grabovičkić, Dejan; Benítez, Pablo; Miñano, Juan C

2012-01-01

The perfect drain for the Maxwell fish eye (MFE) is a non-magnetic dissipative region placed in the focal point to absorb all the incident radiation without reflection or scattering. The perfect drain was recently designed as a material with complex permittivity that depends on frequency. However, this material is only a theoretical material, so it cannot be used in practical devices. The perfect drain has been claimed as necessary for achieving super-resolution (Leonhardt 2009 New J. Phys. 11 093040), which has increased the interest in practical perfect drains suitable for manufacturing. Here, we present a practical perfect drain that is designed using a simple circuit (made of a resistance and a capacitor) connected to the coaxial line. Moreover, we analyze the super-resolution properties of a device equivalent to the MFE, known as a spherical geodesic waveguide, loaded with this perfect drain. The super-resolution analysis for this device is carried out using COMSOL Multiphysics. The results of simulations predict a super-resolution of up to λ/3000. (paper)

Method of processing laundry drain

Energy Technology Data Exchange (ETDEWEB)

Sugimoto, Y; Oda, A; Yusa, H; Kitamura, M; Horiuchi, S

1979-09-28

Purpose: To subject the laundry drain to flocculation precipitation treatment in the prior stage of an inverse osmotic treatment, and subject only the supernatant to the inverse osmotic treatment and the precipitate directly to the condensation treatment, thereby decreasing the frequency of exchange of the inverse osmotic membranes, and reducing the quantity of purifying water. Method: The laundry drain is supplied to a flocculation precipitation tank, and added and mixed with a flocculant and a neutralizing agent, thus being subjected to a flocculation precipitation treatment. The supernatant is transported to a circulation tank through a transportation pipe, and is subjected to an inverse osmotic treatment in inverse osmotic module through the circulation tank, a filter and a high tension pump, and then returned to the circulation tank. The supernatant is thus concentrated to a predetermined concentration by repeating such operations. On the other hand, the precipitate at the bottom part of the flocculation precipitation tank is supplied through the transportation pipe to an evaporator supply tank together with the concentrate from the drain circulation tank, and evaporated and concentrated in the evaporator.

Evaluation of chest tomosynthesis for the detection of pulmonary nodules: effect of clinical experience and comparison with chest radiography

Science.gov (United States)

Zachrisson, Sara; Vikgren, Jenny; Svalkvist, Angelica; Johnsson, Åse A.; Boijsen, Marianne; Flinck, Agneta; Månsson, Lars Gunnar; Kheddache, Susanne; Båth, Magnus

2009-02-01

Chest tomosynthesis refers to the technique of collecting low-dose projections of the chest at different angles and using these projections to reconstruct section images of the chest. In this study, a comparison of chest tomosynthesis and chest radiography in the detection of pulmonary nodules was performed and the effect of clinical experience of chest tomosynthesis was evaluated. Three senior thoracic radiologists, with more than ten years of experience of chest radiology and 6 months of clinical experience of chest tomosynthesis, acted as observers in a jackknife free-response receiver operating characteristics (JAFROC-1) study, performed on 42 patients with and 47 patients without pulmonary nodules examined with both chest tomosynthesis and chest radiography. MDCT was used as reference and the total number of nodules found using MDCT was 131. To investigate the effect of additional clinical experience of chest tomosynthesis, a second reading session of the tomosynthesis images was performed one year after the initial one. The JAFROC-1 figure of merit (FOM) was used as the principal measure of detectability. In comparison with chest radiography, chest tomosynthesis performed significantly better with regard to detectability. The observer-averaged JAFROC-1 FOM was 0.61 for tomosynthesis and 0.40 for radiography, giving a statistically significant difference between the techniques of 0.21 (p<0.0001). The observer-averaged JAFROC-1 FOM of the second reading of the tomosynthesis cases was not significantly higher than that of the first reading, indicating no improvement in detectability due to additional clinical experience of tomosynthesis.

Evisceration of Appendix through the Drain Site: A Rare Case Report.

Science.gov (United States)

Ravishankaran, Praveen; Rajamani, A

2013-06-01

Placing a drain after surgery is a usual procedure in any emergency abdominal operation. The drain is removed as soon as its purpose of draining the intraabdominal collection in served. Evisceration of intraabdominal organs through the drain site is a rare occurance. This case report is about an 12 year old girl who was admitted with blunt trauma abdomen. After completion of emergency laparotomy a drain was placed in the right lower quadrant. When the drain was removed on the 6th post operative day, the appendix eviscerated out of the drain site. The wound was extended a little and an appendectomy was done. This case is presented for its rarity as only two similar instances have been reported in literature so far.

Selective chest imaging for blunt trauma patients: The national emergency X-ray utilization studies (NEXUS-chest algorithm).

Science.gov (United States)

Rodriguez, Robert M; Hendey, Gregory W; Mower, William R

2017-01-01

Chest imaging plays a prominent role in blunt trauma patient evaluation, but indiscriminate imaging is expensive, may delay care, and unnecessarily exposes patients to potentially harmful ionizing radiation. To improve diagnostic chest imaging utilization, we conducted 3 prospective multicenter studies over 12years to derive and validate decision instruments (DIs) to guide the use of chest x-ray (CXR) and chest computed tomography (CT). The first DI, NEXUS Chest x-ray, consists of seven criteria (Age >60years; rapid deceleration mechanism; chest pain; intoxication; altered mental status; distracting painful injury; and chest wall tenderness) and exhibits a sensitivity of 99.0% (95% confidence interval [CI] 98.2-99.4%) and a specificity of 13.3% (95% CI, 12.6%-14.0%) for detecting clinically significant injuries. We developed two NEXUS Chest CT DIs, which are both highly reliable in detecting clinically major injuries (sensitivity of 99.2%; 95% CI 95.4-100%). Designed primarily to focus on detecting major injuries, the NEXUS Chest CT-Major DI consists of six criteria (abnormal CXR; distracting injury; chest wall tenderness; sternal tenderness; thoracic spine tenderness; and scapular tenderness) and exhibits higher specificity (37.9%; 95% CI 35.8-40.1%). Designed to reliability detect both major and minor injuries (sensitivity 95.4%; 95% CI 93.6-96.9%) with resulting lower specificity (25.5%; 95% CI 23.5-27.5%), the NEXUS CT-All rule consists of seven elements (the six NEXUS CT-Major criteria plus rapid deceleration mechanism). The purpose of this review is to synthesize the three DIs into a novel, cohesive summary algorithm with practical implementation recommendations to guide selective chest imaging in adult blunt trauma patients. Copyright © 2016 Elsevier Inc. All rights reserved.

Characterization Plan for Soils Around Drain Line PLA-100115

Energy Technology Data Exchange (ETDEWEB)

D. Shanklin

2006-05-24

This Characterization Plan supports the Hazardous Waste Management Act/Resource Conservation and Recovery Act (HWMA/RCRA) closure of soils that may have been contaminated by releases from drain line PLA-100115, located within the Idaho Nuclear Technology and Engineering Center at the Idaho National Laboratory Site. The requirements to address the closure of soils contaminated by a potential release from this line in a characterization plan was identified in the "HWMA/RCRA Less Than 90-day Generator Closure Report for the VES-SFE-126."

Comparison of chest compression quality between the modified chest compression method with the use of smartphone application and the standardized traditional chest compression method during CPR.

Science.gov (United States)

Park, Sang-Sub

2014-01-01

The purpose of this study is to grasp difference in quality of chest compression accuracy between the modified chest compression method with the use of smartphone application and the standardized traditional chest compression method. Participants were progressed 64 people except 6 absentees among 70 people who agreed to participation with completing the CPR curriculum. In the classification of group in participants, the modified chest compression method was called as smartphone group (33 people). The standardized chest compression method was called as traditional group (31 people). The common equipments in both groups were used Manikin for practice and Manikin for evaluation. In the meantime, the smartphone group for application was utilized Android and iOS Operating System (OS) of 2 smartphone products (G, i). The measurement period was conducted from September 25th to 26th, 2012. Data analysis was used SPSS WIN 12.0 program. As a result of research, the proper compression depth (mm) was shown the proper compression depth (p< 0.01) in traditional group (53.77 mm) compared to smartphone group (48.35 mm). Even the proper chest compression (%) was formed suitably (p< 0.05) in traditional group (73.96%) more than smartphone group (60.51%). As for the awareness of chest compression accuracy, the traditional group (3.83 points) had the higher awareness of chest compression accuracy (p< 0.001) than the smartphone group (2.32 points). In the questionnaire that was additionally carried out 1 question only in smartphone group, the modified chest compression method with the use of smartphone had the high negative reason in rescuer for occurrence of hand back pain (48.5%) and unstable posture (21.2%).

Usefulness of routine computed tomography in the evaluation of penetrating war injuries to the chest.

Science.gov (United States)

Darwish, Bassam; Mahfouz, Mohammad Z; Izzat, Mohammad Bashar

2018-05-02

This review was conducted to compare the contributions of chest X-ray (CXR) and computed tomography (CT) towards detecting intrathoracic damage in patients with penetrating war injuries to the chest and to determine whether identification of additional injuries by chest CT will have an impact on the choice of therapeutic interventions and clinical outcomes. We reviewed records of 449 patients (374 men, mean age 29.3 ± 14.8 years) who were admitted to our hospital with penetrating war injuries to the chest over a 7-year period. Collected data included mechanisms of injury, associated injuries, results of CXRs and chest CTs, methods of management, in-hospital stays, complications and mortalities. Immediate screening CXRs were obtained in all patients not requiring emergent thoracotomies, of which 91.4% showed positive signs of injury. Chest CTs were performed at the discretion of the physicians in 49.4% of patients, and CXR-positive findings were confirmed in all cases, while revealing additional injuries in 11% of patients. Chest CT findings led to additional closed chest drainage in 5.6% of patients but had no impact on treatment strategy in 94.4% of scanned patients. Follow-up CXRs showed new positive findings in 22 patients, leading to additional closed chest drainage in 3 patients and delayed open thoracotomies in 7 other patients. CXRs continue as the primary diagnostic modality in the assessment of patients with penetrating war injuries to the chest. Chest CTs can be omitted in most patients, thus reducing CT imaging case-load substantially, while most clinically significant chest injuries remain sufficiently recognized.

Chest Reconstruction and Chest Dysphoria in Transmasculine Minors and Young Adults: Comparisons of Nonsurgical and Postsurgical Cohorts.

Science.gov (United States)

Olson-Kennedy, Johanna; Warus, Jonathan; Okonta, Vivian; Belzer, Marvin; Clark, Leslie F

2018-05-01

Transmasculine youth, who are assigned female at birth but have a gender identity along the masculine spectrum, often report considerable distress after breast development (chest dysphoria). Professional guidelines lack clarity regarding referring minors (defined as people younger than 18 years) for chest surgery because there are no data documenting the effect of chest surgery on minors. To examine the amount of chest dysphoria in transmasculine youth who had had chest reconstruction surgery compared with those who had not undergone this surgery. Using a novel measure of chest dysphoria, this cohort study at a large, urban, hospital-affiliated ambulatory clinic specializing in transgender youth care collected survey data about testosterone use and chest distress among transmasculine youth and young adults. Additional information about regret and adverse effects was collected from those who had undergone surgery. Eligible youth were 13 to 25 years old, had been assigned female at birth, and had an identified gender as something other than female. Recruitment occurred during clinical visits and via telephone between June 2016 and December 2016. Surveys were collected from participants who had undergone chest surgery at the time of survey collection and an equal number of youth who had not undergone surgery. Outcomes were chest dysphoria composite score (range 0-51, with higher scores indicating greater distress) in all participants; desire for chest surgery in patients who had not had surgery; and regret about surgery and complications of surgery in patients who were postsurgical. Of 136 completed surveys, 68 (50.0%) were from postsurgical participants, and 68 (50.0%) were from nonsurgical participants. At the time of the survey, the mean (SD) age was 19 (2.5) years for postsurgical participants and 17 (2.5) years for nonsurgical participants. Chest dysphoria composite score mean (SD) was 29.6 (10.0) for participants who had not undergone chest reconstruction, which

Ultrasonography of chest wall lesion

Energy Technology Data Exchange (ETDEWEB)

Park, Cheol Min; Kim, C. H.; Cha, I. H.; Chung, K. B.; Ser, W. H.; Choi, Y. H. [Seoul National University College of Medicine, Seoul (Korea, Republic of)

1989-12-15

Thirty-one patients with chest wall diseases were studied with ultrasound to evaluate its role in chest wall lesions. There were eight infectious conditions, 9 benign tumors, 11 malignant lesions and 3 miscellaneous cases. Diffuse chest wall thickening with heterogeneous echogenicity and obliteration of subcutaneous fat layer are findings of acute infection. In cases of tuberculous smpyema necessitates, pleural abnormality extended to the chest wall through intercostal space. Benign tumors were well demarcated, except in 4 cases of lipoma/lipomatosis. Malignant lesions showed irregular soft tissue masses, bone destruction, pleural effusion and subcutaneous invasion. Multiple enlarged lymph nodes were also shown. Ultrasound can demonstrate te internal structure, extent, depth and associated findings such as pleural effusion, bone destruction and peripheral lung involvement. Ultrasound is not only safe, non-invasive and an effective diagnostic imaging modality for chest wall disease, but can also guide aspiration or biopsy for pathologic diagnosis

Ultrasonography of chest wall lesion

International Nuclear Information System (INIS)

Park, Cheol Min; Kim, C. H.; Cha, I. H.; Chung, K. B.; Ser, W. H.; Choi, Y. H.

1989-01-01

Thirty-one patients with chest wall diseases were studied with ultrasound to evaluate its role in chest wall lesions. There were eight infectious conditions, 9 benign tumors, 11 malignant lesions and 3 miscellaneous cases. Diffuse chest wall thickening with heterogeneous echogenicity and obliteration of subcutaneous fat layer are findings of acute infection. In cases of tuberculous smpyema necessitates, pleural abnormality extended to the chest wall through intercostal space. Benign tumors were well demarcated, except in 4 cases of lipoma/lipomatosis. Malignant lesions showed irregular soft tissue masses, bone destruction, pleural effusion and subcutaneous invasion. Multiple enlarged lymph nodes were also shown. Ultrasound can demonstrate te internal structure, extent, depth and associated findings such as pleural effusion, bone destruction and peripheral lung involvement. Ultrasound is not only safe, non-invasive and an effective diagnostic imaging modality for chest wall disease, but can also guide aspiration or biopsy for pathologic diagnosis

Mechanical decontamination techniques for floor drain systems

International Nuclear Information System (INIS)

Palau, G.L.

1987-01-01

The unprecedented nature of cleanup activities at Three Mile Island Unit 2 (TMI-2) following the 1979 accident has necessitated the development of new techniques to deal with radiation and contamination in the plant. One of these problems was decontamination of floor drain systems, which had become highly contaminated with various forms of dirt and sludge containing high levels of fission products and fuel from the damaged reactor core. The bulk of this contamination is loosely adherent to the drain pipe walls; however, significant amounts of contamination have become incorporated into pipe wall oxide and corrosion layers and embedded in microscopic pits and fissures in the pipe wall material. The need to remove this contamination was recognized early in the TMI-2 cleanup effort. A program consisting of development and laboratory testing of floor drain decontamination techniques was undertaken early in the cleanup with support from the Electric Power Research Institute (EPRI). Based on this initial research, two techniques were judged to show promise for use at TMI-2: a rotating brush hone system and a high-pressure water mole nozzle system. Actual use of these devices to clean floor drains at TMI-2 has yielded mixed decontamination results. The decontamination effectiveness that has been obtained is highly dependent on the nature of the contamination in the drain pipe and the combination of decontamination techniques used

Brain drain of China and India

OpenAIRE

Li, Yuan

2012-01-01

Abstract Under the background of globalization, brain drain is a common phenomenon in many countries. Talents flow from developing countries to developed countries, and this phenomenon unavoidably exerts various and profound influences to both the source countries and the receiving countries. This thesis deals with the phenomenon of brain drain with the aim to investigate the phenomenon further and carry out two case studies of China and India. The research method is main...

Clinical assessment compared with chest X-Ray after removal of chest tube to diagnose pneumothorax

International Nuclear Information System (INIS)

Majeed, F. A.; Noor, Q. U. H.; Mehmood, U.; Imtiaz, T.; Zafar, U.

