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Sample records for chest wall treatment

  1. Ultrasonography of chest wall lesion

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

    1989-12-15

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

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

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    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.

  3. Treatment of a Recurrent Chest Wall Desmoid Tumor Using a CT-Guided Steroid Injection

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    Rhee, Sung Jung; Paik, Sang Hyun; Shin, Hwa Kyoon; Paik, Jai Soung; Lee, Eun Hye [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

    2012-06-15

    We report on a 41-year-old woman with a chest wall desmoid tumour who was successfully treated with a computed tomography (CT)-guided steroid injection. She presented with a palpable mass in the right upper chest wall and was treated by surgical excision and postoperative radiation therapy due to recurrence of the mass at the surgical site. At 20 months after the second operation, a recurrent mass was again detected in the anterosuperior portion of the previous surgical site on CT. We performed a CT-guided steroid injection weekly for 4 weeks by applying a mixture of 3 mL of triamcinolone acetonide (40 mg/mL) and 3 mL of 1% Lidocaine, administering 4-6 mL of the mixture, to the lesion. Six months later, CT showed a marked decrease in the size of the mass.

  4. Primary chest wall lymphoma: A rare entity

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    Binay Kumar Shah

    2015-01-01

    Full Text Available Primary chest wall lymphoma is a rare but curable condition. This paper reports a case of a 52-year-old female patient who presented with a primary chest wall diffuse large B-cell lymphoma.

  5. Quiescent Volcano-Chest Wall Hemangioma.

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    Saldanha, Elroy; Martis, John J S; Kumar, B Vinod; D'Cunha, Rithesh J; Vijin, V

    2017-08-01

    Chest wall hemangiomas are rare tumors that may originate within the soft tissue or from the ribs. Intramuscular hemangioma is infrequent, representing less than 1 % of all hemangiomas, and the localization in the chest wall is even less frequent. They are typically cutaneous in location, large, and poorly circumscribed and can be locally destructive. We present a case of a 34-year-old lady presented with firm lump 3 × 3 cm in left upper and inner quadrant of left breast well defined borders, non-pulsatile and restricted mobility. Sono-mammogram was suggestive of ill-defined lesion at 10 o'clock position. CT chest was conclusive of chest wall hemangioma. The patient underwent excision of the lump. HPE was suggestive of cavernous hemangioma. Cavernous hemangioma typically manifest at birth or before the age of 30 years. CT is more sensitive than plain radiography in detecting phleboliths, which are present in approximately 30 % of cavernous hemangiomas. Surgical excision would be treatment of choice. In this case, the site of the lesion was in the breast clinically mimicking that of a fibroadenoma which warrants hemangioma as a differential diagnosis.

  6. 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.

  7. Chest wall ectopic synovial bursa cyst.

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    Michail, P; Filis, C; Pikoulis, E; Varelas, P; Kyrochristos, D; Mihail, S; Bastounis, E

    1999-11-01

    We report an unusual case of chest wall tumor in a 27-year-old patient. A complete resection was accomplished, and the patient had an excellent postoperative course. Histologically, the mass was confirmed to be an ectopic synovial bursa cyst. Although rare, synovial cysts should be considered in any case of a fluctuating chest wall mass. We also discuss the etiology and diagnostic approach of cystic masses of the chest wall.

  8. Foreign bodies in pleura and chest wall.

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    Weissberg, Dov; Weissberg-Kasav, Dorit

    2008-09-01

    In contrast to other locations, foreign bodies in pleura and chest wall have been rarely reported and there is no consensus with regard to treatment. Between 1971 and 2001, 22 patients with foreign bodies in pleura or chest wall were admitted to our department. Their charts were reviewed for preoperative diagnosis, history, kind and location of the foreign bodies, length of retention, management of patients, and complications. Three etiologic groups were identified: iatrogenic (11 patients), traumatic-intentional (10), and accidental (1). Foreign bodies were extracted in 21 patients: at thoracotomy in 6, direct pleuroscopy in 6, video-thoracoscopy in 4, and simple incision in 5. One foreign body was left behind because of objection of parents. There were no complications and no deaths. Follow-up lasted from one year to 7 years in 15 patients (68.2%). Seven patients did not show for follow-up. Foreign bodies should be removed from pleura and chest wall, when possible. Small, blunt, peripherally located foreign bodies may be left behind if difficulties at extraction are anticipated. Thoracotomy may be needed for treatment of associated injuries, and for removal of materials used in plombage, because of adhesions. In others the use of videothoracoscopy is preferable. Physicians performing diagnostic and therapeutic procedures in anatomic proximity of pleura should exert utmost care to avoid iatrogenic introduction of a foreign body.

  9. Neurofibromas as bilateral cystic chest wall swellings.

    African Journals Online (AJOL)

    Serrano-Egea A, Santo-Briz A, Garcia-Munoz H,. Martinez-Tello F.J. Chest wall harmatoma:a report of two cases with secondary aneurismal bone cysts. Path. Resec. Pract. 2001; 197: 835-9. 9. Ballas K, Rafailidis S, Simeonidis N, Papanikolaou. K, Aimoniotou E, Sakadamis AK. Anterior chest wall. African Health Sciences ...

  10. Novel titanium constructs for chest wall reconstruction in children.

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    Stephenson, Jacob T; Song, Kit; Avansino, Jeffrey R; Mesher, Andrew; Waldhausen, John H T

    2011-05-01

    We have previously reported the use of the vertical expandable prosthetic titanium rib (VEPTR) for treatment of thoracic dystrophy. This report describes our experience with this device and other novel titanium constructs for chest wall reconstruction. This is a retrospective chart review of all children and adolescents undergoing chest wall reconstruction with titanium constructs between December 2005 and May 2010. Six patients have undergone chest wall reconstruction with VEPTR or other titanium constructs. Four had chest wall resection for primary malignancy, 1 had metastatic chest wall tumor resection, and 1 had congenital chest wall deformity. There were no immediate complications, and all patients have exhibited excellent respiratory function with no scoliosis. Chest wall reconstruction after tumor resection or for primary chest wall deformities can be effectively accomplished with VEPTR and other customized titanium constructs. Goals should be durable protection of intrathoracic organs and preservation of thoracic volume and function throughout growth. Careful preoperative evaluation and patient-specific planning are important aspects of successful reconstruction. Copyright © 2011 Elsevier Inc. All rights reserved.

  11. Chest wall tumors presenting as breast lumps.

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    Shousha, Sami; Sinnett, H Dudley

    2004-01-01

    Two recently seen patients presenting with large breast lumps that proved to be pure mesenchymal tumors arising from the underlying chest wall are presented. One tumor proved to be a giant cell tumor of soft tissue and the other an osteogenic sarcoma. It is suggested that these two cases may not be unique and that some mesenchymal breast tumors might have their origin in the chest wall. Breast computed tomography (CT) scans would help identify similar cases.

  12. Chest wall myositis in a patient with acute coronary syndrome.

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    Hussein, Laila; Al-Rawi, Harith

    2014-10-13

    We describe a case of a 42-year-old man who presented to the emergency department with severe left-sided chest pain and chest tenderness of 1-day duration. The pain was episodic and was aggravated by any chest wall movement. His initial blood tests and ECG were suggestive of acute coronary syndrome (ACS). However, his pattern of pain, lack of response to opiates, raised creatine kinase and signs of pleurisy on chest radiograph raised a suspicion of an alternative diagnosis. The patient showed a dramatic response in pain relief to non-steroidal anti-inflammatory medication. He was suspected to have chest wall myositis with pleural involvement in the form of pleurodynia. His serology test was positive for coxsackie virus antibodies. We will discuss in this case report the pathognomonic features, diagnosis and treatment of a rare infectious condition known as Bornholm disease. 2014 BMJ Publishing Group Ltd.

  13. High-dose melphalan followed by radical radiotherapy for the treatment of massive plasmacytoma of the chest wall.

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    Das-Gupta, E P; Sidra, G M; Bessell, E M; Lush, R J; Byrne, J L; Russell, N H

    2003-10-01

    We report three cases of massive chest wall plasmacytoma, each greater than 10 cm in diameter, without evidence of overt myeloma, whom we treated with a combination of VAD chemotherapy consolidated by high-dose melphalan and autologous peripheral blood stem cell transplantation and radical radiotherapy. All three patients completed all components of their therapy without experiencing any major side effects and one patient has had a durable remission. The other two patients have had disease progression but at sites other than the original tumour.

  14. 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

  15. Chest wall tumor at relapse of multiple myeloma

    African Journals Online (AJOL)

    EB

    lytic defect in cranial bone. The skeletal radiograph showed diffuse lytic lesions. Treatment with melphalan and prednisone (MP protocol) was started and bisphosphanate was administered regularly. After two cycles of MP therapy, the patient presented a chest wall tumor, dyspnea and cough (figure 1). The WBC rose to ...

  16. Chondrosarcoma of the chest wall: single-center experience.

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    Al-Refaie, Reda E; Amer, Sameh; Ismail, Mohammed F; Al-Shabrawy, Mohammed; Al-Gamal, Galal; Mokbel, Ehab

    2014-09-01

    chondrosarcoma is the most common primary tumor of the chest wall. We analyzed cases of chest wall chondrosarcoma to establish the presentation, diagnostic tools, surgical treatment, and outcome. this was a retrospective observational analysis of 45 patients who underwent surgery for chondrosarcoma. the mean age was 42.3 ± 8.5 years, and 57.8% patients were male. Symptoms were a painful chest wall mass in 91.1% of patients. Chest radiography and computed tomography, and biopsy were the diagnostic tools. The tumor was right-sided in 57.8% of patients. It was located in the lateral (71.1%), anterior (26.7%), or posterior (2.2%) chest wall. The mean tumor diameter was 7.6 ± 3.3 cm. Radical en-bloc excision was performed in all patients. Chest wall reconstruction was carried out using methylmethacrylate and Prolene mesh (42.2%), Prolene mesh alone (37.8%), and direct closure (20%). A muscle flap was used for soft tissue reconstruction in 11.1%. Complications were encountered in 6.7%. There was no operative mortality. Follow-up was complete in 66.7% of patients. The mean follow-up period was 3.7 ± 2.1 years. Local recurrences and late mortality occurred in 4.4%. surgery for chondrosarcoma can be performed with acceptable morbidity and mortality. Proper selection of patients and radical en-block excision of the tumor are the keys for successful treatment and better outcomes. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  17. Evaluation and treatment of musculoskeletal chest pain.

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    Ayloo, Amba; Cvengros, Teresa; Marella, Srimannarayana

    2013-12-01

    This article summarizes the evaluation and treatment of musculoskeletal causes of chest pain. Conditions such as costochondritis, rib pain caused by stress fractures, slipping rib syndrome, chest wall muscle injuries, fibromyalgia, and herpes zoster are discussed, with emphasis on evaluation and treatment of these and other disorders. Many of these conditions can be diagnosed by the primary care clinician in the office by history and physical examination. Treatment is also discussed, including description of manual therapy and exercises as needed for some of the conditions. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Treatment planning study of Volumetric Modulated Arc Therapy and three dimensional field-in-field techniques for left chest-wall cancers with regional lymph nodes.

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    Xu, Heping; Hatcher, Gillian

    2016-01-01

    This study aims to investigate whether there are dosimetric advantages to using VMAT (Volumetric Modulated Arc Therapy) for left-sided chest-wall patients over the three-dimensional conformal field-in-field (FinF) technique. There is a lack of dosimetric studies dedicated for chest-wall patients. Potential dosimetric advantage could be obtained using VMAT due to complex geometry of PTVs (Planning Target Volumes) and OARs (Organs at Risk) in chest-wall and lymph nodes. VMAT and FinF plans were generated and evaluated based on DVHs (Dose Volume Histograms) for both PTVs and OARs for 22 left-sided chest-wall patients with involved regional nodes. PTV HIs (Homogeneity Indices) and CIs (Conformity Indices), and EUDs (Equivalent Uniform Doses) for PTVs and OARs were also evaluated for comparisons between VMAT and FinF. FinF planning met PTV criteria adequately in all cases except two. In these two cases, VMAT was able to meet PTV criteria adequately. VMAT demonstrated significant reduction in left lung V 20 Gy in chest-wall patients compared to FinF plans. The volumes of the right lung and right breast receiving 5 Gy were much higher in VMAT than those in FinF for all patients. Compared to the FinF technique, there is a generally limited benefit using VMAT for left-sided chest-wall patients due to large low-dose-bath to OARs with insignificant improvement in PTV coverage. In case where FinF planning cannot meet dose constrains, VMAT provides a viable option. The use of VMAT planning over the FinF technique in chest-wall cancers should be carefully analyzed on an individual basis.

