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Sample records for chest wall resection

  1. Massive chest wall resection and reconstruction for malignant disease

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    Foroulis, Christophoros N; Kleontas, Athanassios D; Tagarakis, George; Nana, Chryssoula; Alexiou, Ioannis; Grosomanidis, Vasilis; Tossios, Paschalis; Papadaki, Elena; Kioumis, Ioannis; Baka, Sofia; Zarogoulidis, Paul; Anastasiadis, Kyriakos

    2016-01-01

    Objective Malignant chest wall tumors are rare neoplasms. Resection with wide-free margins is an important prognostic factor, and massive chest wall resection and reconstruction are often necessary. A recent case series of 20 consecutive patients is reported in order to find any possible correlation between tumor histology, extent of resection, type of reconstruction, and adjuvant treatment with short- and long-term outcomes. Methods Twenty patients were submitted to chest wall resection and reconstruction for malignant chest wall neoplasms between 2006 and 2014. The mean age (ten males) was 59±4 years. The size and histology of the tumor, the technique of reconstruction, and the short- and long-term follow-up records were noted. Results The median maximum diameter of tumors was 10 cm (5.4–32 cm). Subtotal sternal resection was performed in nine cases, and the resection of multiple ribs was performed in eleven cases. The median area of chest wall defect was 108 cm2 (60–340 cm2). Histology revealed soft tissue, bone, and cartilage sarcomas in 16 cases (80%), most of them chondrosarcomas. The rest of the tumors was metastatic tumors in two cases and localized malignant pleural mesothelioma and non-Hodgkin lymphoma in one case. The chest wall defect was reconstructed by using the “sandwich technique” (propylene mesh/methyl methacrylate/propylene mesh) in nine cases of large anterior defects or by using a 2 mm polytetrafluoroethylene (e-PTFE) mesh in nine cases of lateral or posterior defects. Support from a plastic surgeon was necessary to cover the full-thickness chest wall defects in seven cases. Adjuvant oncologic treatment was administered in 13 patients. Local recurrences were observed in five cases where surgical reintervention was finally necessary in two cases. Recurrences were associated with larger tumors, histology of malignant fibrous histiocytoma, and initial incomplete resection or misdiagnosis made by nonthoracic surgeons. Three patients died

  2. Massive chest wall resection and reconstruction for malignant disease

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    Foroulis CN

    2016-04-01

    Full Text Available Christophoros N Foroulis,1 Athanassios D Kleontas,1 George Tagarakis,1 Chryssoula Nana,1 Ioannis Alexiou,1 Vasilis Grosomanidis,1 Paschalis Tossios,1 Elena Papadaki,2 Ioannis Kioumis,2 Sofia Baka,3 Paul Zarogoulidis,2 Kyriakos Anastasiadis11Department of Cardiothoracic Surgery, Aristotle University School of Medicine, AHEPA University Hospital, 2Pulmonary Department-Oncology Unit, “G. Papanikolaou” General Hospital, Aristotle University of Thessaloniki, 3Oncology Department, European Interbalkan Medical Center, Thessaloniki, GreeceObjective: Malignant chest wall tumors are rare neoplasms. Resection with wide-free margins is an important prognostic factor, and massive chest wall resection and reconstruction are often necessary. A recent case series of 20 consecutive patients is reported in order to find any possible correlation between tumor histology, extent of resection, type of reconstruction, and adjuvant treatment with short- and long-term outcomes.Methods: Twenty patients were submitted to chest wall resection and reconstruction for malignant chest wall neoplasms between 2006 and 2014. The mean age (ten males was 59±4 years. The size and histology of the tumor, the technique of reconstruction, and the short- and long-term follow-up records were noted.Results: The median maximum diameter of tumors was 10 cm (5.4–32 cm. Subtotal sternal resection was performed in nine cases, and the resection of multiple ribs was performed in eleven cases. The median area of chest wall defect was 108 cm2 (60–340 cm2. Histology revealed soft tissue, bone, and cartilage sarcomas in 16 cases (80%, most of them chondrosarcomas. The rest of the tumors was metastatic tumors in two cases and localized malignant pleural mesothelioma and non-Hodgkin lymphoma in one case. The chest wall defect was reconstructed by using the “sandwich technique” (propylene mesh/methyl methacrylate/propylene mesh in nine cases of large anterior defects or by using a 2

  3. Resection and debridement of chest-wall tumors and general aspects of reconstruction

    International Nuclear Information System (INIS)

    The main criterion for adequate local control of a chest-wall malignancy remains wide excision. With the available techniques of skeletal and soft-tissue reconstruction, even large lesions can be resected with safe margins. The primary purpose is to achieve a curative resection, although a significant number of symptomatic patients can benefit from palliative resection provided by such procedures. A key element in the success in treating chest-wall tumors is a multidisciplinary approach by all participating physicians, namely the thoracic surgeon, the plastic and reconstructive surgeon, the radiotherapist, and the medical oncologist. 70 references

  4. Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

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    Turna, Akif; Kavakli, Kuthan; Sapmaz, Ersin; Arslan, Hakan; Caylak, Hasan; Gokce, Hasan Suat; Demirkaya, Ahmet

    2014-01-01

    The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide chest wall resection with a low morbidity rate. In this report, we describe the reconstruction of a wide anterior chest wall defect with a patient-specific custom-made titanium implant. An infected mammary tumour recurrence in a 62-year old female, located at the anterior chest wall including the sternum, was resected, followed by a large custom-made titanium implant. Latissimus dorsi flap and split-thickness graft were also used for covering the implant successfully. A titanium custom-made chest wall implant could be a viable alternative for patients who had large chest wall tumours. PMID:24227881

  5. Reconstruction with a patient-specific titanium implant after a wide anterior chest wall resection

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    Turna, Akif; KAVAKLI, Kuthan; SAPMAZ, Ersin; Arslan, Hakan; Caylak, Hasan; Gokce, Hasan Suat; Demirkaya, Ahmet

    2013-01-01

    The reconstruction of full-thickness chest wall defects is a challenging problem for thoracic surgeons, particularly after a wide resection of the chest wall that includes the sternum. The location and the size of the defect play a major role when selecting the method of reconstruction, while acceptable cosmetic and functional results remain the primary goal. Improvements in preoperative imaging techniques and reconstruction materials have an important role when planning and performing a wide...

  6. Urgent resection of bleeding congenital mesenchymal chest wall hamartoma in an infant

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    Bieda, Jan-Christoph

    2013-10-01

    Full Text Available We report a case with prenatally diagnosed large cystic-solid mesenchymal chest wall hamartoma. An attempt of conservative management was made however repeated intralesional hemorrhage led to enlargement and severe anemia which required urgent resection at the age of 8 weeks. The infant had an unimpaired development over a follow-up of 4 years.

  7. Full-thickness chest wall resection for locally recurrent breast cancer

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    Friedel, Godehard

    2005-08-01

    Full Text Available Aim: In spite of available recommendations, therapeutic procedures of locally recurrent breast cancer are very different. In a retrospective study, the possibilities and results of complete, full-thickness chest wall resection are presented.Methods: Between 1985 and 2004, 51 women underwent complete, full-thickness chest wall resection with primary coverage. Primary surgical therapy of breast cancer had been mastectomy in 88%. Median age of patients undergoing surgery for a local recurrence was 57 (29 - 81 years. The median interval between surgery of the primary tumour and of the local recurrence was 70.3 (10.7 - 327.2 months; median follow-up was 29.4 (1.8 - 230.9 months. 40 (78.4% patients required rib resections, 15 (29.4% of them in combination with partial sternal resection. In 4 (7.8% patients complete and in 7 (13.7% patients partial sternal resection without additional rib resection were performed.Coverage was mainly realized using latissimus dorsi myocutaneous flaps (n=44; 86.3%. Survival rates were calculated by means of the Kaplan-Meier method, the relative risk using univariate and multivariate Cox-regression analysis.Results: In the total collective, cumulative 5-, 10- and 15-year survival (YS rates were 39%, 31% and 23%, respectively, median survival 46.4 months. R0 resection was associated with a 5-YS of 42%. Prognostic factors were age at the time of primary surgery, disease-free interval and tumour invasion of bony structures. Mortality was 2%, morbidity 35%.Conclusion: Full-thickness chest wall resection of locally recurrent breast cancer is possible in almost any patient when performed by a team of thoracic and plastic surgeons. Only radical resection provides good long-term results with low mortality and morbidity.

  8. Extended Resection of Chest Wall Tumors with Reconstruction Using Poly Methyl Methacrylate-Mesh Prosthesis

    International Nuclear Information System (INIS)

    This prospective study evaluates the early result of patients with massive chest wall tumors treated by extended resection and reconstruction using Prolene or Marlex mesh-enforced with Poly Methyl Methacrylate Bone Cement (PMMC) prosthesis. Material and Methods: This surgery was performed on 40 patients with a mean age of 45±18 (12-62) at the Department of Surgery, National Cancer Institute, Cairo University between 1998-2001. Primary chest wall tumors were the indications of surgery in 42.5%, while secondary involvement extending from other sites principally breast cancer were the indications for 57.5%. In 85% of patients more than 3 ribs were involved by tumors and lesions were more than 10 cm in the greatest dimension in 50% of cases. Resection involved sternum in 15 (37.5%) cases and in 45% of cases complete extensive rib resections extended between costovertebral junctions and the costochondral junctions were performed. Additional resections of nearby organs were needed in 20 (50%) of cases including partial lung resection in 14 cases, partial vertebral resection in 3 cases and diaphragm resection for 3 cases. Immediate bony reconstruction by inserting Prolene or Marlex mesh-enforced with Poly Methyl Methacrylate Bone Cement (PMMC) prosthesis to the resulting chest wall defect was performed in 36 cases, whereas, 4 cases had delayed reconstruction. Primary simple soft tissue closure was sufficient for 37.5% of patients; whereas 35% were covered by local rotational flap and 27.5% needed myocutaneous flaps. No patient with this immediate reconstruction needed ventilatory support or tracheostomy and flail chest was not noticed ICU stay was markedly reduced; whereas 85% required less than 7 days. Immediate post operative (40 days) complications were found in 14 patients (35%) and cases with additional lung resection had more complication rate than others (64% vs 19%). Infection occurred in 3 patients and conservative treatment for 3-4 weeks using frequent

  9. Chest wall resection and reconstruction using titanium micromesh covered with Marlex mesh for metastatic follicular thyroid carcinoma: a case report

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    Suganuma Nobuyasu

    2009-06-01

    Full Text Available Abstract Introduction The distant metastases from differentiated thyroid carcinomas are often untreatable. In particular, bone metastasis is significantly related to poor prognosis since radioactive iodine therapy is generally less effective. Therefore, surgical resection is considered one of the treatments for patients with bone metastases. We report chest wall resection and reconstruction using titanium micromesh covered with polypropylene mesh (Marlex mesh for metastatic rib bones as a result of follicular thyroid carcinoma. Case presentation A 51-year-old man was referred to our institution with a painful chest wall tumor. He presented with a 15 × 10 cm bony swelling on the left chest wall and multiple small lung nodules from follicular thyroid carcinoma. Completion total thyroidectomy, chest wall resection and reconstruction using titanium micromesh covered with Marlex mesh were performed. There were no critical complications associated with surgical treatments and tumor pain disappeared during the postoperative period. Then, he received radioactive iodine therapy and the uptake of radioactive iodine was well observed in bilateral lung fields. Conclusion Reconstruction using titanium micromesh covered with Marlex mesh is possible for repairing the wide chest wall resection required for thyroid carcinoma metastasis. This technique would help to enhance treatment efficacy in the combination therapy of radioactive iodine and surgery in patients with large thyroid carcinoma metastasis in the chest wall.

  10. Chest wall resection and reconstruction using titanium micromesh covered with Marlex mesh for metastatic follicular thyroid carcinoma: a case report

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    Suganuma Nobuyasu; Wada Nobuyuki; Arai Hiromasa; Nakayama Hirotaka; Fujii Keita; Masudo Katsuhiko; Yukawa Norio; Rino Yasushi; Masuda Munetaka; Imada Toshio

    2009-01-01

    Abstract Introduction The distant metastases from differentiated thyroid carcinomas are often untreatable. In particular, bone metastasis is significantly related to poor prognosis since radioactive iodine therapy is generally less effective. Therefore, surgical resection is considered one of the treatments for patients with bone metastases. We report chest wall resection and reconstruction using titanium micromesh covered with polypropylene mesh (Marlex mesh) for metastatic rib bones as a re...

  11. Dynamic 3D printed titanium copy prosthesis: a novel design for large chest wall resection and reconstruction.

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    Aragón, Javier; Pérez Méndez, Itzell

    2016-06-01

    Due to high rates of complications, chest wall resection and reconstruction is a high risk procedure when large size of resection is required. Many different prosthetic materials have been used with similar results. Recently, thanks to the new advances in technology, personalized reconstruction have been possible with specific custom-made prosthesis. Nevertheless, they all generate certain amount of stiffness in thoracic motion because of his rigidity. In this report, we present a forward step in prosthesis design based on tridimensional titanium-printed technology. An exact copy of the resected chest wall was made, even endowing simulated sternochondral articulations, to achieve the most exact adaptation and best functional results, with a view to minimize postoperative complications. This novel design, may constitute an important step towards the improvement of the functional postoperative outcomes compared to the other prosthesis, on the hope, to reduce postoperative complications. PMID:27293863

  12. Lymphomas presenting as chest wall tumors

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    Witte, Biruta; Hürtgen, Martin

    2006-01-01

    Four cases of thoracic lymphoma mimicking chest wall tumors are presented. As resection is not the treatment of first choice in lymphomas, pretherapeutical evaluation of chest wall tumors should include a thoroughly staging and a biopsy for histopathological diagnosis. Chest wall destruction due to an anterior mediastinal mass, or a chest wall tumor associated with mediastinal lymph node enlargement, could be suspicious of thoracic lymphoma. Lymphoma with chest wall involvement mostly turns o...

  13. Chest Wall tumor: combined management

    International Nuclear Information System (INIS)

    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

  14. Resección tumoral en bloque y reconstrucción de pared torácica In-bloc tumor resection and chest wall reconstruction

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    D. Palafox

    2011-09-01

    Full Text Available La resección de una neoplasia pulmonar o mediastínica que afecta simultáneamente a la pared torácica y la reconstrucción del defecto originado por la misma, son procedimientos quirúrgicos que se pueden realizar en un mismo tiempo operatorio. Con la reconstrucción primaria se busca preservar la función respiratoria y la integridad de la caja torácica, permitiendo al paciente una buena mecánica respiratoria, a la vez que un resultado estético satisfactorio y evitando la necesidad de una nueva intervención quirúrgica. Existen diversas técnicas y disponemos de diferentes materiales protésicos para su realización. Presentamos a continuación el caso de un paciente al que se le realizó satisfactoriamente una resección tumoral en bloque y reconstrucción de la pared torácica.Resection of a pulmonary or mediastinic neoplasm which simultaneously affects chest wall and reconstruction of the defect, are surgical proceedings that can be performed in the same surgical time. The objectives of reconstructing primarily the chest wall are to preserve the respiratory function and the thoracic wall integrity, therefore offering the patient appropriate respiratory mechanics, satisfactory aesthetic result and avoiding the needding for a second surgical intervention. There are several techniques and materials available for the surgery performance. We present the case of a patient who underwent successfully tumoral resection in-bloc and chest wall reconstruction.

  15. Surgical treatment with sternal and rib resection for patients with post-irradiation ulcer of the chest wall

    International Nuclear Information System (INIS)

    Postoperative radiotherapy is widely performed in the treatment of patients with lymph node metastases from carcinoma of the breast, however, depending on the dose, cases are seen in which radiation ulcers develop and require surgical management. In the present paper we report a patient in whom postoperative radiotherapy was performed because parasternal lymph node metastasis was discovered at the time of surgery and who 15 months later experienced thoracic wall recurrence. Since metastasis to the contralateral lung was observed at that time, reoperation was not attempted, and when radiotherapy was again administered, an extensive radiation ulcer developed in association with sternal and costal necrosis. The skin and subcutaneous tissue together with the sternum and ribs were widely resected followed by the thoracoplasty using a latissimus dorsi musculocutaneous flap. Since there was no postoperative infection, the skin flap was accepted well, and the outcome was satisfactory from the standpoint of quality of life, we have reported the case. (author)

  16. Solitary Plasmacytoma of the Chest Wall

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    Servet Kayhan

    2014-03-01

    Full Text Available A previously healthy 55-year-old man with right sided lateral chest pain admitted to clinic. It was found a solid and painful mass at the right 4th rib in physical examination. Chest X-ray and thoracic computarized tomography showed an opacity measured 60x33 mm within the right chest wall destructing the 4th rib. Needle aspiration was performed from tumor and cytologic examination showed atypic plasma cell infiltration. The patient was scheduled for a chest wall resection and reconstructive surgery. Examination of a permanent section showed that the chest wall tumor was solitary plasmacytoma. There was no evidence of multiple myeloma recurrence after two years from the operation.

  17. [Dedifferentiated Chondrosarcoma of the Chest Wall].

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    Saitoh, Genkichi; Yoneshima, Yasuto; Nakamura, Toshihiko; Kitagawa, Dai; Kinjo, Nao; Ohgaki, Kippei; Maehara, Shinichiro; Teramoto, Seiichi; Adachi, Eisuke; Ikeda, Yoichi; Mine, Mari

    2016-08-01

    A 79-year-old man complaining of an anterior chest mass with pain had an abnormal shadow on chest X-ray. A mass, 7 cm in size, with destruction of the right 4th rib was found on chest computed tomography. A F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) corresponding to the lesion showed an abnormal accumulation of FDG with the standardized uptake value(SUV) max=16.19. A malignant tumor of the chest wall origin was suspected and the tumor was resected with the 3th, 4th, and 5th ribs. Histologically, the tumor was diagnosed as dedifferentiated chondrosarcoma. He died of local recurrence about 5 months after the operation. PMID:27476566

  18. Sonographic Findings of Variable Chest Wall Disorders

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    Shim, Mi Suk; Kim, Ji Young; Cho, Woo Ho; Kim, Joung Sook; Jeong, Myeong Ja; Kim, Soung Hee; Kim, Jae Hyung; Kim, Soo Hyun; Jun, Woo Sun [Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of)

    2008-06-15

    Variable chest wall disorders include hemorrhage, inflammation and a tumor on the chest wall. Especially in females, abnormal anterior chest wall findings can appear as breast lesions due to the anatomic relationship between the chest wall and the breast. Sonography is the first diagnostic tool to utilize for chest wall disorders and has an important role for the differential diagnosis. In this study, we introduce sonographic findings of the various chest wall disorders that are discovered incidentally during an examination for a palpable mass or pain in the breast. We also describe sonographic findings that additionally performed of sonography-guided core needle biopsy

  19. Actinomycosis involving the chest wall: CT findings

    International Nuclear Information System (INIS)

    Two cases of pulmonary actinomycosis with extension to involve the chest wall that were evaluated using computerized tomography are reported. In both cases, the relation of pulmonary and chest wall disease was best shown using CT

  20. [NECROTIZING FASCIITIS OF THE CHEST WALL].

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    Farah, Raymond; Asla, Husam

    2016-04-01

    Necrotizing fasciitis (NF) is a bacterial dermo-hypodermitis affecting the soft tissue and muscular fascia. It is an uncommon and severe infection caused by microorganisms called 'flesh eating bacteria', mainly represented by group A beta-haemolytic streptococcus. NF remains a life-threatening condition associated with a high mortality rate. Its location on the chest wall is extremely rare. The few reported cases are subsequent to thoracic drainage, lung surgery or esophageal resection. This is a case report of an 80-year old female with comorbidity of heart disease, a past history of coronary artery by-pass and diabetes. She was admitted to the emergency room with acute NF of the chest and shortly after diagnosis, the patient died. Due to the fast decline observed in this disease, we would like to emphasize the importance of early recognition and diagnosis. PMID:27323534

  1. Surgery of chest wall deformities

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    Matos, AC; Bernardo, JE; Fernandes, LE; Antunes, MJ

    1997-01-01

    OBJECTIVE: To evaluate the medium-term results of 77 surgical corrections in patients with chest wall deformities, 53 (68.8%) with pectus excavatum and 24 with pectus carinatum, operated upon from 1985 to 1994. METHODS: The mean age of the patients was 14.7 years (4-39 years) and 77% were younger than 15 years of age. There were 59 male (76.7%) and 18 female patients. Only four had a family history of the malformation. Seven patients (9.1%) presented with asthma-like symptoms, and 13 (16....

  2. Anterior chest wall examination reviewed

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    F. Trotta

    2011-09-01

    Full Text Available Anterior chest wall involvement is not infrequently observed within inflammatory arthropaties, particularly if one considers seronegative spondiloarthritides and SAPHO syndrome. Physical examination is unreliable and conventional X-rays analysis is an unsatisfactory tool during diagnostic work-up of this region. Scintigraphic techniques yield informations both on the activity and on the anatomical extent of the disease while computerized tomography visualize the elementary lesions, such as erosions, which characterize the process. Moreover, when available, magnetic resonance imaging couple the ability to finely visualize such lesions with the possibility to show early alterations and to characterize the “activity” of the disease, presenting itself as a powerful tool both for diagnosis and follow-up. This review briefly shows the applications of imaging techniques for the evaluation of the anterior chest wall focusing on what has been done in the SAPHO syndrome which can be considered prototypical for this regional involvement since it is the osteo-articular target mainly affected by the disease.

  3. Dedifferentiated Chondrosarcoma of the Rib Masquerading as a Giant Chest Wall Tumor in a Teenage Girl: An Unusual Presentation

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    Abraham, Viju Joseph; Devgarha, Sanjeev; Mathur, Rajendra Mohan; Sisodia, Anula; Yadav, Amita

    2014-01-01

    Chondrosarcoma of the chest wall is a rare primary neoplasm found to occur in elderly men. Patients present with an enlarging, painful, anterior chest wall mass arising from either the vicinity of the costochondral junction or the sternum. Treatment includes wide resection with appropriate chest wall reconstruction. We report an unusual presentation of this uncommon tumor occurring as a huge chest wall mass in a young teenage girl.

  4. Plastic surgery in chest wall reconstruction: relevant aspects - case series

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    Diogo Franco

    2015-12-01

    Full Text Available Objective: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. Methods: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. Results: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. Conclusion: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

  5. Classification of chest wall diseases.

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    Pozzi, E; Gulotta, C

    1993-01-01

    Several disorders of the thoracic cage are known to cause respiratory failure, by means of relatively simple mechanisms, such as the increased work of breathing, which results in alveolar hypoventilation. A variety of pathogenic mechanisms may be considered, as functions of the types of thoracic disorders present. As causes of these additional potential mechanisms, we considered the following: 1) ventilation-perfusion (V/Q) inhomogeneity; 2) inability to cough; 3) malformation or acquired defect of the respiratory centres; and 4) excess blood volume and fluid retention, which aggravate work of breathing and V/Q inhomogeneity. All of these disorders can be grouped into two major categories (which nevertheless have some of the pathophysiology in common): the mechanical syndrome and the neuromuscular or paralytic syndrome. In this paper we discuss chest wall diseases falling into the first category; namely, kyphoscoliosis, fibrothorax, thoracoplasty, ankylosing spondylitis and obesity-hypoventilation. Congenital deformities of the thoracic cage, which do not have important effects on ventilatory apparatus (e.g. pectus excavatum and pectus carinatum), were also considered. PMID:8472068

  6. A case of radiation ulcer of chest wall with osteomyelitis

    International Nuclear Information System (INIS)

    We report a case of anterior chest skin ulcer with rib and sternum osteomyelitis following radiation therapy for post operative mammary carcinoma. Operation was performed six times including debridement with sternum and rib resection reconstruction and skin grafting. It took about one and a half years after first operation to heal the ulcer with osteomyelitis. Principle of treatment for radiation ulcer accompanied by osteomyelitis is complete resection of the damaged lesion. However, it is difficult to evaluate the exact area of the damaged lesion. Therefore it is not rare to repeat its recurrence and have trouble with its treatment. In this case, it was considered that the resected area was insufficient on the initial operation. In order to treat for radiation ulcers accompanied by osteomyelitis, enough resection of the damaged lesion in the initial operation is necessary. Ultimately, in our case, the resection of all sternum, part of the right second to fifth rib and part of left second to seventh rib was necessary. It is generally said that reconstructing bone structure is required in the case of wide defect of chest wall. Though, we did not perform reconstruction of the bone structures, there is no problem in the condition of respiratory system. The surrounding soft tissues changed to hard enough to avoid paradoxical breathing. (author)

  7. Reconstruction with a pectoralis major myocutaneous flap after left first rib and clavicular chest wall resection for a metastasis from laryngeal cancer.

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    Caronia, Francesco Paolo; Fiorelli, Alfonso; Zanchini, Fabio; Santini, Mario; Lo Monte, Attilio Ignazio; Castorina, Sergio

    2016-05-01

    We presented a case of recurrent metastasis from epidermoid cancer that occurred in the left clavicle of a patient with a history of laryngeal cancer treated on April 2005 with extended hemilaryngectomy, neck dissection and chemoradiation therapy. On September 2008, he developed a left clavicular metastasis. The disease was initially well controlled by chemoradiotherapy but it recurred 17 months later. The optimal treatment plan was established by several multidisciplinary meetings and the patient subsequently underwent an en bloc resection of the left clavicle, first rib and all the other involved structures. Coverage of the thoracic defect was achieved using pectoralis major myocutaneous flap. The patient had a successful surgical outcome. At 1-year follow-up, he had no evidence of disease, a good cosmetic result and returned to normal daily activity. He died for bone metastasis with an overall 21 months post-surgical survival. PMID:25319560

  8. Chest wall tuberculosis; CT findings in 14 patients

    International Nuclear Information System (INIS)

    To present CT findings of chest wall tuberculosis. CT scans were obtained in 14 patients with proven chest wall tuberculosis. Diagnosis was confirmed by means of right open thoracostomy with abscess evacuation (n=1), excision and curettage (n=11) or excision and curettage along with resection of the involved lung (n=2). The images were assessed with emphasis for the extrapleural, pleural, and pulmonary lesions. All patients showed juxtacostal soft tissue mass with central low attenuation and peripheral rim enhancement. The lesions were located in the left hemithorax in eight patients and in the right in six. Multiple lesions were found in three patients (two in one and three in two). Rib destruction was observed in four patients. Intercostal muscle involvement of thickening and enhancement were shown in all patients. Thirteen patients (93%) had evidence of pulmonary tuberculosis: active pulmonary tuberculosis in nine and stable tuberculosis in four. Pleural lesions, including empyema necessitatis in six, were observed in eleven (79%). On CT scan, chest wall tuberculosis is characterized by juxtacostal soft tissue lesion with central low attenuation and peripheral rim enhancement. Rib destruction may be associated. Additionally, enhancing intercostal muscle suggest direct inflammatory process of tuberculosis and spread channel to the chest wall involvement of pleuropulmonary tuberculosis

  9. Imaging of Chest Wall Lesions in Children

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    A. Hekmatnia

    2008-01-01

    Full Text Available Chest wall lesions in childhood include a wide range of pathologies; Benign lesions include lipoma, neurofibroma, lymphangioma, hemangioma, and mesenchymal hamartoma."nMalignant lesions include Neuroblastoma, Rhabdo-myosarcoma, Ewing sarcoma, and Askin tumor."nSystemic diseases such as leukemia, lymphoma, Langerhans cell histiocytosis, and also infections such as tuberculosis, and actinomycosis may also cause chest wall lesions."nThe imaging characteristics of these lesions are re-viewed, but only a minority of the lesions shows diagnostic imaging features, and most of lesions re-quire biopsy and histopathological examination for "ndefinitive diagnosis."nThe role of different modalities is discussed with an emphasis on magnetic resonance imaging for demonstrating lesion morphology and local spread. Computed tomography and neuclear medicine being used mainly to assess remote disease."nIn this lecture, we discuss about imaging of chest wall lesions in children.

  10. Algorithm of chest wall keloid treatment.

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    Long, Xiao; Zhang, Mingzi; Wang, Yang; Zhao, Ru; Wang, Youbin; Wang, Xiaojun

    2016-08-01

    Keloids are common in the Asian population. Multiple or huge keloids can appear on the chest wall because of its tendency to develop acne, sebaceous cyst, etc. It is difficult to find an ideal treatment for keloids in this area due to the limit of local soft tissues and higher recurrence rate. This study aims at establishing an individualized protocol that could be easily applied according to the size and number of chest wall keloids.A total of 445 patients received various methods (4 protocols) of treatment in our department from September 2006 to September 2012 according to the size and number of their chest wall keloids. All of the patients received adjuvant radiotherapy in our hospital. Patient and Observer Scar Assessment Scale (POSAS) was used to assess the treatment effect by both doctors and patients. With mean follow-up time of 13 months (range: 6-18 months), 362 patients participated in the assessment of POSAS with doctors.Both the doctors and the patients themselves used POSAS to evaluate the treatment effect. The recurrence rate was 0.83%. There was an obvious significant difference (P keloids. This algorithm could play a guiding role for surgeons when dealing with chest wall keloid treatment. PMID:27583896

  11. Free Tensor Fascia Lata Flap and Synthetic Mesh Reconstruction for Full-Thickness Chest Wall Defect

    OpenAIRE

    Jumpei Ono; Akira Takeda; Minekatsu Akimoto; Akira Iyoda; Yoshio Matsui; Yukitoshi Satoh; Eiju Uchinuma

    2013-01-01

    A large full-thickness chest wall defect over 10 cm in diameter requires skeletal reconstruction and soft tissue coverage. Use of various flaps for soft tissue coverage was previously reported, but en bloc resection in each case affects these flap pedicles and sizes. We present a case of a 74-year-old man with a soft tissue tumor involving the left lateral chest wall. We performed an en block resection and skeletal reconstruction using a mesh, free tensor fascia lata (TFL) flap for soft tissu...

  12. Primary Burkitt Lymphoma of the Chest Wall

    OpenAIRE

    Rommel Lu

    2012-01-01

    Burkitt lymphoma (BL) originating in the skin and soft tissue at any site is exceedingly rare. This paper is about a case of primary sporadic BL that presented as an isolated, rapidly enlarging chest wall mass arising from skin and/or soft tissue in an adult. As with other BL presentations, this patient was treated with aggressive chemotherapy with central nervous system (CNS) chemoprophylaxis, but he later died because of sepsis.

  13. Primary Burkitt Lymphoma of the Chest Wall

    Directory of Open Access Journals (Sweden)

    Rommel Lu

    2012-01-01

    Full Text Available Burkitt lymphoma (BL originating in the skin and soft tissue at any site is exceedingly rare. This paper is about a case of primary sporadic BL that presented as an isolated, rapidly enlarging chest wall mass arising from skin and/or soft tissue in an adult. As with other BL presentations, this patient was treated with aggressive chemotherapy with central nervous system (CNS chemoprophylaxis, but he later died because of sepsis.

  14. Salmonella typhimurium abscess of the chest wall

    OpenAIRE

    Tonziello, Gilda; Valentinotti, Romina; Arbore, Enrico; Cassetti, Paolo; Luzzati, Roberto

    2013-01-01

    Patient: Male, 73 Final Diagnosis: Salmonella typhimurium abscess of the chest wall Symptoms: — Medication: Ciprofloxacin Clinical Procedure:— Specialty: Infectious Diseases Objective: Unusual clinical course Background: Non-typhoid Salmonella extra-intestinal infections usually develop in infants and in adult patients with pre-existing predisposing conditions. Blood stream infections and urinary tract infections are the most common clinical presentations, but other sites of infection may be ...

  15. Reconstruction of chest, abdominal walls and perineum

    OpenAIRE

    Vijaykumar D; Vijayaraghavan Sundeep

    2007-01-01

    The structural integrity of the chest and abdominal walls and perineum is frequently altered by cancer extirpation. Advances in reconstructive surgery and the availability of innovative techniques have helped the cancer surgeon to proceed with radical excisions with minimum morbidity. The ability to harvest flaps from distant sites and the availability of good prosthetic materials have now become part of the routine armamentarium of the plastic surgeon engaged in reconstructive surgery of the...

  16. Management of radiation necrosis and advanced cancer of the chest wall in patients with breast malignancy

    International Nuclear Information System (INIS)

    Aggressive resection, with individualized reconstruction by several methods, is of value in many patients with radiation necrosis and/or advanced breast cancer of the chest wall. Although this does not always significantly lengthen survival, it can improve the quality of life markedly in many instances. Remarkably large defects can be reconstructed with single-stage procedures

  17. Spectral characteristics of chest wall breath sounds in normal subjects.

    OpenAIRE

    Gavriely, N; Nissan, M.; Rubin, A. H.; Cugell, D. W.

    1995-01-01

    BACKGROUND--This study was carried out to establish a reliable bank of information on the spectral characteristics of chest wall breath sounds from healthy men and women, both non-smokers and smokers. METHODS--Chest wall breath sounds from 272 men and 81 women were measured using contact acoustic sensors, amplifiers, and fast Fourier transform (FFT) based spectral analysis software. Inspiratory and expiratory sounds were picked up at three standard locations on the chest wall during breathing...

  18. Biometric estimation of chest wall thickness of females

    International Nuclear Information System (INIS)

    Optimal use of whole-body counting data to estimate pulmonary deposition of many of the actinides is dependent upon accurate measurement of the thickness of the chest wall because of severe attenuation of low-energy x rays and photons associated with the decay of these radionuclides. An algorithm for estimation of female chest wall thicknesses, verified by real-time ultrasonic measurements, has been derived based on the correlation of measured chest wall thickness and other common biometric quantities. Use of this algorithm will reduce the error generally associated with estimation of internal actinide deposition previously resulting from assuming an average chest wall thickness for all female subjects

  19. Long-term survival after chest-wall reconstruction with musculocutaneous flaps

    International Nuclear Information System (INIS)

    Reconstruction of chest-wall defects with musculocutaneous flaps permits resection of advanced chest-wall tumors and of tissues severely damaged by radiotherapy in patients who in a previous era were not surgically treatable. To determine the long-term outcome from this surgery, the records of 96 patients who had undergone chest-wall resection with musculocutaneous flap reconstruction were reviewed. Median survival for the entire group was 20.5 months, but a more accurate prediction of outcome could be obtained by dividing the patients into three groups. In group I, patients free of known malignancy and undergoing resection of radionecrotic tissues, median survival was 60.0 months. In group II, patients with resectable disease and free of tumor following surgery, median survival was 31.1 months. In group III, patients incompletely resected or known to have metastatic disease following surgery, median survival was only 12.5 months. Even in group III, however, some individuals achieved prolonged survival and lasting benefits from the surgery, so these data should not be used to exclude patients from undergoing necessary palliative procedures

  20. The role of imaging for the surgeon in primary malignant bone tumors of the chest wall

    International Nuclear Information System (INIS)

    Primary malignant chest wall tumors are rare. The most frequent primary malignant tumor of the chest wall is chondrosarcoma, less common are primary bone tumors belonging to the Ewing Family Bone Tumors (EFBT), or even rarer are osteosarcomas. They represent a challenging clinical entities for surgeons as the treatment of choice for these neoplasms is surgical resection, excluding EFBT which are normally treated by a multidisciplinary approach. Positive margins after surgical procedure are the principal risk factor of local recurrence, therefore to perform adequate surgery a correct preoperative staging is mandatory. Imaging techniques are used for diagnosis, to determine anatomic site and extension, to perform a guided biopsy, for local and general staging, to evaluate chemotherapy response, to detect the presence of a recurrence. This article will focus on the role of imaging in guiding this often difficult surgery and the different technical possibilities adopted in our department to restore the mechanics of the thoracic cage after wide resections

  1. Surgical treatment of T3 lung cancer invading the chest wall.

    Science.gov (United States)

    Beltrami, V; Bezzi, M; Illuminati, G; Forte, A; Angelici, A; Bertagni, A; Ciulli, A; Gallinaro, L; Lorenzotti, A; Montesano, G; Palumbo, P G; Prece, V

    1999-01-01

    Lung tumors invading the chest wall are classed as belonging to the T3 group and are considered potentially resectable. Their management, however, is controversial, and extrapleural resection, when possible, is preferred to en bloc resection which is regarded as a far more invasive and dangerous operation. Five year survival rates for completely resected cases range in the literature from 25 to 35%, but survival rates are much worse if lymph node metastases are present. These poor outcomes have prompted the development of combined surgical approaches: preoperative radiation therapy, with or without chemotherapy, has been used with an improvement in resectability rates, but only modest results in terms of median survival; in a number of case series, increased operative morbidity and mortality have been reported with this approach. The present report relates to 122 patients treated by en bloc (20 cases) or extrapleural (102 cases) resection, 31 of whom also received neoadjuvant treatment. The operative mortality was 4.6%. Median survival was 17 months after en bloc resection and 19 months after extrapleural resection. Though no statistically significant difference was found, extrapleural resection would appear to yield better results than the en bloc procedure. PMID:10742890

  2. Measurement of chest wall displacement based on terahertz wave

    Science.gov (United States)

    Li, Hui; Lv, Hao; Jiao, Teng; Lu, Guohua; Li, Sheng; Li, Zhao; Liu, Miao; Jing, Xijing; Wang, Jianqi

    2015-02-01

    Measurement of chest wall displacement is an important approach for measuring mechanics of chest wall, which has considerable significance for assessing respiratory system and diagnosing pulmonary diseases. However, existing optical methods for measuring chest wall displacement are inconvenient for some specific patients such as the female patients and the patients with bandaged chest. In this letter, we proposed a method for measuring chest wall displacement based on terahertz wave and established corresponding mathematic model and set up a terahertz measurement system. The main advantages of this method are that it can measure the chest wall displacement of the subjects without taking off clothes or arranging any markers. To validate this method and assess the performance of the terahertz system, in vitro, the displacement of a water module driven by a linear guide rail was measured by the terahertz system and compared with the actual displacement of the water module. The results showed that the waveforms measured with two methods have a good agreement, and the relative error is less than 5% and sufficiently good for measurement demands. In vivo, the synchronous experiment was performed on five human volunteers with the terahertz system and a respiratory belt transducer. The results demonstrate that this method has good performance and promising prospects for measuring chest wall displacement.

  3. Synovial sarcoma of the chest wall: a case report and literature review

    OpenAIRE

    Braham, Emna; Aloui, Slim; Aouadi, Samira; Drira, Ikram; Kilani, Tarek; El Mezni, Faouzi

    2013-01-01

    Synovial sarcoma is a malignant soft-tissue tumor that most commonly occurs in the extremities of young adults. Synovial sarcoma arising from the chest wall is rare and only some cases had been reported in the literature. We present a 57-year-old woman who presented with chest pain. Radiologic evaluation revealed a right parietal tumor destructing the mid-portion of the 8th rib, with heterogeneous enhancement and invasion of the pectoral muscle and extra pleural fat. A surgical resection cons...

  4. Severe Chest Wall Toxicity From Cryoablation in the Setting of Prior Stereotactic Ablative Radiotherapy.

    Science.gov (United States)

    Chaudhuri, Aadel A; Binkley, Michael S; Aggarwal, Sonya; Qian, Yushen; Carter, Justin N; Shah, Rajesh; Loo, Billy W

    2016-01-01

    We present the case of a 42-year-old woman with metastatic synovial sarcoma of parotid origin, treated definitively with chemoradiation, who subsequently developed oligometastatic disease limited to the lungs. She underwent multiple left and right lung wedge resections and left lower lobectomy, followed by right lower lobe stereotactic ablative radiotherapy (SABR), 54 Gy in three fractions to a right lower lobe lesion abutting the chest wall. Two years later, she was treated with cryoablation for a separate right upper lobe nodule abutting the chest wall. Two months later, she presented with acute shortness of breath, pleuritic chest pain, decreased peripheral blood O2 saturation, and productive cough. A computed tomography (CT) scan demonstrated severe chest wall necrosis in the area of recent cryoablation that, in retrospect, also received a significant radiation dose from her prior SABR. This case demonstrates that clinicians should exercise caution in using cryoablation when treating lung tumors abutting a previously irradiated chest wall. Note: Drs. Loo and Shah contributed equally as co-senior authors. PMID:27004154

  5. Chest Wall Involvement as a Manifestation of Brucellosis

    OpenAIRE

    K Rahmdel; R Golsha; Golshah, E; R Rezaie Shirazi; N Sadre Momtaz

    2011-01-01

    Brucellosis continues to be a common infectious disease in some parts of the world. Although the disease has different presentations, but chest wall involvement, as a manifestation of brucellosis is rare. In this study, we report three cases of chest wall involvement as manifesting feature of Brucellosis in Iran. They presented with a history of parasternal masses revealed to a diagnosis of Brucellosis and responded well to the treatment. Brucellosis may present with strange and unpredictable...

  6. Chest wall segmentation in automated 3D breast ultrasound scans.

    Science.gov (United States)

    Tan, Tao; Platel, Bram; Mann, Ritse M; Huisman, Henkjan; Karssemeijer, Nico

    2013-12-01

    In this paper, we present an automatic method to segment the chest wall in automated 3D breast ultrasound images. Determining the location of the chest wall in automated 3D breast ultrasound images is necessary in computer-aided detection systems to remove automatically detected cancer candidates beyond the chest wall and it can be of great help for inter- and intra-modal image registration. We show that the visible part of the chest wall in an automated 3D breast ultrasound image can be accurately modeled by a cylinder. We fit the surface of our cylinder model to a set of automatically detected rib-surface points. The detection of the rib-surface points is done by a classifier using features representing local image intensity patterns and presence of rib shadows. Due to attenuation of the ultrasound signal, a clear shadow is visible behind the ribs. Evaluation of our segmentation method is done by computing the distance of manually annotated rib points to the surface of the automatically detected chest wall. We examined the performance on images obtained with the two most common 3D breast ultrasound devices in the market. In a dataset of 142 images, the average mean distance of the annotated points to the segmented chest wall was 5.59 ± 3.08 mm. PMID:23273891

  7. Ineffective Ventilation During Conscious Sedation Due to Chest Wall Rigidity After Intravenous Midazolam and Fentanyl

    OpenAIRE

    Ackerman, William E.; Phero, James C; Theodore, Gregg T.

    1990-01-01

    Chest wall rigidity has been reported after the administration of high-dose intravenous fentanyl. This case report supports the observation that low-dose intravenous fentanyl may also cause chest wall rigidity. The treatment of chest wall rigidity with naloxone or neuromuscular blocking agents is controversial. A discussion of the management of fentanyl-induced chest wall rigidity is presented.

  8. RECURRENT SALMONELLA TYPHI CHEST WALL ABSCESSES IN A DIABETIC LADY

    Directory of Open Access Journals (Sweden)

    Jayasri Helen

    2014-09-01

    Full Text Available : Salmonella enterica serovar typhi causing typhoid fever is common in many parts of the world particularly in developing countries. Extra intestinal manifestations are uncommon and occur in immunocompromised individuals such as patients with diabetes, HIV infection, chronic steroid use, chemotherapy and malignancy. We report a case of Salmonella typhi causing recurrent chest wall abscesses in a lady with uncontrolled diabetes. She was admitted with high grade fever, left sided chest wall abscess and a previous history of two similar chest wall abscesses. After hospitalization prompt incision and drainage was done and aerobic culture of pus grew moderate growth of Salmonella typhi resistant to ciprofloxacin and sensitive to cephalosporins. Based on culture report our patient was treated with oral azithromycin for ten days and parenteral ceftriaxone for six weeks. There was rapid and full recovery and six months follow up revealed no recurrence.

  9. CYSTIC HYGROMA OF CHEST WALL- 2 Reported Cases

    Directory of Open Access Journals (Sweden)

    Tapan Shah

    2012-07-01

    Full Text Available Hygromas arise in the sites of primitive lymphatic lakes, on the floor of the mouth, under the jaw, in the neck and in the axillae, but they can occur virtually anywhere in the body. Their occurrence on the chest wall is very rare and they progressively grow with age infiltrating into the local tissues, insinuating lymphatic pseudopods and form cysts in and around muscle fibers and nerves, making them difficult and hazardous to remove. Here, we have reported 2 cases of cystic hygroma of chest wall in children

  10. Endoscopic thyroidectomy through anterior chest wall:a report of 28 cases

    Institute of Scientific and Technical Information of China (English)

    柯重伟; 郑成竹; 陈丹磊; 胡明根; 李际辉; 印慨

    2004-01-01

    Objective: To retrospectively evaluate the feasibility and clinical value of endoscopic thyroidectomy through anterior chest wall. Methods: From December 2002 to May 2003, 28 patients with an average of age of 28 years old(rangeing from 20 to 45) were performed endoscopic thyroidectomy through anterior chest wall. The subcutaneous space in the anterior chest wall and the subplatysmal space in the neck were bluntly dissected through a 10-mm incision between the nipples, and CO2 was insufllated at 6 - 8 mmHg to create the operative space. Three trocars were inserted in the mammary regions; and dissection of the thyroid, division of the thyroid vessels and parenchyma were performed endoscopically using an ultrasonically activated scalpel. The recurrent laryngeal nerve, the superior laryngeal nerve, and the parathyroid glands were preserved properly. Results: There were 3 mass resections, 17 subtotal lobectomies, 2 total lobectomies, 6 subtotal lobectomies plus contralateral mass resections. The mean operative time was (87.1 ± 26.0) min; the mean blood loss during operation was (47.9 ± 19.6) ml; and the mean postoperative hospital stay was (3.4 ± 0.7) d. The drainage tubes were pulled out at 36 - 60 h postoperatively. There were no conversions to open surgery or complications. No scars can be found in the neck, and the patients were satisfied with the postoperative appearance. Conclusion: Endoscopic thyroidectomy through anterior chest wall combined with low-pressure subcutaneous CO2 insufflation is a feasible and safe procedure. It can bring satisfactory cosmetic results. It is believed that endoscopic thyroidectomy by such approach will find a role in the future.

  11. Palpation for muscular tenderness in the anterior chest wall

    DEFF Research Database (Denmark)

    Christensen, Henrik Wulff; Vach, Werner; Manniche, Claus; Haghfelt, Torben; Hartvigsen, Lisbeth; Høilund-Carlsen, Poul Flemming

    2003-01-01

    OBJECTIVE: To asses the interobserver and intraobserver reliability (in terms of day-to-day and hour-to-hour reliability) of palpation for muscular tenderness in the anterior chest wall. DESIGN: A repeated measures designs was used. SETTING: Department of Nuclear Medicine, Odense University...... Hospital, Denmark. PARTICIPANTS: Two experienced chiropractors examined 29 patients and 27 subjects in the interobserver part, and 1 of the 2 chiropractors examined 14 patients and 15 subjects in the intraobserver studies. INTERVENTION: Palpation for muscular tenderness was done in 14 predetermined areas...... of the anterior chest wall with all subjects sitting. Each dimension was rated as absent or present for tenderness or pain for each location. All examinations were carried out according to a standard written procedure. RESULTS: Based on a pooled analysis of data from palpation of the anterior chest...

  12. Pattern of dose prescription in chest wall irradiation

    International Nuclear Information System (INIS)

    The method described, in this paper, gives a solution to obtain dose uniformity in chest wall. This method can be followed for routine clinical practice. The distribution with the new technique can still be improved with the use of wedge along with breast cone provided the machine is equipped with asymmetric wedge

  13. Thoracic Wall Reconstruction after Tumor Resection

    OpenAIRE

    HARATI, KAMRAN; Kolbenschlag, Jonas; Behr, Björn; Goertz, Ole; Hirsch, Tobias; Kapalschinski, Nicolai; Ring, Andrej; Lehnhardt, Marcus; Daigeler, Adrien

    2015-01-01

    Introduction Surgical treatment of malignant thoracic wall tumors represents a formidable challenge. In particular, locally advanced tumors that have already infiltrated critical anatomic structures are associated with a high surgical morbidity and can result in full-thickness defects of the thoracic wall. Plastic surgery can reduce this surgical morbidity by reconstructing the thoracic wall through various tissue transfer techniques. Sufficient soft-tissue reconstruction of the thoracic w...

  14. CYSTIC HYGROMA OF CHEST WALL- 2 Reported Cases

    OpenAIRE

    Tapan Shah; Dipen Patel; Yash Vaidhya; Jigar Jadeja; Sharad Patel; Asit Patel

    2012-01-01

    Hygromas arise in the sites of primitive lymphatic lakes, on the floor of the mouth, under the jaw, in the neck and in the axillae, but they can occur virtually anywhere in the body. Their occurrence on the chest wall is very rare and they progressively grow with age infiltrating into the local tissues, insinuating lymphatic pseudopods and form cysts in and around muscle fibers and nerves, making them difficult and hazardous to remove. Here, we have reported 2 cases of cystic hygroma of chest...

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

    International Nuclear Information System (INIS)

    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)

  16. Brown fat distribution in the chest wall of infants - normal appearance, distribution and evolution on CT scans of the chest

    International Nuclear Information System (INIS)

    While reviewing chest CT scans of infants, we repeatedly observed hyperdense enhancing tissue in the chest wall that is not well described in radiology literature. This study was undertaken to describe the imaging features of this tissue in chest walls of infants. CT scans of the chest conducted on all infants between April 2008 and October 2009 were retrospectively reviewed. CT studies with any deviation from normal radiation or contrast dose or those with chest wall anatomical distortion were excluded. One hundred eighty-eight infants were scanned, with 202 MDCTs, of which 180 (89.1%) received contrast agent. Fifty-four of 180 (30%) cases revealed focal areas of hyperdensity in various locations. All positive cases ranged between 2 days and 9 months of age. The areas of distribution of hyperdensity had excellent correlation with known areas of brown fat in the chest wall, known from nuclear medicine studies, and hence we concluded these to represent the same. Brown fat in the chest wall can be seen as enhancing tissue on contrast CT scans done on infants. This is a normal morphological component with the brown fat converting to normal fat. It is important to recognize it in the chest wall of infants to avoid misinterpretation. (orig.)

  17. Brown fat distribution in the chest wall of infants - normal appearance, distribution and evolution on CT scans of the chest

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, Priya; Babyn, Paul S.; Shammas, Amer; Miller, Stephen F. [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto (Canada)

    2011-08-15

    While reviewing chest CT scans of infants, we repeatedly observed hyperdense enhancing tissue in the chest wall that is not well described in radiology literature. This study was undertaken to describe the imaging features of this tissue in chest walls of infants. CT scans of the chest conducted on all infants between April 2008 and October 2009 were retrospectively reviewed. CT studies with any deviation from normal radiation or contrast dose or those with chest wall anatomical distortion were excluded. One hundred eighty-eight infants were scanned, with 202 MDCTs, of which 180 (89.1%) received contrast agent. Fifty-four of 180 (30%) cases revealed focal areas of hyperdensity in various locations. All positive cases ranged between 2 days and 9 months of age. The areas of distribution of hyperdensity had excellent correlation with known areas of brown fat in the chest wall, known from nuclear medicine studies, and hence we concluded these to represent the same. Brown fat in the chest wall can be seen as enhancing tissue on contrast CT scans done on infants. This is a normal morphological component with the brown fat converting to normal fat. It is important to recognize it in the chest wall of infants to avoid misinterpretation. (orig.)

  18. Electron arc irradiation of the postmastectomy chest wall: clinical results

    International Nuclear Information System (INIS)

    Purpose/Objective: Since 1980 electron arc irradiation of the postmastectomy chest wall has been the preferred technique for patients with advanced breast cancer at the our institution. Here we report the results of this technique in 150 consecutive patients from 1980 to 1994. Materials and Methods: Thoracic computerized tomography was used to determine internal mammary lymph node depth and chest wall thickness, and for computerized dosimetry calculations in all patients. Total doses of 45-50 Gy in 5 to 5 (1(2)) weeks were delivered to the chest wall and internal mammary lymph nodes via electron arc and, in most cases, supraclavicular and axillary nodes were treated with a matching photon field. Patients were assessed for acute and late radiation changes, local and distant control of disease, and survival. The 10 most recently treated patients were censored for disease progression, survival, and late effects calculations, thus giving a mean follow up of 49 months and a median of 33 months. All patients had advanced disease: T stages 1, 2, 3, and 4 represented 21%, 39%, 21% and 19% of the study population, with a mean number of positive axillary lymph nodes of 6.5 (0-29). Analysis was performed according to adjuvant status (no residual disease, n = 90), residual disease (positive margin, n = 15, and primary radiation, n = 2), or recurrent disease (n = 33). Results: Acute radiation reactions were generally mild and self limiting. 27% of patients developed moist desquamation, and 32% had brisk erythema. Actuarial 5 year local control, freedom from distant failure and overall survival was 91%, 64%, and 67% in the adjuvant group; 84%, 50%, and 53% in the residual disease group; and 63%, 34%, and 30% in the recurrent disease group, respectively. In univariate cox regressions, the number of positive lymph nodes was predictive for local failure in the adjuvant group (p<0.037). Chronic complications were minimal with 10% of patients having arm edema, 15% hyperpigmentation

  19. Electron arc irradiation of the postmastectomy chest wall: clinical results

    International Nuclear Information System (INIS)

    Background and purpose: Since 1980 electron arc irradiation of the postmastectomy chest wall has been the preferred technique for patients with advanced breast cancer at our institution. Here we report the results of this technique in 140 consecutive patients treated from 1980 to 1993. Materials and Methods: Thoracic computerized tomography was used to determine internal mammary lymph node depth and chest wall thickness, and for computerized dosimetry calculations. Total doses of 45-50 Gy in 5 to 5 (1(2)) weeks were delivered to the chest wall and internal mammary lymph nodes via electron arc and, in most cases, supraclavicular and axillary nodes were treated with a matching photon field. Patients were assessed for acute and late radiation changes, local and distant control of disease, and survival. Patients had a minimum follow-up of 1 year after completion of radiation treatment, and a mean follow up interval of 49 months and a median of 33 months. All patients had advanced disease: T stages 1, 2, 3, and 4 represented 21%, 39%, 21% and 19% of the study population, with a mean number of positive axillary lymph nodes of 6.5 (range, 0-29). Analysis was performed according to adjuvant status (no residual disease, n=90), residual disease (positive margin, n=15, and primary radiation, n=2), or recurrent disease (n=33). Results: Acute radiation reactions were generally mild and self limiting. A total of 26% of patients developed moist desquamation, and 32% had brisk erythema. Actuarial 5 year local-regional control, freedom from distant failure, and cause-specific survival was 91%, 64%, and 75% in the adjuvant group; 84%, 50%, and 53% in the residual disease group; and 63%, 34%, and 32% in the recurrent disease group, respectively. In univariate Cox regressions, the number of positive lymph nodes was predictive for local failure in the adjuvant group (P=0.037). Chronic complications were minimal with 11% of patients having arm edema, 17% hyperpigmentation, and 13

  20. Von Reckling-hausen disease associated to thyroid carcinoma and malignant schwannoma of the chest wall. A case

    International Nuclear Information System (INIS)

    The multiple neurofibromatosis is an autosomal dominant hereditary disease associated to malignant schwannoma in about 3% of the cases and very rarely to others cancers. The study provides information on the case of a 32 year-old woman who suffers from this disease and presented two synchronous cancers: a papillary carcinoma of thyroid and a malignant schwannoma of the chest wall. The thyroid tumour was managed with hemithyroidectomy, hormonotherapy and radiotherapy, and the lesion of the thoracic wall was treated with local radical resection application of Marlex mesh and rotation of a musculocutaneous flap of the dorsal muscle. A review of the literature on the clinical aspects of this association and the surgical techniques employed to cover the defect of the chest wall is presented. (authors)

  1. Chest wall tuberculosis - A clinical and imaging experience

    International Nuclear Information System (INIS)

    Tuberculous infection of the thoracic cage is rare and is difficult to discern clinically or on radiographs. This study aims to describe the common sites and the imaging appearances of chest wall tuberculosis. A retrospective review of the clinical and imaging records of 12 confirmed cases of thoracic cage tuberculosis (excluding that of the spine), seen over the last 7 years, was performed. Imaging studies available included radiographs, ultrasonographies (USGs), and computed tomography (CT) scans. Pathological confirmation was obtained in all cases. All patients had clinical signs and symptoms localized to the site of involvement, whether it was the sternum, sternoclavicular joints, or ribs. CT scan revealed sternal destruction in three patients and osteolytic lesions with sclerosis of the articular surfaces of the sternoclavicular joints in two patients. In five patients with rib lesions, USG elegantly demonstrated the bone destruction underlying the cold abscess. All cases were confirmed to be of tuberculous origin by pathology studies of the aspirated/curetted material, obtained by CT / USG guidance. Tuberculous etiology should be considered for patients presenting with atypical sites of skeletal inflammation. CT scan plays an important role in the evaluation of these patients. However, the use of USG for demonstrating rib destruction in a chest wall cold abscess has so far been under-emphasized, as has been the role of CT and USG guided aspiration in confirming the aetiology

  2. Anterior chest wall tuberculous abscess: a case report

    Directory of Open Access Journals (Sweden)

    Papavramidis Theodossis S

    2007-11-01

    Full Text Available Abstract The granulomatous inflammation of tuberculosis usually involves the lungs and the hilar lymph nodes. Musculoskeletal tuberculosis (TB occurs in 1–3% of patients with TB, while TB of the chest wall constitutes 1% to 5% of all cases of musculoskeletal TB. Furthermore, nowadays it is rarer to find extrapulmonary TB in immunocompetent rather that non-immunocompetent patients. The present case reports a fifty-six-year-old immunocompetent man with an anterior chest wall tuberculous abscess. The rarity of the present case relates both to the localization of the tuberculous abscess, and to the fact that the patient was immunocompetent. The diagnosis of musculoskeletal tuberculous infection remains a challenge for clinicians and requires a high index of suspicion. The combination of indolent onset of symptoms, positive tuberculin skin test, and compatible radiographic findings, strongly suggests the diagnosis. TB, however, must be confirmed by positive culture or histologic proof. Prompt diagnosis and treatment are important to prevent serious bone and joint destruction.

  3. Measurements of the human anterior chest wall by ultrasound and estimates of chest wall thickness for use in determination of transuranic nuclides in the lung

    International Nuclear Information System (INIS)

    The low energy photons on which the in vivo detection of plutonium isotopes and americium 241 is based are severely attenuated in body tissues. To assess the activity of these radionuclides in the lungs by external measurement it is necessary to estimate or measure the thickness of tissues overlying the lungs. It is also desirable to distinguish between muscle and adipose tissues in the chest wall because of the difference in their attenuation properties. Diagnostic ultrasound machines developed for medical use are suitable for this purpose. Experience gained since 1978 in ultrasonic measurements of chest wall thickness and the current measurement procedure are described. The concept of ''equivalent muscle chest wall thickness'' is introduced and a method for calculating the parameter is given. Both chest wall thickness and equivalent muscle chest wall thickness have been found to correlate well with Quetelets Index (weight divided by height squared). Residual correlations with other parameters have been examined. Empirical formulae are given that can be used to predict the chest wall thickness and equivalent muscle chest wall thickness of a subject of given weight, height and age. (author)

  4. HUGE SYNOVIAL SARCOMA ARISING FROM CHEST WALL: A RARE CASE REPORT

    Directory of Open Access Journals (Sweden)

    Waddi Sudhakar

    2015-02-01

    Full Text Available Synovial sarcomas are the fourth most common malignant soft - tissue tumors, and typically develop in para - articular locations of the extremities. However, the occurrence of these tumors in the chest wall is rare. In this article, we report the interesting case of a 27 - year - old male with spindle cell variant of synovial sarcoma arising in the anterior chest wall with a brief review of the literature. KEYWORDS:Synovial sarcoma;chest wall;spindle cell variant

  5. Elastofibroma dorsi – differential diagnosis in chest wall tumours

    Directory of Open Access Journals (Sweden)

    Steinau Hans-Ulrich

    2007-02-01

    Full Text Available Abstract Background Elastofibromas are benign soft tissue tumours mostly of the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle with a prevalence of up to 24% in the elderly. The pathogenesis of the lesion is still unclear, but repetitive microtrauma by friction between the scapula and the thoracic wall may cause the reactive hyperproliferation of fibroelastic tissue. Methods We present a series of seven cases with elastofibroma dorsi with reference to clinical findings, further clinical course and functional results after resection, as well as recurrence. Data were obtained retrospectively by clinical examination, phone calls to the patients' general practitioners and charts review. Follow-up time ranged from four months to nine years and averaged 53 months. Results The patients presented with swelling of the infrascapular region or snapping scapula. In three cases, the lesion was painful. The ratio men/women was 2/5 with a mean age of 64 years. The tumor sizes ranged from 3 to 13 cm. The typical macroscopic aspect was characterized as poorly defined fibroelastic soft tissue lesion with a white and yellow cut surface caused by intermingled remnants of fatty tissue. Microscopically, the lesions consisted of broad collagenous strands and densely packed enlarged and fragmented elastic fibres with mostly round shapes. In all patients but one, postoperative seroma (which had to be punctuated occurred after resection; however, at follow-up time, no patient reported any decrease of function or sensation at the shoulder or the arm of the operated side. None of the patients experienced a relapse. Conclusion In differential diagnosis of soft tissue tumors located at this specific site, elastofibroma should be considered as likely diagnosis. Due to its benign behaviour, the tumor should be resected only in symptomatic patients.