2017-01-01

Objective: To evaluate clinical judgment in ruling out pneumothorax during the removal of the chest tube by auscultating the chest before removal and after the extubation of the chest tube in comparison to x ray radiological results. Study Design: Descriptive cross sectional study. Place and Duration of Study: Combined Military Hospital (CMH) Lahore Pakistan, from August 2015 to March 2016. Material and Methods: A sample size of 100 was calculated. Patients were selected via non probability purposive sampling. Children under 14 years were not included. The patients with mal-positioned chest tube, surgical site infection, air leak and the patients with more than one chest tube on one side were excluded. A proforma was made and filled by one person. Chest tubes were removed by two trained senior registrars according to a protocol devised. It was ensured that there was no air leak present before removal clinically and radiologically. Another chest x-ray was done within 24 hours of extubation to detect any pathology that might have occurred during the process. Any complication in the patient clinically was observed till the x-ray film became available. Two sets of readings were obtained. Set A included auscultation findings and set B included x ray results. Results: Out of 100 patients, 60 (60 percent) were males and 40 (40 percent) females. The ages of the patients ranged between 17-77 years. Mean age of the patient was 43.27 ± 17.05 years. In set A out of 100 (100 percent) no pneumothorax developed clinically. In set B out of 100 patients 99 (99 percent) showed no pneumothorax on chest x ray, only 1 (1 percent) showed pneumothorax which was not significant (less than 15 percent on X ray). However, the patient remained asymptomatic clinically and there was no need of reinsertion of the chest tube. Conclusion: Auscultatory findings in diagnosing a significant pneumothorax are justified. Hence, if the chest tube is removed according to the protocol, clinically by

Chest complication after abdominal surgery

International Nuclear Information System (INIS)

Koh, B. H.; Choi, J. Y.; Hahm, C. K.; Kang, S. R.

1981-01-01

In spite of many advances in medicine, anesthetic technique and surgical managements, pulmonary problems are the most frequent postoperative complications, particularly after abdominal surgery. As postoperative pulmonary complications, atelectasis, pleural effusion, pneumonia, chronic bronchitis and lung abscess can be occurred. This study include evaluation of chest films of 2006 patients (927 male, 1079 female), who had been operated abdominal surgery from Jan. 1979 to June, 1980 in the Hanyang university hospital. The results were as follows: 1. 70 cases out of total 2006 cases (3.5%) developed postoperative chest complications, 51 cases (5.5%) in male, 19 cases (1.8%) in female. 2. The complication rate was increased according to the increase of age. The incidence of the postoperative complications over 40 years of age was higher than the overall average complications rate. 3. The most common postoperative pulmonary complication was pleural effusion, next pneumonia, atelectasis and pulmonary edema respectively. 4. The complication rate of the group of upper abdominal surgery is much higher than the group of lower abdominal surgery. 5. Complication rate was increased according to increase of the duration of operation. 6. There were significant correlations between the operation site and side of the complicated hemithorax

Digital chest radiography

DEFF Research Database (Denmark)

Debess, Jeanne Elisabeth; Vejle-Sørensen, Jens Kristian; Thomsen, Henrik

,3 mAs and SID SID of 180 centimetres using a phantom and lithium fluoride thermo luminescence dosimeter (TLD). Dose to risk organs mamma, thyroid and colon are measured at different collimations with one-centimetre steps. TLD results are used to estimate dose reduction for different collimations...... at the conference. Conclusion: Collimation improvement in basic chest radiography can reduce the radiation to female patients at chest x-ray examinations....

Use of Chest Computed Tomography in Stable Patients with Blunt Thoracic Trauma: Clinical and Forensic Perspective

Directory of Open Access Journals (Sweden)

Makbule Ergin

2011-01-01

fractures were the most common injury. Thorax computed tomography was significantly superior to chest radiography in detecting pneumothorax , hemothorax and lung contusion. Eightyone life threatening lesions were detected and 50 (61%; pneumothorax 13, hemothorax 24, lung contusion 9,and pneumomediastinum 4 of these lesions could not be detected with plain chest radiography. The clinical management [in 15 patients (30%], and the forensic assesment was changed [in 14 (28%] patients were changed.  Conclusion:We concluded that using Computed Tomography of the thorax in thoracic travmas prive meticulous assesment in management of patients and forens icissues.

46 CFR 169.743 - Portable magazine chests.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Portable magazine chests. 169.743 Section 169.743... Vessel Control, Miscellaneous Systems, and Equipment Markings § 169.743 Portable magazine chests. Portable magazine chests must be marked in letters at least 3 inches high: “PORTABLE MAGAZINE CHEST...

Pleural subxyphoid drain confers better pulmonary function and clinical outcomes in chronic obstructive pulmonary disease after off-pump coronary artery bypass grafting: a randomized controlled trial

Directory of Open Access Journals (Sweden)

Solange Guizilini

2014-12-01

Full Text Available Objective: To evaluate the lung function and clinical outcome in severe chronic obstructive pulmonary disease in patients undergoing off-pump coronary artery bypass grafting with left internal thoracic artery graft, comparing the pleural drain insertion in the intercostal versus subxyphoid region. Methods: A randomized controlled trial. Chronic obstructive pulmonary disease patients were randomized into two groups according pleural drain site: II group (n=27 - pleural drain in intercostal space; SI group (n=29 - pleural drain in the subxyphoid region. Spirometry values (Forced Vital Capacity - and Forced expiratory volume in 1 second were obtained on preoperative and 1, 3 and 5 postoperative days. Chest x-ray from preoperative until postoperative day 5 (POD5 was performed for monitoring respiratory events, such as atelectasis and pleural effusion. Pulmonary shunt fraction and pain score was evaluate preoperatively and on postoperative day 1. Results: In both groups there was a significant decrease of the spirometry values (Forced Vital Capacity and Forced expiratory volume in 1 second until POD5 (P<0.05. However, when compared, SI group presented less decrease in these parameters (P<0.05. Pulmonary shunt fraction was significantly lower in SI group (P<0.05. Respiratory events, pain score, orotracheal intubation time and postoperative length of hospital stay were lower in the SI group (P<0.05. Conclusion: Subxyphoid pleural drainage in severe Chronic obstructive pulmonary disease patients determined better preservation and recovery of pulmonary capacity and volumes with lower pulmonary shunt fraction and better clinical outcomes on early postoperative off-pump coronary artery bypass grafting.

Conservative use of chest-tube insertion in children with pleural effusion.

Science.gov (United States)

Epaud, R; Aubertin, G; Larroquet, M; Pointe, H Ducou-le; Helardot, P; Clement, A; Fauroux, B

2006-04-01

The aim of this work was to evaluate the effect of a more conservative use of chest-tube insertion on the short-term and long-term outcome of pleural infection. Sixty-five patients with pleural infection, aged 1 month to 16 years were each treated according to one of the two protocols: classical management with chest-tube insertion (classical group, n = 33), or conservative use of chest-tube insertion (conservative group, n = 32), with drainage indicated only in the case of voluminous pleural effusion defined by a mediastinal shift and respiratory distress and/or an uncontrolled septic situation. The two groups were comparable with regard to age, baseline C-reactive protein (CRP) value and white blood cell counts, pleural thickness, identified bacteria, and antibiotic treatment. Chest-tube insertion was performed in 17 patients (52%) of the classical group compared to eight patients (25%) of the conservative group (P = 0.03). Duration of temperature above 39 degrees C was shorter in the conservative group (10 +/- 1 vs. 14 +/- 1 days, P = 0.01), as was the normalization of CRP (13 +/- 1 vs. 17 +/- 1 days, P = 0.03). Duration of hospitalization and intravenous (IV) antibiotherapy as well as the delay of chest-radiograph normalization was not significantly different between the two groups. A more conservative use of chest-tube insertion did not change short- and long-term outcome of the pleural infection in children. Drainage could be restricted to the most severely affected patients with pleural empyema causing a mediastinal shift and respiratory distress and/or presenting with an uncontrolled septic situation.

MRI of the Chest

Medline Plus

Full Text Available ... chest is performed to: assess abnormal masses, including cancer of the lungs or other tissues, which either cannot be assessed ... in diagnosing a broad range of conditions, including cancer, heart and ... tissues, except for lung abnormalities where Chest CT is a preferred imaging ...

Persistent air leaks: a review with an emphasis on bronchoscopic management

Science.gov (United States)

Lazarus, Donald R.

2017-01-01

Persistent air leak (PAL) is a cause of significant morbidity in patients who have undergone lung surgery and those with significant parenchymal lung disease suffering from a pneumothorax. Its management can be complex and challenging. Although conservative treatment with chest drain and observation is usually effective, other invasive techniques are needed when conservative treatment fails. Surgical management and medical pleurodesis have long been the usual treatments for PAL. More recently numerous bronchoscopic procedures have been introduced to treat PAL in those patients who are poor candidates for surgery or who decline surgery. These techniques include bronchoscopic use of sealants, sclerosants, and various types of implanted devices. Recently, removable one-way valves have been developed that are able to be placed bronchoscopically in the affected airways, ameliorating air-leaks in patients who are not candidates for surgery. Future comparative trials are needed to refine our understanding of the indications, effectiveness, and complications of bronchoscopic techniques for treating PAL. The following article will review the basic principles of management of PAL particularly focusing on bronchoscopic techniques. PMID:29268535

Nodule detection in digital chest radiography: Summary of the radius chest trial

International Nuclear Information System (INIS)

Haakansson, M.; Baath, M.; Boerjesson, S.; Kheddache, S.; Grahn, A.; Ruschin, M.; Tingberg, A.; Mattson, S.; Maansson, L. G.

2005-01-01

As a part of the Europe-wide research project 'Unification of physical and clinical requirements for medical X-ray imaging' - governed by the Radiological Imaging Unification Strategies (RADIUS) Group - a major image quality trial was conducted by members of the group. The RADIUS chest trial aimed at thoroughly examining various aspects of nodule detection in digital chest radiography, such as the effects of nodule location, system noise, anatomical noise, and anatomical background. The main findings of the RADIUS chest trial concerning the detection of a lung nodule with a size in the order of 10 mm can be summarised as: (1) the detectability of the nodule is largely dependent on its location in the chest, (2) the system noise has a minor impact on the detectability at the dose levels used today, (3) the disturbance of the anatomical noise is larger than that of the system noise but smaller than that of the anatomical background and (4) the anatomical background acts as noise to a large extent and is the major image component affecting the detectability of the nodule. (authors)

Regional variance of visually lossless threshold in compressed chest CT images: Lung versus mediastinum and chest wall

International Nuclear Information System (INIS)

Kim, Tae Jung; Lee, Kyoung Ho; Kim, Bohyoung; Kim, Kil Joong; Chun, Eun Ju; Bajpai, Vasundhara; Kim, Young Hoon; Hahn, Seokyung; Lee, Kyung Won

2009-01-01

Objective: To estimate the visually lossless threshold (VLT) for the Joint Photographic Experts Group (JPEG) 2000 compression of chest CT images and to demonstrate the variance of the VLT between the lung and mediastinum/chest wall. Subjects and methods: Eighty images were compressed reversibly (as negative control) and irreversibly to 5:1, 10:1, 15:1 and 20:1. Five radiologists determined if the compressed images were distinguishable from their originals in the lung and mediastinum/chest wall. Exact tests for paired proportions were used to compare the readers' responses between the reversible and irreversible compressions and between the lung and mediastinum/chest wall. Results: At reversible, 5:1, 10:1, 15:1, and 20:1 compressions, 0%, 0%, 3-49% (p < .004, for three readers), 69-99% (p < .001, for all readers), and 100% of the 80 image pairs were distinguishable in the lung, respectively; and 0%, 0%, 74-100% (p < .001, for all readers), 100%, and 100% were distinguishable in the mediastinum/chest wall, respectively. The image pairs were less frequently distinguishable in the lung than in the mediastinum/chest wall at 10:1 (p < .001, for all readers) and 15:1 (p < .001, for two readers). In 321 image comparisons, the image pairs were indistinguishable in the lung but distinguishable in the mediastinum/chest wall, whereas there was no instance of the opposite. Conclusion: For JPEG2000 compression of chest CT images, the VLT is between 5:1 and 10:1. The lung is more tolerant to the compression than the mediastinum/chest wall.

Regional variance of visually lossless threshold in compressed chest CT images: Lung versus mediastinum and chest wall

Energy Technology Data Exchange (ETDEWEB)

Kim, Tae Jung [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of); Lee, Kyoung Ho [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of)], E-mail: kholee@snubhrad.snu.ac.kr; Kim, Bohyoung; Kim, Kil Joong; Chun, Eun Ju; Bajpai, Vasundhara; Kim, Young Hoon [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of); Hahn, Seokyung [Medical Research Collaborating Center, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744 (Korea, Republic of); Seoul National University College of Medicine (Korea, Republic of); Lee, Kyung Won [Department of Radiology, Seoul National University Bundang Hospital, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea, Republic of); Seoul National University College of Medicine, Institute of Radiation Medicine, Seoul National University Medical Research Center (Korea, Republic of)

2009-03-15

Objective: To estimate the visually lossless threshold (VLT) for the Joint Photographic Experts Group (JPEG) 2000 compression of chest CT images and to demonstrate the variance of the VLT between the lung and mediastinum/chest wall. Subjects and methods: Eighty images were compressed reversibly (as negative control) and irreversibly to 5:1, 10:1, 15:1 and 20:1. Five radiologists determined if the compressed images were distinguishable from their originals in the lung and mediastinum/chest wall. Exact tests for paired proportions were used to compare the readers' responses between the reversible and irreversible compressions and between the lung and mediastinum/chest wall. Results: At reversible, 5:1, 10:1, 15:1, and 20:1 compressions, 0%, 0%, 3-49% (p < .004, for three readers), 69-99% (p < .001, for all readers), and 100% of the 80 image pairs were distinguishable in the lung, respectively; and 0%, 0%, 74-100% (p < .001, for all readers), 100%, and 100% were distinguishable in the mediastinum/chest wall, respectively. The image pairs were less frequently distinguishable in the lung than in the mediastinum/chest wall at 10:1 (p < .001, for all readers) and 15:1 (p < .001, for two readers). In 321 image comparisons, the image pairs were indistinguishable in the lung but distinguishable in the mediastinum/chest wall, whereas there was no instance of the opposite. Conclusion: For JPEG2000 compression of chest CT images, the VLT is between 5:1 and 10:1. The lung is more tolerant to the compression than the mediastinum/chest wall.

CSER 94-011: Use of glovebags for demister draining operations

International Nuclear Information System (INIS)

Hess, A.L.

1994-01-01

A criticality safety review is presented for the use of plastic-sheet glovebags for the operations of draining demisters on the 26-inch vacuum system headers. A criticality drain is required because of the possibility for spilling liquid of sufficient volume and fissile content for criticality. It is recommended that the glovebag design include a rigid, 2ft x 2ft floor with a central drain feeding a geometrically favorable spill-catch vessel, plus a screen grid above the bottom for drain protection

CIVILIAN GUNSHOT WOUNDS TO THE CHEST: A CLINICOPATHOLOGICAL ANALYSIS OF AN ANNUAL CASELOAD AT A LEVEL 1 TRAUMA CENTRE.

Science.gov (United States)

Meijering, V M; Hattam, A T; Navsaria, P H; Nicol, A J; Edu, S

2017-06-01

Gunshot wounds (GSW) to the chest are common presentations to trauma centres in South Africa. The clinical management and outcome of GSW to the chest are significantly altered by missile trajectory and the associated anatomical structures injured making them challenging injuries to treat. Currently, the management of GSW chest is based on scant evidence and treatment is typically according to algorithms based largely on the anecdotal experience of high volume institutions and experienced clinicians. Ethical approval was obtained for this study. The Electronic Trauma Health Registry (eTHR) Application of the Trauma Centre at Groote Schuur Hospital in Cape Town was interrogated for the year 2015 for all patients with GSW chest. The data was then analysed using descriptive statistics. A total of 141 patients with GSW to the chest were admitted to the Trauma Centre with a median age of 26 years. More than half of the patients, 53. 2% (n = 75) sustained an isolated GSW to the chest. Overall, 29.1% (n = 41) patients sustained a thoracoabdominal injury, which accounts for a significant higher amount of emergency surgeries compared to patients with non thoracoabdominal injuries (54% vs 15%, p = chest surgery of which 5 patients survived. Overall mortality was 7.1% (n = 10) of which 5 patients died from a thoracic cause. Civilian GSW to the chest are common injuries seen in Cape Town, often with concomitant injuries leading to increased morbidity. Significantly more emergency surgeries were done in patients with thoracoabdominal injury. Overall few patients needed chest-related emergency operative intervention (9.2%) with a survival rate of 38.5%. Overall mortality of patients with GSW chest who reached the hospital was 7.1% of whom 50% died from a thoracic cause.

Draining after breast reduction: a randomised controlled inter-patient study

NARCIS (Netherlands)

Corion, Leonard U. M.; Smeulders, Mark J. C.; van Zuijlen, Paul P. M.; van der Horst, Chantal M. A. M.

2009-01-01

One hundred and seven bilateral breast reductions were prospectively randomised during surgery to receive or not receive wound drains. Fifty-five patients were randomised to have a drain and 52 to not have a drain. There was no statistical difference in the number of complications between the

Study of the patency of different peritoneal drains used prophylactically in bariatric surgery.