  19. Thrombophlebitis of the lateral chest wall (Mondor's disease).

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    Crisan, D; Badea, R; Crisan, Maria

    2014-01-01

    Mondor's disease is a rare condition, which involves the thrombophlebitis of the superficial veins of the breast and anterior chest wall. A 37-year-old woman presented with sudden onset of local pain and edema on her right chest wall, accompanied by a longitudinal retraction of the skin during arm abduction in the area. Clinical, histological and ultrasonographic findings confirmed Mondor's disease and the treatment was symptomatic, using pain relievers and warm compresses. The symptomatology remitted within 2 weeks of therapy. Mondor's disease is a rare condition where ultrasound complements the clinical evaluation and allows the characterization of certain abnormalities, which correlated with functional biochemical data and other procedures may substitute the need of biopsy.

  20. Thrombophlebitis of the lateral chest wall (Mondor′s disease

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    D Crisan

    2014-01-01

    Full Text Available Mondor′s disease is a rare condition, which involves the thrombophlebitis of the superficial veins of the breast and anterior chest wall. A 37-year-old woman presented with sudden onset of local pain and edema on her right chest wall, accompanied by a longitudinal retraction of the skin during arm abduction in the area. Clinical, histological and ultrasonographic findings confirmed Mondor′s disease and the treatment was symptomatic, using pain relievers and warm compresses. The symptomatology remitted within 2 weeks of therapy. Mondor′s disease is a rare condition where ultrasound complements the clinical evaluation and allows the characterization of certain abnormalities, which correlated with functional biochemical data and other procedures may substitute the need of biopsy.

  1. Chest Wall Segmentation in Automated 3D Breast Ultrasound Scans

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    Tan, T.; Platel, B.; Mann, R.M.; Huisman, H.; Karssemeijer, N.

    2013-01-01

    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

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

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    Diogo Franco

    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.

  3. Materials and techniques in chest wall reconstruction: a review.

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    Sanna, Stefano; Brandolini, Jury; Pardolesi, Alessandro; Argnani, Desideria; Mengozzi, Marta; Dell'Amore, Andrea; Solli, Piergiorgio

    2017-01-01

    Extensive chest wall resection and reconstruction are a challenging procedure that requires a multidisciplinary approach, including input from thoracic surgeon, plastic surgeon and oncologist. In particular chest wall neoplastic pathology is associated with high surgical morbidity and can result in full thickness defects hard to reconstruct. The goals of a successful chest wall reconstruction are to restore the chest wall rigidity, preserve pulmonary mechanic and protect the intrathoracic organs minimizing the thoracic deformity. In case of large full thickness defects synthetic, biologic or composite meshes can be used, with or without titanium plate to restore thoracic cage rigidity as like as more recently the use of allograft to reconstruct the sternum. After skeletal stability is established full tissue coverage can be achieved using direct suture, skin graft or local advancement flaps, pedicled myocutaneous flaps or free flaps. The aim of this article is to illustrate the indications, various materials and techniques for chest wall reconstruction with the goal to obtain the best chest wall rigidity and soft tissue coverage.

  4. Chest wall myositis in a patient with acute coronary syndrome

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    Hussein, Laila; Al-Rawi, Harith

    2014-01-01

    We describe a case of a 42-year-old man who presented to the emergency department with severe left-sided chest pain and chest tenderness of 1-day duration. The pain was episodic and was aggravated by any chest wall movement. His initial blood tests and ECG were suggestive of acute coronary syndrome (ACS). However, his pattern of pain, lack of response to opiates, raised creatine kinase and signs of pleurisy on chest radiograph raised a suspicion of an alternative diagnosis. The patient showed...

  5. Physiotherapy as an adjuvant to the surgical treatment of anterior chest wall deformities: a necessity? A prospective descriptive study in 21 patients.

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    Schoenmakers, M A; Gulmans, V A; Bax, N M; Helders, P J

    2000-10-01

    The authors postulated that physiotherapy as an adjuvant to the surgical treatment of anterior chest wall deformities is only indicated if specific abnormalities can be found that could be corrected by physiotherapy. The purpose of this study is to investigate whether such abnormalities can be found and to evaluate their course during a postoperative period of 18 months. Twenty-one patients, 16 with pectus excavatum and 5 with pectus carinatum, were evaluated 6 weeks before and 6 weeks, 6 months, and 18 months after surgical correction. Postural impairments, spinal mobility and curvature, muscle strength, and muscle length were evaluated. Preoperatively, poor posture was seen in 10 patients, nonstructural scoliosis in 11, and abdominal muscle weakness in 4 patients. None of the patients had restriction of spinal mobility or shortened pectoral muscles. Six weeks after surgery, poor posture was seen in 9, nonstructural scoliosis in 11, and abdominal muscle weakness in 10 patients. The authors found a higher percentage of recovery for abdominal muscle weakness than for poor posture (90% versus 33%, respectively). The authors found preoperative postural impairments in 52% of their patients, in patients with pectus carinatum as well as in patients with pectus excavatum. In patients without postural impairments, physiotherapy is not necessary, with the exception of postoperative pulmonary care.

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

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    Stephans, Kevin L., E-mail: stephak@ccf.org [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH (United States); Djemil, Toufik; Tendulkar, Rahul D. [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH (United States); Robinson, Cliff G. [Department of Radiation Oncology, Siteman Cancer Center, Washington University, St Louis, MO (United States); Reddy, Chandana A.; Videtic, Gregory M.M. [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, OH (United States)

    2012-02-01

    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 cm{sup 3}. 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 cm{sup 3} or less and V60 to 3 cm{sup 3} or less should result in a 10% to 15% risk of late chest wall toxicity or lower.

  7. The treatment of spine and chest wall deformities with fused ribs by expansion thoracostomy and insertion of vertical expandable prosthetic titanium rib: growth of thoracic spine and improvement of lung volumes.

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    Emans, John B; Caubet, Jean François; Ordonez, Claudia L; Lee, Edward Y; Ciarlo, Michelle

    2005-09-01

    Prospective clinical trial of vertical expandable prosthetic titanium rib (VEPTR) in patients with combined spine and chest wall deformity with scoliosis and fused ribs. Report the efficacy and safety of expansion thoracostomy and VEPTR surgery in the treatment of thoracic insufficiency syndrome (TIS) associated with fused ribs. Traditional attitudes toward early-onset combined chest and spine deformity assume that thoracic deformity is best controlled by treatment directed at spine deformity, often involving early spinal arthrodesis. Campbell and others have heightened awareness of the interrelationship between lung, chest, and spine development during growth and characterized TIS as the inability of the thorax to support normal respiration or lung growth. Expansion thoracostomy and VEPTR insertion was developed to directly control both spine and chest wall deformity during growth, while permitting continued vertebral column and chest growth at an early stage. Multidisciplinary evaluation of children with combined spine and chest wall deformity included pediatric pulmonologist, thoracic, and orthopedic surgeon evaluations. One or more opening wedge expansion thoracostomies and placement of VEPTR devices were performed as described by Campbell, with repeated device lengthenings during growth. Parameters measured included Cobb angle, length of thoracic spine, CT-derived lung volumes, and in older children pulmonary function tests. Thirty-one patients with fused ribs and TIS were treated, 4 of whom had undergone prior spinal arthrodesis at other institutions with continued progression of deformity. In 30 patients, the spinal deformity was controlled and growth continued in the thoracic spine during treatment at rates similar to normals. Increased volume of the constricted hemithorax and total lung volumes obtained during expansion thoracostomy were maintained at follow-up. Complications included device migration, infection, and brachial plexus palsy. Expansion

  8. Ventilation distribution and chest wall mechanics in microgravity

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    Paiva, M.; Wantier, M.; Verbanck, S.; Engel, L. A.; Prisk, G. K.; Guy, H. J. B.; West, J. B.

    1997-01-01

    The effect of gravity on lung ventilation distribution and the mechanisms of the chest wall were investigated. The following tests were performed with the respiratory monitoring system of the Anthorack, flown onboard Spacelab D2 mission: single breath washout (SBW), multiple breath washout (MBW) and argon rebreathing (ARB). In order to study chest wall mechanisms in microgravity, a respiratory inductive plethysmograph was used. The SBW tests did not reach statistical significance, while the ARB tests showed that gravity independent inhomogeneity of specific ventilation is larger than gravity dependent inhomogeneity. In which concerns the chest wall mechanisms, the analysis on the four astronauts during the normal respirations of the relaxation maneuver showed a 40 percent increase on the abdominal contribution to respiration.

  9. Chest wall syndrome among primary care patients: a cohort study

    Directory of Open Access Journals (Sweden)

    Verdon François

    2007-09-01

    Full Text Available Abstract Background The epidemiology of chest pain differs strongly between outpatient and emergency settings. In general practice, the most frequent cause is the chest wall pain. However, there is a lack of information about the characteristics of this syndrome. The aims of the study are to describe the clinical aspects of chest wall syndrome (CWS. Methods Prospective, observational, cohort study of patients attending 58 private practices over a five-week period from March to May 2001 with undifferentiated chest pain. During a one-year follow-up, questionnaires including detailed history and physical exam, were filled out at initial consultation, 3 and 12 months. The outcomes were: clinical characteristics associated with the CWS diagnosis and clinical evolution of the syndrome. Results Among 24 620 consultations, we observed 672 cases of chest pain and 300 (44.6% patients had a diagnosis of chest wall syndrome. It affected all ages with a sex ratio of 1:1. History and sensibility to palpation were the keys for diagnosis. Pain was generally moderate, well localised, continuous or intermittent over a number of hours to days or weeks, and amplified by position or movement. The pain however, may be acute. Eighty-eight patients were affected at several painful sites, and 210 patients at a single site, most frequently in the midline or a left-sided site. Pain was a cause of anxiety and cardiac concern, especially when acute. CWS coexisted with coronary disease in 19 and neoplasm in 6. Outcome at one year was favourable even though CWS recurred in half of patients. Conclusion CWS is common and benign, but leads to anxiety and recurred frequently. Because the majority of chest wall pain is left-sided, the possibility of coexistence with coronary disease needs careful consideration.

  10. MULTIMODALITY THERAPY FOR OSTEOSARCOMA OF THE STERNUM WITH RECONSTRUCTION OF COMPLEX CHEST WALL DEFECTS

    Directory of Open Access Journals (Sweden)

    V. E. Ivanov

    2017-01-01

    Full Text Available Background. Osteosarcoma is a high-grade malignant bone tumor that accounts for up to 6 % of all bone neoplasms. There are only a few published cases of primary sternal osteosarcomas, reflecting the rarity of these tumors. Recently, there has been a growing interest in performing radical excisions of chest wall tumors followed by combined single-stage reconstruction of the rib cage with implants made of biologically compatible materials. Material and methods. We present the case of a 49-year-old woman diagnosed with osteosarcoma of the sternum. The patient received a combined modality treatment including chemotherapy, radiotherapy and surgery. Titanium nickelid implants were used for the reconstruction of chest wall defects. Results. The multimodality treatment with reconstruction of postoperative chest wall defects allowed the achievement of the optimal quality of life for 21 months in the patient with very poor prognosis. Conclusion. The chest wall reconstruction using biocompatible materials from titanium nickelid appeared to be an effective and safe technique for the treatment of chest wall tumors.

  11. Radical resection of giant chondrosarcoma of the anterior chest wall

    Directory of Open Access Journals (Sweden)

    Stanić Vojkan

    2008-01-01

    Full Text Available Background. Chondrosarcomas represent approximately 30% of primary malignant bone tumors, the most frequent of which is on anterior thoracic wall. Case report. We presented a case of 50-year-old man suffering from a slowgrowing, painless giant chondrosarcoma of the anterior chest wall. A wide resection was performed to excise the tumor including attached skin, right breast, ribs, sternum, soft tissues and parietal pleura. Mediastinum was not affected by the tumor. After resecting a 26 × 20 × 22 cm segment, the chest wall defect was reconstructed with a Marlex mesh and extensive latissimus dorsi myocutaneous flap pedicled on the right thoracodorsal vessels. Histopatology diagnosis was chondrosarcoma G 2−3. The mechanics of ventilation was not altered and respiratory function was normal from the immediate postoperative period. Three years after the operation postoperative results showed no local recurrence and excellent functional and aesthetic results were evident. Respiratory function remained unaltered. Conclusion. According to the results it can be concluded that the use of Marlex mash and myocutaneous flap is good method for stabilization of the chest wall and enough to avoid paradoxical respiratory movements in managing giant chondrosarcoma of the anterior chest wall.