  6. Predicting Chest Wall Pain From Lung Stereotactic Body Radiotherapy for Different Fractionation Schemes

    International Nuclear Information System (INIS)

    Purpose: Recent studies with two fractionation schemes predicted that the volume of chest wall receiving >30 Gy (V30) correlated with chest wall pain after stereotactic body radiation therapy (SBRT) to the lung. This study developed a predictive model of chest wall pain incorporating radiobiologic effects, using clinical data from four distinct SBRT fractionation schemes. Methods and Materials: 102 SBRT patients were treated with four different fractionations: 60 Gy in three fractions, 50 Gy in five fractions, 48 Gy in four fractions, and 50 Gy in 10 fractions. To account for radiobiologic effects, a modified equivalent uniform dose (mEUD) model calculated the dose to the chest wall with volume weighting. For comparison, V30 and maximum point dose were also reported. Using univariable logistic regression, the association of radiation dose and clinical variables with chest wall pain was assessed by uncertainty coefficient (U) and C statistic (C) of receiver operator curve. The significant associations from the univariable model were verified with a multivariable model. Results: 106 lesions in 102 patients with a mean age of 72 were included, with a mean of 25.5 (range, 12–55) months of follow-up. Twenty patients reported chest wall pain at a mean time of 8.1 (95% confidence interval, 6.3–9.8) months after treatment. The mEUD models, V30, and maximum point dose were significant predictors of chest wall pain (p < 0.0005). mEUD improved prediction of chest wall pain compared with V30 (C = 0.79 vs. 0.77 and U = 0.16 vs. 0.11). The mEUD with moderate weighting (a = 5) better predicted chest wall pain than did mEUD without weighting (a = 1) (C = 0.79 vs. 0.77 and U = 0.16 vs. 0.14). Body mass index (BMI) was significantly associated with chest wall pain (p = 0.008). On multivariable analysis, mEUD and BMI remained significant predictors of chest wall pain (p = 0.0003 and 0.03, respectively). Conclusion: mEUD with moderate weighting better predicted chest wall pain

  7. Involvement of the chest and abdominal wall as a rave manifestation in Hodgkin's disease

    International Nuclear Information System (INIS)

    Radiological findings of chest and abdominal wall involvement in Hodgkin's disease are reported. This manifestation was diagnosed in one patient in the primary staging and in two patients during the course of the disease. Typical radiological findings are soft tissue masses in the chest and abdominal wall, in two cases with continous tumor growth of enlarged mediastinal lymphnodes into the anterior chest wall. The axial computed tomography is the best method to evaluate the extent of chest and abdominal wall involvement in Hodgkin's disease. (orig.)

  8. A triceps musculocutaneous flap for chest-wall defects

    Energy Technology Data Exchange (ETDEWEB)

    Hartrampf, C.R. Jr.; Elliott, L.F.; Feldman, S. (Emory Univ. School of Medicine, Atlanta, GA (USA))

    1990-09-01

    A posterior upper arm flap based on the profunda brachii vessels has been described to cover soft-tissue defects in the upper anterolateral chest. In our series, the posterior upper arm skin is elevated with the long head of the triceps muscle to cover seven chest-wall defects resulting from indolent postradiation open wounds following partial TRAM flap failure (n = 2), soft-tissue deficiencies following partial TRAM flap loss (n = 3), and primarily as an ancillary flap in TRAM flap breast reconstruction (n = 2). This flap also may be used to supply well-vascularized tissue in the regions of the shoulder, axilla, and posterolateral back. A prerequisite for this operation is redundant tissue of the upper arm often present in middle-aged women and in patients with lymphedema following mastectomy. In our series of seven patients, all donor sites were closed primarily, and there was no subjective functional deficit following transfer of the long head of the triceps muscle.

  9. A triceps musculocutaneous flap for chest-wall defects

    International Nuclear Information System (INIS)

    A posterior upper arm flap based on the profunda brachii vessels has been described to cover soft-tissue defects in the upper anterolateral chest. In our series, the posterior upper arm skin is elevated with the long head of the triceps muscle to cover seven chest-wall defects resulting from indolent postradiation open wounds following partial TRAM flap failure (n = 2), soft-tissue deficiencies following partial TRAM flap loss (n = 3), and primarily as an ancillary flap in TRAM flap breast reconstruction (n = 2). This flap also may be used to supply well-vascularized tissue in the regions of the shoulder, axilla, and posterolateral back. A prerequisite for this operation is redundant tissue of the upper arm often present in middle-aged women and in patients with lymphedema following mastectomy. In our series of seven patients, all donor sites were closed primarily, and there was no subjective functional deficit following transfer of the long head of the triceps muscle

  10. Mechanical properties of lungs and chest wall during spontaneous breathing.

    Science.gov (United States)

    Nagels, J; Làndsér, F J; van der Linden, L; Clément, J; Van de Woestijne, K P

    1980-09-01

    Using a forced oscillation technique, we measured the resistance (Rrs) and reactance (Xrs) of the respiratory system between 2 and 32 Hz at three different lung volumes in 15 healthy subjects and 7 patients with chronic obstructive pulmonary disease. Rrs and Xrs were partitioned, by means of a pressure recording in the esophagus, into the resistance and reactance of lung and airways (L) and the chest wall. The measurements were validated by checking the adequacy of the frequency response of the esophagus, by the lack of difference between thoracic and mouth flow, by an estimation of the error introduced by the shunt impedance of the cheeks, and by comparisons with the values of pulmonary compliance and resistance determined in the same subjects with classical techniques. In both healthy subjects and patients, the chest wall has a low resistance that increases somewhat at low lung volumes and behaves functionally as a two-compartment system, with low capacitance at frequencies exceeding 4 Hz. Rrs varies with lung volume and is markedly frequency dependent in patients; both phenomena are due primarily to corresponding variations of RL. In healthy subjects, at and above functional residual capacity (FRC) level, the lungs behave as a one-compartment system, the reactance of which is mainly determined by the gaseous inertance, at least beyond 2 Hz. In patients and in healthy subjects breathing below FRC, the observed frequency dependence of resistance and the simultaneous increase in resonant frequency can be simulated satisfactorily by Mead's two-compartment model, assuming a large increase in peripheral airways resistance. PMID:7204163

  11. Eye wall resections for intraocular tumors: Our experience

    Directory of Open Access Journals (Sweden)

    Tandava Krishnan

    2014-01-01

    Full Text Available We conducted a retrospective review of 11 eyes undergoing eye wall resection between October 1998 and October 2009. The median age of 11 patients was 29 years. Decreased vision (eight was the most common presenting symptom. Ciliary body medulloepithelioma was the most common clinical diagnosis (six. Medulloepithelioma was the most common histopathological diagnosis (four. The duration of follow-up ranged from 0.5 to 67 months (median 11 months. Three eyes needed to be enucleated in the postoperative period (margin involvement two eyes, recurrence one eye. Postoperative complications among others included retinal detachment (three, vitreous hemorrhage (three, cataract (two, and suprachoroidal hemorrhage (two. To conclude, prognosis of this procedure continues to be guarded needing close postoperative follow-up.

  12. Customized Titanium Implant for Chest Wall Reconstruction in Complex Poland Syndrome

    Directory of Open Access Journals (Sweden)

    Ivan E. Rodriguez

    2014-02-01

    Full Text Available Summary: This report describes a new method for the surgical repair of the chest wall deformity encountered in complex Poland’s syndrome. In this report, we describe the use of a customized titanium implant that was used to replace the missing second through fifth ribs and to provide chest wall stabilization before breast reconstruction. This approach might be considered an alternative to autologous rib grafting in patients who have reached skeletal maturity. It avoids the morbidity and risk associated with rib grafts and improves chest wall symmetry.

  13. Aspergillosis of bilateral breast and chest wall in an immunocompetent male masquerading as breast cancer

    Directory of Open Access Journals (Sweden)

    Jitendra G Nasit

    2013-01-01

    Full Text Available Fungal species are not frequently encountered in an immunocompetent host. Invasive aspergillosis typically occurs in severely immunocompromised patient. Aspergillus infection of breast and chest wall are rarely encountered in an immunocompetent as well as in immunocompromised host. Till date only 13 cases of fungal infection of breast and chest wall have been reported in the literature. This report presents a case of aspergillosis of bilateral breast and chest wall in an immunocompetent male, clinically mimicking breast cancer. Diagnosis was achieved by fine-needle aspiration cytology and subsequently Aspergillus flavus was identified on fungal culture. The patient was successfully treated with voriconazole. Prompt diagnosis by cytology and appropriate treatment is necessary to prevent adverse outcome. Here, we present this rare case of fungal infection of breast and chest wall with relevant review of the literature.

  14. Obesity Increases the Risk of Chest Wall Pain From Thoracic Stereotactic Body Radiation Therapy

    International Nuclear Information System (INIS)

    Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumors within 30, or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI ≥29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.

  15. Prediction of Chest Wall Toxicity From Lung Stereotactic Body Radiotherapy (SBRT)

    International Nuclear Information System (INIS)

    Purpose: To determine patient, tumor, and treatment factors related to the development of late chest wall toxicity after lung stereotactic body radiotherapy (SBRT). Methods and Materials: We reviewed a registry of 134 patients treated with lung SBRT to 60 Gy in 3 fractions who had greater than 1 year of clinical follow-up and no history of multiple treatments to the same lobe (n = 48). Patients were treated as per Radiation Therapy Oncology Group Protocol 0236 without specific chest wall avoidance criteria. The chest wall was retrospectively contoured. Thirty-two lesions measured less than 3 cm, and sixteen measured 3 to 5 cm. The median planning target volume was 29 cm3. Results: With a median follow-up of 18.8 months, 10 patients had late symptomatic chest wall toxicity (4 Grade 1 and 6 Grade 2) at a median of 8.8 months after SBRT. No patient characteristics (age, diabetes, hypertension, peripheral vascular disease, or body mass index) were predictive for toxicity, whereas there was a trend for continued smoking (p = 0.066; odds ratio [OR], 4.4). Greatest single tumor dimension (p = 0.047; OR, 2.63) and planning target volume (p = 0.040; OR, 1.04) were correlated with toxicity, whereas distance from tumor edge to chest wall and gross tumor volume did not reach statistical significance. Volumes of chest wall receiving 30 Gy (V30) through 70 Gy (V70) were all highly significant, although this correlation weakened for V65 and V70 and maximum chest wall point dose only trended to significance (p = 0.06). On multivariate analysis, tumor volume was no longer correlated with toxicity and only V30 through V60 remained statistically significant. Conclusions: Tumor size and chest wall dosimetry are correlated to late chest wall toxicity. Only chest wall V30 through V60 remained significant on multivariate analysis. Restricting V30 to 30 cm3 or less and V60 to 3 cm3 or less should result in a 10% to 15% risk of late chest wall toxicity or lower.

  16. Pulmonary Aspergillus chest wall involvement in chronic granulomatous disease: CT and MRI findings

    International Nuclear Information System (INIS)

    Pulmonary Aspergillus infection in patients with chronic granulomatous disease tends to involve the chest wall and consequently carries a high mortality rate. We report the findings of computed tomography (CT) and magnetic resonance imaging (MRI) in three such cases. We suggest that CT and MRI have a complementary role in evaluating chest wall invasion by pulmonary Aspergillus infection in chronic granulomatous disease. (orig./GDG)

  17. Chest wall reconstruction with acellular dermal matrix (Strattice™) and a TRAM flap

    DEFF Research Database (Denmark)

    Brunbjerg, Mette Eline; Juhl, Alexander Andersen; Damsgaard, Tine Engberg

    2014-01-01

    Mette Eline Brunbjerg, Alexander Andersen Juhl, Tine E. Damsgaard. "Chest wall reconstruction with acellular dermal matrix (Strattice™) and a TRAM flap.” Acta Oncol. 2013 Jun;52(5):1052-4. Epub 2012 Oct 24. PMID: 23095144......Mette Eline Brunbjerg, Alexander Andersen Juhl, Tine E. Damsgaard. "Chest wall reconstruction with acellular dermal matrix (Strattice™) and a TRAM flap.” Acta Oncol. 2013 Jun;52(5):1052-4. Epub 2012 Oct 24. PMID: 23095144...

  18. Treatment of chest wall tuberculosis with transdermal ultrasound-mediated drug delivery

    OpenAIRE

    Han, Yi; ZHAO, QIUYUE; YU, DAPING; LIU, ZHIDONG

    2015-01-01

    Chest wall tuberculosis (TB) is an endemic disease with a large number of variants. The condition affects numerous parts of the body and can penetrate the skin to form chronic open ulcers. Current treatment methods include oral anti-TB drugs and surgery. However, conventional drug treatments are not effective due to the difficulty in achieving an effective local concentration, and certain patients are unable to tolerate surgery. The recurrence rate for chest wall TB is high following surgery,...

  19. Chondrosarcoma of chest wall metastasising to the larynx: Case report and review of literature

    OpenAIRE

    Ashish Singhal; Charu Mahajan; Rahat Hadi; Namrata P Awasthi

    2015-01-01

    Chondrosarcoma is the most common malignant tumor of the chest wall. Most patients present with painful progressive swelling in the anterior chest wall arising from the costochondrosternal junction. CT scan with intravenous contrast is the investigation of choice. Wide excision with adequate margins is the standard treatment for localized disease after image guided biopsy. The role of chemotherapy and radiotherapy is limited. Lung is the most common site for metastasis. Metastasis to the lary...

  20. Estimating adipose tissue in the chest wall using ultrasonic and alternate 40K and biometric measurements

    International Nuclear Information System (INIS)

    The percentage of adipose (fat) tissue in the chest wall must be known to accurately measure Pu in the human lung. Correction factors of 100% or more in x-ray detection efficiency are common. Methods using simple 40K and biometric measurement techniques were investigated to determine the adipose content in the human chest wall. These methods predict adipose content to within 15% of the absolute ultrasonic value. These new methods are discussed and compared with conventional ultrasonic measurement techniques

  1. Normalized mean shapes and reference index values for computerized quantitative assessment indices of chest wall deformities

    Science.gov (United States)

    Kim, Ho Chul; Park, Man Sik; Lee, Seong Keon; Nam, Ki Chang; Park, Hyung Joo; Kim, Min Gi; Song, Jae-Jun; Choi, Hyuk

    2015-11-01

    We previously proposed a computerized index (eccentricity index [EI]) for chest-wall deformity measurements, such as pectus excavatum. We sought to define mean shapes based on normal chest walls and to propose for computerized index reference values of that are used in the quantitative analysis of the severity of chest-wall deformities. A total of 584 patients were classified into 18 groups, and a database of their chest-wall computed tomography (CT) scan images was constructed. The boundaries of the chest wall were extracted by using a segmentation algorithm, and the mean shapes were subsequently developed. The reference index values were calculated from the developed mean shapes. Reference index values for the EI were compared with a conventional index, the Haller index (HI). A close association has been shown between the two indices in multiple subjects (r = 0.974, P < 0.001). The newly developed mean shapes and reference index values supply both reliability and objectivity to the diagnosis, analysis, and treatment of chest-wall deformities. They promise to be highly useful in clinical settings.

  2. Multidetector computed tomography-spectrum of blunt chest wall and lung injuries in polytraumatized patients

    Energy Technology Data Exchange (ETDEWEB)

    Peters, S., E-mail: soeren.peters@rub.d [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany); Nicolas, V.; Heyer, C.M. [Department of Radiology and Nuclear Medicine, BG Universitaetsklinikum Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789 Bochum (Germany)

    2010-04-15

    Accidental injuries are the leading cause of death in the 15 to 44-year-old age group. Blunt chest trauma is often encountered in these patients and is associated with a mortality of up to 25%. Although conventional radiography still plays an important role in the initial emergency room setting, for follow-up in the intensive care unit, multidetector computed tomography has established itself as the standard imaging method for the evaluation of chest trauma patients. The following review presents salient radiological findings of the chest wall and shoulder girdle, thoracic spine, pleural space, and lung in polytraumatized patients.

  3. Chondrosarcoma of chest wall metastasising to the larynx: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Ashish Singhal

    2015-01-01

    Full Text Available Chondrosarcoma is the most common malignant tumor of the chest wall. Most patients present with painful progressive swelling in the anterior chest wall arising from the costochondrosternal junction. CT scan with intravenous contrast is the investigation of choice. Wide excision with adequate margins is the standard treatment for localized disease after image guided biopsy. The role of chemotherapy and radiotherapy is limited. Lung is the most common site for metastasis. Metastasis to the larynx from chondrosarcoma has not been reported in the literature though primary chondrosarcoma can occur in the larynx. We hereby report a case of laryngeal metastasis from chondrosarcoma of the chest wall as a part of disease failure.

  4. Use of omental pedicle flap for radiation induced chest wall ulcer. A case report

    International Nuclear Information System (INIS)

    A 79-year-old female with breast carcinoma undergoing a classical Halsted radical mastectomy followed by irradiation (total; 180 Gy) 20 years before developed a left anterior chest wall ulcer. The ulcer was 10.0 x 8.0 cm in size with osteolysis of 3rd, 4th and 5th ribs, exposed pericardium, and parietal pleura with a pleuro-cutaneous fistula. After thorough debridement, an omental pedicle flap was transposed onto the chest wall defect and subsequently covered using a split-skin graft. The omental pedicle flap was 90% effective in covering the pericardial defect and resulted in a complete closure of the pleuro-cutaneous fistula. This report emphasises that an omental pedicle flap is effective in the treatment of radio-necrosis of the chest wall and also stresses the importance of judging the extent of debridement of radio-necrotic tissue. (author)

  5. Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model

    OpenAIRE

    Battle, Ceri Elisabeth; Hutchings, Hayley; Lovett, Simon; Bouamra, Omar; Jones, Sally; Sen, Aruni; Gagg, James; Robinson, David; Hartford-Beynon, Jake; Williams, Jeremy; Evans, Adrian

    2014-01-01

    Introduction Blunt chest wall trauma accounts for over 15% of all trauma admissions to Emergency Departments worldwide. Reported mortality rates vary between 4 and 60%. Management of this patient group is challenging as a result of the delayed on-set of complications. The aim of this study was to develop and validate a prognostic model that can be used to assist in the management of blunt chest wall trauma. Methods There were two distinct phases to the overall study; the development and the v...

  6. Determination of the chest wall thickness as calibration parameter for dosimetric partial-body counting

    International Nuclear Information System (INIS)

    The authors describe actual partial body measurements with Phoswich detectors in the in-vivo laboratory of the Institute for Technology in Karlsruhe. The chest wall thickness is estimated from the radio of body weight to body length. This formula includes several uncertainties. The aim of the project was the reduction of the uncertainties of the empirical formula using ultrasonography. This method allows an accuracy of plus or minus 1.1 mm for the determined chest wall thickness. Besides the experimental study several voxel models were used to determine the efficiency of modeled measuring systems. The voxel models reach the same accuracy as the ultrasound method.

  7. Estimating adipose tissue in the chest wall using ultrasonic and alternate 40K and biometric measurements

    International Nuclear Information System (INIS)

    The percentage of adipose (fat) tissue in the chest wall must be known to accurately measure Pu in the human lung. Correction factors of 100% or more in X-ray detection efficiency are common in a normal population of individuals of differing body composition and have been determined in the past by means of elaborate and costly ultrasonic measurements of the subject's chest. Methods using simple 40K and biometric measurement techniques have been investigated to determine the adipose content in the human chest wall. These methods compare favorably with ultrasonic measurements and allow laboratories not possessing ultrasonic equipment to make appropriate corrections for x-ray detection efficiency. These methods predict adipose content to within 15% of the absolute ultrasonic value. (author)

  8. Heart failure due to severe myocardial calcification; A rare complication after irradiation on the chest wall

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Shouichi; Maida, Kiyoshi; Yokoyama, Hitoshi; Tanaka, Shigeo (Aomori Prefectural Central Hospital (Japan))

    1993-11-01

    A 28-year-old female who had had irradiation on the chest wall at the age of 5 as a remedy for keloid granulation after burn, recently developed congestive heart failure. Severe tricuspid regurgitation was demonstrated by echocardiography with a certain calcification in the cardiac shadow on chest radiogram. Calcified right ventricle and ventricular septum were noticed operatively, which disturbed ventricular motion and also caused tricuspid valve deformity. These calcified myocardium apparently corresponded with the irradiation field. After tricuspid valve replacement, she regained physical activity satisfactorily without congestive heart failure. Because she had no other known causes of cardiac calcification such as hypercalcemia, myocarditis, myocardial infarction or renal diseases, irradiation on the chest wall could be responsible for the severe myocardial calcification. (author).

  9. Intravascular Papillary Endothelial Hyperplasia(Masson's Tumor) of the Chest Wall: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ga Ram [Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of); Joo, Seung Ho; Kie, Jeong Hae; Hong, Ki Pyo; Shim, Joo Eun [NHIC Ilsan Hospital, Ilsan (Korea, Republic of)

    2009-12-15

    Intravascular papillary endothelial hyperplasia is a rare tumor-like lesion caused by hyperplastic proliferation of endothlial cells that is usually an incidental findings within thrombosed dilated blood vessels or vascular tumor. We report the sonographic appearance and pathological correlation of intravascular papillary endothelial hyperplasia that presented as an intramuscular solitary mass in chest wall

  10. Chest Wall Thickness Measurements and the Dosimetric Implications for Male Radiation Workers at the KAERI

    International Nuclear Information System (INIS)

    Using ultrasound techniques, the Korea Atomic Energy Research Institute has measured chest wall thicknesses of a group of male workers at the Korea Atomic Energy Research Institute. A site-specific biometric equation has been developed for these workers. Chest wall thickness is an important modifier on lung counting efficiency. These data have been put into the perspective of the ICRP recommended dose limits for occupationally exposed workers:100 mSv in a 5-year period with a maximum of 50 mSv in any one year. For measured chest wall thicknesses of 1.9 cm to 4.1 cm and a 30 min counting time, the achievable MDAs for natural uranium in the KAERI lung counter vary from 5.75 mg to 11.28 mg. These values are close to, or even exceed, the predicted amounts of natural uranium that will remain in the lung (absorption type M and S) after an intake equal to the Annual Limit on Intake corresponding to a committed dose of 20 mSv. This paper shows that the KAERI lung counter probably cannot detect an intake of Type S natural uranium in a worker with a chest wall thickness equal to the average value (2.7 cm) under routine counting conditions

  11. Properties of novel composite meshes in chest wall reconstruction: A comparative animal study

    Directory of Open Access Journals (Sweden)

    Patrick Zardo

    2014-01-01

    Conclusion: We consider composite grafts a suitable alternative for chest wall reconstruction. They are characterized by good overall biointegration and limited perigraft-fibrosis, thus potentially facilitating redo-procedures, even though a hydrophilic coating per se does not appear to prevent intrathoracic adhesion formation.

  12. Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities

    International Nuclear Information System (INIS)

    Conventional post-mastectomy radiation therapy is delivered with tangential fields for chest wall and separate fields for regional nodes. Although chest wall and regional nodes delineation has been discussed with RTOG contouring atlas, CT-based planning to treat chest wall and regional nodes as a whole target has not been widely accepted. We herein discuss the dosimetric characteristics of a linac IMRT technique for treating chest wall and regional nodes as a whole PTV after modified radical mastectomy, and observe acute toxicities following irradiation. Patients indicated for PMRT were eligible. Chest wall and supra/infraclavicular region +/−internal mammary nodes were contoured as a whole PTV on planning CT. A simplified linac IMRT plan was designed using either integrated full beams or two segments of half beams split at caudal edge of clavicle head. DVHs were used to evaluate plans. The acute toxicities were followed up regularly. Totally, 85 patients were enrolled. Of these, 45 had left-sided lesions, and 35 received IMN irradiation. Planning designs yielded 55 integrated and 30 segmented plans, with median number of beams of 8 (6–12). The integrated and segmented plans had similar conformity (1.41±0.14 vs. 1.47±0.15, p=0.053) and homogeneity indexes (0.13±0.01 vs. 0.14±0.02, p=0.069). The percent volume of PTV receiving >110% prescription dose was <5%. As compared to segmented plans, integrated plans typically increased V5 of ipsilateral lung (p=0.005), and heart (p=0.001) in patients with left-sided lesions. Similarly, integrated plans had higher spinal cord Dmax (p=0.009), ipsilateral humeral head (p<0.001), and contralateral lung Dmean (p=0.019). During follow-up, 36 (42%) were identified to have ≥ grade 2 radiation dermatitis (RD). Of these, 35 developed moist desquamation. The median time to onset of moist desquamation was 6 (4–7) weeks from start of RT. The sites of moist desquamation were most frequently occurred in anterior axillary fold

  13. Evaluation of anterior chest wall implanted port: technical aspects, results, and complications

    International Nuclear Information System (INIS)

    To evaluate the technical aspects, results and complications of patients with implanted anterior chest wall port. Between April 1997 and June 1999, a total of 63 implanted ports were placed at the anterior chest wall of 63 consecutive patients by interventional radiologists. The indications were chemotherapy in 61 patients and total parenteral nutrition in two. The peripheral portion of the subclavian vein was punctured under fluoroscopic guidance via ipsilateral peripheral vein during venography. A central venous catheter was placed in the superior vena cava, and using the subcutaneous tunneling method, a connected infusion port was implanted at the anterior chest wall. Results and complications were reviewed, and by means of Kaplan-Meier survival analysis, the expected patency of the port was determined. The technical success rate for implanted port at the anterior chest wall was 100% (63/63 patients). In two patients, hematoma and oozing were treated by compression. The duration of port implantation ranged from 12 to 855 (mean, 187) days, and the port patency rate was 305.7±47.6 days. In seven patients (completed chemotherapy (n=3D3), central venous thrombosis (n=3D3) catheter-related infection (n=3D1)), the port was removed. Catheter obstruction occurred in two patients, and in one, the use of urokinase led to successful recanalization. Sixteen patients died of an underlying malignancy, but no catheter-related death was noted. Implantation of an anterior chest wall port is a safe and useful procedure, with long patency, for patients requiring chemotherapy and long-term venous access. (author)

  14. Short TI inversion-recovery MR imaging of chest wall malignancies

    International Nuclear Information System (INIS)

    Short-T1 inversion-recovery (STIR) sequences have greater constant, less motion sensitivity, and require shorter imaging times than conventional T2-weighted spin-echo (SE) sequences and are therefore particularly useful for staging chest wall malignancies. MR studies of 49 patients with possible chest wall malignancies were reviewed. Images were produced at 0.15 T with a variety of SE sequences. Forty-five also had STIR (repetition time, 1,400 - 2,100; echo time, 36 or 40; inversion time, 100 or 125). MR studies indicated chest wall involvement in 39 of 49 patients; 12 had obvious rib encasement, the most definitive finding. IN 13, lesions detected on STIR were either not visible or seen only in retrospect on T1 SE images. In five of five, STIR was clearly superior to T2 SE for delineation of tumor margins. The authors have discontinued using T2 SE sequences for chest neoplasms in favor of the higher contrast and sensitivity of STIR

  15. Unusual chest wall pain caused by thoracic disc herniation in a professional baseball pitcher.

    Science.gov (United States)

    Kato, Kinshi; Yabuki, Shoji; Otani, Koji; Nikaido, Takuya; Otoshi, Ken-Ichi; Watanabe, Kazuyuki; Kikuchi, Shin-Ichi; Konno, Shin-Ichi

    2016-06-01

    Symptomatic thoracic disc herniation is clinically rare. There are few cases of disc herniation of the thoracic spine in top athletes described in the literature. We herein present a rare case of chest wall pain due to thoracic disc herniation in a professional baseball pitcher. A 30-year-old, left-handed pitcher complained of left-sided chest wall pain in the region of his lower ribs during a game. Neurological examination revealed hypoesthesia of the left side of the chest at the level of the lower thoracic spine. Magnetic resonance imaging (MRI) of the thoracic spine showed a left-sided paramedian disc herniation at the T9-T10 level. The player was initially prescribed rest, administration of pregabalin (150 mg twice a day), and subsequent physical rehabilitation. He was able to resume full training and pitching without medication 6 months after the onset. A follow-up MRI of the thoracic spine showed a reduction in the size of the herniated disc compared to the initial findings. Though relatively rare, thoracic disc herniation should be considered in cases of chest wall pain in athletes. PMID:26983590

  16. Unilateral chest wall anomaly in a patient with Gardner' s syndrome: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Song, Eun Hee; Lee, So Yeon; Park, Hee Jin; Kwon, Heon Ju; Kim, Mi Sung; Park, Hae Won; Kwang, Hyon Joo [Dept. of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Hye Jin [Dept. of Radiology, Eulji General Hospital, Eulji University School of Medicine, Seoul (Korea, Republic of)

    2014-05-15

    Gardner syndrome is a familial disease consisting of colonic polyposis, osteomas, and soft tissue tumors. We describe unilateral chest wall anomaly in a 32-year-old man with Gardner syndrome. A chest radiograph showed asymmetric hypertrophy of the right seventh to tenth ribs. CT images showed increased size of the medullary portions of these lesions, but relatively normal thickness of the cortex. Intercostal muscles along the right seventh to tenth ribs were hypertrophied as compared with the contralateral ribs. Both lungs were clear but the volume of right lung showed slightly smaller than left one.

  17. Malignant Mesothelioma Presenting as a Giant Chest, Abdominal and Pelvic Wall Mass

    Energy Technology Data Exchange (ETDEWEB)

    Shao, Zhi Hong; Gao, Xiao Long; Yi, Xiang Hua; Wang, Pei Jun [Tongji Hospital of Tongji University, Shanghai (China)

    2011-11-15

    Malignant mesothelioma (MM) is a relatively rare carcinoma of the mesothelial cells, and it is usually located in the pleural or peritoneal cavity. Here we report on a unique case of MM that developed in the chest, abdominal and pelvic walls in a 77-year-old female patient. CT and MRI revealed mesothelioma that manifested as a giant mass in the right flank and bilateral pelvic walls. The diagnosis was confirmed by the pathology and immunohistochemistry. Though rare, accurate investigation of the radiological features of a body wall MM may help make an exact diagnosis.

  18. Chest wall thickness measurements and the dosimetric implications for male workers in the uranium industry

    International Nuclear Information System (INIS)

    The Human Monitoring Laboratory has measured the chest wall thickness and adipose mass fraction of a group of workers at three Canadian uranium refinery, conversion plant, and fuel fabrication sites using ultrasound. A site specific biometric equation has been developed for these workers, who seem to be somewhat larger than other workers reported in the literature. The average chest wall thickness of the seated persons measured at the uranium conversion plant and refinery was about 3.8 cm, and at the fuel fabrication facility was 3.4 cm. These values are not statistically different. Persons measured in a seated geometry had a thinner chest wall thickness than persons measured in a supine geometry - the decrease was in the range of 0.3 cm to 0.5 cm. It follows that a seated geometry will give a lower MDA (or decision level) than a supine geometry. Chest wall thickness is a very important modifier for lung counting efficiency and this data has been put into the perspective of the impending Canadian dose limits that will reduce the limit of occupationally exposed workers to essentially 20 mSv per year. Natural uranium must be measured based on the 235U emissions at these type of facilities. The refining and conversion process removes 234Th and the equilibrium is disturbed. This is unfortunate as the MDA values for this nuclide are approximately a factor of three lower than the values quoted below. The sensitivity of the germanium and phoswich based lung counting system has been compared. Achievable MDA's (30 minute counting time) with a four-phoswich-detector array lie in the range of 4.7 mg to 13.5 mg of natural uranium based on the 235U emissions over a range of chest wall thicknesses of 1.6 cm to 6.0 cm. The average achievable MDA is about 8.5 mg which can be reduced to about 6.2 mg by doubling the counting time. Similarly, MDA's (30 minute counting time) obtainable with a germanium lung counting system will lie in the range of 3 mg to 28 mg of natural uranium

  19. Reconstrução da parede torácica nos defeitos adquiridos Chest wall reconstruction in acquired defects

    Directory of Open Access Journals (Sweden)

    Marcus Vinicius H. de Carvalho

    2010-02-01

    Full Text Available Acquired chest wall defects present a challenging problem for thoracic surgeons. Many of such defects can be repaired with the use of local and regional musculocutaneous flaps, but larger defects compromising skeletal structure require increasingly sophisticated reconstructive techniques. The following discussion will review the options for repair acquired chest wall defects based in literature. The authors searched the Pubmed (www.pubmed.com and found citations from January 1996 to February 2008. By reading the titles and the abstracts most of the citations were discharged because they focused in congenital chest wall defects or were cases report. However, many papers were found describing the outcome of large series of patients with acquired chest wall deformities. A review of recent literature shows that the repair of chest wall defects with soft tissues, if possible, remains the treatment of choice. Large chest wall defects require skeletal reconstruction to prevent paradoxical respiration. The selection of the most appropriate flap is primary dictated by the location and the size of the defect. It is important to transfer tissue with good vitality, so understanding the vascular supply is imperative. Autogenous grafts have been used in the past for skeletal reconstruction but a combination of synthetic materials with musculocutaneous flaps has been used lately. Based in the literature, the use of prosthetic material in chest wall reconstruction does not significantly increases the risk of wound infection.

  20. Chest wall granuloma associated with BCG vaccination presenting as hot abscess in an immunocompetent infant.

    Science.gov (United States)

    Lee, Hyun Seung; Seo, Kyung Jin; Kim, Jae Jun

    2015-01-01

    Bacillus-Calmette-Gue´rin (BCG) vaccine is a live attenuated vaccine to prevent tuberculosis by cell mediated immune response and is routinely administered early after birth. Although it is considered to be a very safe vaccine, sometimes a variety of complications may develop. Herein we describe a clinically unusual case of chest wall granuloma considered to be induced by BCG, presenting as hot abscess, and developed 7 months after BCG vaccination in an immunocompetent infant. The diagnosis was made based on the history, histopathology and virological studies. We suggest, although very rare, a BCG disease should be considered as a differential diagnosis in case of chest wall abscess, even if this is presenting as a hot abscess and even in immunocompetent infants if their age is related to BCG vaccination complications. PMID:25887440

  1. Radiofrequency ablation and percutaneous permanent iodine-125 implantation as salvage therapy for giant recurrent sclerosing epithelioid fibrosarcoma of the chest wall: A case report

    Science.gov (United States)

    KE, SHAN; DING, XUE-MEI; GAO, JUN; WANG, SHAO-HONG; ZHANG, JUN; KONG, JIAN; SUN, WEN-BING

    2015-01-01

    Sclerosing epithelioid fibrosarcoma (SEF) is a rare soft-tissue sarcoma for which there is no standardized treatment regimen available. The current treatment options for SEF are resection, radiation and chemotherapy. Surgical resection remains the mainstay of therapy for SEF. However, SEF is an aggressive tumor that is prone to repeated local recurrence if not widely excised. Radiation and chemotherapy are less commonly used due to the insensitivity of SEF to these therapies. The treatment of recurrent SEF is even more challenging. The present study describes a patient who presented with a giant recurrent SEF arising from the chest wall that was accompanied by emergent bleeding. The patient was a 70-year-old male who had multiple comorbid diseases, including hypertension and chronic cardiac dysfunction. A computed tomography (CT) scan indicated the involvement of the sternum and anterior mediastinum. However, the patient refused any further surgery. Subsequent to careful discussion and consideration, radiofrequency (RF) ablation and percutaneous iodine-125 implantation was administered. The emergent bleeding was successfully stopped and the tumor was eliminated using RF ablation. Percutaneous iodine-125 implantation under CT guidance established effective control on the growth of the tumor involving the mediastinum. Despite this, the tumor recurred 6 months after treatment. The patient refused any further treatment and was discharged. In conclusion, RF ablation and percutaneous permanent iodine-125 implantation is a feasible and safe salvage therapy for patients with recurrent SEF of the chest wall. PMID:26137032

  2. Instant Abdominal Wall Reconstruction with Biologic Mesh following Resection of Locally Advanced Colonic Cancer

    OpenAIRE

    Oskay Kaya; Engin Olcucuoglu; Gaye Seker; Hakan Kulacoglu

    2012-01-01

    We present a case of immediate abdominal wall reconstruction with biologic mesh following the resection of locally advanced colonic cancer. The tumor in the right colon did not respond to neoadjuvant chemotherapy. Surgical enbloc excision, including excision of the invasion in the abdominal wall, was achieved, and the defect was reconstructed with porcine dermal collagen mesh. The patient was discharged with no complication, and adaptation of the mesh was excellent at the six-month followup.

  3. Case of chest-wall rigidity in a preterm infant caused by prenatal fentanyl administration

    OpenAIRE

    Eventov-Friedman, S; Rozin, I; Shinwell, E S

    2010-01-01

    The inability to appropriately ventilate neonates shortly after their birth could be related in rare cases to chest-wall rigidity caused by the placental transfer of fentanyl. Although this adverse effect is recognized when fentanyl is administered to neonates after their birth, the prenatal phenomenon is less known. Treatment with either naloxone or muscle relaxants reverses the fentanyl effect and may prevent unnecessary excessive ventilatory settings.

  4. Multidisciplinary approach to treatment of radiation-induced chest wall sarcoma.

    Science.gov (United States)

    Kara, H Volkan; Gandolfi, Brad M; Williams, Judson B; D'Amico, Thomas A; Zenn, Michael R

    2016-08-01

    Radiation-induced sarcoma (RIS) is a rare complication following therapeutic external irradiation for lung cancer patients. Patients with RIS may develop recurrence or metastasis of the previous disease and also at high risk for early chest wall complications following operation, which requires close follow-up and multidisciplinary approach. We present a challenging case of RIS with a multidisciplinary teamwork in the decision-making and successful management. PMID:25663293

  5. Individualized chest wall compensating bolus for electron irradiation following mastectomy: an ultrasound approach

    International Nuclear Information System (INIS)

    A-mode ultrasound is used in a procedure to construct individualized tissue compensating bolus for electron beam irradiation of the chest wall, where the thickness of tissues over the lung may vary by as much as 3 cm. Electron energies corresponding to the thickest tissues in the field would normally cause lung tissues beneath the thinner regions to receive the full tumor dose. The problem is made more serious by the fact that electron ranges in lung are 2-3 times greater than in muscle. We feel that some form of individualized compensation is necessary for patients with large variations in chest wall thickness within a given electron treatment field. The A-Scan procedure is particularly suited to deliniation of the pleura-lung interface because of the strong identifiable reflection from this discontinuity. In the first approach, a moldable gelatanous bolus material, mixed to transmit ultrasound at 5 MHz with a velocity equal to the speed of sound in muscle, is placed on the chest wall covering the entire field. The thickness of the compensating material is then reduced at each point in the field so that the total thickness (muscle plus compensator) indicated by the A-scan is everywhere the same as the chosen maximum treatment depth. Because the compensator has nearly the same electron stopping power as muscle, the compensated chest wall is now uniform in thickness over the entire field. In the second approach, we sacrifice the one-step advantages of using sonically transparent compensator material in order to obtain a more rugged and rapid setting compensator. Four patients have been treated with no evidence of pneumonitis. The more elegant combination of these two approaches awaits the development of rugged materials which are both quick setting and sonically transparent

  6. Severe neonatal hypercalcemia in 4-month-old, presented with respiratory distress and chest wall deformity

    Directory of Open Access Journals (Sweden)

    Akram Aljahdali

    2015-01-01

    Full Text Available Neonatal severe hyperparathyroidism (NSHPT is a rare disease affecting calcium metabolism and results in severe life-treating hypocalcemia of the neonates. Diagnosis can be challenging due to variable and nonspecific symptomatology. We are reporting on a 4-month-old female infant presenting with respiratory distress and chest wall deformity. We are trying to highlight different surgical options for this rare disease and importance of close collaboration with the pediatric endocrinologist in the treatment plan for those patients.

  7. VAC® for external fixation of flail chest

    OpenAIRE

    Rikke Winge; Berg, Jais O.; Rikke Albret; Christen Krag

    2012-01-01

    A large anterior chest wall defect following tumor resection was reconstructed with a Gore- Tex® membrane and a combined musculocutaneous rectus femoris and tensor fasciae latae free flap. Subsequent paradoxical respiration impeded weaning from the ventilator. Appliance of Vacuum Assisted Closure® (VAC®) resulted in immediate chest wall stability and a decrease in the patient’s need for respiratory support. Shortly thereafter, the VAC® was discontinued and the patient was discharged from the ...

  8. Thermoplastic patient fixation. Influence on chest wall and target motion during radiotherapy of lung cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kovacs, A.; Hadjiev, J.; Lakosi, F.; Vallyon, M.; Cselik, Z.; Bogner, P.; Repa, I. [Kaposvar Univ. (Hungary). Health Science Center; Horvath, A. [Debrecen Univ. (Hungary). Dept. of Radiotherapy

    2007-05-15

    Background and Purpose: Several methods have been developed to reduce tumor motions and patient movements during radiotherapy of lung cancer. In this study, a multislice CT-based analysis was performed to examine the effect of a thermoplastic patient immobilization system on the chest wall and tumor motions. Patients and Methods: Ten patients with stage II-IV lung cancer were enrolled into the study. According to tumor localization, five patients had peripheral, and five patients central lung cancer (T2-T4). In total, six series of measurements were made with a multislice CT scanner, both with and without mask fixation, in normal breathing, at maximal tidal volume inhalation, and at maximal tidal volume exhalation. Results: Movements of chest wall, diaphragm and tumor, with and without mask, under different breathing conditions were registered. With the use of the immobilization system, no significant difference was found in diaphragmatic movements (mean deviation of diaphragm: 41.7-40.5 mm to the right, and 40.5-36.8 mm to the left side) and in tumor motions (mean deviation of tumor: 15.3-12.4 mm in craniocaudal, and 11.5-8.8 mm in posterolateral direction, mean medial deviation: 4.6-4.1 mm, mean lateral deviation: 7.2-5 mm). Significant differences were observed concerning tumor motions in anteroposterior direction (mean: 8.9-6.3 mm) and transverse chest movements in anteroposterior direction. Conclusion: Besides the advantage of optimal patient positioning, the movements of the bony chest wall can be considerably reduced by using the immobilization system. However, this fixation system has limitations concerning its suitability for minimizing tumor motions. (orig.)

  9. An unusual case of isolated, serial metastases of gallbladder carcinoma involving the chest wall, axilla, breast and lung parenchyma

    Directory of Open Access Journals (Sweden)

    Matthew J. Iott

    2013-02-01

    Full Text Available In the English literature, only 9 cases of adenocarcinoma of the gallbladder with cutaneous metastasis have been reported so far. One case of multiple cutaneous metastases along with deposits in the breast tissue has been reported. We present a case of incidental metastatic gallbladder carcinoma with no intra-abdominal disease presenting as a series of four isolated cutaneous right chest wall, axillary nodal, breast and pulmonary metastases following resection and adjuvant chemoradiation for her primary tumor. In spite of the metastatic disease coupled with the aggressive nature of the cancer, this patient reported that her energy level had returned to baseline with a good appetite and a stable weight indicating a good performance status and now is alive at 25 months since diagnosis. Her serially-presented, oligometastatic diseases were well-controlled by concurrent chemoradiation and stereotactic radiation therapy. We report this case study because of its rarity and for the purpose of complementing current literature with an additional example of cutaneous metastasis from adenocarcinoma of the gallbladder.

  10. What Is Chest MRI?

    Science.gov (United States)

    ... from the NHLBI on Twitter. What Is Chest MRI? Chest MRI (magnetic resonance imaging) is a safe, noninvasive test. "Noninvasive" means that ... your chest wall, heart, and blood vessels. Chest MRI uses radio waves, magnets, and a computer to ...

  11. Management of radiation necrosis of the chest wall following mastectomy: a new treatment option

    International Nuclear Information System (INIS)

    A technique for covering areas of osteoradionecrosis in the medial aspect of the chest wall has been described. Utilizing a tissue expander, the skin was stretched sufficiently to obtain a suitable length whereby the medial defect could be covered and the donor site closed primarily. Such an operative approach should be considered when the patient presents with a medially located ulcer of small to moderate size and when nonirradiated skin is regionally available. Using this technique, long myocutaneous flaps that require extensive dissection, loss of functioning muscle, and resulting donor defects are avoided

  12. Numerical simulation on dynamic response of the chest wall loaded by the blast wave

    OpenAIRE

    Kang, Jianyi; Yu, Chunxiang; Li, Huimin; Chen, Jing; Liu, Hai

    2015-01-01

    In this paper, a three-dimensional finite element model of the human thorax was constructed using Mimics software and Icem CFD software. This model was loaded with a 100-kPa blast wave and constructed to analyze the dynamic response of the chest wall. The simulation results have shown that a blast wave can cause stress concentration on the ribs and ribs inward movement. The third, fourth, and fifth ribs have the maximum inward moving velocity of 1.6 m / s without any injury for the human body...

  13. Dosimetric evaluation of integrated IMRT treatment of the chest wall and supraclavicular region for breast cancer after modified radical mastectomy

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Bo; Wei, Xian-ding; Zhao, Yu-tian [Department of Radiation Oncology, the Fourth Affiliated Hospital of Suzhou University, Wuxi (China); Ma, Chang-Ming, E-mail: charlie.ma@fccc.edu [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)

    2014-07-01

    To investigate the dosimetric characteristics of irradiation of the chest wall and supraclavicular region as an integrated volume with intensity-modulated radiation therapy (IMRT) after modified radical mastectomy. This study included 246 patients who received modified radical mastectomy. The patients were scanned with computed tomography, and the chest wall (with or without the internal mammary lymph nodes) and supraclavicular region were delineated. For 143 patients, the chest wall and supraclavicular region were combined as an integrated planning volume and treated with IMRT. For 103 patients, conventional treatments were employed with 2 tangential fields for the chest wall, abutting a mixed field of 6-MV x-rays (16 Gy) and 9-MeV electrons (34 Gy) for the upper supraclavicular region. The common prescription dose was 50 Gy/25 Fx/5 W to 90% of the target volume. The dosimetric characteristics of the chest wall, the supraclavicular region, and normal organs were compared. For the chest wall target, compared with conventional treatments, the integrated IMRT plans lowered the maximum dose, increased the minimum dose, and resulted in better conformity and uniformity of the target volume. There was an increase in minimum, average, and 95% prescription dose for the integrated IMRT plans in the supraclavicular region, and conformity and uniformity were improved. The V{sub 30} of the ipsilateral lung and V{sub 10}, V{sub 30}, and mean dose of the heart on the integrated IMRT plans were lower than those of the conventional plans. The V{sub 5} and V{sub 10} of the ipsilateral lung and V{sub 5} of the heart were higher on the integrated IMRT plans (p < 0.05) than on conventional plans. Without an increase in the radiation dose to organs at risk, the integrated IMRT treatment plans improved the dose distribution of the supraclavicular region and showed better dose conformity and uniformity of the integrated target volume of the chest wall and supraclavicular region.

  14. Factors Associated With Chest Wall Toxicity After Accelerated Partial Breast Irradiation Using High-Dose-Rate Brachytherapy

    International Nuclear Information System (INIS)

    Purpose: The purpose of this analysis was to evaluate dose-volume relationships associated with a higher probability for developing chest wall toxicity (pain) after accelerated partial breast irradiation (APBI) by using both single-lumen and multilumen brachytherapy. Methods and Materials: Rib dose data were available for 89 patients treated with APBI and were correlated with the development of chest wall/rib pain at any point after treatment. Ribs were contoured on computed tomography planning scans, and rib dose-volume histograms (DVH) along with histograms for other structures were constructed. Rib DVH data for all patients were sampled at all volumes ≥0.008 cubic centimeter (cc) (for maximum dose related to pain) and at volumes of 0.5, 1, 2, and 3 cc for analysis. Rib pain was evaluated at each follow-up visit. Patient responses were marked as yes or no. No attempt was made to grade responses. Eighty-nine responses were available for this analysis. Results: Nineteen patients (21.3%) complained of transient chest wall/rib pain at any point in follow-up. Analysis showed a direct correlation between total dose received and volume of rib irradiated with the probability of developing rib/chest wall pain at any point after follow-up. The median maximum dose at volumes ≥0.008 cc of rib in patients who experienced chest wall pain was 132% of the prescribed dose versus 95% of the prescribed dose in those patients who did not experience pain (p = 0.0035). Conclusions: Although the incidence of chest wall/rib pain is quite low with APBI brachytherapy, attempts should be made to keep the volume of rib irradiated at a minimum and the maximum dose received by the chest wall as low as reasonably achievable.

  15. Solitary metastatic adenocarcinoma of the sternum treated by total sternectomy and chest wall reconstruction using a Gore-Tex patch and myocutaneous flap: a case report

    Directory of Open Access Journals (Sweden)

    Korfer Reiner

    2010-03-01

    Full Text Available Abstract Introduction The consequences of bone metastasis are often devastating. Although the exact incidence of bone metastasis is unknown, it is estimated that 350,000 people die of bone metastasis annually in the United States. The incidence of local recurrences after mastectomy and breast-conserving therapy varies between 5% and 40% depending on the risk factors and primary therapy utilized. So far, a standard therapy of local recurrence has not been defined, while indications of resection and reconstruction considerations have been infrequently described. This case report reviews the use of sternectomy for breast cancer recurrence, highlights the need for thorough clinical and radiologic evaluation to ensure the absence of other systemic diseases, and suggests the use of serratus anterior muscle flap as a pedicle graft to cover full-thickness defects of the anterior chest wall. Case presentation We report the case of a 70-year-old Caucasian woman who was referred to our hospital for the management of a retrosternal mediastinal mass. She had undergone radical mastectomy in 1999. Computed tomography and magnetic resonance imaging revealed a 74.23 × 37.7 × 133.6-mm mass in the anterior mediastinum adjacent to the main pulmonary artery, the right ventricle and the ascending aorta. We performed total sternectomy at all layers encompassing the skin, the subcutaneous tissues, the right pectoralis major muscle, all the costal cartilages, and the anterior part of the pericardium. The defect was immediately closed using a 0.6 mm Gore-Tex cardiovascular patch combined with a serratus anterior muscle flap. Our patient had remained asymptomatic during her follow-up examination after 18 months. Conclusion Chest wall resection has become a critical component of the thoracic surgeon's armamentarium. It may be performed to treat either benign conditions (osteoradionecrosis, osteomyelitis or malignant diseases. There are, however, very few reports on the

  16. Reconstruction of full thickness abdominal wall defect following tumor resection: A case report

    Directory of Open Access Journals (Sweden)

    Kovačević Predrag

    2014-01-01

    Full Text Available Introduction. Reconstruction of a full thickness abdominal wall defect is a demanding procedure for general and also for plastic surgeons, requiring vigorous planning and reconstruction of three layers. Case Outline. We present a case of a 70-year-old patient with a huge abdominal wall tumor with 40 years evolution. Surgery was performed under general anesthesia. Full thickness abdominal defect appeared after the tumor resection. Reconstruction followed in the same act. The defect was reconstructed using a combination of techniques, including omental flap, fascia lata graft, local skin flaps and skin grafts. After surgery no major complications were noted, only a partial skin flap loss, which was repaired using partial thickness skin grafts. The final result was described by the patient as very good, without hernia formation. Conclusion. Omenthoplasty, abdominal wall reconstruction in combination with free fascia lata graft and skin grafts can be one of good options for the reconstruction of full thickness abdominal wall defects.

  17. Low-grade extraskeletal osteosarcoma of the chest wall: case report and review of literature

    Directory of Open Access Journals (Sweden)

    Chetaille Bruno

    2010-11-01

    Full Text Available Abstract Background Low-grade extraskeletal osteosarcomas (ESOS are extremely rare. Case presentation We present the first case of low-grade ESOS of the chest wall, which occurred in a 30-year-old man. Because of initial misdiagnosis and patient's refusal of surgery, the diagnosis was done after a 4-year history of a slowly growing mass in soft tissues, leading to a huge (30-cm diameter calcified mass locally extended over the left chest wall. Final diagnosis was helped by molecular analysis of MDM2 and CDK4 oncogenes. Unfortunately, at this time, no surgical treatment was possible due to loco-regional extension, and despite chemotherapy, the patient died one year after diagnosis, five years after the first symptoms. Conclusion We describe the clinical, radiological and bio-pathological features of this unique case, and review the literature concerning low-grade ESOS. Our case highlights the diagnostic difficulties for such very rare tumours and the interest of molecular analysis in ambiguous cases.

  18. Radiation induced skin cancer the chest wall 30 years later from breast cancer operation

    Energy Technology Data Exchange (ETDEWEB)

    Miyamoto, Kouji; Togawa, Tamotsu; Hasegawa, Takeshi; Matsunami, Hidetoshi; Ikeda, Tsuneko [Matsunami General Hospital, Kasamatsu, Gifu (Japan); Matsuo, Youichi

    1998-10-01

    This paper describes the skin cancer on the frontal chest wall induced by postoperative irradiation 30 years later from mastectomy. The patients was a 62-year-old woman, who received mastectomy of the right breast cancer (invasive ductal carcinoma, comedo type) at 31 years old, and received the postoperative radiotherapy of total 11,628 rad over 38 times. On the first medical examination in author`s hospital, the patient had an ulcer of about 10 cm diameter and was diagnosed the radiation induced skin cancer (well differentiated squamous cell carcinoma) in the biopsy. Because of the general condition of the patient was extremely bad and the skin cancer had highly developed, the excision was thought to be impossible. The radiotherapy (16 Gy) and combined local chemotherapy by OK 432 and Bleomycin were performed. In spite of the short term treatment, these therapies were effective on the reduction of the tumor size and the hemostasis, and brought the patient the improvement of QOL. The general condition of the patient improved to be stable and she recovered enough to go out from the hospital for 6 months. After 10 months, she showed anorexia and dyspnea and died after about 1 year from the admission. The present case is extremely rare, and it is required the radical therapy like the excision of chest wall at early stage. (K.H.)

  19. Chest wall involvement by lung cancer. Thin-section computed tomography based on radiologic-pathologic correlation

    Energy Technology Data Exchange (ETDEWEB)

    Yamada, Kouzo; Katou, Yuji; Oshita, Fumihiro [Kanagawa Cancer Center, Yokohama (Japan)] [and others

    1996-10-01

    The aim of this retrospective study was to evaluate the role of conventional computed tomography (CT) findings and thin-section CT findings in predicting chest wall invasion by lung cancer, and the results of surgery according to the depth of chest wall involvement. We reviewed 33 patients with lung cancer adjacent to the pleural surface who underwent conventional CT scanning and subsequent thoracotomy. All the patients were examined with a TCT-900S, HELIX scanner (Toshiba, Tokyo) following bolus intravenous contrast medium administration (conventional: 60 ml; thin-section: 40 ml). The conventional CT images (taken at 10 mm intervals with 10 mm collimation) and thin-section CT images (taken at 2 mm intervals with 2 mm collimation) were reconstructed employing an extended scale (window level: 40; window width: 400) using standard images. A comparison of the diagnoses based on the thin-section CT findings and pathological examination findings showed thin-section CT to be 82% accurate for chest wall invasion compared to 48% for conventional CT. We conclude that thin-section CT is useful for the accurate evaluation of chest wall invasion in lung cancer, especially for patients in whom findings by conventional CT suggest possible tumor invasion of the chest wall. (author)

  20. Evaluation of the safety of high-frequency chest wall oscillation (HFCWO therapy in blunt thoracic trauma patients

    Directory of Open Access Journals (Sweden)

    Becker Brian

    2008-10-01

    Full Text Available Abstract Background Airway clearance is frequently needed by patients suffering from blunt chest wall trauma. High Frequency Chest Wall Oscillation (HFCWO has been shown to be effective in helping to clear secretions from the lungs of patients with cystic fibrosis, bronchiectasis, asthma, primary ciliary dyskinesia, emphysema, COPD, and many others. Chest wall trauma patients are at increased risk for development of pulmonary complications related to airway clearance. These patients frequently have chest tubes, drains, catheters, etc. which could become dislodged during HFCWO. This prospective observational study was conducted to determine if HFCWO treatment, as provided by The Vest™ Airway Clearance System (Hill-Rom, Saint Paul, MN, was safe and well tolerated by these patients. Methods Twenty-five blunt thoracic trauma patients were entered into the study. These patients were consented. Each patient was prescribed 2, 15 minute HFCWO treatments per day using The Vest® Airway Clearance System (Hill-Rom, Inc., St Paul, MN. The Vest® system was set to a frequency of 10–12 Hz and a pressure of 2–3 (arbitrary unit. Physiological parameters were measured before, during, and after treatment. Patients were free to refuse or terminate a treatment early for any reason. Results No chest tubes, lines, drains or catheters were dislodged as a result of treatment. One patient with flail chest had a chest tube placed after one treatment due to increasing serous effusion. No treatments were missed and continued without further incident. Post treatment survey showed 76% experienced mild or no pain and more productive cough. Thirty days after discharge there were no deaths or hospital re-admissions. Conclusion This study suggests that HFCWO treatment is safe for trauma patients with lung and chest wall injuries. These findings support further work to demonstrate the airway clearance benefits of HFCWO treatment.

  1. Nodular Fasciitis of the Chest Wall as seen on Breast Sonography: This Clinically Simulated Palpable Breast Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Woo Jeong; Lee, Jin Hwa; Kang, Eun Ju; Kim, Dae Cheol; Cho, Se Heon; Nam, Kyung Jin [Dong-A University College of Medicine, Busan (Korea, Republic of)

    2011-09-15

    Nodular fasciitis is a rapidly growing benign soft tissue tumor that is related to the fascia and this tumor is generally seen in young and middle aged adults. It is often seen as a subcutaneous solitary nodule in an upper extremity. Clinically, it is often mistaken for a malignancy. We present here a rare case of nodular fasciitis of the chest wall and that was observed on breast sonography (US) and this lesion clinically simulated palpable breast cancer. US may be helpful for evaluating a chest wall lesion that is misunderstood to be a breast lump. So, if the lesion's location is vague, US can reveal the exact location and characteristics of the mass. Although the incidence of nodular fasciitis is rare, nodular fasciitis should be considered in the differential diagnosis when a lesion is located in the chest wall

  2. Low incidence of chest wall pain with a risk-adapted lung stereotactic body radiation therapy approach using three or five fractions based on chest wall dosimetry.

    Directory of Open Access Journals (Sweden)

    Thibaud P Coroller

    Full Text Available PURPOSE: To examine the frequency and potential of dose-volume predictors for chest wall (CW toxicity (pain and/or rib fracture for patients receiving lung stereotactic body radiotherapy (SBRT using treatment planning methods to minimize CW dose and a risk-adapted fractionation scheme. METHODS: We reviewed data from 72 treatment plans, from 69 lung SBRT patients with at least one year of follow-up or CW toxicity, who were treated at our center between 2010 and 2013. Treatment plans were optimized to reduce CW dose and patients received a risk-adapted fractionation of 18 Gy×3 fractions (54 Gy total if the CW V30 was less than 30 mL or 10-12 Gy×5 fractions (50-60 Gy total otherwise. The association between CW toxicity and patient characteristics, treatment parameters and dose metrics, including biologically equivalent dose, were analyzed using logistic regression. RESULTS: With a median follow-up of 20 months, 6 (8.3% patients developed CW pain including three (4.2% grade 1, two (2.8% grade 2 and one (1.4% grade 3. Five (6.9% patients developed rib fractures, one of which was symptomatic. No significant associations between CW toxicity and patient and dosimetric variables were identified on univariate nor multivariate analysis. CONCLUSIONS: Optimization of treatment plans to reduce CW dose and a risk-adapted fractionation strategy of three or five fractions based on the CW V30 resulted in a low incidence of CW toxicity. Under these conditions, none of the patient characteristics or dose metrics we examined appeared to be predictive of CW pain.