Science.gov (United States)

Salgado Júnior, Wilson; Macedo Neto, Marcelo Martins; dos Santos, José Sebastião; Sakarankutty, Ajith Kumar; Ceneviva, Reginaldo; de Castro e Silva, Orlando

2009-05-21

To compare the performance of different types of abdominal drains used in bariatric surgery. A vertical banded Roux-en-Y gastric bypass was performed in 33 morbidly obese patients. Drainage of the peritoneal cavity was performed in each case using three different types of drain selected in a randomized manner: a latex tubular drain, a Watterman tubulolaminar drain, and a silicone channeled drain. Drain permeability, contamination of the drained fluid, ease of handling, and patient discomfort were evaluated postoperatively over a period of 7 d. The patients with the silicone channeled drain had larger volumes of drainage compared to patients with tubular and tubulolaminar drains between the third and seventh postoperative days. In addition, a lower incidence of discomfort and of contamination with bacteria of a more pathogenic profile was observed in the patients with the silicone channeled drain. The silicone channeled drain was more comfortable and had less chance of occlusion, which is important in the detection of delayed dehiscence.

Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

Science.gov (United States)

Masuda, Norikazu; Yasojima, Hiroyuki; Mizutani, Makiko; Nakamori, Shoji; Kanazawa, Toru; Kuriyama, Keiko; Mano, Masayuki; Sekimoto, Mitsugu

2014-01-01

Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient's chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery. PMID:24660001

Primary Chest Wall Abscess Mimicking a Breast Tumor That Occurred after Blunt Chest Trauma: A Case Report

Directory of Open Access Journals (Sweden)

Yusuke Yamaoka

2014-01-01

Full Text Available Primary chest wall abscess occurring after blunt chest trauma is rare. We present the case of a 50-year-old woman who presented with a swelling in her left breast. The patient had experienced blunt chest trauma 2 months back. Needle aspiration revealed pus formation in the patient’s chest. Computed tomography revealed a mass in the lower region of the left mammary gland, with thickening of the parietal pleura and skin and fracture of the fifth rib under the abscess. Following antibiotic administration and irrigation of the affected region, surgical debridement was performed. During surgery, we found that the pectoralis major muscle at the level of the fifth rib was markedly damaged, although the necrotic tissue did not contact the mammary gland. We diagnosed the lesion as a chest wall abscess that occurred in response to blunt chest trauma. Her postoperative course was uneventful. There has been no recurrence for six months after surgery.

Preliminary report from the World Health Organisation Chest Radiography in Epidemiological Studies project

Energy Technology Data Exchange (ETDEWEB)

Mahomed, Nasreen [University of the Witwatersrand, Department of Radiology, Johannesburg (South Africa); University of the Witwatersrand, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg (South Africa); Fancourt, Nicholas [Johns Hopkins Bloomberg School of Public Health, Baltimore (United States); Murdoch Children' s Research Institute, Melbourne (Australia); De Campo, John; De Campo, Margaret [Murdoch Children' s Research Institute, Melbourne (Australia); Melbourne University, Melbourne (Australia); Akano, Aliu [Department of Radiology National Hospital, Abuja (Nigeria); Medical Research Council, Gambia (South Africa); Cherian, Thomas [World Health Organization, Geneva (Switzerland); Cohen, Olivia G. [Johns Hopkins Bloomberg School of Public Health, Baltimore (United States); World Health Organization, Geneva (Switzerland); Greenberg, David [Soroka University Medical Center, Beer-Sheva (Israel); Lacey, Stephen [Murdoch Children' s Research Institute, Melbourne (Australia); Kohli, Neera [King George Medical University, Lucknow (India); Lederman, Henrique M. [Paulista School of Medicine, Hospital Sao Paulo, Sao Paulo (Brazil); Madhi, Shabir A. [University of the Witwatersrand, Medical Research Council: Respiratory and Meningeal Pathogens Research Unit, Johannesburg (South Africa); University of the Witwatersrand, Department of Science and Technology/National Research Foundation: Vaccine Preventable Diseases, Johannesburg (South Africa); Manduku, Veronica [Kenya Medical Research Institute (KEMRI), Nairobi (Kenya); McCollum, Eric D. [Johns Hopkins School of Medicine, Eudowood Division of Pediatric Respiratory Sciences, Baltimore (United States); Johns Hopkins Bloomberg School of Public Health, Baltimore (United States); Park, Kate [Oxford University Hospitals NHS Foundation Trust, Oxford (United Kingdom); Ribo-Aristizabal, Jose Luis [Hospital Sant Joan de Deu, Barcelona (Spain); Bar-Zeev, Naor [University of Malawi, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, College of Medicine, Blantyre (Malawi); University of Liverpool, Centre for Global Vaccine Research, Liverpool (United Kingdom); O' Brien, Katherine L. [Johns Hopkins Bloomberg School of Public Health, Baltimore (United States); Mulholland, Kim [Murdoch Children' s Research Institute, Melbourne (Australia); London School of Hygiene and Tropical Medicine, London (United Kingdom)

2017-10-15

Childhood pneumonia is among the leading infectious causes of mortality in children younger than 5 years of age globally. Streptococcus pneumoniae (pneumococcus) is the leading infectious cause of childhood bacterial pneumonia. The diagnosis of childhood pneumonia remains a critical epidemiological task for monitoring vaccine and treatment program effectiveness. The chest radiograph remains the most readily available and common imaging modality to assess childhood pneumonia. In 1997, the World Health Organization Radiology Working Group was established to provide a consensus method for the standardized definition for the interpretation of pediatric frontal chest radiographs, for use in bacterial vaccine efficacy trials in children. The definition was not designed for use in individual patient clinical management because of its emphasis on specificity at the expense of sensitivity. These definitions and endpoint conclusions were published in 2001 and an analysis of observer variation for these conclusions using a reference library of chest radiographs was published in 2005. In response to the technical needs identified through subsequent meetings, the World Health Organization Chest Radiography in Epidemiological Studies (CRES) project was initiated and is designed to be a continuation of the World Health Organization Radiology Working Group. The aims of the World Health Organization CRES project are to clarify the definitions used in the World Health Organization defined standardized interpretation of pediatric chest radiographs in bacterial vaccine impact and pneumonia epidemiological studies, reinforce the focus on reproducible chest radiograph readings, provide training and support with World Health Organization defined standardized interpretation of chest radiographs and develop guidelines and tools for investigators and site staff to assist in obtaining high-quality chest radiographs. (orig.)

Preliminary report from the World Health Organisation Chest Radiography in Epidemiological Studies project.

Science.gov (United States)

Mahomed, Nasreen; Fancourt, Nicholas; de Campo, John; de Campo, Margaret; Akano, Aliu; Cherian, Thomas; Cohen, Olivia G; Greenberg, David; Lacey, Stephen; Kohli, Neera; Lederman, Henrique M; Madhi, Shabir A; Manduku, Veronica; McCollum, Eric D; Park, Kate; Ribo-Aristizabal, Jose Luis; Bar-Zeev, Naor; O'Brien, Katherine L; Mulholland, Kim

2017-10-01

Childhood pneumonia is among the leading infectious causes of mortality in children younger than 5 years of age globally. Streptococcus pneumoniae (pneumococcus) is the leading infectious cause of childhood bacterial pneumonia. The diagnosis of childhood pneumonia remains a critical epidemiological task for monitoring vaccine and treatment program effectiveness. The chest radiograph remains the most readily available and common imaging modality to assess childhood pneumonia. In 1997, the World Health Organization Radiology Working Group was established to provide a consensus method for the standardized definition for the interpretation of pediatric frontal chest radiographs, for use in bacterial vaccine efficacy trials in children. The definition was not designed for use in individual patient clinical management because of its emphasis on specificity at the expense of sensitivity. These definitions and endpoint conclusions were published in 2001 and an analysis of observer variation for these conclusions using a reference library of chest radiographs was published in 2005. In response to the technical needs identified through subsequent meetings, the World Health Organization Chest Radiography in Epidemiological Studies (CRES) project was initiated and is designed to be a continuation of the World Health Organization Radiology Working Group. The aims of the World Health Organization CRES project are to clarify the definitions used in the World Health Organization defined standardized interpretation of pediatric chest radiographs in bacterial vaccine impact and pneumonia epidemiological studies, reinforce the focus on reproducible chest radiograph readings, provide training and support with World Health Organization defined standardized interpretation of chest radiographs and develop guidelines and tools for investigators and site staff to assist in obtaining high-quality chest radiographs.

Preliminary report from the World Health Organisation Chest Radiography in Epidemiological Studies project

International Nuclear Information System (INIS)

Mahomed, Nasreen; Fancourt, Nicholas; De Campo, John; De Campo, Margaret; Akano, Aliu; Cherian, Thomas; Cohen, Olivia G.; Greenberg, David; Lacey, Stephen; Kohli, Neera; Lederman, Henrique M.; Madhi, Shabir A.; Manduku, Veronica; McCollum, Eric D.; Park, Kate; Ribo-Aristizabal, Jose Luis; Bar-Zeev, Naor; O'Brien, Katherine L.; Mulholland, Kim

2017-01-01

Childhood pneumonia is among the leading infectious causes of mortality in children younger than 5 years of age globally. Streptococcus pneumoniae (pneumococcus) is the leading infectious cause of childhood bacterial pneumonia. The diagnosis of childhood pneumonia remains a critical epidemiological task for monitoring vaccine and treatment program effectiveness. The chest radiograph remains the most readily available and common imaging modality to assess childhood pneumonia. In 1997, the World Health Organization Radiology Working Group was established to provide a consensus method for the standardized definition for the interpretation of pediatric frontal chest radiographs, for use in bacterial vaccine efficacy trials in children. The definition was not designed for use in individual patient clinical management because of its emphasis on specificity at the expense of sensitivity. These definitions and endpoint conclusions were published in 2001 and an analysis of observer variation for these conclusions using a reference library of chest radiographs was published in 2005. In response to the technical needs identified through subsequent meetings, the World Health Organization Chest Radiography in Epidemiological Studies (CRES) project was initiated and is designed to be a continuation of the World Health Organization Radiology Working Group. The aims of the World Health Organization CRES project are to clarify the definitions used in the World Health Organization defined standardized interpretation of pediatric chest radiographs in bacterial vaccine impact and pneumonia epidemiological studies, reinforce the focus on reproducible chest radiograph readings, provide training and support with World Health Organization defined standardized interpretation of chest radiographs and develop guidelines and tools for investigators and site staff to assist in obtaining high-quality chest radiographs. (orig.)

Surgical treatment of chest instability

International Nuclear Information System (INIS)

Kitka, M.; Masek, M.

2015-01-01

Fractures of the ribs is the most common thoracic injury after blunt trauma. Chest wall instability (flail chest) is a common occurrence in the presence of multiple ribs fracture. Unilateral or bilateral fractures more ribs anteriorly or posteriorly will produce enough instability that paradoxical respiratory motion results in hypoventilation of an unacceptable degree. Open approach and surgical stabilisation of the chest preserved pulmonary function, improved pain control, minimized posttraumatic deformities and shorter back to work time. (author)

Clinical Utility of Chest Computed Tomography in Patients with Rib Fractures CT Chest and Rib Fractures

OpenAIRE

Chapman, Brandon C.; Overbey, Douglas M.; Tesfalidet, Feven; Schramm, Kristofer; Stovall, Robert T.; French, Andrew; Johnson, Jeffrey L.; Burlew, Clay C.; Barnett, Carlton; Moore, Ernest E.; Pieracci, Fredric M.

2016-01-01

Background Chest CT is more sensitive than a chest X-ray (CXR) in diagnosing rib fractures; however, the clinical significance of these fractures remains unclear. Objectives The purpose of this study was to determine the added diagnostic use of chest CT performed after CXR in patients with either known or suspected rib fractures secondary to blunt trauma. Methods Retrospective coho...

Chest pain

International Nuclear Information System (INIS)

Martinez A, Juan Carlos; Saenz M, Oscar; Martinez M, Camilo; Gonzales A Francisco; Nicolas R, Jose; Vergara V, Erika P; Pereira G, Alberto M

2010-01-01

In emergency departments, chest pain is one of the leading motives of consultation. We thus consider it important to review aspects such as its classification, causes, and clinical profiles. Initial assessment should include a full clinical history comprising thorough anamnesis and physical examination. Adequate interpretation of auxiliary tests, ordered in accordance with suspected clinical conditions, should lead to accurate diagnosis. We highlight certain symptoms and clinical signs, ECG and X-ray findings, cardiac bio markers, arterial blood gases, and CT-scanning. Scores of severity and prognosis such as TIMI are assessed. Optimal treatment of the clinical conditions leading to chest pain depends on adequate initial approach and assessment.

Imaging of blunt chest trauma

International Nuclear Information System (INIS)

Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A.

2000-01-01

In western European countries most blunt chest traumas are associated with motor vehicle and sport-related accidents. In Switzerland, 39 of 10,000 inhabitants were involved and severely injured in road accidents in 1998. Fifty two percent of them suffered from blunt chest trauma. According to the Swiss Federal Office of Statistics, traumas represented in men the fourth major cause of death (4 %) after cardiovascular disease (38 %), cancer (28 %), and respiratory disease (7 %) in 1998. The outcome of chest trauma patients is determined mainly by the severity of the lesions, the prompt appropriate treatment delivered on the scene of the accident, the time needed to transport the patient to a trauma center, and the immediate recognition of the lesions by a trained emergency team. Other determining factors include age as well as coexisting cardiac, pulmonary, and renal diseases. Our purpose was to review the wide spectrum of pathologies related to blunt chest trauma involving the chest wall, pleura, lungs, trachea and bronchi, aorta, aortic arch vessels, and diaphragm. A particular focus on the diagnostic impact of CT is demonstrated. (orig.)

Correlations between quality indexes of chest compression.

Science.gov (United States)

Zhang, Feng-Ling; Yan, Li; Huang, Su-Fang; Bai, Xiang-Jun

2013-01-01

Cardiopulmonary resuscitation (CPR) is a kind of emergency treatment for cardiopulmonary arrest, and chest compression is the most important and necessary part of CPR. The American Heart Association published the new Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care in 2010 and demanded for better performance of chest compression practice, especially in compression depth and rate. The current study was to explore the relationship of quality indexes of chest compression and to identify the key points in chest compression training and practice. Totally 219 healthcare workers accepted chest compression training by using Laerdal ACLS advanced life support resuscitation model. The quality indexes of chest compression, including compression hands placement, compression rate, compression depth, and chest wall recoil as well as self-reported fatigue time were monitored by the Laerdal Computer Skills and Reporting System. The quality of chest compression was related to the gender of the compressor. The indexes in males, including self-reported fatigue time, the accuracy of compression depth and the compression rate, the accuracy of compression rate, were higher than those in females. However, the accuracy of chest recoil was higher in females than in males. The quality indexes of chest compression were correlated with each other. The self-reported fatigue time was related to all the indexes except the compression rate. It is necessary to offer CPR training courses regularly. In clinical practice, it might be better to change the practitioner before fatigue, especially for females or weak practitioners. In training projects, more attention should be paid to the control of compression rate, in order to delay the fatigue, guarantee enough compression depth and improve the quality of chest compression.

Can ECG-gated MDCT be considered an obligatory step to plan and manage a new chest-pain unit?

International Nuclear Information System (INIS)

Runza, G.; Alaimo, V.; La Grutta, L.; Galia, M.; Basile, A.; Cademartiri, F.; Krestin, G.P.; Midiri, M.

2007-01-01

The recent improvements in multi-detector computed tomography technology and its application in cardiac field allow to consider this non-invasive imaging technique as a promising comprehensive method for detecting significant coronary stenoses in a chest-pain unit. The possibility to use the ECG-synchronisation acquisition protocol, normally limited to the cardiac volume, for the entire thoracic vascular system should have the remarkable potential to reduce invasive and non-invasive procedures actually used to investigate acute chest pain and the number of unnecessary hospital admissions without reducing appropriate admissions in patients with chest pain

Operative videothoracoscopy in the surgical treatment of penetrating firearms wounds of the chest.

Science.gov (United States)

Brusov, P G; Kuritsyn, A N; Urazovsky, N Y; Tariverdiev, M L

1998-09-01

lung injuries was obtained largely with intracorporeal knot tying. The duration of the procedures ranged from 40 to 90 minutes. No morbidity nor mortality was encountered in patients undergoing OVT. Postoperative pain was minimized by using OVT placement of catheters in the chest wall soft tissue with local administration of 2% Trimecain. Patients were able to stand in 10 to 12 hours and to walk by the end of the first postoperative day. All patients who underwent OVT were evacuated without drains by the third or fourth postoperative day, all tolerating sitting and standing positions. We conclude that early OVT in the military field hospital for continued bleeding, clotted hemothorax, and continued major air leakage has several advantages in military patients with PFAWT: early definition and management of organ injury; identification and control of bleeding in most instances; earlier and more accurate assessment for thoracotomy; vigorous lavage and removal of projectiles such as bone fragments and evacuation of clotted hemothorax; early debridement with suture closure of the thoracic wall canal; and minimal postoperative pain with dramatically reduced suppurative sequelae and bronchopleural fistulae.

Utility of Objective Chest Tube Management After Pulmonary Resection Using a Digital Drainage System.