  12. [Reconstruction of full-thickness chest wall defects].

    Science.gov (United States)

    Guo, Lingli; Xing, Xin; Li, Junhui; Xue, Chunyu; Bi, Hongda; Li, Zhigang

    2011-12-01

    To investigate the surgical techniques and effectiveness for reconstruction of severe full-thickness chest wall defects. Between January 2006 and December 2010, 14 patients with full-thickness chest wall defects were treated, including 12 cases caused by giant chest wall malignant tumor excision, 1 case by thermocompression injury, and 1 case by radiation necrosis. There were 8 males and 6 females with an average age of 42 years (range, 23-65 years). The size of chest wall defects ranged from 8 cm x 5 cm to 26 cm x 14 cm. All patients complicated by rib defect (1-5 ribs), and 3 cases by sternum defect. Thoracic skeleton reconstruction was performed with Vicryl mesh or polytetrafluoroethylene mesh in 10 patients. Other 4 patients did not undergo thoracic skeleton reconstruction. The bilobed skin flaps, pectoralis major myocutaneous flap, latissimus dorsi myocutaneous flap, and rectus abdominis myocutaneous flap were utilized for repairing soft tissue defects. The size of the dissected flaps ranged from 10 cm x 7 cm to 25 cm x 13 cm. The donor sites were sutured directly or were repaired by free skin graft. Poor healing of incision occurred in 2 cases, which was cured after debridement, myocutaneous flap transfer, and skin graft. The other wounds healed by first intention. All patients were followed up 6-36 months (mean, 8 months). No tumor recurrence during follow-up, except 1 patient with osteosarcoma who died of liver metastasis at 6 months after operation. Transient slight paradoxical respiration occurred in 1 patient who did not undergo thoracic skeleton reconstruction at 5 days after operation. Integrity of chest wall in other patients was restored without paradoxical respiration and dyspnea. Depending on the cause, the size, and the location of defect, single or combination flaps could be used to repair soft tissue defect, and thoracic skeleton reconstruction should be performed when defect is severe by means of synthetic materials.

  13. Primary infiltrating ductal carcinoma of the axillary breast with metastasis to the contralateral chest wall

    Directory of Open Access Journals (Sweden)

    Li-Min Sun

    2013-06-01

    Full Text Available Primary infiltrating ductal carcinoma of the axillary breast is rare and has a high frequency of lymph node (LN involvement. We report a woman with primary infiltrating ductal carcinoma arising from the right axillary breast with metastasis to the contralateral chest wall. Excisional biopsy of the left chest wall nodule and the right axillary mass was carried out and both showed invasive ductal carcinomas histologically. The lesion of the right axillary mass arose from the breast tissue, rather than the LN. Further surgery proved the right axillary LN metastasis. After further review, a primary infiltrating ductal carcinoma of the right axillary breast with metastasis to axillary LNs and contralateral chest wall was diagnosed. The patient also received chemotherapy and radiation and there was no evidence of tumor recurrence after treatment. The present report demonstrated a rare case with uncommon manifestation. Lesions of uncertain origin around the periphery of the breast should be suspected for breast carcinoma.

  14. 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.

  15. Giant Anterior Chest Wall Basal Cell Carcinoma: An Approach to Palliative Reconstruction

    Directory of Open Access Journals (Sweden)

    Pauline Joy F. Santos

    2016-01-01

    Full Text Available Anterior chest wall giant basal cell carcinoma (GBCC is a rare skin malignancy that requires a multidisciplinary treatment approach. This case report demonstrates the challenges of anterior chest wall GBCC reconstruction for the purpose of palliative therapy in a 72-year-old female. Surgical resection of the lesion included the manubrium and upper four ribs. The defect was closed with bilateral pectoral advancement flaps, FlexHD, and pedicled VRAM. The palliative nature of this case made hybrid reconstruction more appropriate than rigid sternal reconstruction. In advanced metastatic cancers, the ultimate goals should be to avoid risk for infection and provide adequate coverage for the defect.

  16. Palpation for muscular tenderness in the anterior chest wall

    DEFF Research Database (Denmark)

    Christensen, H.W.; Vach, W.; Manniche, C.

    2003-01-01

    palpating for intercostal tenderness or tenderness in the minor and major pectoral muscles in a population of patients with and without chest pain. This may hamper the ability of clinicians to diagnose and classify the musculoskeletal component of chest pain if based exclusively on palpation of the anterior......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...

  17. Management of tumors of the chest wall in childhood: a review

    NARCIS (Netherlands)

    van den Berg, Hendrik; van Rijn, Rick R.; Merks, Johannes Hm

    2008-01-01

    Chest wall tumors in childhood are major challenges with respect to diagnostic workup and treatment. Incidence rate is less than 1 per 1,000,000 and various benign and malignant diseases are noted. From the malignant diseases, Ewing tumors and rhabdomyosarcoma tumors are most often seen. Depending

  18. Extraocular sebaceous carcinoma on the chest wall - a case report.

    Science.gov (United States)

    Mn, Raghuveer; Sr, Diwakar; Thulasi, Vasudevaiah; Shenoy, K Manjunath

    2014-06-01

    Sebaceous carcinoma is a rare aggressive skin cancer derived from the epithelium of sebaceous glands. Sebaceous carcinomas are generally divided as ocular or extraocular locations. Very few cases of extra ocular sebaceous carcinomas have been reported till date. Among them only six cases were reported which were on the chest wall. We are hereby reporting the seventh case of sebaceous carcinoma on the chest wall. The disease exhibits diverse clinical presentations and histologic patterns, often resulting in a delay in an accurate diagnosis as it may mimic many other cutaneous malignancies like Dermatofibrosarcoma protuberance Basal Cell Carcinoma or Squamous Cell Carcinoma. High degree of suspicion is required and sebaceous carcinoma should be considered as one of the differential diagnosis for an ulceroproliferative growth on the skin.

  19. En Bloc Resection for Lung Cancer with Chest Wall Invasion

    Directory of Open Access Journals (Sweden)

    Yu-Teng Lin

    2006-04-01

    Conclusion: En bloc resection for bronchogenic carcinoma invading the chest wall provides a favorable prognosis in cases without nodal metastasis. Significant postoperative mortality is associated with old age (> 80 years. The 5-year survival rate is not significantly different between the patients with involvement of the parietal pleura only and the patients with involvement of the parietal pleura and the soft tissue and/or bone.

  20. Giant Chest Wall Hematoma Mimicking Elastofibroma Dorsi: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Yeon Soo; Park, Kuhn; Kim, Jong Ok; Choi, Eun Seok; Kang, Si Won [Daejeon St. Mary' s Hospital, The Catholic University of Korea, Daejeon (Korea, Republic of)

    2011-02-15

    Hematoma on the thoracic wall is very rare. We describe here a 63-year-old man with a huge chest wall hematoma and the man had no history of trauma. The patient was found to have a large mass located subjacent to the inferior angle of the right scapula area and the CT and MRI findings were similar to those of an elastofibroma dorsi. We describe the CT and MRI findings of this hematoma and how to make the differential diagnosis from elastofibroma dorsi

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

    Directory of Open Access Journals (Sweden)

    Yusuke Yamaoka

    2014-01-01

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

  2. Hemorrhagic lesion on the chest wall after trauma.

    LENUS (Irish Health Repository)

    Roche, Lisa

    2018-01-01

    A 59-year-old woman presented with a burning, rapidly progressive mass on the midchest, occurring after a fall, 4 months prior. Examination found a large well-circumscribed mass over the lower xiphisternum (Figs 1 and 2). Results of baseline investigations were normal apart from mildly elevated liver function values. A computerized tomography scan confirmed a 6.4- x 4.9-cm lobulated soft tissue heterogeneous-density mass located in the subcutaneous fat with ill-defined borders and no obvious infiltration of the chest wall. A single focal abnormality\\r\

  3. Pneumothorax, without chest wall fracture, following airbag deployment

    Directory of Open Access Journals (Sweden)

    Samuel Parsons

    2010-12-01

    Full Text Available Air bags are an automatic crash protection system. They have been shown to reduce mortality from motor vehicle accidents by 31% following direct head-on impacts, by 19% following any frontal impact and by 11% overall. Despite obvious benefits there has been a corresponding increase in the number of injuries resulting from their deployment. We describe a case of a pneumothorax in the absence of chest wall pathology associated with airbag deployment, in a belted driver. There has been one previous description of pneumothorax associated with airbag deployment, in an unbelted driver.

  4. Treatment of 336 cases of chest trauma.

    Science.gov (United States)

    Zhang, Jing; Chu, Xiang-Yang; Liu, Yi; Wang, Yun-Xi

    2012-01-01

    To summarize the clinical features, diagnosis and treatment of chest trauma. A retrospective analysis was conducted among 336 cases of chest trauma admitted to our hospital from January 2009 to May 2011. 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 respiratory distress syndrome, three of multiple organ failure, and four of severe multiple traumas. (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 diaphragmatic 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 combination of strong anti-infection therapy and mechanical ventilation is an effective treatment strategy.

  5. Skin and chest wall dose with multi-catheter and MammoSite breast brachytherapy: Implications for late toxicity.

    Science.gov (United States)

    Cuttino, Laurie W; Todor, Dorin; Rosu, Miheala; Arthur, Douglas W

    2009-01-01

    Accelerated partial breast irradiation (APBI) continues to increase in popularity. Up to 14% of patients treated with the MammoSite (MS) report some degree of chronic pain, which may be related to chest wall toxicity. Reports from several institutions using the multicatheter (MC) technique have not shown associated elevated chest wall toxicity. Additionally, a recent investigation has suggested that increased toxicity may occur with the MS when the dose to the chest wall exceeds 125% of the prescribed dose. This investigation compares the skin and chest wall doses of a cohort of patients treated with the MC technique to a group treated with the MS. The dosimetric data for 43 patients treated with the MC technique and 83 patients treated with the MS at Virginia Commonwealth University were reviewed. This cohort represents consecutively treated patients from our most recent experience to minimize any learning curve effect on dosimetry. Plans were generated using 3D software (Brachyvision, Varian Medical Systems, Inc., Palo Alto, CA). Multiple dwell positions were used for all MS patients to optimize dose delivery. The minimum distances from the planning target volume to the skin and chest wall were calculated, as well as the maximum doses delivered to the skin and chest wall. The mean skin distances for patients treated with the MC technique and the MS were 0.5 and 0.9cm, respectively (pskin distance, the mean skin dose for the MC technique was only 2.3Gy per fraction (67% of prescription dose). The mean skin dose for the MS was 3.2Gy per fraction (94% of prescription dose, pskin dose for the MS was 3.6Gy per fraction (105% of prescription dose, pskin doses in excess of 125% for the MC and MS were 0% and 9.6%, respectively. The percentage of patients receiving chest wall doses in excess of 125% for the MC and MS were 0% and 38.6%, respectively. The MC technique results in more conformal dose delivery, with significantly lower mean skin and chest wall doses. Treatment

  6. Bodybuilding-induced Mondor's disease of the chest wall.

    Science.gov (United States)

    Tröbinger, Christian; Wiedermann, Christian J

    2017-01-01

    To describe the association of bodybuilding abdominal exercise with the development of superficial sclerosing thrombophlebitis of the anterolateral thoracoabdominal wall. A single case study. University-affiliated regional community hospital. A 54-year-old man presented with an otherwise unremarkable past medical history 4 weeks after the start of left-sided chest discomfort. He had undergone orthopedic surgery of the right shoulder three months earlier. Two months after surgery, he had re-started bodybuilding with thoracoabdominal training. Soon thereafter, he noted a painful induration at the left side of his trunk. Doppler and duplex sonography revealed complete venous occlusion compatible with sclerosing thrombophlebitis leading to a palpable, subcutaneous, cord-like lesion on the left side of his trunk. Physical examination and routine laboratory findings were normal. The lesion spontaneously resolved over a course of 3 months. Mondor's disease of the subcutaneous veins of the chest wall which has been associated with breast or axillary surgery, malignant and systemic diseases can also appear in subjects performing intense thoracoabdominal exercise training. Although it requires only symptomatic therapy, physicians and therapists must be aware of the existence of this disease because, although benign and self-limiting, malignant and systemic diseases need to be ruled out. Copyright © 2016 Elsevier Ltd. All rights reserved.