  3. VAC® for external fixation of flail chest

    DEFF Research Database (Denmark)

    Winge, Rikke; Berg, Jais O; Albret, Rikke;

    2012-01-01

    A large aterior chest wall defect following tumor resection was reconstructed with a Gore-Tex® membrane and a combined musculocutaneous rectus femoris and tensor fasciae latae free flap. Subsequent paradoxical respiration impeded weaning from the ventilator. Appliance of Vacuum Assisted Closure...

  4. Complex regional pain syndrome with associated chest wall dystonia: a case report

    Directory of Open Access Journals (Sweden)

    Schwartzman Robert J

    2011-09-01

    Full Text Available Abstract Patients with complex regional pain syndrome (CRPS often suffer from an array of associated movement disorders, including dystonia of an affected limb. We present a case of a patient with long standing CRPS after a brachial plexus injury, who after displaying several features of the movement disorder previously, developed painful dystonia of chest wall musculature. Detailed neurologic examination found palpable sustained contractions of the pectoral and intercostal muscles in addition to surface allodynia. Needle electromyography of the intercostal and paraspinal muscles supported the diagnosis of dystonia. In addition, pulmonary function testing showed both restrictive and obstructive features in the absence of a clear cardiopulmonary etiology. Treatment was initiated with intrathecal baclofen and the patient had symptomatic relief and improvement of dystonia. This case illustrates a novel form of the movement disorder associated with CRPS with response to intrathecal baclofen treatment.

  5. Biometric estimation of chest wall thickness in female nonradiation workers of a monazite processing plant

    International Nuclear Information System (INIS)

    Chest wall thickness (CWT) was estimated in fifty four female nonradiation workers of a monazite processing plant by biometric measurements. The CWT ranged from 4.12 cm to 6.94 cm giving an average of 5.19 ± 0.76 cm. CWT was found to have very good correlation with percent Body Fat and abdominal circumference but poor correlation with Body Mass Index, Body Build Index, Slenderness, age etc. CWT increases with age especially in the upper middle-aged group (> 35 years). A single measurement of abdominal circumference can be used to estimate CWT with 94 % accuracy. A factor of 0.0587 was derived to estimate CWT from abdominal circumference. The study also showed that about 11 % of the subjects were obese. The results obtained will be very useful for the accurate measurement of Low Energy Photons like 239Pu and 241Am deposited in the lung. (author)

  6. Resecciones de pared torácica y su reconstrucción Resection of thoracic wall and its repair

    Directory of Open Access Journals (Sweden)

    Abel Nicolás Monzón Fernández

    2009-03-01

    Full Text Available Introducción: El tratamiento quirúrgico de los tumores de pared torácica ya sean primarios o metastásicos requiere de un procedimiento específico por parte de los cirujanos, porque la cirugía oncológica precisa de una reconstrucción adecuada como una necesidad fisiológica e imprescindible para la supervivencia del paciente. Métodos: Se presenta una serie de 26 pacientes que requirieron resección amplia de la pared torácica (esternal y/o con costillas con márgenes libres de enfermedad y reconstrucción con tejidos sintéticos o con colgajos musculocutáneos pediculados solos o combinados en el mismo acto quirúrgico. Resultados: Tras el análisis patológico seis de los tumores extirpados fueron de procedencia benigna y 20 malignos, con predominio de 6 condrosarcomas, 5 metástasis, 3 tumores de Askin, entre otros tipos histológicos. No hubo fallecidos en la serie por complicaciones, pero si por progresión de la enfermedad en número de 9. Se presentó una sobrevida a 5 años del 44,7%. La mayoría de las muertes correspondió a etapas avanzadas de la enfermedad. Conclusiones: La resección amplia de tumores de pared torácica con reconstrucción mediante prótesis y colgajos músculos cutáneos es un método seguro que puede practicarse en un solo tiempo quirúrgico, el cual ofrece una buena sobrevida y una óptima calidad de vida.Introduction: Surgical treatment of chest wall tumours (primary or metastatic requires specific skills by surgeons, due that oncological surgery needs suitable reconstruction as a condition for the survival of the patient. Methods: We present a series of 26 patients who needed extensive resection of the thoracic wall (external and/or ribs with disease free margins and reconstruction with syntetic tissues or muscle-skin flaps pedicled single or combing during the same surgical intervention. Results: The aetiology of the extirpated tumours, following pathology assessment, were bening 6 and 20 malignant

  7. Chest Wall Thickness Measurements and the Dosimetric Implications for Male Workers in the South Korean Uranium Industry

    International Nuclear Information System (INIS)

    Using ultrasound techniques, the Human Monitoring Laboratory has measured chest wall thicknesses of a group of male workers at the Korea Atomic Energy Research Institute. A site-specific biometric equation has been developed for these workers, who are somewhat smaller than other workers reported in the literature. Chest wall thickness is an important modifier on lung counting efficiency. These data have been put into the perspective of the ICRP recommended dose limits for occupationally exposed workers: 100 mSv in a 5-year period with a maximum of 50 mSv in any one year. For measured chest wall thicknesses of 1.9 cm to 4.1 cm and a 30 min counting time, the achievable MDAs for natural uranium in the KAERI lung counter vary from 6.6 mg to 13.2 mg. These values are close to, or even exceed, the predicted amounts of natural uranium that will remain in the lung (absorption type M and S) after an intake equal to the Annual Limit on Intake corresponding to a committed dose of 20 mSv. This paper shows that the KAERI lung counter probably cannot detect an intake of Type S natural uranium in a worker with a chest wall thickness equal to the average value (2.7 cm) under routine counting conditions. (author)

  8. Biometric estimation of chest wall thickness of female radiation workers as an aid in in-vivo detection of the actinides

    International Nuclear Information System (INIS)

    An equation was derived to estimate female chest wall thickness from a series of biometric measurements. This technique will result in improved performance for actinide detection in females by accounting for variations in chest wall thickness in derivation of calibration factors

  9. Cine magnetic resonance imaging, computed tomography and ultrasonography in the evaluation of chest wall invasion of lung cancer

    International Nuclear Information System (INIS)

    To assess the usefulness of cine-magnetic resonance imaging (cine-MRI) in the evaluation of chest wall invasion, we compared the results of cine-MRI with those of computed tomography (CT) and ultrasonography (US). Eleven patients were examined who had no pain and who were difficult to diagnose by routine examinations. MRI was performed with a Magnetom SP/4000, 1.5T unit (Siemens, Germany). For cine imaging, continuous turbo-FLUSH (ultra fast low angle shot) images were obtained at an orthogonal section to the chest wall during slow deep breathing. A CT scan was performed using a TCT 900S or Super Helix (Toshiba, Japan) at 1 cm intervals, with section thicknesses of 1 cm throughout the entire chest. US was performed with a model SSA-270A (Toshiba, Japan) with 7.5-MHz linear array scanners (PLF-705S; Toshiba, Japan). Sensitivity, specificity and accuracy were 67%, 75% and 73% for cine MRI, 67%, 63% and 64% for CT, 33%, 75% and 64% for US, respectively. These results indicate that cine MRI is potentially useful for the diagnosis of chest wall invasion of lung cancer. (author)

  10. Actinomicose pulmonar com envolvimento da parede torácica Lung actinomycosis with chest wall involvement

    Directory of Open Access Journals (Sweden)

    Marcelo Cunha Fatureto

    2007-02-01

    Full Text Available A Actinomicose é uma infecção rara, crônica, supurativa e granulomatosa que pode envolver diversos órgãos. A infecção pulmonar geralmente está relacionada à imunodepressão e à saúde bucal precária. O envolvimento torácico é incomum (10 - 20%, a parede torácica é acometida em apenas 12% destes casos. No presente trabalho, é descrito o caso de um paciente de 26 anos, não HIV e sem co-morbidades, assintomático respiratório, com massa infra-escapular, de crescimento progressivo, muito dolorosa, com sinais locais flogísticos, sem trauma local, apresentando febre persistente, com três meses de evolução. O diagnóstico inicial foi de neoplasia de partes moles de parede torácica. À biopsia incisional da referida massa, houve saída de secreção gelatinosa vinhosa com grânulos amarelados, sugestivos de actinomicose, sendo confirmado por exame anatomopatológico. Empiricamente foi instituída ciprofloxacina devido alergia à cefalosporina. Houve excelente resposta clínica à drenagem externa e à medicação prescrita. Não houve recaída da doença em 18 meses de seguimento.Actinomycosis is an uncommon suppurative granulomatous chronic infection that may involve several organs. Lung infection is usually related to immunodepression and poor oral hygiene. Cases of thoracic involvement are rare (10 - 20% and only 12% of such cases affect the chest wall. This report describes the case of a 26-year-old HIV-negative patient without comorbidities or respiratory complaints who presented a very painful, progressively growing infrascapular mass, with local phlogistic signs and no local trauma, and persistent fever. It had been progressing for three months. The initial diagnosis was neoplasia of chest wall soft tissue. However, incision biopsy in this mass produced a red wine-colored gelatinous secretion containing yellowish granules suggestive of actinomycosis, which was later confirmed by anatomopathological examination

  11. Effects of chest wall compression on expiratory flow rates in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Masafumi Nozoe

    2016-01-01

    Full Text Available Background: Manual chest wall compression (CWC during expiration is a technique for removing airway secretions in patients with respiratory disorders. However, there have been no reports about the physiological effects of CWC in patients with chronic obstructive pulmonary disease (COPD. Objective: To compare the effects of CWC on expiratory flow rates in patients with COPD and asymptomatic controls. Method: Fourteen subjects were recruited from among patients with COPD who were receiving pulmonary rehabilitation at the University Hospital (COPD group. Fourteen age-matched healthy subjects were also consecutively recruited from the local community (Healthy control group. Airflow and lung volume changes were measured continuously with the subjects lying in supine position during 1 minute of quiet breathing (QB and during 1 minute of CWC by a physical therapist. Results: During CWC, both the COPD group and the healthy control group showed significantly higher peak expiratory flow rates (PEFRs than during QB (mean difference for COPD group 0.14 L/sec, 95% confidence interval (CI 0.04 to 0.24, p<0.01, mean difference for healthy control group 0.39 L/sec, 95% CI 0.25 to 0.57, p<0.01. In the between-group comparisons, PEFR was significantly higher in the healthy control group than in the COPD group (-0.25 L/sec, 95% CI -0.43 to -0.07, p<0.01. However, the expiratory flow rates at the lung volume at the PEFR during QB and at 50% and 25% of tidal volume during QB increased in the healthy control group (mean difference for healthy control group 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.31 L/sec, 95% CI 0.15 to 0.47, p<0.01: 0.27 L/sec, 95% CI 0.13 to 0.41, p<0.01, respectively but not in the COPD group (0.05 L/sec, 95% CI -0.01 to 0.12: -0.01 L/sec, 95% CI -0.11 to 0.08: 0.02 L/sec, 95% CI -0.05 to 0.90 with the application of CWC. Conclusion: The effects of chest wall compression on expiratory flow rates was different between COPD patients and

  12. Small bowel resection - discharge

    Science.gov (United States)

    ... incision is red, warm, swollen, or more painful Short of breath or chest pain Swollen legs or pain in your calves Alternative Names Small intestine surgery - discharge; Bowel resection - small intestine - discharge; Resection of ...

  13. Evaluating proton stereotactic body radiotherapy to reduce chest wall dose in the treatment of lung cancer

    International Nuclear Information System (INIS)

    Stereotactic body radiotherapy (SBRT) can produce excellent local control of several types of solid tumor; however, toxicity to nearby critical structures is a concern. We found previously that in SBRT for lung cancer, the chest wall (CW) volume receiving 20, 30, or 40 Gy (V20, V30, or V40) was linked with the development of neuropathy. Here we sought to determine whether the dosimetric advantages of protons could produce lower CW doses than traditional photon-based SBRT. We searched an institutional database to identify patients treated with photon SBRT for lung cancer with tumors within 20 was 364.0 cm3 and 160.0 cm3 (p 30 was 144.6 cm3vs 77.0 cm3 (p = 0.0012), V35 was 93.9 cm3vs 57.9 cm3 (p = 0.005), V40 was 66.5 cm3vs 45.4 cm3 (p = 0.0112), and mean lung dose was 5.9 Gy vs 3.8 Gy (p = 0.0001) for photons and protons, respectively. Coverage of the planning target volume (PTV) was comparable between the 2 sets of plans (96.4% for photons and 97% for protons). From a dosimetric standpoint, proton SBRT can achieve the same coverage of the PTV while significantly reducing the dose to the CW and lung relative to photon SBRT and therefore may be beneficial for the treatment of lesions closer to critical structures

  14. Total and local impedances of the chest wall up to 10 Hz.

    Science.gov (United States)

    Barnas, G M; Yoshino, K; Fredberg, J; Kikuchi, Y; Loring, S H; Mead, J

    1990-04-01

    To understand how bical mechanical chest wall (CW) properties are related to those of the CW as a whole, we measured esophageal and gastric pressures, CW volume changes (measured with a head-out body plethysmograph), and anteroposterior and transverse CW diameter changes (measured with magnetometers attached to the surface) during sinusoidal forcing at the mouth (2.5% vital capacity, 0.5-10 Hz) in four healthy subjects. Total CW resistance decreased sharply as frequency rose to 3-4 Hz and remained relatively constant at higher frequencies. Total CW reactance became less negative with increasing frequency but showed no tendency to change sign. Above 2 Hz, diameters measured at different locations changed asynchronously between and within the rib cage and abdomen. "Local pathway impedances" (ratios of esophageal or gastric pressure to a rate of diameter change) showed frequency dependence similar to that of the total CW less than 3 Hz. Local pathway impedances increased during contraction of respiratory muscles acting on the pathway. We conclude that 1) total CW behavior is mainly a reflection of its individual local properties at less than or equal to 3 Hz, 2) local impedances within the rib cage or within the abdomen can change independently in some situations, and 3) asynchronies that develop within the CW during forcing greater than 3 Hz suggest that two compartments may be insufficient to describe CW properties from impedance measurements. PMID:2140827

  15. A rare chest wall localized soft tissue sarcoma: Clear cell sarcoma

    Directory of Open Access Journals (Sweden)

    Ulaş Alabalık

    2013-03-01

    Full Text Available The clear cell sarcomas of soft tissue are rare tumorsoriginating from neural crest cells and presenting withpoor prognosis. By the reason of the resemblance ofhistological properties to malign melanoma (eg. the immunoreactivityto S100 and HMB45, the presence of melanosomesultrastructurally, these tumors are also definedas malign melanomas of soft tissue. But distinctivelyfrom cutaneous melanoma, clear cell sarcoma is almostalways deeply localized and the biological behaviour ofthe last one is also different. The differential diagnosisbetween clear cell sarcoma and desmoplastic or spindlecell malign melanoma may be more difficult because ofthe dermal localization of the last ones. In our case, itwas observed an infiltrative tumor composed of uniformseeming cells with vesicular nuclei, distinct nucleoli, paleeosinophilic and sometimes clear, scant cytoplasms, inaddition to necrotic areas. On immunohistochemical examination,the tumoral cells showed a positive immunoreactivityto vimentin, S100, HMB45, and SMA, while showingnegative immunoreactivity with CD34, PanCK, EMA,LCA, CD99 and desmin. Ki-67 proliferation index was determinedas approximately 50%. Because of deep localizationand different morphological-immunohistochemicalfindings of the tumor, the case was diagnosed as “clearcell sarcoma”. It was observed a tumor with similar morphologyin the biopsy sample taken from vertebra of thepatient one month later than the first material and this wascommented as the metastasis of the tumor to vertebra.Key words: Clear cell sarcoma, chest wall, metastasis,vertebral, HMB-45, S-100

  16. Aortic wall low density on chest CT: atheromatous plaque vs. thrombosed false lumen

    International Nuclear Information System (INIS)

    A curvilinear or thick band-like low density on aortic wall on CT scan is sometimes problematic. The point is whether its represents atheromatous plaque of thrombosed false lumen of the dissecting aneurysm. We reviewed 212 randomly selected chest CT cases with regard to low density on the thoracic aorta. Thirty two patients showed visible low density on the aorta. Seven patients had dissecting aneurysm confirmed by aortography and/or CT scan. Atheromatous palque did not exceed 4mm in its maximum thickness and appeared as curvilinear rim, while thrombosed false lumen of the dissecting aneurysm exceeded 10mm in its maximum thickness in all cases with the shape of crescent, half-moon or thick band. Maximum transverse diameter of thoracic aorta was more than 4cm in all cases of dissecting aneurysm while none of the atheromatous plaque cases showed more than 4cm. Thrombosed false lumen of the dissecting aneurysm can reliably be distinguished from atheroma by its thicker low density region and larger size of the aorta.

  17. Modulated electron radiotherapy treatment planning using a photon multileaf collimator for post-mastectomized chest walls

    International Nuclear Information System (INIS)

    Background and purpose: To evaluate the feasibility of using a photon MLC (xMLC) for modulated electron radiotherapy treatment (MERT) as an alternative to conventional post-mastectomy chest wall (CW) irradiation. A Monte Carlo (MC) based planning system was developed to overcome the inaccuracy of the 'pencil beam' algorithm. MC techniques are known to accurately calculate the dose distributions of electron beams, allowing the explicit simulation of electron interactions within the MLC. Materials and methods: Four real clinical CW cases were planned using MERT which were compared with the conventional electron treatments based on blocks and by a straightforward approach using the MLC, and not the blocks (as an intermediate step to MERT) to shape the same segments with SSD between 60 and 70 cm depending on PTV size. MC calculations were verified with an array of ionization chambers and radiochromic films in a solid water phantom. Results: Tests based on gamma analysis between MC dose distributions and radiochromic film measurements showed an excellent agreement. Differences in the absolute dose measured with a plane-parallel chamber at a reference point were below 3% for all cases. MERT solution showed a better PTV coverage and a significant reduction of the doses to the organs at risk (OARs). Conclusion: MERT can effectively improve the current electron treatments by obtaining a better PTV coverage and sparing healthy tissues. More directly, block-shaped treatments could be replaced by MLC-shaped non-modulated segments providing similar results.

  18. [Reconstruction of the anterior chest wall by a sandwich-type combination of a synthetic support and a muscle flap from the latissimus dorsi. Apropos of a case].

    Science.gov (United States)

    Lanfrey, E; Grolleau, J L; Glock, Y; Chavoin, J P; Costagliola, M

    1996-04-01

    Reconstruction of the chest wall after balistic or other trauma requires good and muscle cover and creation of a new, stable and airtight wall. The authors present a case of balistic trauma of the right anterolateral chest wall which was urgently debrided and subsequently reconstructed by sandwich combination of a latissimus dorsi muscle flap and synthetic material composed of a sheet of PTFE and creation of two methylmethylacrylate ribs. The advantage of this technique is that it avoids the use of autologous tissue from an already weakened chest wall and confers a new chest stability in several sites corresponding to the wall defect with easily available and easy-to-use materials. PMID:8761064

  19. Extrinsic tracheal compression caused by scoliosis of the thoracic spine and chest wall degormity: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Baek, Kyong min Sarah; Lee, Bae Young; Kim, Hyeon Sook; Song, Kyung Sup; Kang, Hyeon Hul; Lee, Sang Haak; Moon, Hwa Sik [St. Paul' s Hospital, College of Medicine, The Catholic University of Korea, Seoul (Korea, Republic of)

    2014-05-15

    Extrinsic airway compression due to chest wall deformity is not commonly observed. Although this condition can be diagnosed more easily with the help of multidetector CT, the standard treatment method has not yet been definitely established. We report a case of an eighteen-year-old male who suffered from severe extrinsic tracheal compression due to scoliosis and straightening of the thoracic spine, confirmed on CT and bronchoscopy. The patient underwent successful placement of tracheal stent but later died of bleeding from the tracheostomy site probably due to tracheo-brachiocephalic artery fistula. We describe the CT and bronchoscopic findings of extrinsic airway compression due to chest wall deformity as well as the optimal treatment method, and discuss the possible explanation for bleeding in the patient along with review of the literature.

  20. Bone scan findings of chest wall pain syndrome after stereotactic body radiation therapy: implications for the pathophysiology of the syndrome

    OpenAIRE

    Lloyd, Shane; Decker, Roy H.; Evans, Suzanne B.

    2013-01-01

    We present a case of a 72-year-old woman treated with stereotactic body radiation therapy (SBRT) for peripherally located stage I non-small cell lung cancer (NSCLC). After treatment she developed ipsilateral grade II chest wall pain. A bone scan showed nonspecific and heterogeneous increased radiotracer uptake in the volume of ribs receiving 30% of the prescription dose of radiation (V30). We present a color wash image demonstrating excellent concordance between the V30 and the area of scinti...

  1. A study of the first heart sound spectra in normal anesthetized cats: possible origins and chest wall influences.

    OpenAIRE

    Fazzalari, N L; Mazumdar, J; Ghista, D. N.; Allen, D G; de Bruin, H

    1984-01-01

    Heart sound recordings were taken from cats. The heart sounds were recorded directly from the chest wall and through an esophageal tube. The phono transducer and the esophageal tube were both placed over the base of the heart. Ultrasound M-mode, or motion-mode, recordings were taken to study the mitral valve dynamics. After analogue to digital conversion, electrocardiogram gated first heart sounds of each phono record were analyzed by the fast Fourier transform to obtain a frequency spectrum....

  2. Rib cage deformities alter respiratory muscle action and chest wall function in patients with severe osteogenesis imperfecta.

    Directory of Open Access Journals (Sweden)

    Antonella LoMauro

    Full Text Available BACKGROUND: Osteogenesis imperfecta (OI is an inherited connective tissue disorder characterized by bone fragility, multiple fractures and significant chest wall deformities. Cardiopulmonary insufficiency is the leading cause of death in these patients. METHODS: Seven patients with severe OI type III, 15 with moderate OI type IV and 26 healthy subjects were studied. In addition to standard spirometry, rib cage geometry, breathing pattern and regional chest wall volume changes at rest in seated and supine position were assessed by opto-electronic plethysmography to investigate if structural modifications of the rib cage in OI have consequences on ventilatory pattern. One-way or two-way analysis of variance was performed to compare the results between the three groups and the two postures. RESULTS: Both OI type III and IV patients showed reduced FVC and FEV(1 compared to predicted values, on condition that updated reference equations are considered. In both positions, ventilation was lower in OI patients than control because of lower tidal volume (p<0.01. In contrast to OI type IV patients, whose chest wall geometry and function was normal, OI type III patients were characterized by reduced (p<0.01 angle at the sternum (pectus carinatum, paradoxical inspiratory inward motion of the pulmonary rib cage, significant thoraco-abdominal asynchronies and rib cage distortions in supine position (p<0.001. CONCLUSIONS: In conclusion, the restrictive respiratory pattern of Osteogenesis Imperfecta is closely related to the severity of the disease and to the sternal deformities. Pectus carinatum characterizes OI type III patients and alters respiratory muscles coordination, leading to chest wall and rib cage distortions and an inefficient ventilator pattern. OI type IV is characterized by lower alterations in the respiratory function. These findings suggest that functional assessment and treatment of OI should be differentiated in these two forms of the

  3. Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease

    OpenAIRE

    Takara, L.S.; Cunha, T M; Barbosa, P.; M.K. Rodrigues; Oliveira, M. F.; Nery, L E; J.A. Neder

    2012-01-01

    This study evaluated the dynamic behavior of total and compartmental chest wall volumes [(VCW) = rib cage (VRC) + abdomen (VAB)] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III) underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim) at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyperinf...

  4. Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease

    OpenAIRE

    Takara, L.S.; Cunha, T M; Barbosa, P.; M.K. Rodrigues; Oliveira, M. F.; Nery, L E; J.A. Neder

    2012-01-01

    This study evaluated the dynamic behavior of total and compartmental chest wall volumes [(V CW) = rib cage (V RC) + abdomen (V AB)] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III) underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim) at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyper...

  5. Hyperthermia combined with radiation therapy for superficial breast cancer and chest wall recurrence: A review of the randomised data

    OpenAIRE

    Zagar, Timothy M.; OLESON, JAMES R.; Vujaskovic, Zeljko; Dewhirst, Mark W.; Craciunescu, Oana I; BLACKWELL, KIMBERLY L.; Prosnitz, Leonard R.; Jones, Ellen L.

    2010-01-01

    Hyperthermia has long been used in combination with radiation for the treatment of superficial malignancies, in part due to its radiosensitising capabilities. Patients who suffer superficial recurrences of breast cancer, be it in their chest wall following mastectomy, or in their breast after breast conservation, typically have poor clinical outcomes. They often develop distant metastatic disease, but one must not overlook the problems associated with an uncontrolled local failure. Morbidity ...

  6. Chest-wall thickness and percent thoracic fat estimation by B-mode ultrasound: system and procedure review

    International Nuclear Information System (INIS)

    Accurate measurement of chest wall thickness is necessary for estimation of lung burden of transuranic elements in humans. To achieve tis capability, the ORNL Whole Body Counter has acquired a B-mode ultrasonic imaging system for defining the structure within the thorax of the body. This report contains a review of the ultrasound system in use at the ORNL Whole Body Counter, including its theory of operation, and te procedure for use of the system. Future developmental plans are also presented

  7. 3D analysis of the chest wall motion for monitoring late-onset Pompe disease patients.

    Science.gov (United States)

    Meric, Henri; Falaize, Line; Pradon, Didier; Orlikowski, David; Prigent, Hélène; Lofaso, Frédéric

    2016-02-01

    Late-onset Pompe disease, for which enzyme replacement therapy is available, induces progressive diaphragmatic weakness. Monitoring diaphragmatic function is therefore crucial but is hindered by the need to insert esophageal and gastric probes. Vital capacity (VC), inspiratory capacity, maximal inspiratory pressure, and sniff nasal pressure are noninvasive measurements but reflect only global inspiratory-muscle function. Diaphragmatic function may be assessable noninvasively based on abdominal contribution to breathing and abdominal volume change during the VC maneuver (AVC-VC), obtained by 3-dimensional chest-wall analysis. In 11 patients, we assessed the relationships between the above-listed noninvasive variables and the invasively measured Gilbert index reflecting the diaphragmatic contribution to breathing (ratio of gastric pressure over transdiaphragmatic pressure swings during spontaneous breathing). Only abdominal contribution to breathing and AVC-VC correlated significantly with the Gilbert index (R = 0.977, P = 0.0001; and R = 0.944, P = 0.001 respectively). AVC-VC correlated significantly with transdiaphragmatic pressure swing during the sniff maneuver (R = 0.743, P = 0.0009) and with phrenic magnetic stimulation (R = 0.610, P = 0.046). Repeat testing 1 year later in the first 6 patients showed concordant changes in abdominal contribution to breathing, Gilbert index, and VC. Abdominal contribution to breathing and AVC-VC are reliable and noninvasive indices of diaphragmatic function in Pompe disease, and therefore hold promise as clinical monitoring tools. PMID:26711305

  8. VAC® for external fixation of flail chest.

    Science.gov (United States)

    Winge, Rikke; Berg, Jais O; Albret, Rikke; Krag, Christen

    2012-05-29

    A large aterior chest wall defect following tumor resection was reconstructed with a Gore-Tex® membrane and a combined musculocutaneous rectus femoris and tensor fasciae latae free flap. Subsequent paradoxical respiration impeded weaning from the ventilator. Appliance of Vacuum Assisted Closure® (VAC®) resulted in immediate chest wall stability and a decrease in the patient's need for respiratory support. Shortly thereafter, the VAC® was discontinued and the patient was discharged from the intensive care unit (ICU). This case report is the first to describe the successful use of VAC® as an adjuvant to a one-stage procedure for large thoracic wall reconstruction, allowing sufficient temporary external fixation to eliminate paradoxical respiration and plausibly shorten the stay in the ICU. No adverse effects on flap healing or haemodynamics were recorded. It is likely that external VAC® can improve thoracic stability and pulmonary function in a patient with flail chest and decrease the need for mechanical ventilation. PMID:24765464

  9. Tangential beam IMRT versus tangential beam 3D-CRT of the chest wall in postmastectomy breast cancer patients: A dosimetric comparison

    OpenAIRE

    AI-Yahya Khaled; Mohamed Adel; Aziz Alaradi Abdul; Rudat Volker; Altuwaijri Saleh

    2011-01-01

    Abstract Background This study evaluates the dose distribution of reversed planned tangential beam intensity modulated radiotherapy (IMRT) compared to standard wedged tangential beam three-dimensionally planned conformal radiotherapy (3D-CRT) of the chest wall in unselected postmastectomy breast cancer patients Methods For 20 unselected subsequent postmastectomy breast cancer patients tangential beam IMRT and tangential beam 3D-CRT plans were generated for the radiotherapy of the chest wall. ...

  10. Chest wall desmoid tumours treated with definitive radiotherapy: a plan comparison of 3D conformal radiotherapy, intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy

    OpenAIRE

    Liu, Jia; Ng, Diana; Lee, James; Stalley, Paul; Hong, Angela

    2016-01-01

    Purpose Definitive radiotherapy is often used for chest wall desmoid tumours due to size or anatomical location. The delivery of radiotherapy is challenging due to the large size and constraints of normal surrounding structures. We compared the dosimetry of 3D conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc radiotherapy (VMAT) to evaluate the best treatment option. Methods and materials Ten consecutive patients with inoperable chest wall de...

  11. A study of the first heart sound spectra in normal anesthetized cats: possible origins and chest wall influences.

    Science.gov (United States)

    Fazzalari, N L; Mazumdar, J; Ghista, D N; Allen, D G; de Bruin, H

    1984-01-01

    Heart sound recordings were taken from cats. The heart sounds were recorded directly from the chest wall and through an esophageal tube. The phono transducer and the esophageal tube were both placed over the base of the heart. Ultrasound M-mode, or motion-mode, recordings were taken to study the mitral valve dynamics. After analogue to digital conversion, electrocardiogram gated first heart sounds of each phono record were analyzed by the fast Fourier transform to obtain a frequency spectrum. Relative energies in 15 Hz bandwidths up to 150 Hz were correlated with the mitral valve closing velocity of the anterior mitral leaflet, obtained from the M-mode echocardiograms. The closing velocity correlated best with the energy in the 30-45 Hz bandwidth and 60-75 Hz bandwidth for the externally and internally monitored phonocardiogram respectively. The chest wall acted as a low pass filter, that is, the wall favoured the transmission of low frequencies and the energy transmitted decreased as wall thickness increased. PMID:6713253

  12. Dystrophic calcinosis with both a huge calcified mass in the cervical spine and calcification in the chest wall in a patient with rheumatoid overlap syndrome.

    Science.gov (United States)

    Nakamura, Tadashi; Hirakawa, Kei; Takaoka, Hirokazu; Iyama, Ken-Ichi

    2016-05-01

    Dystrophic calcinosis in soft tissue occurs in damaged or devitalized tissues in the presence of normal calcium and phosphorous metabolism. It is often noted in subcutaneous tissues in patients with collagen vascular diseases and may involve a relatively localized area or be widespread. A 74-year-old Japanese woman with an overlap of rheumatoid arthritis, Sjögren's syndrome, and systemic sclerosis developed a huge tumor-like mass at the atlanto-axial vertebral joint region that caused severe cervical pain and difficulty in activities of daily living. She also had subcutaneous dystrophic calcification in the soft tissue of the chest wall. Calcinosis associated with systemic sclerosis is a well-recognized phenomenon, but a destructive paraspinal tumor in the cervical spine associated with overlap syndrome is extremely unique. Because calcinosis in spinal locations can be complicated by neurological involvement, patients with progressive symptoms may require surgical intervention. Surgical resection and biological therapy improved this patient's life and activities of daily living. Calcinosis is common in the conditions reviewed here, and different agents have been used for treatment. However, calcinosis management is poorly organized and lacks an accepted classification, systematic studies, and clinical therapeutic trials. The association of calcinosis and collagen vascular diseases is clinically and etiologically important. Although a combination of calcinosis and rheumatoid overlap syndrome is rare, various collagen vascular diseases may occur simultaneously. A perceptive diagnostic approach toward these diseases is critical, and early diagnosis and treatment are needed to prevent dystrophic calcinosis. PMID:24894107

  13. Soft tissue mass of the chest wall as the sole manifestation of brucellosis in a 7-year-old boy

    OpenAIRE

    2011-01-01

    We report the case of a child who presented with a subcutaneous mass on the left side of the chest wall of one month's duration. The mass was painful and increasing in size over time. He had a history of weight loss and a decrease in appetite, but no history of fever or trauma. He had ingested raw camel milk, but had no history of contact with animals. He was diagnosed by the standard tube agglutination titer and tissue culture for brucellosis, treated with surgery and three months of antibru...

  14. Chest X-Ray

    Medline Plus

    Full Text Available ... chest x-ray is used to evaluate the lungs, heart and chest wall and may be used ... diagnose and monitor treatment for a variety of lung conditions such as pneumonia, emphysema and cancer. A ...

  15. Chest wall secondary chondrosarcoma arising from enchondroma in a young Asian female

    Directory of Open Access Journals (Sweden)

    Chih Chiang Nieh

    2014-01-01

    CONCLUSION: Secondary chondrosarcoma in a young Asian female arising from a benign solitary enchondroma in the absence of multiple enchondromatosis, such as Ollier disease or Maffucci syndrome, is extremely rare. Regular follow up including physical assessment and radiological imaging can result in earlier detection of malignant transformation obviating the need for aggressive surgical treatment involving multiple rib resections.

  16. Statistical methods for analysis of coordination of chest wall motion using optical reflectance imaging of multiple markers

    Science.gov (United States)

    Kenyon, C. M.; Ghezzo, R. H.; Cala, S. J.; Ferrigno, Giancarlo; Pedotti, Antonio; Macklem, P. T.; Rochester, D. F.

    1994-07-01

    To analyze coordination of chest wall motion we have used principle component analysis (PCA) and multiple regression analysis (MRA) with respect to spirometry on the displacements of 93 optical reflective markers placed upon the chest wall (CW). Each marker is tracked at 10 Hz with an accuracy of 0.2 mm in each spatial dimension using the ELITE system (IEEE Trans. Biomed. Eng. 11:943-949, 1985). PCA enables the degree of linear coordination between all of the markers to be assessed using the eigenvectors and eigenvalues of the covariance of the matrix of marker displacements in each dimension against time. Thus the number of linear degrees of freedom (DOF) which contribute more than a particular amount to the total variance can be determined and analyzed. MRA with respect to spirometrically measured lung volume changes enables identification of the CW points whose movement correlates best with lung volume. We have used this analysis to compare a quiet breathing sequence with one where tidal volume was increased fourfold involuntarily and show that the number of DOF with eigenvalues accounting for >5% of the covariance increased from 2 to 3. Also the point whose movement correlated best with lung volume changed from halfway down the lower costal margin to a more lateral point at the level of the bottom of the sternum. This quantification of CW coordination may be useful in analysis and staging of many respiratory disorders and is applicable to any nonrigid body motion where points can be tracked.

  17. Acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women.

    Science.gov (United States)

    Muniz de Souza, Helga; Rocha, Taciano; Campos, Shirley Lima; Brandão, Daniella Cunha; Fink, James B; Aliverti, Andrea; de Andrade, Armele Dornelas

    2016-06-15

    It is not completely described how aging affect ventilatory kinematics and what are the mechanisms adopted by the elderly population to overcome these structural modifications. Given this, the aim was to evaluate the acute effects of different inspiratory efforts on ventilatory pattern and chest wall compartmental distribution in elderly women. Variables assessed included: tidal volume (Vt), total chest wall volume (Vcw), pulmonary rib cage (Vrcp%), abdominal rib cage (Vrca%) and abdominal compartment (Vab%) relative contributions to tidal volume. These variables were assessed during quiet breathing, maximal inspiratory pressure maneuver (MIP), and moderate inspiratory resistance (MIR; i.e., 40% of MIP). 22 young women (age: 23.9±2.5 years) and 22 elderly women (age: 68.2±5.0 years) participated to this study. It was possible to show that during quiet breathing, Vab% was predominant in elderly (p<0.001), in young, however, Vab% was similar to Vrcp% (p=0.095). During MIR, Vrcp% was predominant in young (p<0.001) and comparable to Vab% in elderly (p=0.249). When MIP was imposed, both groups presented a predominance of Vrcp%. In conclusion, there are differences in abdominal kinematics between young and elderly women during different inspiratory efforts. In elderly, during moderate inspiratory resistance, the pattern is beneficial, deep, and slow. Although, during maximal inspiratory resistance, the ventilatory pattern seems to predict imminent muscle fatigue. PMID:26900004

  18. Uncertainty induced by chest wall thickness assessment methods on lung activity estimation for plutonium and americium: a large population-based study

    International Nuclear Information System (INIS)

    In vivo lung counting aims at assessing the retained activity in the lungs. The calibration factor relating the measured counts to the worker’s specific retained lung activity can be obtained by several means and strongly depends on the chest wall thickness. Here we compare, for 374 male nuclear workers, the activity assessed with a reference protocol, where the material equivalent chest wall thickness is known from ultrasound measurements, with two other protocols. The counting system is an array of four germanium detectors. It is found that non site-specific equations for the assessment of the chest wall thickness induce large biases in the assessment of activity. For plutonium isotopes or 241Am the proportion of workers for whom the retained activity is within ± 10% of the reference one is smaller than 10%. The use of site-specific equations raises this proportion to 20% and 58% for plutonium and 241Am, respectively. Finally, for the studied population, when site-specific equations are used for the chest wall thickness, the standard uncertainties for the lung activity are 42% and 12.5%, for plutonium and 241Am, respectively. Due to the relatively large size of the studied population, these values are a relatively robust estimate of the uncertainties due to the assessment of the chest wall thickness for the current practice at this site. (paper)

  19. Abdominal wall metastasis in scar after open resection of an adrenocortical carcinoma

    Directory of Open Access Journals (Sweden)

    Nikhil Gupta

    2011-12-01

    Full Text Available A 42-year-old man patient presented with progressively increasing, occasionally painful lump in the left upper and central abdomen. Investigations revealed well-defined capsulated left adrenocortical carcinoma. Tumor was resected successfully along with left kidney. Tumor recurred in the abdominal surgical scar 1.5 years after surgery. We are reporting this case because of rarity of metastatic recurrence of an adrenocortical carcinoma in the abdominal surgical scar 1.5 years after resection of primary tumor.

  20. Cutaneous reinnervation of the rectus abdominis musculocutaneous flap after chest wall reconstruction: development of herpes zoster in the transplanted musculocutaneous flap.

    Science.gov (United States)

    Tomita, K; Inoue, K

    1998-08-01

    We report a patient in whom herpes zoster developed in the transplanted rectus abdominis musculocutaneous flap 14 months after a chest wall reconstruction for recurrent breast cancer. Based on the distribution of the varicella zoster virus spreading along the sensory nerve fibers, we concluded that the virus spread along the reinnervated sensory nerves from the dorsal ganglia, through the intercostal nerves, and into the flap skin. It is suggested that this finding demonstrates the pathway of reinnervation into the transferred musculocutaneous flap on the chest wall. PMID:9718154

  1. The Effect of Pre-Injury Anti-Platelet Therapy on the Development of Complications in Isolated Blunt Chest Wall Trauma: A Retrospective Study

    OpenAIRE

    Battle, Ceri; Hutchings, Hayley; Bouamra, Omar; Phillip A Evans

    2014-01-01

    Introduction The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department due to the development of late complications are well recognised in the literature. Pre-injury anti-platelet therapy has been previously investigated as a risk factor for poor outcomes following traumatic head injury, but not in the blunt chest wall trauma patient cohort. The aim of this study was to investigate pre-injury anti-platelet therapy as a risk factor for the developmen...

  2. Determination of the chest wall thickness as calibration parameter for dosimetric partial-body counting; Bestimmung der Brustwandstaerke als Kalibrierparameter fuer dosimetrische Teilkoerpermessungen

    Energy Technology Data Exchange (ETDEWEB)

    Guen, H. [Fachhochschule Giessen-Friedberg, Giessen (Germany). Inst. fuer Medizinische Physik und Strahlenschutz; Karlsruher Institut fuer Technologie, Eggenstein-Leopoldshafen (Germany). Inst. fuer Strahlenforschung; Hegenbart, L. [Karlsruher Institut fuer Technologie, Eggenstein-Leopoldshafen (Germany). Inst. fuer Strahlenforschung; Breckow, J. [Fachhochschule Giessen-Friedberg, Giessen (Germany). Inst. fuer Medizinische Physik und Strahlenschutz

    2010-05-15

    The authors describe actual partial body measurements with Phoswich detectors in the in-vivo laboratory of the Institute for Technology in Karlsruhe. The chest wall thickness is estimated from the radio of body weight to body length. This formula includes several uncertainties. The aim of the project was the reduction of the uncertainties of the empirical formula using ultrasonography. This method allows an accuracy of plus or minus 1.1 mm for the determined chest wall thickness. Besides the experimental study several voxel models were used to determine the efficiency of modeled measuring systems. The voxel models reach the same accuracy as the ultrasound method.

  3. Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    L.S. Takara

    2012-12-01

    Full Text Available This study evaluated the dynamic behavior of total and compartmental chest wall volumes [(V CW = rib cage (V RC + abdomen (V AB] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyperinflation was considered to be present when end-expiratory (EE V CW increased in relation to resting values. There was a noticeable heterogeneity in the patterns of V CW regulation as EEV CW increased non-linearly in 17/30 "hyperinflators" and decreased in 13/30 "non-hyperinflators" (P < 0.05. EEV AB decreased slightly in 8 of the "hyperinflators", thereby reducing and slowing the rate of increase in end-inspiratory (EI V CW (P < 0.05. In contrast, decreases in EEV CW in the "non-hyperinflators" were due to the combination of stable EEV RC with marked reductions in EEV AB. These patients showed lower EIV CW and end-exercise dyspnea scores but longer Tlim than their counterparts (P < 0.05. Dyspnea increased and Tlim decreased non-linearly with a faster rate of increase in EIV CW regardless of the presence or absence of dynamic hyperinflation (P < 0.001. However, no significant between-group differences were observed in metabolic, pulmonary gas exchange and cardiovascular responses to exercise. Chest wall volumes are continuously regulated during exercise in order to postpone (or even avoid their migration to higher operating volumes in patients with COPD, a dynamic process that is strongly dependent on the behavior of the abdominal compartment.

  4. Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease

    Energy Technology Data Exchange (ETDEWEB)

    Takara, L.S.; Cunha, T.M.; Barbosa, P.; Rodrigues, M.K.; Oliveira, M.F.; Nery, L.E. [Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP (Brazil); Neder, J.A. [Setor de Função Pulmonar e Fisiologia Clínica do Exercício, Disciplina de Pneumologia, Departamento de Medicina, Universidade Federal de São Paulo, São Paulo, SP (Brazil); Division of Respiratory and Critical Care Medicine, Department of Medicine, Queen' s University, Kingston, ON (Canada)

    2012-10-15

    This study evaluated the dynamic behavior of total and compartmental chest wall volumes [(V{sub CW}) = rib cage (V{sub RC}) + abdomen (V{sub AB})] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III) underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim) at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyperinflation was considered to be present when end-expiratory (EE) V{sub CW} increased in relation to resting values. There was a noticeable heterogeneity in the patterns of V{sub CW} regulation as EEV{sub CW} increased non-linearly in 17/30 “hyperinflators” and decreased in 13/30 “non-hyperinflators” (P < 0.05). EEV{sub AB} decreased slightly in 8 of the “hyperinflators”, thereby reducing and slowing the rate of increase in end-inspiratory (EI) V{sub CW} (P < 0.05). In contrast, decreases in EEV{sub CW} in the “non-hyperinflators” were due to the combination of stable EEV{sub RC} with marked reductions in EEV{sub AB}. These patients showed lower EIV{sub CW} and end-exercise dyspnea scores but longer Tlim than their counterparts (P < 0.05). Dyspnea increased and Tlim decreased non-linearly with a faster rate of increase in EIV{sub CW} regardless of the presence or absence of dynamic hyperinflation (P < 0.001). However, no significant between-group differences were observed in metabolic, pulmonary gas exchange and cardiovascular responses to exercise. Chest wall volumes are continuously regulated during exercise in order to postpone (or even avoid) their migration to higher operating volumes in patients with COPD, a dynamic process that is strongly dependent on the behavior of the abdominal compartment.

  5. Dynamics of chest wall volume regulation during constant work rate exercise in patients with chronic obstructive pulmonary disease

    International Nuclear Information System (INIS)

    This study evaluated the dynamic behavior of total and compartmental chest wall volumes [(VCW) = rib cage (VRC) + abdomen (VAB)] as measured breath-by-breath by optoelectronic plethysmography during constant-load exercise in patients with stable chronic obstructive pulmonary disease. Thirty males (GOLD stages II-III) underwent a cardiopulmonary exercise test to the limit of tolerance (Tlim) at 75% of peak work rate on an electronically braked cycle ergometer. Exercise-induced dynamic hyperinflation was considered to be present when end-expiratory (EE) VCW increased in relation to resting values. There was a noticeable heterogeneity in the patterns of VCW regulation as EEVCW increased non-linearly in 17/30 “hyperinflators” and decreased in 13/30 “non-hyperinflators” (P < 0.05). EEVAB decreased slightly in 8 of the “hyperinflators”, thereby reducing and slowing the rate of increase in end-inspiratory (EI) VCW (P < 0.05). In contrast, decreases in EEVCW in the “non-hyperinflators” were due to the combination of stable EEVRC with marked reductions in EEVAB. These patients showed lower EIVCW and end-exercise dyspnea scores but longer Tlim than their counterparts (P < 0.05). Dyspnea increased and Tlim decreased non-linearly with a faster rate of increase in EIVCW regardless of the presence or absence of dynamic hyperinflation (P < 0.001). However, no significant between-group differences were observed in metabolic, pulmonary gas exchange and cardiovascular responses to exercise. Chest wall volumes are continuously regulated during exercise in order to postpone (or even avoid) their migration to higher operating volumes in patients with COPD, a dynamic process that is strongly dependent on the behavior of the abdominal compartment

  6. A case of parachordoma on the chest wall and literature review

    Directory of Open Access Journals (Sweden)

    Jie Zhang

    2013-01-01

    Full Text Available Parachordoma is an extremely uncommon soft-tissue tumor, which mainly occurs in the deep soft-tissue of the distal parts of the limbs, such as deep fascia, muscle tendon, synovial or soft-tissue closed to the bone. Nevertheless, the literature reports about parachordoma on the thoracic wall were scarce. The clinical and imaging manifestation has a non-specific appearance. In this article, we reported one case of parachordoma of the thoracic wall that we met in clinical works and reviewed the literature.

  7. Volume Modulated Arc Therapy (VMAT for pulmonary Stereotactic Body Radiotherapy (SBRT in patients with lesions in close approximation to the chest wall

    Directory of Open Access Journals (Sweden)

    ThomasJ.FitzGerald

    2013-02-01

    VMAT technology has potential of limiting radiation dose to sensitive chest wall regions in patients with lesions in close approximation to this structure. This would also have potential value to lesions treated with SBRT in other body regions where targets abut critical structures.

  8. Radiotherapy to the chest wall following mastectomy for node-negative breast cancer: A systematic review

    International Nuclear Information System (INIS)

    Background. Although nodal status is the major determinant of risk of locoregional relapse (LRR), other factors also contribute, and these assume a greater significance for those with node-negative breast cancer. Previous reviews of post-mastectomy radiotherapy have included studies using radiotherapy techniques or doses no longer considered clinically appropriate. Objectives. To determine the effectiveness of post-mastectomy radiotherapy in women with node-negative breast cancer with particular reference to those patient and tumour factors which contribute to an increased risk of LRR. Methods. A systematic literature review was conducted. Trials using inadequate or orthovoltage radiotherapy were excluded. Data linking potential risk factors, either individually or in combination, to the occurrence of LRR were handled qualitatively. Data from randomised trials of post-mastectomy radiotherapy were included in a meta-analysis. Results. Baseline risk of LRR is increased in the presence of lymphovascular invasion, a grade 3 tumour, tumours greater than 2 cm or a close resection margin and in patients who are pre-menopausal or aged less than 50. Those with no risk factors have a baseline risk of LRR of approximately 5% or less rising to a risk of 15% or more for those with two or more risk factors. In the meta-analysis of three randomised trials of mastectomy and axillary clearance (667 patients), the addition of radiotherapy resulted in an 83% reduction in the risk of LRR (P < 0.00001) and in a 14% improvement in survival (P = 0.16). Conclusion. The use of post-mastectomy radiotherapy for women with node-negative breast cancer requires re-evaluation. Radiotherapy should be considered for those with two or more risk factors.

  9. Reproducibility of The Abdominal and Chest Wall Position by Voluntary Breath-Hold Technique Using a Laser-Based Monitoring and Visual Feedback System

    International Nuclear Information System (INIS)

    Purpose: The voluntary breath-hold (BH) technique is a simple method to control the respiration-related motion of a tumor during irradiation. However, the abdominal and chest wall position may not be accurately reproduced using the BH technique. The purpose of this study was to examine whether visual feedback can reduce the fluctuation in wall motion during BH using a new respiratory monitoring device. Methods and Materials: We developed a laser-based BH monitoring and visual feedback system. For this study, five healthy volunteers were enrolled. The volunteers, practicing abdominal breathing, performed shallow end-expiration BH (SEBH), shallow end-inspiration BH (SIBH), and deep end-inspiration BH (DIBH) with or without visual feedback. The abdominal and chest wall positions were measured at 80-ms intervals during BHs. Results: The fluctuation in the chest wall position was smaller than that of the abdominal wall position. The reproducibility of the wall position was improved by visual feedback. With a monitoring device, visual feedback reduced the mean deviation of the abdominal wall from 2.1 ± 1.3 mm to 1.5 ± 0.5 mm, 2.5 ± 1.9 mm to 1.1 ± 0.4 mm, and 6.6 ± 2.4 mm to 2.6 ± 1.4 mm in SEBH, SIBH, and DIBH, respectively. Conclusions: Volunteers can perform the BH maneuver in a highly reproducible fashion when informed about the position of the wall, although in the case of DIBH, the deviation in the wall position remained substantial

  10. Characteristics Of Congenital Chest Wall Deformities In Referred Patients To Tehran Imam Khomeini And Kashan Shahid Beheshti Hospital During 1991-2001

    Directory of Open Access Journals (Sweden)

    Davoodabadi A

    2004-08-01

    Full Text Available Background: Infants and children present with a wide range of congenital chest wall deformities which have both physiologic psychologic consequences and are often associated with other abnormalities. Surgical intervention offers excellent cosmetic results with minimal morbidity and mortality. In order to investigation of chest wall deformities, and surgical results, this study was performed. Materials and Methods: A descriptive study on existing data on 60 consecutive patients with chest wall deformity during 10 years carried out. Patient's characteristics such as age, gender, signs and symptoms type of operation, associated disorder, syndrome, and surgical complications were considered. Results: Pectus excavatum 60% and pectus carinatum 30% Poland syn 6.7% 9 sternal cleft 3.2. Inpectus, M/F: Was 3/1 and others were 1:1. Age of admission 4 to 27 years 13.4±6.82 and association syndromes were, turner, Morgue and marfan, most patients were operated in delayed time (75 and hence, scoliosis was common than others. Conclusion: Pectus excavatum was the most common deformity and if scoliosis was prominent and most operation was done in old age but surgical result was excellent no anyone expired and complication was a little. So we recommended that all of the chest deformities must be operated in anytime.

  11. Sternal Cleft and Pectus Excavatum: A Combined Approach for the Correction of a Complex Anterior Chest Wall Malformation in a Teenager.

    Science.gov (United States)

    Tocchioni, Francesca; Ghionzoli, Marco; Lo Piccolo, Roberto; Deaconu, Diana E; Facchini, Flavio; Milanez De Campos, Jose R; Messineo, Antonio

    2015-06-01

    Congenital sternal cleft is a rare chest wall malformation. Because of the flexibility of the chest in infants, surgical repair should be performed by primary closure in the neonatal period. In adolescents and adults, different techniques have been suggested to overcome the lack of sternal bone tissue. We describe a very rare case of an 18-year-old woman with a complete bifid sternum associated with pectus excavatum for whom a satisfactory cosmetic and functional result was obtained by adequate surgical planning, which entailed a combination of two standardized surgical techniques. PMID:26046903

  12. Impact of Fractionation and Dose in a Multivariate Model for Radiation-Induced Chest Wall Pain

    Energy Technology Data Exchange (ETDEWEB)

    Din, Shaun U. [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Williams, Eric L.; Jackson, Andrew [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Rosenzweig, Kenneth E. [Department of Radiation Oncology, Mount Sinai Medical Center, New York, New York (United States); Wu, Abraham J.; Foster, Amanda [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Yorke, Ellen D. [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Rimner, Andreas, E-mail: rimnera@mskcc.org [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States)

    2015-10-01

    Purpose: To determine the role of patient/tumor characteristics, radiation dose, and fractionation using the linear-quadratic (LQ) model to predict stereotactic body radiation therapy–induced grade ≥2 chest wall pain (CWP2) in a larger series and develop clinically useful constraints for patients treated with different fraction numbers. Methods and Materials: A total of 316 lung tumors in 295 patients were treated with stereotactic body radiation therapy in 3 to 5 fractions to 39 to 60 Gy. Absolute dose–absolute volume chest wall (CW) histograms were acquired. The raw dose-volume histograms (α/β = ∞ Gy) were converted via the LQ model to equivalent doses in 2-Gy fractions (normalized total dose, NTD) with α/β from 0 to 25 Gy in 0.1-Gy steps. The Cox proportional hazards (CPH) model was used in univariate and multivariate models to identify and assess CWP2 exposed to a given physical and NTD. Results: The median follow-up was 15.4 months, and the median time to development of CWP2 was 7.4 months. On a univariate CPH model, prescription dose, prescription dose per fraction, number of fractions, D83cc, distance of tumor to CW, and body mass index were all statistically significant for the development of CWP2. Linear-quadratic correction improved the CPH model significance over the physical dose. The best-fit α/β was 2.1 Gy, and the physical dose (α/β = ∞ Gy) was outside the upper 95% confidence limit. With α/β = 2.1 Gy, V{sub NTD99Gy} was most significant, with median V{sub NTD99Gy} = 31.5 cm{sup 3} (hazard ratio 3.87, P<.001). Conclusion: There were several predictive factors for the development of CWP2. The LQ-adjusted doses using the best-fit α/β = 2.1 Gy is a better predictor of CWP2 than the physical dose. To aid dosimetrists, we have calculated the physical dose equivalent corresponding to V{sub NTD99Gy} = 31.5 cm{sup 3} for the 3- to 5-fraction groups.

  13. Impact of Fractionation and Dose in a Multivariate Model for Radiation-Induced Chest Wall Pain

    International Nuclear Information System (INIS)

    Purpose: To determine the role of patient/tumor characteristics, radiation dose, and fractionation using the linear-quadratic (LQ) model to predict stereotactic body radiation therapy–induced grade ≥2 chest wall pain (CWP2) in a larger series and develop clinically useful constraints for patients treated with different fraction numbers. Methods and Materials: A total of 316 lung tumors in 295 patients were treated with stereotactic body radiation therapy in 3 to 5 fractions to 39 to 60 Gy. Absolute dose–absolute volume chest wall (CW) histograms were acquired. The raw dose-volume histograms (α/β = ∞ Gy) were converted via the LQ model to equivalent doses in 2-Gy fractions (normalized total dose, NTD) with α/β from 0 to 25 Gy in 0.1-Gy steps. The Cox proportional hazards (CPH) model was used in univariate and multivariate models to identify and assess CWP2 exposed to a given physical and NTD. Results: The median follow-up was 15.4 months, and the median time to development of CWP2 was 7.4 months. On a univariate CPH model, prescription dose, prescription dose per fraction, number of fractions, D83cc, distance of tumor to CW, and body mass index were all statistically significant for the development of CWP2. Linear-quadratic correction improved the CPH model significance over the physical dose. The best-fit α/β was 2.1 Gy, and the physical dose (α/β = ∞ Gy) was outside the upper 95% confidence limit. With α/β = 2.1 Gy, VNTD99Gy was most significant, with median VNTD99Gy = 31.5 cm3 (hazard ratio 3.87, P<.001). Conclusion: There were several predictive factors for the development of CWP2. The LQ-adjusted doses using the best-fit α/β = 2.1 Gy is a better predictor of CWP2 than the physical dose. To aid dosimetrists, we have calculated the physical dose equivalent corresponding to VNTD99Gy = 31.5 cm3 for the 3- to 5-fraction groups

  14. Occurrence of Breast Cancer After Chest Wall Irradiation for Pediatric Cancer, as Detected by a Multimodal Screening Program

    Energy Technology Data Exchange (ETDEWEB)

    Terenziani, Monica [Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Casalini, Patrizia [Molecular Biology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Scaperrotta, Gianfranco; Gandola, Lorenza; Trecate, Giovanna [Radiology and Radiotherapy Departments, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Catania, Serena; Cefalo, Graziella [Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Conti, Alberto [Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Massimino, Maura; Meazza, Cristina; Podda, Marta; Spreafico, Filippo [Pediatric Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Suman, Laura [Radiology and Radiotherapy Departments, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy); Gennaro, Massimiliano, E-mail: gennaromassimiliano@istitutotumori.mi.it [Breast Surgery Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milano (Italy)

    2013-01-01

    Purpose: To assess the occurrence of breast cancer (BC) after exposure to ionizing radiation for pediatric cancer, by means of a multimodal screening program. Patients and Methods: We identified 86 patients who had received chest wall radiation therapy for pediatric cancer. Clinical breast examination (CBE), ultrasound (US), and mammography (MX) were performed yearly. Magnetic resonance imaging (MRI) was added as of October 2007. We calculated the risk of developing BC by radiation therapy dose, patient age, and menarche before or after primary treatment. Results: Eleven women developed a BC from July 2002-February 2010. The sensitivity of the screening methods was 36% for CBE, 73% for MX, 55% for US, and 100% for MRI; the specificity was 91%, 99%, 95%, and 80% for CBE, MX, US, and MRI, respectively. The annual BC detection rate was 2.9%. The median age at BC diagnosis was 33 years. Although age had no influence, menarche before as opposed to after radiation therapy correlated significantly with BC (P=.027): the annual BC detection rate in the former subgroup was 5.3%. Conclusions: Mammography proved more sensitive and specific in our cohort of young women than CBE or US. Magnetic resonance imaging proved 100% sensitive (but this preliminary finding needs to be confirmed). Our cohort of patients carries a 10-fold BC risk at an age more than 20 years younger than in the general population.

  15. Occurrence of Breast Cancer After Chest Wall Irradiation for Pediatric Cancer, as Detected by a Multimodal Screening Program

    International Nuclear Information System (INIS)

    Purpose: To assess the occurrence of breast cancer (BC) after exposure to ionizing radiation for pediatric cancer, by means of a multimodal screening program. Patients and Methods: We identified 86 patients who had received chest wall radiation therapy for pediatric cancer. Clinical breast examination (CBE), ultrasound (US), and mammography (MX) were performed yearly. Magnetic resonance imaging (MRI) was added as of October 2007. We calculated the risk of developing BC by radiation therapy dose, patient age, and menarche before or after primary treatment. Results: Eleven women developed a BC from July 2002-February 2010. The sensitivity of the screening methods was 36% for CBE, 73% for MX, 55% for US, and 100% for MRI; the specificity was 91%, 99%, 95%, and 80% for CBE, MX, US, and MRI, respectively. The annual BC detection rate was 2.9%. The median age at BC diagnosis was 33 years. Although age had no influence, menarche before as opposed to after radiation therapy correlated significantly with BC (P=.027): the annual BC detection rate in the former subgroup was 5.3%. Conclusions: Mammography proved more sensitive and specific in our cohort of young women than CBE or US. Magnetic resonance imaging proved 100% sensitive (but this preliminary finding needs to be confirmed). Our cohort of patients carries a 10-fold BC risk at an age more than 20 years younger than in the general population.