Science.gov (United States)

Takamochi, Kazuya; Imashimizu, Kota; Fukui, Mariko; Maeyashiki, Tatsuo; Suzuki, Mikiko; Ueda, Takuya; Matsuzawa, Hironori; Hirayama, Shunki; Matsunaga, Takeshi; Oh, Shiaki; Suzuki, Kenji

2017-07-01

We sought to evaluate the clinical utility of chest tube management after pulmonary resection based on objective digital monitoring of pleural pressure and digital surveillance for air leaks. We prospectively recorded the perioperative data of 308 patients who underwent pulmonary resection between December 2013 and January 2016. We used information from a digital monitoring thoracic drainage system to measure peak air leakage during the first 24 hours after the operation, patterns of air leakage over the first 72 hours, and patterns of pleural pressure changes until the chest tubes were removed. There were 240 patients with lung cancer and 68 patients with other diseases. The operations included 49 wedge resections, 58 segmentectomies, and 201 lobectomies. A postoperative air leak was observed in 61 patients (20%). A prolonged air leak exceeding 20 mL/min lasting 5 days or more was observed in 18 patients (5.8%). Multivariate analysis of various perioperative factors showed forced expiratory volume in 1 second below 70%, patterns of air leakage, defined as exacerbating and remitting or without a trend toward improvement, and peak air leakage of 100 mL/min or more were significant positive predictors of prolonged air leak. Fluctuations in pleural pressure occurred just after the air leakage rate decreased to less than 20 mL/min. Digital monitoring of peak air leakage and patterns of air leakage were useful for predicting prolonged air leak after pulmonary resection. Information on the disappearance of air leak could be derived from the change in the rate of air leakage and from the increase in fluctuation of pleural pressure. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Approach to chest pain and acute myocardial infarction.

Science.gov (United States)

Pandie, S; Hellenberg, D; Hellig, F; Ntsekhe, M

2016-03-01

Patient history, physical examination, 12-lead electrocardiogram (ECG) and cardiac biomarkers are key components of an effective chest pain assessment. The first priority is excluding serious chest pain syndromes, namely acute coronary syndromes (ACSs), aortic dissection, pulmonary embolism, cardiac tamponade and tension pneumothorax. On history, the mnemonic SOCRATES (Site Onset Character Radiation Association Time Exacerbating/relieving factor and Severity) helps differentiate cardiac from non-cardiac pain. On examination, evaluation of vital signs, evidence of murmurs, rubs, heart failure, tension pneumothoraces and chest infections are important. A 12-lead ECG should be interpreted within 10 minutes of first medical contact, specifically to identify ST elevation myocardial infarction (STEMI). High-sensitivity troponins improve the rapid rule-out of myocardial infarction (MI) and confirmation of non-ST elevation MI (NSTEMI). ACS (STEMI and NSTEMI/unstable anginapectoris (UAP)) result from acute destabilisation of coronary atheroma with resultant complete (STEMI) or subtotal (NSTEMI/UAP) thrombotic coronary occlusion. The management of STEMI patients includes providing urgent reperfusion: primary percutaneous coronary intervention(PPCI) if available, deliverable within 60 - 120 minutes, and fibrinolysis if PPCI is not available. Essential adjunctive therapies include antiplatelet therapy (aspirin, P2Y12 inhibitors), anticoagulation (heparin or low-molecular-weight heparin) and cardiac monitoring.

The forgotten view: Chest X-ray - Lateral view

Directory of Open Access Journals (Sweden)

Abraham M. Ittyachen

2017-01-01

Full Text Available With CT (computed tomography chest gaining more importance as a diagnostic tool, chest X-ray especially the lateral view is taken less commonly nowadays. Besides CT chest is also proven to be superior to chest X-ray in patients with major blunt trauma. We are presenting a 68-year old male who was partially treated from outside for a left sided pneumonia. He came to our hospital because of persisting chest pain. Chest X-ray, frontal view (postero-anterior was almost normal except for a mild opacity in the left lower zone. CT scan of the chest revealed a fluid collection posteriorly enclosed within enhancing pleura. Chest X-ray, left lateral view showed a corresponding posterior pleural based opacity. We are presenting this case to highlight the importance of the lateral view of the chest X-ray. In selected cases there is still a role for the lateral view. With the three dimensional visualization provided by the CT, the lateral view of the chest may be easier to understand. Consequent to the initial diagnosis by CT further follow up can be done with the chest X-ray. In a limited way this mitigates unnecessary expenditure and more importantly prevents the patient from exposure to harmful radiation in the form of repeated CT.

An Equal-Strain Analytical Solution for the Radial Consolidation of Unsaturated Soils by Vertical Drains considering Drain Resistance

Directory of Open Access Journals (Sweden)

Feng Zhou

2018-01-01

Full Text Available Developing an analytical solution for the consolidation of unsaturated soils remains a challenging task due to the complexity of coupled governing equations for air and water phases. This paper presents an equal-strain model for the radial consolidation of unsaturated soils by vertical drains, and the effect of drain resistance is also considered. Simplified governing equations are established, and an analytical solution to calculate the excess pore-air and pore-water pressures is derived by using the methods of matrix analysis and eigenfunction expansion. The average degrees of consolidation for air and water phases and the ground surface settlement are also given. The solutions of the equal-strain model are verified by comparing the proposed free-strain model with the equal-strain model, and reasonably good agreement is obtained. Moreover, parametric studies regarding the drain resistance effect are graphically presented.

Percutaneous Retrieval of a Retained Jackson-Pratt Drain Fragment

International Nuclear Information System (INIS)

Namyslowski, Jan; Halin, Neil J.; Greenfield, Alan J.

1996-01-01

A retained intraabdominal Jackson-Pratt drain fragment was percutaneously retrieved using an inflated angioplasty balloon that had been maneuvered inside of the drain lumen over a hydrophilic-coated steerable guidewire

Pleural effusion: diagnosis, treatment, and management

Science.gov (United States)

Karkhanis, Vinaya S; Joshi, Jyotsna M

2012-01-01

A pleural effusion is an excessive accumulation of fluid in the pleural space. It can pose a diagnostic dilemma to the treating physician because it may be related to disorders of the lung or pleura, or to a systemic disorder. Patients most commonly present with dyspnea, initially on exertion, predominantly dry cough, and pleuritic chest pain. To treat pleural effusion appropriately, it is important to determine its etiology. However, the etiology of pleural effusion remains unclear in nearly 20% of cases. Thoracocentesis should be performed for new and unexplained pleural effusions. Laboratory testing helps to distinguish pleural fluid transudate from an exudate. The diagnostic evaluation of pleural effusion includes chemical and microbiological studies, as well as cytological analysis, which can provide further information about the etiology of the disease process. Immunohistochemistry provides increased diagnostic accuracy. Transudative effusions are usually managed by treating the underlying medical disorder. However, a large, refractory pleural effusion, whether a transudate or exudate, must be drained to provide symptomatic relief. Management of exudative effusion depends on the underlying etiology of the effusion. Malignant effusions are usually drained to palliate symptoms and may require pleurodesis to prevent recurrence. Pleural biopsy is recommended for evaluation and exclusion of various etiologies, such as tuberculosis or malignant disease. Percutaneous closed pleural biopsy is easiest to perform, the least expensive, with minimal complications, and should be used routinely. Empyemas need to be treated with appropriate antibiotics and intercostal drainage. Surgery may be needed in selected cases where drainage procedure fails to produce improvement or to restore lung function and for closure of bronchopleural fistula. PMID:27147861

Relationship of bleeding complications and impairment of draining veins after α-n-butyl cyanoacrylate embolization of brain arteriovenous malformations

International Nuclear Information System (INIS)

Fang Bing; Wang Yirong; Li Tielin; Duan Chuanzhi; Wang Qiujing; Zhao Qingping

2007-01-01

Objective: To investigate the causes, consequences and management of injuries to the draining veins after embolization of brain arterioven0us malformations (BAVMs) with α-n-butyl cyanoacrylate (NBCA). Methods: The angiographic imaging data of 189 BAVMs patients who underwent NBCA embolization were studied retrospectively. The status of the draining veins before and after NBCA embolization was observed and compared. The intracerebral hemorrhage (ICH)complications and their relation to their angiographic features were analyzed. Results: Twenty-three patients out of 189 patients showed injuries to the draining venous system, including 10 low-grade injury, 6 moderate injury, and 7 high-grade injury. Six patients suffered from ICH after embolization, of whom 4 patients were due to injuries of the draining veins (2 moderate and 2 high-grade). In the 3 months follow-up evaluation of 4 patients with ICH, one died, one was in vegetative state, and the other two patients suffered from residual severe or minor (1 patient for each) permanent neurological deficits. Conclusion: Our findings suggest that injury of the draining veins is the major cause of ICH and may lead to serious consequences after embolization of BAVMs with NBCA. (authors)

Diagnosis and treatment of musculoskeletal chest pain: design of a multi-purpose trial

DEFF Research Database (Denmark)

Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner

2008-01-01

manipulation of the cervical and thoracic spine, mobilisation, and soft tissue techniques. b) Advice promoting self-management and individual instructions focusing on posture and muscle stretch (advice group). Outcome measures are pain, physical function, overall health, self-perceived treatment effect......BACKGROUND: Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain...... may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect...

Incidental findings in chest X-rays; Zufallsbefunde im Roentgenthorax

Energy Technology Data Exchange (ETDEWEB)

Wielpuetz, M.O.; Kauczor, H.U. [Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaet Heidelberg, Translational Lung Research Center (TLRC), Deutsches Zentrum fuer Lungenforschung (DZL), Heidelberg (Germany); Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie mit Nuklearmedizin, Thoraxklinik, Heidelberg (Germany); Weckbach, S. [Universitaetsklinikum Heidelberg, Klinik fuer Diagnostische und Interventionelle Radiologie, Heidelberg (Germany); Universitaet Heidelberg, Translational Lung Research Center (TLRC), Deutsches Zentrum fuer Lungenforschung (DZL), Heidelberg (Germany)

2017-04-15

Conventional projection radiography (chest x-ray) is one of the most frequently requested procedures in radiology. Even though chest x-ray imaging is frequently performed in asymptomatic patients for preoperative assessment, clinically relevant incidental findings are relatively scarce. This is due to the relatively low sensitivity of chest x-rays where few clinically relevant incidental findings are to be expected, as any detectable pathologies will as a rule already be clinically symptomatic. Recommendations from relevant societies for the management of incidental findings, apart from the clarification of incidental nodules, do not exist. This review article therefore describes the most frequent and typical incidental findings of lung parenchyma (apart from pulmonary nodules), mediastinal structures including the hilum of the lungs, pleura, chest wall and major vessels. Also described are those findings which can be diagnosed with sufficient certainty from chest x-rays so that further clarification is not necessary and those which must be further clarified by multislice imaging procedures or other techniques. (orig.) [German] Eine der haeufigsten Untersuchungen in der Radiologie ist die konventionelle Projektionsradiographie des Thorax (Roentgenthorax). Auch wenn projektionsradiographische Aufnahmen im Rahmen einer praeoperativen Abklaerung haeufig als orientierende Untersuchung angefertigt werden, sind - bedingt durch die relativ geringe Sensitivitaet des Roentgenthorax - wenig klinisch relevante Zufallsbefunde zu erwarten, da nachweisbare Pathologien in der Regel bereits auch klinisch apparent sind. Empfehlungen entsprechender Fachgesellschaften zu Zufallsbefunden im Roentgenthorax jenseits der Abklaerung von Rundherden liegen nicht vor. Die vorliegende Arbeit beleuchtet daher haeufige und typische Zufallsbefunde des Lungenparenchyms (ausser den Lungenrundherden), der mediastinalen Strukturen einschliesslich der Hili, der Pleura, der Thoraxwand sowie der

Early appearance of SARS on chest CT scan

International Nuclear Information System (INIS)

Cheng Xiaoguang; Feng Suchen; Xia Guoguang; Zhao Tao; Gu Xiang; Qu Hui

2003-01-01

Objective: To evaluate the early appearance of SARS on chest CT scan and its role in the early diagnosis. Methods: Forty cases of SARS in keeping with the criteria of the Ministry of Health had chest CT scans within 7 days of onset of symptoms, and CR chest X-ray films were available as well. These chest X-rays and CT images were retrospectively reviewed to determine if there were any abnormalities on the images. The lesions on the chest CT images were then further analyzed in terms of the number, location, size, and density. Results: Positive abnormalities on chest CT scans were revealed in all 40 SARS cases. Positive findings on CR chest films were showed in only 25 cases, equivocal in 6, and normal in 9 cases. The main abnormalities seen on CT and X-rays were pulmonary infiltrations varied markedly in severity. 70 % cases had 1 or 2 lesions on chest CT scan, 30 % cases had 3 or more lesions. The lesions seen on chest CT scan tended to be ground-glass opacification, sometimes with consolidation which was very faint and inhomogeneous, easily missed on chest X-rays. Typically the lesions were located in the periphery of the lung, or both central and peripheral lung, but very rare in a pure central location. They were commonly in the shape of patch or ball. Conclusions: Chest CT scan is much more sensitive in detecting the lesions of the lung in SARS. The early appearance of SARS on chest CT scan is characteristic but non-specific, indicating that chest CT scan plays a very important role in the early diagnosis and differential diagnosis of SARS

Laparoscopic elective cholecystectomy with and without drain: A controlled randomised trial

Directory of Open Access Journals (Sweden)

Gouda El-labban

2012-01-01

Full Text Available Background : Laparoscopic cholecystectomy is the main method of treatment of symptomatic gallstones. Routine drainage after laparoscopic cholecystectomy is an issue of considerable debate. Therefore, a controlled randomised trial was designed to assess the value of drains in elective laparoscopic cholecystectomy. Materials and Methods: During a two-year period (From April 2008 to January 2010, 80 patients were simply randomised to have a drain placed (group A, an 8-mm pentose tube drain was retained below the liver bed, whereas 80 patients were randomised not to have a drain (group B placed in the subhepatic space. End points of this trial were to detect any differences in morbidity, postoperative pain, wound infection and hospital stay between the two groups. Results : There was no mortality in either group and no statistically significant difference in postoperative pain, nausea and vomiting, wound infection or abdominal collection between the two groups. However, hospital stay was longer in the drain group than in group without drain and it is appearing that the use of drain delays hospital discharge. Conclusion : The routine use of a drain in non-complicated laparoscopic cholecystectomy has nothing to offer; in contrast, it is associated with longer hospital stay.

Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes.

Science.gov (United States)

Upchurch, Cameron P; Grijalva, Carlos G; Wunderink, Richard G; Williams, Derek J; Waterer, Grant W; Anderson, Evan J; Zhu, Yuwei; Hart, Eric M; Carroll, Frank; Bramley, Anna M; Jain, Seema; Edwards, Kathryn M; Self, Wesley H

2018-03-01

The clinical significance of pneumonia visualized on CT scan in the setting of a normal chest radiograph is uncertain. In a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia (CAP), we compared the presenting clinical features, pathogens present, and outcomes of patients with pneumonia visualized on a CT scan but not on a concurrent chest radiograph (CT-only pneumonia) and those with pneumonia visualized on a chest radiograph. All patients underwent chest radiography; the decision to obtain CT imaging was determined by the treating clinicians. Chest radiographs and CT images were interpreted by study-dedicated thoracic radiologists blinded to the clinical data. The study population included 2,251 adults with CAP; 2,185 patients (97%) had pneumonia visualized on chest radiography, whereas 66 patients (3%) had pneumonia visualized on CT scan but not on concurrent chest radiography. Overall, these patients with CT-only pneumonia had a clinical profile similar to those with pneumonia visualized on chest radiography, including comorbidities, vital signs, hospital length of stay, prevalence of viral (30% vs 26%) and bacterial (12% vs 14%) pathogens, ICU admission (23% vs 21%), use of mechanical ventilation (6% vs 5%), septic shock (5% vs 4%), and inhospital mortality (0 vs 2%). Adults hospitalized with CAP who had radiological evidence of pneumonia on CT scan but not on concurrent chest radiograph had pathogens, disease severity, and outcomes similar to patients who had signs of pneumonia on chest radiography. These findings support using the same management principles for patients with CT-only pneumonia and those with pneumonia seen on chest radiography. Copyright © 2017 American College of Chest Physicians. All rights reserved.

Powerful Software to Simulate Soil Consolidation Problems with Prefabricated Vertical Drains

OpenAIRE

Gonzalo García-Ros; Iván Alhama; Manuel Cánovas

2018-01-01

The present work describes the program Simulation of Consolidation with Vertical Drains (SICOMED_2018), a tool for the solution of consolidation processes in heterogeneous soils, with totally or partially penetrating prefabricated vertical drains (PVD) and considering both the effects of the smear zone, generated when introducing the drain into the ground, and the limitation in the discharge capacity of the drain. In order to provide a completely free program, the code Next-Generation Simulat...

Improving screen-film chest radiography

International Nuclear Information System (INIS)

Shaikh, N.; Baker, R.A.