  7. Multi-Detector CT Findings of Palpable Chest Wall Masses in Children: A Pictorial Essay

    Energy Technology Data Exchange (ETDEWEB)

    Park, Chan Ho; Kim, Young Tong [Dept. of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan (Korea, Republic of); Hong, Hyun Sook [Dept. of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon (Korea, Republic of)

    2013-03-15

    A wide variety of diseases manifest as palpable chest wall masses in children. These include normal variation, congenital anomalies, trauma, infection, axillary lymphadenopathies, soft tissue tumors and bone tumors. Given that most of these diseases are associated with chest wall deformity, diagnosis is difficult by physical examination or ultrasonography alone. However, multi-detector CT with three dimensional reconstruction is useful in the characterization and differential diagnosis of palpable chest wall lesions. In this article, we review the spectrum of palpable chest wall diseases and illustrate their multi-detector CT presentation.

  8. Lung stereotactic ablative radiotherapy (SABR): dosimetric considerations for chest wall toxicity

    Science.gov (United States)

    Murray, Louise; Karakaya, Ebru; Hinsley, Samantha; Naisbitt, Mitchell; Lilley, John; Snee, Michael; Clarke, Katy; Musunuru, Hima B; Ramasamy, Satiavani; Turner, Rob

    2016-01-01

    Objective: To investigate chest wall pain in patients with peripheral early stage lung cancer treated with stereotactic ablative radiotherapy (SABR), and to identify factors predictive of Common Terminology Criteria of Adverse Events Grade 2 + chest wall pain. Methods: Patients who received 55 Gy in five fractions were included. A chest wall structure was retrospectively defined on planning scans, and chest wall dosimetry and tumour-related factors recorded. Logistic regression was performed to identify factors predictive of ≥Grade 2 chest wall pain. Results: 182 patients and 187 tumours were included. There were 20 (10.9%) episodes of ≥Grade 2 chest wall pain. Multivariate logistic regression demonstrated that the maximum dose received by 1 cm3 of chest wall (Dmax1 cm3) and tumour size were significant predictors of ≥Grade 2 chest wall pain [Dmax1 cm3 odds ratio : 1.104, 95% confidence interval : 1.012–1.204, p = 0.025; tumour size (mm) odds ratio : 1.080, 95% confidence interval : 1.026–1.136, p = 0.003]. This model was an adequate fit to the data (Hosmer and Lemeshow test non-significant) and a fair discriminator for chest wall pain (area under receiver-operating characteristic curve: 0.74). Using the multivariate logistic regression model, parameters for Dmax1 cm3 are provided, which predict <10% and <20% risks of ≥Grade 2 chest wall pain for different tumour sizes. Conclusion: Grade 2+ chest wall pain is an uncommon side effect of lung SABR. Larger tumour size and increasing Dmax1 cm3 are significant predictors of ≥Grade 2 chest wall pain. When planning lung SABR, it is prudent to try to avoid hot volumes in the chest wall, particularly for larger tumours. Advances in knowledge: This article demonstrates that Grade 2 or greater chest wall pain following lung SABR is more common when the tumour is larger in size and the Dmax1 cm3 of the chest wall is higher. When planning lung SABR, the risk of chest

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

    Energy Technology Data Exchange (ETDEWEB)

    Rocca, M., E-mail: michele.rocca@ior.it [General and Thoracic Surgery, The Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna (Italy); Salone, M. [General and Thoracic Surgery, The Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna (Italy); Galletti, S. [Ultrasound Unit, The Rizzoli Orthopaedic Institute, Bologna (Italy); Balladelli, A. [Laboratory of Experimental Oncology, The Rizzoli Orthopaedic Institute, Bologna (Italy); Vanel, D. [Research in Imaging Musculo Skeletal Tumors, The Rizzoli Orthopaedic Institute, Bologna (Italy); Briccoli, A. [General and Thoracic Surgery, The Rizzoli Orthopaedic Institute, Via Pupilli 1, 40136 Bologna (Italy)

    2013-12-01

    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.

  10. 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.

  11. Modulation of chest wall intermuscular coherence: effects of lung volume excursion and transcranial direct current stimulation.

    Science.gov (United States)

    Tomczak, Corey R; Greidanus, Krista R; Boliek, Carol A

    2013-08-01

    Chest wall muscle recruitment varies as a function of the breathing task performed. However, the cortical control of the chest wall muscles during different breathing tasks is not known. We studied chest wall intermuscular coherence during various task-related lung volume excursions in 10 healthy adults (34 ± 15 yr; 2 men, 8 women) and determined if transcranial direct current stimulation (tDCS) could modulate chest wall intermuscular coherence during these tasks. Simultaneous assessment of regional intercostal and oblique electromyographic activity was measured while participants performed standardized tidal breathing, speech, maximum phonation, and vital capacity tasks. Lung volume and chest wall kinematics were determined using variable inductance plethysmography. We found that chest wall area of intermuscular coherence was greater during tidal and speech breathing compared with phonation and vital capacity (all P < 0.05) and between tidal breathing compared with speech breathing (P < 0.05). Anodal tDCS increased chest wall area of intermuscular coherence from 0.04 ± 0.09 prestimulation to 0.18 ± 0.19 poststimulation for vital capacity (P < 0.05). Sham tDCS and cathodal tDCS had no effect on coherence during lung volume excursions. Chest wall kinematics were not affected by tDCS. Our findings indicate that lung volume excursions about the midrange of vital capacity elicit a greater area of chest wall intermuscular coherence compared with lung volume excursions spanning the entire range of vital capacity in healthy adults. Our findings also demonstrate that brief tDCS may modulate the cortical control of the chest wall muscles in a stimulation- and lung volume excursion task-dependent manner but does not affect chest wall kinematics in healthy adults.

  12. Chest wall dynamics and muscle recruitment during professional flute playing.

    Science.gov (United States)

    Cossette, Isabelle; Monaco, Pierpaolo; Aliverti, Andrea; Macklem, Peter T

    2008-02-01

    Respiratory parameters and sound were recorded during professional flute playing in order to assess what physiological processes were associated with the control of sound production that results in 'breath support' which in turn is associated with high quality playing. Four standing young professional flautists played flute excerpts with and without breath support. Recordings included optoelectronic plethysmographic measurements of chest wall volume (V(cw)) and its compartments, surface electromyography of the scalene, lateral abdominal, rectus abdominus, parasternal and sternocleidomastoid muscles, mouth pressure, and sound. Flow was estimated from differentiating V(cw) during playing. Results showed that flute support entails antagonistic contraction of non-diaphragmatic inspiratory muscles that tends to hold the rib cage at higher lung volume. This relieves the expiratory muscles from the task of producing the right mouth pressure, especially at the end of the phrases, so they can contribute more to the finer control of mouth pressure modulations required for high quality playing.

  13. Reconstruction of the chest wall after excision of a giant malignant ...

    African Journals Online (AJOL)

    2011-07-29

    Jul 29, 2011 ... Novoa N, Benito P, Jiménez MF, de Juan A, Luis Aranda J, Varela G. Reconstruction of chest wall defects after resection of large neoplasms: Ten-year experience. Interact Cardiovasc Thorac Surg 2005;4:250-5. 8. King RM, Pairolero PC, Trastek VF, Piehler JM, Payne WS, Bernatz PE. Primary chest wall ...

  14. [Reconstructive method after resection of chest wall, diaphragm and pericardium, mainly using Composix-mesh].

    Science.gov (United States)

    Takahashi, Noriyuki

    2014-10-01

    This study examined utility and question about the reconstructive prostheses in 11 cases which were resected chest wall and/or diaphragm and/or pericardium. One of 3 patients, who were used metal plates after chest wall resection, was prevented from post-operative irradiation therapy by limitation and diffuse reflection of beam by the metal plates. Gore-Tex( ePTFE) sheets, which were used for coverage of diaphragm defect and pericardium defect, occurred no problems. Composix-meshes (Composix-Kugel, Hernia-patch) were used for 7 cases which had large defects due to resection of chest wall and diaphragm. These kinds of meshes (or patches) consist of double layer mesh and memory recoil ring and then have airtightness and rigidity. After reconstruction of chest wall and diaphragm there were no problems without any flail chest.

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

    Science.gov (United States)

    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

  16. 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 ...

  17. Extraocular Sebaceous Carcinoma on the Chest Wall – A Case Report

    OpenAIRE

    MN, Raghuveer; SR, Diwakar; Thulasi, Vasudevaiah; Shenoy, K Manjunath

    2014-01-01

    Sebaceous carcinoma is a rare aggressive skin cancer derived from the epithelium of sebaceous glands. Sebaceous carcinomas are generally divided as ocular or extraocular locations. Very few cases of extra ocular sebaceous carcinomas have been reported till date. Among them only six cases were reported which were on the chest wall. We are hereby reporting the seventh case of sebaceous carcinoma on the chest wall. The disease exhibits diverse clinical presentations and histologic patterns, ofte...

  18. Reconstruction of Chest Wall by Cryopreserved Sternal Allograft after Resection of Aneurysmal Bone Cyst of Sternum

    Directory of Open Access Journals (Sweden)

    Kambiz Sheikhy

    2017-01-01

    Full Text Available A 20-year-old female was referred to our hospital due to deformity and bulging in anterior aspect of chest wall in sternal area. Chest X-ray and CT scan confirmed a large mass with destruction of sternum. Pathologic diagnosis after incisional biopsy was compatible with aneurysmal bone cyst. We resected sternum completely and reconstructed large anterior defect by a cryopreserved sternal allograft. In follow-up of patient there was no unstability of chest wall with good cosmetic result.

  19. Penetrating cardiac injuries in blunt chest wall trauma.

    Science.gov (United States)

    Kanchan, Tanuj; Menezes, Ritesh G; Sirohi, Parmendra

    2012-08-01

    The present photocase illustrates the possible mechanism of direct cardiac injuries from broken sharp jagged fractured ends of ribs in blunt force trauma to the chest in run over traffic mishaps. We propose that the projecting fractured ends of the ribs penetrate the underlying thoracic organs due to the transient phenomenon of deformation of chest cavity under pressure in run over traffic mishaps. Copyright © 2012 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

  20. Surgical repair of right atrial wall rupture after blunt chest trauma.

    Science.gov (United States)

    Telich-Tarriba, Jose E; Anaya-Ayala, Javier E; Reardon, Michael J

    2012-01-01

    Right atrial wall rupture after blunt chest trauma is a catastrophic event associated with high mortality rates. We report the case of a 24-year-old woman who was ejected 40 feet during a motor vehicle accident. Upon presentation, she was awake and alert, with a systolic blood pressure of 100 mmHg. Chest computed tomography disclosed a large pericardial effusion; transthoracic echocardiography confirmed this finding and also found right ventricular diastolic collapse. A diagnosis of cardiac tamponade with probable cardiac injury was made; the patient was taken to the operating room, where median sternotomy revealed a 1-cm laceration of the right atrial appendage. This lesion was directly repaired with 4-0 polypropylene suture. Her postoperative course was uneventful, and she continued to recover from injuries to the musculoskeletal system. This case highlights the need for a high degree of suspicion of cardiac injuries after blunt chest trauma. An algorithm is proposed for rapid recognition, diagnosis, and treatment of these lesions.

  1. [Emergency treatment in chest trauma (author's transl)].

    Science.gov (United States)

    Bauer, H; Welsch, K H; Schmidt, G; Härtel, U

    1979-04-01

    The measures taken by the emergency physician can in many cases decisively affect the subsequent course of a chest trauma. In cases where the injured person has to be extricated from collapsed structures the medical officer has to decide on the mode and sequence of the rescue operation, prevent further damage and initiate shock therapy, intubation and artificial ventilation while the rescue operation is in progress. Emergency treatment also includes infusion therapy, if necessary via a central venous catheter; intubation, suction drainage and artificial ventilation; evacuation of fluid from the pleural cavity, mediastinum and pericardium combined with electrodiagnosis (ECG) and electrotherapy (defibrillation) if necessary. By closely observing the reaction and condition of the patient during transport to hospital he can provide important information regarding further treatment, especially in polytraumatized persons. Close collaboration between the trained rescue teams of the Fire Service, the emergency medical officer and the hospital staff has succeeded in reducing the mortality rate of combined chest injuries to 13%. 87% of cases who had received emergency treatment were subsequently admitted to hospital.