  16. Surgical resection of cerebellar hemangioblastoma with enhanced wall thickness: A report of two cases

    OpenAIRE

    Sun, Zhenxing; Yuan, Dan; SUN, YAXING; YAN, PENGXIANG; Zuo, Huancong

    2015-01-01

    Hemangioblastomas are tumors of the central nervous system, and the cerebellum is the most common site of occurrence. Cerebellar hemangioblastoma with enhanced wall thickness is rare and often misdiagnosed preoperatively. At present, no unified radiological classification system based on magnetic resonance imaging (MRI) findings exists for cerebellar hemangioblastoma, and this tumor type can be solid or cystic mass, according to the MRI findings. The most common presentation of cerebellar hem...

  17. Low-dose Photofrin-induced PDT offers excellent clinical response with minimal morbidity in chest wall recurrence of breast cancer

    Science.gov (United States)

    Allison, Ron; Mang, Thomas S.

    2000-03-01

    Limited therapeutic options exist when chest wall recurrence form breast cancer progresses despite standard salvage treatment. As photodynamic therapy offers excellent response for cutaneous lesions this may be a possible indication for PDT. A total of 102 treatment fields were illuminated on 9 women with biopsy proven chest wall recurrence of breast cancer which was progressing despite salvage surgery, radiation, and chemi-hormonal therapy. PDT consisted of outpatient IV infusion of Photofrin at 0.8 mg/kg followed 48 hours laser by illumination at 140-170 J/cm2 via a KTP Yag laser coupled to a dye unit. No patient was lost to follow up. At 6 months post PDT; complete response, defined as total lesion elimination was 89 percent, partial response 8 percent, and no response 3 percent. No photosensitivity was seen and no patient developed scarring, fibrosis, or healing difficulties. Low dose Photofrin induced PDT is very active against chest wall lesions. Despite fragile and heavily pre-treated tissues, excellent clinical and cosmetic outcome was obtained. PDT is an underutilized modality for this indication.

  18. Dose–Volume Parameters Predict for the Development of Chest Wall Pain After Stereotactic Body Radiation for Lung Cancer

    International Nuclear Information System (INIS)

    Purpose: Chest wall (CW) pain has recently been recognized as an important adverse effect of stereotactic body radiation therapy (SBRT) for non–small-cell lung cancer (NSCLC). We developed a dose–volume model to predict the development of this toxicity. Methods and Materials: A total of 126 patients with primary, clinically node-negative NSCLC received three to five fractions of SBRT to doses of 40–60 Gy and were prospectively followed. The dose–absolute volume histograms of two different definitions of the CW as an organ at risk (CW3cm and CW2cm) were examined for all 126 patients. Results: With a median follow-up of 16 months, the 2-year estimated actuarial incidence of Grade ≥ 2 CW pain was 39%. The median time to onset of Grade ≥ 2 CW pain (National Cancer Institute Common Terminology Criteria for Adverse Events, Version 3.0) was 9 months. There was no predictive advantage for biologically corrected dose over physical dose. Neither fraction number (p = 0.07) nor prescription dose (p = 0.07) were significantly correlated with the development of Grade ≥ 2 CW pain. Cox Proportional Hazards analysis identified significant correlation with a broad range of dose-volume combinations, with the CW volume receiving 30 Gy (V30) as one of the strongest predictors (p 3 of CW2cm, there was a significant correlation with Grade ≥ 2 CW pain (p = 0.004). Conclusions: CW toxicity after SBRT is common and long-term follow-up is needed to identify affected patients. A volume of CW ≥ 70 cm3 receiving 30 Gy is significantly correlated with Grade ≥ 2 CW pain. We are currently applying this constraint at our institution for patients receiving thoracic SBRT. An actuarial atlas of our data is provided as an electronic supplement to facilitate data-sharing and meta-analysis relating to CW pain.

  19. Chest wall stabilization and reconstruction: short and long-term results 5 years after the introduction of a new titanium plates system

    Science.gov (United States)

    Sollitto, Francesco; Loizzi, Domenico; Di Gennaro, Francesco; Scarascia, Daniele; Carlucci, Annalisa; Giudice, Giuseppe; Armenio, Andrea; Ludovico, Rossana; Loizzi, Michele

    2016-01-01

    Background We report short and long-term results with the dedicated Synthes® titanium plates system, introduced 5 years ago, for chest wall stabilization and reconstruction. Methods We retrospectively analyzed (January 2010 to December 2014) 27 consecutive patients (22 males, 5 females; range 16–83 years, median age 60 years), treated with this system: primary [3] and secondary [8] chest wall tumor; flail chest [5]; multiple ribs fractures [5]; sternal dehiscence-diastasis [3]; sternal fracture [1]; sternoclavicular joint dislocation [1]; Poland syndrome [1]. Short-term results were evaluated as: operating time, post-operative morbidity, mortality, hospital stay; long-term results as: survival, plates-related morbidity, spirometric values, chest pain [measured with Verbal Rating Scale (VRS) and SF12 standard V1 questionnaire]. Results Each patient received from 1 to 10 (median 2) titanium plates/splints; median operating time was 150 min (range: 115–430 min). Post-operative course: 15 patients (55.6%) uneventful, 10 (37%) minor complications, 2 (7.4%) major complications; no post-operative mortality. Median post-operative hospital stay was 13 days (range: 5–129 days). At a median follow-up of 20 months (range: 1–59 months), 21 patients (78%) were alive, 6 (22%) died. Three patients presented long-term plates-related morbidity: plates rupture [2], pin plate dislodgment [1]; two required a second surgical look. One-year from surgery median spirometric values were: FVC 3.31 L (90%), FEV1 2.46 L (78%), DLCO 20.9 mL/mmHg/min (76%). On 21 alive patients, 7 (33.3%) reported no pain (VRS score 0), 10 (47.6%) mild (score 2), 4 (19.1%) moderate (score 4), no-one severe (score >4); 15 (71.5%) reported none or mild, 6 (28.5%) moderate pain influencing quality of life. Conclusions An optimal chest wall stabilization and reconstruction was achieved with the Synthes® titanium plates system, with minimal morbidity, no post-operative mortality, acceptable operating time

  20. Doxifluridine, medroxyprogesterone acetate and cyclophosphamide (DMpC) combination therapy found effective for case of chest wall recurrent breast cancer with bone and pleural metastases

    International Nuclear Information System (INIS)

    A 67-year-old woman in poor general condition consulted my clinic with complaints of dyspnea and right chest wall pain. There was a huge and moist ulcer, caused by recurrence and post-radiation, on her right anterior to posterior chest wall. A chest X-ray demonstrated massive pleural effusion. Bone scinti gram showed multiple metastases in the spine, femur and pelvis. Her general condition was so poor that standard chemotherapy was unsuitable. Therefore, the patient was orally administered DMpC (doxifluridine, medroxyprogesterone acetate and cyclophosphamide) combination therapy. The pleural effusion had completely disappeared after 11 weeks, and the elevated serum CA15-3 and CEA value returned to a normal range 13 weeks later. No side effects were observed from this therapy. The patient clinically achieved good quality of life (QOL) in 6 months form this therapy with zoredronic acid administration. DMpC therapy appears to have few side effects and might be an effective treatment option for recurrent breast cancer patients with a poor general health condition. (author)

  1. VAC® for external fixation of flail chest

    Directory of Open Access Journals (Sweden)

    Rikke Winge

    2012-06-01

    Full Text Available A large anterior chest wall defect following tumor resection was reconstructed with a Gore- Tex® membrane and a combined musculocutaneous rectus femoris and tensor fasciae latae free flap. Subsequent paradoxical respiration impeded weaning from the ventilator. Appliance of Vacuum Assisted Closure® (VAC® resulted in immediate chest wall stability and a decrease in the patient’s need for respiratory support. Shortly thereafter, the VAC® was discontinued and the patient was discharged from the intensive care unit (ICU. This case report is the first to describe the successful use of VAC® as an adjuvant to a one-stage procedure for large thoracic wall reconstruction, allowing sufficient temporary external fixation to eliminate paradoxical respiration and plausibly shorten the stay in the ICU. No adverse effects on flap healing or haemodynamics were recorded. It is likely that external VAC® can improve thoracic stability and pulmonary function in a patient with flail chest and decrease the need for mechanical ventilation.

  2. Image-guided intensity-modulated radiotherapy for refractory bilateral breast cancer in a patient with extensive cutaneous metastasis in the chest and abdominal walls

    Directory of Open Access Journals (Sweden)

    Lu YF

    2016-05-01

    Full Text Available Yueh-Feng Lu,1 Yu-Chin Lin,2 Kuo-Hsin Chen,3,4 Pei-Wei Shueng,1 Hsin-Pei Yeh,1 Chen-Hsi Hsieh1,5,6 1Division of Radiation Oncology, Department of Radiology, 2Division of Oncology and Hematology, Department of Medicine, 3Department of Surgery, Far Eastern Memorial Hospital, New Taipei City, 4Department of Electrical Engineering, Yuan-Ze University, Taoyuan, 5Department of Medicine, 6Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan Abstract: Treatment for bilateral breast cancer with chest wall and abdominal skin invasion normally involves conventional radiotherapy (RT; however, conventional RT provides inadequate target volume coverage and excessive treatment of large volumes of normal tissue. Helical tomotherapy (HT has the ability to deliver continuous craniocaudal irradiation that suppresses junction problems and provides good conformity of dose distribution. A 47-year-old female with stage IV bilateral breast cancer with chest wall and pectoralis major muscle invasion, lymphadenopathy, bilateral pleural effusion, and multiple bone metastases received chemotherapy and target therapy beginning in January 2014; 4 months after the initiation of chemotherapy, computed tomography revealed progression of chest and abdominal wall invasion. A total dose of 70.2 Gy was delivered to both breasts, the chest wall, the abdominal wall, and the bilateral supraclavicular nodal areas in 39 fractions via HT. The total planning target volume was 4,533.29 cm3. The percent of lung volume receiving at least 20 Gy (V20 was 28%, 22%, and 25% for the right lung, left lung, and whole lung, respectively. The mean dose to the heart was 8.6 Gy. Follow-up computed tomography revealed complete response after the RT course. Grade 1 dysphagia, weight loss, grade 2 neutropenia, and grade 3 dermatitis were noted during the RT course. Pain score decreased from 6 to 1. No cardiac, pulmonary, liver, or intestinal toxicity

  3. Chest MRI

    Science.gov (United States)

    Nuclear magnetic resonance - chest; Magnetic resonance imaging - chest; NMR - chest; MRI of the thorax; Thoracic MRI ... healthy enough to filter the contrast. During the MRI, the person who operates the machine will watch ...

  4. Chest wall deformity and respiratory distress in a 17-year-old patient with achondroplasia: CT and MRI evaluation

    International Nuclear Information System (INIS)

    A marked thoracic deformity associated with intrathoracic tracheal narrowing was seen in a 17-year old with achondroplasia and dyspnea. The role of chest deformity and its evaluation by CT and MRI in achondroplastic patients with respiratory symptoms are considered. (orig.)

  5. Chest wall deformity and respiratory distress in a 17-year-old patient with achondroplasia: CT and MRI evaluation

    Energy Technology Data Exchange (ETDEWEB)

    Herman, T.E.; Siegel, M.J.; McAlister, W.H. (Washington Univ. School of Medicine, St. Louis, MO (United States). Mallinckrodt Inst. of Radiology)

    1992-06-01

    A marked thoracic deformity associated with intrathoracic tracheal narrowing was seen in a 17-year old with achondroplasia and dyspnea. The role of chest deformity and its evaluation by CT and MRI in achondroplastic patients with respiratory symptoms are considered. (orig.).

  6. Tangential beam IMRT versus tangential beam 3D-CRT of the chest wall in postmastectomy breast cancer patients: A dosimetric comparison

    Directory of Open Access Journals (Sweden)

    AI-Yahya Khaled

    2011-03-01

    Full Text Available Abstract Background This study evaluates the dose distribution of reversed planned tangential beam intensity modulated radiotherapy (IMRT compared to standard wedged tangential beam three-dimensionally planned conformal radiotherapy (3D-CRT of the chest wall in unselected postmastectomy breast cancer patients Methods For 20 unselected subsequent postmastectomy breast cancer patients tangential beam IMRT and tangential beam 3D-CRT plans were generated for the radiotherapy of the chest wall. The prescribed dose was 50 Gy in 25 fractions. Dose-volume histograms were evaluated for the PTV and organs at risk. Parameters of the dose distribution were compared using the Wilcoxon matched pairs test. Results Tangential beam IMRT statistically significantly reduced the ipsilateral mean lung dose by an average of 21% (1129 cGy versus 1437 cGy. In all patients treated on the left side, the heart volume encompassed by the 70% isodose line (V70%; 35 Gy was reduced by an average of 43% (5.7% versus 10.6%, and the mean heart dose by an average of 20% (704 cGy versus 877 cGy. The PTV showed a significantly better conformity index with IMRT; the homogeneity index was not significantly different. Conclusions Tangential beam IMRT significantly reduced the dose-volume of the ipsilateral lung and heart in unselected postmastectomy breast cancer patients.

  7. Re-surgery and chest wall re-irradiation for recurrent breast cancer - a second curative approach

    International Nuclear Information System (INIS)

    Repeat radiation is a rarely used treatment strategy that must be performed with caution. The efficacy and toxicity of a second curative radiotherapy series was investigated in cases of recurrent breast cancer. Forty-two patients treated from 1993 to 2003 with resection (n = 30) and postoperative re-irradiation or definitive re-irradiation (n = 12) for recurrent breast cancer were enrolled in the study. Concurrent hyperthermia was performed in 29 patients. The median age was 57 years. The median pre-radiation exposure was 54Gy. Re-irradiation was conventionally fractionated to a median total dose of 60Gy. After a median follow-up of 41 months (range 3-92 months) higher graded late toxicity > G3 according to CTC 3.0 and LENT-SOMA was not observed. The estimated 5-year local control rate reached 62%. The estimated 5-year overall survival rate was 59%. Significantly inferior survival was associated with recurrence within two years (40 vs. 71%, p < ([0-9]).01) and presence of macroscopic tumour load (24 vs. 75%, p = 0.03). Repeat radiotherapy for recurrent breast cancer with total radiation doses of 60 Gy and the addition of hyperthermia in the majority of patients was feasible, with acceptable late morbidity and improved prognosis, particularly in patients with previous resection of recurrent tumours

  8. Radio-guided occult lesion localisation using iodine 125 Seeds “ROLLIS” to guide surgical removal of an impalpable posterior chest wall melanoma metastasis

    Energy Technology Data Exchange (ETDEWEB)

    Dissanayake, Shashini [Western Hospital, Footscray, Victoria (Australia); Dissanayake, Deepthi [Royal Perth Hospital Perth, Perth, Western Australia (Australia); Taylor, Donna B [Royal Perth Hospital Perth, Perth, Western Australia (Australia); School of Surgery, University of Western Australia, Crawley, Western Australia (Australia); Western Hospital, Footscray, Victoria (Australia)

    2015-09-15

    Cancer screening and surveillance programmes and the use of sophisticated imaging tools such as positron emission tomography-computed tomography (PET-CT) have increased the detection of impalpable lesions requiring imaging guidance for excision. A new technique involves intra-lesional insertion of a low-activity iodine-125 ({sup 125}I) seed and detection of the radioactive signal in theatre using a hand-held gamma probe to guide surgery. Whilst several studies describe using this method to guide the removal of impalpable breast lesions, only a handful of publications report its use to guide excision of lesions outside the breast. We describe a case in which radio-guided occult lesion localisation using an iodine 125 seed was used to guide excision of an impalpable posterior chest wall metastasis detected on PET-CT.

  9. Description of GTV and CTV for radiation therapy of breast carcinomas: breast and chest wall; La radiotherapie du sein et de la paroi thoracique: les volumes a traiter

    Energy Technology Data Exchange (ETDEWEB)

    Dilhuydy, J.M. [Institut Bergonie, Service de Radiotherapie, 33 - Bordeaux (France); Bussieres, E. [Insitut Bergonie, Service de Chirurgie, 33 - Bordeaux (France); Romestaing, P. [Centre Hospitalier Lyon-Sud, Service de Radiotherapie, 69 - Pierre Benite (France)

    2001-10-01

    The radiotherapy of the breast or the chest wall is a complex technique. The definition of the gross tumour volume and the clinical target volume depends on clinical, anatomical and histological criteria. The volumes are located by physical examination, mammography, echography and tomodensitometry. The implantation of surgical clips in the lumpectomy cavity is useful for the boost field. The planning target volume takes into consideration movements of tissues during respiration and variations in beam geometry characteristics. The organs at risk (heart, lung) must be considered systematically. Technical contrivances are necessary to modify and homogenize dose distribution. Conformational irradiation allows an individually design treatment planning. Intensity modulated radiotherapy technique is a future advantageous technique still under evaluation. (authors)

  10. Radio-guided occult lesion localisation using iodine 125 Seeds “ROLLIS” to guide surgical removal of an impalpable posterior chest wall melanoma metastasis

    International Nuclear Information System (INIS)

    Cancer screening and surveillance programmes and the use of sophisticated imaging tools such as positron emission tomography-computed tomography (PET-CT) have increased the detection of impalpable lesions requiring imaging guidance for excision. A new technique involves intra-lesional insertion of a low-activity iodine-125 (125I) seed and detection of the radioactive signal in theatre using a hand-held gamma probe to guide surgery. Whilst several studies describe using this method to guide the removal of impalpable breast lesions, only a handful of publications report its use to guide excision of lesions outside the breast. We describe a case in which radio-guided occult lesion localisation using an iodine 125 seed was used to guide excision of an impalpable posterior chest wall metastasis detected on PET-CT

  11. Extravascular chest wall technetium 99m diethylene triamine penta-acetic acid: Implications for the measurement of renal function during renography

    International Nuclear Information System (INIS)

    Measurement of individual kidney glomerular filtration rate (IKGFR) from the gamma-camera technetium 99m diethylene triamine penta-acetic acid (99mTc-DTPA) renogram requires a continuous measurement of arterial activity. This is usually based on a region of interest (ROI) placed over the cardiac blood pool on the posterior view, with the assumption of negligible contamination from activity in the extravascular space of the chest wall. By injecting a small dose of technetium 99m human serum albumin (HSA) before the 99mTc-DTPA in 12 patients undergoing routine renography, the contribution of extravascular activity to the total signal recorded over the cardiac blood pool was calculated to be 11.0% (SE 2.1%) 1.5 min after DTPA injection, rising to 35.1% (SE 2.5%) at 15 min. Subtraction of the time-activity curve recorded from a ROI of the same size over the right lung generated a 'pure' blood signal as shown by almost identical HSA/DTPA signal ratios recorded in blood samples taken 5 min after HSA and 15 min after DTPA and from the gamma-camera at the corresponding times. The effect of using a cardiac blood pool time-activity curve uncorrected for extravascular activity was to overestimate IKGFR by an average factor of 1.17 (SE 0.03). (orig.)

  12. Chest drainage.

    Science.gov (United States)

    Carter, Chris

    2014-07-15

    As an intensive care nurse with experience of caring for critically ill patients in the UK and on deployed operations overseas, I found the CPD article useful in reviewing the pathophysiology of a pneumothorax, use of intrapleural chest drains, observations that should be recorded, and nursing care and management of a patient with an intrapleural chest drain. Reflecting on the time out activities in the CPD article was valuable. PMID:25005418

  13. Dosimetric comparison for volumetric modulated arc therapy and intensity-modulated radiotherapy on the left-sided chest wall and internal mammary nodes irradiation in treating post-mastectomy breast cancer

    OpenAIRE

    Zhang, Qian; Yu, Xiao Li; Hu, Wei Gang; Chen, Jia Yi; Wang, Jia Zhou; Ye, Jin Song; Guo, Xiao Mao

    2015-01-01

    Background The aim of the study was to evaluate the dosimetric benefit of applying volumetric modulated arc therapy (VMAT) on the post-mastectomy left-sided breast cancer patients, with the involvement of internal mammary nodes (IMN). Patients and methods The prescription dose was 50 Gy delivered in 25 fractions, and the clinical target volume included the left chest wall (CW) and IMN. VMAT plans were created and compared with intensity-modulated radiotherapy (IMRT) plans on Pinnacle treatmen...

  14. Reversibility of stress-echo induced ST-segment depression by long-term oral n-3 PUFA supplementation in subjects with chest pain syndrome, normal wall motion at stress-echo and normal coronary angiogram

    OpenAIRE

    Ziacchi Vigilio; Gaibazzi Nicola

    2004-01-01

    Abstract Background Normal coronary arteries may coexist with abnormal coronary and systemic endothelial function in patients with chest pain. Recent work by the renowned Pisa echo-group elegantly suggests that isolated ST-segment depression during stress-echo (SE) can be used as a marker of coronary endothelial dysfunction, in the absence of stress-inducible wall motion abnormalities and in the absence of angiographically-significant coronary artery disease (CAD). The long chain n-3 polyunsa...

  15. SU-E-T-583: Operated Left Breast and Chest Wall Radiotherapy: A Dosimetric Comparison Between 3DCRT, IMRT and VMAT

    Energy Technology Data Exchange (ETDEWEB)

    Sarkar, B [AMRI Cancer Centre and GLA university, Mathura, Kolkata, West bengal (India); Roy, S [AMRI Cancer Centre, Kolkata, Kolkata, West bengal (India); Munshi, A [Fortis Memorial Research Institute, Gurgon, haryana (India); Pradhan, A [GLA University, Mathura, Uttar Pradesh (India)

    2015-06-15

    Purpose: To evaluate the comparative dosimetric efficacy between field and field 3DCRT(FnF), multiple field Intensity modulated radiotherapy (SnS IMRT) and, partial arc volumetric modulated arc therapy (VMAT) in case of post operative left side breast and chest wall irradiation. Methods: CT study set of fifteen post-operative left breast and chest wall patient was tested for a treatment plan of 50Gy in 25 fraction using partial arc VMAT, SnSIMRT and tangential beam 3DCRT . 3DCRT FnF gantry angle was ranging for left medial tangential 290±17{sup 0} and Lt lateral tangential l14°±12{sup 0}. For IMRT four fixed beam at gantry angle G130{sup 0} G110{sup 0} G300{sup 0} and G330{sup 0} was used, in case of insufficient dose another beam G150{sup 0} was added. In case of partial arc VMAT, lateral tangential arc G130{sup 0}-G100{sup 0} and medial tangential arc G280{sup 0}-G310{sup 0}. Inverse optimization was opted to cover at least 95%PTV by 95% prescription dose (RxD) and a strong weightage on reduction of heart and lung dose. PTV coverage was evaluated for it’s clinically acceptability depending on the tumor spatial location and its quadrant. Out of the three plans, any one was used for the actual patient treatment. Results: Dosimetric analysis done for breast PTV, left lung, heart and the opposite breast. PTV mean dose and maximum dose was 5129.8±214.8cGy, 4749.0±329.7cGy, 5024.6±73.4cGy and 5855.2±510.7cGy, 5340.7±146.1cGy, 5347.2±196.8cGy for FnF, VMAT and IMRT respectively. Ipsilateral lung volume receiving 20Gy and 5Gy was 23.6±9.5cGy and 32.7±10.3cGy for FnF, 18.6±8.7cGy and 38.8±15.2cGy for VMAT and 25.7±9.6cGy and 50.7±8.4cGy for IMRT respectively. Heart mean and 2cc dose was 867.9±456.7cGy and 5038.5±184.3cGy for FnF, 532.6±263cGy and 3632.1±990.6 for VMAT, 711±229.9cGy and 4421±463.7cGy for IMRT respectively. VMAT shows minimum contralateral breast dose 168±113.8cGy. Conclusion: VMAT shows a better tumor conformity, minimum heart

  16. SPECT Analysis of Cardiac Perfusion Changes After Whole-Breast/Chest Wall Radiation Therapy With or Without Active Breathing Coordinator: Results of a Randomized Phase 3 Trial

    Energy Technology Data Exchange (ETDEWEB)

    Zellars, Richard, E-mail: zellari@jhmi.edu [Johns Hopkins Medical Institution, Baltimore, Maryland (United States); Bravo, Paco E. [University of Washington Medical Center, Seattle, Washington (United States); Tryggestad, Erik [Mayo Clinic, Rochester, Minnesota (United States); Hopfer, Kari [Hahnemann University, Philadelphia, Pennsylvania (United States); Myers, Lee; Tahari, Abdel; Asrari, Fariba; Ziessman, Harvey [Johns Hopkins Medical Institution, Baltimore, Maryland (United States); Garrett-Mayer, Elizabeth [Medical University of South Carolina, Charleston, South Carolina (United States)

    2014-03-15

    Purpose: Cardiac muscle perfusion, as determined by single-photon emission computed tomography (SPECT), decreases after breast and/or chest wall (BCW) irradiation. The active breathing coordinator (ABC) enables radiation delivery when the BCW is farther from the heart, thereby decreasing cardiac exposure. We hypothesized that ABC would prevent radiation-induced cardiac toxicity and conducted a randomized controlled trial evaluating myocardial perfusion changes after radiation for left-sided breast cancer with or without ABC. Methods and Materials: Stages I to III left breast cancer patients requiring adjuvant radiation therapy (XRT) were randomized to ABC or No-ABC. Myocardial perfusion was evaluated by SPECT scans (before and 6 months after BCW radiation) using 2 methods: (1) fully automated quantitative polar mapping; and (2) semiquantitative visual assessment. The left ventricle was divided into 20 segments for the polar map and 17 segments for the visual method. Segments were grouped by anatomical rings (apical, mid, basal) or by coronary artery distribution. For the visual method, 2 nuclear medicine physicians, blinded to treatment groups, scored each segment's perfusion. Scores were analyzed with nonparametric tests and linear regression. Results: Between 2006 and 2010, 57 patients were enrolled and 43 were available for analysis. The cohorts were well matched. The apical and left anterior descending coronary artery segments had significant decreases in perfusion on SPECT scans in both ABC and No-ABC cohorts. In unadjusted and adjusted analyses, controlling for pretreatment perfusion score, age, and chemotherapy, ABC was not significantly associated with prevention of perfusion deficits. Conclusions: In this randomized controlled trial, ABC does not appear to prevent radiation-induced cardiac perfusion deficits.

  17. SPECT Analysis of Cardiac Perfusion Changes After Whole-Breast/Chest Wall Radiation Therapy With or Without Active Breathing Coordinator: Results of a Randomized Phase 3 Trial

    International Nuclear Information System (INIS)

    Purpose: Cardiac muscle perfusion, as determined by single-photon emission computed tomography (SPECT), decreases after breast and/or chest wall (BCW) irradiation. The active breathing coordinator (ABC) enables radiation delivery when the BCW is farther from the heart, thereby decreasing cardiac exposure. We hypothesized that ABC would prevent radiation-induced cardiac toxicity and conducted a randomized controlled trial evaluating myocardial perfusion changes after radiation for left-sided breast cancer with or without ABC. Methods and Materials: Stages I to III left breast cancer patients requiring adjuvant radiation therapy (XRT) were randomized to ABC or No-ABC. Myocardial perfusion was evaluated by SPECT scans (before and 6 months after BCW radiation) using 2 methods: (1) fully automated quantitative polar mapping; and (2) semiquantitative visual assessment. The left ventricle was divided into 20 segments for the polar map and 17 segments for the visual method. Segments were grouped by anatomical rings (apical, mid, basal) or by coronary artery distribution. For the visual method, 2 nuclear medicine physicians, blinded to treatment groups, scored each segment's perfusion. Scores were analyzed with nonparametric tests and linear regression. Results: Between 2006 and 2010, 57 patients were enrolled and 43 were available for analysis. The cohorts were well matched. The apical and left anterior descending coronary artery segments had significant decreases in perfusion on SPECT scans in both ABC and No-ABC cohorts. In unadjusted and adjusted analyses, controlling for pretreatment perfusion score, age, and chemotherapy, ABC was not significantly associated with prevention of perfusion deficits. Conclusions: In this randomized controlled trial, ABC does not appear to prevent radiation-induced cardiac perfusion deficits

  18. 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

    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 ...

  19. A pilot study of the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with mucus hypersecretion

    Directory of Open Access Journals (Sweden)

    Chakravorty I

    2011-12-01

    Full Text Available Indranil Chakravorty1, Kamaljit Chahal2, Gillian Austin21St George's Hospital, London, 2East and North Hertfordshire NHS Trust, Lister Hospital and Primary Care Trust, Stevenage, Hertfordshire, UKIntroduction: Chronic obstructive pulmonary disease (COPD patients with mucus hypersecretion tend to demonstrate increased frequency of infective exacerbations and a steeper slope of decline in lung function. Enhanced mucociliary clearance with high-frequency chest wall oscillation (HFCWO devices previously used in cystic fibrosis and bronchiectasis patients may offer the opportunity for community-based, self-managed therapy to improve quality of life and lung function.Study design and methods: A randomized controlled crossover pilot study of HFCWO compared with conventional treatment was conducted in 22 patients with moderate to severe COPD and mucus hypersecretion. Patients spent 4 weeks using an HFCWO (SmartVest® device and 4 weeks in a conventional phase with a 2-week washout. Eleven patients started with HFCWO and changed to conventional treatment, whereas the other eleven patients started conventional treatment and crossed over to HFCWO.Results: The patients were elderly with a mean age of 71 (standard deviation [SD] 10 years and were at the upper end of the normal range of body mass index (25 [SD 4.2] kg/m2. The majority of patients had moderate to severe COPD with a mean percentage predicted forced expiratory volume in 1 second of 41 (SD 15.6 and percentage predicted forced vital capacity of 73 (SD 17.7. Baseline sputum production was negatively correlated to lung function and positively to St George's Respiratory Questionnaire. Symptom scores and St George's Respiratory Questionnaire symptom dimension improved significantly (-8, P < 0.05. Sputum production showed a declining trend in the HFCWO phase, although not reaching statistical significance. The HFCWO device was well tolerated with good reported compliance.Conclusion: This pilot study

  20. 经胸骨前径路三孔法内镜甲状腺切除术的体会%Three-port endoscopic thyroidectomy via anterior chest wall approach

    Institute of Scientific and Technical Information of China (English)

    张勇; 吴永红

    2012-01-01

    目的:探讨经胸骨前径路三孔法内镜甲状腺切除术的临床疗效及应用价值.方法:回顾分析为17例患者经胸骨前径路行三孔法内镜甲状腺切除术的临床资料.结果:17例手术均获成功,无一例中转开放手术,未损伤喉上神经、喉返神经及甲状旁腺.手术时间100~ 150 min,平均134 min;术中出血量30 ~50ml,平均42ml.患者对术后美容效果均非常满意.结论:选择合适的手术病例,经胸骨前径路行三孔法内镜甲状腺切除术是安全可行的,疗效确切,具有很好的美容效果.%Objective; To discuss the clinical efficacy and application value of three-port endoscopic thyroidectomy through anterior chest wall. Methods;The clinical data of 17 patients who underwent three-port endoscopic thyroidectoroy through anterior chest wall were analyzed retrospectively. Results;Seventeen operations were all successful,without conversions to open procedures. No injuries of the superior laryngeal nerve, recurrent laryngeal nerve, or parathyroid occurred. The average operating time was 134 min(100-150 min) .average blood loss was 42 ml(30-50 ml). All the patients were very satisfied with the cosmetic results. Conclusions;Three-port endoscopic thyroidectomy through anterior chest wall is safe and feasible for selected appropriate cases, with the advantages of excellent cosmetic results and definite therapeutic effect.

  1. Dosimetric Comparison of Volumetric Modulated Arc Therapy, Static Field Intensity Modulated Radiation Therapy, and 3D Conformal Planning for the Treatment of a Right-Sided Reconstructed Chest Wall and Regional Nodal Case

    Directory of Open Access Journals (Sweden)

    Vishruta A. Dumane

    2014-01-01

    Full Text Available We compared 3D conformal planning, static field intensity modulated radiation therapy (IMRT, and volumetric modulated arc therapy (VMAT to investigate the suitable treatment plan and delivery method for a right-sided reconstructed chest wall and nodal case. The dose prescribed for the reconstructed chest wall and regional nodes was 50.4 Gy. Plans were compared for target coverage and doses of the lungs, heart, contralateral breast, and healthy tissue. All plans achieved acceptable coverage of the target and IMNs. The best right lung sparing achieved with 3D was a V20 Gy of 31.09%. Compared to it, VMAT reduced the same by 10.85% and improved the CI and HI over 3D by 18.75% and 2%, respectively. The ipsilateral lung V5 Gy to V20 Gy decreased with VMAT over IMRT by as high as 17.1%. The contralateral lung V5 Gy was also lowered with VMAT compared to IMRT by 16.22%. The MU and treatment beams were lowered with VMAT over IMRT by 30% and 10, respectively, decreasing the treatment time by >50%. VMAT was the treatment plan and delivery method of choice for this case due to a combination of improved lung sparing and reduced treatment time without compromising target coverage.

  2. Diastolic timed Vibro-Percussion at 50 Hz delivered across a chest wall sized meat barrier enhances clot dissolution and remotely administered Streptokinase effectiveness in an in-vitro model of acute coronary thrombosis

    Directory of Open Access Journals (Sweden)

    Hoffmann Andrew

    2012-11-01

    Full Text Available Abstract Background Low Frequency Vibro-Percussion (LFVP assists clearance of thrombi in catheter systems and when applied to the heart and timed to diastole is known to enhance coronary flow. However LFVP on a clotted coronary like vessel given engagement over a chest wall sized barrier (to resemble non-invasive heart attack therapy requires study. Methods One hour old clots (n=16 were dispensed within a flexible segment of Soft-Flo catheter (4 mm lumen, weighted, interfaced with Heparinized Saline (HS, secured atop a curved dampening base, and photographed. A ~4 cm meat slab was placed over the segment and randomized to receive intermittent LFVP (engaged, - disengaged at 1 second intervals, or no LFVP for 20 minutes. HS was pulsed (~120/80 mmHg, with the diastolic phase coordinated to match LFVP delivery. The segment was then re-photographed and aspirated of fluid to determine post clot weight. The trial was then repeated with 0.5 mls of Streptokinase (15,000 IU/100 microlitre delivered ~ 2 cm upstream from the clot. Results LFVP - HS only samples (vs. controls showed; a development of clot length fluid channels absent in the control group (p Conclusion Diastolic timed LFVP (50 Hz engaged across a chest wall sized barrier enhances clot disruptive effects to an underlying coronary like system.

  3. Chest pain

    Science.gov (United States)

    ... back. A tear in the wall of the aorta, the large blood vessel that takes blood from ... You have high cholesterol, high blood pressure, or diabetes You already have heart disease Call your doctor ...

  4. Potential of ultrasound in the pediatric chest

    International Nuclear Information System (INIS)

    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

  5. 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.

  6. Thymic carcinoma presenting as atypical chest pain.

    Science.gov (United States)

    Siddiqui, Sadiq; Connelly, Tara; Keita, Luther; Blazkova, Sylvie; Veerasingam, Dave

    2015-01-01

    A 58-year-old woman with a 2-month history of atypical chest pain was referred to the chest pain clinic by the general practitioner. Exercise stress test was positive and subsequent coronary angiogram revealed significant triple vessel disease with left ventricular impairment requiring a coronary artery bypass graft (CABG). The patient had a chest X-ray as part of the preoperative work up. Chest X-ray revealed a large anterior mediastinal mass. Subsequent thorax CT revealed a 7.2 cm anterior mediastinal mass. CT-guided biopsy of the mass revealed the diagnosis of a poorly differentiated thymic basaloid carcinoma. The patient was successfully treated with concomitant surgery involving complete resection of the mass and a CABG procedure. PMID:26607199

  7. The chest

    International Nuclear Information System (INIS)

    Radiographic interpretation of chest films of newborns in respiratory distress remains one of the most difficult aspects of pediatric radiology. Complex pulmonary and cardiac adjustments to extrauterine life are rapidly taking place. The small, fluid-filled fetal lung must rid itself of fluid and fill with air. The high vascular resistance of the fetal pulmonary bed and the open ductus arteriosus allow shunting of blood in both directions. Films taken in this period of time may show lungs that resemble those seen in congestive heart failure or fluid overload. When these findings are observed in infants who may appear dusky or even cyanotic, the result may be the diagnosis of disease in normal infants passing through a stormy transition period. To make things worse, the films are taken as portable surpine films, usually in an isolette in the intensive care unit (ICU). The phase of respiration is difficult, if not impossible, to control, and lateral films are usually not obtained. Many of the infants are on assisted ventilation either by tube or nasal prongs-nasal continuous positive airway pressure (CPAP)-and lungs can appear over-inflated or whited out, depending on the pressures used and the phase of the respiratory cycle. Prolonged crying itself can make lungs appear semiopaque; the next breath may show such a dramatic reinflation that it is hard to believe the two films are of the same infant, made only seconds apart. Is the heart large? Or is it the thymus? Are the lungs ''wet''? Is there infection? Is there pulmonary vascular engorgement? Why are these films so hard to interpret? They have no easy answers. The radiologist must realize that the neonatal intensive care personnel, armed though they may be with blood gas values, are no better at interpreting films. If anything, they read into them what they wish to see

  8. Chest X-Ray

    Medline Plus

    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 ...

  9. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    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.)

  10. Imaging of blunt chest trauma

    Energy Technology Data Exchange (ETDEWEB)

    Wicky, S.; Wintermark, M.; Schnyder, P.; Capasso, P.; Denys, A. [Centre Hospitalier Universitaire Vaudois, Lausanne (Switzerland). Dept. of Radiology

    2000-10-01

    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.)

  11. wall

    Directory of Open Access Journals (Sweden)

    Irshad Kashif

    2016-01-01

    Full Text Available Maintaining indoor climatic conditions of buildings compatible with the occupant comfort by consuming minimum energy, especially in a tropical climate becomes a challenging problem for researchers. This paper aims to investigate this problem by evaluating the effect of different kind of Photovoltaic Trombe wall system (PV-TW on thermal comfort, energy consumption and CO2 emission. A detailed simulation model of a single room building integrated with PV-TW was modelled using TRNSYS software. Results show that 14-35% PMV index and 26-38% PPD index reduces as system shifted from SPV-TW to DGPV-TW as compared to normal buildings. Thermal comfort indexes (PMV and PPD lie in the recommended range of ASHARE for both DPV-TW and DGPV-TW except for the few months when RH%, solar radiation intensity and ambient temperature were high. Moreover PVTW system significantly reduces energy consumption and CO2 emission of the building and also 2-4.8 °C of temperature differences between indoor and outdoor climate of building was examined.

  12. Quantitative Imaging Assessment of an Alternative Approach to Surgical Mitral Valve Leaflet Resection: An Acute Porcine Study.

    Science.gov (United States)

    Boronyak, Steven M; Fredi, Joseph L; Young, Michael N; Dumont, Douglas M; Williams, Phillip E; Byram, Brett C; Merryman, W David

    2016-07-01

    This study reports the initial in vivo use of a combined radiofrequency ablation and cryo-anchoring (RFC) catheter as an alternative to surgical mitral valve (MV) leaflet resection. Radiofrequency ablation thermally shrinks enlarged collagenous tissues, providing an alternative to leaflet resection, and cryo-anchoring provides reversible attachment of a catheter to freely mobile MV leaflets. Excised porcine MVs (n = 9) were tested in a left heart flow simulator to establish treatment efficacy criteria. Resected leaflet area was quantified by tracking markers on the leaflet surface, and leaflet length reductions were directly measured on echocardiography. Leaflet area decreased by 38 ± 2.7%, and leaflet length decreased by 9.2 ± 1.8% following RFC catheter treatment. The RFC catheter was then tested acutely in healthy pigs (n = 5) under epicardial echocardiographic guidance, open-chest without cardiopulmonary bypass, using mid-ventricular free wall access. Leaflet length was quantified using echocardiography. Quantitative assessment of MV leaflet length revealed that leaflet resection was successful in 4 of 5 pigs, with a leaflet length reduction of 13.3 ± 4.6%. Histological, mechanical, and gross pathological findings also confirmed that RFC catheter treatment was efficacious. The RFC catheter significantly reduces MV leaflet size in an acute animal model, providing a possible percutaneous alternative to surgical leaflet resection. PMID:26508331

  13. Prostate resection - minimally invasive

    Science.gov (United States)

    ... microwave thermotherapy; TUMT; BPH - resection; Benign prostatic hyperplasia (hypertrophy) - resection; Prostate - enlarged - resection ... passing an instrument through the opening in your penis (meatus). You will be given general anesthesia (asleep ...

  14. Chest x-ray

    Science.gov (United States)

    Chest radiography; Serial chest x-ray; X-ray - chest ... You stand in front of the x-ray machine. You will be told to hold your breath when the x-ray is taken. Two images are usually taken. You will ...

  15. Characterisation of manual chest physiotherapy and respiratory response in mechanically ventilated children

    OpenAIRE

    Gregson, Rachael Kathleen

    2008-01-01

    Chest physiotherapy is integral to the management of mechanically ventilated children and previous research has confirmed that chest wall vibrations are the manual techniques used most frequently by physiotherapists in this population. Chest wall vibrations involve the application of a compressive force to the chest during expiration, with the aim of removing accumulated secretions and improving lung aeration. However, these techniques are largely unquantified and may vary grea...

  16. Successful Resection of Giant Mediastinal Lipofibroadenoma of the Thymus by Video-Assisted Thoracoscopic Surgery.

    Science.gov (United States)

    Makdisi, George; Roden, Anja C; Shen, K Robert

    2015-08-01

    We report the case of a 20-year-old man who presented with a large heterogeneous mass incidentally found on a chest roentgenogram performed in the context of acute onset of fever and cough. A chest computed tomography scan showed a large heterogenous mass in the anterior mediastinum. The patient underwent surgical resection by a right video-assisted thoracoscopic approach. The resected mass was completely encapsulated and was histologically determined to be a lipofibroadenoma. Complete resection is curative. This is the sixth reported case of lipofibroadenoma of the thymus in the English literature and the first reported case of video-assisted thoracoscopic resection of a lipofibroadenoma. PMID:26234840

  17. Severe Pulmonary Valve Regurgitation 40 Years After Blunt Chest Trauma.

    Science.gov (United States)

    Fuglsang, Simon; Heiberg, Johan; Hjortdal, Vibeke Elisabeth

    2015-10-01

    Severe pulmonary valve regurgitation caused by a pulmonary valve tear is a rare complication to a blunt chest trauma. In this case report, we present a patient with pulmonary regurgitation originating from a chest trauma 40 years ago. Possible mechanisms are osseous pinch of the pulmonary valve between the anterior chest wall and the vertebral column, and retrograde blowout from severe compression of the lungs. PMID:26434447

  18. CT of blunt chest trauma in children

    International Nuclear Information System (INIS)

    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.)

  19. Chest CT in infants and children

    International Nuclear Information System (INIS)

    Computed tomography (CT) is a powerful and irreplaceable imaging technique in the evaluation of thoracic disease in infants and children. Recent advances in CT technology, with multi-detector equipment now widely available in most institutions, allowing a highly detailed evaluation of the chest in a short time period has resulted in expanding indications of chest CT in paediatric patients. Its improved diagnostic yield along with a widespread availability has also resulted in an increased number of CT examinations in children, not always with beneficial impact on patient management and outcome. Accordingly with the ALARA concept, a judicious and correct use of CT is strongly advisable in order to reduce unnecessary high dose radiation exposure. The objective of this paper is to review the use of chest CT in paediatric patients focused mainly on basic technical aspects and clinical applications in the evaluation of the lungs, mediastinum and chest wall

  20. 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...

  1. 体表膈肌肌电对睡眠呼吸暂停事件的鉴别作用%Distinguishing central from obstructive sleep apnea with chest wall surface electrodes

    Institute of Scientific and Technical Information of China (English)

    朱慧儿; 王玮; 罗远明

    2012-01-01

    Objective To determine whether or not diaphragm electromyography recorded from chest wall surface electrodes (EMGsur) can be used to distinguish central from obstructive sleep apnea.Methods Ten patients ( age (44±10) years,body mass index (25.9±1.8) kg/m2 ) with suspected obstructive sleep apnea referred from Guangzhou Institute of Respiratory Disease were studied between January and September 2009. EMGsur and diaphragm electromyography from esophageal electrode (EMGeso) were recorded during conventional overnight full polysomnography. And chest-abdominal movement was measured with chest and abdominal bands.Results High-quality EMGsur and EMGeso were recorded in all subjects except for one who could not tolerate a multipair esophageal electrode.Excellent correlation was found between EMGsur and EMGeso during sleep including apnea events ( r=0.81±0.06,P<0.05 ).The central sleep apnea events diagnosed by EMGeso were exactly the same as those diagnosed by EMGsur.However,the central sleep apnea events diagnosed by EMGsur were less than those diagnosed by conventional thoracic-abdominal bands ( 7±11 vs 28±31,P<0.05 ).Conclusion EMGsur may be used to distinguish central from obstructive sleep apnea events.%目的 探讨体表电极记录膈肌肌电是否有助于准确区分阻塞性睡眠呼吸暂停(OSA)与中枢性睡眠呼吸暂停(CSA)事件.方法 选择2009年1-9月广州呼吸疾病研究所就诊并疑有睡眠呼吸暂停综合征的10例患者,其中男8例,女2例;年龄(44±10)岁,体质指数(25.9±1.8) kg/m2.对患者进行整夜常规多导睡眠监测的同时记录体表膈肌肌电信号、食管膈肌肌电信号,分析体表膈肌肌电与食管膈肌肌电的相关性,并比较胸腹带、体表膈肌肌电和食管膈肌肌电在判断CSA事件方面的差异.结果 除1例患者外,其他9例患者均能耐受多导食管电极检查,并可记录到高质量的食管膈肌肌电信号和体表膈肌肌电信号.食管膈肌肌电和

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

    International Nuclear Information System (INIS)

    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.)

  3. Effect of previous thoracic surgery on gallium uptake in the chest

    International Nuclear Information System (INIS)

    To determine the frequency, average duration, and characteristic patterns of persistent gallium uptake caused by thoracotomy, serial postsurgical scans of 51 patients were reviewed. In each of these cases a thoracotomy had been performed for resection of lung cancer, and there had been no evidence of recurrent tumor for at least 2 yr following surgery. Postoperative gallium activity due to non-neoplastic postoperative changes occurred in 15 patients. Five of six patients scanned within 3 mo of surgery and six of 21 scanned 3 to 6 mo following surgery showed persistent uptake at the operative site. All 13 patients who had subsequent scans demonstrated eventual clearing. Activity persisted more than 18 mo postoperatively in only one patient. Patterns of gallium accumulation included both focal chest wall uptake at the incision site and diffuse pleural activity

  4. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    Directory of Open Access Journals (Sweden)

    João Palas

    2014-01-01

    Full Text Available Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  5. Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

    International Nuclear Information System (INIS)

    Imaging plays an essential part of chest trauma care. By definition, the employed imaging technique in the emergency setting should reach the correct diagnosis as fast as possible. In severe chest blunt trauma, multidetector computer tomography (MDCT) has become part of the initial workup, mainly due to its high sensitivity and diagnostic accuracy of the technique for the detection and characterization of thoracic injuries and also due to its wide availability in tertiary care centers. The aim of this paper is to review and illustrate a spectrum of characteristic MDCT findings of blunt traumatic injuries of the chest including the lungs, mediastinum, pleural space, and chest wall.

  6. 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...

  7. Chest X-Ray

    Medline Plus

    Full Text Available ... this Site RadiologyInfo.org is produced by: Image/Video Gallery Your radiologist explains chest x-ray. Transcript ... time! Spotlight Recently posted: Pediatric MRI Intravascular Ultrasound Video: Chest CT Video:Thyroid Ultrasound Video: Head CT ...

  8. Open resections for congenital lung malformations

    Directory of Open Access Journals (Sweden)

    Mullassery Dhanya

    2008-01-01

    Full Text Available Aim: Pediatric lung resection is a relatively uncommon procedure that is usually performed for congenital lesions. In recent years, thoracoscopic resection has become increasingly popular, particularly for small peripheral lesions. The aim of this study was to review our experience with traditional open lung resection in order to evaluate the existing "gold standard." Materials and Methods: We carried out a retrospective analysis of all children having lung resection for congenital lesions at our institution between 1997 and 2004. Data were collected from analysis of case notes, operative records and clinical consultation. The mean follow-up was 37.95 months. The data were analyzed using SPSS. Results: Forty-one children (13 F/28 M underwent major lung resections during the study period. Their median age was 4.66 months (1 day-9 years. The resected lesions included 21 congenital cystic adenomatoid malformations, 14 congenital lobar emphysema, four sequestrations and one bronchogenic cyst. Fifty percent of the lesions were diagnosed antenatally. Twenty-six patients had a complete lobectomy while 15 patients had parenchymal sparing resection of the lesion alone. Mean postoperative stay was 5.7 days. There have been no complications in any of the patients. All patients are currently alive, asymptomatic and well. None of the patients have any significant chest deformity. Conclusions: We conclude that open lung resection enables parenchymal sparing surgery, is versatile, has few complications and produces very good long-term results. It remains the "gold standard" against which minimally invasive techniques may be judged.

  9. Large bowel resection

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/002941.htm Large bowel resection To use the sharing features on this page, please enable JavaScript. Large bowel resection is surgery to remove all or ...

  10. Effectiveness of chest physiotherapy in the management of bronchiectasis

    International Nuclear Information System (INIS)

    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)

  11. Sternal resection and reconstruction for local recurrence of breast cancer using the sternal allograft transplantation technique.

    Science.gov (United States)

    Dell'amore, Andrea; Nizar, Asadi; Dolci, Giampiero; Cassanelli, Nicola; Caroli, Guido; Luciano, Giulia; Greco, Domenico; Bini, Alessandro; Stella, Franco

    2013-03-01

    Sternal involvement in patients with breast cancer is relatively rare and its treatment is still controversial. Surgery is usually indicated in cases of single metastases in a multimodality protocol. Partial or complete sternectomy associated or not with the resection of surrounding tissues is the technique of choice to obtain safety margins and radical treatment of the disease. The most challenging part of the operation is the reconstruction of the anterior chest wall in order to avoid secondary complications and respiratory failure. In the last few years, different techniques and materials have been used to reconstruct the sternum. We report our experience in two patients with recurrent breast cancer using the sternal allograft technique to replace the sternum after partial sternectomy. The use of a sternal-allograft provides excellent functional and cosmetic results without complications during the follow-up period. The implantation technique is simple and reproducible. PMID:22884436

  12. Efeitos de duas técnicas de incentivo respiratório na mobilidade toracoabdominal após cirurgia abdominal alta Effects of two respiratory incentive techniques on chest wall mobility after upper abdominal surgery

    Directory of Open Access Journals (Sweden)

    Maria Elaine Trevisan

    2010-12-01

    with the Voldyne device, and group 2 (n=6, submitted to a split-inspiration pattern training. Chest wall expansion was rated by measuring thorax circumferences before surgery and on the 1st, 3rd, and 5th post-operative (PO days. In both groups a significant decrease was found in circumference values on the 1st PO day, which gradually recovered, until on the 5th PO day no significant differences were found as compared to pre-operative measures. Group 1 showed significantly better thoracic-abdominal expansion rates than group 2's, as well as higher recovery time rates all through. Though both breathing techniques used were effective, inspiratory incentive using the Voldyne device showed better results in recovering chest mobility after upper abdominal surgery.

  13. Chest X-Ray

    Medline Plus

    Full Text Available ... the most commonly performed x-ray exams and use a very small dose of ionizing radiation to ... to your health. While a chest x-ray use a tiny dose of ionizing radiation, the benefit ...

  14. Learning chest imaging

    Energy Technology Data Exchange (ETDEWEB)

    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.

  15. Digital chest radiography

    DEFF Research Database (Denmark)

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

    2015-01-01

    Purpose: Quality improvement of basic radiography focusing 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 of age are included in the study. The clinical research is performed between September and November 2014 where 3rd year Radiography students collect data on four Danish x-ray departments using identical procedures under guidance of...... conference. Conclusion: Collimation improvement in basic chest radiography can reduce the radiation to female patients at chest x-ray examinations....

  16. Digital chest radiography

    DEFF Research Database (Denmark)

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

    2015-01-01

    Background: Chest radiography is one of the most common examinations in radiology departments. In 2013 approximately 80,000 chest x-rays were performed on women in the fertile age. Even low dose for the examinationCorrect collimation Purpose: Quality improvement of basic radiography focusing 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...... of age are included in the study. The clinical research is performed between September and November 2014 where 3rd year Radiography students collect data on four Danish x-ray departments using identical procedures under guidance of clinical supervisors. Optimal collimation is determined by European...

  17. Chest X-Ray

    Medline Plus

    Full Text Available ... also be useful to help diagnose and monitor treatment for a variety of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray requires no special preparation. ...

  18. Chest X-Ray

    Medline Plus

    Full Text Available ... However, it’s important to consider the likelihood of benefit to your health. While a chest x-ray use a tiny dose of ionizing radiation, the benefit of an accurate diagnosis far outweighs any risk. ...

  19. Management of chest keloids

    Directory of Open Access Journals (Sweden)

    Kim June Kyu

    2011-04-01

    Full Text Available Abstract Keloid formation is one of the most challenging clinical problems in wound healing. With increasing frequency of open heart surgery, chest keloid formations are not infrequent in the clinical practice. The numerous treatment methods including surgical excision, intralesional steroid injection, radiation therapy, laser therapy, silicone gel sheeting, and pressure therapy underscore how little is understood about keloids. Keloids have a tendency to recur after surgical excision as a single treatment. Stretching tension is clearly associated with keloid generation, as keloids tend to occur on high tension sites such as chest region. The authors treated 58 chest keloid patients with surgical excision followed by intraoperative and postoperative intralesional steroid injection. Even with minor complications and recurrences, our protocol results in excellent outcomes in cases of chest keloids.

  20. Chest X-Ray

    Medline Plus

    Full Text Available ... Angioplasty & vascular stenting Video: Arthrography Video: Contrast Material Radiology and You Take our survey About this Site ... radiologist explains chest x-ray. Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. Geoffrey ...

  1. Chest X-Ray

    Medline Plus

    Full Text Available ... of ionizing radiation, the benefit of an accurate diagnosis far outweighs any risk. For more information about chest x-rays, visit Radiology Info dot org. Thank you for your time! ...

  2. Chest X-Ray

    Medline Plus

    Full Text Available ... Site Index A-Z Spotlight June is Men's Health Month Recently posted: Focused Ultrasound for Uterine Fibroids ... to consider the likelihood of benefit to your health. While a chest x-ray use a tiny ...

  3. An unusual case of flail chest: surgical repair using Marlex mesh

    OpenAIRE

    Heriot, A G; Wells, F C

    1997-01-01

    The case history is presented of a patient with neurofibromatosis with a chest wall defect present from birth. Abnormal rib development had resulted in a flail segment with painful paradoxical movement and unsightly costal cartilage protrusion. Chest wall reconstruction using Marlex mesh resulted in an excellent cosmetic and functional repair. 




  4. Chest injuries associated with head injury

    Directory of Open Access Journals (Sweden)

    Wilfred Chukwuemeka Mezue

    2012-01-01

    Full Text Available Background: Although there have been significant advances in the management of traumatic brain injury (TBI, associated severe injuries, in particular chest injuries, remain a major challenge. This paper analyses the contribution of chest injuries to the outcome of head injuries in the University of Nigeria Teaching Hospital (UNTH and the Memfys Hospital for Neurosurgery (MHN in Enugu, Nigeria. Materials and Methods: This is a retrospective review of the medical records, operative notes, and radiological findings of all patients admitted for head injury who had associated significant chest injuries in the MHN from 2002 to 2009 and the UNTH between 2007 and 2010. Patients with only head injury and other extracranial injury not affecting the chest were excluded. Patients who were inadequately investigated were also excluded. Results: Nineteen patients from the MHN and 11 patients from the UNTH were analyzed. Ages ranged from 9 to 65 years and the male:female ratio was 3:1. Injuries were most common between 30 and 50 years and road traffic accident accounted for 60%. Barotrauma from ventilation was documented in 2 patients. The commonest types of intrathoracic injuries are pneumothorax and hemothorax. Chest wall injuries are more common but carry less morbidity and mortality. Only 20% of patients presented within 48 hours of injury. Management of the associated chest trauma commenced in the referring hospitals only in 26.4% of the patients. All patients with hemo-pneumothorax had tube thoracostomy as did 96% of patients with pneumothorax. 10% of patients with haemothorax needed thoracotomy. Mortality is 43%, which is higher than for patients with only TBI with comparable Glasgow coma scale. Outcome is influenced by the time to admission and the GCS on admission. Conclusion: Associated chest injuries result in higher mortality from head injuries. This association is more likely in the young and more productive. All patients presenting with head and

  5. Influence of floating thoracic wall on dogs pulmonary function and curative effect of pressure dressing on chest%浮动胸壁对犬呼吸功能的影响及加压包扎治疗效果观察

    Institute of Scientific and Technical Information of China (English)

    周志明; 陈拥; 王泽学; 孙颢洁; 梁磊

    2014-01-01

    Objective To study the inlfuence of lfoating thoracic wall on dogs pulmonary function and the curative effect of pressure dressing on chest.Methods Floating thoracic wall models of large areas(20 cm2/kg ) and small areas(10 cm2/kg ) were established in 18 hybrid dogs. the intrpleural pressure(iPP), partial pressure of oxygen in artery(Pao2), partial pressure of carbon dioxide in artery(Paco2) and arterial oxygen saturation(sao2) were measured with blood gas analysis and intrathoracic cannula. and the curative effect of pressure dressing on chest on pulmonary function was studied, too.Results Pao2 and sao2 decreased(P <0.05), but Paco2 increased (P <0.05) in large areas group. Pao2 and sao2 decreased(P <0.05) in small areas group. Compared with the lfoating thoracic wall models, after treatment of pressure dressing on chest, pulmonary function data had no statistical signiifcance in large areas group. PaO2 and SaO2 increased (P <0.05), Paco2 decreased(P <0.05) in small areas group after treatment of pressure dressing on chest.Conclusion The lfail chest of large areas group had a great effect on pulmonary function, but the pressure dressing on chest did not show the therapeutic efifcacy. The pressure dressing on chest was an effective way for improvement of pulmonary function in lfail chest of small areas.%目的:观察浮动胸壁对犬呼吸功能的影响以及胸壁加压包扎的疗效。方法实验用杂交犬18只建立大面积(20cm2/kg)和小面积(10cm2/kg)两组胸壁浮动动物模型,用胸腔置管和血气分析等观察胸膜腔内压(iPP)、动脉血氧分压(Pao2)、动脉血二氧化碳分压(Paco2)及动脉血氧饱和度(sao2)变化和加压包扎治疗的效果。结果大面积组Pao2和sao2下降(P<0.05),Paco2升高(P<0.05);小面积组Pao2和sao2下降(P<0.05)。同模型制作后比较,加压包扎治疗后,大面积组呼吸功能指标差异无显著性意义;小面积

  6. A novel technique for the reconstruction of resected sternoclavicular joints: A case report with a review of the literature

    Directory of Open Access Journals (Sweden)

    Waseem M Hajjar

    2013-01-01

    Full Text Available Sternal metastasis in thyroid cancer is an uncommon occurrence with only a handful of cases of chest wall resections being done. Sternal reconstruction for both primary and secondary tumors has been performed using various techniques and materials such as the mesh, methyl acrylate resin, and steel plates; however, this is a case of papillary thyroid cancer involving the sternum in a 50-year-old woman who had resection of the sternum with reconstruction using titanium bars and clips (STRATOS system fixed to the clavicles with an underlying Proceed mesh. STRATOS system showed good recovery postoperatively. The functional results were excellent with the patient being able to perform all daily activities unassisted after 1 month and almost complete range of motion with acceptable limitations in power of the shoulder muscles after 2 months. We have reviewed all the English language publications of the subject by doing Medline search for the last 25 years and we present here the surgical management of this pathology with our novel approach by using the titanium steel bars to stabilize both medial aspects of the resected clavicles as a promising therapy for manubrial reconstruction and clavicular fixation.