1996-01-01

Traditionally symmetric screens and double emulsion symmetric films with medium to wide latitutde are used for radiography of the chest. Beacuse of mismatch of transmitted exposure through the chest with limited latitude of the film, most of the dense areas of the chest are underexposed. Kodak's recent innovation of a unique asymmetry screen-film system (InSight) alleviates this problem. Our phantom measurement indicates that the InSight system offers wider recording range, and the flexible grid permits more positional latitude than conventional grids. Our five-year extensive clinical experience indicates that dense anatomic structures, such as mediastinum, retrocardiac and subdiaphragmatic, are more visible in the InSight system than in the conventional symmetric system. Similarly, a substantial improvement in image quality in portable chest imaging is realized by use of flexible grids because of scatter rejection and invisible grid lines. (author)

Interpretation of neonatal chest radiography

International Nuclear Information System (INIS)

Yoon, Hye Kyung

2016-01-01

Plain radiographs for infants in the neonatal intensive care unit are obtained using the portable X-ray equipment in order to evaluate the neonatal lungs and also to check the position of the tubes and catheters used for monitoring critically-ill neonates. Neonatal respiratory distress is caused by a variety of medical or surgical disease conditions. Clinical information about the gestational week, respiratory symptoms, and any events during delivery is essential for interpretation of the neonatal chest radiographs. Awareness of common chest abnormality in the prematurely born or term babies is also very important for chest evaluation in the newborn. Furthermore, knowledge about complications such as air leaks and bronchopulmonary dysplasia following treatment are required to accurately inform the clinicians. The purpose of this article was to briefly review radiographic findings of chest diseases in newborns that are relatively common in daily practice

Interpretation of neonatal chest radiography

Energy Technology Data Exchange (ETDEWEB)

Yoon, Hye Kyung [Dept. of Radiology, Kangwon National University Hospital, Chuncheon (Korea, Republic of)

2016-05-15

Plain radiographs for infants in the neonatal intensive care unit are obtained using the portable X-ray equipment in order to evaluate the neonatal lungs and also to check the position of the tubes and catheters used for monitoring critically-ill neonates. Neonatal respiratory distress is caused by a variety of medical or surgical disease conditions. Clinical information about the gestational week, respiratory symptoms, and any events during delivery is essential for interpretation of the neonatal chest radiographs. Awareness of common chest abnormality in the prematurely born or term babies is also very important for chest evaluation in the newborn. Furthermore, knowledge about complications such as air leaks and bronchopulmonary dysplasia following treatment are required to accurately inform the clinicians. The purpose of this article was to briefly review radiographic findings of chest diseases in newborns that are relatively common in daily practice.

Regionally adaptive histogram equalization of the chest

International Nuclear Information System (INIS)

Sherrier, R.H.; Johnson, G.A.

1986-01-01

Advances in digital chest radiography have resulted in the acquisition of high-quality digital images of the human chest. With these advances, there arises a genuine need for image processing algorithms, specific to chest images. The author has implemented the technique of histogram equalization, noting the problems encountered when it is adapted to chest images. These problems have been successfully solved with a regionally adaptive histogram equalization method. Histograms are calculated locally and then modified according to both the mean pixel value of a given region and certain characteristics of the cumulative distribution function. The method allows certain regions of the chest radiograph to be enhanced differentially

Radiology in chest trauma

International Nuclear Information System (INIS)

Wenz, W.; Kloehn, I.; Wolfart, W.; Freiburg Univ.

1979-01-01

In chest trauma, a routine chest film, preferably in the lateral as well as the frontal projection, is the basic part of the work-up. Occasionally valuable additional methods are fluoroscopy, tomography, bronchography, contrast studies of the GI Tract and angiography and angiocardiography. In 679 chest trauma patients, traffic accidents and falls were the main reason for the trauma. There were 248 fractures; then - in order of frequency - hemopneumothorax (76), lung contusion (58), subcutaneous emphysema (33) cardiac (16) and vascular trauma (12) and damage to other organs. While 20-30% mistakes are made in diagnosing rib fractures in acute trauma, there is high accuracy in the diagnosis of the other injuries. Many cases are shown to demonstrate the value of diagnostic radiology. (orig.) [de

The impact of chest compression rates on quality of chest compressions - a manikin study.

Science.gov (United States)

Field, Richard A; Soar, Jasmeet; Davies, Robin P; Akhtar, Naheed; Perkins, Gavin D

2012-03-01

Chest compressions are often performed at a variable rate during cardiopulmonary resuscitation (CPR). The effect of compression rate on other chest compression quality variables (compression depth, duty-cycle, leaning, performance decay over time) is unknown. This randomised controlled cross-over manikin study examined the effect of different compression rates on the other chest compression quality variables. Twenty healthcare professionals performed 2 min of continuous compressions on an instrumented manikin at rates of 80, 100, 120, 140 and 160 min(-1) in a random order. An electronic metronome was used to guide compression rate. Compression data were analysed by repeated measures ANOVA and are presented as mean (SD). Non-parametric data was analysed by Friedman test. At faster compression rates there were significant improvements in the number of compressions delivered (160(2) at 80 min(-1) vs. 312(13) compressions at 160 min(-1), P<0.001); and compression duty-cycle (43(6)% at 80 min(-1) vs. 50(7)% at 160 min(-1), P<0.001). This was at the cost of a significant reduction in compression depth (39.5(10)mm at 80 min(-1) vs. 34.5(11)mm at 160 min(-1), P<0.001); and earlier decay in compression quality (median decay point 120 s at 80 min(-1) vs. 40s at 160 min(-1), P<0.001). Additionally not all participants achieved the target rate (100% at 80 min(-1) vs. 70% at 160 min(-1)). Rates above 120 min(-1) had the greatest impact on reducing chest compression quality. For Guidelines 2005 trained rescuers, a chest compression rate of 100-120 min(-1) for 2 min is feasible whilst maintaining adequate chest compression quality in terms of depth, duty-cycle, leaning, and decay in compression performance. Further studies are needed to assess the impact of the Guidelines 2010 recommendation for deeper and faster chest compressions. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Sensitivity analysis of the agricultural policy/environmental extender (APEX) for phosphorus loads in tile-drained landscapes

Science.gov (United States)

Numerical modeling is an economical and feasible approach for quantifying the effects of best management practices on phosphorus (P) loadings from agricultural fields. However, tools that simulate both surface and subsurface P pathways are limited and have not been robustly evaluated in tile-drained...

Use of intubating laryngeal mask airway in a morbidly obese patient with chest trauma in an emergency setting

Directory of Open Access Journals (Sweden)

Tripat Bindra

2011-01-01

Full Text Available A morbidly obese male who sustained blunt trauma chest with bilateral pneumothorax was referred to the intensive care unit for management of his condition. Problems encountered in managing the patient were gradually increasing hypoxemia (chest trauma with multiple rib fractures with lung contusions and difficult mask ventilation and intubation (morbid obesity, heavy jaw, short and thick neck. We performed awake endotracheal intubation using an intubating laryngeal mask airway (ILMA size 4 and provided mechanical ventilation to the patient. This report suggests that ILMA can be very useful in the management of difficult airway outside the operating room and can help in preventing adverse events in an emergency setting.

Rethinking "Brain Drain" in the Era of Globalisation

Science.gov (United States)

Rizvi, Fazal

2005-01-01

This paper discusses a range of issues concerning the idea of "brain drain" within the context of recent thinking on transnational mobility. It argues that the traditional analyses of brain drain are not sufficient, and that we can usefully approach the topic from a postcolonial perspective concerned with issues of identity, national…

Use of chest sonography in acute-care radiology☆

Science.gov (United States)

De Luca, C.; Valentino, M.; Rimondi, M.R.; Branchini, M.; Baleni, M. Casadio; Barozzi, L.

2008-01-01

Diagnosis of acute lung disease is a daily challenge for radiologists working in acute-care areas. It is generally based on the results of chest radiography performed under technically unfavorable conditions. Computed tomography (CT) is undoubtedly more accurate in these cases, but it cannot always be performed on critically ill patients who need continuous care. The use of thoracic ultrasonography (US) has recently been proposed for the study of acute lung disease. It can be carried out rapidly at the bedside and does not require any particularly sophisticated equipment. This report analyzes our experience with chest sonography as a supplement to chest radiography in an Emergency Radiology Unit. We performed chest sonography – as an adjunct to chest radiography – on 168 patients with acute chest pathology. Static and dynamic US signs were analyzed in light of radiographic findings and, when possible, CT. The use of chest US improved the authors' ability to provide confident diagnoses of acute disease of the chest and lungs. PMID:23397048

Unilateral Hemithorax Opacification on Chest Radiograph : Comparison of Diagnostic Accuracy of Chest Ultrasonography with CT

Energy Technology Data Exchange (ETDEWEB)

Namkung, Sook; Lee, Kyung Soo; Kwon, O Jung [Samsung Medical Center, Seoul (Korea, Republic of); Chung, Seung Eun [Sangkye Paek Hospital, Seoul (Korea, Republic of)

1996-12-15

To compare the diagnostic accuracy of chest ultrasonography (US) with computed tomography (CT) inpatients with opacification more than one third of unilateral hemithorax on chest radiograph (CXR). Chest US and CT scans from 41 consecutive patients with opacification more than one third of unilateral hemithorax on CXR were prospectively evaluated by two independent radiologists. Each radiologist recorded 1) the nature of pleural effusion (transudate vs. exudate), 2) presence or absence of pulmonary lesion, 3) the characteristic of pulmonary lesion (consolidation or atelectasis and tumor), and 4) presence of solid pleural tumor. The diagnostic accuracy of chest US was compared with CT scan in patients with pleural, pulmonary or other disease. In 32 patients with pleural effusion, differentiation between transudate and exudate was feasible in 27 (84%) patients with US and 26 (81%) patients with CT. In 32 patients with pulmonary and other pleural diseases, sensitivity, specificity and accuracy of US in lesion detection were 86%, 75% and 83% respectively when CT was regarded as a diagnostic gold standard. The diagnostic accuracy of chest US is comparable to CT in patients with hemithorax opacification on CXR

Unilateral Hemithorax Opacification on Chest Radiograph : Comparison of Diagnostic Accuracy of Chest Ultrasonography with CT

International Nuclear Information System (INIS)

Namkung, Sook; Lee, Kyung Soo; Kwon, O Jung; Chung, Seung Eun

1996-01-01

To compare the diagnostic accuracy of chest ultrasonography (US) with computed tomography (CT) inpatients with opacification more than one third of unilateral hemithorax on chest radiograph (CXR). Chest US and CT scans from 41 consecutive patients with opacification more than one third of unilateral hemithorax on CXR were prospectively evaluated by two independent radiologists. Each radiologist recorded 1) the nature of pleural effusion (transudate vs. exudate), 2) presence or absence of pulmonary lesion, 3) the characteristic of pulmonary lesion (consolidation or atelectasis and tumor), and 4) presence of solid pleural tumor. The diagnostic accuracy of chest US was compared with CT scan in patients with pleural, pulmonary or other disease. In 32 patients with pleural effusion, differentiation between transudate and exudate was feasible in 27 (84%) patients with US and 26 (81%) patients with CT. In 32 patients with pulmonary and other pleural diseases, sensitivity, specificity and accuracy of US in lesion detection were 86%, 75% and 83% respectively when CT was regarded as a diagnostic gold standard. The diagnostic accuracy of chest US is comparable to CT in patients with hemithorax opacification on CXR

Management of Pleural Space After Lung Resection by Cryoneuroablation of Phrenic Nerve: A Randomized Study.

Science.gov (United States)

Pan, Xiao-Jie; Ou, De-Bin; Lin, Xing; Ye, Ming-Fang

2017-06-01

Residual air space problems after pulmonary lobectomy are an important concern in thoracic surgical practice, and various procedures have been applied to manage them. This study describes a novel technique using controllable paralysis of the diaphragm by localized freezing of the phrenic nerve, and assesses the effectiveness of this procedure to reduce air space after pulmonary lobectomy. In this prospective randomized study, 207 patients who underwent lobectomy or bilobectomy and systematic mediastinal node dissection in our department between January 2009 and November 2013 were randomly allocated to a cryoneuroablation group or a conventional group. Patients in the cryoneuroablation group (n = 104) received phrenic nerve cryoneuroablation after lung procedures, and patients in the conventional group (n = 103) did not receive cryoneuroablation after the procedure. Data regarding preoperative clinical and surgical characteristics in both groups were collected. Both groups were compared with regard to postoperative parameters such as total amount of pleural drainage, duration of chest tube placement, length of hospital stay, requirement for repeat chest drain insertion, prolonged air leak, and residual space. Perioperative lung function was also compared in both groups. Recovery of diaphragmatic movement in the cryoneuroablation group was checked by fluoroscopy on the 15th, 30th, and 60th day after surgery. There was no statistically significant difference in patient characteristics between the 2 groups; nor was there a difference in terms of hospital stay, new drain requirement, and incidence of empyema. In comparison with the conventional group, the cryoneuroablation group had less total drainage (1024 ± 562 vs 1520 ± 631 mL, P phrenic nerve offers a reasonable option for prevention of residual air space following major pulmonary resection.

Chest trauma in children, single center experience.

Science.gov (United States)

Ismail, Mohamed Fouad; al-Refaie, Reda Ibrahim

2012-10-01

Trauma is the leading cause of mortality in children over one year of age in industrialized countries. In this retrospective study we reviewed all chest trauma in pediatric patients admitted to Mansoura University Emergency Hospital from January 1997 to January 2007. Our hospital received 472 patients under the age of 18. Male patients were 374 with a mean age of 9.2±4.9 years. Causes were penetrating trauma (2.1%) and blunt trauma (97.9%). The trauma was pedestrian injuries (38.3%), motor vehicle (28.1%), motorcycle crash (19.9%), falling from height (6.7%), animal trauma (2.9%), and sports injury (1.2%). Type of injury was pulmonary contusions (27.1%) and lacerations (6.9%), rib fractures (23.9%), flail chest (2.5%), hemothorax (18%), hemopneumothorax (11.8%), pneumothorax (23.7%), surgical emphysema (6.1%), tracheobronchial injury (5.3%), and diaphragm injury (2.1%). Associated lesions were head injuries (38.9%), bone fractures (33.5%), and abdominal injuries (16.7%). Management was conservative (29.9%), tube thoracostomy (58.1%), and thoracotomy (12.1%). Mortality rate was 7.2% and multiple trauma was the main cause of death (82.3%) (Ptrauma is the most common cause of pediatric chest trauma and often due to pedestrian injuries. Rib fractures and pulmonary contusions are the most frequent injuries. Delay in diagnosis and multiple trauma are associated with high incidence of mortality. Copyright © 2011 SEPAR. Published by Elsevier España, S.L. All rights reserved.

Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-acquired Pneumonia.

Science.gov (United States)

Claessens, Yann-Erick; Debray, Marie-Pierre; Tubach, Florence; Brun, Anne-Laure; Rammaert, Blandine; Hausfater, Pierre; Naccache, Jean-Marc; Ray, Patrick; Choquet, Christophe; Carette, Marie-France; Mayaud, Charles; Leport, Catherine; Duval, Xavier

2015-10-15

Clinical decision making relative to community-acquired pneumonia (CAP) diagnosis is difficult. Chest radiograph is key in establishing parenchymal lung involvement. However, radiologic performance may lead to misdiagnosis, rendering questionable the use of chest computed tomography (CT) scan in patients with clinically suspected CAP. To assess whether early multidetector chest CT scan affects diagnosis and management of patients visiting the emergency department with suspected CAP. A total of 319 prospectively enrolled patients with clinically suspected CAP underwent multidetector chest CT scan within 4 hours. CAP diagnosis probability (definite, probable, possible, or excluded) and therapeutic plans (antibiotic initiation/discontinuation, hospitalization/discharge) were established by emergency physicians before and after CT scan results. The adjudication committee established the final CAP classification on Day 28. Chest radiograph revealed a parenchymal infiltrate in 188 patients. CAP was initially classified as definite in 143 patients (44.8%), probable or possible in 172 (53.8%), and excluded in 4 (1.2%). CT scan revealed a parenchymal infiltrate in 40 (33%) of the patients without infiltrate on chest radiograph and excluded CAP in 56 (29.8%) of the 188 with parenchymal infiltrate on radiograph. CT scan modified classification in 187 (58.6%; 95% confidence interval, 53.2-64.0), leading to 50.8% definite CAP and 28.8% excluded CAP, and 80% of modifications were in accordance with adjudication committee classification. Because of CT scan, antibiotics were initiated in 51 (16%) and discontinued in 29 (9%), and hospitalization was decided in 22 and discharge in 23. In CAP-suspected patients visiting the emergency unit, early CT scan findings complementary to chest radiograph markedly affect both diagnosis and clinical management. Clinical trial registered with www.clinicaltrials.gov (NCT 01574066).

Management of non-traumatic chest pain by the French Emergency Medical System: Insights from the DOLORES registry.