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

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    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.)

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

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    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.

  4. FLAIL CHEST

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    Anton Crnjac

    2003-12-01

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

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

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    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.

  6. Paragonimiasis mimicking chest cancer and abdominal wall metastaisis: A case report

    Science.gov (United States)

    ZHOU, RONGXING; ZHANG, MINJIA; CHENG, NANSHENG; ZHOU, YONG

    2016-01-01

    Typical human paragonimiasis demonstrates an elevated eosinophil count, positive immunoblot, nodular shadows of the lung and pleural thickening with pleural effusion, and these symptoms may be confused with chest cancer. In the present case, a rare case of human paragonimiasis mimicking chest cancer and abdominal wall metastasis is described, the 39-year-old male patient was admitted in our hospital for cough, weight loss 5 kg and a firm mass in right upper abdominal wall. The laboratory test showed unremarkable hematology and biochemistry results. Chest X-ray, Plain computed tomography of the chest and abdomen showed right pleural effusion, several nodules in right lower lung and a mass in the right upper abdominal wall. The initial diagnosis was lung or chest cancer with abdominal wall metastasis, and the abdominal wall mass was resected for the final diagnosis. The biopsy revealed eosinophilic granuloma with Charcot-Leyden crystal formation infiltrated in the muscular fibers. Subsequent to assessment of the antibodies against parasites, the final diagnosis of paragonimiasis was made. PMID:27313691

  7. 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.

  8. Implementing a tantalum wire mesh to increase the skin dose in low-energy electron irradiation of the chest wall.

    Science.gov (United States)

    Cederbaum, M; Ravkin, A; Rosenblatt, E; Gez, E

    2001-01-01

    Radiation treatment of the post-mastectomy chest wall is performed in our institution by straight-on electron irradiation. The chest-wall thickness is measured and the beam energy is chosen so that the chest wall is treated to therapeutic doses, while sparing the underlying lung tissue. The most commonly chosen energies are 6 and 9 MeV. The skin dose should be 90% of the dose prescribed to the chest wall, which is higher than can be achieved with 6- and 9-MeV beams because of the low surface dose. The addition of a bolus slab during part of the treatment can correct for this; however, the added depth means that a higher energy has to be chosen, which will increase the lung dose (the higher the electron energy, the slower the falloff of the electron depth-dose curve). A mesh of a high-Z material above the skin gives rise to obliquely scattered and low-energy electrons that effectively spoil the buildup zone. Dosimetric measurements of a Tantalum (Ta) mesh were performed using a dose scanner in a water tank and a film inserted in a humanoid phantom during a simulated treatment. Measurements were also done for the clinically relevant cases of oblique beam incidence and with the mesh placed 1 cm above the surface. The measurements demonstrate the spoiling of the buildup zone, while having only a moderate influence on the dose distribution beyond the dose maximum. The mesh also changes the absolute dose. In a fractionated regime, the first part of the treatment would be without the mesh, adding it only during the latter fractions. The total dose distribution gives 90% to the skin, while leaving the depth-dose characteristics beyond the dose maximum virtually unchanged.

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

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    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.

  10. Continuous on-line measurements of respiratory system, lung and chest wall mechanics during mechanic ventilation.

    Science.gov (United States)

    Kárason, S; Søndergaard, S; Lundin, S; Stenqvist, O

    2001-08-01

    We present a concept of on-line, manoeuvre-free monitoring of respiratory mechanics during dynamic conditions, displaying calculated alveolar pressure/volume curves continuously and separating lung and chest wall mechanics. Prospective observational study. Intensive care unit of a university hospital. Ten ventilator-treated patients with acute lung injury. Different positive end-expiratory pressure (PEEP) and tidal volumes, low flow inflation. Previously validated methods were used to present a single-value dynostatic compliance for the whole breath and a dynostatic volume-dependent initial, middle and final compliance within the breath. A high individual variation of respiratory mechanics was observed. Reproducibility of repeated measurements was satisfactory (coefficients of variations for dynostatic volume-dependent compliance: mechanics during ongoing ventilator treatment.

  11. Cine MRI enables better therapeutic planning than CT in cases of possible lung cancer chest wall invasion.

    Science.gov (United States)

    Kajiwara, Naohiro; Akata, Soichi; Uchida, Osamu; Usuda, Jitsuo; Ohira, Tatsuo; Kawate, Norihiko; Ikeda, Norihiko

    2010-08-01

    To evaluate the hypothesis that lung cancer treatment planning (whether or not to use induction therapy) can be improved if respiratory dynamic cine magnetic resonance imaging (RD MR) is used. We studied 100 lung cancer patients, 76 men and 21 women, scheduled for thoracotomies between May 1997 and December 2006 wherein it was unclear preoperatively whether chest wall invasion would be found. We evaluated the accuracy of RD MR as compared with the findings at operation and postoperative pathology. The accuracy of RD MRI for evaluating chest wall invasion was compared with the efficacy of CT and MRI within our own group of patients and with data from the studies of other investigators. Concerning the evaluation of chest wall invasion, conventional computed tomography (CT) had 43.9% specificity, 60.0% sensitivity and 47.1% accuracy, while RD MR had 68.5% specificity, 100.0% sensitivity and 77.0% accuracy. RD MRI was particularly useful in the evaluation of cancers around 5 cm in diameter that were located adjacent to the diaphragm. Postoperative evaluation of superior sulcus tumor cases that had received induction therapy also showed that the RD MR procedure enabled an accurate decision in 87.5% of cases, and there were no false negative cases. RD MR is more useful than CT or standard MRI for evaluating thoracic wall invasion. This noninvasive method enhances the reliability of deciding whether induction therapy should be employed. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  12. A rare entity of tubercular mastitis with chest wall extension in a male

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    Ved Prakash

    2015-01-01

    Full Text Available Tuberculosis (TB is a chronic granulomatous inflammation involving usually the lung parenchyma and hilar lymph nodes. Extrapulmonary involvement is seen in about 15-20% of all cases of TB (EPTB. But breast TB is rare form of EPTB. We present a case of an immunocompetent male presenting with tubercular mastitis associated with chest wall extension. The rarity of this case lies in the site of involvement (chest wall, the way of presentation, and because of the immunocompetent status of the patient.

  13. Reconstruction of Anterior Chest Wall with Polypropylene Mesh: Two Primary Sternal Chondrosarcoma Cases.

    Science.gov (United States)

    Kawana, Shinichi; Yamamoto, Hiromasa; Maki, Yuho; Sugimoto, Seiichiro; Toyooka, Shinichi; Miyoshi, Shinichiro

    2017-06-01

     Primary sternal chondrosarcoma is a rare malignant tumor that is refractory to chemotherapy and radiation. Effective therapy is radical resection of the tumor. We present two patients with primary sternal chondrosarcoma who underwent a radical resection of the lower half of the sternum and bilateral ribs, followed by reconstruction with 2 sheets of polypropylene mesh layered orthogonally. The patients have maintained almost the same pulmonary function as preoperative values, with stability of the chest wall. Although there are various ways to reconstruct the anterior chest wall, reconstruction with polypropylene mesh layered orthogonally is an easy-to-use and sufficient method.

  14. Effect of high-frequency chest wall oscillation on pulmonary function after pulmonary lobectomy for non-small cell lung cancer.

    Science.gov (United States)

    Park, Heesung; Park, JoonSuk; Woo, Sook Young; Yi, Young Hee; Kim, Kwhanmien

    2012-09-01

    We examined the feasibility of high-frequency chest wall oscillationtherapy in immediate postoperative lung recruitment after pulmonary lobectomy for non-small cell lung cancer compared to conventional chest physiotherapy. A prospective, single-blind, randomized trial was conducted at Samsung Medical Center between March 2010 and May 2010. Patients were randomized to either the high-frequency chest wall oscillation group or the conventional percussive physiotherapy (control) group. : Briefly, the eligibility criteria included 1) participants between the ages of 35 and 70 yrs, 2) candidates of lobectomy for non-small cell lung cancer, and 3) the first elective surgery of the day. Sixty-six patients were enrolled in the study. Patients in the control group had routine postoperative percussive chest physiotherapy four times a day. Participants in the high-frequency chest wall oscillation group received three sessions of high-frequency chest wall oscillation treatment every 8 hrs for 15 mins starting 4 hrs after surgery. All the treatments and measurements were performed by randomly assigned nursing staff who had received standardized education for respiratory care and who were not aware of the details of the study. The primary outcome was postoperative change of forced expiratory volume for 1 sec, and secondary outcomes were changes in arterial oxygen partial pressure and saturation. Safety outcomes and pain scores were also investigated. Patients in the high-frequency chest wall oscillation group experienced significantly improved recovery of pulmonary function as assessed by forced expiratory volume for 1 sec on the third and fifth postoperative days (p = .03) and improved oxygenation on the first postoperative day (p < .01). There were no significant differences in pain score or analgesic requirements. There were no unexpected complications, such as hemodynamic deterioration, postoperative bleeding or chest tube, and wound problems associated with the high

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

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    A. M. Khadjibaev

    2016-01-01

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

  16. Effects of Air Stacking Maneuver on Cough Peak Flow and Chest Wall Compartmental Volumes of Subjects With Amyotrophic Lateral Sclerosis.

    Science.gov (United States)

    Sarmento, Antonio; Resqueti, Vanessa; Dourado-Júnior, Mario; Saturnino, Lailane; Aliverti, Andrea; Fregonezi, Guilherme; de Andrade, Armele Dornelas

    2017-11-01

    To assess the acute effects of air stacking on cough peak flow (CPF) and chest wall compartmental volumes of persons with amyotrophic lateral sclerosis (ALS) versus healthy subjects positioned at 45° body inclination. Cross-sectional study with a matched-pair design. University hospital. Persons (N=24) with ALS (n=12) and age-matched healthy subjects (n=12). CPF, chest wall compartmental inspiratory capacity, chest wall vital capacity, chest wall tidal volume and operational volumes, breathing pattern, and percentage of contribution of the compartments to the inspired volume were measured by optoelectronic plethysmography. Compared with healthy subjects, significantly lower CPF (P=.007), chest wall compartmental inspiratory capacity (P<.001), chest wall vital capacity (P<.001), and chest wall tidal volume (P<.001) were found in subjects with ALS. Immediately after air stacking, CPF (P<.001) and chest wall compartmental inspiratory capacity (P<.001) significantly increased in both groups, with values returning to basal only in healthy subjects. After air stacking, the abdominal compartment (P=.004) was determined to be responsible for the inspired volume in subjects with ALS. Significantly higher chest wall vital capacity (P=.05) was observed in subjects with ALS 5 minutes after air stacking, with the rib cage compartment (P=.049) being responsible for volume change. No differences were found in chest wall vital capacity and compartmental volumes of healthy subjects. Chest wall tidal volume (P<.001) significantly increased during the protocol in the healthy subjects, mainly because of end-inspiratory (P<.001) and abdominal volumes (P=.008). No significant differences were observed in percentage of contribution of the compartments to the inspired volume and end-expiratory volume of both groups. No significant differences were found in chest wall tidal volume, operational volume, and breathing pattern in persons with ALS. Air stacking is effective in increasing CPF

  17. Mortality and life-threatening events after vertical expandable prosthetic titanium rib surgery in children with hypoplastic chest wall deformity.