  7. CHEST PHYSIOTHERAPY FOR INFANTS

    Directory of Open Access Journals (Sweden)

    Preeti S. Christian (M.P.T Cardiopulmonary Conditions

    2014-10-01

    Full Text Available In the normal lung, secretions are removed by Mucociliary activity, normal breathing cycles, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce the ability to clear secretions, and may increase exacerbations and infections. Many chest physiotherapy techniques like postural drainage, percussion and vibration are used since many years. These techniques are derived from adult studies but these techniques are quite stressful for the infants as the infant respiratory system is different from the adult respiratory system. Advance chest physiotherapy techniques were developed specifically for infants; in accordance with their physiological characteristics. So this review is to introduce some new chest physiotherapy helpful for newborn infants.

  8. Lung cancer: assessing resectability

    OpenAIRE

    Quint, Leslie E

    2003-01-01

    Staging classification in patients with non-small cell lung cancer does not always correlate perfectly with surgical resectability. Therefore, it is important to evaluate individual features of a patient’s tumor in order to determine if surgical resection is the optimal method of treatment, regardless of tumor stage. Such features include characteristics of the primary tumor, regional lymph nodes and distant sites.

  9. Chest X-Ray

    Medline Plus

    Full Text Available ... Pediatric Ultrasound Video: Angioplasty & vascular stenting Video: Arthrography Radiology and You About this Site RadiologyInfo.org is ... radiologist explains chest x-ray. Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. Geoffrey ...

  10. Chest X-Ray

    Medline Plus

    Full Text Available ... this Site RadiologyInfo.org is produced by: Image/Video Gallery Your radiologist explains chest x-ray. Transcript ... Recently posted: Focused Ultrasound for Uterine Fibroids Dementia Video: General Ultrasound Video: Pediatric Nuclear Medicine Radiology and ...

  11. Chest injury in victims of Bam earthquake

    Institute of Scientific and Technical Information of China (English)

    Seyed Mohammad Ghodsi; Moosa Zargar; Ali Khaji; Mojgan Karbakhsh

    2006-01-01

    Objective: To analyze the data of trauma patients with thoracic injury in the earthquake of Bam admitted to hospitals of Tehran University of Medical Science (TUMS)for better understanding the type and consequence of thoracic injuries in a major earthquake.Methods: After Bam earthquake registering 6.5 on the Richter scale, 526 trauma patients were admitted to hospitals of TUMS. Among them, 53 patients sustained thoracic injury.Results: This group was composed of 21 females (39.6%) and 32 males (60.4%). Fifteen patients (28.3%) had isolated chest injuries. Rib fracture (36.4%) was the most common injury in our patients and haemo/pneumothorax (25.5%) followed. Superficial injury was the most common accompanying injury. Multipletrauma patients with chest injury had higher injury severity score (ISS) versus patients with isolated chest injury (P =0.003).Conclusions: Chest wall injuries and haemo/pneumothorax comprise a considerable number of injuries in survival victims of earthquakes. Consequently, the majority of these patients can be treated with observation or tube thoracostomy. We should train and equip the health workers and members of rescue teams to treat and manage these patients in the field.

  12. Pediatric digital chest imaging

    International Nuclear Information System (INIS)

    The Philips Computed Radiography system performs well with pediatric portable chest radiographs, handling the throughout of a busy intensive care service 24 hours a day. Images are excellent and routinely provide a conventional (unenhanced) image and an edge-enhanced image. Radiation dose is decreased by the lowered frequency of repeat examinations and the ability of the plates to respond to a much lower dose and still provide an adequate image. The high quality and uniform density of serial PCR portable radiographs greatly enhances diagnostic content of the films. Decreased resolution has not been a problem clinically. Image manipulation and electronic transfer to remote viewing stations appear to be helpful and are currently being evaluated further. The PCR system provides a marked improvement in pediatric portable chest radiology

  13. Sandstorm in the chest?

    Directory of Open Access Journals (Sweden)

    Talluri MR

    2011-07-01

    Full Text Available A 32 year old female presented with dry cough and progressive breathlessness of one year duration. There was no history suggestive of collagen vascular disease, lung parenchymal infection or allergic airway disease. Clinical evaluation showed basal fine inspiratory crepitations. Radiographic examination of the chest revealed a black pleura line and lung parenchymal calcification. CT scan of the chest demonstrated nodular calcification of lung parenchyma with a “crazy pavement” pattern, which is suggestive of alveolar calcification. Pulmonary function test showed a severe restrictive defect. On transbronchial lung biopsy calcific spherules suggestive of the alveolar microlithiasis were seen. Diagnosis of pulmonary alveolar microlithiasis was made and symptomatic treatment was given, as there is no specific therapy available. The case illustrates an unusual cause of shortness of breath in a young female with striking radiographic features.

  14. Large bowel resection - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100089.htm Large bowel resection - Series To use the sharing features ... 6 out of 6 Normal anatomy Overview The large bowel [large intestine or the colon] is part ...

  15. Large bowel resection - discharge

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000151.htm Large bowel resection - discharge To use the sharing features ... surgery to remove all or part of your large intestine (large bowel). You may also have had ...

  16. Laparoscopic Colon Resection

    Science.gov (United States)

    ... inches to complete the procedure. What are the Advantages of Laparoscopic Colon Resection? Results may vary depending ... type of procedure and patient’s overall condition. Common advantages are: Less postoperative pain May shorten hospital stay ...

  17. CHEST PHYSIOTHERAPY FOR INFANTS

    OpenAIRE

    Preeti S. Christian (M.P.T Cardiopulmonary Conditions)

    2014-01-01

    In the normal lung, secretions are removed by Mucociliary activity, normal breathing cycles, and cough. In disease, increased secretion viscosity and volume, dyskinesia of the cilia, and ineffective cough combine to reduce the ability to clear secretions, and may increase exacerbations and infections. Many chest physiotherapy techniques like postural drainage, percussion and vibration are used since many years. These techniques are derived from adult studies but these techniques are quite str...

  18. Liver resection for cancer

    Institute of Scientific and Technical Information of China (English)

    RW Parks; OJ Garden

    2001-01-01

    STORY OF HEPATIC RESECTION The earliest hepatic surgery was almost exclusively performed for trauma with records from as for tumor were those of Langenbuch in 1888 [3] , Tiffany in 1890 [4],and Lucke in 1891[5].By1899,76 cases of liver resection had been reported with a mortality rate of 14.9% [6], a remarkably low figure for operations of this magnitude,all performed at the end of the 19th century.

  19. Resection of the primary tumor in stage IV breast cancer

    OpenAIRE

    Shien, Tadahiko; Doihara, Hiroyoshi

    2014-01-01

    Stage IV breast cancer refers to breast cancer that has already metastasized to distant regions when initially diagnosed. Treatment for stage IV is intended to “prolong survival and palliate symptoms”. Resection of a primary tumor is considered to be “effective only at alleviating chest symptoms and providing local control” in spite of the advances of imaging examination and medication for breast cancer. Molecular target and endocrine drugs are very effective and useful to tailor-make a treat...

  20. Sleeve resection for delayed presentation of traumatic bronchial transection.

    LENUS (Irish Health Repository)

    Mohamed, H Y

    2010-02-01

    Tracheobronchial disruption is uncommon in blunt chest trauma. Many of these patients die before reaching the hospital. In the majority of survivors diagnosis is occasionally delayed resulting in complications like airway stenosis and lung collapse. Thus it is important to have radiological follow up after severe thoracic trauma. Sleeve resection can be an excellent option to conserve lung tissue in delayed presentation of bronchial transection.

  1. Can the Physicians or Surgions Do without Chest Radiograph?

    Directory of Open Access Journals (Sweden)

    Mehrdad Bakhshayeshkaram

    2009-01-01

    Full Text Available   "nThe question is how much information is there in chest radiographs ? "nWe can consider the approximate heart size. Rough quantification of heart failure, very basic anatomy of the heart. The chest radiograph is widely available, cheap and very low long term risk of radiation. Chest radiographs are required in the initial consultation of heart or lung diseases. Follow-up radiographs are only required in certain situations. Chest radiographs contain significant information. But nowadays we look less critically, because it is easy to order echo, CT or MRI. Examples of frequently encountered abnormalities seen in our daily practice: "n-Change in hilar size or adenopathy "n-Alteration in hilar contour "n-Bronchial wall thickening "n-Obscuration of normal hilar structures "n   

  2. The neonatal chest

    Energy Technology Data Exchange (ETDEWEB)

    Lobo, Luisa [Servico de Imagiologia Geral do Hospital de Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisbon (Portugal)]. E-mail: mluisalobo@gmail.com

    2006-11-15

    Lung diseases represent one of the most life threatening conditions in the newborn. Important progresses in modern perinatal care has resulted in a significantly improved survival and decreased morbidity, in both term and preterm infants. Most of these improvements are directly related to the better management of neonatal lung conditions, and infants of very low gestational ages are now surviving. This article reviews the common spectrum of diseases of the neonatal lung, including medical and surgical conditions, with emphasis to the radiological contribution in the evaluation and management of these infants. Imaging evaluation of the neonatal chest, including the assessment of catheters, lines and tubes are presented.

  3. The neonatal chest

    International Nuclear Information System (INIS)

    Lung diseases represent one of the most life threatening conditions in the newborn. Important progresses in modern perinatal care has resulted in a significantly improved survival and decreased morbidity, in both term and preterm infants. Most of these improvements are directly related to the better management of neonatal lung conditions, and infants of very low gestational ages are now surviving. This article reviews the common spectrum of diseases of the neonatal lung, including medical and surgical conditions, with emphasis to the radiological contribution in the evaluation and management of these infants. Imaging evaluation of the neonatal chest, including the assessment of catheters, lines and tubes are presented

  4. Picture quiz: a case of sudden severe chest pain.

    Science.gov (United States)

    Rabia, Mustafa Abu; Sullivan, P; Stivaros, Stavros M

    2007-01-01

    An 18-year-old male with no previous medical history presented to hospital with sudden onset of acute epigastric pain radiating to the anterior chest wall and both shoulders. There was no history of recent trauma and he had not been vomiting. PMID:21611610

  5. Ultrasonographic ifndings at the resected area after hepatectomy

    Institute of Scientific and Technical Information of China (English)

    Guo-Qiang Mo; Xue-Ming Liu

    2006-01-01

    BACKGROUND: Since hepatectomy has been widely performed, different operative manner, operating areas, and material in the residual cavity may be found ultrasonographi-cally near the resected area after the operation. In this study, we investigated the changes of focal ultrasonography at the resected area post hepatectomy and recognized the characteristic ultrasonographic images. METHODS:176 patients whose ultrasonographic ifndings were studied in the residual area during the early and later periods after hepatectomy were retrospectively analyzed in terms of operative manner, operative area, and material in the residual cavity. RESULTS: There were absence of partial hepatic lobe or hepatic segment, focal anechoic area with thin wall or mixed mass at the resected area, and conformation of irregular high-echoic conglomeration at the resected area, cystic non-anechoic area, and mixed mass with irregularly thickened wall at the resected area, inconsistent internal echoes, and color Doppler twinking artifacts around the material and the residual cavity after curettage and aspiration. CONCLUSIONS: Focal ultrasonographic ifndings at the resected area after hepatectomy vary with different operative procedures, operative area, resection size, absence or existence of material, and kinds of material in the residual cavity.

  6. 乳腺癌术后胸壁和锁骨上区整体调强剂量学探讨%Irradiation of the chest wall and regional nodes as an integrated volume with IMRT for breast cancer after mastectomy:from dosimetry to clinical observation

    Institute of Scientific and Technical Information of China (English)

    邹勤舟; 魏贤顶; 赵于天; 张福正; 杨波

    2012-01-01

    Objective To discuss dosimetric characteristics of integrated volume for chest wall target and supraclavicular target with IMRT for breast cancer after mastectomy, and observe a-cute side - effects following irradiation. Methods It was plan for breast cancer after mastectomy of 146cases, the plan for integrated volume with IMRT for breast cancer in 43 cases choice3 fields for chest wall target area and 2 fields for supraclavicular target area and 1 field for the total target area, the general plan in 103 cases was 3D - CRT for chest wall target joining plan of mixed irradiation by 6 MV X — ray and 9 MeV electronic line for supraclavicular target. prescription dose was 50 Gy/25 times, to meet the requirements of 90 % prescription dose for target area; and dosimetry characteristics on the chest wall target and supraclavicular target area and normal organ are compared. Results The plan of integrated volume with IMRT for breast cancer for the chest wall target area compared with general plan reduces the maximum dose and enhance the minimum dose and a better target conformal and uniformity. The plan of integrated volume with IMRT for breast cancer for Supraclavicular target area compared with general plan, the minimum dose and the average dose of prescription dose and 95% contains the target volume, and conformal and uniformity for the target region was increased obviously. The plan of integrated volume with IMRT for breast cancer for the normal organ compared with general plan, the V30 and V10 and V30 and Dmean of the ipsilateral lung and heart were lowed, while the V5 and V10 of the ipsilateral lung and heart were increased, it were no statistical difference of V20 of the ipsilateral lung and Dmean of the contralateral lung and Dmean of the contralateral breast, ≥grade 2 radiational dermatitis was identified in 38% patients, no patient developed radiation pneumonitis. Conclusion The plan for integrated volume with IMRT for breast cancer can improve the dose of

  7. Pulmonary tuberculosis mimicking lung cancer on radiological findings: Evaluation of chest CT findings in pathologically proven 76 patients

    International Nuclear Information System (INIS)

    To evaluate chest CT features of pulmonary tuberculosis mimicking lung malignancy. We retrospectively reviewed chest CT findings for 76 consecutive patients (21-84 years, average: 63 years; M : F = 30 : 46) who underwent an invasive diagnostic procedure under the suspicion of lung cancer and were pathologically diagnosed as pulmonary tuberculosis by bronchoscopic biopsy (n = 49), transthoracic needle biopsy (n = 17), and surgical resection (n = 10). We categorized the chest CT patterns of those lesions as follows: bronchial narrowing or obstruction without a central mass like lesion (pattern 1), central mass-like lesion with distal atelectasis or obstructive pneumonia (pattern 2), peripheral nodule or mass including mass-like consolidation (pattern 3), and cavitary lesion (pattern 4). CT findings were reviewed with respect to the patterns and the locations of the lesions, parenchymal abnormalities adjacent to the lesions, the size, the border and pattern of enhancement for the peripheral nodule or mass and the thickness of the cavitary wall in the cavitary lesion. We also evaluated the abnormalities regarding the lymph node and pleura. Pattern 1 was the most common finding (n = 34), followed by pattern 3 (n = 23), pattern 2 (n = 11) and finally, pattern 4 (n = 8). The most frequently involving site in pattern 1 and 2 was the right middle lobe (n = 14/45). However, in pattern 3 and 4, the superior segment of right lower lobe (n = 5/31) was most frequently involved. Ill-defined small nodules and/or larger confluent nodules were found in the adjacent lung and at the other segment of the lung in 31 patients (40.8%). Enlarged lymph nodes were most commonly detected in the right paratracheal area (n = 9/18). Pleural effusion was demonstrated in 10 patients. On the CT, pulmonary tuberculosis mimicking lung cancer most commonly presented with bronchial narrowing or obstruction without a central mass-like lesion, which resulted in distal atelectasis and obstructive

  8. A new specifically designed forceps for chest drain insertion.

    LENUS (Irish Health Repository)

    Andrews, Emmet

    2012-02-03

    Insertion of a chest drain can be associated with serious complications. It is recommended that the drain is inserted with blunt dissection through the chest wall but there is no specific instrument to aid this task. We describe a new reusable forceps that has been designed specifically to facilitate the insertion of chest drains.A feasibility study of its use in patients who required a chest drain as part of elective cardiothoracic operations was undertaken. The primary end-point was successful and accurate placement of the drain. The operators also completed a questionnaire rating defined aspects of the procedure. The new instrument was used to insert the chest drain in 30 patients (19 male, 11 female; median age 61.5 years (range 16-81 years)). The drain was inserted successfully without the trocar in all cases and there were no complications. Use of the instrument rated as significantly easier relative to experience of previous techniques in all specified aspects. The new device can be used to insert intercostal chest drains safely and efficiently without using the trocar or any other instrument.

  9. Endometriosis Abdominal wall

    International Nuclear Information System (INIS)

    Endometriosis of abdominal wall is a rare entity wi ch frequently appears after gynecological surgery. Case history includes three cases of parietal endometriosis wi ch were treated in Maciel Hospital of Montevideo. The report refers to etiological diagnostic aspects and highlights the importance of total resection in order to achieve definitive healing

  10. Imaging of blunt chest trauma

    International Nuclear Information System (INIS)

    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.)

  11. 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.

  12. [Complete Resection of Non-seminomatous Germ Cell Tumor with Plastron Approach].

    Science.gov (United States)

    Suzuki, Jun; Oizumi, Hiroyuki; Kato, Hirohisa; Endoh, Makoto; Watarai, Hikaru; Hamada, Akira; Suzuki, Katsuyuki; Nakahashi, Kenta; Sasage, Takayuki; Sadahiro, Mitsuaki

    2016-07-01

    A 17-year-old man was admitted to our hospital for the abnormal chest shadow. Chest computed tomography(CT) demonstrated mediastinal tumor, measuring 13 cm in diameter with high serum level of alpha fetoprotein (AFP) and human chorionic gonadotropin (hCG). The lesions were diagnosed as mixed germ cell tumors including a non-seminomatous malignant component by CT guided needle biopsy. After 5 courses of chemotherapy, the serum AFP and hCG were decreased almost normal level but the tumor size was not changed. Because it seemed to be difficult to get sufficient operating field with standard median sternotomy and patient wanted to treat funnel chest, we selected tumor resection with plastron approach. The tumor was completely resected with a good operation field by this procedure. PMID:27365059

  13. Chest radiographic findings of leptospirosis

    International Nuclear Information System (INIS)

    1. A study on chest radiographic findings of 54 cases with pneumonia like symptoms was performed. Of 54 cases, 8 cases were confirmed to be leptospirosis and 7 cases were leptospirosis combined with Korean hemorrhagic fever. 2. Of 8 cases of leptospirosis, 4 cases showed abnormal chest radiographic findings: acinar nodular type 2, massive confluent consolidation type 2. Of 7 cases of leptospirosis combined with Korean hemorrhagic fever: acinar nodular type 3, massive confluent consolidation type 1, and increased interstitial markings type 1 respectively. 3. It was considered to be difficult to diagnose the leptospirosis on chest radiographic findings alone, especially the case combined with Korean hemorrhagic fever.

  14. Chest radiographic findings of leptospirosis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Mee Hyun; Jung, Hee Tae; Lee, Young Joong; Yoon, Jong Sup [Hallym University College of Medicine, Seoul (Korea, Republic of)

    1986-04-15

    1. A study on chest radiographic findings of 54 cases with pneumonia like symptoms was performed. Of 54 cases, 8 cases were confirmed to be leptospirosis and 7 cases were leptospirosis combined with Korean hemorrhagic fever. 2. Of 8 cases of leptospirosis, 4 cases showed abnormal chest radiographic findings: acinar nodular type 2, massive confluent consolidation type 2. Of 7 cases of leptospirosis combined with Korean hemorrhagic fever: acinar nodular type 3, massive confluent consolidation type 1, and increased interstitial markings type 1 respectively. 3. It was considered to be difficult to diagnose the leptospirosis on chest radiographic findings alone, especially the case combined with Korean hemorrhagic fever.

  15. Radiology illustrated. Chest radiology

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Kyung Soo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of). Dept. of Radiology; Han, Joungho [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of). Dept. of Pathology; Chung, Man Pyo [Sungkyunkwan Univ. School of Medicine, Seoul (Korea, Republic of). Dept. of Medicine; Jeong, Yeon Joo [Pusan National Univ. Hospital, Busan (Korea, Republic of). Dept. of Radiology

    2014-04-01

    Pattern approach to the diagnosis of lung diseases based on CT scan appearances. Guide to quick and reliable differential diagnosis. CT-pathology correlation. Emphasis on state-of-the-art MDCT. The purpose of this atlas is to illustrate how to achieve reliable diagnoses when confronted by the different abnormalities, or ''disease patterns'', that may be visualized on CT scans of the chest. The task of pattern recognition has been greatly facilitated by the advent of multidetector CT (MDCT), and the focus of the book is very much on the role of state-of-the-art MDCT. A wide range of disease patterns and distributions are covered, with emphasis on the typical imaging characteristics of the various focal and diffuse lung diseases. In addition, clinical information relevant to differential diagnosis is provided and the underlying gross and microscopic pathology is depicted, permitting CT-pathology correlation. The entire information relevant to each disease pattern is also tabulated for ease of reference. This book will be an invaluable handy tool that will enable the reader to quickly and easily reach a diagnosis appropriate to the pattern of lung abnormality identified on CT scans.

  16. 乳腺癌术后胸壁大体积复发二野和六野调强放疗剂量学比较%A dosimetric comparison of the tangential beams IMRT with multifield beams IMRT of the chest wall in postmastectomy breast cancer recurrent patients

    Institute of Scientific and Technical Information of China (English)

    李永武; 孙晓南; 王奇; 刘海; 施国治

    2013-01-01

    目的 比较乳腺癌术后胸壁大体积复发2野和6野调强放疗的计划差异.方法 对8例乳腺切除术后胸壁大体积复发病例,Pinnacle计划系统上分别对PTV进行2野调强和6野调强放疗计划设计,PTV处方剂量为50 Gy/25次(GTV后续计划补量至66~70 Gy),比较2种计划95%处方剂量PTV适形指数(CI)、均匀性指数(HI)及心脏、同侧肺剂量.结果 6野IMRT计划的CI和HI均优于2野IMRT计划,6野和2野的CI分别为(0.66±0.08)和(0.53±0.10)(t=7.99,P<0.05),HI分别为(1.36±0.08)和(2.19±0.78)(t=9.04,P<0.05).2个计划中肺V5、V10、V20、V35和心脏Dmax、V35、Dmean值比较差异无统计学意义.结论 乳腺癌切除术后胸壁大体积复发患者行放疗,6野静态逆向调强放疗计划靶区覆盖优于2野,而心肺受量方面无明显差异.%Objective To compare the dose distribution of reserved planned tangential beam IMRT(2-field IMRT) with multifields beams IMRT(6-field IMRT) of the bulk-recurrent chest wall in postmastectomy breast cancer patients.Methods For 8 patients with chest wall in postmastectomy breast cancer bulk-recurrence,2-field IMRT and 6-field IMRT plans were generated on PTV in Pinnacle Planning System.The prescribed dose of PTV was 50 Gy in 25 fractions and GTV was 66-70 Gy which irradiated incrementally by subsequent plan in 8-10 fractions.The conformal index (CI) and homogeneity index (HI) of 95% of prescribed dose over PTV were compared,while the dose distribution on ipsilateral lung and heart were evaluated.Results The CI of PTV by 6-field IMRT (0.66 ± 0.08) was higher than that of the2-field IMRT (0.53±0.10)(t=7.99,P<0.05).The HI ofPTV by6-field IMRT (1.36±0.08)waslower than that of 2-field IMRT (2.19 ±0.78) (t =9.04,P <0.05).There was no statistical difference in V5,V10,V20 and V35 for ipsilateral lung and in D V35 and D for heart between two plans.Conclusions Compared with 2-field IMRT,6-field IMRT might have a better dose distribution on

  17. The effects of ultrashortwave irradiation and chest-wall vibration therapy on serum eosinophil cationic protein and the percentage of eosinophil in the sputum of children with asthma%超短波和胸壁振动辅助治疗对轻、中度儿童哮喘诱导痰EOS及血清ECP的影响

    Institute of Scientific and Technical Information of China (English)

    赵飞; 乔艳红; 刘丰; 王一彪

    2008-01-01

    Objective To study the effect of ultrashortwave irradiation and chest-wall vibration therapy on serum eosinophil cationic protein(ECP)and percentage of eosinophil(EOS%)in the sputum of children with mild to moderate asthma. Methods A total of 68 children with asthma were divided into a control group and a treatment group.The control group WaS treated with conventional treatment only,while the treatment group was given ultrashortwave irradiation and chest-wall vibration therapy in addition to the conventional treatment.The serum ECP,EOS% in induced sputum,FEV1.0%,and PEF% were measured before and after treatment.The relationships among ECP,EOS%,FEV1.0% and PEF% were analyzed.Results FEV1.0% and PEF% were negatively correlated with serum ECP and EOS% in children with asthma.Compared with the control group,ECP and EOS% were significantly reduced after treatment,while FEV1.0% and PEF% were significantly elevated. Conclusion Uhrashortwave irradiation and chest-wall vibration therapy can improve ventilation by ameliorating airway inflammation and obstruction.%目的 探讨超短波和胸壁振动辅助治疗儿童哮喘对诱导痰嗜酸粒细胞百分数(EOS%)、血清嗜酸粒细胞阳离子蛋白(ECP)及肺通气功能的影响.方法 68例哮喘儿童随机分为对照组和治疗组,对照组采用常规治疗,治疗组除常规治疗外,先后行超短波和胸壁振动辅助治疗,并分别于治疗前、后采血测ECP,行肺通气功能检查及诱导痰EOS%分类.结果 哮喘儿童诱导痰EOS%、血清ECP与肺通气功能指标第1秒最大呼气量占预计值的百分数(FEV1.0%)及呼气峰流速占预计值的百分数(PEF%)均呈显著负相关(P<0.01);与对照组比较,治疗后治疗组血清ECP、诱导痰EOS%均显著降低,FEV1.0%、PEF%显著升高(P<0.05或0.01).结论 超短波和胸壁振动辅助治疗儿童哮喘具有减轻气道炎症和气道受阻、提高肺通气功能的作用.

  18. Ewing sarcoma of the thoracic wall

    International Nuclear Information System (INIS)

    Ewing's sarcomas in the chest wall have in common the facts that the ribs are mainly changed asteolytically; sclerosing is initially seen very seldom, it usually occurs after the therapy; and periosteal detachment with stratification or spicula formation was not observed. All our children had considerably larger intrathoracic tumors than tumors palpable at the chest wall and a notably low number of symptoms in regard of the partially gigantic tumors. (orig.)

  19. Chest Pain (Beyond the Basics)

    Science.gov (United States)

    ... number of problems related to the stomach and intestines can cause pain that spreads to or even begins in the chest, including ulcers, gallbladder disease, pancreatitis, and irritable bowel syndrome. (See "Patient information: Peptic ulcer disease (Beyond the ...

  20. Preoperative therapies for resectable and borderline resectable pancreatic cancer

    OpenAIRE

    Varadhachary, Gauri R.

    2011-01-01

    In the era of multidetector high quality CT imaging, it is feasible and critical to use objective criteria to define resectable pancreatic cancer. This allows accurate pretreatment staging and the development of stage-specific therapy. Tumors of borderline resectability have emerged as a distinct subset and the definition has been expanded in the last few years. Borderline resectable tumors are defined as those with tumor abutment of

  1. Effects of modified chest-up Trendelenburg position on cerebral oxygen metabolism and early postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of the colorectal carcinoma%改良抬胸Trendelenburg位对腹腔镜结直肠癌根治术老年患者脑氧代谢和早期术后认知功能的影响

    Institute of Scientific and Technical Information of China (English)

    施锋; 李金宝; 邓小明; 许波

    2016-01-01

    Objective To study the effects of modified chest-up Trendelenburg position on cerebral oxygen metabolism and early postoperative cognitive function in elderly patients undergoing laparoscopic radical resection of colorectal carcinoma.Methods Eighty ASA Ⅰ or Ⅱ patients,60-82 years old,weighing 44-69 kg,scheduled for elective laparoscopic radical resection of colorectal carcinoma,were randomly divided into 2 groups (n=40):group M,patients in chest-up position using custom-made posture cushions,group T,patients in conventional Trendelenburg position.Blood samples were simultaneously taken from radial artery and jugular bulb at 5 min after regular general anesthesia induction in supine position (T1),immediately after pneumoperitoneum in modified Trendelenburg position or Trendelenburg position(T2),at 30 min (T3),60 min(T4),90 min(T5) after pneumoperitoneum,and at 15 min after deflation in horizon position (T6).The values of blood gas,blood glucose,lactate,and MAP were recorded.he differences of arteriovenous O2 content (Ca-jvDO2) and glucose content (Da-jvglu) were calculated.Cognitive function was assessed by mini-mental state examination at 24 h before anesthesia and at 6,24,48 h and 72 h after anesthesia.Results Compared with T1,arterial partial pressure carbon dioxide(PaCO2) at T3-6,jugular venous partial pressure oxygen(PjvO2) at T3-5 and jugular venous oxygen saturation(SjvO2) at T4-5 were significantly increased in both groups,MAP at T2 were significantly decreased in both groups,MAP at T4-6 were significantly increased in group M,MAP at T3-6,SjvO2 [(75±9)%] at T6 and jugular venous lactate (Lacjv)[(2.0±0.5) mmol/L] at T5 were significantly increased and Ca-jvDO2[(5.2±1.5)%] at T5 were significantly decreased in group T(P<0.05).Compared with group T,CajvDO2[(5.9±1.6)%] at T5 was not significantly decreased,MAP at T4-6,SjvO2[(75±9)%] and Lacjv[(1.5±0.5) mmol/L] at T5 were not significantly increased,Da-jvglu before and after pneumoperitoneum

  2. Endoscopic resection of subepithelial tumors

    OpenAIRE

    Schmidt, Arthur; Bauder, Markus; Riecken, Bettina; Caca, Karel

    2014-01-01

    Management of subepithelial tumors (SETs) remains challenging. Endoscopic ultrasound (EUS) has improved differential diagnosis of these tumors but a definitive diagnosis on EUS findings alone can be achieved in the minority of cases. Complete endoscopic resection may provide a reasonable approach for tissue acquisition and may also be therapeutic in case of malignant lesions. Small SET restricted to the submucosa can be removed with established basic resection techniques. However, resection o...

  3. An unusual cause for recurrent chest infections.

    LENUS (Irish Health Repository)

    Lobo, Ronstan

    2012-10-01

    We present a case of an elderly non-smoking gentleman who, since 2005, had been admitted multiple times for recurrent episodes of shortness of breath, wheeze, cough and sputum. The patient was treated as exacerbations of chronic obstructive pulmonary disease (COPD) and\\/or lower respiratory tract infections. Bronchoscopy was done which revealed multiple hard nodules in the trachea and bronchi with posterior tracheal wall sparing. Biopsies confirmed this as tracheopathia osteochondroplastica (TO). He had increasing frequency of admission due to methicillin-resistant Staphylococcus aureus and pseudomonas infections, which failed to clear despite intravenous, prolonged oral and nebulised antibiotics. The patient developed increasing respiratory distress and respiratory failure. The patient died peacefully in 2012. This case report highlights the typical pathological and radiological findings of TO and the pitfalls of misdiagnosing patients with recurrent chest infections as COPD.

  4. Three-dimensional simulation, surgical navigation and thoracoscopic lung resection

    OpenAIRE

    Kanzaki, Masato; Kikkawa, Takuma; Sakamoto, Kei; Maeda, Hideyuki; Wachi, Naoko; Komine, Hiroshi; Oyama, Kunihiro; Murasugi, Masahide; Onuki, Takamasa

    2013-01-01

    This report describes a 3-dimensional (3-D) video-assisted thoracoscopic lung resection guided by a 3-D video navigation system having a patient-specific 3-D reconstructed pulmonary model obtained by preoperative simulation. A 78-year-old man was found to have a small solitary pulmonary nodule in the left upper lobe in chest computed tomography. By a virtual 3-D pulmonary model the tumor was found to be involved in two subsegments (S1 + 2c and S3a). Complete video-assisted thoracoscopic surge...

  5. Robotic Lung Resection for Non-Small Cell Lung Cancer.

    Science.gov (United States)

    Wei, Benjamin; Eldaif, Shady M; Cerfolio, Robert J

    2016-07-01

    Robotic-assisted pulmonary lobectomy can be considered for patients able to tolerate conventional lobectomy. Contraindications to resection via thoracotomy apply to patients undergoing robotic lobectomy. Team training, familiarity with equipment, troubleshooting, and preparation are critical for successful robotic lobectomy. Robotic lobectomy is associated with decreased rates of blood loss, blood transfusion, air leak, chest tube duration, length of stay, and mortality compared with thoracotomy. Robotic lobectomy offers many of the same benefits in perioperative morbidity and mortality, and additional advantages in optics, dexterity, and surgeon ergonomics as video-assisted thoracic lobectomy. Long-term oncologic efficacy and cost implications remain areas of study. PMID:27261913

  6. [Experience with thoracoscopy for rifle gunshot penetrating trauma of the chest; report of a case].

    Science.gov (United States)

    Kambayashi, T; Moriuchi, T; Noguchi, T; Kamakari, K; Terada, T

    2005-10-01

    A 57-year-old man came to our hospital by ambulance for a chest injury by a rifle gunshot. He had a penetrating injury of the chest wall, hemopneumothorax and pulmonary laceration. He was managed with chest drainage, oxygen inhalation. His respiratory and cardiac status was stable. However, for the purpose to prevent the development of empyema or pneumonia, and to check the existence of damage of intrathoracic structures by the gunshot injury, thoracoscopy was performed next day. He discharged without postoperative complications 17 days after the injury. Open thoracotomy is reported to be required in only about 10-15% of patients with chest injuries. However, operative indication of the chest injuries may spread in the future with the spread of thoracoscopy and its low invasiveness. PMID:16235855

  7. Airway hyperresponsiveness with chest strapping: A matter of heterogeneity or reduced lung volume?

    Science.gov (United States)

    Pellegrino, Riccardo; Pompilio, Pasquale P; Bruni, Giulia Innocenti; Scano, Giorgio; Crimi, Claudia; Biasco, Luigi; Coletta, Giuseppe; Cornara, Giuseppe; Torchio, Roberto; Brusasco, Vito; Dellacà, Raffaele L

    2009-03-31

    Chest wall strapping has been recently shown to be associated with an increase in airway responsiveness to methacholine. To investigate whether this is the result of the decreased lung volume or an increased heterogeneity due to chest wall distortion, ten healthy volunteers underwent a methacholine challenge at control conditions and after selective strapping of the rib cage, the abdomen or the whole chest wall resulting in similar decrements of functional residual capacity and total lung capacity but causing different distribution of the bronchoconstrictor. Methacholine during strapping reduced forced expiratory flow, dynamic compliance, and reactance at 5Hz and increased pulmonary resistance and respiratory resistance at 5Hz that were significantly greater than at control and associated with a blunted bronchodilator effect of the deep breath. However, no significant differences were observed between selective and total chest wall strapping, suggesting that the major mechanism for increasing airway responsiveness with chest wall strapping is the breathing at low lung volume rather than regional heterogeneities. PMID:19429518

  8. Totally endoscopic robotic resection of left atrial myxoma with persistent left superior vena cava.

    Science.gov (United States)

    Tarui, Tatsuya; Ishikawa, Norihiko; Ohtake, Hiroshi; Watanabe, Go

    2016-07-01

    A 68-year old man with a cardiac tumour was admitted for robotic tumour resection using the da Vinci S Surgical System. While undergoing preoperative examination, he was found to have a persistent left superior vena cava. After general anaesthesia and single-lung ventilation, cardiopulmonary bypass was established, with venous drainage through bilateral internal jugular and right femoral veins and arterial return through the right femoral artery. Robotic tumour resection was performed by four ports in the right chest. There were no difficulties during the operation, and successful tumour resection was achieved with satisfactory margins. He was discharged without complications. Persistent left superior vena cava is very rare, but if diagnosed preoperatively and an appropriate operative plan is made, robotic cardiac surgery can be performed safely. With robotic surgery, cardiac tumour resection can be feasibly performed, with cosmetic benefits. PMID:26989070

  9. Combined endoscopic and laparoscopic approach for palliative resection of metastatic melanoma of the stomach

    Directory of Open Access Journals (Sweden)

    Pritchard SA

    2006-03-01

    Full Text Available Abstract Background Metastatic tumours of the stomach present a clinical dilemma for the surgeon. Palliative surgical resection can alleviate symptoms and prolong survival in selected patients. However, previous studies have used open methods of surgical resection with potentially high morbidity and mortality. We describe the use of laparoscopic wedge resection of the stomach for palliative resection of metastatic melanoma to highlight the benefits of this technique. Case presentation A 58 year old male was investigated for iron deficiency anaemia while under treatment for pulmonary metastatic malignant melanoma. An upper gastrointestinal endoscopy revealed a 5 cm diameter ulcer on the anterior wall of the stomach, biopsies from the ulcer confirmed metastatic melanoma. Laparoscopic wedge resection of the stomach lesion was performed without complication. Conclusion Laparoscopic approach has many benefits and is useful for the palliative resection of rare tumours of the stomach in order to preserve the quality of life. Its use should be considered in selected patients.

  10. 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. PMID:24887787

  11. Gunshot wounds to the chest

    OpenAIRE

    Holmen, Lillian Beate

    2013-01-01

    Introduction: This is a review of gunshot wounds to the chest. Although uncommon in Norway, they represent a big health problem in other parts of the world and in war situations. Method: A systematic literature search using PubMed and McMaster+. Results: Gunshot wounds to the chest can be highly lethal. Depending on the injured organ, a large percentage of the patients die before reaching the hospital. There is a big difference between low-velocity and high-velocity weapons. Low velocity inju...

  12. Inflation and deflation pressure-volume loops in anesthetized pinnipeds confirms compliant chest and lungs

    OpenAIRE

    Fahlman, Andreas; Loring, Stephen H.; Johnson, Shawn P.; Haulena, Martin; Trites, Andrew W.; Fravel, Vanessa A.; Van Bonn, William G.

    2014-01-01

    We examined structural properties of the marine mammal respiratory system, and tested Scholander's hypothesis that the chest is highly compliant by measuring the mechanical properties of the respiratory system in five species of pinniped under anesthesia (Pacific harbor seal, Phoca vitulina; northern elephant seal, Mirounga angustirostris; northern fur seal Callorhinus ursinus; California sea lion, Zalophus californianus; and Steller sea lion, Eumetopias jubatus). We found that the chest wall...

  13. [Influences of chest deformation by upper abdominal retractor on respiratory system impedance during abdominal surgery].

    Science.gov (United States)

    Oka, T; Ozawa, Y; Sato, J

    1999-02-01

    The present study was carried out to clarify the effects of chest deformation by upper abdominal retractor on respiratory system impedance during abdominal surgery. We measured the impedances of respiratory system (RS), lung, and chest wall (CW) in nine anesthetized paralyzed subjects employing a pseudorandom noise forced volume oscillation technique. These measurements were performed before and after the lifting chest wall by upper abdominal retractor. The effects of chest deformation was significant on the impedances of RS, lung, while no discernible effect was found in CW impedance. Lifting chest wall decreased RS resistance which was totally accounted for by the decrease in lung resistance, whereas the lifting did not affect reactance in either RS or lung. The mathematical modeling showed the significant lifting effect on the resistance of the parenchyma. In conclusion, change in RS mechanics produced by chest deformation by upper abdominal retractor is dominated in lung but not in CW. Among the lung mechanical components, parenchyma is the primary site of the lifting effect. PMID:10087819

  14. Perioperative chemotherapy and hepatic resection for resectable colorectal liver metastases.

    Science.gov (United States)

    Beppu, Toru; Sakamoto, Yasuo; Hayashi, Hiromitsu; Baba, Hideo

    2015-02-01

    The role of perioperative chemotherapy in the management of initially resectable colorectal liver metastases (CRLM) is still unclear. The EPOC trial [the European Organization for Research and Treatment of Cancer (EORTC) 40983] is an important study that declares perioperative chemotherapy as the standard of care for patients with resectable CRLM, and the strategy is widely accepted in western countries. Compared with surgery alone, perioperative FOLFOX therapy significantly increased progression-free survival (PFS) in eligible patients or those with resected CRLM. Overall survival (OS) data from the EPOC trial were recently published in The Lancet Oncology, 2013. Here, we discussed the findings and recommendations from the EORTC 40983 trial. PMID:25713806

  15. Cholesterol crystal embolization diagnosed on bladder transurethral resection.

    Science.gov (United States)

    Chatelain, Denis; Cordonnier, Carole; Brevet, Marie; Petit, Jacques; Sevestre, Henri

    2005-08-01

    Cholesterol crystal embolization (CCE) is a severe systemic disorder caused by vascular migration of cholesterol crystals originating from ulcerative atherosclerotic plaques located in large arteries. We report 2 cases of CCE diagnosed on bladder transurethral resection in 2 men aged 94 and 72 years. Both patients had atherosclerosis disease. One patient had been treated by heparin 1 month before for pulmonary embolism and the other had had a coronary angiography and bypass graft surgery 5 months before for silent myocardial infarction. One patient presented with hematuria and the other with acute renal failure. Cystoscopy showed multiple papillary tumors of the bladder wall. Bladder transurethral resections showed transitional cell carcinoma with cholesterol crystals occluding the lumen of small arterioles in the submucosa. Eight cases of CCE in the bladder wall have been reported in the literature in 3 women and 5 men aged 56 to 79 years. Cholesterol crystal embolization is often discovered in the bladder wall on necropsy specimens. Only 2 cases have been fortuitously discovered on bladder transurethral resection performed for transitional cell carcinoma. Cholesterol crystal embolization in the bladder wall is often a marker of severe disease although the evolution is quite favorable in our patients, still alive 1 and 2 years after diagnosis. PMID:16084459

  16. New developments in ultrasonic imaging of the chest and other body organs

    International Nuclear Information System (INIS)

    The accurate measurement of transuranic elements deposited in the lung is a complex task. One of the problems is measuring uranium-L x-rays associated with plutonium passing through the chest of an accidentally exposed subject. Because the normal human chest-wall thickness varies from about 1 to 4.5 cm, it is important that an accurate determination be made for every person counted for plutonium or for other heavy elements with similar emissions. An ultrasonic B-scanning system (brightness modulated time-base) was developed for defining the structure within the body. Computer programs were written to determine the distance between the lung and chest-wall interface and the outer surface of the chest wall at several points on each scan. These points are exponentially averaged to obtain an average chest-wall thickness that is used, with other information, to derive a calibration factor for plutonium in the subject. It is also combined with the counting data to obtain the plutonium lung burden. Since photon transmission characteristics differ in fat and soft tissue, assessing the fat content is important and can provide a correction factor for counter sensitivity when viewing various organs. The main advantage of the B-scanning and three-dimensional systems are discussed

  17. O5.105-ALA FLUORESCENCE GUIDED RESECTION OF HEMANGIOBLASTOMAS - IS IT USEFUL WITH CONVENTIONAL SURGICAL TOOLS?

    OpenAIRE

    Campos, J M; Sainz, L.; Presti, A. Lo; Ramirez, M.; Aguirre, D.; Ordoñez, C.; Daoud, L.

    2014-01-01

    BACKGROUND: The use of 5-aminolevulinic acid (5-ALA) for fluorescent guided malignant glioma surgery has proved to be useful to ensure a complete resection and thus, a best survival result. One report has described its usefulness for the detection of hemangioblastoma fragments at the cyst wall after apparently complete tumor resection. Von Hippel-Lindau disease patients suffer from many CNS hemangioblastomas, requiring multiple surgical procedures for resection of tumors, many times obscured ...

  18. LAPAROSCOPIC RESECTION IN COLORECTAL CANCER

    Institute of Scientific and Technical Information of China (English)

    Reinhard Bittner

    2005-01-01

    @@ 1 Introduction The feasibility of colon resection using the laparoscope was demonstrated as early as 1991[1~3]. It was shown one year later that it is also possible to use the laparoscope in abdominoperineal resection of the rectum for rectal carcinoma[4, 5]. One year after this, the first study was reported in which the results of anterior resection with the laparoscope were compared with the conventional operation in a small number of patients with carcinoma of the rectum[6]. The first reports on the feasibility of total excision of the mesorectum in patients with carcinoma of the middle or lower third of the rectum were first published at the start of this century[7~9]. It can be stated in summary that resection of the colon or rectum using the laparoscope is not of disadvantage to the patient, given that the surgeon has appropriate experience and the patient has been properly selected.

  19. Multi-institutional analysis of T3 subtypes and adjuvant radiotherapy effects in resected T3N0 non-small cell lung cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Yun Seon; Lee, Ik Jae; Cho, Jae Ho [Dept. of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2015-06-15

    We evaluated the prognostic significance of T3 subtypes and the role of adjuvant radiotherapy in patients with resected the American Joint Committee on Cancer stage IIB T3N0M0 non-small cell lung cancer (NSCLC). T3N0 NSCLC patients who underwent resection from January 1990 to October 2009 (n = 102) were enrolled and categorized into 6 subgroups according to the extent of invasion: parietal pleura chest wall invasion, mediastinal pleural invasion, diaphragm invasion, separated tumor nodules in the same lobe, endobronchial tumor <2 cm distal to the carina, and tumor-associated collapse. The median overall survival (OS) and disease-free survival (DFS) were 55.3 months and 51.2 months, respectively. In postoperative T3N0M0 patients, the tumor size was a significant prognostic factor for survival (OS, p = 0.035 and DFS, p = 0.035, respectively). Patients with endobronchial tumors within 2 cm of the carina also showed better OS and DFS than those in the other T3 subtypes (p = 0.018 and p = 0.016, respectively). However, adjuvant radiotherapy did not cause any improvement in survival (OS, p = 0.518 and DFS, p = 0.463, respectively). Only patients with mediastinal pleural invasion (n = 25) demonstrated improved OS and DFS after adjuvant radiotherapy (n = 18) (p = 0.012 and p = 0.040, respectively). The T3N0 NSCLC subtype that showed the most favorable prognosis is the one with endobronchial tumors within 2 cm of the carina. Adjuvant radiotherapy is not effective in improving survival outcome in resected T3N0 NSCLC.

  20. [Laparoscopic rectal resection technique].

    Science.gov (United States)

    Anthuber, M; Kriening, B; Schrempf, M; Geißler, B; Märkl, B; Rüth, S

    2016-07-01

    The quality of radical oncological operations for patients with rectal cancer determines the rate of local recurrence and long-term survival. Neoadjuvant chemoradiotherapy for locally advanced tumors, a standardized surgical procedure for rectal tumors less than 12 cm from the anus with total mesorectal excision (TME) and preservation of the autonomous nerve system for sexual and bladder function have significantly improved the oncological results and quality of life of patients. The TME procedure for rectal resection has been performed laparoscopically in Germany for almost 20 years; however, no reliable data are available on the frequency of laparoscopic procedures in rectal cancer patients in Germany. The rate of minimally invasive procedures is estimated to be less than 20 %. A prerequisite for using the laparoscopic approach is implicit adherence to the described standards of open surgery. Available data from prospective randomized trials, systematic reviews and meta-analyses indicate that in the early postoperative phase the generally well-known positive effects of the minimally invasive approach to the benefit of patients can be realized without any long-term negative impact on the oncological results; however, the results of many of these studies are difficult to interpret because it could not be confirmed whether the hospitals and surgeons involved had successfully completed the learning curve. In this article we would like to present our technique, which we have developed over the past 17 years in more than 1000 patients. Based on our experiences the laparoscopic approach can be highly recommended as a suitable alternative to the open procedure. PMID:27277556

  1. Chest Wall Pain as the Presenting Symptom of Leptomeningeal Carcinomatosis

    OpenAIRE

    Sim, Kyoung Bo; Nam, Ki Yeun; Lee, Ho Jun; Park, Jin-Woo; Ryu, Gi Hyeong; Chang, Jihea; Kwon, Bum Sun

    2014-01-01

    Leptomeningeal metastasis (LMM), also referred to as leptomeningeal carcinomatosis, results from diffuse infiltration of the leptomeninges by malignant cells originating from extra-meningeal primary tumors. It occurs in approximately 5%-10% of patients with solid tumor. Among solid tumors, the most common types leading to infiltration of the leptomeninges are breast cancer, lung cancer, and melanoma. Patients with LMM may present various signs and symptoms. Herein, we report a rare case with ...

  2. Nuclear imaging of the chest

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Y.W. [Samsung Cheil General Hospital, Seoul (Korea, Republic of). Dept. of Radiology; Kim, E.E. [Texas Univ., Houston, TX (United States). Cancer Center; Isawa, T. [Yokohama Higashi National Hospital (Japan)

    1998-01-01

    This book provides up-to-the minute information on the diagnostic nuclear imaging of chest disorders. The authors have endeavored to integrate and consolidate the many different subspecialities in order to enable a holistic understanding of chest diseases from the nuclear medicine standpoint. Highlights of the book include in addition to the cardiac scan the description of aerosol lung imaging in COPD and other important pulmonary diseases and the updates on breast and lung cancer imaging, as well as imaging of the bony thorax and esophagus. It is required reading not only for nuclear medicine practitioners and researchers but also for all interested radiologists, traumatologists, pulmonologists, oncologists and cardiologists. (orig.) 217 figs., 25 tabs.

  3. Chest shape in preterm newborn infants

    International Nuclear Information System (INIS)

    The suggestion that thoracic shape of anteroposterior radiographs reflects lung compliance was examined in 62 preterm newborn infants (none with pulmonary hypoplasia) by measuring ratios of upper to lower chest widths. Chest shape did not vary significantly with the presence of respiratory distress syndrome (RDS) or with gender, Apgar score, endotracheal intubation, radiographic severity of RDS, or age at radiography. However, decreased maturity was associated with a relatively wide upper chest and narrow lower chest. Developmental factors may be more important than lung compliance (and the other factors noted) in determining the radiographic configuration of the infantile chest

  4. Radiology of occupational chest disease

    International Nuclear Information System (INIS)

    Radiologic manifestations of occupational lung disease are summarized and classified in this book according to the ILO system. The interpretation of chest roentgenograms outlines the progression of each disease and is accompanied with clinically-oriented explanations. Some of the specific diseases covered include asbestosis, coal worker's pneumoconiosis, silicosis, non-mining inhalation of silica and silicates, beryllium induced disease, inhalation of organics and metallics, and occupationally induced asthma

  5. X-ray face mask and chest shield device

    International Nuclear Information System (INIS)

    A protective face mask is designed to shield an x-ray technician or machine operator primarily from random secondary or scatter x-rays deflected towards his face, head and neck by the table, walls, equipment and other reflecting elements in an x-ray room or chamber. The face mask and chest shield device can be mounted on a patient's shoulders in reverse attitude to protect the back of a patient's head and neck from the x-ray beam. The face mask is relatively or substantially transparent and contains lead in combination with a plastic ionomer or comonomer, which to a degree absorbs or resists penetration of the random deflected secondary or scatter x-rays or the x-ray beam through the mask. The face mask is removably attachable to the chest shield for easy application of the device to and support upon the shoulders of the technician or the patient. (author)

  6. Gastric tumors on chest radiographs

    International Nuclear Information System (INIS)

    Gastric neoplasms of three patients protruded into their gas-containing fornices and were first visualized on plain chest radiographs. Endoscopy and/or surgery confirmed these to be a polyp, a leiomyoma, and an adenocarcinoma. The polyp, 1.3 cm in diameter, was the smallest of these three, but smaller lesions may be detectable under suitable conditions. Adequate technique and positioning, sufficiently large lesions in the upper portion of the stomach, a central beam tangential to the tumor, sufficient gas in the stomach, and careful scrutiny by the observer are required. Lesions may be more readily visualized during chest radiography when oral sodium bicarbonate is used to distend the stomach. In chest radiography, exposure limited to the lung fields has been advocated for economy and dose reduction. However, too small an exposure field may result in loss of information potentially beneficial to the patient. Using the smaller of two popular film sizes (35 x 43 cm and 35 x 35 cm), the saving in surface and bone marrow doses is negligible, and the saving in gonad dose may be nil over that when shielding is used. The interest of the observer may be absorbed by a concomitant cardiac or pulmonary lesion. Careful scrutiny of the entire radiograph is therefore essential. (author)

  7. 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

    We prospectively analyzed our experience with operative videothoracoscopy (OVT) performed in a field military hospital in cases of penetrating firearms wounds of the thorax (PFAWT) sustained in Chechnya. From February to April 1996, we treated 206 wounded patients, of whom 37 (18.0%) had sustained chest injuries. PFAWT were present in 23 soldiers, accounting for 62.2% of all chest injuries. Twelve injuries were confined to the thorax, eight patients had associated injuries, and three soldiers had thoracoabdominal injuries. Nineteen patients had pleural drainage performed during medical evacuation. The thoracic injuries were right-sided (17), involved bullets or shell splinters (23); were through and through (16), represented solitary wounds (19), and were associated with internal organ injuries (21). Fifteen patients had indications for OVT when they were delivered from the battle-field 1.5 to 22 hours after injury. All patients manifested signs of hemorrhagic shock and hemodynamic instability. Indications for OVT were ongoing intrapleural bleeding (6), clotted hemothorax (6), or marked air leakage (3) preventing lung inflation with the OP-02 apparatus (field modification). OVT revealed 12 lung wounds, nine of which were multiple wounds, pleural bleeding in 6 patients, clotted hemothorax in 11 patients, and foreign bodies in 5 patients. Two patients underwent thoracotomy, one for suspicion of heart injury and the second because we could not adequately visualize and control bleeding revealed at OVT to be from the intercostal artery in the left costovertebral angle. Eight of 23 patients had no indication for operative videothoracoscopy and were managed with continued pleural aspiration and drug therapy. Wedge resection of the lung using an Endo-GIA-30 stapler was necessary in two patients because of parenchymal destruction and bleeding. Evacuation of clotted blood by fragmentation and aspiration was satisfactory in all cases. Satisfactory manual suturing of selected

  8. Clinical spectrum of pulmonary hamartoma diagnosed by surgical resection

    International Nuclear Information System (INIS)

    We retrospectively reviewed our institutional experience of pulmonary hamartomas. We analyzed the records of 23 patients with pulmonary hamartomas which were diagnosed by surgical resection. There were 12 males and 11 females. Their mean age was 53.5 years old (range: 28 to 71 years). Twenty patients were asymptomatic, 2 had chest pain and 1 had a cough. Twenty-two patients had solitary and only 1 patient had multiple lesions. The tumor sizes ranged from 0.5 to 3.0 cm (mean: 1.5 cm). Graphically, 6 patients had calcification which was not popcorn-like. We could not diagnose nodules by bronchoscopic biopsy, which was preoperatively performed in 17 patients. Surgery was performed because we could not rule out malignancy in all patients. Surgical procedures consisted of 6 enucleation, 16 wedge resection and 1 lobectomy. Video-assisted thoracic surgery was performed in 17 patients. To diagnose pulmonary nodule, whose malignancy is difficult to determine, surgical resection should be considered. (author)

  9. Active breathing control (ABC): Determination and reduction of breathing-induced organ motion in the chest

    International Nuclear Information System (INIS)

    Purpose: Extensive radiotherapy volumes for tumors of the chest are partly caused by interfractional organ motion. We evaluated the feasibility of respiratory observation tools using the active breathing control (ABC) system and the effect on breathing cycle regularity and reproducibility. Methods and Materials: Thirty-six patients with unresectable tumors of the chest were selected for evaluation of the ABC system. Computed tomography scans were performed at various respiratory phases starting at the same couch position without patient movement. Threshold levels were set at minimum and maximum volume during normal breathing cycles and at a volume defined as shallow breathing, reflecting the subjective maximal tolerable reduction of breath volume. To evaluate the extent of organ movement, 13 landmarks were considering using commercial software for image coregistration. In 4 patients, second examinations were performed during therapy. Results: Investigating the differences in a normal breathing cycle versus shallow breathing, a statistically significant reduction of respiratory motion in the upper, middle, and lower regions of the chest could be detected, representing potential movement reduction achieved through reduced breath volume. Evaluating interfraction reproducibility, the mean displacement ranged between 0.24 mm (chest wall/tracheal bifurcation) to 3.5 mm (diaphragm) for expiration and shallow breathing and 0.24 mm (chest wall) to 5.25 mm (diaphragm) for normal inspiration. Conclusions: By modifying regularity of the respiratory cycle through reduction of breath volume, a significant and reproducible reduction of chest and diaphragm motion is possible, enabling reduction of treatment planning margins

  10. New developments in ultrasonic imaging of the chest and other body organs

    International Nuclear Information System (INIS)

    The ultrasonic imaging system described herein was developed to measure chest-wall thickness and the percentage of fat in the chest and around other body organs. The system uses pulse-echo techniques to transmit and detect sound waves reflected from the interfaces of body organs and adjacent tissue. A computer draws these interfaces on colour scans, and a code is used to exponentially average data from several points on each scan to find the average thicknesses of the chest wall and fat layers. These average thicknesses are then used to adjust X-ray calibration factors for plutonium lung counters. The correction factor for three subjects measured for fat content ranging from 12.6% to 22.2% was 18% to 41%. The ultrasonic system also defines the shape and position of the kidneys and liver, so we are able to place detectors on the body more accurately during in-vivo radiation measurements. A technique was also developed for displaying the interfaces from a series of ultrasonic chest scans to produce a topographical map that enables one to understand the shape and contour of the lung and chest-wall interface better. (author)

  11. New developments in ultrasonic imaging of the chest and other body organs

    International Nuclear Information System (INIS)

    The ultrasonic imaging system described herein was developed to measure chest-wall thickness and the percentage of fat in the chest and around other body organs. The system uses pulse-echo techniques to transmit and detect sound waves reflected from the interfaces of body organs and adjacent tissue. A computer draws these interfaces on color scans, and a code is used to exponentially average data from several points on each scan to find the average thicknesses of the chest wall and fat layers. These average thicknesses are then used to adjust x-ray calibration factors for plutonium lung counters. The correction factor for three subjects measured for fat content ranging from 12.6 to 22.2% was 18 to 41%. The ultrasonic system also defines the shape and position of the kidneys and liver so we are able to more accurately place detectors on the body during in-vivo radiation measurements. We have also developed a technique for displaying the interfaces from a series of ultrasonic chest scans to produce a topographical map that enables us to better understand the shape and contour of the lung and chest-wall interface

  12. Novel computed tomographic chest metrics to detect pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Li Chin-Shang

    2011-03-01

    Full Text Available Abstract Background Early diagnosis of pulmonary hypertension (PH can potentially improve survival and quality of life. Detecting PH using echocardiography is often insensitive in subjects with lung fibrosis or hyperinflation. Right heart catheterization (RHC for the diagnosis of PH adds risk and expense due to its invasive nature. Pre-defined measurements utilizing computed tomography (CT of the chest may be an alternative non-invasive method of detecting PH. Methods This study retrospectively reviewed 101 acutely hospitalized inpatients with heterogeneous diagnoses, who consecutively underwent CT chest and RHC during the same admission. Two separate teams, each consisting of a radiologist and pulmonologist, blinded to clinical and RHC data, individually reviewed the chest CT's. Results Multiple regression analyses controlling for age, sex, ascending aortic diameter, body surface area, thoracic diameter and pulmonary wedge pressure showed that a main pulmonary artery (PA diameter ≥29 mm (odds ratio (OR = 4.8, right descending PA diameter ≥19 mm (OR = 7.0, true right descending PA diameter ≥ 16 mm (OR = 4.1, true left descending PA diameter ≥ 21 mm (OR = 15.5, right ventricular (RV free wall ≥ 6 mm (OR = 30.5, RV wall/left ventricular (LV wall ratio ≥0.32 (OR = 8.8, RV/LV lumen ratio ≥1.28 (OR = 28.8, main PA/ascending aorta ratio ≥0.84 (OR = 6.0 and main PA/descending aorta ratio ≥ 1.29 (OR = 5.7 were significant predictors of PH in this population of hospitalized patients. Conclusion This combination of easily measured CT-based metrics may, upon confirmatory studies, aid in the non-invasive detection of PH and hence in the determination of RHC candidacy in acutely hospitalized patients.