Science.gov (United States)

Manzo-Silberman, Stéphane; Assez, Nathalie; Vivien, Benoît; Tazarourte, Karim; Mokni, Tarak; Bounes, Vincent; Greffet, Agnès; Bataille, Vincent; Mulak, Geneviève; Goldstein, Patrick; Ducassé, Jean Louis; Spaulding, Christian; Charpentier, Sandrine

2015-03-01

The early recognition of acute coronary syndromes is a priority in health care systems, to reduce revascularization delays. In France, patients are encouraged to call emergency numbers (15, 112), which are routed to a Medical Dispatch Centre where physicians conduct an interview and decide on the appropriate response. However, the effectiveness of this system has not yet been assessed. To describe and analyse the response of emergency physicians receiving calls for chest pain in the French Emergency Medical System. From 16 November to 13 December 2009, calls to the Medical Dispatch Centre for non-traumatic chest pain were included prospectively in a multicentre observational study. Clinical characteristics and triage decisions were collected. A total of 1647 patients were included in the study. An interview was conducted with the patient in only 30.5% of cases, and with relatives, bystanders or physicians in the other cases. A Mobile Intensive Care Unit was dispatched to 854 patients (51.9%) presenting with typical angina chest pains and a high risk of cardiovascular disease. Paramedics were sent to 516 patients (31.3%) and a general practitioner was sent to 169 patients (10.3%). Patients were given medical advice only by telephone in 108 cases (6.6%). Emergency physicians in the Medical Dispatch Centre sent an effecter to the majority of patients who called the Emergency Medical System for chest pain. The response level was based on the characteristics of the chest pain and the patient's risk profile. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

FROM BRAIN DRAIN TO BRAIN NETWORKING

Directory of Open Access Journals (Sweden)

Irina BONCEA

2015-06-01

Full Text Available Scientific networking is the most accessible way a country can turn the brain drain into brain gain. Diaspora’s members offer valuable information, advice or financial support from the destination country, without being necessary to return. This article aims to investigate Romania’s potential of turning brain drain into brain networking, using evidence from the medical sector. The main factors influencing the collaboration with the country of origin are investigated. The conclusions suggest that Romania could benefit from the diaspora option, through an active implication at institutional level and the implementation of a strategy in this area.

Investigation of the dosimetry of chest tomosynthesis

Science.gov (United States)

Svalkvist, Angelica; Zachrisson, Sara; Månsson, Lars Gunnar; Båth, Magnus

2009-02-01

Chest tomosynthesis has recently been introduced to healthcare as a low-dose alternative to CT or as a tool for improved diagnostics in chest radiography with only a modest increase in radiation dose to the patient. However, no detailed description of the dosimetry for this type of examination has been presented. The aim of this work was therefore to investigate the dosimetry of chest tomosynthesis. The chest tomosynthesis examination was assumed to be performed using a stationary detector and a vertically moving x-ray tube, exposing the patient from different angles. The Monte Carlo based computer software PCXMC was used to determine the effective dose delivered to a standard-sized patient from various angles using different assumptions of the distribution of the effective dose over the different projections. The obtained conversion factors between input dose measures and effective dose for chest tomosynthesis for different angular intervals were then compared with the horizontal projection. The results indicate that the error introduced by using conversion factors for the PA projection in chest radiography for estimating the effective dose of chest tomosynthesis is small for normally sized patients, especially if a conversion factor between KAP and effective dose is used.

Carbon accumulation in pristine and drained mires

Energy Technology Data Exchange (ETDEWEB)

Maekilae, M.

2011-07-01

The carbon accumulation of 73 peat columns from 48 pristine and drained mires was investigated using a total of 367 dates and age-depth models derived from bulk density measurements. Peat columns were collected from mires of varying depth, age, degree of natural state and nutrient conditions in aapa mire and raised bog regions and coastal mires from southern and central Finland and Russian Karelia. Particular attention was paid to the accumulation of carbon over the last 300 years, as this period encompasses the best estimates of the oxic layer (acrotelm) age across the range of sites investigated. In general, drained mires are initially more nutrient-rich than pristine mires. Organic matter decomposes more rapidly at drained sites than at pristine sites, resulting in thinner peat layers and carbon accumulation but a higher dry bulk density and carbon content. The average carbon accumulation was calculated as 24.0 g m-2 yr-1 at pristine sites and 19.4 g m-2 yr-1 at drained sites, while for peat layers younger than 300 years the respective figures were 45.3 and 34.5 g m-2 yr-1 at pristine and drained sites. For the <300-year-old peat layers studied here, the average thickness was 19 cm less and the carbon accumulation rate 10.8 g m-2 yr-1 lower in drained areas than in pristine areas. The amount carbon accumulation of surface peat layers depends upon the mire site type, vegetation and natural state; variations reflect differences in plant communities as well as factors that affect biomass production and decay rates. The highest accumulation rates and thus carbon binding for layers younger than 300 years were measured in the ombrotrophic mire site types (Sphagnum fuscum bog and Sphagnum fuscum pine bog), and the second highest rates in wet, treeless oligotrophic and minerotrophic mire site types. The lowest values of carbon accumulation over the last 300 years were obtained for the most transformed, sparsely forested and forested mire site types, where the water

Management of spontaneous pneumothorax compared to British Thoracic Society (BTS) 2003 guidelines: a district general hospital audit.

Science.gov (United States)

Medford, Andrew Rl; Pepperell, Justin Ct

2007-10-01

In 1993, the British Thoracic Society (BTS) issued guidelines for the management of spontaneous pneumothorax (SP). These were refined in 2003. To determine adherence to the 2003 BTS SP guidelines in a district general hospital. An initial retrospective audit of 52 episodes of acute SP was performed. Subsequent intervention involved a junior doctor educational update on both the 2003 BTS guidelines and the initial audit results, and the setting up of an online guideline hyperlink. After the educational intervention a further prospective re-audit of 28 SP episodes was performed. Management of SP deviated considerably from the 2003 BTS guidelines in the initial audit - deviation rate 26.9%. After the intervention, a number of clinical management deviations persisted (32.1% deviation rate); these included failure to insert a chest drain despite unsuccessful aspiration, and attempting aspiration of symptomatic secondary SPs. Specific tools to improve standards might include a pneumothorax proforma to improve record keeping and a pneumothorax care pathway to reduce management deviations compared to BTS guidelines. Successful change also requires identification of the total target audience for any educational intervention.

Computed tomography of chest wall abscess

International Nuclear Information System (INIS)

Ikezoe, Junpei; Morimoto, Shizuo; Akira, Masanori

1986-01-01

Inflammatory lesions of the chest wall become less common because of the improvement of antibiotics and chemotherapeutic agents. Over a 5-year period, 7 patients with chest wall inflammatory diseases underwent chest computed tomography. These were 2 tuberculous pericostal abscesses, 2 empyema necessitatis, 1 spinal caries, and 2 bacterial chest wall abscesses (unknown organisms). Computed tomography (CT) helped in demonstrating the density, border, site, and extent of the lesions. CT images also demonstrated the accompaning abnormalities which included bone changes, pleural calcification, or old tuberculous changes of the lung. CT was very effective to demonstrate the communicating portions from the inside of the bony thorax to the outside of the bony thorax in 2 empyema necessitatis. (author)

Method of draining water through a solid waste site without leaching

Science.gov (United States)

Treat, Russell L.; Gee, Glendon W.; Whyatt, Greg A.

1993-01-01

The present invention is a method of preventing water from leaching solid waste sites by preventing atmospheric precipitation from contacting waste as the water flows through a solid waste site. The method comprises placing at least one drain hole through the solid waste site. The drain hole is seated to prevent waste material from entering the drain hole, and the solid waste site cover material is layered and graded to direct water to flow toward the drain hole and to soil beneath the waste site.

46 CFR 196.37-47 - Portable magazine chests.

Science.gov (United States)

2010-10-01

... 46 Shipping 7 2010-10-01 2010-10-01 false Portable magazine chests. 196.37-47 Section 196.37-47... Markings for Fire and Emergency Equipment, etc. § 196.37-47 Portable magazine chests. (a) Portable magazine chests shall be marked in letters at least 3 inches high: PORTABLE MAGAZINE CHEST — FLAMMABLE — KEEP...

Cash's textbook of chest, heart and vascular disorders for physiotherapists

International Nuclear Information System (INIS)

Downie, P.A.; Innocenti, D.M.; Jackson, S.E.

1987-01-01

A very high proportion of the patients treated by physiotherapy will have had a chest radiograph (x-ray) either because their primary disease is pulmonary or there is some long standing heart or lung illness which should be taken into account during the management of an acute problem. This chapter outlines the principles involved in reading the radiograph

The single chest tube versus double chest tube application after pulmonary lobectomy: A systematic review and meta-analysis

Directory of Open Access Journals (Sweden)

Xuefei Zhang

2016-01-01

Conclusion: Compared with the double chest tube, the single chest tube significantly decreases amount of drainage, duration of chest tube drainage, pain score, the number of patients who need thoracentesis, and cost. Although there is convincing evidence to confirm the results mentioned herein, they still need to be confirmed by large-sample, multicenter, randomized, controlled trials.

Pulmonary disease in cystic fibrosis: assessment with chest CT at chest radiography dose levels.

Science.gov (United States)

Ernst, Caroline W; Basten, Ines A; Ilsen, Bart; Buls, Nico; Van Gompel, Gert; De Wachter, Elke; Nieboer, Koenraad H; Verhelle, Filip; Malfroot, Anne; Coomans, Danny; De Maeseneer, Michel; de Mey, Johan

2014-11-01

To investigate a computed tomographic (CT) protocol with iterative reconstruction at conventional radiography dose levels for the assessment of structural lung abnormalities in patients with cystic fibrosis ( CF cystic fibrosis ). In this institutional review board-approved study, 38 patients with CF cystic fibrosis (age range, 6-58 years; 21 patients 18 years) underwent investigative CT (at minimal exposure settings combined with iterative reconstruction) as a replacement of yearly follow-up posteroanterior chest radiography. Verbal informed consent was obtained from all patients or their parents. CT images were randomized and rated independently by two radiologists with use of the Bhalla scoring system. In addition, mosaic perfusion was evaluated. As reference, the previous available conventional chest CT scan was used. Differences in Bhalla scores were assessed with the χ(2) test and intraclass correlation coefficients ( ICC intraclass correlation coefficient s). Radiation doses for CT and radiography were assessed for adults (>18 years) and children (chest CT protocol can replace the two yearly follow-up chest radiographic examinations without major dose penalty and with similar diagnostic quality compared with conventional CT.

Guidelines of the French Speaking Society for Chest Medicine for management of malignant pleural mesothelioma.

Science.gov (United States)

Scherpereel, Arnaud

2007-06-01

Previously considered as a rare tumor, malignant pleural mesothelioma (MPM) has become a very important public health issue. In fact, MPM is a tumor with a poor survival, and its incidence is expected to continue to increase for at least the next 10 years. Asbestos exposure is the main factor involved in MPM pathogenesis. The diagnosis of MPM may be difficult because of differential diagnosis such as pleural benign disease induced by asbestos exposure or pleural metastasis of adenocarcinoma. Management of patients with MPM also remains complicated because they are often referred for evaluation late in the evolution of the disease. Moreover, MPM exhibits a high resistance to radiotherapy and chemotherapy; only few patients are candidates for radical surgery. New therapeutic strategies such as gene or cell therapy are still on clinical trial. Therefore, an optimal treatment of MPM is not clearly defined yet, despite the introduction of recent drugs. Between April 2005 and January 2006, the French Speaking Society for Chest Medicine (SPLF), in collaboration with other French scientific societies, brought together experts on mesothelioma to draw up recommendations in order to provide clinicians with clear, concise, up-to-date guidelines on management of MPM, presented in this report.

Inverse problem in anisotropic poroelasticity: drained constants from undrained ultrasound measurements.

Science.gov (United States)

Berryman, James G; Nakagawa, Seiji

2010-02-01

Poroelastic analysis has traditionally focused on the relationship between dry and drained constants, which are assumed known, and the saturated or undrained constants, which are assumed unknown. However, there are many applications in this field of study for which the main measurements can only be made on the saturated/undrained system, and then it is uncertain what the effects of the fluids were on the system, since the drained constants remain a mystery. The work presented here shows how to deduce drained constants from undrained constants for anisotropic systems having symmetries ranging from isotropic to orthotropic. Laboratory ultrasound data are then inverted for the drained constants in three granular packings: one of glass beads, and two others for distinct types of more or less angular sand grain packings. Experiments were performed under uniaxial stress, which resulted in hexagonal (transversely isotropic) symmetry of the poroelastic response. One important conclusion from the general analysis is that the drained constants are uniquely related to the undrained constants, assuming that porosity, grain bulk modulus, and pore fluid bulk modulus are already known. Since the resulting system of equations for all the drained constants is linear, measurement error in undrained constants also propagates linearly into the computed drained constants.

Inverse problem in anisotropic poroelasticity: Drained constants from undrained ultrasound measurements

Energy Technology Data Exchange (ETDEWEB)

Berryman, J.G.; Nakagawa, S.

2009-11-20

Poroelastic analysis has traditionally focused on the relationship between dry or drained constants which are assumed known and the saturated or undrained constants which are assumed unknown. However, there are many applications in this field of study for which the main measurements can only be made on the saturated/undrained system, and then it is uncertain what the eects of the uids were on the system, since the drained constants remain a mystery. The work presented here shows how to deduce drained constants from undrained constants for anisotropic systems having symmetries ranging from isotropic to orthotropic. Laboratory ultrasound data are then inverted for the drained constants in three granular packings: one of glass beads, and two others for distinct types of more or less angular sand grain packings. Experiments were performed under uniaxial stress, which resulted in hexagonal (transversely isotropic) symmetry of the poroelastic response. One important conclusion from the general analysis is that the drained constants are uniquely related to the undrained constants, assuming that porosity, grain bulk modulus, and pore uid bulk modulus are already known. Since the resulting system of equations for all the drained constants is linear, measurement error in undrained constants also propagates linearly into the computed drained constants.

Detecting peatland drains with Object Based Image Analysis and Geoeye-1 imagery.

Science.gov (United States)

Connolly, J; Holden, N M

2017-12-01

Peatlands play an important role in the global carbon cycle. They provide important ecosystem services including carbon sequestration and storage. Drainage disturbs peatland ecosystem services. Mapping drains is difficult and expensive and their spatial extent is, in many cases, unknown. An object based image analysis (OBIA) was performed on a very high resolution satellite image (Geoeye-1) to extract information about drain location and extent on a blanket peatland in Ireland. Two accuracy assessment methods: Error matrix and the completeness, correctness and quality (CCQ) were used to assess the extracted data across the peatland and at several sub sites. The cost of the OBIA method was compared with manual digitisation and field survey. The drain maps were also used to assess the costs relating to blocking drains vs. a business-as-usual scenario and estimating the impact of each on carbon fluxes at the study site. The OBIA method performed well at almost all sites. Almost 500 km of drains were detected within the peatland. In the error matrix method, overall accuracy (OA) of detecting the drains was 94% and the kappa statistic was 0.66. The OA for all sub-areas, except one, was 95-97%. The CCQ was 85%, 85% and 71% respectively. The OBIA method was the most cost effective way to map peatland drains and was at least 55% cheaper than either field survey or manual digitisation, respectively. The extracted drain maps were used constrain the study area CO 2 flux which was 19% smaller than the prescribed Peatland Code value for drained peatlands. The OBIA method used in this study showed that it is possible to accurately extract maps of fine scale peatland drains over large areas in a cost effective manner. The development of methods to map the spatial extent of drains is important as they play a critical role in peatland carbon dynamics. The objective of this study was to extract data on the spatial extent of drains on a blanket bog in the west of Ireland. The

Detecting peatland drains with Object Based Image Analysis and Geoeye-1 imagery

Directory of Open Access Journals (Sweden)

J. Connolly

2017-03-01

Full Text Available Abstract Background Peatlands play an important role in the global carbon cycle. They provide important ecosystem services including carbon sequestration and storage. Drainage disturbs peatland ecosystem services. Mapping drains is difficult and expensive and their spatial extent is, in many cases, unknown. An object based image analysis (OBIA was performed on a very high resolution satellite image (Geoeye-1 to extract information about drain location and extent on a blanket peatland in Ireland. Two accuracy assessment methods: Error matrix and the completeness, correctness and quality (CCQ were used to assess the extracted data across the peatland and at several sub sites. The cost of the OBIA method was compared with manual digitisation and field survey. The drain maps were also used to assess the costs relating to blocking drains vs. a business-as-usual scenario and estimating the impact of each on carbon fluxes at the study site. Results The OBIA method performed well at almost all sites. Almost 500 km of drains were detected within the peatland. In the error matrix method, overall accuracy (OA of detecting the drains was 94% and the kappa statistic was 0.66. The OA for all sub-areas, except one, was 95–97%. The CCQ was 85%, 85% and 71% respectively. The OBIA method was the most cost effective way to map peatland drains and was at least 55% cheaper than either field survey or manual digitisation, respectively. The extracted drain maps were used constrain the study area CO2 flux which was 19% smaller than the prescribed Peatland Code value for drained peatlands. Conclusions The OBIA method used in this study showed that it is possible to accurately extract maps of fine scale peatland drains over large areas in a cost effective manner. The development of methods to map the spatial extent of drains is important as they play a critical role in peatland carbon dynamics. The objective of this study was to extract data on the spatial extent of

Traumatic chest injury in children: A single thoracic surgeon′s experience in two Nigerian tertiary hospitals

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Kelechi Emmanuel Okonta

2015-01-01

Full Text Available Background: This study was to determine the extent and outcome of childhood chest injury in Nigeria, and to compare results with that of other literatures. Patients and Methods: A Prospective study of all children under 18 years of age with chest trauma in two tertiary hospitals in Southern Nigeria from January 2012 to December 2014 was reviewed. The aetiology, type, associated injury, mechanism, treatment and outcome were evaluated. The patients were followed up in the clinic. The data were analysed using SPSS version 20.0 with a significant P 12-h versus 2 who presented <12-h and 6 of children between 0 and 9 years versus 3 at 10-18 years of age had empyema thoracis (P value not significant. One death was recorded. Conclusion: Chest trauma in children is still not common, and blunt chest injury from falls and automobile accidents are more common than penetrating chest injury. Treatment with tube thoracostomy is the major management modality with empyema thoracis as the most common complication.