    Science.gov (United States)

    Betz, Randal R; Mulcahey, Mary Jane; Ramirez, Norman; Flynn, John M; Smith, John T; St Hilaire, Tricia; Campbell, Robert M

    2008-12-01

    Severe complex hypoplastic chest wall and spine deformity with thoracic insufficiency syndrome may be associated with premature death secondary to multisystem involvement. The vertical expandable prosthetic titanium rib (VEPTR) reconstructs the chest wall to address the thoracic insufficiency seen in this patient population. The purpose of this study is to report the mortality and life-threatening adverse events in a cohort of subjects with severe hypoplastic chest wall deformity, specifically with Jeune syndrome and Jarcho-Levin syndrome, after treatment with the VEPTR device. A cohort of 43 patients with either Jeune syndrome or Jarcho-Levin syndrome was extracted from a multicenter Investigational Device Exemption study of 214 patients who had surgery with the VEPTR device. Of the 43 patients, 19 had Jeune syndrome and 24 had Jarcho-Levin syndrome. Fatal and life-threatening adverse events were analyzed, including an assessment of time postsurgery, etiology, and the relationship of the adverse event to the surgical procedure. Four (9%) of the 43 patients died during the follow-up period. All 4 (100%) of these patients had Jeune syndrome. After the initial surgery, 2 died within 6 months, and the remaining 2 within 1 year. Causes of death included respiratory complications in 2, renal failure in 1, and liver failure in 1. An additional 4 (9%) of the 43 patients had life-threatening adverse events. Two (50%) patients were diagnosed with Jeune syndrome and the remaining 2 (50%) with Jarcho-Levin syndrome. Two of the 4 life-threatening events were related to the surgery perioperatively: necrotizing enterocolitis and acute respiratory distress syndrome. The other two events included cardiac arrest secondary to central line placement and Demerol overdose. Surgeons should be aware of the potential for fatality and life-threatening events that occur in patients with hypoplastic chest wall and spine deformity undergoing surgical treatment. The majority of these events

  18. Airbag-related chest wall burn as a marker of underlying injury: a case report

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    Monkhouse Simon J

    2008-03-01

    Full Text Available Abstract Introduction This case of a man who sustained an airbag-induced thoracic injury and burn, highlights the potential harm that can be caused by airbags. It also serves to illustrate that a surface burn which looks small and benign can actually be a surface marker of a more serious injury. Staff working in emergency departments need to be aware of the risk of possible airbag-associated injuries. Case presentation A 65-year-old man was the driver in a frontal collision. He was wearing a seatbelt. The airbag was activated and caused a superficial chest wall burn. Initial chest x-rays were unremarkable but following deterioration in his condition, a computed tomography scan revealed a serious sternal fracture. The location of the fracture was marked on the surface by the burn. Conclusion Airbags can cause significant chest wall injuries and burns. Surface burns at the point of impact should not be dismissed as trivial as the forces involved can cause significant injury. We recommend that all people with chest wall injuries and/or burns due to airbags should have more detailed chest imaging as initial emergency radiographs can be falsely reassuring.

  19. Role of Quantitative Wall Motion Analysis in Patients with Acute Chest Pain at Emergency Department.

    Science.gov (United States)

    Kim, Kyung-Hee; Na, Sang-Hoon; Park, Jin-Sik

    2017-03-01

    Evaluation of acute chest pain in emergency department (ED), using limited resource and time, is still very difficult despite recent development of many diagnostic tools. In this study, we tried to determine the applicability of new semi-automated cardiac function analysis tool, velocity vector imaging (VVI), in the evaluation of the patients with acute chest pain in ED. We prospectively enrolled 48 patients, who visited ED with acute chest pain, and store images to analyze VVI from July 2005 to July 2007. In 677 of 768 segments (88%), the analysis by VVI was feasible among 48 patients. Peak systolic radial velocity (Vpeak) and strain significantly decreased according to visual regional wall motion abnormality (Vpeak, 3.50 ± 1.34 cm/s for normal vs. 3.46 ± 1.52 cm/s for hypokinesia, 2.51 ± 1.26 for akinesia, p patient with acute chest pain at ED.

  20. Computer Assisted Diagnosis of Chest Pain. Adjunctive Treatment Protocols

    Science.gov (United States)

    1984-07-30

    physical etiology for chest pain. Disorders that present with epigastric pain such as gastritis , peptic ulcer, pancreatitis, and cholelithiasis may...shaking chills seen in bacterial pneumonia. TREATMENT: The treatment of pneumonia consists of bed rest, hydration, adequate nutrition , an

  1. Study of frequency of operated chest wall tumors In Al Zahra hospital from 2007 to 2009,Isfahan,Iran

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    seyed abas Tabatabai

    2011-08-01

    Conclusion: According to the results of this study about 59% of the chest wall tumors were malignant and in the case of being hesitant about existing a mass on the chest wall, needed measurements for treatmentand and on time removal of the mass must be done.

  2. Morganella Morganii Causing Abscess Over the Anterior Chest Wall- A Case Report

    OpenAIRE

    D., Vijaya; JV, Sathish; MK, Yashaswini; S, Sulaiman

    2014-01-01

    A 17-year-old female college student presented with recurrent abscess over the anterior chest wall since one and half year. Morganella morganii was isolated from the aspirated pus. Patient was started on oral ciprofloxacin and the lesion resolved in two weeks.

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

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    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.

  4. 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

  5. Does a minimal invasive approach reduce anterior chest wall numbness and postoperative pain in plate fixation of clavicle fractures?

    Science.gov (United States)

    Beirer, Marc; Postl, Lukas; Crönlein, Moritz; Siebenlist, Sebastian; Huber-Wagner, Stefan; Braun, Karl F; Biberthaler, Peter; Kirchhoff, Chlodwig

    2015-05-28

    Fractures of the clavicle present very common injuries with a peak of incidence in young active patients. Recently published randomized clinical trials demonstrated an improved functional outcome and a lower rate of nonunions in comparison to non-operative treatment. Anterior chest wall numbness due to injury of the supraclavicular nerve and postoperative pain constitute common surgery related complications in plate fixation of displaced clavicle fractures. We recently developed a technique for mini open plating (MOP) of the clavicle to reduce postoperative numbness and pain. The purpose of this study was to analyze the size of anterior chest wall numbness and the intensity of postoperative pain in MOP in comparison to conventional open plating (COP) of clavicle fractures. 24 patients (mean age 38.2 ± 14.2 yrs.) with a displaced fracture of the clavicle (Orthopaedic Trauma Association B1.2-C1.2) surgically treated using a locking compression plate (LCP) were enrolled. 12 patients underwent MOP and another 12 patients COP. Anterior chest wall numbness was measured with a transparency grid on the second postoperative day and at the six months follow-up. Postoperative pain was evaluated using the Visual Analog Scale (VAS). Mean ratio of skin incision length to plate length was 0.61 ± 0.04 in the MOP group and 0.85 ± 0.06 in the COP group (p VAS was 2.6 ± 1.4 points in the MOP group and 3.4 ± 1.6 points in the COP group (p = 0.20). In our study, MOP significantly reduced anterior chest wall numbness in comparison to a conventional open approach postoperative as well as at the six months follow-up. Postoperative pain tended to be lower in the MOP group, however this difference was not statistically significant. ClinicalTrials.gov NCT02247778 . Registered 21 September 2014.

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

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Young Hwan; Oh, Joo Hyeong; Yoon, Yup; Kim, Si Young [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    2000-07-01

    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)

  7. Effects of positive expiratory pressure on chest wall volumes in subjects with stroke compared to healthy controls: a case-control study.

    Science.gov (United States)

    Cabral, Elis E A; Resqueti, Vanessa R; Lima, Illia N D F; Gualdi, Lucien P; Aliverti, Andrea; Fregonezi, Guilherme A F

    2017-07-08

    Alterations in respiratory system kinematics in stroke lead to restrictive pattern associated with decreased lung volumes. Chest physical therapy, such as positive expiratory pressure, may be useful in the treatment of these patients; however, the optimum intensity to promote volume and motion changes of the chest wall remains unclear. To assess the effect of different intensities of positive expiratory pressure on chest wall kinematics in subjects with stroke compared to healthy controls. 16 subjects with chronic stroke and 16 healthy controls matched for age, gender, and body mass index were recruited. Chest wall volumes were assessed using optoelectronic plethysmography during quiet breathing, 5 minutes, and recovery. Three different intensities of positive expiratory pressure (10, 15, and 20cmH2O) were administered in a random order with a 30 minutes rest interval between intensities. During positive expiratory pressure, tidal chest wall expansion increased in both groups compared to quiet breathing; however, this increase was not significant in the subjects with stroke (0.41 vs. 1.32L, 0.56 vs. 1.54L, 0.52 vs. 1.8L, at 10, 15, 20cmH2O positive expiratory pressure, for stroke and control groups; p<0.001). End-expiratory chest wall volume decreased in controls, mainly due to the abdomen, and increased in the stroke group, mainly due the pulmonary rib cage. Positive expiratory pressure administration facilitates acute lung expansion of the chest wall and its compartments in restricted subjects with stroke. Positive expiratory pressure intensities above 10cmH2O should be used with caution as the increase in end-expiratory volume led to hyperinflation in subjects with stroke. Copyright © 2017 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

  8. 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.

  9. Utility of CT scan for the diagnosis of chest wall tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Khalil, A.; Le Breton, C.; Tassart, M.; Korzec, J.; Bigot, J.M.; Carette, M.F. [Department of Radiology, Tenon Hospital, Paris (France)

    1999-10-01

    The objective of this study was to determine the utility of CT scan findings for the diagnosis of chest wall tuberculosis, excluding the spine. We reviewed 15 patients (13 Africans and 2 Indians) with chest wall tuberculosis, retrospectively. The radiologic examination consisted of a plain X-ray and a CT scan of the chest for each patient. The site of disease was the rib in 13 patients or the body of the sternum in 2 patients. One rib was involved in 11 patients, 2 contiguous ribs (one site) in 2 patients, and bilateral disease (two sites) was observed in the remaining patient. The 14 rib sites involved the posterior arc or costovertebral joint in 11 cases, the anterior arc in 2 cases, and the anterior and middle arc in 1 case. The CT scan findings were an abscess (n = 14) or a soft tissue mass (n = 2), osteolytic lesions (n = 13), periosteal reaction (n = 10), and sequestrum (n = 14). Bone sclerosis was observed only in 3 cases of rib involvement. The association of a soft tissue abscess, an osteolytic lesion, and sequestrum, especially in immigrants to France, suggests chest wall tuberculosis on CT scan. (orig.) With 5 figs., 2 tabs., 11 refs.

  10. Fireworks-induced chest wall granulomatous disease: 18F-FDG PET/CT imaging.

    Science.gov (United States)

    Le, Stephanie T; Nguyen, Ba Duong

    2014-04-01

    The authors present a case of 18F-FDG-avid granulomatous reaction induced by fireworks injury of the chest wall in a patient with esophageal adenocarcinoma. This hypermetabolic lesion, involving the right pectoralis muscles, appeared slightly more prominent on restaging PET/CT imaging following chemotherapy and radiation therapy. Excisional biopsy of the lesion established the diagnosis of foreign-body granulomatous-type inflammation with surrounding foci of non-polarizable black foreign material and ruled out malignancy. The patient recalled accidentally shooting himself in the chest with a Roman candle at the age of 3.

  11. 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.

  12. 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.

  13. Melioidosis of Chest Wall Masquerading as a Tubercular Cold ...

    African Journals Online (AJOL)

    tubercular treatment for four months when he presented to us. The investigation details for suspected pulmonary tuberculosis were not available with the patient. He had no associated comorbidities like diabetes, hypertension, renal or hepatic disease.

  14. A comparison of skin and chest wall dose delivered with multicatheter, Contura multilumen balloon, and MammoSite breast brachytherapy.

    Science.gov (United States)

    Cuttino, Laurie W; Todor, Dorin; Rosu, Mihaela; Arthur, Douglas W

    2011-01-01

    Skin and chest wall doses have been correlated with toxicity in patients treated with breast brachytherapy . This investigation compared the ability to control skin and chest wall doses between patients treated with multicatheter (MC), Contura multilumen balloon (CMLB), and MammoSite (MS) brachytherapy. 43 patients treated with the MC technique, 45 patients treated with the CMLB, and 83 patients treated with the MS were reviewed. The maximum doses delivered to the skin and chest wall were calculated for all patients. The mean maximum skin doses for the MC, CMLB, and MS were 2.3 Gy (67% of prescription dose), 2.8 Gy (82% of prescription dose), and 3.2 Gy per fraction (94% of prescription dose), respectively. Although the skin distances were similar (p = 0.23) for the two balloon techniques, the mean skin dose with the CMLB was significantly lower than with the MS (p = 0.05). The mean maximum rib doses for the MC, CMLB, and MS were 2.3 Gy (67% of prescription dose), 2.8 Gy (82% of prescription dose), and 3.6 Gy per fraction (105% of prescription dose), respectively. Again, the mean rib dose with the CMLB was significantly lower than with the MS (p = 0.002). The MC and CMLB techniques are associated with significantly lower mean skin and rib doses than is the MS. Treatment with the MS was associated with significantly more patients receiving doses to the skin or rib in excess of 125% of the prescription. Treatment with the CMLB may prove to yield less normal tissue toxicity than treatment with the MS. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature

    Directory of Open Access Journals (Sweden)

    Shagun Bhatia Shah

    2017-01-01

    Full Text Available Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors' personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search.