  13. Novel computed tomographic chest metrics to detect pulmonary hypertension

    International Nuclear Information System (INIS)

    Early diagnosis of pulmonary hypertension (PH) can potentially improve survival and quality of life. Detecting PH using echocardiography is often insensitive in subjects with lung fibrosis or hyperinflation. Right heart catheterization (RHC) for the diagnosis of PH adds risk and expense due to its invasive nature. Pre-defined measurements utilizing computed tomography (CT) of the chest may be an alternative non-invasive method of detecting PH. This study retrospectively reviewed 101 acutely hospitalized inpatients with heterogeneous diagnoses, who consecutively underwent CT chest and RHC during the same admission. Two separate teams, each consisting of a radiologist and pulmonologist, blinded to clinical and RHC data, individually reviewed the chest CT's. Multiple regression analyses controlling for age, sex, ascending aortic diameter, body surface area, thoracic diameter and pulmonary wedge pressure showed that a main pulmonary artery (PA) diameter ≥29 mm (odds ratio (OR) = 4.8), right descending PA diameter ≥19 mm (OR = 7.0), true right descending PA diameter ≥ 16 mm (OR = 4.1), true left descending PA diameter ≥ 21 mm (OR = 15.5), right ventricular (RV) free wall ≥ 6 mm (OR = 30.5), RV wall/left ventricular (LV) wall ratio ≥0.32 (OR = 8.8), RV/LV lumen ratio ≥1.28 (OR = 28.8), main PA/ascending aorta ratio ≥0.84 (OR = 6.0) and main PA/descending aorta ratio ≥ 1.29 (OR = 5.7) were significant predictors of PH in this population of hospitalized patients. This combination of easily measured CT-based metrics may, upon confirmatory studies, aid in the non-invasive detection of PH and hence in the determination of RHC candidacy in acutely hospitalized patients

  14. Multistage resection of esophageal squamous cell cancer of the cardia – successful despite complications

    Science.gov (United States)

    Ptach, Anna; Sadowski, Andrzej; Chruścicka, Iwona; Pęksa, Rafał; Rak, Piotr

    2015-01-01

    Surgery is the treatment of choice for squamous cell esophageal cancer. Complete resection of the esophagus with reconstruction of the digestive tract is performed for tumors located in the chest or cardia. The aim of the report is to present the case of a complete esophageal and gastric resection complicated by colon graft necrosis. The patient was a 45-year-old woman diagnosed with cancer of the cardia infiltrating the distal section of the esophagus and the body and fundus of the stomach. The initial surgical procedure included the opening of three body cavities followed by resection of the thoracic esophagus, stomach, and a portion of the left hepatic lobe. Right colon interposition was performed to restore digestive tract continuity. On the 8th day, a leak was observed in the esophagointestinal anastomosis. Management consisted in two surgical procedures, one of which ended in the removal of the colon patch. The fourth and final procedure was conducted after 10 months. PMID:26702285

  15. The application of capnography to differentiate peri-chest tube air leak from parenchymal leak following pulmonary surgery

    OpenAIRE

    Oparka, Jonathan D.; Walker, William S

    2014-01-01

    Prolonged air leak is a common complication of pulmonary resection. However, while a bubbling chest drain is commonly related to parenchymal air leakage, it may also be caused by air entering the pleural cavity via an incomplete seal of the tissues at the chest tube insertion site. Examination alone is not sufficient to guide the surgeon as to which of the above complications is responsible for drain bubbling. We describe a simple method, whereby a CO2 monitoring device is attached to the che...

  16. 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.)

  17. Impalement Injuries of the Chest

    OpenAIRE

    Edwin, F; Tettey, M; Sereboe, L; Aniteye, E; Kotei, D; Tamatey, M; Entsuamensah, K; Delia, I; Frimpong-Boateng, K

    2009-01-01

    Impalement injuries of the chest are uncommon in civilian practice with few reports in the literature. We report three cases of thoracic impalement seen over a 5 year period with unusual underlying mechanisms. In two of the cases, the impalement was obvious; in the third, the impalement was concealed having occurred 5 months earlier. In Case 1, the underlying mechanism was a high-speed road traffic accident. The patient was impaled by a metallic square pipe piled by the roadside. In Case 2, t...

  18. Chest dynamics asymmetry facilitates earlier detection of pneumothorax.

    Science.gov (United States)

    Waisman, D; Landesberg, A; Kohn, S; Faingersh, A; Klotzman, I C; Gover, A; Kessel, I; Rotschild, A

    2016-02-01

    Pneumothorax is usually diagnosed when signs of life-threatening tension pneumothorax develop. The case report describes novel data derived from miniature superficial sensors that continuously monitored the amplitude and symmetry of the chest wall tidal displacement (TDi) in a premature infant that suffered from pneumothorax. Off-line analysis of the TDi revealed slowly progressing asymmetric ventilation that could be detected 38 min before the diagnosis was made. The TDi provides novel and valuable information that can assist in early detection and decision making. PMID:26814803

  19. Parenteral Nutrition in Liver Resection

    Directory of Open Access Journals (Sweden)

    Carlo Chiarla

    2012-01-01

    Full Text Available Albeit a very large number of experiments have assessed the impact of various substrates on liver regeneration after partial hepatectomy, a limited number of clinical studies have evaluated artificial nutrition in liver resection patients. This is a peculiar topic because many patients do not need artificial nutrition, while several patients need it because of malnutrition and/or prolonged inability to feeding caused by complications. The optimal nutritional regimen to support liver regeneration, within other postoperative problems or complications, is not yet exactly defined. This short review addresses relevant aspects and potential developments in the issue of postoperative parenteral nutrition after liver resection.

  20. 应用4DCT研究乳腺癌根治术后胸壁IMRT的放射物理学优势%The radiation physics advantages of 4DCT on intensity-modulated radiotherapy of chest wall after radical mastectomy

    Institute of Scientific and Technical Information of China (English)

    王文岩; 肖志清; 王艳强; 张玉峰; 郭晗; 薛晓英

    2014-01-01

    Objective To invesigate the influence of breathing motion on intensity-modulated radiotherapy (IMRT) of chest wall after radical mastectomy,and explore clinical value of accurately determined target volume.Methods A total of 17 radical mastectomy patients underwent 3DCT simulation scans sequentially followed by 4DCT simulation scans during free breathing.The targets and normal organs was determined based on CT images respectively.Three sets of radiotherapy plan were designed for each patient:plan 3D,plan 4D and plan 3D-A.The Plan 3D and plan 4D was designed based on 3D and 4D targets respectively.Plan 3D was copied to 4D target with the same isocenter coordinates.The dose distribution was calculated separately to evaluate the dose-volume histograms parameters for PTV,ipsilateral lung and heart,respectively.Two planning parameters was compared with paired t-test or Wilcoxon sign-rank test.Results The average volume of PTV4D was (10.35 ± 4.80) % larger than PTV3D (P =0.000).Compared with plan 3D,the V100,V95,V90,D95,D90,Dmin of plan 3D-A were reduced,that were (0.78 -18.0)% (P=0.000),(0.01-3.90)% (P=0.000),(0-2.12)% (P=0.000),(13-222) cGy (P=0.000),(1-118) cGy (P=0.000),(6-1 910) cGy (P=0.000).However,the V20,V10,V5,Dmean of the ipsilateral lung and V30 of heart were same between 3D plan and 4D plan (P =0.288,0.407,0.435,0.758,0.575).Conclusions The respiratory motion may reduce the target dose and its coverage in chest wall treatments,so 4DCT plan could accurately define target volume without increasing the exposure dose of normal tissues.%目的 探讨根治术后乳腺癌胸壁IMRT时为克服呼吸运动影响应用4DCT确定靶区的临床价值.方法 对入组的17例乳腺癌根治术后患者序贯进行常规CT和4DCT扫描并采集图像,分别勾画靶区和正常组织.根据每位患者的3D、4D靶区分别制定3D计划和4D计划,并将3D计划按等中心坐标直接复制到4D靶区上比较差异及OAR剂量学变化,并行配对t

  1. 微创改良胸肋抬举术治疗漏斗胸%Minimally invasive surgical treatment of improved costa sternales lifts in treatment of congenital funnel chest

    Institute of Scientific and Technical Information of China (English)

    杜佳辉; 赵松; 侯智亮; 薛颢雨; 贾敬周

    2012-01-01

    Objective To investigate the safety and effect of minimally invasive surgical treatment of improved costa ster-nales lifts in treatment the children with congenital funnel chest. Methods Fifty patients were retrospectively evaluated with congenital funnel chest including the males (n =35) and females(n = 15). There were eleven patients with asymmetric funnel chest and eight patients combined with costal margin holds the deformity. All the patients were enforced the minimally invasive costa sternales lifts technique. The improvement was a small longitudinal incision on the chest wall about 3 ~5cm. Intersecting sternum with the V - type keeped continuous complete and continuous periosteum after resection of cartilage. We exalted the fixed sternum after keepping the continuous rib periosteum and shortting the periosteum complete ribs. Results The sternum raised about an average of 3. 1 (1. 5 - 5.0) cm and the average spinula between sternum and spine was about 6. 2 (4.0 ~ 9. 7) cm. Follow - up 3 - 24months, funnel chest of all the patients were corrected and eight patients combined with costal margin were corrected satisfactorily. Only one patient left chest wall a-symmetry and flat chest. Serious complication was not observed. Conclusions The minimally invasive surgical treatment of improved costa sternales lifts in treatment of the children with congenital funnel chest may be a safe and effective method with small trauma and few complications and may be worthy to be popularized.%目的 探讨微创改良胸肋抬举术治疗儿童先天性漏斗胸的安全性和疗效.方法 回顾性分析先天性漏斗胸患儿50例,男35例,女15例.其中不对称漏斗胸11例,合并肋缘外翻畸形8例.均行微创改良胸肋抬举术,即胸壁纵行小切口,长3~5cm,V型横断胸骨保留其后骨膜连续完整,间断切除肋软骨,保留骨膜连续完整,折叠、缩短缝合肋骨骨膜,抬举并固定胸骨,从而矫治漏斗胸.结果 术后胸骨平均抬高3

  2. COMPLETE LEFT MAIN BRONCHUS DISRUPTION DUE TO BLUNT CHEST TRAUMA

    Directory of Open Access Journals (Sweden)

    Mohammed Nasser Aldahmashi

    2014-12-01

    Full Text Available Isolated tracheobronchial disruption is an uncommon injury usually associated with severe blunt thoracic trauma. We report a 14 year-old female case with avulsion of the left main bronchus occurring after blunt chest trauma due to a down fallen wall. A successful surgical repair of the totally avulsed left main bronchus was carried out. The postoperative course was uneventful with improvement in the respiratory status. The patient regained wellness within days in the intensive care unit, and the diagnosis of traumatic rupture of the left main bronchus was approved by bonchoscopy and the computerized tomography (CT scan of the chest. Surgical repair of the disrupted left main bronchus was accomplished 10 days from the admission and the bronchoscopic evaluation of the anastomosis and patency was achieved. The patient was discharged with her lung fully expanded on chest X-ray. The diagnosis and preoperative management of this uncommon post traumatic condition is discussed. We conclude that, in a patient with sustained severe blunt thoracic trauma, a high index of suspicion for trachea-bronchial disruptions must be maintained to detect these rare lesions. Skilful and early surgical treatment is required for proper management of such cases.

  3. X-ray face mask and chest shield device

    International Nuclear Information System (INIS)

    A protective face mask is disclosed that is designed to shield an x-ray technician or machine operator primarily from random secondary or scatter x-rays deflected toward his face, head and neck by the table, walls, equipment and other reflecting elements in an x-ray room or chamber, during the period of exposure while adjacent the object or person being exposed to the x-ray beam. The face mask and chest shield device can be mounted on a patient's shoulders in reverse attitude to protect the back of a patient's head and neck from the x-ray beam while being exposed to such beam for chest or upper body portion study and examination. The face mask is relatively or substantially transparent and contains lead in combination with a plastic ionomer or comonomer, which absorbs or resists penetration, to a degree, of the random deflected secondary or scatter x-rays or the x-ray beam through the mask. The face mask is removably attachable to the chest shield for facile application of the device to and support upon the shoulders of the technician or the patient

  4. Radical resection of pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Alexander Koliopanos; C Avgerinos; Athanasios Farfaras; C Manes; Christos Dervenis

    2008-01-01

    BACKGROUND:Pancreatic adenocarcinoma (PCa) is a disease with dismal prognosis, and the only possibility of cure, albeit small, is based on the combination of complete resection with negative histopathological margins (R0 resection) with adjuvant treatment. Therefore, a lot of effort has been made during the last decade to assess the role of extensive surgery in both local recurrence and survival of patients with PCa. DATA SOURCES:Medline search and manual cross-referencing were utilized to identify published evidence-based data for PCa surgery between 1973 and 2006, with emphasis to feasibility, efifcacy, long-term survival, disease free survival, recurrence rates, pain relief and quality of life. RESULTS: Extended surgery is safe and feasible in high volume surgical centers with comparable short-term results. Organ preserving surgery is a main goal because of quality of life reasons and is performed whenever possible from the tumor extent. Concerning long-term survival major vein resection does not adversely affect outcome. To date, there are no changes in long-term survival attributed to the extended lymph node dissection. However, there is a beneift in locoregional control with fewer local recurrences and extended lymphadenectomy allows better staging for the disease. CONCLUSIONS:Extended PCa surgery is safe and feasible despite the inconclusive results in patient's survival beneift. In the future, appropriately powered randomized trials of standard vs. extended resections may show improved outcomes for PCa patients.

  5. Bowel resection in Nigerian children

    Directory of Open Access Journals (Sweden)

    Abdur-Rahman L

    2009-01-01

    Full Text Available Background : Although bowel resections are commonly done for congenital malformations in children in developed countries, they usually follow neglected and preventable acquired diseases of the intestine in developing countries. Objectives : To determine the indications and outcome of bowel resections in children of a developing country in a university teaching hospital. Materials and Methods: Data of the patients operated (from birth to 15 years was retrospectively collected over eight years (January 1999 to December 2006. The biodata of children included the following: Indications for operation, type of operations, duration of admission, and outcome of treatment including complications. Patients with Hirschsprung′s disease were excluded from the study because bowel resection forms part of their definitive surgical management. Results : There were 70 patients (38 boys and 32 girls. The age ranged between four hours to 15 years (median, five months. There were 16 (22.9% neonates, 26 (37.1% infants, and 28 (40% grown children. The indications were congenital anomalies in the 16 neonates. Also, 23 (88.5% infants had intussusception, 2 (7.7% had midgut vovulusm and 1 (3.8% had congenital small intestine band. Among the grown children, typhoid ileal perforation (TIP was seen in 14 (50.0%, intussusception in 5 (17.9%, and other causes in nine patients. Overall, intussusception was the most common indication for bowel resection, followed by TIP. A total of 24 patients developed 33 complications. Complications included wound infection in 47.8% and anastomotic leak in 42.8%. The duration of admission ranged between 4-35 days (median, 15 days. The overall mortality was 17.1% -; which was highest among neonates (56.3%, followed by the infants (26.9% -. Conclusion : Bowel resections are mainly done for intussusception and complications of TIP at our centre. Late presentation, preexisting malnutrition, and nonavailability of parenteral nutrition

  6. Thoracoscopic Resection of Multiple Müllerian Cysts.

    Science.gov (United States)

    Skancke, Matthew D; Auzenne, Tanya D; Tabbara, Sana O; Mortman, Keith D

    2015-11-01

    Müllerian cysts in the mediastinum were first described by Hattori in 2005 [1]. We report the first known case of multiple müllerian cysts in the thorax in a 35-year-old woman with cough and an abnormal chest roentgenogram. Multiple bilateral cysts were resected thoracoscopically. Histologic examination showed benign ciliated tubal epithelium that stained positive with immunohistochemical stains for estrogen receptor (ER), cancer antigen 125 (CA-125), Wilms' tumor protein 1 (WT-1), and paired box gene 8 (PAX8), confirming müllerian origin. We also review the embryogenesis and pathologic characteristics of müllerian cysts and the rare occurrence of their migration to the thorax. PMID:26522538

  7. [Mediastinal Mature Teratoma Necessitating Resection of Superior Vena Cava].

    Science.gov (United States)

    Aragaki, Masato; Iimura, Yasuaki; Hasegawa, Naoto; Kaga, Kichizo

    2015-09-01

    A 43-year-old woman was referred to our hospital for an abnormal shadow on chest X-ray. Computed tomography revealed a tumor with calcification of 9.8 cm in size at the anterior mediastinum. The infiltration into the left brachiocephalic vein and superior vena cava by tumor was suspected. Surgery was performed under a diagnosis of mature teratoma. The tumor was found to adhere firmly to superior vena cava (SVC), left brachiocephalic vein, right phrenic nerve, and the arch of the azygos vein. To ensure the blood flow, an artificial blood vessel was placed between left brachiocephalic vein and right atrium. Then SVC was clamped and the tumor was resected with the part of SVC. PMID:26329629

  8. Why x-ray chests

    International Nuclear Information System (INIS)

    In order to assess the validity of screening chest radiography at Chalk River Nuclear Laboratories, the yield of occult major disease and its significance to the afflicted employees have been examined over a ten year period. The study suggests that the incidence rate of occult disease which in retrospect proved to have been of major or life-threatening importance to the afflicted employee approximates 1 per 1000 population per annum. Major benefit accrued only to about 1 in 3 of these employees, the remainder gaining little more than that which would have followed treatment had their diseases presented symptomatically. These results are considered in relation to the health surveillance needs of a population generally and selectively exposed to diverse health hazards within the nuclear industry. (auth)

  9. Chest pain in focal musculoskeletal disorders

    DEFF Research Database (Denmark)

    Stochkendahl, Mette Jensen; Christensen, Henrik Wulff

    2010-01-01

    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...

  10. Frequency of anomalies associated with chest deformity in physically fit male candidates reporting for military recruitment

    International Nuclear Information System (INIS)

    To identify the frequency of anomalies associated with chest deformity in physical fit male candidates reporting for military recruitment. Study Design: Observational. Place and Duration of Study: Department of Thoracic Surgery, CMH Rawalpindi from 1st Jan 2008 to 31 Dec 2011. Patients and Methods: Normal healthy physically fit young adolescents being recruited for army were scrolled and those exhibiting chest deformity were isolated and subjected to evaluation. Convenience sampling was carried out. All candidates of chest wall deformity thereafter underwent a thorough physical checkup, pulmonary function tests and echocardiography. Results: A total of 3735 candidates of chest deformity reported at our center for evaluation over this duration. Single deformity patients 3380 (90.5%), mixed deformity patients 355 (9.5%). We found that none of the candidates had any derangement of the lung function tests or electrocardiographic abnormality despite their deformity. However echocardiography detected an abnormality in 161 (4.3%) individuals who were otherwise asymptomatic. Conclusion: Chest deformity should be excluded before physical tests, in all the male candidates reporting for enrolment. If slightest of doubt exists that a candidate has chest deformity then he should be evaluated with echocardiography to exclude cardiac abnormality. Although the associated frequency is only 4.3% but this can subsequently result in a grave event like death. (author)

  11. Resection indications of radius head fractures

    OpenAIRE

    Domanic, Unsal; Taser, Omer; Akalin, Yilmaz; Cakmak, Mehmet

    2004-01-01

    Boundaries of resection indication of radius head and timing of resection problems in radius head fractures are discussed on our cases with literature on the subject. In Mason type II. And type III., the best treatment is resection of the head. But it must be performed as soon as possible.

  12. Estimation of cartilaginous region in noncontrast CT of the chest

    Science.gov (United States)

    Zhao, Qian; Safdar, Nabile; Yu, Glenna; Myers, Emmarie; Sandler, Anthony; Linguraru, Marius George

    2014-03-01

    Pectus excavatum is a posterior depression of the sternum and adjacent costal cartilages and is the most common congenital deformity of the anterior chest wall. Its surgical repair can be performed via minimally invasive procedures that involve sternum and cartilage relocation and benefit from adequate surgical planning. In this study, we propose a method to estimate the cartilage regions in thoracic CT scans, which is the first step of statistical modeling of the osseous and cartilaginous structures for the rib cage. The ribs and sternum are first segmented by using interactive region growing and removing the vertebral column with morphological operations. The entire chest wall is also segmented to estimate the skin surface. After the segmentation, surface meshes are generated from the volumetric data and the skeleton of the ribs is extracted using surface contraction method. Then the cartilage surface is approximated via contracting the skin surface to the osseous structure. The ribs' skeleton is projected to the cartilage surface and the cartilages are estimated using cubic interpolation given the joints with the sternum. The final cartilage regions are formed by the cartilage surface inside the convex hull of the estimated cartilages. The method was validated with the CT scans of two pectus excavatum patients and three healthy subjects. The average distance between the estimated cartilage surface and the ground truth is 2.89 mm. The promising results indicate the effectiveness of cartilage surface estimation using the skin surface.

  13. [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." PMID:25734676

  14. In search of optimum chest radiography techniques

    International Nuclear Information System (INIS)

    A nation-wide study of chest radiography in Sweden previously revealed a large variation in the physical and technical factors involved, in particular radiation dose. In this study image quality could not be assessed unambiguously. The aim was to try to establish correlation between visual grading of radiographs and physical and technical factors in order to find the optimum chest X-ray system. The physical and technical performance of 24 chest units was evaluated. Radiographs were taken of an anthropomorphic chest phantom supplied with test structures simulating various pathologies. Image quality was assessed by visual grading analysis of the radiographs. The physical and technical parameters of the units rated best were used to exemplify good radiographic practice. Results were in agreement with the recommendations issued by the Commission of the European Communities (CEC). It was also shown that low radiation dose is compatible with high-quality radiographic imaging of the chest. (Author)

  15. Radiographic, CT and MRI spectrum of hydatid disease of the chest: a pictorial essay

    International Nuclear Information System (INIS)

    Thirty patients with thoracic hydatidosis (Echinococcus granulosus) were studied. The hydatid cysts were located in the lung parenchyma (70%), mediastinum (6.7%), inside the heart (10%), the pleurae (10%) and the chest wall (3.3%). Complications of thoracic hydatid cysts, such as rupture, infection, pleural involvement, spread and calcifications are presented. Computed tomography (CT) without and/or with contrast enhancement was performed in all patients (30). Findings from conventional chest radiographs were compared with CT and confirmed by pathology (30). In 10 cases (33.3%), magnetic resonance imaging was also performed. The diagnostic spectrum of hydatid cysts, including variations and developmental stages, is presented in this pictorial essay. (orig.)

  16. Assessing resectability of lung cancer

    International Nuclear Information System (INIS)

    In order to assess the value of computed tomography (CT) of the mediastinum, upper abdomen and head in the assessment of resectability of lung cancer, the CT findings of 262 patients, of whom 198 underwent thoracotomy, were anlyzed retrospectively and the stagings obtained at CT and thoracotomy were compared. Mediastinal CT reliably predicted resectability when there was no evidence of mediastinal involvement. However, it was often impossible to determine whether tumour with apparent mediastinal infiltration on CT was resectable or not. The sole finding of lymph node enlargement did not permit differentiation of benign from malignant lymphadenopathy when the lymph node diameter as < 25 mm and the lymphadenopathy was confined to one lymph node station. Upper abdominal metastases were found in 6.1% and brain metastases in 4.6% of patients and neither the histological type nor other features of the tumour were found to be useful predictors of their presence. The large number of non-specific findings decreased the utility of abdominal CT. The appropriate strategy for the pre-operative evaluation of patients with lung cancer is discussed. (author). 29 refs.; 1 fig.; 10 tabs

  17. Liver resection over the last decade

    DEFF Research Database (Denmark)

    Wettergren, A.; Larsen, P.N.; Rasmussen, A.;

    2008-01-01

    of hepatic metastases from colorectal cancer and hepatocellular carcinoma in our institution. MATERIALS AND METHODS: The patients who underwent their primary liver resection from 1.1.1995-31.12.2004 in our institution were included. The surgical outcome was reviewed retrospectively and the five-year survival...... after resection of hepatic metastases from colorectal cancer and hepatocellular carcinoma was estimated. RESULTS: 141 patients (71M/70F), median age 58 years (1-78), underwent a liver resection in the ten-year period. The number of resections increased from two in 1995 to 32 in 2004. Median hospital......AIMS: The results after liver resection have improved over the last decade with an operative mortality rate of less than 5% in high-volume centres. The aim of the present study was to assess the perioperative outcome after hepatic resection and to assess the long-term survival after liver resection...

  18. Hemivaginal septum resection in a patient with a rare variant of Herlyn-Werner-Wunderlich syndrome.

    Science.gov (United States)

    Pereira, Nigel; Anderson, Sharon H; Verrecchio, Elizabeth S; Brown, M Allyson; Glassner, Michael J

    2014-01-01

    Herlyn-Werner-Wunderlich syndrome is characterized by a triad of uterine didelphys, obstructed hemivagina, and ipsilateral renal agenesis. The syndrome should be suspected in any young woman with abdominal pain or cyclic dysmenorrhea, and radiologic evidence of müllerian duct and renal anomalies. Herein is presented the case of a 25-year-old woman with a rare variant of Herlyn-Werner-Wunderlich syndrome, characterized by an anomalous connection between the 2 endocervical canals, who underwent hemivaginal septum resection to relieve progressively worsening dysmenorrhea. The right hemivaginal septum was resected medially from the left cervix and laterally off the right vaginal wall. Hydrodissection between the hemivaginal septum and right cervix facilitated surgical resection. After resection of the hemivaginal septum there was complete resolution of dysmenorrhea and no recurrence of hematometra or hematocolpos. PMID:24858986

  19. Coring-type laparoscopic resection of a cavitated non-communicating rudimentary horn under hysteroscopic assistance.

    Science.gov (United States)

    Akdemir, Ali; Ergenoglu, Ahmet Mete; Yeniel, Ahmet Özgür; Sendag, Fatih; Karadadaş, Nedim

    2014-07-01

    Non-communicating accessory uterine horns with an endometrial cavity are the most common and clinically significant unicornuate subtype of Müllerian duct abnormality. They are generally associated with symptoms of dysmenorrhea, dyspareunia, infertility, endometriosis, adhesions, and life-threatening cornual pregnancy. Treatment options include surgical resection of the rudimentary horn, hysteroscopic recanalization, and endometrial ablation. Currently, laparoscopic resection is the recommended treatment choice. Dissection of the rudimentary horn from the unicornuate uterus is the most challenging part of this procedure and may compromise the remaining unicornuate uterus wall. Here we describe a case of laparoscopic coring-type resection of a non-communicating functional rudimentary horn firmly attached to the unicornuate uterus, by using hysteroscopic assistance. The use of hysteroscopy, adjunct to laparoscopy, facilitates the coring-type resection and may strengthen the remaining myometrial scar. PMID:25056476

  20. Resection of a large ectopic parathyroid adenoma: A case report

    Science.gov (United States)

    Sato, Seijiro; Kitahara, Akihiko; Koike, Terumoto; Hashimoto, Takehisa; Ohashi, Riuko; Motoi, Noriko; Tsuchida, Masanori

    2016-01-01

    Introduction Parathyroid adenomas are the most common cause of primary hyperparathyroidism. However, cases of parathyroid adenomas greater than 4 cm with osteitis fibrosa cystica are extremely rare. Herein, we report a case of resection of a large ectopic mediastinal parathyroid adenoma. Case presentations A 46-year-old female with chief complaints of bone pain and gait disturbance was referred to our hospital. Physical examination revealed many mobile teeth in her oral cavity, distortion of the vertebral body, and bowlegs. Laboratory tests showed hypercalcemia, hypophosphatemia, and elevated serum levels of intact parathyroid hormone. Chest CT revealed a 42-mm well–defined, enhancing mass in front of the left-sided tracheal bifurcation. Her findings were diagnosed as primary hyperparathyroidism due to an ectopic mediastinal parathyroid tumor. We performed a median sternotomy and resected the tumor. The tumor was a solid, yellowish-brown mass measuring 42 × 42 mm. Pathologically, the tumor consisted mainly of chief cells with some oxyphil cells; there were no necrotic areas or nuclear atypia, and few mitotic figures. We diagnosed the tumor as an ectopic mediastinal parathyroid adenoma. Eight months after the resection, her serum calcium, phosphorus, and intact PTH levels were normal. Discussion and conclusions Parathyroid adenomas and parathyroid carcinomas have disparate natural histories, but they can be difficult to differentiate on the basis of preoperative clinical characteristics. We believe that long-term follow-up of these cases is required because there have been few reports on the postoperative natural history of large parathyroid adenomas. PMID:27078868

  1. 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

  2. Chest CT in children: anesthesia and atelectasis

    International Nuclear Information System (INIS)

    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

  3. Impacts to the chest of PMHSs - Influence of impact location and load distribution on chest response.

    Science.gov (United States)

    Holmqvist, Kristian; Svensson, Mats Y; Davidsson, Johan; Gutsche, Andreas; Tomasch, Ernst; Darok, Mario; Ravnik, Dean

    2016-02-01

    The chest response of the human body has been studied for several load conditions, but is not well known in the case of steering wheel rim-to-chest impact in heavy goods vehicle frontal collisions. The aim of this study was to determine the response of the human chest in a set of simulated steering wheel impacts. PMHS tests were carried out and analysed. The steering wheel load pattern was represented by a rigid pendulum with a straight bar-shaped front. A crash test dummy chest calibration pendulum was utilised for comparison. In this study, a set of rigid bar impacts were directed at various heights of the chest, spanning approximately 120mm around the fourth intercostal space. The impact energy was set below a level estimated to cause rib fracture. The analysed results consist of responses, evaluated with respect to differences in the impacting shape and impact heights on compression and viscous criteria chest injury responses. The results showed that the bar impacts consistently produced lesser scaled chest compressions than the hub; the Middle bar responses were around 90% of the hub responses. A superior bar impact provided lesser chest compression; the average response was 86% of the Middle bar response. For inferior bar impacts, the chest compression response was 116% of the chest compression in the middle. The damping properties of the chest caused the compression to decrease in the high speed bar impacts to 88% of that in low speed impacts. From the analysis it could be concluded that the bar impact shape provides lower chest criteria responses compared to the hub. Further, the bar responses are dependent on the impact location of the chest. Inertial and viscous effects of the upper body affect the responses. The results can be used to assess the responses of human substitutes such as anthropomorphic test devices and finite element human body models, which will benefit the development process of heavy goods vehicle safety systems. PMID:26687541

  4. Technique for chest radiography for pneumoconiosis

    International Nuclear Information System (INIS)

    Routine radiographic chest examinations have been performed using a variety of techniques. Although chest radiography is one of the most commonly performed radiographic examinations, it is often difficult to obtain consistently good quality roentgenograms. This publication provides a simple guide and relatively easy solution to the many problems that radiologic technologists might encounter. The language is purposely relatively simple and care has been taken to avoid difficult mathematical and physical explanations. The intent is to provide an easily referrable text for those who may encounter difficulties in producing acceptable chest radiographs

  5. Chest pain of cardiac and noncardiac origin.

    Science.gov (United States)

    Lenfant, Claude

    2010-10-01

    Chest pain is one of the most common symptoms driving patients to a physician's office or the hospital's emergency department. In approximately half of the cases, chest pain is of cardiac origin, either ischemic cardiac or nonischemic cardiac disease. The other half is due to noncardiac causes, primarily esophageal disorder. Pain from either origin may occur in the same patient. In addition, psychological and psychiatric factors play a significant role in the perception and severity of the chest pain, irrespective of its cause. Chest pain of ischemic cardiac disease is called angina pectoris. Stable angina may be the prelude of ischemic cardiac disease; and for this reason, it is essential to ensure a correct diagnosis. In most cases, further testing, such as exercise testing and angiography, should be considered. The more severe form of chest pain, unstable angina, also requires a firm diagnosis because it indicates severe coronary disease and is the earliest manifestation of acute myocardial infarction. Once a diagnosis of stable or unstable angina is established, and if a decision is made not to use invasive therapy, such as coronary bypass, percutaneous transluminal coronary angioplasty, or stent insertion, effective medical treatment of associated cardiac risk factors is a must. Acute myocardial infarction occurring after a diagnosis of angina greatly increases the risk of subsequent death. Chest pain in women warrants added attention because women underestimate their likelihood to have coronary heart disease. A factor that complicates the clinical assessment of patients with chest pain (both cardiac and noncardiac in origin) is the relatively common presence of psychological and psychiatric conditions such as depression or panic disorder. These factors have been found to cause or worsen chest pain; but unfortunately, they may not be easily detected. Noncardiac chest pain represents the remaining half of all cases of chest pain. Although there are a number of

  6. Initial experience with a synthetic sealant PleuraSeal™ after pulmonary resections: a prospective study with retrospective case matched controls

    OpenAIRE

    Hennings Ellen; Lin Rong; Dango Sebastian; Passlick Bernward

    2010-01-01

    Abstract The objective of this study was to evaluate postoperative outcome and efficacy of a hydrogel tissue sealant for prevention of alveolar leakage after open lung resections. 20 consecutive patients were enrolled in the PleuraSeal™ sealant group (PSG) and case matched with 20 retrospective controls (CG) with standard treatment. Assessment of postoperative air leakage was performed until chest tube removal. Patients were followed until 30 days after discharge. At end of surgery, 100% in t...

  7. Cell Wall

    OpenAIRE

    Jamet, Elisabeth; Canut, Hervé; Boudart, Georges; Albenne, Cécile; Pont-Lezica, Rafael F

    2008-01-01

    This chapter covers our present knowledge of cell wall proteomics highlighting the distinctive features of cell walls and cell wall proteins in relation to problems encountered for protein extraction, separation and identification. It provides clues to design strategies for efficient cell wall proteomic studies. It gives an overview of the kinds of proteins that have yet been identified: the expected proteins vs the identified proteins. Finally, the new vision of the cell wall proteome, and t...

  8. [A case of abdominal wall actinomycosis].

    Science.gov (United States)

    Kim, Kyung Hoon; Lee, Jin Soo; Cho, Hyeong Jun; Choi, Seung Bong; Cheung, Dae Young; Kim, Jin Il; Lee, In Kyu

    2015-04-01

    Actinomycosis is a chronic suppurative granulomatous infectious disease caused by actinomyces species that is characterized by formation of characteristic clumps called as sulfur granules. Abdominal actinomycosis is a rare disease and is often difficult to diagnose before operation. Abdominal actinomycosis infiltrating into the abdominal wall and adhering to the colon is even rarer. Most abdominal actinomycosis develops after operation, trauma or inflammatory bowel disease, and is also considered as an opportunistic infection in immunocompromised patient with underlying malignancy, diabetes mellitus, human immunodeficiency virus infection, etc. Actinomycosis is diagnosed based on histologic demonstration of sulfur granules in surgically resected specimen or pus, and treatment consists of long-term penicillin based antibiotics therapy with or without surgical resection. Herein, we report an unusual case of abdominal wall actinomycosis which developed in a patient after acupuncture and presented as abdominal wall mass that was first mistaken for abdominal wall invasion of diverticulum perforation. PMID:25896158

  9. Digital chest radiography: collimation and dose reduction

    DEFF Research Database (Denmark)

    Debess, Jeanne; Johnsen, Karen Kirstine; Vejle-Sørensen, Jens Kristian;

    Purpose: Quality improvement of basic radiography focusing 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 of age are included in the study. The clinical research is performed between September and November 2014 where 3rd year Radiography students collect data on four Danish x-ray departments using identical procedures under guidance of...... conference. Conclusion: Collimation improvement in basic chest radiography can reduce the radiation to female patients at chest x-ray examinations....

  10. Common Acupoints in Chest and Abdomen

    Institute of Scientific and Technical Information of China (English)

    Journal of Acupuncture and Tuina Science Editor; CUI Xue-jun

    2003-01-01

    @@ Tiantu (CV 21) Location: In the center of the suprasternal fossa(Fig. l ). Indications: Cough, dyspnea, chest pain, pharyngolaryngeal swelling and pains, sudden hoarseness of the voice, goiter, globus hystericus, and dysphagia.

  11. Angina - when you have chest pain

    Science.gov (United States)

    ... or having sex. How to treat your chest pain Sit, stay calm, and rest. Your symptoms will often go away soon after you stop activity. If you are lying down, sit up in bed. Try deep breathing to ...

  12. Open-Chest Management after Heart Transplantation

    OpenAIRE

    Takayama, Hiroo; Leone, Richard J.; Aldea, Gabriel S.; Fishbein, Daniel P.; Verrier, Edward D.; Salerno, Christopher T.

    2006-01-01

    Postcardiotomy open-chest management has been widely used in cardiac surgery. Although this strategy can be applied to heart transplantation, the use of immunosuppressants in transplant recipients raises particular concerns about sternal wound infection and impaired healing.

  13. Aspergillosis - chest x-ray (image)

    Science.gov (United States)

    ... usually occurs in immunocompromised individuals. Here, a chest x-ray shows that the fungus has invaded the lung ... are usually seen as black areas on an x-ray. The cloudiness on the left side of this ...

  14. Tuberculosis, advanced - chest x-rays (image)

    Science.gov (United States)

    Tuberculosis is an infectious disease that causes inflammation, the formation of tubercules and other growths within tissue, ... death. These chest x-rays show advanced pulmonary tuberculosis. There are multiple light areas (opacities) of varying ...

  15. Surface Chest Motion Decomposition for Cardiovascular Monitoring

    OpenAIRE

    Ghufran Shafiq; Kalyana C. Veluvolu

    2014-01-01

    Surface chest motion can be easily monitored with a wide variety of sensors such as pressure belts, fiber Bragg gratings and inertial sensors, etc. The current applications of these sensors are mainly restricted to respiratory motion monitoring/analysis due to the technical challenges involved in separation of the cardiac motion from the dominant respiratory motion. The contribution of heart to the surface chest motion is relatively very small as compared to the respiratory motion. Further, t...

  16. Tuberculous spondylitis presenting as severe chest pain

    Directory of Open Access Journals (Sweden)

    Martha A. Kaeser

    2012-04-01

    Full Text Available This case report describes a 32-year-old male who presented to an emergency department with severe chest pain and a history of cough, fever, night sweats, loss of appetite and weight. Chest radiography revealed a left upper lobe consolidation and multiple compression deformities in the thoracic spine. Magnetic resonance imaging demonstrated significant kyphosis and vertebral plana at two thoracic levels. Anterior compression of the spinal cord and adjacent soft tissue masses were also noted.

  17. Psychiatric syndromes associated with atypical chest pain

    OpenAIRE

    Nikolić Gordana; Tasić Ivan; Manojlović Snežana; Samardžić Ljiljana; Tošić Suzana; Ćirić Zoran

    2010-01-01

    Background/Aim. Chest pain often indicates coronary disease, but in 25% of patients there is no evidence of ischemic heart disease using standard diagnostic tests. Beside that, cardiologic examinations are repeated several times for months. If other medical causes could not be found, there is a possibility that chest pain is a symptom of psychiatric disorder. The aim of this study was to determine the presence of psychiatric syndromes, increased somatization, anxiety, stress life events expos...

  18. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    OpenAIRE

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

    2013-01-01

    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours.

  19. Results of Thoracotomy in Penetrating Chest Trauma

    OpenAIRE

    Mahmood Aghaei-Afshar; Foroogh Mangeli; Sara Farifteh

    2012-01-01

    Background: Thoracotomy is a surgical procedure to access the chest components, which is often performed after severe bleeding caused by heart damage, lung laceration and other similar injuries.Materials and Methods: This is a cross-sectional study which was conducted on all patients with penetrating chest trauma during April 2000 to October 2008.Results: In 5% of cases, thoracotomy was used for treatment in which severe bleeding was the main surgical indication. It was the most common findin...

  20. Treatment of 336 cases of chest trauma

    OpenAIRE

    Jing ZHANG; Xiang-yang CHU; Liu, Yi; Wang, Yun-Xi

    2012-01-01

    【Abstract】Objective: To summarize the clinical features, diagnosis and treatment of chest trauma. Methods: A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011. Results: Out of all cases, 325 were cured, accounting for 96.7%; 11 died, accounting for 3.3%. Among the dead cases, one died of hemorrhagic shock, three of acute respi-ratory distress syndrome, three of multiple organ failure, and ...

  1. Late clotted haemothorax after blunt chest trauma.

    OpenAIRE

    Sinha, P; Sarkar, P

    1998-01-01

    A clotted haemothorax can develop any time after blunt chest trauma. Two cases are described in which late clotted haemothoraces developed which were treated by limited thoracotomy and evacuation of clots. Late clotted haemothorax may occur even in the absence of any abnormal initial clinical findings. Early detection and treatment is important to avoid the complications of fibrothorax and empyema with permanent pulmonary dysfunction. After blunt chest trauma patients should be advised to ret...

  2. ABDOMINOPERINEAL RESECTION OF THE RECTUM

    Directory of Open Access Journals (Sweden)

    E. Tarcoveanu

    2006-04-01

    Full Text Available The abdominoperineal resection is a procedure that combine a low anterior resection and the complete perineal excision of the anus and rectum. The paper discuss the surgical anatomy of the rectum, the history, the indications and complications of the procedure. It is also described the technique of the abdominoperineal resection: the abdominal approach is through a lower midline incision, and then, the small bowell is packed into the upper side of the abdomen. The sigmoid colon is mobilized by the incising the posterior and lateral peritoneum. The peritoneal dissection is continued distally parallel to the rectum. The inferior mesenteric artery is identified and ligated just distal to the take off of the left colic artery or higher. The next step is the total mesorectal excision, performed by entering in the retrorectal space, in the avascular space of areolar tissue, above the promontory of the sacrum and anteriorly the presacral nerves. This plane should be continued by sharp disection laterally and caudally till the pelvic floor. Anterior dissection of the rectum is achived by incision the recto-vesical reflection and dissection of the Denonvilliers fascia (in men and in women the mobilization of the rectum is finished by the incision and the dissection of the recto-vaginal reflection. The colon can be now divided proximally. The next step is the perineal resection: an eliptical incision is made to encompass the anus with an adequate margin of tissue. The skin edges are then grasped and the subcutaneous tissue is divided with cautery; the dissection is continued into the fat of the ischio-anal fossa and the inferior rectal vessels are divided. The levator ani is than divided. After the complete posterior dissection of the rectum, the specimen may be delivered into the perineal wound and then, the anteriorly final dissection can be achived. In men the dissection plane is between the rectum and the prostate / urethra, and in women between the

  3. How to remove a chest drain.

    Science.gov (United States)

    Allibone, Elizabeth

    2015-10-01

    RATIONALE AND KEY POINTS: This article aims to help nurses to undertake the removal of a chest drain in a safe, effective and patient-centred manner. This procedure requires two practitioners. The chest drain will have been inserted aseptically to remove air, blood, fluid or pus from the pleural cavity. ▶ Chest drains may be small or wide bore depending on the underlying condition and clinical setting. They may be secured with a mattress suture and/or an anchor suture. ▶ Chest drains are usually removed under medical instructions when the patient's lung has inflated, the underlying condition has resolved, there is no evidence of respiratory compromise or failure, and their anticoagulation status has been assessed as satisfactory. ▶ Chest drains secured with a mattress suture should be removed by two practitioners. One practitioner is required to remove the tube and the other to tie the mattress suture (if present) and secure the site. REFLECTIVE ACTIVITY: Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. How reading this article will change your practice. 2. How this article could be used to educate patients with chest drains. Subscribers can upload their reflective accounts at: rcni.com/portfolio . PMID:26443174

  4. Management of chest trauma: a review.

    Science.gov (United States)

    Adebonojo, S A

    1993-01-01

    The incidence of chest trauma has increased significantly since the turn of the century especially in developed countries where rapid means of transportation has become part of daily life. Although gunshot wounds (GSWs) were the commonest causes of chest trauma in wartime, road traffic accidents (RTAs) have become the scourge of peacetime and modern civilization. Chest trauma is more common in males during the 2nd to the 5th decades of life with an average age of 40 years reducing their life expectancy by another 40 years at the most productive and active period of their lives. Despite improvement in ambulance service and rapid mobilization of victims from the scene of accident, about 10% of chest injured patients will die on the spot and another 5% die within an hour of reaching the hospital. Of the remaining 85%, five percent will require emergency thoracotomy for various reasons while 80% will respond to resuscitative measures and tube thoracostomy drainage alone. The primary aims in the management of chest trauma are prompt restoration of normal cardiorespiratory functions, control of haemorrhage, treatment of associated injuries and prevention of sepsis. Although the overall survival rate of trauma has improved in recent years, deaths are often due to airway obstruction, exsanguinating haemorrhage, flail chest, tension pneumothorax, cardiac tamponade and associated intracranial, intraabdominal and skeletal injuries. PMID:8398932

  5. Results Of Endoscopic Transnasal Resection Of Sinonasal Inverted Papiloma

    Directory of Open Access Journals (Sweden)

    Baradaranfar M. H

    2003-08-01

    Full Text Available Inverted papilloma is an uncommon benign neoplasm originating from lateral nasal wall. It commonly invades paranasal sinuses and sometimes invasion to orbit and intracranial structures are seen. There are many surgical methods for its treatment, one of them is endoscopic transnasal approach."nMaterials and Methods: Between 1997 and 2001, 11 patients with this tumor were operated in Amiralam hospital in Tehran and Shahid Rahnemun in Yazd. Nine patients were operated by endoscopic transnasal route and two patients by combined Caldwell-luc and endoscopic transnasal routes."nResults: Tumors were on the right side in 3 patients, on the left side in 7 patients, and bilateral in one patient. There were no intracranial or orbital extensions. No pathologic report of malignancy was made. Surgical technique included complete tumor resection, anterior and posterior ethomidectomies, sphenoidectomy, frontal recess tumor resection and wide maxillary antrostomy, in cases in whom tumor was attached to lamina papyracea, the lamina was removed without any manipulation to orbital periosteum. Mean follow-up time was 29.8 months. There was no recurrence in 82% of cases. Tumor recurred in 18% of cases. No complications were seen."nConclusion: Although the standard treatment for this tumor is medial maxillectomy but endoscopic resection is an effective method in surgery of this tumor. It seems that if tumor does not extend to areas unreachable by endoscopic surgery, due to lower morbidity and excellent visualization of tumor, this method is preferable.

  6. Cricotracheal resection for laryngeal invasion by thyroid carcinoma: our experience.

    Science.gov (United States)

    Morisod, Benoît; Monnier, Philippe; Simon, Christian; Sandu, Kishore

    2014-08-01

    Invasion of the laryngeal framework by thyroid carcinoma requires specific surgical techniques and carries a higher rate of complications that deserve to be highlighted. We reviewed our data from 1995 to 2012 and found six patients with laryngotracheal invasion by thyroid carcinoma. All underwent total thyroidectomy and single-stage cricotracheal resection, plus anterolateral neck dissection. Three had airway obstruction that necessitated prior endoscopic debulking. None of the patients needed a tracheotomy. There were four cases of papillary carcinoma, and two cases of undifferentiated carcinoma. One patient died of complications of the procedure (anastomotic dehiscence and tracheo-innominate artery fistula). Another died 2 months after the procedure from local recurrence and aspiration pneumonia. One case presented recurrence at 15 months, which was managed by re-excision and adjuvant radiotherapy; after 26 months of follow-up, he has no evidence of locoregional recurrence. The three other patients are alive without evidence of disease at 6, 18 and 41 months, respectively. Cricotracheal resection for subglottic invasion by thyroid carcinoma is an effective procedure, but carries significant risks of complications. This could be attributed to the devascularisation of the tracheal wall due to the simultaneous neck dissection, sacrifice of the strap muscles or of a patch of oesophageal muscle layer. We advocate a sternocleidomastoid flap to cover the anastomosis. Cricotracheal resection for subglottic invasion can be curative with good functional outcomes, even for the advanced stages of thyroid cancer. Endoscopic debulking of the airway prior to the procedure avoids tracheotomy. PMID:24129693

  7. Precision resection of intestine using ultrashort laser pulses

    Science.gov (United States)

    Beck, Rainer J.; Gora, Wojciech S.; Jayne, David; Hand, Duncan P.; Shephard, Jonathan D.

    2016-03-01

    Endoscopic resection of early colorectal neoplasms typically employs electrocautery tools, which lack precision and run the risk of full thickness thermal injury to the bowel wall with subsequent perforation. We present a means of endoluminal colonic ablation using picosecond laser pulses as a potential alternative to mitigate these limitations. High intensity ultrashort laser pulses enable nonlinear absorption processes, plasma generation, and as a consequence a predominantly non-thermal ablation regimen. Robust process parameters for the laser resection are demonstrated using fresh ex vivo pig intestine samples. Square cavities with comparable thickness to early colorectal neoplasms are removed for a wavelength of 1030 nm and 515 nm using a picosecond laser system. The corresponding histology sections exhibit in both cases only minimal collateral damage to the surrounding tissue. The ablation depth can be controlled precisely by means of the pulse energy. Overall, the application of ultrafast lasers for the resection of intestine enables significantly improved precision and reduced thermal damage to the surrounding tissue compared to conventional electrocautery.

  8. Liver Resections for Metastases from Intraabdominal Leiomyosarcoma

    OpenAIRE

    Antonio Nocchi Kalil; Bianca De Lourdes Pereira; Marcia Cristina Lima Brenner; Luiz Pereira-Lima

    1999-01-01

    This paper discusses liver resection for intraabdominal leiomyosarcoma metastases as a therapy for carefully selected patients. Of the 83 hepatectomies performed from 1992 to 1996, five were resections for liver metastases due to intraabdominal leiomyosarcoma, in 3 patients. The surgical indication was single liver metastases, without any evidence of extrahepatic disease. No mortality occurred during surgery and the longest survival was 38 months. We concluded that liver resection for leiomyo...

  9. Hepatic Resection Using a Water Jet Dissector

    OpenAIRE

    H. U. Baer; Stain, S. C.; Guastella, T.; G. J. Maddern; Blumgart, L. H.

    1993-01-01

    The mortality and morbidity in major hepatic resection is often related to hemorrhage. A high pressure, high velocity water jet has been developed and has been utilized to assist in hepatic parenchymal transection. Sixty-seven major hepatic resections were performed for solid hepatic tumors. The tissue fracture technique was used in 51 patients (76%), and the water jet dissector was used predominantly in 16 patients (24%). The extent of hepatic resection using each technique was similar. The ...

  10. Improving surgical resection rate in lung cancer

    OpenAIRE

    Laroche, C.; Wells, F; Coulden, R.; Stewart, S; Goddard, M; Lowry, E.; Price, A; Gilligan, D.

    1998-01-01

    BACKGROUND—Surgical resection is the recognised treatment of choice for patients with stage I or II non-small cell lung cancer (NSCLC). In the UK surgical resection rates have remained far lower (20%), despite the recent introduction of fast access investigation units. It remains unclear therefore why UK surgical resection rates lag so far behind those of other countries.
METHODS—A new quick access two stop investigation service was established at Papworth in November 199...

  11. Cardiac pathologies incidentally detected with non-gated chest CT; Inzidentelle Pathologien des Herzens im Thorax-CT

    Energy Technology Data Exchange (ETDEWEB)

    Scherer, Axel; Kroepil, P.; Lanzman, R.S.; Moedder, U. [Inst. fuer Radiologie, Universitaetsklinikum Duesseldorf, Heinrich-Heine-Univ. (Germany); Choy, G.; Abbara, S. [Cardiovascular Imaging Section, Massachusetts General Hospital, Harvard Medical School (United States)

    2009-12-15

    Cardiac imaging using electrocardiogram-gated multi-detector computed tomography (MDCT) permits noninvasive diagnosis of congenital and acquired cardiac pathologies and has thus become increasingly important in the last years. Several studies investigated the incidence and relevance of incidental extracardiac structures within the lungs, mediastinum, chest wall, and abdomen with gated coronary CT. This resulted in the general acceptance of the review of extracardiac structures as a routine component of coronary CT interpretation. On the other hand radiologists tend to neglect pericardial and cardiac pathologies in non-gated chest CT, which is primarily performed for the evaluation of the respiratory system or for tumor staging. Since the introduction of multi-detector spiral CT technology, the incidental detection of cardiac and pericardial findings has become possible using non-gated chest CT. This article reviews the imaging appearances and differential diagnostic considerations of incidental cardiac entities that may be encountered in non-gated chest CT. (orig.)

  12. 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.

  13. Endoscopic resection of sinonasal malignancies.

    Science.gov (United States)

    Nicolai, Piero; Castelnuovo, Paolo; Bolzoni Villaret, Andrea

    2011-04-01

    Malignant tumors of the sinonasal tract are rare, accounting for only 1% of all malignancies. Although they are associated with substantial histological heterogeneity, surgery plays a key role in their management. This review addresses the evolution of current treatments in view of the introduction of endoscopic resection techniques. The absence of facial incisions and osteotomies, decreased hospitalization time, better control of bleeding, improved visualization of tumor borders, and reduced morbidity and mortality rate are the major advantages of endoscopic techniques in comparison to traditional external approaches. The major criticisms focus on oncologic results in view of the short/intermediate follow-up of large series, which have commonly grouped together several histologies that may be associated with different prognoses. Since prospective studies contrasting the results of endoscopic and craniofacial resections are difficult to carry out given the rarity of the disease together with ethical issues, the creation of a large database would favor the analysis of several variables related to the patient, tumor, and treatment on survival performed on a large number of patients. PMID:21243539

  14. Vaginoscopic resection of vaginal septum.

    Science.gov (United States)

    Nassif, Joseph; Al Chami, Ali; Abu Musa, Antoine; Nassar, Anwar H; Kurdi, Ahmad; Ghulmiyyah, Labib

    2012-12-01

    We report the resection of a vaginal septum while preserving the virginity of a 12-year-old girl with Herlyn-Werner-Wunderlich Syndrome (HWWS) having a didelphys uterus, obstructed hemivagina, and an ipsilateral renal agenesis with follow-up at 18 months. Successful resection of the vaginal septum with conservation of the hymenal ring and complete drainage of both the hematocolpos and the hematometra were achieved. Cyclic dysmenorrhea and pelvic pain were completely resolved on follow-up visits at 4, 6, and 18 months. Office hysteroscopy performed during the last follow-up visit revealed a patent vaginal vault without evidence of adenosis or recurrence of the vaginal septum. Vaginoscopy is a safe, convenient, and efficient diagnostic and therapeutic modality that can be used in the management of patients with an obstructed hemivagina. It maintains the patient's virginity and it is useful in patients with a restrictive vaginal opening or narrow vaginal canal. Furthermore, the hysteroscopic excision of the vaginal septum offers minimal risk of recurrence of the septal defect. PMID:23315718

  15. Awake operative videothoracoscopic pulmonary resections.

    Science.gov (United States)

    Pompeo, Eugenio; Mineo, Tommaso C

    2008-08-01

    The authors' initial experience with awake videothoracoscopic lung resection suggests that these procedures can be easily and safely performed under sole thoracic epidural anesthesia with no mortality and negligible morbidity. One major concern was that operating on a ventilating lung would render surgical maneuvers more difficult because of the lung movements and lack of a sufficient operating space. Instead, the open pneumothorax created after trocar insertion produces a satisfactory lung collapse that does not hamper surgical maneuvers. These results contradict the accepted assumption that the main prerequisite for allowing successful thoracoscopic lung surgery is general anesthesia with one-lung ventilation. No particular training is necessary to accomplish an awake pulmonary resection for teams experienced in thoracoscopic surgery, and conversions to general anesthesia are mainly caused by the presence of extensive fibrous pleural adhesions or the development of intractable panic attacks. Overall, awake pulmonary resection is easily accepted and well tolerated by patients, as confirmed by the high anesthesia satisfaction score, which was better than in nonawake control patients. Nonetheless, thoracic epidural anesthesia has potential complications, including epidural hematoma, spinal cord injury, and phrenic nerve palsy caused by inadvertently high anesthetic level, but these never occurred in the authors' experience. Further concerns relate to patient participation in operating room conversations or risk for development of perioperative panic attacks. However, the authors have found that reassuring the patient during the procedure, explaining step-by-step what is being performed, and even showing the ongoing procedure on the operating video can greatly improve the perioperative wellness and expectations of patients, particularly if the procedure is performed for oncologic diseases. Panic attacks occurred in few patients and could be usually managed through

  16. Psychiatric syndromes associated with atypical chest pain

    Directory of Open Access Journals (Sweden)

    Nikolić Gordana

    2010-01-01

    Full Text Available Background/Aim. Chest pain often indicates coronary disease, but in 25% of patients there is no evidence of ischemic heart disease using standard diagnostic tests. Beside that, cardiologic examinations are repeated several times for months. If other medical causes could not be found, there is a possibility that chest pain is a symptom of psychiatric disorder. The aim of this study was to determine the presence of psychiatric syndromes, increased somatization, anxiety, stress life events exposure and characteristic of chest pain expression in persons with atypical chest pain and coronary patients, as well as to define predictive parameters for atypical chest pain. Method. We compared 30 patients with atypical chest pain (E group to 30 coronary patients (K group, after cardiological and psychiatric evaluation. We have applied: Mini International Neuropsychiatric Interview (MINI, The Symptom Checklist 90-R (SCL-90 R, Beck Anxiety Inventory (BAI, Holms-Rahe Scale of stress life events (H-R, Questionnaire for pain expression Pain-O-Meter (POM. Significant differences between groups and predictive value of the parameters for atypical chest pain were determined. Results. The E group participants compared to the group K were younger (33.4 ± 5.4 : 48.3 ± 6,4 years, p < 0.001, had a moderate anxiety level (20.4 ± 11.9 : 9.6 ± 3.8, p < 0.001, panic and somatiform disorders were present in the half of the E group, as well as eleveted somatization score (SOM ≥ 63 -50% : 10%, p < 0.01 and a higher H-R score level (102.0 ± 52.2 : 46.5 ± 55.0, p < 0.001. Pain was mild, accompanied with panic. The half of the E group subjects had somatoform and panic disorders. Conclusion. Somatoform and panic disorders are associated with atypical chest pain. Pain expression is mild, accompained with panic. Predictive factors for atypical chest pain are: age under 40, anxiety level > 20, somatization ≥ 63, presence of panic and somatoform disorders, H-R score > 102

  17. [LAPAROSCOPIC APPROACH AND SURGICAL CONSIDERATIONS IN RESECTION OF A LARGE EPIPHRENIC ESOPHAGEAL DIVERTICULUM].