46 CFR 108.651 - Portable magazine chests.

Science.gov (United States)

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Portable magazine chests. 108.651 Section 108.651... AND EQUIPMENT Equipment Markings and Instructions § 108.651 Portable magazine chests. Each portable magazine chest must be marked: “PORTABLE MAGAZINE CHEST—FLAMMABLE—KEEP LIGHTS AND FIRE AWAY” in letters at...

Controlling the ambipolarity and improvement of RF performance using Gaussian Drain Doped TFET

Science.gov (United States)

Nigam, Kaushal; Gupta, Sarthak; Pandey, Sunil; Kondekar, P. N.; Sharma, Dheeraj

2018-05-01

Ambipolar conduction in tunnel field-effect transistors (TFETs) has been occurred as an inherent issue due to drain-channel tunneling. It makes TFET less efficient and restricts its application in complementary digital circuits. Therefore, this manuscript reports the application of Gaussian doping profile on nanometer regime silicon channel TFETs to completely eliminate the ambipolarity. For this, Gaussian doping is used in the drain region of conventional gate-drain overlap TFET to control the tunneling of electrons from the valence band of channel to the conduction band of drain. As a result, barrier width at the drain/channel junction increases significantly leading to the suppression of an ambipolar current even when higher doping concentration (1 ? 10 ? cm ?) is considered in the drain region. However, significant improvement in terms of RF figure-of-merits such as cut-off frequency (f ?), gain bandwidth product (GBW), and gate-to-drain capacitance (C ?) is achieved with Gaussian doped gate on drain overlap TFET as compared to its counterpart TFET.

MEDICAL BRAIN DRAIN - A THEORETICAL APPROACH

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Boncea Irina

2013-07-01

Full Text Available Medical brain drain is defined as the migration of health personnel from developing countries to developed countries and between industrialized nations in search for better opportunities. This phenomenon became a global growing concern due to its impact on both the donor and the destination countries. This article aims to present the main theoretical contributions starting from 1950 until today and the historical evolution, in the attempt of correlating the particular case of medical brain drain with the theory and evolution of the brain drain in general. This article raises questions and offers answers, identifies the main issues and looks for possible solutions in order to reduce the emigration of medical doctors. Factors of influence include push (low level of income, poor working conditions, the absence of job openings and social recognition, oppressive political climate and pull (better remuneration and working conditions, prospects for career development, job satisfaction, security factors. Developing countries are confronting with the loss of their most valuable intellectuals and the investment in their education, at the benefit of developed nations. An ethical debate arises as the disparities between countries increases, industrialized nations filling in the gaps in health systems with professionals from countries already facing shortages. However, recent literature emphasizes the possibility of a “beneficial brain drain” through education incentives offered by the emigration prospects. Other sources of “brain gain” for donor country are the remittances, the scientific networks and return migration. Measures to stem the medical brain drain involve the common effort and collaboration between developing and developed countries and international organizations. Measures adopted by donor countries include higher salaries, better working conditions, security, career opportunities, incentives to stimulate return migration. Destination

Potential of ultrasound in the pediatric chest

Energy Technology Data Exchange (ETDEWEB)

Trinavarat, Panruethai, E-mail: pantrinavarat@hotmail.com [Department of Radiology, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330 (Thailand); Riccabona, Michael, E-mail: michael.riccabona@klinikum-graz.at [Department of Radiology, Division of Pediatric Radiology, University Hospital Graz (Austria)

2014-09-15

Ultrasound (US) of chest, even with inherent limitations of the US beam and air, has been useful in many pediatric chest conditions. It has extended its role and is now widely used by many subspecialists in medicine. This review article will cover techniques, indications, and applications of chest US in neonates, infants and children, including also different common as well as some rare and modern aspects and applications, such as pleural effusion, pneumothorax, pulmonary lesions, mediastinum, diaphragm, and chest wall. Other related imaging modalities are also briefly discussed.

Chest pain in focal musculoskeletal disorders

DEFF Research Database (Denmark)

Stochkendahl, Mette Jensen; Christensen, Henrik Wulff

2010-01-01

overlapping conditions and syndromes of focal disorders, including Tietze syndrome, costochondritis, chest wall syndrome, muscle tenderness, slipping rib, cervical angina, and segmental dysfunction of the cervical and thoracic spine, have been reported to cause pain. For most of these syndromes, evidence......The musculoskeletal system is a recognized source of chest pain. However, despite the apparently benign origin, patients with musculoskeletal chest pain remain under-diagnosed, untreated, and potentially continuously disabled in terms of anxiety, depression, and activities of daily living. Several...... arises mainly from case stories and empiric knowledge. For segmental dysfunction, clinical features of musculoskeletal chest pain have been characterized in a few clinical trials. This article summarizes the most commonly encountered syndromes of focal musculoskeletal disorders in clinical practice....

Brain drain: Propulsive factors and consequences

Directory of Open Access Journals (Sweden)

Dragan ILIC

2018-01-01

Full Text Available When speaking about the total number of highly educated individuals’ migration, it is easy to spot that it is rapidly increasing. The brain drain issues should be taken very seriously especially in under developed and in the developing countries, knowing that the human capital is globally mobile and that highly educated individuals can without any issues market their knowledge around the globe. Dealing with it requires a carefully tailored strategy for these countries, which are suffering from severe human capital losses on annual basis. Since the labor markets of today are highly competitive, it is necessary for these countries to secure good advancement and doing business opportunities. The purpose of this research is to provide an insight into the key propulsive factors and potential consequences caused by the brain drain. The method used in order to conduct the research was a carefully designed questionnaire taken by the date subject enrolled at the third and fourth years of state governed and privately owned universities. This research shows that one of the key reasons for brain drain in underdeveloped and in the developing countries is shortage of further educational advancement opportunities.

CT of blunt chest trauma in children

International Nuclear Information System (INIS)

Manson, D.; Babyn, P.S.; Palder, S.; Bergmann, K.

1993-01-01

While trauma is still the leading cause of death in the pediatric age range, it is surprising how little the CT appearances of pediatric chest injury have been investigated in the literature. We have reviewed the CT findings of blunt chest trauma in 44 children for whom chest CT examinations were requested to investigate the extent of intrathoracic injury. We noted a propensity for pulmonary contusions to be located posteriorly or posteromedially, and for them to be anatomically nonsegmental and crescentic in shape. This is possibly attributable to the relatively compliant anterior chest wall in children. The CT appearances of other major thoracic injuries are described, including pulmonary lacerations, pneumothoraces, malpositioned chest tubes, mediastinal hematomas, aortic injury, tracheobronchial injury, hemopericardium, and spinal injuries with paraspinal fluid collections. Children demonstrating findings incidental to the actual injury yet important to the subsequent therapy are also presented. We conclude that, in the event of clinically significant blunt chest trauma, the single supine chest examination in the trauma room is insufficient to adequately identify the extent of intrathoracic injury. With the exception of concern for aortic injury for which aortography is indicated, a dynamically enhanced CT scan of the thorax should be performed as clinically significant findings may result in altered therapy. (orig.)

A study on the digital image transfer application mass chest X-ray system up-grade

International Nuclear Information System (INIS)

Kim, Sun Chil; Park, Jong Sam; Lee, Jon Il

2003-01-01

By converting movable indirect mass chest X-ray devices for vehicles into digital systems and upgrading it to share information with the hospital's medical image information system, excellencies have been confirmed as a result of installing and running this type of system and are listed hereinafter. Upgrading analog systems, such as indirect mass chest X-ray devices dependent on printed film, to digital systems allows them to be run and managed much more efficiently, contributing to the increase in the stability and the efficiency of the system. Unlike existing images, communication based on DICOM standards allow images to be compatible with the hospital's outer and inner network PACS systems, extending the scope of the radiation departments information system. Assuming chest-exclusive indirect mass chest X-rays, a linked development of CAD (Computer Aided Diagnosis, Detector) becomes possible. By applying wireless Internet, Web-PACS for movable indirect mass chest X-ray devices for vehicles will become possible. Research in these fields must continue and if the superior image quality and convenience of digital systems are confirmed, I believe that the conversion of systems still dependent on analog images to modernized digital systems is a must

Drain Tube-Induced Jejunal Penetration Masquerading as Bile Leak following Whipple's Operation.

Science.gov (United States)

Bae, Sang Ho; Lee, Tae Hoon; Lee, Sae Hwan; Lee, Suck-Ho; Park, Sang-Heum; Kim, Sun-Joo; Kim, Chang Ho

2011-05-01

A 70-year-old man had undergone pancreaticoduodenectomy due to a distal common bile duct malignancy. After the operation, serous fluid discharge decreased from two drain tubes in the retroperitoneum. Over four weeks, the appearance of the serous fluid changed to a greenish bile color and the patient persistently drained over 300 ml/day. Viewed as bile leak at the choledochojejunostomy, treatment called for endoscopic diagnosis and therapy. Cap-fitted forward-viewing endoscopy demonstrated that the distal tip of a pancreatic drain catheter inserted at the pancreaticojejunostomy site had penetrated the opposite jejunum wall. One of the drain tubes primarily placed in the retroperitoneum had also penetrated the jejunum wall, with the distal tip positioned near the choledochojejunostomy site. No leak of contrast appeared beyond the jejunum or anastomosis site. Following repositioning of a penetrating catheter of the pancreaticojejunostomy, four days later, the patient underwent removal of two drain tubes without additional complications. In conclusion, the distal tip of the catheter, placed to drain pancreatic juice, penetrated the jejunum wall and may have caused localized perijejunal inflammation. The other drain tube, placed in the retroperitoneal space, might then have penetrated the inflamed wall of the jejunum, allowing persistent bile drainage via the drain tube. The results masqueraded as bile leakage following pancreaticoduodenectomy.

Potential Benefits of Rib Fracture Fixation in Patients with Flail Chest and Multiple Non-flail Rib Fractures.

Science.gov (United States)

Qiu, Meiguang; Shi, Zhanjun; Xiao, Jun; Zhang, Xuming; Ling, Shishui; Ling, Hao

2016-12-01

The purpose of this study is to evaluate the potential benefits of rib fracture fixation in patients with flail chest and multiple non-flail rib fractures versus conventional treatment modalities. A retrospective reviewed study compared 86 cases which received surgical treatment between June 2009 and May 2013 to 76 cases which received conservative treatment between January 2006 and May 2009. The patients were divided into the flail chest ( n  = 38) and multiple non-flail rib fracture groups ( n  = 124). In the flail chest group, the mechanical ventilation time, ICU monitoring time, tracheostomies, thoracic deformity, and impaired pulmonary function and return to full-time employment were compared. In the multiple non-flail rib fracture group, fracture healing, visual analog scale (VAS) pain score, inpatient length of stay, atelectatic, pulmonary complications, and normal activity-returning time were compared. Patients in the flail chest operative fixation group had significantly shorter ICU stay, decreased ventilator requirements, fewer tracheostomies, less thoracic deformity and impaired pulmonary function, and more returned to full-time employment. Patients in the multiple non-flail rib fracture operative fixation had shorter hospital stay, less pain, earlier return to normal activity, more fracture healing, less atelectasis, and fewer pulmonary infections. This study demonstrates the potential benefits of surgical stabilization of flail chest and multiple non-flail rib fractures with plate fixation. When compared with conventional conservative management, operatively managed patients demonstrated improved clinical outcomes.

Chest CT in children: anesthesia and atelectasis

Energy Technology Data Exchange (ETDEWEB)

Newman, Beverley; Gawande, Rakhee [Lucile Packard Children' s Hospital, Department of Radiology, Stanford, CA (United States); Krane, Elliot J. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford, CA (United States); Holmes, Tyson H. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Psychiatry and Behavioral Sciences, Stanford, CA (United States); Robinson, Terry E. [Stanford University School of Medicine, Lucile Packard Children' s Hospital, Department of Pulmonary Medicine and Cystic Fibrosis Center for Excellence in Pulmonary Biology, Stanford, CA (United States)

2014-02-15

There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

Chest CT in children: anesthesia and atelectasis

International Nuclear Information System (INIS)

Newman, Beverley; Gawande, Rakhee; Krane, Elliot J.; Holmes, Tyson H.; Robinson, Terry E.

2014-01-01

There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain

Dual-source CT in chest pain diagnosis

International Nuclear Information System (INIS)

Johnson, Thorsten R.C.; Nikolaou, K.; Fink, C.; Rist, C.; Reiser, M.F.; Becker, C.R.; Becker, A.; Knez, A.

2007-01-01

With the depiction of pulmonary arteries, coronary arteries, and the aorta, CT angiography of the chest offers a comprehensive diagnostic work-up of unclear chest pain. The aim of this study was to assess the diagnostic accuracy of dual-source CT in this patient group. A total of 47 patients suffering from unclear chest pain were examined with a Siemens Somatom Definition. Volume and flow of contrast media (Ultravist, Schering) were adapted to the body weight. The examinations were evaluated with regard to image quality and contrast opacification and to the diagnostic accuracy with reference to the final clinical diagnosis. Adequate contrast opacification was achieved in all examinations. The depiction of the coronary arteries was diagnostic in all cases. The cause of chest pain could be identified in 41 cases. Among the diagnoses were coronary and myocardial pathologies, valvular disease, aortic aneurysms and dissections, pulmonary embolism, and pneumonic consolidation. DSCT angiography of the chest offers a very good image quality even at high heart rates so that a high diagnostic accuracy is achieved in patients with acute chest pain. (orig.) [de

A Novel Device for Accurate Chest Tube Insertion

DEFF Research Database (Denmark)

Katballe, Niels; Moeller, Lars B; Olesen, Winnie H

2016-01-01

BACKGROUND: Optimal positioning of a large-bore chest tube is in the part of the pleural cavity that needs drainage. It is recommended that the chest tube be positioned apically in pneumothorax and basally for fluids. However, targeted chest tube positioning to a specific part of the pleural cavity...... can be a challenge. METHODS: A new medical device, the KatGuide, was developed for accurate guiding of a chest tube (28F) to an intended part of the pleural cavity. The primary end point of this randomized, controlled trial was optimal position of the chest tube. The optimal position in pneumothorax...

Reexpansion pulmonary edema after chest drainage for pneumothorax: A case report and literature overview

Directory of Open Access Journals (Sweden)

M. Verhagen

2015-01-01

Conclusion: RPE is characterized by rapidly progressive respiratory failure and tachycardia after intercostal chest drainage. Early recognition of signs and symptoms of RPE is important to initiate early management and allow for a favorable outcome.

Chest computed tomography in children undergoing extra-corporeal membrane oxygenation: a 9-year single-centre experience

Energy Technology Data Exchange (ETDEWEB)

Goodwin, Susie J.; Calder, Alistair D. [Great Ormond Street Hospital for Children NHS Foundation Trust, Radiology Department, London (United Kingdom); Randle, Elise; Iguchi, Akane; Brown, Katherine; Hoskote, Aparna [Great Ormond Street Hospital for Children NHS Foundation Trust, Cardiac Intensive Care and ECMO, London (United Kingdom)

2014-06-15

We retrospectively reviewed the imaging findings, indications, technique and clinical impact in children who had undergone chest CT while undergoing extra-corporeal membrane oxygenation (ECMO). Radiology and ECMO databases were searched to identify all 19 children who had undergone chest CT (20 scans in total) while on ECMO at our institution between May 2003 and May 2012. We reviewed all CT scans for imaging findings. Chest CT is performed in a minority of children on ECMO (4.5% in our series). Timing of chest CT following commencement of ECMO varied among patient groups but generally it was performed earlier in the neonatal group. Clinically significant imaging findings were found in the majority of chest CT scans. Many scans contained several findings, with most cases demonstrating parenchymal or pleural abnormalities. Case examples illustrate the spectrum of imaging findings, including underlying pathology such as necrotising pneumonia and severe barotrauma, and ECMO-related complications such as tension haemothoraces and cannula migration. The results of chest CT led to a change in patient management in 16 of 19 children (84%). There were no adverse events related to patient transfer. An understanding of scan technique and awareness of potential findings is important for the radiologist to provide prompt and optimal image acquisition and interpretation in appropriate patients. (orig.)