  16. Anesthesia for minimally invasive chest wall reconstructive surgeries: Our experience and review of literature

    Science.gov (United States)

    Shah, Shagun Bhatia; Hariharan, Uma; Bhargava, Ajay Kumar; Darlong, Laleng M.

    2017-01-01

    Minimal access procedures have revolutionized the field of surgery and opened newer challenges for the anesthesiologists. Pectus carinatum or pigeon chest is an uncommon chest wall deformity characterized by a protruding breast bone (sternum) and ribs caused by an overgrowth of the costal cartilages. It can cause a multitude of problems, including severe pain from an intercostal neuropathy, respiratory dysfunction, and psychologic issues from the cosmetic disfigurement. Pulmonary function indices, namely, forced expiratory volume over 1 s, forced vital capacity, vital capacity, and total lung capacity are markedly compromised in pectus excavatum. Earlier, open surgical correction in the form of the Ravitch procedure was followed. Currently, in the era of minimally invasive surgery, Nuss technique (pectus bar procedure) is a promising step in chest wall reconstructive surgery for pectus excavatum. Reverse Nuss is a corrective, minimally invasive surgery for pectus carinatum chest deformity. A tailor-made anesthetic technique for this new procedure has been described here based on the authors’ personal experience and thorough review of literature based on Medline, Embase, and Scopus databases search. PMID:28757834

  17. Decreased Lung Perfusion After Breast/Chest Wall Irradiation: Quantitative Results From a Prospective Clinical Trial

    Energy Technology Data Exchange (ETDEWEB)

    Liss, Adam L., E-mail: adamliss68@gmail.com [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Marsh, Robin B. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Kapadia, Nirav S. [Department of Radiation Oncology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire (United States); McShan, Daniel L. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Rogers, Virginia E. [Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Balter, James M.; Moran, Jean M.; Brock, Kristy K.; Schipper, Matt J.; Jagsi, Reshma [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Griffith, Kent A. [Biostatistics Unit, University of Michigan, Ann Arbor, Michigan (United States); Flaherty, Kevin R. [Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan (United States); Frey, Kirk A. [Division of Nuclear Medicine, Department of Radiology, University of Michigan, Ann Arbor, Michigan (United States); Pierce, Lori J. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

    2017-02-01

    Purpose: To quantify lung perfusion changes after breast/chest wall radiation therapy (RT) using pre- and post-RT single photon emission computed tomography/computed tomography (SPECT/CT) attenuation-corrected perfusion scans; and correlate decreased perfusion with adjuvant RT dose for breast cancer in a prospective clinical trial. Methods and Materials: As part of an institutional review board–approved trial studying the impact of RT technique on lung function in node-positive breast cancer, patients received breast/chest wall and regional nodal irradiation including superior internal mammary node RT to 50 to 52.2 Gy with a boost to the tumor bed/mastectomy scar. All patients underwent quantitative SPECT/CT lung perfusion scanning before RT and 1 year after RT. The SPECT/CT scans were co-registered, and the ratio of decreased perfusion after RT relative to the pre-RT perfusion scan was calculated to allow for direct comparison of SPECT/CT perfusion changes with delivered RT dose. The average ratio of decreased perfusion was calculated in 10-Gy dose increments from 0 to 60 Gy. Results: Fifty patients had complete lung SPECT/CT perfusion data available. No patient developed symptoms consistent with pulmonary toxicity. Nearly all patients demonstrated decreased perfusion in the left lung according to voxel-based analyses. The average ratio of lung perfusion deficits increased for each 10-Gy increment in radiation dose to the lung, with the largest changes in regions of lung that received 50 to 60 Gy (ratio 0.72 [95% confidence interval 0.64-0.79], P<.001) compared with the 0- to 10-Gy region. For each increase in 10 Gy to the left lung, the lung perfusion ratio decreased by 0.06 (P<.001). Conclusions: In the assessment of 50 patients with node-positive breast cancer treated with RT in a prospective clinical trial, decreased lung perfusion by SPECT/CT was demonstrated. Our study allowed for quantification of lung perfusion defects in a prospective cohort of

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

    OpenAIRE

    Masafumi Nozoe; Kyoshi Mase; Tomoyuki Ogino; Shigefumi Murakami; Sachie Takashima; Kazuhisa Domen

    2016-01-01

    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 receivi...

  19. Desmoid fibromatosis of the shoulder and of the upper chest wall following a clavicular fracture.

    Science.gov (United States)

    Icard, P; Le Rochais, J P; Galateau, F; Evrard, C

    1999-05-01

    A desmoid tumor of the shoulder girdle infiltrating the upper chest wall and weighing 1500 g was almost completely removed in an 18-year-old man, 27 months after a bifocal fracture of the clavicule. Thirteen years later, the patient was free of recurrence. The interval time between trauma and diagnosis, as the particular characteristics of aggressive fibromatosis, strongly support a major causal role of the clavicular fracture in the occurrence of this tumor.

  20. Gasless video-assisted bilateral thyroidectomy by the anterior chest wall approach: 4 years of experience.

    Science.gov (United States)

    Cai, Qian; Huang, Xiao-ming; Sun, Wei; Zheng, Yi-qing; Liang, Fa-ya; Han, Ping; Jiang, Xiao-yu

    2012-06-01

    Thyroidectomy can be performed in a variety of ways, and gasless video-assisted approaches have recently become more popular. We performed a study of thyroidectomy on 77 patients with bilateral thyroid lesions carried out using a gasless video-assisted unilateral anterior chest wall approach. Seventy-seven patients underwent bilateral thyroidectomy by the gasless video-assisted unilateral anterior chest wall approach, whereas 64 patients underwent conventional surgery during the same time frame and were considered to be the control group. The eligibility criteria for thyroid surgery by gasless video-assisted unilateral anterior chest wall approach were: no previous neck surgical history, no radiotherapy history, a diagnosis of benign thyroid tumor according to preoperative computed tomographic scan, no inflammation-related diseases or thyroid hyperfunction, no lymphadenectasis, and bilateral tumors ≤ 4 cm in diameter (1 side ≤ 2 cm, located in the lower part of the thyroid and near the surface of the thyroid). The 2 groups were compared by surgical style, complications, operative time, cosmetic result, and postoperative pain. The 2 groups were matched in terms of age and sex; the scoring for operative procedure (P=0.443), postoperative drainage (P=0.686), and postoperative pain (P=0.294) were not significantly different. The gasless video-assisted group had less bleeding during surgery than the conventional group and had better cosmetic results (Pvideo-assisted group had 1 case of ecchymoma and 1 case of temporary recurrent laryngeal nerve paralysis, but both recovered within a month. The complication rates in the 2 groups were not significantly different (χ=1.423, P=0.292). The gasless video-assisted thyroidectomy by the unilateral anterior chest wall approach is a safe and feasible way to treat patients with benign bilateral thyroid lesion with good cosmetic results. The gasless video-assisted thyroidectomy is a valid surgical option for selected patients

  1. Impact of Prior Unilateral Chest Wall Radiotherapy on Outcomes in Bilateral Breast Reconstruction.

    Science.gov (United States)

    de Araujo, Thiago B; Jue Xu, Mary; Susarla, Srinivas M; Shmelev, Karen; Jiang, Wei; Pribaz, Julian J; Hergrueter, Charles; Carty, Matthew J; Caterson, Stephanie; Chun, Yoon S

    2016-10-01

    The purpose of this study was to evaluate the impact of prior unilateral chest wall radiotherapy on reconstructive outcomes among patients undergoing bilateral immediate breast reconstruction. A retrospective evaluation of patients with a history of unilateral chest wall radiotherapy was performed. In each patient, the previously irradiated and reconstructed breast was compared to the contralateral nonirradiated side, which served as an internal control. Descriptive and bivariate statistics were computed. Multiple regression statistics were computed to identify adjusted associations between chest wall radiotherapy and complications. Seventy patients were included in the study. The mean follow-up period was 51.8 months (range, 10 to 113 months). Thirty-eight patients underwent implant-based breast reconstruction; 32 patients underwent abdominal autologous flap reconstruction. Previously irradiated breast had a significantly higher rate of overall complications (51 percent versus 27 percent; p radiotherapy was a significant risk factor for breast-related complications (OR, 2.98; p radiotherapy is associated with a 3-fold increased risk of postoperative complications following immediate breast reconstruction. Therapeutic, III.

  2. Coronary artery bypass grafting and concomitant excision of chest wall chondrosarcoma

    Directory of Open Access Journals (Sweden)

    Ganti Somsekhar

    2009-02-01

    Full Text Available Abstract Coexistence of coronary artery disease and cancer with both requiring surgical treatment at the same time is rare. A 52 year male undergoing elective coronary artery bypass grafting was incidentally discovered to have a large soft tissue mass of variable consistency with cartilaginous elements arising from the right costal margin and adjoining ribs by a broad attachment and protruding into right pleural cavity. Frozen section suggested it to be either a chondrosarcoma or a teratoma. A wide excision of the mass with the adjoining muscle and periosteum along with quadruple coronary artery bypass grafting was done. This report is unusual on account of a being the first reported case in world literature of concomitant excision of chondrosarcoma and coronary artery bypass grafting and b the conservative management of the incidentally discovered chondrosarcoma by wide excision rather than chest wall resection with no local recurrence to date. Pathology of chondrosarcoma, in particular, and various management strategies when coronary artery disease and cancer coexist, in general, is discussed.

  3. Predicting outcome of patients with chest wall injury.

    Science.gov (United States)

    Pressley, Crystal M; Fry, William R; Philp, Allan S; Berry, Stepheny D; Smith, R Stephen

    2012-12-01

    Rib fractures occur in 10% of injured patients, are associated with morbidity and mortality, and frequently necessitate intensive care unit (ICU) care. A scoring system that identifies the risk for respiratory failure early in the evaluation process may allow early intervention to improve outcomes. The aim of this study was to test the hypothesis that a scoring system based on initial clinical findings can identify patients with rib fractures at greatest risk for morbidity and mortality. A simple scoring system to stratify risk was developed and applied to patients through a retrospective trauma registry review. Points were assigned as follows: age 65 years = 3 points; 5 fractures = 3 points; no pulmonary contusion = 0 points, mild pulmonary contusion = 1 point, severe pulmonary contusion = 2 points, bilateral pulmonary contusion = 3 points; and bilateral rib fracture absent = 0 points, bilateral rib fracture absent present = 2 points. A review of trauma registry patients with rib fractures (June 2008 to February 2010) at a state-designated level 1 trauma center was performed. Data reviewed included age, number of fractures, bilateral injury, presence of pulmonary contusion, classification of the contusion, length of hospital stay, mechanical ventilation, ICU admission, and length of stay. The scoring system was retrospectively applied to 649 patients to determine validity. A score ≤ 7 indicated lower mortality (24 of 579 [4.2%]) compared with patients with scores > 7 (10 of 70 [14.3%]) (Fisher's 2-sided P = .0018). Patients with scores ≤ 6 were less likely to be admitted to an ICU (29.7%) compared with those with scores ≥ 7 (56.7%) (P 4 (59.7%) (P 5 predicted a longer length of stay and a longer period of ventilation. This scoring system may assist in the earlier implementation of treatment strategies such epidural anesthesia, ventilation, and operative fixation of fractures. Copyright © 2012. Published by Elsevier Inc.

  4. The effect of pre-injury anti-platelet therapy on the development of complications in isolated blunt chest wall trauma: a retrospective study.

    Directory of Open Access Journals (Sweden)

    Ceri Battle

    Full Text Available 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 development of complications in the recovery phase following blunt chest wall trauma. METHODS: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in Wales in 2012 and 2013. Using univariate and multivariable logistic regression analysis, pre-injury platelet therapy was investigated as a risk factor for the development of complications following blunt chest wall trauma. Previously identified risk factors were included in the analysis to address the influence of confounding. RESULTS: A total of 1303 isolated blunt chest wall trauma patients presented to the ED in Morriston Hospital in 2012 and 2013 with complications recorded in 144 patients (11%. On multi-variable analysis, pre-injury anti-platelet therapy was found to be a significant risk factor for the development of complications following isolated blunt chest wall trauma (odds ratio: 16.9; 95% confidence intervals: 8.2-35.2. As in previous studies patient age, number of rib fractures, chronic lung disease and pre-injury anti-coagulant use were also found to be significant risk factors. CONCLUSIONS: Pre-injury anti-platelet therapy is being increasingly used as a first line treatment for a number of conditions and there is a concurrent increase in trauma in the elderly population. Pre-injury anti-platelet therapy should be considered as a risk factor for the development of complications by clinicians managing

  5. Comparison of different levels of positive expiratory pressure on chest wall volumes in healthy children and patients with fibrosis

    OpenAIRE

    Brilhante, Silvia Angélica; Florêncio, Rêcio Bento; Gualdi, Lucien Peroni; Resqueti,Vanessa Regiane; Aliverti,Andrea; Andrade, Armele de Fátima Dornelas de; Fregonezi, Guilherme Augusto de Freitas

    2017-01-01

    ABSTRACT Positive Expiratory Pressure (PEP) improves lung function, however, PEP-induced changes are not fully established. The aim of this study was to assess the acute effects of different PEP levels on chest wall volumes and the breathing pattern in children with Cystic Fibrosis (CF). Anthropometric data, lung function values, and respiratory muscle strength were collected. Chest wall volumes were assessed by Optoelectronic plethysmography at rest and during the use of different PEP levels...