    Science.gov (United States)

    Rudnicki, Yaron; Inbar, Roy; Barkay, Olga; Shpitz, Baruch; Ghinea, Ronen; Avital, Shmuel

    2015-08-01

    Epiphrenic diverticulum of the esophagus is an uncommon finding. Small diverticula are usually asymptomatic in nature. Large diverticula may present with dysphagia, chest or upper abdominal discomfort, vomiting, irritating cough or halitosis. There are a few different surgical approaches to epiphrenic diverticulum resection. It can be performed with an abdominal or a thoracic approach and in an open or a laparoscopic manner. In this case report we present a 70 years old male patient with a giant epiphrenic diverticulum and dysphagia. The patient was operated upon via a laparoscopic abdominal approach with intra-operative endoscopic assistance and underwent a diverticulum resection. We present a review of the different kinds of esophageal diverticula, the mechanism of their formation, and the surgical considerations associated with choosing the appropriate surgical approach. PMID:26480613

  18. Utility of chest CT for differentiating primary and secondary achalasia

    International Nuclear Information System (INIS)

    Aim: To determine the computed tomography (CT) findings of primary and secondary achalasia and to assess the utility of CT for differentiating these conditions. Methods: A computerized search revealed 13 patients with primary achalasia and 15 with secondary achalasia who underwent chest CT during a 10-year period. The images were reviewed to determine whether there was distal oesophageal narrowing (including the length/contour of narrowing), oesophageal dilation, oesophageal wall thickening (including degree/symmetry/pattern of thickening), a soft-tissue mass at the gastro-oesophageal junction, mediastinal adenopathy, or other findings of malignant tumour. Results: Eleven (85%) of 13 patients with primary achalasia had distal oesophageal narrowing at CT that was smooth in all patients; four (31%) had oesophageal wall thickening that was smooth and symmetric in all patients; none had a soft-tissue mass at the gastro-oesophageal junction or mediastinal lymphadenopathy; and two (15%) had pulmonary metastases from unrelated lung cancers. In contrast, 12 (80%) of 15 patients with secondary achalasia had distal oesophageal narrowing at CT; 11 (73%) had distal oesophageal wall thickening that was nodular/lobulate and asymmetric in seven (64%) and smooth and symmetric in four (36%); six (40%) had a soft-tissue mass at the gastro-oesophageal junction; seven (47%) had mediastinal lymphadenopathy; and all 15 had other findings of malignant tumour. Conclusion: CT is a useful technique for differentiating primary and secondary achalasia. Distal oesophageal wall thickening that is nodular/lobulate and asymmetric, a soft-tissue mass at the gastro-oesophageal junction, mediastinal lymphadenopathy, and pulmonary, hepatic, or osseous metastases are findings that favour secondary achalasia. - Highlights: • CT is a useful technique for differentiating primary and secondary achalasia. • Nodular/lobulated distal oesophageal wall thickening favors secondary achalasia. • A soft

  19. The Role of Video-Assisted Thoracoscopic Therapeutic Resection for Medically Failed Pulmonary Tuberculosis

    Science.gov (United States)

    Tseng, Yau-Lin; Chang, Jia-Ming; Liu, Yi-Sheng; Cheng, Lili; Chen, Ying-Yuan; Wu, Ming-Ho; Lu, Chung-Lan; Yen, Yi-Ting

    2016-01-01

    Abstract There are few reports regarding video-assisted thoracoscopic therapeutic resection for medically failed pulmonary tuberculosis (TB). We reviewed our surgical results of video-assisted thoracoscopic surgery (VATS) therapeutic resection for pulmonary TB with medical failure, and its correlation with image characteristics on chest computed tomography (CT) scan. Between January 2007 and December 2012, among the 203 patients who had surgery for TB, the medical records of 89 patients undergoing therapeutic resection for medically failed pulmonary TB were reviewed. Clinical information and the image characteristics of CT scan were investigated and analyzed. Forty-six of the 89 patients undergoing successful VATS therapeutic resection had significantly lower grading in pleural thickening (P the 38 patients with multi-drug resistant pulmonary tuberculosis (MDRTB) who successfully underwent VATS had significantly lower grading in pleural thickening (P = 0.001), peribronchial lymph node calcification (P = 0.019), and cavity (P = 0.017). They were preoperatively medicated for a shorter period of time (221.6 ± 90.8 vs 596.1 ± 432.5 days; P = 0.001), and had more sublobar resection (44.4% vs 10%), less blood loss (165.3 ± 148.3 vs 468.0 ± 439.9 mL; P = 0.009), and shorter hospital stay (5.4 ± 2.6 vs 11.8 ± 6.9 days; P = 0.001). Without multiple cavities, peribronchial lymph node calcification, and extensive pleural thickening, VATS therapeutic resection could be safely performed in selected patients with medically failed pulmonary TB as an effective adjunct with satisfactory results. PMID:27149451

  20. A Review of Esophageal Chest Pain.

    Science.gov (United States)

    Coss-Adame, Enrique; Rao, Satish S C

    2015-11-01

    Noncardiac chest pain is a term that encompasses all causes of chest pain after a cardiac source has been excluded. This article focuses on esophageal sources for chest pain. Esophageal chest pain (ECP) is common, affects quality of life, and carries a substantial health care burden. The lack of a systematic approach toward the diagnosis and treatment of ECP has led to significant disability and increased health care costs for this condition. Identifying the underlying cause(s) or mechanism(s) for chest pain is key for its successful management. Common etiologies include gastroesophageal reflux disease, esophageal hypersensitivity, dysmotility, and psychological conditions, including panic disorder and anxiety. However, the pathophysiology of this condition is not yet fully understood. Randomized controlled trials have shown that proton pump inhibitor therapy (either omeprazole, lansoprazole, or rabeprazole) can be effective. Evidence for the use of antidepressants and the adenosine receptor antagonist theophylline is fair. Psychological treatments, notably cognitive behavioral therapy, may be useful in select patients. Surgery is not recommended. There remains a large unmet need for identifying the phenotype and prevalence of pathophysiologic mechanisms of ECP as well as for well-designed multicenter clinical trials of current and novel therapies. PMID:27134590

  1. Drop attack during chest radiography: Case report

    International Nuclear Information System (INIS)

    Chest radiography is the first line of thoracic imaging performed in patients with thoracic diseases. It is probably the most frequently performed type of X-ray examination. It is recommended to be performed in the full upright position except where the patient's condition will not permit. This is because the erect technique allows full expansion of the lungs, prevents engorgement of pulmonary vessels and also helps in fluid level evaluation. However, little is reported on the negative effects associated with erect radiography. Herein, we present a case of drop attack during erect chest radiography. - Highlights: • Radiographers should be aware of the possibilities of drop attach during erect chest radiography. • A patient's determination to stand for chest radiograph may not always relate with the ability. • The causes of some drop attacks may be unknown. • Watching patients during radiographic exposure is essential. • Being alert and working very fast during erect chest examinations is important

  2. Chest trauma in children: A local experience

    International Nuclear Information System (INIS)

    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)

  3. Classification and management of chest trauma

    International Nuclear Information System (INIS)

    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)

  4. Perioperative nursing for laparoscopic liver resection

    Institute of Scientific and Technical Information of China (English)

    CHEN Li-jia; WEN Guo-fen

    2005-01-01

    Sir Run Run Shaw Hospital (SRRSH) has developed a form of laparoscopic hepatectomy, resecting by curettage and suction. Such resection has been carried out successfully in 6 patients who had liver tumors. The results are satisfactory. And after the operation, there is a very effective perioperative nursing ensuring the patient's recovery.

  5. Liver resection in liver transplant recipients

    Institute of Scientific and Technical Information of China (English)

    Gabriele Marangoni; Walid Faraj; Harsheet Sethi; Mohamed Rela; Paolo Muiesan; Nigel Heaton

    2008-01-01

    BACKGROUND: Liver resection after liver transplantation is a relatively uncommon procedure. Indications for liver resection include hepatic artery thrombosis (HAT), non-anastomotic biliary stricture (ischemic biliary lesions), liver abscess, liver trauma and recurrence of hepatocellular carcinoma (HCC). Organ shortage and lower survival after re-transplantation have encouraged us to make attempts at graft salvage. METHODS: Eleven resections at a mean of 59 months after liver transplantation were made over 18 years. Indications for liver resection included HCC recurrence in 4 patients, ischemic cholangiopathy, segmental HAT, sepsis and infected hematoma in 2 each, and ischemic segmentⅣafter split liver transplantation in 1. RESULTS: There was no perioperative mortality. Morbidity included one re-laparotomy for small bowel perforation, one bile leak treated conservatively, one right subphrenic collection, one wound infection and 5 episodes of Gram-negative sepsis. One patient underwent re-transplantation 4 months after resection for chronic rejection. There were 3 deaths, two from HCC recurrence and one from post-transplant lymphoproliferative disorder. The overall mean follow-up after resection was 48 months. CONCLUSIONS: Liver resection in liver transplant recipients is safe, and has good outcome in selected patients and avoids re-transplantation in the majority of patients. Recipients with recurrent HCC in graft may beneift from resection, but cure is uncommon.

  6. Studies on regional ventilation observed from a lateral side of the chest

    International Nuclear Information System (INIS)

    Three normal subjects ranging in age from 27 to 35 and three patients with unilateral pulmonary resection were studied. The subjects were seated. A scinticamera was placed for dorsal or lateral side of the chest. The subject was instructed to inhale 5 mCi of xenon-133 from functional residual capacity. During rebreathing in the spirometer circuit, carbon dioxide was removed by a soda-lime absorber and oxygen was added at a rate sufficient to maintain a constant volume. External counts were measured for determinating a half-time (Tsub(1/2)) of washout during normal breathing at rest after equilibrium was reached. The influence of xenon-133 entered in the chest on external counts was corrected. It was found that about 10 % of radioactive counts of xenon-133 in the right lung were detected from lateral view of the left side of the chest in the patients. The value of a half-time in the dorsal lower portion of the lung was the smallest, that is, the portion was somewhat better ventilated than the others. Horizontal uneveness as well as vertical uneveness of ventilation were observed. Horizontal uneveness was influenced by the movement of diaphragma and by a belly-band. (author)

  7. Neoadjuvant chemoradiation with IMRT in resectable and borderline resectable pancreatic cancer

    International Nuclear Information System (INIS)

    Purpose: Neoadjuvant chemoradiation is an alternative to the surgery-first approach for resectable pancreatic cancer (PDA) and represents the standard of care for borderline resectable (BLR). Materials and methods: All patients with resectable and BLR PDA treated with neoadjuvant chemoradiation using IMRT between 1/2009 and 11/2011 were reviewed. Patients were treated to a customized CTV which included the primary mass and regional vessels. Results: Neoadjuvant chemoradiation was completed in 69 patients (39 BLR and 30 resectable). Induction chemotherapy was used in 32 (82%) of the 39 patients with BLR disease prior to chemoXRT. All resectable patients were treated with chemoXRT alone. Following neoadjuvant treatment, 48 (70%) of the 69 patients underwent successful pancreatic resection with 47 (98%) being margin negative (RO). In 30 of the BLR patients who had arterial abutment or SMV occlusion, 19 (63%) were surgically resected and all had RO resections. The cumulative incidence of local failure at 1 and 2 years was 2% (95% CI 0–6%) and 9% (95% CI 0.6–17%) respectively. The median overall survival for all patients, patients undergoing resection, and patients without resection were 20, 26 and 11 months respectively. Sixteen (23%) of the 69 patients are alive without disease with a median follow-up of 47 months (36–60). Conclusion: Neoadjuvant chemoXRT can facilitate a margin negative resection in patients with localized PCa

  8. Results of Thoracotomy in Penetrating Chest Trauma

    Directory of Open Access Journals (Sweden)

    Mahmood Aghaei-Afshar

    2012-04-01

    Full Text Available Background: Thoracotomy is a surgical procedure to access the chest components, which is often performed after severe bleeding caused by heart damage, lung laceration and other similar injuries.Materials and Methods: This is a cross-sectional study which was conducted on all patients with penetrating chest trauma during April 2000 to October 2008.Results: In 5% of cases, thoracotomy was used for treatment in which severe bleeding was the main surgical indication. It was the most common finding followed by lung laceration thoracotomy.Conclusion: Most urban injuries are treatable by chest tube. About 3 to 10 percent of cases may require a thoracotomy in which severe bleeding is the most common indication of surgery.

  9. Cardiogenic shock following blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Rodríguez-González Fayna

    2010-01-01

    Full Text Available Cardiac contusion, usually caused by blunt chest trauma, has been recognized with increased frequency over the past decades. Traffic accidents are the most frequent cause of cardiac contusions resulting from a direct blow to the chest. Other causes of blunt cardiac injury are numerous and include violent fall impacts, interpersonal aggression, explosions, and various types of high-risk sports. Myocardial contusion is difficult to diagnose; clinical presentation varies greatly, ranging from lack of symptoms to cardiogenic shock and arrhythmia. Although death is rare, cardiac contusion can be fatal. We present a case of cardiac contusion due to blunt chest trauma secondary to a fall impact, which manifested as cardiogenic shock.

  10. Surgical resection for pulmonary metastases of sweat gland carcinoma.

    OpenAIRE

    Osaki, T; Kodate, M.; Nakanishi, R.; Mitsudomi, T.; Shirakusa, T.

    1994-01-01

    A case of axillary sweat gland carcinoma which metastasised to both lungs six years after resection of the primary lesion is described. The lesions were resected and three years later two further pulmonary metastases were resected.

  11. Clinicodemographic aspect of resectable pancreatic cancer and prognostic factors for resectable cancer

    Directory of Open Access Journals (Sweden)

    Chiang Kun-Chun

    2012-05-01

    Full Text Available Abstract Background Pancreatic adenocarcinoma (PCA is one of the most lethal human malignancies, and radical surgery remains the cornerstone of treatment. After resection, the overall 5-year survival rate is only 10% to 29%. At the time of presentation, however, about 40% of patients generally have distant metastases and another 40% are usually diagnosed with locally advanced cancers. The remaining 20% of patients are indicated for surgery on the basis of the results of preoperative imaging studies; however, about half of these patients are found to be unsuitable for resection during surgical exploration. In the current study, we aimed to determine the clinicopathological characteristics that predict the resectability of PCA and to conduct a prognostic analysis of PCA after resection to identify favorable survival factors. Methods We retrospectively reviewed the medical files of 688 patients (422 men and 266 women who had undergone surgery for histopathologically proven PCA in the Department of Surgery at Chang Gung Memorial Hospital in Taiwan from 1981 to 2006. We compared the clinical characteristics of patients who underwent resection and patients who did not undergo resection in order to identify the predictive factors for successful resectability of PCA, and we conducted prognostic analysis for PCA after resection. Results A carbohydrate antigen 19–9 (CA 19–9 level of 37 U/ml or greater and a tumor size of 3 cm or more independently predicted resectability of PCA. In terms of survival after resection, PCA patients with better nutritional status (measured as having an albumin level greater than 3.5 g/dl, radical resection, early tumor stage and better-differentiated tumors were associated with favorable survival. Conclusions Besides traditional imaging studies, preoperative CA 19–9 levels and tumor size can also be used to determine the resectability of PCA. Better nutritional status, curative resection, early tumor stage and well

  12. Chest pain related to crack cocaine smoking

    International Nuclear Information System (INIS)

    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

  13. Misdiagnosed Chest Pain: Spontaneous Esophageal Rupture

    Science.gov (United States)

    Inci, Sinan; Gundogdu, Fuat; Gungor, Hasan; Arslan, Sakir; Turkyilmaz, Atila; Eroglu, Atila

    2013-01-01

    Chest pain is one of themost common complaints expressed by patients presenting to the emergency department, and any initial evaluation should always consider life-threatening causes. Esophageal rupture is a serious condition with a highmortality rate. If diagnosed, successful therapy depends on the size of the rupture and the time elapsed between rupture and diagnosis.We report on a 41-year-old woman who presented to the emergency department complaining of left-sided chest pain for two hours. PMID:27122690

  14. Outcomes following resection of intrahepatic cholangiocarcinoma

    Science.gov (United States)

    Tabrizian, Parissa; Jibara, Ghalib; Hechtman, Jaclyn F; Franssen, Bernardo; Labow, Daniel M; Schwartz, Myron E; Thung, Swan N; Sarpel, Umut

    2015-01-01

    Objectives The aim of this analysis was to examine prognostic features and outcomes in patients undergoing resection for intrahepatic cholangiocarcinoma (ICC). Methods A retrospective chart review was performed in all patients who underwent R0 or R1 resection for primary ICC between 1995 and 2011. Clinical data were abstracted and statistical analyses were conducted in the standard fashion. Results A total of 82 patients underwent curative hepatectomy for primary ICC; 51 patients in this cohort developed recurrence. The median follow-up of survivors was 27 months (range: 1–116 months). Recurrences were intrahepatic (65%), associated with multiple tumours (54%) and occurred during the first 2 years after hepatectomy (86%). The main factor associated with recurrence after resection was the presence of satellite lesions. Overall 5-year disease-free survival after primary resection was 16%. Factors associated with poor survival were transfusion and perineural invasion. Treatment of recurrence was undertaken in 89% of patients and repeat surgical resection was performed in 15 patients. The 3-year survival rate after recurrence was 25%. Prolonged survival after recurrence was associated with a solitary tumour recurrence. Conclusions Despite curative resection of ICC, recurrence can be expected to occur in 79% of patients at 5 years. Predictors of survival and recurrence after resection vary in the literature. In patients with recurrence, selection of the optimal treatment remains challenging. PMID:25395176

  15. Presacral schwannoma: laparoscopic resection, a viable option

    Science.gov (United States)

    Jatal, Sudhir; Pai, Vishwas D.; Rakhi, Bharat

    2016-01-01

    Schwannomas are benign nerve sheath tumours arising from Schwann cells. Presacral schwannomas are rare with only case report and short case series being reported in literature. Complete surgical resection is the treatment of choice for these rare tumours. Approach to surgical resection depends on the type of the tumour. Type 3 tumours have conventionally been treated with open intra or extra peritoneal approach. With improvement in the laparoscopic surgical skills, more and more complex surgical procedures have been attempted via this approach. We are presenting a case of presacral schwannoma in an overweight lady treated by laparoscopic resection. PMID:27275489

  16. Optimal beam quality for chest digital radiography

    International Nuclear Information System (INIS)

    To investigate the optimal beam quality for chest computed radiography (CR), we measured the radiographic contrast and evaluated the image quality of chest CR using various X-ray tube voltages. The constant between lung and rib or heart increased on CR image obtained by lowering the tube voltage from 140 to 60 kV, but the degree of increase was less. Scattered radiation was reduced on CR images with a lower tube voltage. The Wiener spectrum of CR images with a low tube voltage showed a low value under identical conditions of amount of light stimulated emission. The quality of chest CR image obtained using a lower tube voltage (80 kV and 100 kV) was evaluated as being superior to those obtained with a higher tube voltage (120 kV and 140 kV). Considering the problem of tube loading and exposure in clinical applications, a tube voltage of 90 to 100 kV (0.1 mm copper filter backed by 0.5 mm aluminum) is recommended for chest CR. (author)

  17. Radiography of the chest and upper airway

    International Nuclear Information System (INIS)

    The techniques of radiography of the chest in all pediatric-age groups differ only slightly from those used in adult radiography. The technologist's principal challenge, however, relates to optimum handling of the patient with respect to positioning and radiation protection. The hints provided in this chapter should permit the conscientious radiographer to obtain high quality radiographs on all pediatric patients

  18. The HEART score for chest pain patients

    NARCIS (Netherlands)

    Backus, B.E.

    2012-01-01

    The HEART score was developed to improve risk stratification in chest pain patients in the emergency department (ED). This thesis describes series of validation studies of the HEART score and sub studies for individual elements of the score. The predictive value of the HEART score for the occurrence

  19. Coccidioidomycosis - chest x-ray (image)

    Science.gov (United States)

    This chest x-ray shows the affects of a fungal infection, coccidioidomycosis. In the middle of the left lung (seen on the ... defined borders. Other diseases that may explain these x-ray findings include lung abscesses, chronic pulmonary tuberculosis, chronic ...

  20. Cardiac injuries in blunt chest trauma

    OpenAIRE

    Tobon-Gomez Catalina; Huguet Marina; Bijnens Bart H; Frangi Alejandro F; Petit Marius

    2009-01-01

    Abstract Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use of Cardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a 12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualization of myocardial damage resulting from the trauma.

  1. Adenocarcinoma - chest x-ray (image)

    Science.gov (United States)

    This chest x-ray shows adenocarcinoma of the lung. There is a rounded light spot in the right upper lung (left side ... density. Diseases that may cause this type of x-ray result would be tuberculous or fungal granuloma, and ...

  2. Chest trauma in childhood. Radiological findings

    International Nuclear Information System (INIS)

    Blunt thoracic trauma is frequently associated with further injuries (head and/or blunt abdominal trauma). The prognosis also depends on the concurrent injuries. The initial evaluation of an injured child is based on the chest X-ray and abdominal ultrasound examination. Additional information can be obtained by a CT scan in mediastinal injuries. (orig./MG)

  3. Treatment of 336 cases of chest trauma

    Directory of Open Access Journals (Sweden)

    ZHANG Jing

    2012-06-01

    Full Text Available 【Abstract】Objective: To summarize the clinical features, diagnosis and treatment of chest trauma. Methods: A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011. Results: Out of all cases, 325 were cured, accounting for 96.7%; 11 died, accounting for 3.3%. Among the dead cases, one died of hemorrhagic shock, three of acute respi-ratory distress syndrome, three of multiple organ failure, and four of severe multiple traumas. Conclusions: (1 For patients with severe chest trauma, early emergency treatment is crucial to save life. (2 Open thoracic surgery is needed for acute cardiac tamponade, intrapulmonary vascular injuries, progressive intrathoracic bleeding, lung laceration, tracheal breakage, and diaphrag-matic injury. In addition, operative timing and method should be well chosen. (3 Pulmonary contusion is one of common complications in chest trauma, for which the com-bination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy. Key words: Thoracic injuries; Thoracotomy; Emer-gency treatment

  4. An experience of corrective surgery of 37 cases of chest deformity

    International Nuclear Information System (INIS)

    The study was carried out to ascertain the cosmetic outcome of corrective surgery for pectus deformity and to determine the morbidity associated with it. Study Design: Quasi-experimental study. Place and Duration of Study: The study was conducted in CMH Rawalpindi and CMH Quetta from 2007 to 2012. Methodology: Total number of cases operated for chest deformity was 37. Modified Welch procedure with sub perichondrial resection was done with a strut of prolene mesh in a majority of excavatum repairs and k wires in few. Pectoroplasty was subsequently carried out in all patients. Midline incision was made in a majority of patients. Submammary incision was made in some female patients with a lower deformity due to better cosmetic outcome. Inclusion criterion was patients with chest deformity without any cardiac and spinal deformity. Results: Age range was between 4 years to 12 years with mean age of 8 +- 2.3 years. Twenty four (65%) deformities were of excavatum and 9 (24%) were of carinatum type. Four (11%) cases were of unilateral asymmetrical deformity. Mean operating time was 95 +- 11 minutes. Transfusion was required in only 1 (3%) of the cases. There was no perioperative mortality. Four (11%) patients had formation of seroma and 3 (8%) developed pneumothorax which was aspirated without placement of chest tube. Two (5%) had surgical site infection. Fifteen (41%) patients were satisfied and 21 (57%) reported excellent results. Conclusion: Chest deformity correction is safe and effective procedure with acceptable cosmetic results. It is easy to perform and improves self image of the suffering individual. (author)

  5. Ambiguous walls

    DEFF Research Database (Denmark)

    Mody, Astrid

    2012-01-01

    The introduction of Light Emitting Diodes (LEDs) in the built environment has encouraged myriad applications, often embedded in surfaces as an integrated part of the architecture. Thus the wall as responsive luminous skin is becoming, if not common, at least familiar. Taking into account how wall...

  6. Get Smart: Know When Antibiotics Work - Bronchitis (Chest Cold)

    Science.gov (United States)

    ... Farm Get Smart About Antibiotics Week Bronchitis (Chest Cold) Language: English Español (Spanish) Recommend on Facebook Tweet ... types—acute bronchitis. Causes Acute bronchitis, or chest cold, often occurs after an upper respiratory infection like ...

  7. The vascular pedicle width seen on chest PA in normal Korean adults

    Energy Technology Data Exchange (ETDEWEB)

    Sunwoo, Hee Jung; Ahn, Myeong Im; Baik, Jun Hyun; Jung, Youn Ju; Kim, Jee Young [St. Vincent' s Hospital, The Catholic University of Korea, Suwon (Korea, Republic of); Park, Seog Hee [Kangnam St. Mary' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of)

    2006-06-15

    We wanted to measure the vascular pedicle width (VPW) in normal Korean adults and correlate the VPW with the body physique and we also wanted to establish the index for normal VPWs, which could be utilized in reading chest PAs. We VPW was measured on the posteroanterior (PA) chest radiographs of 262 normal Korean adults (134 men and 128 women, age range: 22-88 years, mean age: 45.2 years), who visited the hospital for a general health examination. The relationship between the VPW and the height and the Body Mass Index (BMI) was evaluated. Correlations between height and the thoracic spine length (TSL) and between the BMI and the lateral chest wall thickness (CWT) were analyzed as well. The mean VPW was 47.4 ({+-} 6.4) mm. The VPW was positively correlated with the height ({rho} < 0.01) and the BMI ({rho} < 0.01) of the subject. The patient's height was well correlated with the TSL, and the BMI was correlated with the CWT (r = 0.75, r = 0.76). The table for the normal VPWs according to patient's TSL and CWT was established. By measuring the TSL and the CWT on chest PA, which reflect the height and BMI, respectively, and by utilizing the provided table for the normal VPW, we can determine the normality of a patient's VPW.

  8. Ultrasonido de tórax en ninos Ultrasound of the pediatric's chest

    Directory of Open Access Journals (Sweden)

    Isabel Fuentealba T

    2012-09-01

    Full Text Available El Ultrasonido es un examen complementario en el estudio por imágenes del tórax. En los últimos tiempos se ha ampliado su utilización especialmente en el estudio del tórax pediátrico ya que es una alternativa de imagen que no usa radiación y por otra parte, es considerado por algunos autores como el examen de primera línea en la evaluación de algunas patologías específicas como: aumento de volumen superficial de la pared torácica, movimiento diafragmático, timo y derrame pleural. El objetivo de este artículo es revisar las principales indicaciones en el estudio del tórax pediátrico por ultrasonido en patología no cardiológica.Ultrasound is an alternative technique for the examination of the chest. Recently chest ultrasound has expanded its use mainly on the study of pediatric patients, since it does not use radiation and it is considered by some authors as the first line test in the evaluation of some specific conditions like: superficial lumps and bumps of the chest wall, diaphragm motility, thymus characterization and pleural effusions. The purpose of this paper is to review the main indications for pediatric chest ultrasound in non-cardiac diseases.

  9. Chest CT abnormalities and quality of life: relationship in adult cystic fibrosis

    Science.gov (United States)

    Kilcoyne, Aoife; Lavelle, Lisa P.; McCarthy, Colin J.; McEvoy, Sinead H.; Fleming, Hannah; Gallagher, Annika; Loeve, Martine; Tiddens, Harm; McKone, Edward; Gallagher, Charles C.

    2016-01-01

    Background To evaluate the relationship between lung parenchymal abnormalities on chest CT and health-related quality of life in adult cystic fibrosis (CF). Methods The chest CT scans of 101 consecutive CF adults (mean age 27.8±7.9, 64 males) were prospectively scored by two blinded radiologists in consensus using a modified Bhalla score. Health-related quality of life was assessed using the revised Quittner Cystic Fibrosis Questionnaire (CFQ-R). Multiple regressions were performed with each of the CFQ-R domains and all clinical and imaging findings to assess independent correlations. Results There were 18 inpatients and 83 outpatients. For the cohort of inpatients, CT abnormalities were significantly (P<0.005 for all) associated with Respiratory Symptoms (Air Trapping), and also with Social Functioning (Consolidation) and Role Functioning (Consolidation). For outpatients, CT abnormalities were significantly (P<0.005 for all) associated with Respiratory Symptoms (Consolidation) and also with Physical Functioning (Consolidation), Vitality (Consolidation, Severity of Bronchiectasis), Eating Problems (airway wall thickening), Treatment Burden (Total CT Score), Body Image (Severity of Bronchiectasis) and Role Functioning (Tree-in-bud nodules). Consolidation was the commonest independent CT predictor for both inpatients (predictor for 2 domains) and outpatients (predictor in 3 domains). Several chest CT abnormalities excluded traditional measures such as FEV1 and BMI from the majority of CFQ-R domains. Conclusions Chest CT abnormalities are significantly associated with quality of life measures in adult CF, independent of clinical or spirometric measurements. PMID:27047946

  10. Hepatic metastasis from adrenocortical carcinoma fifteen years after primary resection

    Directory of Open Access Journals (Sweden)

    Mohammed Mawardi

    2012-01-01

    Full Text Available We report the case of a 73-year-old man who presented with an asymptomatic hepatic mass during investigation of mild chronic obstructive pulmonary disease by a plain chest radiograph, followed by ultrasonography, which revealed a solitary hepatic lesion measuring 7.1 cm × 6.5 cm × 5.8 cm in dimension. Fine- needle aspiration of the mass revealed malignant cells compatible with hepatocellular carcinoma. Interestingly, the patient had a left adrenalectomy and complete left nephrectomy in 1987, for a non-functioning left adrenocortical carcinoma (ACC. The ACC was diagnosed as stage two, with no evidence of local invasion or distant metastases. No adjuvant therapy was recommended postoperatively. After a five-year follow-up, there was no evidence of ACC recurrence and the patient was declared cured from his ACC. The patient underwent a complete segmental resection of the right lobe of the liver successfully. The final diagnosis of the mass was a well-differentiated metastatic adrenocortical carcinoma.

  11. Tracheal schwannoma: management by endoscopic laser resection.

    OpenAIRE

    Rusch, V. W.; Schmidt, R. A.

    1994-01-01

    The case history is presented of a patient with a tracheal schwannoma who remains free of disease five and a half years after laser resection. This illustrates the potential of this approach in the management of tracheal schwannoma.

  12. Optimizing Adjuvant Therapy for Resected Pancreatic Cancer

    Science.gov (United States)

    In this clinical trial, patients with resected pancreatic head cancer will be randomly assigned to receive either gemcitabine with or without erlotinib for 5 treatment cycles. Patients who do not experience disease progression or recurrence will then be r

  13. Normal Echosemiotics of Resected Parenchymatous Organs

    Directory of Open Access Journals (Sweden)

    Rykhtik P.I.

    2013-03-01

    Full Text Available The aim of the investigation was to develop ultrasonic techniques of the resected liver, pancreas, and kidney, and study their normal echosemiotics after different types of resection. Materials and Methods. We examined 404 patients after various hepatectomies, 145 — after extended pancreaticoduodenal resections, and 123 — after different types of nephrectomy. Ultrasound was performed on scanners Voluson 730 PRO (GE, USA and Technos (Esaote, Italy in early postoperative period — on day 2–3 and on day 7–10, and in follow-up care — 3, 6 and 12 months after the operation. Results. We developed an ultrasound technique and established sonographic criteria to assess resected parenchymatous organs, represented normal ultrasound semiotics of the liver, pancreas and kidney after different types of resection. The number and location of hepatic veins in hepatic stump was found to be of primary importance in determining the hepatectomy type; and it was called the hepatic vein rule. An additional criterion was the portal vein branching character. The assessment criteria of pancreatic stump were its size in the body of pancreas and diameter of the major pancreatic duct, as well as spatial location of anastomosed loop of jejunum and gastric remnant. During the first postoperative month slight dilatation of Wirsung duct up to 3–4 mm with its following recovery is permissible. In late postoperative period, the duct dilatation over 3 mm is considered pathological. To determine the nephrectomy type it is necessary to assess the form of the organ and the resection area. Normal echogram can be misinterpreted after frontal nephrectomy due to different parenchymal thickness in its resected and remaining parts. Conclusion. The developed echosemiotics of resected parenchymatous organ in the majority of cases enables to take a correct view of the volume and character of the surgery, and determine postoperative state of the stump.

  14. Localized gastric amyloidosis differentiated histologically from scirrhous gastric cancer using endoscopic mucosal resection: a case report

    Directory of Open Access Journals (Sweden)

    Kamata Tsugumasa

    2012-08-01

    Full Text Available Abstract Introduction Amyloidosis most often manifests as a systemic involvement of multiple tissues and organs, and an amyloidal deposit confined to the stomach is extremely rare. It is sometimes difficult to provide a definitive diagnosis of localized gastric amyloidosis by biopsy specimen and diagnosis of amyloidosis in some cases has been finalized only after surgical resection of the stomach. Case presentation A 76-year-old Japanese woman with epigastric discomfort underwent an esophagogastroduodenoscopy procedure. The esophagogastroduodenoscopy revealed gastric wall thickening, suggesting scirrhous gastric carcinoma, at the greater curvature from the upper to the lower part of the gastric corpus. A biopsy specimen revealed amyloid deposits in the submucosal layer with no malignant findings. We resected a representative portion of the lesion by endoscopic mucosal resection using the strip biopsy method to obtain sufficient tissue specimens, and then conducted a detailed histological evaluation of the samples. The resected specimens revealed deposition of amyloidal materials in the gastric mucosa and submucosa without any malignant findings. Congo red staining results were positive for amyloidal protein and exhibited green birefringence under polarized light. Congo red staining with prior potassium permanganate incubation confirmed the light chain (AL amyloid protein type. Based on these results, gastric malignancy, systemic amyloidosis and amyloid deposits induced by inflammatory disease were excluded and this lesion was consequently diagnosed as localized gastric amyloidosis. Our patient was an older woman and there were no findings relative to an increase in gastrointestinal symptoms or anemia, so no further treatment was performed. She continued to be in good condition without any finding of disease progression six years after verification of our diagnosis. Conclusions We report an unusual case of primary amyloidosis of the stomach

  15. Investigation of the Chest-Ear Radio Propagation Channel

    DEFF Research Database (Denmark)

    Kvist, Søren Helstrup; Jakobsen, Kaj Bjarne

    2010-01-01

    The path gain (|S21|) between antennas on the chest and at the ear is presented as a function of the position of the antenna on the chest. A monopole antenna and a printed Inverted-F Antenna (IFA) are considered for placement on the chest. The path gain is found by HFSS simulations as well as...

  16. Thymic tuberculosis preoperatively evaluated with thallium-201 SPECT: two resected cases.

    Science.gov (United States)

    Iwata, Takashi; Inoue, Kiyotoshi; Mizuguchi, Shinjiro; Tsukioka, Takuma; Morita, Ryuhei; Suehiro, Shigefumi

    2007-02-01

    We present 2 resected cases of thymic tuberculosis, which had been preoperatively diagnosed as invasive thymoma, using a thallium-201 ((201)Tl) single photon emission computed tomography ((201)Tl SPECT). [Patient 1] A 74-old-male with a 32-year history of steroid therapy for rheumatic arthritis was diagnosed with an anterior mediastinal tumor by routine chest CT scans after onset of myocardial infarction. [Patient 2] A 56-old-female with a 28-year history of diabetes mellitus presented with a dry cough. A chest CT demonstrated an anterior mediastinal tumor. Neither patient showed pulmonary infiltrations on chest x-ray. (201)Tl SPECT was undertaken for each patient. Abnormal findings could not be detected on a planar image of the scintigraphy; however, on SPECT images accumulations of (201)Tl were clearly detected in the anterior mediastinal mass and a thymoma was thus suspected in each case. Total thymectomy was carried out in each case and the mass then diagnosed as caseous granuloma in the thymus. Both patients are well without recurrence after operation. In patients with a (201)Tl SPECT positive anterior mediastinal tumor associated with an immunologically deficient status, and with negative findings in planar images on thallium scintigraphy, the possibility of thymic tuberculosis should be considered. PMID:17392671

  17. Liver resection for intermediate hepatocellular carcinoma.

    Science.gov (United States)

    Yi, Peng-Sheng; Zhang, Ming; Zhao, Ji-Tong; Xu, Ming-Qing

    2016-05-18

    Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in China. The Barcelona Clinic Liver Cancer (BCLC) staging system is regarded as the gold standard staging system for HCC, classifying HCC as early, intermediate, or advanced. For intermediate HCC, trans-catheter arterial chemoembolization (TACE) is recommended as the optimal strategy by the BCLC guideline. This review investigates whether liver resection is better than TACE for intermediate HCC. Based on published studies, we compare the survival benefits and complications of liver resection and TACE for intermediate HCC. We also compare the survival benefits of liver resection in early and intermediate HCC. We find that liver resection can achieve better or at least comparable survival outcomes compared with TACE for intermediate HCC; however, we do not observe a significant difference between liver resection and TACE in terms of safety and morbidity. We conclude that liver resection may improve the short- and long-term survival of carefully selected intermediate HCC patients, and the procedure may be safely performed in the management of intermediate HCC. PMID:27190577

  18. Management of borderline resectable pancreatic cancer

    Institute of Scientific and Technical Information of China (English)

    Amit; Mahipal; Jessica; Frakes; Sarah; Hoffe; Richard; Kim

    2015-01-01

    Pancreatic cancer is the fourth most common cause of cancer death in the United States. Surgery remains the only curative option; however only 20% of the patients have resectable disease at the time of initialpresentation. The definition of borderline resectable pancreatic cancer is not uniform but generally denotes to regional vessel involvement that makes it unlikely to have negative surgical margins. The accurate staging of pancreatic cancer requires triple phase computed tomography or magnetic resonance imaging of the pancreas. Management of patients with borderline resectable pancreatic cancer remains unclear. The data for treatment of these patients is primarily derived from retrospective single institution experience. The prospective trials have been plagued by small numbers and poor accrual. Neoadjuvant therapy is recommended and typically consists of chemotherapy and radiation therapy. The chemotherapeutic regimens continue to evolve along with type and dose of radiation therapy. Gemcitabine or 5-fluorouracil based chemotherapeutic combinations are administered. The type and dose of radiation vary among different institutions. With neoadjuvant treatment, approximately 50% of the patients are able to undergo surgical resections with negative margins obtained in greater than 80% of the patients. Newer trials are attempting to standardize the definition of borderline resectable pancreatic cancer and treatment regimens. In this review, we outline the definition, imaging requirements and management of patients with borderline resectable pancreatic cancer.

  19. Assessing non-resectability of lung cancer

    International Nuclear Information System (INIS)

    To investigate whether the assessment of resectability of lung cancer can be reliably made on the basis of computed tomography (CT), the thoracic CT scans of 96 lung cancer patients who were operated on, and in whom the tumour was classified to be of stage III at preoperative CT or at thoracotomy, were analysed. Of the patients, 58 underwent complete resection of the tumour, whereas thoracotomy resulted in non-complete resection or exploration only in 38 cases. Overlapping of the CT findings in the groups of complete and non-successful resection was observed. The majority of tumours with apparent growth to the carina, trachea, oesophagus or great vessels at CT were completely resected. Tumours that only bordered on the pleura could not be distinguished from those with pleural invasion. Mediastinal lymph node enlargement did not always mean metastatic spread. We conclude that there is no definite sign that identifies non-resectability of lung tumours, and a certain proportion of non-curative thoracotomies must be accepted. (orig.)

  20. Chest Traumas due to Bicycle accident in Childhood

    Directory of Open Access Journals (Sweden)

    Ufuk Cobanoglu

    2011-09-01

    Full Text Available Aim:Childhood injuries are the leading cause of death in children and result in significant healthcare utilization. Trauma is the second most common cause of mortality in children aged 1-4 years and leading cause of death in children older than 4 years. Thoracic injury is the second most leading cause of death in traumatized children. Multisystemic injury is found in more than 50% of children with thoracic injuries most of which are secondary to blunt traumas. We planned this study to evaluate thorax trauma cases secondary to bicycle driving in childhood and to draw attention to the importance of the regulation of traffic rules, the education of bicycle drivers.Material and Methods:  A retrospective evaluation was performed in 17 pediatric patients admitted to the Department of Thoracic Surgery during 2006-2010 with a diagnosis of chest trauma due to bicycle driving. For every patient, a pediatric trauma score (PTS was calculated. Descriptive statistics were performed for PTS. Results; Eleven (64.70% cases were injured due to the tricycle accidents and six cases 6 (35.29% were injured due to the two-wheeled bicycle accidents. The most frequent thoracic pathologies included pulmonary contusion (41.2% and chest wall contusion (29.41%. Extrathoracic injuries were seen in 35.29%, the extremities (17.64% and abdomino pelvic (11.76% being the most commonly involved. Treatment consisted of symptomatic treatment in 12 patients (70.58%, tube thoracostomy in 2 patients (11.76%, and thoracotomy in 1 patient (5.9%. The morbidity was seen in 3 patients (17.64%. The mortality rate was 5.9% (n:1. The mean PTS of the cases who had additional system injuries were significantly worse than the cases who had isolated chest traumas Conclusions: The pediatric thorax has a greater cartilage content and incomplete ossification of the ribs. Due to the pliability of the pediatric rib cage and mediastinal mobility, significant intrathoracic injury may exist in the

  1. Extracardiac chest sonography in children: Radiographic and clinical implications

    International Nuclear Information System (INIS)

    Thirty-nine infants and children underwent high-resolution chest US for chest masses, opaque hemithorax identified on chest radiographs, and for documentation and localization of pleural fluid. Masses included cystic hygromas, thymic cysts, diaphragmatic eventration, round pneumonia, lung abscesses, and pleural pseudotumors. Complete chest opacification was due to pneumonia, pleural fluid, pulmonary hypoplasia, pleural metastasis, and bronchial foreign bodies. Sonographic examination of pleural disease allowed differentiation of pleural thickening from free fluid and guided aspiration of pockets of loculated fluid. Therapeutic decisions were changed in 29 of 39 patients based on the results of the chest US examinations

  2. Chest radiograph interpretation by medical students

    International Nuclear Information System (INIS)

    AIM: To assess the ability of final year medical students to interpret conventional chest radiographs. MATERIALS AND METHODS: Ten conventional chest radiographs were selected from a teaching hospital radiology department library that were good radiological examples of common conditions. All were conditions that a medical student should be expected to recognize by the end of their training. One normal radiograph was included. The radiographs were shown to 52 final year medical students who were asked to describe their findings. RESULTS: The median score achieved was 12.5 out of 20 (range 6-18). There was no difference between the median scores of male and female students (12.5 and 12.3, respectively, p=0.82) but male students were more likely to be certain of their answers than female students (median certainty scores 23.0 and 14.0, respectively). The overall degree of certainty was low. On no radiograph were more than 25% of students definite about their answer. Students had received little formal radiology teaching (2-42 h, median 21) and few expressed an interest in radiology as a career. Only two (3.8%) students thought they were good at interpreting chest radiographs, 17 (32.7%) thought they were bad or awful. CONCLUSION: Medical students reaching the end of their training do not perform well at interpreting simple chest radiographs. They lack confidence and have received little formal radiological tuition. Perhaps as a result, few are interested in radiology as a career, which is a matter for concern in view of the current shortage of radiologists in the UK

  3. Chest x-ray following heart transplantation

    International Nuclear Information System (INIS)

    In the cardio vascular Surgery Departiment of the University of Padua, where the first heart transplant operation in Italy took place in November, 14, 1985, in a period of six months, nine heart transplants have been performed. The post-operative follow-up of these patients included, among other tests, a chest X-ray, which has given us many morphological and functional data concerning both the circulatory and the pulmonary systems

  4. Injuries of the chestFNx01

    Directory of Open Access Journals (Sweden)

    Deodhar S

    1979-01-01

    Full Text Available Thirty cases of chest injuries were admitted in the Department of Surgery, K.E.M. Hospital, Bombay. These injuries seem to be fairly common. Detailed examination at the time of admission is necessary to assess the clinical presentation and the presence of major complications. Institution of intra-peritoneal drainage, restoration of negative intra-pleural pressure and active respiratory physiotherapy constitute an important part of the treatment. The literature on this subject is briefly reviewed

  5. Idiopathic Thoracic Epidural Lipomatosis with Chest Pain

    OpenAIRE

    Lee, Sang-Beom; Park, Hyung-Ki; Chang, Jae-Chil; Jin, So-Young

    2011-01-01

    Spinal epidural lipomatosis (SEL) is an overgrowth of the normally encapsulated adipose tissue in the epidural space around the spinal cord in the thoracic and lumbar spine causing compression of the neural components. Idiopathic SEL in non-obese patients is exceptional. Idiopathic SEL can result in thoracic myelopathy and lumbar radiculopathy. A thoracic radiculopathy due to idiopathic SEL has not been reported yet. We report a case of idiopathic SEL with intractable chest pain and paresthes...

  6. Effective dose from chest tomosynthesis in children

    International Nuclear Information System (INIS)

    Tomosynthesis (digital tomography) is a recently introduced low-dose alternative to CT in the evaluation of the lungs in patients with cystic fibrosis and pulmonary nodules. Previous studies have reported an adult effective dose of 0.12-0.13 mSv for chest tomosynthesis. The aim of this study was to determine the paediatric effective dose from the dose-area-product. During a 3-y period, 38 children with cystic fibrosis and 36 paediatric oncology patients were examined with chest tomosynthesis, totally 169 posteroanterior and 17 anteroposterior examinations (40 boys and 34 girls, mean age 13.7 y, range 7-20 y). Using recently reported paediatric chest tomosynthesis conversion factors (0.23-1.09 mSv Gy cm-2) corrected for sex, age and energy, the mean posteroanterior effective dose calculated was 0.17 mSv; using the proposed simplified conversion factors of 0.6 (8-10 y), 0.4 (11-14 y) and 0.3 mSv Gy cm-2 (15-19 y), the mean posteroanterior effective dose calculated was 0.15 mSv. As the difference in the calculated effective dose was minor, it is recommendable to use the simplified conversion factors. Using the conversion factor for adult chest tomosynthesis (0.26 mSv Gy cm-2), the mean effective dose was 0.11 mSv. Anteroposterior exposures had considerably higher effective dose. By using conversion factors adapted for children, the calculated risks from radiologic procedures will be more accurate. (authors)

  7. Revisit image control for pediatric chest radiography

    International Nuclear Information System (INIS)

    The aim of this study was to analyze the fraction defectiveness and efficacy of the patient immobilization device (PID) for pediatric chest radiography. We examined 840 plain chest radiographs in six hospitals, including four children's hospitals and two general hospitals. The mean age of the patients was 1.9 years (range 0-5 years). Two boardqualified pediatric radiologists rated (into three grades, by consensus) the degree of inspiration, rotation, lordosis, scoliosis, and cutoff or coning as well as the quality of the chest radiographs. The incidence of ''poor'' and ''very poor'' quality examinations was 2/140 and 3/140 in each of two children's hospitals using PID. The corresponding figures were 9/139 and 17/140 in the two children's hospitals that did not use PID. The general hospital using PID had 14/140 ''poor'' and ''very poor'' examinations. The general hospital that did not use PID had 28/140 ''poor'' and ''very poor'' examinations. Thus, statistically better quality chest radiography was obtained with the use of PID (P<0.001). Likewise, rotation, lordosis, and scoliosis were less frequently diagnosed as present when PID was used (P<0.001, 0.001, 0.05). Cutoff or coning had no relation to the use of PID (P=0.13). No significant difference was found between the degree of inspiration and the use of PID (P=0.56). Fraction defectiveness in the general hospital that did not use PID was as much as 14 times higher than that of the children's hospitals that used PID. The patient immobilization device is recommended for hospitals with technologists not specifically trained for pediatric examination. (author)

  8. Occult sternal metastasis identified by laminography in patients with chest pain.

    Science.gov (United States)

    LaBan, M M; Newman, J M

    1984-04-01

    Six patients with occult sternal metastasis presenting with chest pain, and four with sternal deformity associated with "arthritis" had undergone routine roentgenographic examinations, reported as "normal." Subsequent laminography of the sternum demonstrated lytic lesions confirmed by needle biopsy. Adenocarcinoma of the lung and breast were identified in two each of four patients; myeloma and kidney neoplasms were the primary source of malignancy in the remaining two patients. In widespread malignancy, metastasis to the skeletal chest wall is a well-recognized occurrence. Infrequently, it can be an isolated manifestation of an occult or recurrent malignancy, initially overlooked when routine roentgenograms are read as normal. Although sternal x-rays remain the most important means of diagnosis, in suspected cases of sternal metastasis laminography alone may initially reveal lytic lesions. PMID:6712441

  9. Surface Chest Motion Decomposition for Cardiovascular Monitoring

    Science.gov (United States)

    Shafiq, Ghufran; Veluvolu, Kalyana C.

    2014-05-01

    Surface chest motion can be easily monitored with a wide variety of sensors such as pressure belts, fiber Bragg gratings and inertial sensors, etc. The current applications of these sensors are mainly restricted to respiratory motion monitoring/analysis due to the technical challenges involved in separation of the cardiac motion from the dominant respiratory motion. The contribution of heart to the surface chest motion is relatively very small as compared to the respiratory motion. Further, the heart motion spectrally overlaps with the respiratory harmonics and their separation becomes even more challenging. In this paper, we approach this source separation problem with independent component analysis (ICA) framework. ICA with reference (ICA-R) yields only desired component with improved separation, but the method is highly sensitive to the reference generation. Several reference generation approaches are developed to solve the problem. Experimental validation of these proposed approaches is performed with chest displacement data and ECG obtained from healthy subjects under normal breathing and post-exercise conditions. The extracted component morphologically matches well with the collected ECG. Results show that the proposed methods perform better than conventional band pass filtering.

  10. Lung involvement quantification in chest radiographs

    International Nuclear Information System (INIS)

    Tuberculosis (TB) caused by Mycobacterium tuberculosis, is an infectious disease which remains a global health problem. The chest radiography is the commonly method employed to assess the TB's evolution. The methods for quantification of abnormalities of chest are usually performed on CT scans (CT). This quantification is important to assess the TB evolution and treatment and comparing different treatments. However, precise quantification is not feasible for the amount of CT scans required. The purpose of this work is to develop a methodology for quantification of lung damage caused by TB through chest radiographs. It was developed an algorithm for computational processing of exams in Matlab, which creates a lungs' 3D representation, with compromised dilated regions inside. The quantification of lung lesions was also made for the same patients through CT scans. The measurements from the two methods were compared and resulting in strong correlation. Applying statistical Bland and Altman, all samples were within the limits of agreement, with a confidence interval of 95%. The results showed an average variation of around 13% between the two quantification methods. The results suggest the effectiveness and applicability of the method developed, providing better risk-benefit to the patient and cost-benefit ratio for the institution. (author)

  11. Development of an irradiation method of intraoperative radiation therapy for curatively resected rectal cancer

    International Nuclear Information System (INIS)

    Intraoperative radiation therapy (IORT) has been performed to prevent local recurrence of rectal cancer only when positive margins are suspected. To further reduce local recurrence, we attempted to develop a new IORT irradiation method in which electron beam irradiation is administered as uniformly as possible to the intrapelvic dissection surfaces. Low anterior resection and abdominoperineal resection were performed in one male and one female cadaver. Electron beam irradiation was administered by four different methods, and absorbed doses were measured at 15 sites within the pelvis. We also attempted to measure absorbed doses at nine sites within the pelvis in 14 patients treated with IORT. The cadaver study revealed low absorbed doses in the lateral walls of the pelvis when a single irradiation was delivered from the anterior. When the lateral walls of the pelvis were irradiated twice, once each time on the right and left, the absorbed doses were low in the central pelvis and presacrum. Relatively high absorbed doses were achieved in all of these areas by a technique that combined these two methods. Adequate absorbed doses were not achieved by a single irradiation administered from the perineum. This study suggests that electron beam irradiation administered three times to the dissected surfaces in the pelvis after resection of rectal cancer (i.e., to the central pelvis and presacrum from the anterior, and to the left and right lateral walls of the pelvis) is the most suitable method for achieving adequate absorbed doses. (author)

  12. Development of an irradiation method of intraoperative radiation therapy for curatively resected rectal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Sadahiro, Sataro; Suzuki, Toshiyuki; Ishikawa, Kenji [Tokai Univ., Isehara, Kanagawa (Japan). School of Medicine] (and others)

    1999-08-01

    Intraoperative radiation therapy (IORT) has been performed to prevent local recurrence of rectal cancer only when positive margins are suspected. To further reduce local recurrence, we attempted to develop a new IORT irradiation method in which electron beam irradiation is administered as uniformly as possible to the intrapelvic dissection surfaces. Low anterior resection and abdominoperineal resection were performed in one male and one female cadaver. Electron beam irradiation was administered by four different methods, and absorbed doses were measured at 15 sites within the pelvis. We also attempted to measure absorbed doses at nine sites within the pelvis in 14 patients treated with IORT. The cadaver study revealed low absorbed doses in the lateral walls of the pelvis when a single irradiation was delivered from the anterior. When the lateral walls of the pelvis were irradiated twice, once each time on the right and left, the absorbed doses were low in the central pelvis and presacrum. Relatively high absorbed doses were achieved in all of these areas by a technique that combined these two methods. Adequate absorbed doses were not achieved by a single irradiation administered from the perineum. This study suggests that electron beam irradiation administered three times to the dissected surfaces in the pelvis after resection of rectal cancer (i.e., to the central pelvis and presacrum from the anterior, and to the left and right lateral walls of the pelvis) is the most suitable method for achieving adequate absorbed doses. (author)

  13. Extrapleural Inner Thoracic Wall Lesions: Multidetector CT Findings

    International Nuclear Information System (INIS)

    The extrapleural space is external to the parietal pleura in the thorax. The structures within and adjacent to this region include the fat pad, endothoracic fascia, intercostal muscles, connective tissue, nerves, vessels, and ribs. Further, the space is divided into the inner and outer thoracic wall by the innermost intercostal muscle. Extrapleural lesions in the inner thoracic wall are classified as air-containing lesions, fat-containing lesions, and soft tissue-containing lesions according on their main component. Air-containing lesions include extrapleural air from direct chest trauma and extrapleural extension from pneumomediastinum. Prominent extrapleural fat is seen in decreased lung volume conditions, and can also be seen in normal individuals. Soft tissue-containing lesions include extrapleural extensions from a pleural or chest wall infection as well as tumors and extrapleural hematoma. We classify extrapleural lesions in the inner thoracic wall and illustrate their imaging findings

  14. Extrapleural Inner Thoracic Wall Lesions: Multidetector CT Findings

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seung Soo; Kim, Young Tong; Jou, Sung Shik [Soonchunhyang University, Cheonan Hospital, Cheonan (Korea, Republic of)

    2010-06-15

    The extrapleural space is external to the parietal pleura in the thorax. The structures within and adjacent to this region include the fat pad, endothoracic fascia, intercostal muscles, connective tissue, nerves, vessels, and ribs. Further, the space is divided into the inner and outer thoracic wall by the innermost intercostal muscle. Extrapleural lesions in the inner thoracic wall are classified as air-containing lesions, fat-containing lesions, and soft tissue-containing lesions according on their main component. Air-containing lesions include extrapleural air from direct chest trauma and extrapleural extension from pneumomediastinum. Prominent extrapleural fat is seen in decreased lung volume conditions, and can also be seen in normal individuals. Soft tissue-containing lesions include extrapleural extensions from a pleural or chest wall infection as well as tumors and extrapleural hematoma. We classify extrapleural lesions in the inner thoracic wall and illustrate their imaging findings

  15. Initial experience with a synthetic sealant PleuraSeal™ after pulmonary resections: a prospective study with retrospective case matched controls

    Directory of Open Access Journals (Sweden)

    Hennings Ellen

    2010-06-01

    Full Text Available Abstract The objective of this study was to evaluate postoperative outcome and efficacy of a hydrogel tissue sealant for prevention of alveolar leakage after open lung resections. 20 consecutive patients were enrolled in the PleuraSeal™ sealant group (PSG and case matched with 20 retrospective controls (CG with standard treatment. Assessment of postoperative air leakage was performed until chest tube removal. Patients were followed until 30 days after discharge. At end of surgery, 100% in the PSG and 0% in the CG were air leak free (p The study demonstrated a superior efficacy of PleuraSeal™ sealant compared with standard surgical treatment for sustained sealing of postoperative air leakage and causes shorter air leak chest tube duration.

  16. Combined Double Sleeve Lobectomy and Superior Vena Cava Resection for Non-small Cell Lung Cancer with Persistent Left Superior Vena Cava.

    Science.gov (United States)

    Zhu, Daxing; Qiu, Xiaoming; Zhou, Qinghua

    2015-11-01

    A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department. Bronchoscopy displayed complete obstruction of right upper lobe bronchus and infiltration of the bronchus intermedius with tumor. Chest contrast computed tomography revealed the tumor invaded right pulmonary artery, superior vena cava, and the persistant left superior vena cava flowed into the coronary sinus. The tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava (SVC) utilizing ringed polytetrafluoroethylene graft. To the best of our knowledge, this was the first report of complete resection of locally advanced lung cancer involving superior vena cava, right pulmonary artery trunk and main bronchus with persistant left superior vena cava. PMID:26582230

  17. Combined Double Sleeve Lobectomy and Superior Vena Cava Resection for Non-small Cell Lung Cancer with Persistent Left Superior Vena Cava

    Directory of Open Access Journals (Sweden)

    Daxing ZHU

    2015-11-01

    Full Text Available A 65-year-old man with right central type of lung squamous carcinoma was admitted to our department. Bronchoscopy displayed complete obstruction of right upper lobe bronchus and infiltration of the bronchus intermedius with tumor. Chest contrast computed tomography revealed the tumor invaded right pulmonary artery, superior vena cava, and the persistant left superior vena cava flowed into the coronary sinus. The tumor was successfully removed by means of bronchial and pulmonary artery sleeve resection of the right upper and middle lobes combined with resection and reconstruction of superior vena cava (SVC utilizing ringed polytetrafluoroethylene graft. To the best of our knowledge, this was the first report of complete resection of locally advanced lung cancer involving superior vena cava, right pulmonary artery trunk and main bronchus with persistant left superior vena cava.

  18. DNA End Resection:Facts and Mechanisms

    Institute of Scientific and Technical Information of China (English)

    Ting Liu; a Jun Huang; b

    2016-01-01

    DNA double-strand breaks (DSBs), which arise following exposure to a number of endogenous and exogenous agents, can be repaired by either the homologous recombination (HR) or non-homologous end-joining (NHEJ) pathways in eukaryotic cells. A vital step in HR repair is DNA end resection, which generates a long 30 single-stranded DNA (ssDNA) tail that can invade the homologous DNA strand. The generation of 30 ssDNA is not only essential for HR repair, but also promotes activation of the ataxia telangiectasia and Rad3-related protein (ATR). Multiple fac-tors, including the MRN/X complex, C-terminal-binding protein interacting protein (CtIP)/Sae2, exonuclease 1 (EXO1), Bloom syndrome protein (BLM)/Sgs1, DNA2 nuclease/helicase, and several chromatin remodelers, cooperate to complete the process of end resection. Here we review the basic machinery involved in DNA end resection in eukaryotic cells.

  19. Hepatic resection and regeneration. Past and present

    International Nuclear Information System (INIS)

    Hepatic surgery has been performed on condition that the liver regenerates after hepatic resection, and the development of liver anatomy due to Glisson, Rex, and Couinaud has thrown light on hepatic surgery Understanding of feeding and drainage vessels became feasible for systemic hepatic resection; however, it seems to have been the most important problem to control the bleeding during hepatic resection. New types of devices such as cavitron ultrasonic surgical aspirator (CUSA) and Microwave coagulation were exploited to control blood loss during hepatic surgery. Pringle maneuver for exclusion feeding vessels of the liver and the decrease of central venous pressure during anesthesia enabled further decrease of blood loss. Nowadays, 3D-CT imaging may depict feeding and drainage vessels in relation to liver mass, and surgeons can simulate hepatic surgery in virtual reality before surgery, allowing hepatectomy to be performed without blood transfusion. Thus, hepatic resection has been a safe procedure, but there's been a significant research on how much of the liver can be resected without hepatic failure. A prediction scoring system based on ICGR15, resection rates, and age is mostly reliable in some criteria. Even if hepatectomy is performed with a good prediction score, the massive bleeding and associated infection may induce postoperative hepatic failure, while the criteria of postoperative hepatic failure have not yet established. Hepatic failure is supposed to be induced by the apoptosis of mature hepatocytes and necrosis originated from microcirculation disturbance of the liver. Prostaglandin E1 for the improvement of microcirculation, steroid for the inhibition of cytokines inducing apoptosis, and blood purification to exclude cytokines have been tried separately or concomitantly. New therapeutic approaches, especially hepatic regeneration from the stem cell, are expected. (author)

  20. Laparoscopic Resection of Unruptured Rudimentary Horn Pregnancy.

    Science.gov (United States)

    Sharma, Deepti; Usha, M G; Gaikwad, Ramesh; Sudha, S

    2011-01-01

    A non-communicating rudimentary horn is an uncommon site for ectopic pregnancy. Rudimentary horn pregnancy (RHP) is a rare entity but associated with grave clinical consequences. Majority of these cases if not detected timely end up in uterine rupture and present as an obstetrical emergency. We present this case of a 32-year-old, third gravida with a 12 weeks live gestation in the right rudimentary horn, which was successfully managed with laparoscopic resection. Early diagnosis is the key stone in the management of such cases. Laparoscopic resection is a safe and viable option in the surgical management of unruptured RHP. PMID:26085754

  1. Survival benefit in patients after palliative resection vs non-resection colon cancer surgery

    Institute of Scientific and Technical Information of China (English)

    A Beham; M Rentsch; K Püllmann; L Mantouvalou; H Spatz; HJ Schlitt; A Obed

    2006-01-01

    AIM: To evaluate survival in patients undergoing palliative resection versus non-resection surgery for primary colorectal cancer in a retrospective analysis.METHODS: Demographics, TNM status, operating details and survival were reviewed for 67 patients undergoing surgery for incurable colorectal cancer. Palliative resection of the primary tumor was performed in 46 cases in contrast to 21 patients with non-resection of the primary tumor and bypass surgery. Risk factors for postoperative mortality and poor survival were analyzed with univariate and multivariate analyses.RESULTS: The two groups were comparable in terms of age, gender, preoperative presence of ileus and tumor stage. Multivariate analysis showed that median survival was significantly higher in patients with palliative resection surgery (544 vs 233 d). Differentiation of the tumor and tumor size were additional independent factors that were associated with a significantly poorer survival rate.CONCLUSION: Palliative resection surgery for primary colorectal cancer is associated with a higher median survival rate. Also, the presence of liver metastasis and tumor size are associated with poor survival. Therefore,resection of the primary tumor should be considered in patients with non-curable colon cancer.