Spatial variation in herbicide leaching from a marine clay soil via subsurface drains

Science.gov (United States)

Ulén, Barbro M; Larsbo, Mats; Kreuger, Jenny K; Svanbäck, Annika

2013-01-01

Background Subsurface transport via tile drains can significantly contribute to pesticide contamination of surface waters. The spatial variation in subsurface leaching of normally applied herbicides was examined together with phosphorus losses in 24 experimental plots with water sampled flow-proportionally. The study site was a flat, tile-drained area with 60% marine clay in the topsoil in southeast Sweden. The objectives were to quantify the leaching of frequently used herbicides from a tile drained cracking clay soil and to evaluate the variation in leaching within the experimental area and relate this to topsoil management practices (tillage method and structure liming). Results In summer 2009, 0.14, 0.22 and 1.62%, respectively, of simultaneously applied amounts of MCPA, fluroxypyr and clopyralid were leached by heavy rain five days after spraying. In summer 2011, on average 0.70% of applied bentazone was leached by short bursts of intensive rain 12 days after application. Peak flow concentrations for 50% of the treated area for MCPA and 33% for bentazone exceeded the Swedish no-effect guideline values for aquatic ecosystems. Approximately 0.08% of the glyphosate applied was leached in dissolved form in the winters of 2008/2009 and 2010/2011. Based on measurements of glyphosate in particulate form, total glyphosate losses were twice as high (0.16%) in the second winter. The spatial inter-plot variation was large (72–115%) for all five herbicides studied, despite small variations (25%) in water discharge. Conclusions The study shows the importance of local scale soil transport properties for herbicide leaching in cracking clay soils. © 2013 The Authors. Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry. PMID:23658148

Ultrasound estimation of volume of postoperative pleural effusion in cardiac surgery patients.

Science.gov (United States)

Usta, Engin; Mustafi, Migdat; Ziemer, Gerhard

2010-02-01

The aim of this study was to establish a practical simplified formula to facilitate the management of a frequently occurring postoperative complication, pleural effusion. Chest ultrasonography with better sensitivity and reliability in the diagnosis of pleural effusions than chest X-ray can be repeated serially at the bedside without any radiation risk. One hundred and fifty patients after cardiac surgery with basal pleural opacity on chest X-ray have been included in our prospective observational study during a two-year period. Effusion was confirmed on postoperative day (POD) 5.9+/-3.2 per chest ultrasound sonography. Inclusion criteria for subsequent thoracentesis based on clinical grounds alone and were not protocol-driven. Major inclusion criteria were: dyspnea and peripheral oxygen saturation (SpO(2)) levels or = 30 mm). One hundred and thirty-five patients (90%) were drained with a 14-G needle if according to the simplified formula: V (ml)=[16 x D (mm)] the volume of the pleural effusion was around 500 ml. The success rate of obtaining fluid was 100% without any complications. There is a high accuracy between the estimated and drained pleural effusion. Simple quantification of pleural effusion enables time and cost-effective decision-making for thoracentesis in postoperative patients.

Management of cerebrospinal fluid leakage after anterior decompression for ossification of posterior longitudinal ligament in the thoracic spine: the utilization of a volume-controlled pseudomeningocele.

Science.gov (United States)

Cho, Ji Young; Chan, Chee Keong; Lee, Sang-Ho; Choi, Won-Chul; Maeng, Dae Hyeon; Lee, Ho-Yeon

2012-06-01

Retrospective review To determine the efficacy of management of cerebrospinal fluid (CSF) leakage after the anterior thoracic approach. CSF leakage after incidental durotomy commonly occurs after anterior thoracic ossification of posterior longitudinal ligament (OPLL) surgery. Pseudomeningocele will invariably form under such circumstances. Among them, uncontrolled CSF leakage with a fistulous condition is problematic. As a solution, we have managed these durotomies with chest drains alone without any CSF drainage by the concept of a "volume-controlled pseudomeningocele." Between 2001 and 2009, CSF leakage occurred in 26 patients (37.7%) of the total 69 patients who underwent anterior decompression for thoracic OPLL. In the initial 11 cases, subarachnoid drainage was utilized as an augmentive measure in combination with chest tube drainage in the postoperative period (group A). In the subsequent 15 cases, the durotomy was managed in a similar manner but in the absence of any subarachnoid drainage (group B). Various parameters such as the duration of postoperative hospital stay, clinical outcome score, drainage output, resolution of CSF leakage, complications, and additional surgery performed were analyzed and compared between the 2 groups. A resolution of the CSF leakage grading system was also proposed for the residual pseudomeningocele that formed in each group. There were statistically no significant differences in the outcome parameters between the 2 groups and also in patients with grade I or grade II residual pseudomeningocele of the new grading system. Two complications occurred in group A. No reexploration for persistent CSF leakage was required in both groups. CSF leakage managed with controlled chest tube drainage can produce a comparable result with those with additional subarachnoid drainage when watertight dural repair is impossible. The concept of controlled pseudomeningocele may be a useful and practical technique for the treatment of CSF leakage

Imaging of chest wall infections

International Nuclear Information System (INIS)

Chelli Bouaziz, Mouna; Jelassi, Helmi; Chaabane, Skander; Ladeb, Mohamed Fethi; Ben Miled-Mrad, Khaoula

2009-01-01

A wide variety of infections can affect the chest wall including pyogenic, tuberculous, fungal, and some other unusual infections. These potentially life-threatening disorders are frequent especially among immunocompromised patients but often misdiagnosed by physical examination and radiographs. The purpose of this article is to describe the clinical and imaging features of these different chest wall infections according to the different imaging modalities with emphasis on ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The outcome of chest wall infection depends on early diagnosis, severity of the immunosuppression, offending organism, and extent of infection. Because clinical findings and laboratory tests may be not contributive in immunocompromised patients, imaging plays an important role in the early detection and precise assessment of the disease. US, CT, and MRI are all useful: bone destruction is more accurately detected with CT whereas soft tissue involvement are better visualized with US and MRI. CT and US are also used to guide percutaneous biopsy and drainage procedures. MR images are helpful in pre-operative planning of extensive chest wall infections. (orig.)

A comparative study of collimation in bedside chest radiography for preterm infants in two teaching hospitals

International Nuclear Information System (INIS)

Stollfuss, J.; Schneider, K.; Krüger-Stollfuss, I.

2015-01-01

•Potential factors influencing non-optimal image collimation in the setting of bedside chest X-ray in preterm infants were investigated.•A comparable rate of optimal images was observed in two hospitals.•Size, weight or disease severity had no influence on collimation quality.•Unrelated to the years of experience a large variation of the technician in correct collimation was noted (18–86%).•Individualized quality control and education is necessary. Potential factors influencing non-optimal image collimation in the setting of bedside chest X-ray in preterm infants were investigated. A comparable rate of optimal images was observed in two hospitals. Size, weight or disease severity had no influence on collimation quality. Unrelated to the years of experience a large variation of the technician in correct collimation was noted (18–86%). Individualized quality control and education is necessary. Unnecessary exposure of the abdomen, arms or head may lead to a substantial increase of the radiation dose in portable chest X-rays on the neonatal intensive care unit. The objective was to identify potential factors influencing inappropriate exposure of non-thoracic structures in two teaching hospitals. The study analysed 200 consecutive digital chest radiographs in 20 preterm neonates (mean gestation 25 ± 1 weeks). Demographical data, tube settings and exposure parameters were recorded. To grade the collimation, we used a scoring system with a maximum of 12 exposed non-thoracic structures. Length of gestation, age, the radiographer, years of experience in performing X-rays and the number of in situ catheters or lines, were correlated with collimation quality. There was no significant difference between the rates of optimal images obtained in the two hospitals (0.32 vs 0.39, n.s.). Scores showed that most suboptimal images had only mildly reduced image quality (1.40 ± 1.38 vs 1.20 ± 1.43, n.s.). Length of gestation or presence of surgical drains, catheters and

Should the lateral chest radiograph be routinely performed?

International Nuclear Information System (INIS)

Osman, Fatuma; Williams, Imelda

2014-01-01

Background: The chest x-ray is one of the most common plain film radiographic examinations performed. Inclusion of the lateral chest radiograph varies internationally and nationally across radiology departments and states in Australia. Search strategy: A search strategy of the databases Cochrane Library, Ovid Medline/Medline, PubMed, Scopus and Science Direct was conducted. The results were restricted to those published between 1985 and 2013 and those published in English. The following search terms were used: ‘lateral chest’, ‘radiograph’, ‘digital radiography’, ‘chest x-ray’, ‘plain film radiography’, ‘ionising radiation’. The results were restricted to publications with these terms in the title, abstract and/or keywords. Main findings: There are few national or international guidelines pertaining to the inclusion of the lateral chest x-ray as routine. Primary concerns are the increased radiation dose associated with the additional chest view and reduction of medical imaging services cost. Modern digital imaging systems result in a lower radiation dose. The diagnostic yield of the lateral chest x-ray is highly dependent on the clinical indications of the patient. Further research into the routine inclusion of the lateral chest x-ray is recommended. Conclusion: Review of the literature suggests that the lateral chest radiograph should not be performed routinely unless clinically indicated

Role of computed tomography in blunt chest trauma

International Nuclear Information System (INIS)

Cho, Jae Hyun; Kim, Sang Jin; Lee, Chan Wha; Kim, Hae Kyoon

1994-01-01

In patient with blunt trauma of chest, supine AP x-ray cannot differentiate the lung contusion, laceration, atelectasis, and hemothorax definitely. Therefore, computed tomographic evaluation is needed for accurate evaluation of the injuries. In our knowledge, there are few reports about CT findings of blunt chest trauma, in our country, therefore we tried to fluid the characteristic CT findings in patients with blunt trauma. We analyzed the plain x-ray and CT image of 4 patients with blunt chest trauma. Location and morphology of lung parenchymal contusion and laceration, hemopneumothorax, chest wall injuries and location of chest tube. Lung parenchymal contusion was noted in 53 segments., of 16 patients infiltration(n=27 segment), and multiple nodular pattern was noted in 15 segment, pattern of consolidation along the lung periphery was seen in 11 segment. Laceration was noted in 18 lesion and most commonly located in paravertebral area(b=8). CT scan of chest in patient with blunt chest trauma, provides accurate information of the pattern of injuries, and localization, therefore, should be performed as possible

Calculation of the Cardiothoracic Ratio from Portable Anteroposterior Chest Radiography

Science.gov (United States)

Chon, Sung Bin; Oh, Won Sup; Cho, Jun Hwi; Kim, Sam Soo

2011-01-01

Cardiothoracic ratio (CTR), the ratio of cardiac diameter (CD) to thoracic diameter (TD), is a useful screening method to detect cardiomegaly, but is reliable only on posteroanterior chest radiography (chest PA). We performed this cross-sectional 3-phase study to establish reliable CTR from anteroposterior chest radiography (chest AP). First, CDChest PA/CDChest AP ratios were determined at different radiation distances by manipulating chest computed tomography to simulate chest PA and AP. CDChest PA was inferred from multiplying CDChest AP by this ratio. Incorporating this CD and substituting the most recent TDChest PA, we calculated the 'corrected' CTR and compared it with the conventional one in patients who took both the chest radiographies. Finally, its validity was investigated among the critically ill patients who performed portable chest AP. CDChest PA/CDChest AP ratio was {0.00099 × (radiation distance [cm])} + 0.79 (n = 61, r = 1.00, P chest AP with an available previous chest PA. This might help physicians detect congestive cardiomegaly for patients undergoing portable chest AP. PMID:22065900

OPTIMUM: a protocol for a multicentre randomised controlled trial comparing Out Patient Talc slurry via Indwelling pleural catheter for Malignant pleural effusion vs Usual inpatient Management.

Science.gov (United States)

Sivakumar, P; Douiri, A; West, A; Rao, D; Warwick, G; Chen, T; Ahmed, L

2016-10-18

The development of malignant pleural effusion (MPE) results in disabling breathlessness, pain and reduced physical capability with treatment a palliative strategy. Ambulatory management of MPE has the potential to improve quality of life (QoL). The OPTIMUM trial is designed to determine whether full outpatient management of MPE with an indwelling pleural catheter (IPC) and pleurodesis improves QoL compared with traditional inpatient care with a chest drain and talc pleurodesis. OPTIMUM is currently open for any centres interested in collaborating in this study. OPTIMUM is a multicentre non-blinded randomised controlled trial. Patients with a diagnosis of MPE will be identified and screened for eligibility. Consenting participants will be randomised 1:1 either to an outpatient ambulatory pathway using IPCs and talc pleurodesis or standard inpatient treatment with chest drain and talc pleurodesis as per British Thoracic Society guidelines. The primary outcome measure is global health-related QoL at 30 days measured using the EORTC QLQ-C30 questionnaire. Secondary outcome measures include breathlessness and pain measured using a 100 mm Visual Analogue Scale and health-related QoL at 60 and 90 days. A sample size of 142 patients is needed to demonstrate a clinically significant difference of 8 points in global health status at 30 days, for an 80% power and a 5% significance level. The study has been approved by the NRES Committee South East Coast-Brighton and Sussex (reference 15/LO/1018). The trial results will be published in peer-reviewed journals and presented at scientific conferences. UKCRN19615 and ISRCTN15503522; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

A survey of percutaneous chest drainage practice in French university surgical ICU's.

Science.gov (United States)

Remérand, F; Bazin, Y; Gage, J; Laffon, M; Fusciardi, J

2014-04-01

Percutaneous chest drainage guidelines were published in 2010 by the British Thoracic Society. On several points (insertion technique, drain size), they seem to differ from French practices. Our objectives were to evaluate practice of pleural drainage in French University surgical intensive care units (ICU's), and to compare it with the British guidelines. National phone survey. Physicians working in 58 ICU's were surveyed first in 2007, and subsequently in 2012. They were read a questionnaire to evaluate the demographic characteristics of their units, their indication for pleural drainage, how they quantified pleural effusion, and their technique for drain insertion. Data from the two surveys were compared to detect an evolution in practice following the publication of the British guidelines. Results are expressed as the mean response. In 2007, pleural drainage indications relied on various respiratory criteria in 91% of cases (versus 95% in 2012) and/or on pleural effusion volume in 71% of cases (versus 59% in 2012). Trocars (Monod or Joly) were used in 68% of the procedures in 2007. In the rest, either blunt dissection, a Pleurocath® or the Seldinger technique was utilized. From 2007 to 2012, the Seldinger technique increased in frequency (10% versus 22%, P=0.005) while Monod trocar usage decreased (41% vs 29%, P=0.012). Ultrasound before pleural effusion drainage became nearly systematic in 2012 (60% vs 86%, Pdrains) for pleural drainage in French ICU's differs significantly from the British guidelines. Copyright © 2014 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

Mass chest radiography in Greece

International Nuclear Information System (INIS)

Papavasiliou, C.

1987-01-01

In Greece mass chest radiography has been performed regularly on various population groups as a measure to control tuberculosis. Routine chest radiography is performed in most Greek hospitals on admission. In this report available data-admittedly inadequate-directly or indirectly addressing the problem of benefit versus the risk or cost associated with this examination is presented

Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands.

Science.gov (United States)

Heus, C; Mellema, J J; Giannakopoulos, G F; Zuidema, W P

2015-04-25

Most patients with penetrating chest injuries benefit from early treatment with chest tube drainage or surgery. Although penetrating chest injury is not uncommon, few descriptive studies are published, especially in Europe. The aim of this study was to review our experience and further improve our management of penetrating chest injuries in a level I trauma center in the Netherlands. All patients with penetrating chest injury between August 2004 and December 2012 were included. Demographics, mechanism of injury, physiological parameters, Injury Severity Scores (ISS), surgical and non-surgical treatment, length of intensive care unit (ICU) stay, length of hospital stay (LOS), complications and rate of mortality were collected. A total of 159 patients were analyzed. Patients included 116 (73 %) stab wounds and 34 (21 %) gunshot wounds. In 27 patients (17 %), cardiac injury was seen. The mean ISS was 12. Almost half of all patients (49 %) were treated with only chest tube drainage. Alternatively, surgical treatment was performed in 24 % of all cases. Anterolateral incision was most frequently used to gain access to the thoracic cavity. The mean LOS was 9 days. Among all patients, 17 % were admitted to the ICU with a mean stay of 3 days. In 18 (11 %) patients, one or more complications occurred. The 30-day mortality was 7.5 %. Patients presenting with penetrating chest injury are not uncommon in the Netherlands and can mostly be treated conservatively. In one-fourth of the patients, surgical treatment is performed. A structural and vigorous approach is needed for good clinical outcome.

Steam generator fitted with a dynamic draining device

International Nuclear Information System (INIS)

Chaix, J.E.

1982-01-01

This generator has, at its upper part, at least one drying structure for holding the water carried with the steam and communicating at its lower part with at least one discharge pipe for draining off the water, each pipe communicating with a dynamic draining device capable of creating a depression in order to suck up the water contained in the drying structure. Application is for pressurized water nuclear reactors [fr

The value of chest X-ray in the Scottish Referral Guidelines for suspected head and neck cancer in 2144 patients.