  2. Stationary digital chest tomosynthesis for coronary artery calcium scoring

    Science.gov (United States)

    Wu, Gongting; Wang, Jiong; Potuzko, Marci; Harman, Allison; Pearce, Caleb; Shan, Jing; Lee, Yueh Z.; Zhou, Otto; Lu, Jianping

    2016-03-01

    The coronary artery calcium score (CACS) measures the buildup of calcium on the coronary artery wall and has been shown to be an important predictor of the risk of coronary artery diseases (CAD). Currently CACS is measured using CT, though the relatively high cost and high radiation dose has limited its adoption as a routine screening procedure. Digital Chest Tomosynthesis (DCT), a low dose and low cost alternative to CT, and has been shown to achieve 90% of sensitivity of CT in lung disease screening. However commercial DCT requires long scanning time and cannot be adapted for high resolution gated cardiac imaging, necessary for CACS. The stationary DCT system (s- DCT), developed in our lab, has the potential to significantly shorten the scanning time and enables high resolution cardiac gated imaging. Here we report the preliminary results of using s-DCT to estimate the CACS. A phantom heart model was developed and scanned by the s-DCT system and a clinical CT in a phantom model with realistic coronary calcifications. The adapted fan-beam volume reconstruction (AFVR) method, developed specifically for stationary tomosynthesis systems, is used to obtain high resolution tomosynthesis images. A trained cardiologist segmented out the calcifications and the CACS was obtained. We observed a strong correlation between the tomosynthesis derived CACS and CT CACS (r2 = 0.88). Our results shows s-DCT imaging has the potential to estimate CACS, thus providing a possible low cost and low dose imaging protocol for screening and monitoring CAD.

  3. A Phase 1/2 and Biomarker Study of Preoperative Short Course Chemoradiation With Proton Beam Therapy and Capecitabine Followed By Early Surgery for Resectable Pancreatic Ductal Adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Theodore S., E-mail: tshong1@partners.org [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ryan, David P.; Borger, Darrell R.; Blaszkowsky, Lawrence S.; Yeap, Beow Y. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ancukiewicz, Marek [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Deshpande, Vikram; Shinagare, Shweta [Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Wo, Jennifer Y.; Boucher, Yves [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Wadlow, Raymond C.; Kwak, Eunice L.; Allen, Jill N.; Clark, Jeffrey W.; Zhu, Andrew X. [Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Ferrone, Cristina R. [Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); Mamon, Harvey J. [Department of Radiation Oncology, Brigham and Women' s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Adams, Judith; Winrich, Barbara; Grillo, Tarin [Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts (United States); and others

    2014-07-15

    Purpose: To evaluate the safety, efficacy and biomarkers of short-course proton beam radiation and capecitabine, followed by pancreaticoduodenectomy in a phase 1/2 study in pancreatic ductal adenocarcinoma (PDAC) patients. Methods and Materials: Patients with radiographically resectable, biopsy-proven PDAC were treated with neoadjuvant short-course (2-week) proton-based radiation with capecitabine, followed by surgery and adjuvant gemcitabine. The primary objective was to demonstrate a rate of toxicity grade ≥3 of <20%. Exploratory biomarker studies were performed using surgical specimen tissues and peripheral blood. Results: The phase 2 dose was established at 5 daily doses of 5 GyE. Fifty patients were enrolled, of whom 35 patients were treated in the phase 2 portion. There were no grade 4 or 5 toxicities, and only 2 of 35 patients (4.1%) experienced a grade 3 toxicity event (chest wall pain grade 1, colitis grade 1). Of 48 patients eligible for analysis, 37 underwent pancreaticoduodenectomy. Thirty of 37 (81%) had positive nodes. Locoregional failure occurred in 6 of 37 resected patients (16.2%), and distant recurrence occurred in 35 of 48 patients (72.9%). With median follow-up of 38 months, the median progression-free survival for the entire group was 10 months, and overall survival was 17 months. Biomarker studies showed significant associations between worse survival outcomes and the KRAS point mutation change from glycine to aspartic acid at position 12, stromal CXCR7 expression, and circulating biomarkers CEA, CA19-9, and HGF (all, P<.05). Conclusions: This study met the primary endpoint by showing a rate of 4.1% grade 3 toxicity for neoadjuvant short-course proton-based chemoradiation. Treatment was associated with favorable local control. In exploratory analyses, KRAS{sup G12D} status and high CXCR7 expression and circulating CEA, CA19-9, and HGF levels were associated with poor survival.

  4. Segmentation of ribs in digital chest radiographs

    Science.gov (United States)

    Cong, Lin; Guo, Wei; Li, Qiang

    2016-03-01

    Ribs and clavicles in posterior-anterior (PA) digital chest radiographs often overlap with lung abnormalities such as nodules, and cause missing of these abnormalities, it is therefore necessary to remove or reduce the ribs in chest radiographs. The purpose of this study was to develop a fully automated algorithm to segment ribs within lung area in digital radiography (DR) for removal of the ribs. The rib segmentation algorithm consists of three steps. Firstly, a radiograph was pre-processed for contrast adjustment and noise removal; second, generalized Hough transform was employed to localize the lower boundary of the ribs. In the third step, a novel bilateral dynamic programming algorithm was used to accurately segment the upper and lower boundaries of ribs simultaneously. The width of the ribs and the smoothness of the rib boundaries were incorporated in the cost function of the bilateral dynamic programming for obtaining consistent results for the upper and lower boundaries. Our database consisted of 93 DR images, including, respectively, 23 and 70 images acquired with a DR system from Shanghai United-Imaging Healthcare Co. and from GE Healthcare Co. The rib localization algorithm achieved a sensitivity of 98.2% with 0.1 false positives per image. The accuracy of the detected ribs was further evaluated subjectively in 3 levels: "1", good; "2", acceptable; "3", poor. The percentages of good, acceptable, and poor segmentation results were 91.1%, 7.2%, and 1.7%, respectively. Our algorithm can obtain good segmentation results for ribs in chest radiography and would be useful for rib reduction in our future study.

  5. Resectable adenocarcinomas in the pancreatic head: the retroperitoneal resection margin is an independent prognostic factor

    Directory of Open Access Journals (Sweden)

    Eide Tor J

    2008-01-01

    Full Text Available Abstract Background The retroperitoneal margin is frequently microscopically tumour positive in non-curative periampullary adenocarcinoma resections. This margin should be evaluated by serial perpendicular sectioning. The aim of the study was to determine whether retroperitoneal margin involvement independently predicts survival after pancreaticoduodenectomy within a framework of standardized assessment of the resected specimens. Methods 114 consecutive macroscopically margin-free periampullary adenocarcinomas were examined according to a prospective standardized protocol for histopathologic evaluation. The retroperitoneal margin was assessed by serial perpendicular sectioning. The periampullary cancer origin (pancreas, ampulla, distal bile duct or duodenum was registered prospectively and reevaluated retrospectively. Associations between histopathologic factors were evaluated by Chi-square test, Fisher's exact test, Kruskal-Wallis test, and Mann-Whitney test, as appropriate. Survival curves were calculated by the Kaplan-Meier method and compared using the log-rank test. Associations between histopathologic factors and survival were also evaluated by unadjusted and adjusted Cox regression analysis, including stepwise variable selection, in order to identify factors that independently predict a poor prognosis after periampullary adenocarcinoma resections. Results Microscopic resection margin involvement (R1 resection was present in 40 tumours, of which 32 involved the retroperitoneal margin. Involvement of the retroperitoneal margin independently predicted a poor prognosis (p = 0.010; HR 1.89; CI 1.16–3.08 after presumed curative (R0 and R1 resection. In microscopically curative (R0 resections (n = 74, pancreatic tumour origin was the only factor that independently predicted a poor prognosis (p Conclusion Serial perpendicular sectioning of the retroperitoneal resection margin demonstrates that tumour involvement of this margin independently

  6. Resectable adenocarcinomas in the pancreatic head: the retroperitoneal resection margin is an independent prognostic factor

    International Nuclear Information System (INIS)

    The retroperitoneal margin is frequently microscopically tumour positive in non-curative periampullary adenocarcinoma resections. This margin should be evaluated by serial perpendicular sectioning. The aim of the study was to determine whether retroperitoneal margin involvement independently predicts survival after pancreaticoduodenectomy within a framework of standardized assessment of the resected specimens. 114 consecutive macroscopically margin-free periampullary adenocarcinomas were examined according to a prospective standardized protocol for histopathologic evaluation. The retroperitoneal margin was assessed by serial perpendicular sectioning. The periampullary cancer origin (pancreas, ampulla, distal bile duct or duodenum) was registered prospectively and reevaluated retrospectively. Associations between histopathologic factors were evaluated by Chi-square test, Fisher's exact test, Kruskal-Wallis test, and Mann-Whitney test, as appropriate. Survival curves were calculated by the Kaplan-Meier method and compared using the log-rank test. Associations between histopathologic factors and survival were also evaluated by unadjusted and adjusted Cox regression analysis, including stepwise variable selection, in order to identify factors that independently predict a poor prognosis after periampullary adenocarcinoma resections. Microscopic resection margin involvement (R1 resection) was present in 40 tumours, of which 32 involved the retroperitoneal margin. Involvement of the retroperitoneal margin independently predicted a poor prognosis (p = 0.010; HR 1.89; CI 1.16–3.08) after presumed curative (R0 and R1) resection. In microscopically curative (R0) resections (n = 74), pancreatic tumour origin was the only factor that independently predicted a poor prognosis (p < 0.001; HR 4.71 for pancreatic versus ampullary; CI 2.13–10.4). Serial perpendicular sectioning of the retroperitoneal resection margin demonstrates that tumour involvement of this margin

  7. Computed chest tomography in an animal model for decompression sickness: radiologic, physiologic, and pathologic findings

    International Nuclear Information System (INIS)

    This study was conducted to investigate the early pulmonary effects of acute decompression in an animal model for human decompression sickness by CT and light microscopy. Ten test pigs were exposed to severe decompression stress in a chamber dive. Three pigs were kept at ambient pressure to serve as controls. Decompression stress was monitored by measurement of pulmonary artery pressure and arterial and venous Doppler recording of bubbles of inert gas. Chest CT was performed pre- and postdive and in addition the inflated lungs were examined after resection. Each lung was investigated by light microscopy. Hemodynamic data and bubble recordings reflected severe decompression stress in the ten test pigs. Computed tomography revealed large quantities of ectopic gas, predominantly intravascular, in three of ten pigs. These findings corresponded to maximum bubble counts in the Doppler study. The remaining test pigs showed lower bubble grades and no ectopic gas by CT. Sporadic interstitial edema was demonstrated in all animals - both test and control pigs - by CT of resected lungs and on histologic examination. A severe compression-decompression schedule can liberate large volumes of inert gas which are detectable by CT. Despite this severe decompression stress, which led to venous microembolism, CT and light microscopy did not demonstrate changes in lung structure related to the experimental dive. Increased extravascular lung water found in all animals may be due to infusion therapy. (orig.)

  8. Computed chest tomography in an animal model for decompression sickness: radiologic, physiologic, and pathologic findings

    Energy Technology Data Exchange (ETDEWEB)

    Reuter, M.; Struck, N.; Heller, M. [Dept. of Diagnostic Radiology, Christian Albrechts Univ., Kiel (Germany); Tetzlaff, K. [Dept. of Medicine, Christian Albrechts Univ., Kiel (Germany); Brasch, F.; Mueller, K.M. [Inst. of Pathology, Hospital Bergmannsheil, Bochum (Germany); Gerriets, T. [Dept. of Neurology, Medical Univ. at Luebeck (Germany); Weiher, M.; Hansen, J. [Dept. of Anaesthesiology and Hyperbaric Centre Northern Germany, Friedrich Ebert Hospital, Neumuenster (Germany); Hirt, S. [Dept. of Medicine, Cardiac and Vascular Surgery, Christian Albrechts University, Kiel (Germany)

    2000-03-01

    This study was conducted to investigate the early pulmonary effects of acute decompression in an animal model for human decompression sickness by CT and light microscopy. Ten test pigs were exposed to severe decompression stress in a chamber dive. Three pigs were kept at ambient pressure to serve as controls. Decompression stress was monitored by measurement of pulmonary artery pressure and arterial and venous Doppler recording of bubbles of inert gas. Chest CT was performed pre- and postdive and in addition the inflated lungs were examined after resection. Each lung was investigated by light microscopy. Hemodynamic data and bubble recordings reflected severe decompression stress in the ten test pigs. Computed tomography revealed large quantities of ectopic gas, predominantly intravascular, in three of ten pigs. These findings corresponded to maximum bubble counts in the Doppler study. The remaining test pigs showed lower bubble grades and no ectopic gas by CT. Sporadic interstitial edema was demonstrated in all animals - both test and control pigs - by CT of resected lungs and on histologic examination. A severe compression-decompression schedule can liberate large volumes of inert gas which are detectable by CT. Despite this severe decompression stress, which led to venous microembolism, CT and light microscopy did not demonstrate changes in lung structure related to the experimental dive. Increased extravascular lung water found in all animals may be due to infusion therapy. (orig.)

  9. Practical pediatric chest radiology for general radiologists

    International Nuclear Information System (INIS)

    This paper reviews practical problems in the radiologic study of infants and children, provides helpful hints for daily practice, and brings the application of newer imaging modalities up to date for specific clinical problems. The discussion attends to normal variants, diagnostic pitfalls, and iatrogenic problems. The authors cover three major areas: (1) Emphysema in infants and children, including bilateral, unilateral, and localized emphysema. (2) The borderlands of the lungs, including evaluation of diaphragmatic abnormalities, mediastinal and pleural lesions, and air leak phenomena, (3) Newborn chest radiology, with an emphasis on differential diagnosis, natural history of disease processes, and therapeutic complications

  10. Radiological diagnosis and therapy of chest pain

    International Nuclear Information System (INIS)

    The causes and localization of chest pain are numerous. They can derive from infections, traumas, or tumors. Possible sites of origin are: skeletal portions, vertebral column, ribs, and sternum, as well as mediastinum and pleura. In women, occurrence tends to be cyclic and affect the mamma region. Radiological diagnosis includes radiography, nuclear techniques as well as whole body computer-tomography. Radiation therapy is indicated in cases of mediastinal tumor formation. Radiation of painful osteolytic vertebral metastases and rib destructions proves to be an efficient palliative measure. (orig.)

  11. Transformation of Abdominal Wall Endometriosis to Clear Cell Carcinoma

    OpenAIRE

    Maria Paula Ruiz; Darryl Lewis Wallace; Matthew Thomas Connell

    2015-01-01

    Clear cell carcinoma is the least common of the malignant transformations reported in nonpelvic sites of endometriosis. Two cases with clear cell carcinoma transformation arising from endometriosis in abdominal wall scars are presented. These patients underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic washings, and abdominal wall lesion resection. The first case had initial treatment with chemotherapy, while chemotherapy and radiation therapy were given for th...

  12. Use of a sealant to prevent prolonged air leaks after lung resection: a prospective randomized study

    Directory of Open Access Journals (Sweden)

    Lequaglie Cosimo

    2012-10-01

    Full Text Available Abstract Background Pulmonary air leaks are common complications of lung resection and result in prolonged hospital stays and increased costs. The purpose of this study was to investigate whether, compared with standard care, the use of a synthetic polyethylene glycol matrix (CoSeal® could reduce air leaks detected by means of a digital chest drain system (DigiVent™, in patients undergoing lung resection (sutures and/or staples alone. Methods Patients who intraoperatively showed moderate or severe air leaks (evaluated by water submersion tests were intraoperatively randomized to receive just sutures/staples (control group or sutures/staples plus CoSeal® (sealant group. Differences among the groups in terms of air leaks, prolonged air leaks, time to chest tube removal, length of hospital stay and related costs were assessed. Results In total, 216 lung resection patients completed the study. Nineteen patients (18.1% in the control group and 12 (10.8% patients in the sealant group experienced postoperative air leaks, while a prolonged air leak was recorded in 11.4% (n = 12 of patients in the control group and 2.7% (n = 3 of patients in the sealant group. The difference in the incidence of air leaks and prolonged air leaks between the two groups was statistically significant (p = 0.0002 and p = 0.0013. The mean length of hospital stay was significantly shorter in the sealant group (4 days than the control group (8 days (p = 0.0001. We also observed lower costs in the sealant group than the control group. Conclusion The use of CoSeal® may decrease the occurrence and severity of postoperative air leaks after lung resection and is associated with shorter hospital stay. Trial registration Not registered. The trial was approved by the Institutional Review Board of the IRCCS-CROB Basilicata Regional Cancer Institute, Rionero in Vulture, Italy.

  13. Bacteriological research for the contamination of equipment in chest radiography

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Seung Gu; Song, Woon Heung; Kweon, Dae Cheol [Shinhan University, Uijeongbu (Korea, Republic of)

    2015-12-15

    The purpose is to determine the degree of contamination of the equipment for infection control in chest radiography of the radiology department. We confirmed by chemical and bacterial identification of bacteria of the equipment and established a preventive maintenance plan. Chest X-ray radiography contact area on the instrument patients shoulder, hand, chin, chest lateral radiography patient contact areas with a 70% isopropyl alcohol cotton swab were compared to identify the bacteria before and after sterilization on the patient contact area in the chest radiography equipment of the department. The gram positive Staphylococcus was isolated from side shoots handle before disinfection in the chest radiography equipment. For the final identification of antibiotic tested that it was determined by performing the nobobiocin to the sensitive Staphylococcus epidermidis. Chest radiography equipment before disinfecting the handle side of Staphylococcus epidermidis bacteria were detected using a disinfectant should be to prevent hospital infections.

  14. Late sensory changes following chest drain insertion during thoracotomy

    DEFF Research Database (Denmark)

    Wildgaard, K; Ringsted, T K; Ravn, J; Werner, M U; Kehlet, H

    2013-01-01

    BACKGROUND: It is well known that chest drains are associated with severe movement-related acute pain. These noxious stimuli could play a significant role in development and maintenance of persistent post-operative pain. Therefore we studied chest drain sites in post-thoracotomy pain syndrome (PTPS......) patients, in regard to pain and sensory dysfunction. METHODS: We quantified thermal and pressure thresholds on both the chest drain side and the contralateral side in 11 PTPS patients and 10 pain-free post-thoracotomy patients 33 months after the thoracotomy. On average, each patient had two chest drains...... inserted during surgery. RESULTS: At follow up, two patients experienced pain at the chest drain sites, but had maximal pain near or at the thoracotomy scar. Comparison between chest drain side and control side for all 21 patients demonstrated significantly elevated thresholds for warmth detection and heat...

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

    International Nuclear Information System (INIS)

    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)

  16. Evaluation of radiation doses delivered in different chest CT protocols

    OpenAIRE

    Gorycki, Tomasz; Lasek, Iwona; Kamiński, Kamil; Studniarek, Michał

    2014-01-01

    Summary Background There are differences in the reference diagnostic levels for the computed tomography (CT) of the chest as cited in different literature sources. The doses are expressed either in weighted CT dose index (CTDIVOL) used to express the dose per slice, dose-length product (DLP), and effective dose (E). The purpose of this study was to assess the radiation dose used in Low Dose Computer Tomography (LDCT) of the chest in comparison with routine chest CT examinations as well as to ...

  17. Chest Radiography Findings in Primary Pulmonary Tuberculosis in Children

    OpenAIRE

    Milković, Đurđica; Richter, Darko; Zoričić-Letoja, Ivka; Raos, Miljenko; Koncul, Ivan

    2005-01-01

    Plain chest radiography plays a major role in the diagnosis and follow-up of pulmonary tuberculosis in childhood. The aim of our study was to investigate the distribution of characteristic chest radiographic findings at diagnosis in children with pulmonary tuberculosis. The age of the patients and the type and localization of radiographic changes at admission were retrospectively analyzed. We reviewed chest radiographs in 204 children admitted from January 1, 1991 until June 30, 1994 for newl...

  18. Proximal Gastrojejunal Reconstruction after Pancreaticoduodenal Resection

    Directory of Open Access Journals (Sweden)

    M. Wayne

    2012-01-01

    Full Text Available Introduction. Reconstruction by proximal gastrojejunostomy, and distal biliary and pancreatic anastomoses is infrequently used after resection of the head of the pancreas because of fear of fistulas and cholangitis. Pancreaticoduodenectomy is being performed more frequently for cystic malignant and premalignant lesions. Because of this there is a need for endoscopic visualization and biopsy of the residual pancreatic duct, since multi-centricity is characteristic of some of these malignancies. Since endoscopic access of the bile duct and pancreatic duct is difficult and unsuccessful in 50–70% after B II or Roux Y reconstruction, we prospectively studied the merit and complications (early and late of proximal gastrojejunal (PGJ reconstruction after pancreaticoduodenal resection. Material and Methods. Thirty nine consecutive, non-radomized patients underwent pancreaticoduodenectomy and PGJ reconstruction over 14 mos. There were 21 males and 18 females. Results. 7 patients with IPMN have undergone repeat CT scanning for surveillance, with 3 requiring repeat EUS and ERCP. There were no technical difficulties accessing the pancreas or the pancreatic duct, supporting the PGJ reconstruction. Conclusion. Proximal gastrojejunal reconstruction following pancreaticoduodenal resection may be safely done with similar morbidity to traditional pancreaticojejunal reconstructions. PGJ reconstruction may be of greater value when direct visual access to the bile duct or pancreatic duct is necessary, and should be considered when doing resection for mucinous cysts or IPMN of the head of the pancreas.

  19. What Keeps Postpulmonary Resection Patients in Hospital?

    Directory of Open Access Journals (Sweden)

    T Bardell

    2003-01-01

    Full Text Available BACKGROUND: Prolonged air leak (longer than three days was hypothesized to be the primary cause of extended hospital stays following pulmonary resection. Its effect on length of stay (LOS was compared with that of suboptimal pain control, nausea and vomiting, and other causes. Predictors of prolonged LOS and of prolonged air leaks were investigated.

  20. Resection planning for robotic acoustic neuroma surgery

    Science.gov (United States)

    McBrayer, Kepra L.; Wanna, George B.; Dawant, Benoit M.; Balachandran, Ramya; Labadie, Robert F.; Noble, Jack H.

    2016-03-01

    Acoustic neuroma surgery is a procedure in which a benign mass is removed from the Internal Auditory Canal (IAC). Currently this surgical procedure requires manual drilling of the temporal bone followed by exposure and removal of the acoustic neuroma. This procedure is physically and mentally taxing to the surgeon. Our group is working to develop an Acoustic Neuroma Surgery Robot (ANSR) to perform the initial drilling procedure. Planning the ANSR's drilling region using pre-operative CT requires expertise and around 35 minutes' time. We propose an approach for automatically producing a resection plan for the ANSR that would avoid damage to sensitive ear structures and require minimal editing by the surgeon. We first compute an atlas-based segmentation of the mastoid section of the temporal bone, refine it based on the position of anatomical landmarks, and apply a safety margin to the result to produce the automatic resection plan. In experiments with CTs from 9 subjects, our automated process resulted in a resection plan that was verified to be safe in every case. Approximately 2 minutes were required in each case for the surgeon to verify and edit the plan to permit functional access to the IAC. We measured a mean Dice coefficient of 0.99 and surface error of 0.08 mm between the final and automatically proposed plans. These preliminary results indicate that our approach is a viable method for resection planning for the ANSR and drastically reduces the surgeon's planning effort.

  1. Total laparoscopic liver resection in 78 patients

    Directory of Open Access Journals (Sweden)

    Lei Zhang, Ya-Jin Chen, Chang-Zhen Shang, Hong-Wei Zhang, Ze-Jian Huang

    2009-12-01

    Full Text Available AIM: To summarize the clinical experience of laparoscopic hepatectomy at a single center.METHODS: Between November 2003 and March 2009, 78 patients with hepatocellular carcinoma (n = 39, metastatic liver carcinoma (n = 10, and benign liver neoplasms (n = 29 underwent laparoscopic hepatectomy in our unit. A retrospective analysis was done on the clinical outcomes of the 78 patients.RESULTS: The lesions were located in segments I (n = 3, II (n = 16, III (n = 24, IV (n = 11, V (n = 11, VI (n = 9, and VIII (n = 4. The lesion sizes ranged from 0.8 to 15 cm. The number of lesions was three (n = 4, two (n = 8 and one (n = 66 in the study cohort. The surgical procedures included left hemi-hepatectomy (n = 7, left lateral lobectomy (n = 14, segmentectomy (n = 11, local resection (n = 39, and resection of metastatic liver lesions during laparoscopic surgery for rectal cancer (n = 7. Laparoscopic liver resection was successful in all patients, with no conversion to open procedures. Only four patients received blood transfusion (400-800 mL. There were no perioperative complications, such as bleeding and biliary leakage. The liver function of all patients recovered within 1 wk, and no liver failure occurred.CONCLUSION: Laparoscopic hepatectomy is a safe and feasible operation with minimal surgical trauma. It should be performed by a surgeon with sufficient experience in open hepatic resection and who is proficient in laparoscopy.

  2. Current role of bloodless liver resection

    Institute of Scientific and Technical Information of China (English)

    Spiros G Delis; Juan Madariaga; A Bakoyiannis; Ch Dervenis

    2007-01-01

    Liver resections are demanding operations which can have life threatening complications although they are performed by experienced liver surgeons. Recently new technologies are applied in the field of liver surgery, having one goal: safer and easier liver operations. The aim of this article is to address the issue of bloodless liver resection using radiofrequency energy. Radionics, Cool-tipTM System and Tissue Link are some of the devices which are using radiofrequency energy. All information included in this article, refers to these devices in which we have personal experience in our unit of liver surgery. These devices take advantage of its unique combination of radiofrequency current and internal electrode cooling to perform sealing of the small vessels and biliary radicals. Dissection is also feasible with the cool-tip probe. For the purposes of this study patient sex, age, type of disease and type of surgical procedure in association with the duration of parenchymal transection, blood loss, length of hospital stay, morbidity and mortality were analyzed. Cool-tip RF device may provide a unique, simple and rather safe method of bloodless liver resections if used properly. It is indicated mostly in cirrhotic patients with challenging hepatectomies (segment W, central resections). The total operative time is eliminated and the average blood loss is significantly decreased. It is important to note that this technique should not be applied near the hilum or the vena cava to avoid damage of these structures.

  3. Postoperative omental infarction following colonic resection

    Energy Technology Data Exchange (ETDEWEB)

    Kerr, S.F., E-mail: skerr44@doctors.org.uk [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom); Hyland, R.; Rowbotham, E.; Chalmers, A.G. [Department of Radiology, Leeds General Infirmary, Leeds (United Kingdom)

    2012-02-15

    Aim: To illustrate the computed tomography (CT) appearances and natural history of postoperative omental infarction following colonic resection and to highlight the important clinical implications of this radiological diagnosis. Materials and methods: Over a 3 year period, 15 patients with a history of colonic resection were identified as having a CT diagnosis of postoperative omental infarction. Relevant clinical and pathological data were retrospectively collected from the institution's electronic patient records system and all relevant imaging was reviewed, including serial CT images in 10 patients. Results: A diagnosis of postoperative omental infarction was made in symptomatic and asymptomatic patients who had undergone open or laparoscopic colonic resection for benign or malignant disease. CT appearances ranged from diffuse omental stranding to discrete masses, which typically appeared within weeks of surgery and could persist for years. In four (36%) of the patients with colorectal cancer, the CT appearances raised concern for recurrent malignancy, but percutaneous biopsy and/or serial CT allowed a confident diagnosis of omental infarction to be made. Although most cases were self-limiting, three (20%) cases were complicated by secondary infection and required radiological or surgical intervention. Conclusion: Postoperative omental infarction is an under-recognized complication of colonic resection. It has the potential to mimic recurrent malignancy and may require radiological or surgical intervention for secondary infection.

  4. Postoperative omental infarction following colonic resection

    International Nuclear Information System (INIS)

    Aim: To illustrate the computed tomography (CT) appearances and natural history of postoperative omental infarction following colonic resection and to highlight the important clinical implications of this radiological diagnosis. Materials and methods: Over a 3 year period, 15 patients with a history of colonic resection were identified as having a CT diagnosis of postoperative omental infarction. Relevant clinical and pathological data were retrospectively collected from the institution’s electronic patient records system and all relevant imaging was reviewed, including serial CT images in 10 patients. Results: A diagnosis of postoperative omental infarction was made in symptomatic and asymptomatic patients who had undergone open or laparoscopic colonic resection for benign or malignant disease. CT appearances ranged from diffuse omental stranding to discrete masses, which typically appeared within weeks of surgery and could persist for years. In four (36%) of the patients with colorectal cancer, the CT appearances raised concern for recurrent malignancy, but percutaneous biopsy and/or serial CT allowed a confident diagnosis of omental infarction to be made. Although most cases were self-limiting, three (20%) cases were complicated by secondary infection and required radiological or surgical intervention. Conclusion: Postoperative omental infarction is an under-recognized complication of colonic resection. It has the potential to mimic recurrent malignancy and may require radiological or surgical intervention for secondary infection.

  5. Single incision laparoscopic colorectal resection: Our experience

    Directory of Open Access Journals (Sweden)

    Chinnusamy Palanivelu

    2012-01-01

    Full Text Available Background: A prospective case series of single incision multiport laparoscopic colorectal resections for malignancy using conventional laparoscopic trocars and instruments is described. Materials and Methods: Eleven patients (seven men and four women with colonic or rectal pathology underwent single incision multiport laparoscopic colectomy/rectal resection from July till December 2010. Four trocars were placed in a single transumblical incision. The bowel was mobilized laparoscopically and vessels controlled intracorporeally with either intra or extracorporeal anastomosis. Results: Three patients had carcinoma in the caecum, one in the hepatic flexure, two in the rectosigmoid, one in the descending colon, two in the rectum and two had ulcerative pancolitis (one with high grade dysplasia and another with carcinoma rectum. There was no conversion to standard multiport laparoscopy or open surgery. The median age was 52 years (range 24-78 years. The average operating time was 130 min (range 90-210 min. The average incision length was 3.2 cm (2.5-4.0 cm. There were no postoperative complications. The average length of stay was 4.5 days (range 3-8 days. Histopathology showed adequate proximal and distal resection margins with an average lymph node yield of 25 nodes (range 16-30 nodes. Conclusion: Single incision multiport laparoscopic colorectal surgery for malignancy is feasible without extra cost or specialized ports/instrumentation. It does not compromise the oncological radicality of resection. Short-term results are encouraging. Long-term results are awaited.

  6. Cutting edge of endoscopic full-thickness resection for gastric tumor

    Institute of Scientific and Technical Information of China (English)

    Tadateru; Maehata; Osamu; Goto; Hiroya; Takeuchi; Yuko; Kitagawa; Naohisa; Yahagi

    2015-01-01

    Recently,several studies have reported local full-thickness resection techniques using flexible endoscopy for gastric tumors,such as gastrointestinal stromal tumors,gastric carcinoid tumors,and early gastric cancer(EGC). These techniques have the advantage of allowing precise resection lines to be determined using intraluminal endoscopy. Thus,it is possible to minimize the resection area and subsequent deformity. Some of these methods include:(1) classical laparoscopic and endoscopic cooperative surgery(LECS);(2) inverted LECS;(3) combination of laparoscopic and endoscopic approaches to neoplasia with non-exposure technique; and(4) non-exposed endoscopic wall-inversion surgery. Furthermore,a recent prospective multicenter trial of the sentinel node navigation surgery(SNNS) for EGC has shown acceptable results in terms of sentinel node detection rate and the accuracy of nodal metastasis. Endoscopic full-thickness resection with SNNS is expected to become a treatment option that bridges the gap between endoscopic submucosal dissection and standard surgery for EGC. In the future,the indications for these procedures for gastric tumors could be expanded.

  7. Ileal Intussusception Due to Metastasis from Squamous Cell Carcinoma of the Lung Resected 12 Years Previously.

    Science.gov (United States)

    Nakamura, Tomoki; Chino, Osamu; Tajima, Takayuki; Tanaka, Yoichi; Yokoyama, Daiki; Hanashi, Tomoko; Sadahiro, Sotaro; Makuuchi, Hiroyasu

    2015-12-01

    An 88-year-old woman, with a history of resection of stage IIA lung cancer in 1998, was referred to our hospital in August 2010 complaining of upper abdominal pain, vomiting, and dark brown stools. After endoscopic examination, she was admitted with a diagnosis of Mallory-Weiss syndrome. Vomiting occurred when food intake was resumed after fasting. Intestinal obstruction was suspected on abdominal radiography, and complete small bowel obstruction was confirmed by contrast-enhanced imaging after placement of an ileus tube. A small intestinal tumor with intussusception was detected by computed tomography. At laparotomy, there was no ascites. Intussusception was found due to an ileal tumor located approximately 50 cm from the ileocecal valve, and we performed partial small bowel resection. The resected small intestine contained a submucosal tumor approximately 40 mm in diameter that had penetrated the bowel wall to reach the serosa. Pathological examination revealed a submucosal tumor that showed poor continuity with the surrounding mucosa, while the histology was squamous cell carcinoma. Immunohistochemistry showed that the tumor was CK7 positive, CK20 negative, TTF-1 negative, and CK10 positive. Based on these findings, we made a diagnosis of small intestinal metastasis at 12 years after radical resection of squamous cell carcinoma of the lung. PMID:26662663

  8. Cross-chest liposuction in gynaecomastia

    Directory of Open Access Journals (Sweden)

    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.

  9. Acute chest pain emergencies - spouses' prehospital experiences.

    Science.gov (United States)

    Forslund, Kerstin; Quell, Robin; Sørlie, Venke

    2008-10-01

    The call to the Emergency Medical Dispatch Centre is often a person's first contact with the health-care system in cases of acute illness or injury and acute chest pain is a common reason for calling. The aim was to illuminate how spouses to persons with acute chest pain experienced the alarm situation, the emergency call and the prehospital emergency care. Interviews were conducted with nineteen spouses. A phenomenological-hermeneutic approach was used for the analyses. The themes responsibility and uneasiness emerged as well as an overall theme of aloneness. Being a spouse to a person in need of acute medical and nursing assistance was interpreted as "Being responsible and trying to preserve life" and "Being able to manage the uneasiness and having trust in an uncertain situation." When their partners' life was at risk the spouses were in an escalating spiral of worry, uncertainty, stress, fear of loss, feeling of loneliness and desperation. They had to manage emotional distress and felt compelled to act to preserve life, a challenging situation. PMID:18929341

  10. Errors in chest x-ray interpretation

    International Nuclear Information System (INIS)

    Full text: Reporting of adult chest x-rays by appropriately trained radiographers is frequently used in the United Kingdom as one method to maintain a patient focused radiology service in times of increasing workload. With models of advanced practice being developed in Australia, New Zealand and Canada, the spotlight is on the evidence base which underpins radiographer reporting. It is essential that any radiographer who extends their scope of practice to incorporate definitive clinical reporting perform at a level comparable to a consultant radiologist. In any analysis of performance it is important to quantify levels of sensitivity and specificity and to evaluate areas of error and variation. A critical review of the errors made by reporting radiographers in the interpretation of adult chest x-rays will be performed, examining performance in structured clinical examinations, clinical audit and a diagnostic accuracy study from research undertaken by the authors, and including studies which have compared the performance of reporting radiographers and consultant radiologists. overall performance will be examined and common errors discussed using a case based approach. Methods of error reduction, including multidisciplinary team meetings and ongoing learning will be considered

  11. Catastrophic chest pain: blinded by cardiopulmonary disease.

    Science.gov (United States)

    Barreiro, Timothy John; Asiimwe, Denis D; Gemmel, David; Brine, Patrick

    2015-01-01

    A 53-year-old man with a history of diabetic foot ulcer, osteomyelitis, coronary artery disease, hypertension and hyperlipidaemia, presented with chest pain of 3 weeks duration. Eleven days earlier, the patient had had a drug-eluting stent (DES) placed in a branch of the right coronary artery (RCA) after similar chest pain, leading to the findings of a positive nuclear stress test. Since discharge, he was not compliant with taking clopidegrel (Plavix), a concern for in-stent thrombosis with recurrent myocardial ischaemia; but work up was negative and medications were restarted. Within 24 h of admission, he developed bilateral flaccid leg weakness, urine retention and loss of sensation from the umbilicus level down. MRI revealed a T4-T6 epidural abscess. Emergent decompression laminectomy and abscess drainage was completed. Neurological symptoms improved hours after surgery with complete resolution of sensory deficits. Cultures grew Streptococcus sp., treated with intravenous nafcillin for 8 weeks. He regained leg strength with continued improvement seen in rehabilitation. PMID:26135489

  12. Staphylococcus aureus sternal osteomyelitis: a rare cause of chest pain

    Directory of Open Access Journals (Sweden)

    Kaur M

    2015-10-01

    Full Text Available Chest pain is a common presenting symptom with a broad differential. Life-threatening cardiac and pulmonary etiologies of chest pain should be evaluated first. However, it is critical to perform a thorough assessment for other sources of chest pain in order to limit morbidity and mortality from less common causes. We present a rare case of a previously healthy 45 year old man who presented with focal, substernal, reproducible chest pain and Staphylococcus aureus bacteremia who was later found to have primary Staphylococcus aureus sternal osteomyelitis.

  13. Chest trauma in children: current imaging guidelines and techniques.

    LENUS (Irish Health Repository)

    Moore, Michael A

    2011-09-01

    Given the heterogeneous nature of pediatric chest trauma, the optimal imaging approach is tailored to the specific patient. Chest radiography remains the most important imaging modality for initial triage. The decision to perform a chest computed tomography scan should be based on the nature of the trauma, the child\\'s clinical condition, and the initial radiographic findings, taking the age-related pretest probabilities of serious injury into account. The principles of as low as reasonably achievable and Image Gently should be followed. The epidemiology and pathophysiology, imaging techniques, characteristic findings, and evidence-based algorithms for pediatric chest trauma are discussed.

  14. Inflation and deflation pressure-volume loops in anesthetized pinnipeds confirms compliant chest and lungs.

    Science.gov (United States)

    Fahlman, Andreas; Loring, Stephen H; Johnson, Shawn P; Haulena, Martin; Trites, Andrew W; Fravel, Vanessa A; Van Bonn, William G

    2014-01-01

    We examined structural properties of the marine mammal respiratory system, and tested Scholander's hypothesis that the chest is highly compliant by measuring the mechanical properties of the respiratory system in five species of pinniped under anesthesia (Pacific harbor seal, Phoca vitulina; northern elephant seal, Mirounga angustirostris; northern fur seal Callorhinus ursinus; California sea lion, Zalophus californianus; and Steller sea lion, Eumetopias jubatus). We found that the chest wall compliance (CCW) of all five species was greater than lung compliance (airways and alveoli, CL) as predicted by Scholander, which suggests that the chest provides little protection against alveolar collapse or lung squeeze. We also found that specific respiratory compliance was significantly greater in wild animals than in animals raised in an aquatic facility. While differences in ages between the two groups may affect this incidental finding, it is also possible that lung conditioning in free-living animals may increase pulmonary compliance and reduce the risk of lung squeeze during diving. Overall, our data indicate that compliance of excised pinniped lungs provide a good estimate of total respiratory compliance. PMID:25426080

  15. Inflation and deflation pressure-volume loops in anesthetized pinnipeds confirms compliant chest and lungs

    Directory of Open Access Journals (Sweden)

    Andreas eFahlman

    2014-11-01

    Full Text Available We examined structural properties of the marine mammal respiratory system, and tested Scholander’s hypothesis that the chest is highly compliant by measuring the mechanical properties of the respiratory system in five species of pinniped under anesthesia (Pacific harbor seal, Phoca vitulina; northern elephant seal, Mirounga angustirostris; northern fur seal Callorhinus ursinus; California sea lion, Zalophus californianus; and Steller sea lion, Eumetopias jubatus. We found that the chest wall compliance (CCW of all five species was greater than lung compliance (airways and alveoli, CL as predicted by Scholander, which suggests that the chest provides little protection against alveolar collapse or lung squeeze. We also found that specific respiratory compliance was significantly greater in wild animals than in animals raised under human care. While differences in ages between the two groups may affect this incidental finding, it is also possible that lung conditioning in free-living animals may increase pulmonary compliance and reduce the risk of lung squeeze during diving. Overall, our data indicate that compliance of excised pinniped lungs provide a good estimate of total respiratory compliance.

  16. Magnetic resonance imaging of the chest: current and new applications, with an emphasis on pulmonology

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Marcel Koenigkam; Mauad, Fernando Marum, E-mail: marcelk46@yahoo.com.b [Universidade de Sao Paulo (HC/FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Hospital das Clinicas; Elias Junior, Jorge; Muglia, Valdair Francisco [Universidade de Sao Paulo (FMRP/USP), Ribeirao Preto, SP (Brazil). Faculdade de Medicina. Secao de Radiologia

    2011-03-15

    The objective of the present review study was to present the principal applications of magnetic resonance imaging (MRI) of the chest, including the description of new techniques. Over the past decade, this method has evolved considerably because of the development of new equipment, including the simultaneous interconnection of phased-array multiple radiofrequency receiver coils and remote control of the table movement, in addition to faster techniques of image acquisition, such as parallel imaging and partial Fourier acquisitions, as well as the introduction of new contrast agents. All of these advances have allowed MRI to gain ground in the study of various pathologies of the chest, including lung diseases. Currently, MRI is considered the modality of choice for the evaluation of lesions in the mediastinum and in the chest wall, as well as of superior sulcus tumors. However, it can also facilitate the diagnosis of lung, pleural, and cardiac diseases, as well as of those related to the pulmonary vasculature. Pulmonary MRI angiography can be used in order to evaluate various pulmonary vascular diseases, and it has played an ever greater role in the study of thromboembolism. Because cardiac MRI allows morphological and functional assessment in the same test, it has also become part of the clinical routine in the evaluation of various cardiac diseases. Finally, the role of MRI has been extended to the identification and characterization of pulmonary nodules, the evaluation of airway diseases, and the characterization of pleural effusion. (author)

  17. Strain Assessment in Surgically Resected Inflammatory and Neoplastic Bowel Lesions

    DEFF Research Database (Denmark)

    Havre, R F; Leh, S; Gilja, O H;

    2014-01-01

    Purpose: To investigate whether ultrasound-based strain imaging can discriminate between colorectal adenocarcinomas and stenotic Crohn's lesions in newly resected surgical specimens.Materials and Methods: Resected surgical specimens from 27 patients electively operated for colorectal tumors or st...

  18. Secondary diaphragmatic eventration after resection of extralobar pulmonary sequestration

    OpenAIRE

    Kaselas C; Papouis G; Grigoriadis G; Kaselas V

    2007-01-01

    Phrenic nerve preservation is an important factor in operations involving the resection of an extralobar pulmonary sequestration. We present a case of secondary diaphragmatic eventration due to damage to the phrenic nerve after resection of an extralobar pulmonary sequestration.

  19. Prematurity reduces functional adaptation to intestinal resection in piglets

    DEFF Research Database (Denmark)

    Aunsholt, Lise; Thymann, Thomas; Qvist, Niels;

    2015-01-01

    Background: Necrotizing enterocolitis and congenital gastrointestinal malformations in infants often require intestinal resection, with a subsequent risk of short bowel syndrome (SBS). We hypothesized that immediate intestinal adaptation following resection of the distal intestine with placement of...

  20. [Large abdominal wall reconstruction by free flap after recurrence of a dermatofibrosarcoma protuberans].

    Science.gov (United States)

    Le Fourn, B; Lejeune, F; Sartre, J Y; Loirat, Y; Pannier, M

    1996-12-01

    Based on a case of recurrence of a dermatofibrosarcoma protuberans of the abdominal wall, the authors discuss the need for initial wide resection of this type of skin tumour and the possibilities of repair of extensive full thickness defects of the abdominal wall by means of a latissimus dorsi myocutaneous free flap. PMID:9768175

  1. Laparoscopic liver resection: Wedge resections to living donor hepatectomy, are we heading in the right direction?

    OpenAIRE

    Cherian, P Thomas; Mishra, Ashish Kumar; Kumar, Palaniappen; Sachan, Vijayant Kumar; Bharathan, Anand; Srikanth, Gadiyaram; Senadhipan, Baiju; Rela, Mohamad S

    2014-01-01

    Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection (OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learnin...

  2. The EndoRotor®: endoscopic mucosal resection system for non-thermal and rapid removal of esophageal, gastric, and colonic lesions: initial experience in live animals

    Science.gov (United States)

    Hollerbach, Stephan; Wellmann, Axel; Meier, Peter; Ryan, Jeffery; Franco, Ramon; Koehler, Peter

    2016-01-01

    Background and study aims: The EndoRotor® is a novel, non-thermal, automated mechanical endoscopic resection system designed to remove benign mucosal neoplastic tissue throughout the gastrointestinal tract. It uses suction pressure to pull in mucosa and rapidly and precisely cut it while automatically transporting the samples to a collection trap for later histologic evaluation. Patients and methods: To study the technical properties and therapeutic potential of this new tool, we performed multiple upper and lower gastrointestinal endoscopic mucosal resections in three healthy live pigs. Animals were anesthetized and kept artificially ventilated while two physicians performed multiple qualitative mucosal resections on various sites of the pigs’ esophagus, stomach, duodenum, and colon. Results: Rapid resection of flat and slightly elevated mucosa up to several centimeters in size/diameter was performed. No major bleeding occurred during and after resections. When used properly, no gastrointestinal wall perforations occurred during superficial resections. Perforations in the colon were only observed when the device was deliberately pushed against deeper sub-mucosal layers or when exceptional force was applied to penetrate the gastrointestinal wall. Histologic specimens showed complete mucosal removal at resection sites. The flexible catheter could be moved and directed towards most of the areas of interest in the gastrointestinal tract. Conclusion: The EndoRotor rapidly and easily resects flat and slightly elevated gastrointestinal mucosa with a short learning curve. Future studies in humans should be performed to prove its ability for large-area mucosal resections in benign conditions such as laterally spreading adenomas in the colon, or Barrett’s mucosa in the distal esophagus. PMID:27092332

  3. Good results after repeated resection for colorectal liver metastases

    DEFF Research Database (Denmark)

    Rolff, Hans Christian; Calatayud, Dan; Larsen, Peter Nørgaard;

    2012-01-01

    Our study aim was to evaluate the perioperative events, postoperative events and survival after a second liver resection due to colorectal liver metastases (CLM), compared with a matched control group that had only undergone primary liver resection due to CLM.......Our study aim was to evaluate the perioperative events, postoperative events and survival after a second liver resection due to colorectal liver metastases (CLM), compared with a matched control group that had only undergone primary liver resection due to CLM....

  4. LAPAROSCOPIC PANCREATIC RESECTION. FROM ENUCLEATION TO PANCREATODUODENECTOMY. 11-YEAR EXPERIENCE

    OpenAIRE

    Marcel Autran Cesar MACHADO; Rodrigo Canada Trofo SURJAN; Goldman, Suzan Menasce; Jose Celso ARDENGH; Fabio Ferrari MAKDISSI

    2013-01-01

    Context Our experience with laparoscopic pancreatic resection began in 2001. During initial experience, laparoscopy was reserved for selected cases. With increasing experience more complex laparoscopic procedures such as central pancreatectomy and pancreatoduodenectomies were performed. Objectives The aim of this paper is to review our personal experience with laparoscopic pancreatic resection over 11-year period. Methods All patients who underwent laparoscopic pancreatic resection from 2...

  5. Short-term outcomes following laparoscopic resection for colon cancer.

    LENUS (Irish Health Repository)

    Kavanagh, Dara O

    2011-03-01

    Laparoscopic resection for colon cancer has been proven to have a similar oncological efficacy compared to open resection. Despite this, it is performed by a minority of colorectal surgeons. The aim of our study was to evaluate the short-term clinical, oncological and survival outcomes in all patients undergoing laparoscopic resection for colon cancer.

  6. Evaluation of radiation dosage in chest digital tomosynthesis

    International Nuclear Information System (INIS)

    Objective: To evaluate the feasibility of chest digital tomosynthesis (DTS) for lung lesion screening by comparing the effective dose of chest DTS with chest digital radiography (DR), low-dose MSCT and MSCT examinations. Methods: The Fluke lung/chest phantom underwent posterior-anterior (PA), left lateral (LAT) chest DR and DTS with automatic exposure control technique. Using RTI DoseGuard and WinODS, the dose area product (DAP) and effective dose of PA, LAT and total DTS were calculated. CareDose technique was used for MSCT and low-dose MSCT scans, the dose length products (DLP) was acquired.According to the DLP to E (k) conversion coefficient in ICRP 103, the effective dose of low-dose MSCT and MSCT were calculated. Paired t test was used for comparison of the mean effective dose of DTS, DR and low-dose MSCT. Results: The mean effective dose was 0.13 mSv for chest DR and 0.11 mSv for DTS examination. The mean effective dose of low-dose MSCT and MSCT scans were 1.13 mSv and 6.38 mSv. The effective dose of chest DTS was comparable to that of chest DR, and was approximately 1/10 and 1/60 times lower than that of low-dose MSCT and MSCT scans. There was no statistical difference between chest DTS and DR (t=3.514, P>0.01), and there was a significant difference between chest DTS and low-dose MSCT (t=178.769, P<0.01). Conclusion: DTS is a new X-ray tomography which has the advantage of low radiation dosage in chest examination for lung lesion screening comparing with low-dose MSCT. (authors)

  7. Single port-assisted fully laparoscopic abdominoperineal resection (APR) with immediate V-RAM flap reconstruction of the perineal defect.

    LENUS (Irish Health Repository)

    Ali, Sayid

    2012-09-01

    Abdominoperineal resection (APR) of anorectal cancers after neoadjuvant chemoradiotherapy may incur significant perineal morbidity. While vertical rectus abdominis muscle (V-RAM) flaps can fill the pelvic resection space with health tissue, their use has previously been described predominantly in association with laparotomy. Here, we describe a means of combination laparoscopic APR with V-RAM flap reconstruction that allows structural preservation of the entire abdominal wall throughout the oncological resection and of the deep parietal layers after V-RAM donation. Furthermore, a single port access device used at the end colostomy site allows a second senior surgeon assist with an additional two working instruments for the purpose of improved pelvic tissue retraction, especially useful in obese patients.

  8. Observer accuracy in reading chest films

    International Nuclear Information System (INIS)

    Four board-certified radiologists have read and reread four groups of 40 chest radiographs containing nodule and infiltrate images to investigate interreader and intrareader variation. Responses were recorded using a six-point confidence level scale. Accuracy was determined from the area under the receiver operating characteristic (ROC) curve. Accuracies ranged from 0.78 to 0.98, with an average of 0.83 and a mean uncertainty of 8.2%. Intraobserver uncertainties varied from 0.5% to 16%, with a mean of 5.9%. The data were analyzed for the significance of accuracy differences using correlated ROC techniques, the kappa statistic, and the Bonnferoni criteria. Implications for using reader performance as a recertification measure are discussed

  9. Chest magnetic resonance imaging: a protocol suggestion

    Directory of Open Access Journals (Sweden)

    Bruno Hochhegger

    2015-12-01

    Full Text Available Abstract In the recent years, with the development of ultrafast sequences, magnetic resonance imaging (MRI has been established as a valuable diagnostic modality in body imaging. Because of improvements in speed and image quality, MRI is now ready for routine clinical use also in the study of pulmonary diseases. The main advantage of MRI of the lungs is its unique combination of morphological and functional assessment in a single imaging session. In this article, the authors review most technical aspects and suggest a protocol for performing chest MRI. The authors also describe the three major clinical indications for MRI of the lungs: staging of lung tumors; evaluation of pulmonary vascular diseases; and investigation of pulmonary abnormalities in patients who should not be exposed to radiation.

  10. Digital luminescence radiography of the chest

    International Nuclear Information System (INIS)

    The aim of the present study was to evaluate the efficacy of a digital system in chest radiology compared to the conventional film-screen system. The first studies (1-3) were purely clinical, had two parts, one clinical and one using phantoms, and the 5:th used solely phantoms. Except for the first - pilot - study, the studies were performed as receiver operating characteristic (ROC) analysis. From one exposure, two digital radiographs were obtained, one simulating the film-screen radiograph and one enhanced, using an unsharp mask. The conventional radiograph was compared to this double-image, but in addition to this, even to the simulated normal and enhanced separately (1-3). To evaluate the value of inverted (positive) radiographs, the original digital (negative) radiographs were inverted, and then compared to the originals (4). As digitzation means easy storing and transfer of data and possibility of electronic display, the diagnostic performance of an interactive workstation was assessed (5). In the clinical studies, a variety of chest affections were used: atelectasis, tumor, pneumothorax, fibrosis, mediastinal and bony changes, tuberculosis, incompensations and enlargement of the heart (1), pneumothorax (2), fibrosis (3), and tumor (4). In the phantom studies, test objects simulating tumors (4) and pneumothorax (5) were used. In no study was statistical significant difference seen between the digital and conventional system (p>0.05). Neither in the clinical nor the phantom study did inversion of the radiographs improve diagnostic performance. The workstation performed almost equally well as the radiographs even with a resolution of 1.25 1p/mm compared to the digital radiographs 2.5 and film-screen radiographs 5 1p/mm. (au) (50 refs.)

  11. Management of chest drainage tubes after lung surgery.

    Science.gov (United States)

    Satoh, Yukitoshi

    2016-06-01

    Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient's characteristics, and the operative procedures that had been performed. PMID:27048219

  12. Effect of rib-cage structure on acoustic chest impedance

    DEFF Research Database (Denmark)

    Zimmermann, Niels Henrik; Møller, Henrik; Hansen, John; Hammershøi, Dorte; Rubak, Per

    When a stethoscope is placed on the surface of the chest, the coupler picks up sound from heart and lungs transmitted through the tissues of the ribcage and from the surface of the skin. If the acoustic impedance of the chest surface is known, it is possible to optimize the coupler for picking up...

  13. Resuscitation, prolonged cardiac arrest, and an automated chest compression device

    DEFF Research Database (Denmark)

    Risom, Martin; Jørgensen, Henrik; Rasmussen, Lars S;

    2010-01-01

    The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest.......The European Resuscitation Council's 2005 guidelines for cardiopulmonary resuscitation (CPR) emphasize the delivery of uninterrupted chest compressions of adequate depth during cardiac arrest....

  14. Sexual, Physical, Verbal/Emotional Abuse and Unexplained Chest Pain

    Science.gov (United States)

    Eslick, Guy D.; Koloski, Natasha A.; Talley, Nicholas J.

    2011-01-01

    Objectives: Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained…

  15. Lung mass, right upper lung - chest x-ray (image)

    Science.gov (United States)

    This picture is a chest x-ray of a person with a lung mass. This is a front view, where the lungs are the two dark areas and ... visible in the middle of the chest. The x-ray shows a mass in the right upper lung, ...

  16. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis

    Directory of Open Access Journals (Sweden)

    Ritesh Agarwal

    2012-01-01

    Full Text Available AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT chest manifestations in glucocorticoid-naïve allergic bronchopulmonary aspergillosis (ABPA patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-naïve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.

  17. Measurement of characteristic leap interval between chest and falsetto registers

    NARCIS (Netherlands)

    Miller, DG; Svec, JG; Schutte, HK

    2002-01-01

    A markedly smaller time constant distinguishes a chest-falsetto leap from the more usual execution of a sung interval by muscular adjustments in the length and tension of the vocal folds. The features of such a chest-falsetto leap are examined in detail with respect to F-0, peak-to-peak amplitude of

  18. Effect of rib-cage structure on acoustic chest impedance

    DEFF Research Database (Denmark)

    Zimmermann, Niels Henrik; Møller, Henrik; Hansen, John;

    2011-01-01

    When a stethoscope is placed on the surface of the chest, the coupler picks up sound from heart and lungs transmitted through the tissues of the ribcage and from the surface of the skin. If the acoustic impedance of the chest surface is known, it is possible to optimize the coupler for picking up...

  19. Surgical Planning by 3D Printing for Primary Cardiac Schwannoma Resection.

    Science.gov (United States)

    Son, Kuk Hui; Kim, Kun-Woo; Ahn, Chi Bum; Choi, Chang Hu; Park, Kook Yang; Park, Chul Hyun; Lee, Jae-Ik; Jeon, Yang Bin

    2015-11-01

    We report herein a case of benign cardiac schwannoma in the interatrial septum. A 42-year-old woman was transferred from a clinic because of cardiomegaly as determined by chest X-ray. A transthoracic echocardiography and chest computed tomography examination revealed a huge mass in the pericardium compressing the right atrium, superior vena cava (SVC), left atrium, and superior pulmonary vein. To confirm that the tumor originated from either heart or mediastinum, cine magnetic resonance imaging was performed, but the result was not conclusive. To facilitate surgical planning, we used 3D printing. Using a printed heart model, we decided that tumor resection under cardiopulmonary bypass (CPB) through sternotomy would be technically feasible. At surgery, a huge tumor in the interatrial septum was confirmed. By incision on the atrial roof between the aorta and SVC, tumor enucleation was performed successfully under CPB. Pathology revealed benign schwannoma. The patient was discharged without complication. 3D printing of the heart and tumor was found to be helpful when deciding optimal surgical approach. PMID:26446661

  20. Cutaneous metastasis of medullary carcinoma thyroid masquerading as subcutaneous nodules anterior chest and mandibular region.

    Science.gov (United States)

    Mannan, Rahul; Kaur, Jasmine; Kaur, Jasleen; Piplani, Sanjay; Kaur, Harjot; Kaur, Harleen

    2014-01-01

    Cutaneous metastasis of underlying primary malignancies can present to dermatologist with chief complaints of cutaneous lesions. The underlying malignancy is generally diagnosed much later after a complete assessment of the concerned case. Medullary carcinoma thyroid (MCT) is a relatively uncommon primary neoplasia of the thyroid. Very few cases presenting as cutaneous metastases of MCT have been reported in the literature. Most of the cases which have been reported are of the papillary and the follicular types. We here report a case of a patient who presented in the dermatology clinic with the primary complaint of multiple subcutaneous nodules in anterior chest wall and left side of body of mandible. By systematic application of clinical and diagnostic skills these nodules were diagnosed as cutaneous metastasis of MCT bringing to the forefront a history of previously operated thyroid neoplasm. So clinically, the investigation of a flesh coloured subcutaneous nodule, presenting with a short duration, particularly in scalp, jaw, or anterior chest wall should include possibility of metastastic deposits. A dermatologist should keep a possibility of an internal organ malignancy in patients while investigating a case of flesh coloured subcutaneous nodules, presenting with short duration. A systematic application of clinical and diagnostic skills will eventually lead to such a diagnosis even when not suspected clinically at its primary presentation. A prompt and an emphatic diagnosis and treatment will have its bearing on the eventual outcome in all these patients. PMID:25478248