  6. Magnetic resonance imaging of the mediastinum, chest wall and pleura in children.

    Science.gov (United States)

    Manson, David E

    2016-05-01

    The acceptance of applications for the use of chest MRI in children has been somewhat slow and selective. The use of MRI to image chest wall lesions is likely the most common and widely used indication, aside from the widespread and somewhat sophisticated use of MRI in imaging the cardiovascular structures of the chest. In this respect, fairly standard variations of T1-W, T2-W and contrast-enhanced imaging can be used, similar to the sequences used for musculoskeletal lesions elsewhere in the body. Imaging of the anterior mediastinal masses should be performed in conjunction with a detailed pre-test clinical examination to determine potential cardiovascular compromise. MRI in the setting of middle mediastinal adenopathy, congenital mediastinal cysts or posterior mediastinal masses, however, has been shown to be more effective and more comprehensive than multidetector CT. Although sonographic imaging is the initial modality of choice for pleural abnormalities, MR imaging is extremely effective and clinically useful in the setting of a potentially ambiguous sonographic examination. Faster imaging protocols are likely to increase the acceptance of MRI to replace multidetector CT for many pediatric chest lesions.

  7. Invasive versus non-invasive ventilation for acute respiratory failure in neuromuscular disease and chest wall disorders.

    Science.gov (United States)

    Luo, Fang; Annane, Djillali; Orlikowski, David; He, Li; Yang, Mi; Zhou, Muke; Liu, Guan J

    2017-12-04

    acute onset neuromuscular disease and of chronic neuromuscular disease and chest wall disorders. We found no randomised trials on which to elaborate evidence-based practice for the use of non-invasive versus invasive mechanical ventilation. For researchers, there is a need to design and conduct new randomised trials to compare NIV with invasive ventilation in acute neuromuscular respiratory failure. These trials should anticipate variations in treatment responses according to disease condition (acute onset versus acute exacerbation on chronic neuromuscular diseases) and according to the presence or absence of bulbar dysfunction.

  8. Extensive chest wall tissue loss and its management by vertical rectus abdominis myocutaneous flap

    Directory of Open Access Journals (Sweden)

    Sandip Kanti Basu

    2017-01-01

    Full Text Available Extensive electric burn around the chest in children is rare and this type of injury always poses a great challenge for its management. A 12-year-old male child with extensive electric burn of the chest wall was admitted to hospital. It was a neglected case of 9 days old burn; the young boy was in critical condition having systemic features of toxemia with widespread necrosis of the skin, subcutaneous tissues, and muscles along with exposed bones (ribs and sternum with the risk of impending rupture of pleura through the exposed intercostal spaces. After initial resuscitation, a thorough debridement of all necrotic tissues was done. Thereafter, a superiorly based vertical rectus abdominis myocutaneous flap was harvested to cover the exposed bones and intercostal spaces. The remaining raw areas were skin grafted. The child made an excellent recovery with good outcome.

  9. Follow up CT findings of suture granuloma in the chest wall: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ka Eun; Lee, Young Kyung [Kyung Hee Univ. Hospital at Gangdong/School of Medicine/Kyung Hee Univ. Seoul, (Korea, Republic of); Sung, Dong Wook [Kyung Hee Univ. Hospital/School of Medicine/Kyung Hee Univ., Seoul, (Korea, Republic of)

    2012-09-15

    Suture granuloma is a benign tumor defined by an inflammatory reaction and the formation of granuloma, which is caused by the reaction of a foreign body in regards to suture material after surgery. Recently, it has been reported as one of the rare complications following surgery, mainly in regards to non absorbable sutures. The authors hereby report a case along with CT findings and literature review for suture granuloma in the chest wall after lung lobectomy for lung cancer in a 65 year old woman.

  10. Improving breast cancer diagnosis by reducing chest wall effect in diffuse optical tomography

    Science.gov (United States)

    Zhou, Feifei; Mostafa, Atahar; Zhu, Quing

    2017-03-01

    We have developed the ultrasound (US)-guided diffuse optical tomography technique to assist US diagnosis of breast cancer and to predict neoadjuvant chemotherapy response of patients with breast cancer. The technique was implemented using a hand-held hybrid probe consisting of a coregistered US transducer and optical source and detector fibers which couple the light illumination from laser diodes and photon detection to the photomultiplier tube detectors. With the US guidance, diffused light measurements were made at the breast lesion site and the normal contralateral reference site which was used to estimate the background tissue optical properties for imaging reconstruction. However, background optical properties were affected by the chest wall underneath the breast tissue. We have analyzed data from 297 female patients, and results have shown statistically significant correlation between the fitted optical properties (μa and μs‧) and the chest wall depth. After subtracting the background μa at each wavelength, the difference of computed total hemoglobin (tHb) between malignant and benign lesion groups has improved. For early stage malignant lesions, the area-under-the-receiver operator characteristic curve (AUC) has improved from 88.5% to 91.5%. For all malignant lesions, the AUC has improved from 85.3% to 88.1%. Statistical test has revealed the significant difference of the AUC improvements after subtracting background tHb values.

  11. Congenital anomalies of the ribs and chest wall associated with congenital deformities of the spine.

    Science.gov (United States)

    Tsirikos, Athanasios I; McMaster, Michael J

    2005-11-01

    Congenital anomalies of the ribs and chest wall as well as Sprengel deformity of the shoulder are often associated with congenital deformities of the spine. It has been suggested that rib anomalies may adversely affect the progression of the spinal deformity. We conducted a retrospective study of the medical records and spine radiographs of 620 consecutive patients with congenital deformities of the spine; 497 patients (80%) had scoliosis; eighty-eight patients (14%), kyphoscoliosis; and thirty-five patients (6%), kyphosis. The rib anomalies were classified into simple and complex, and the presence of a Sprengel deformity of the shoulder was recorded. The rate of scoliosis deterioration without treatment before the age of eleven years, as well as the patient age and curve size at the time of surgery, was compared for different types of vertebral abnormalities in patients with and without rib anomalies. A total of 119 patients (19.2%) had rib anomalies, which were most commonly associated with congenital scoliosis (111 patients; 93%) and were much less frequently associated with congenital kyphoscoliosis or kyphosis (eight patients). The rib anomalies were simple in ninety-five patients and complex in twenty-four. Eighty-five patients (71%) with rib abnormalities had a scoliosis due to a unilateral failure of vertebral segmentation, and seven patients had mixed or unclassifiable vertebral anomalies. In contrast, only sixteen of 203 patients with a scoliosis due to a hemivertebra alone had rib anomalies. The rib anomalies were most frequently associated with a thoracic or thoracolumbar scoliosis (102 patients; 92%) and occurred on the concavity in eighty-two patients (74%), the convexity in twenty-two patients (20%), and were bilateral in seven patients. The Sprengel deformity occurred in forty-five patients and most frequently in association with a thoracic scoliosis due to a unilateral failure of vertebral segmentation (twenty-seven patients). No significant

  12. Safety and effectiveness of the high-frequency chest wall oscillation vs intrapulmonary percussive ventilation in patients with severe COPD

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    Nicolini A

    2018-02-01

    Full Text Available Antonello Nicolini,1 Bruna Grecchi,2 Maura Ferrari-Bravo,3 Cornelius Barlascini4 1Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy; 2Rehabilitation Unit, ASL4 Chiavarese, Chiavari, Italy; 3Statistics Unit, ASL4 Chiavarese, Chiavari, Italy; 4Health Medicine Unit, Hospital of Sestri Levante, Sestri Levante, Italy Purpose: Chest physiotherapy is an important tool in the treatment of COPD. Intrapulmonary percussive ventilation (IPV and high-frequency chest wall oscillation (HFCWO are techniques designed to create a global percussion of the lung which removes secretions and probably clears the peripheral bronchial tree. We tested the hypothesis that adding IPV or HFCWO to the best pharmacological therapy (PT may provide additional clinical benefit over chest physiotherapy in patients with severe COPD. Methods: Sixty patients were randomized into three groups (20 patients in each group: IPV group (treated with PT and IPV, PT group with (treated with PT and HFCWO, and control group (treated with PT alone. Primary outcome measures included results on the dyspnea scale (modified Medical Research Council and Breathlessness, Cough, and Sputum scale (BCSS, as well as an evaluation of daily life activity (COPD Assessment Test [CAT]. Secondary outcome measures were pulmonary function testing, arterial blood gas analysis, and hematological examinations. Moreover, sputum cell counts were performed at the beginning and at the end of the study. Results: Patients in both the IPV group and the HFCWO group showed a significant improvement in the tests of dyspnea and daily life activity evaluations (modified Medical Research Council scale, BCSS, and CAT compared to the control group, as well as in pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, forced expiratory volume in 1 second/forced vital capacity%, total lung capacity, residual volume, diffusing lung capacity monoxide, maximal inspiratory

  13. Negative-pressure wound therapy and early pedicle flap reconstruction of the chest wall after epirubicin extravasation.

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    Papadakis, Marios; Rahmanian-Schwarz, Afshin; Bednarek, Marzena; Arafkas, Mohamed; Holschneider, Philipp; Hübner, Gunnar

    2017-05-15

    Accidental extravasation is a serious iatrogenic injury among patients receiving anthracycline-containing chemotherapy. The aim of this work is to present a combination therapy for chest wall reconstruction following epirubicin extravasation. Herein, we report a 68-year-old woman with massive soft tissue necrosis of the anterolateral chest wall after epirubicin extravasation from a port implanted in the subclavicular area. The necrotic tissue was resected, the port was removed, and negative-pressure wound therapy was applied. Three weeks later, a latissimus dorsi pedicle flap was successfully used to cover the defect. To the best of the authors' knowledge, this is the first report of a strategy comprising the combination of negative-pressure wound therapy and a latissimus pedicle flap for reconstruction of the chest wall after soft tissue necrosis following epirubicin extravasation.

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

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    Høilund-Carlsen Poul

    2008-03-01

    Full Text Available Abstract Background Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect of various treatments are lacking. Methods/Design We present an ongoing trial on the potential usefulness of chiropractic diagnosis and treatment in patients dismissed from an acute chest pain clinic without a diagnosis of acute coronary syndrome. The aims are to determine the proportion of patients in whom chest pain may be of musculoskeletal rather than cardiac origin and to investigate the decision process of a chiropractor in diagnosing these patients; further, to examine whether chiropractic treatment can reduce pain and improve physical function when compared to advice directed towards promoting self-management, and, finally, to estimate the cost-effectiveness of these procedures. This study will include 300 patients discharged from a university hospital acute chest pain clinic without a diagnosis of acute coronary syndrome or any other obvious cardiac or non-cardiac disease. After completion of the clinic's standard cardiovascular diagnostic procedures, trial patients will be examined according to a standardized protocol including a a self-report questionnaire; b a semi-structured interview; c a general health examination; and d a specific manual examination of the muscles and joints of the neck, thoracic spine, and thorax in order to determine whether the pain is likely to be of musculoskeletal origin. To describe the patients status with

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

    Science.gov (United States)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner; Høilund-Carlsen, Poul Flemming; Haghfelt, Torben; Hartvigsen, Jan

    2008-03-31

    Acute chest pain is a major health problem all over the western world. Active approaches are directed towards diagnosis and treatment of potentially life threatening conditions, especially acute coronary syndrome/ischemic heart disease. However, according to the literature, chest pain may also be due to a variety of extra-cardiac disorders including dysfunction of muscles and joints of the chest wall or the cervical and thoracic part of the spine. The diagnostic approaches and treatment options for this group of patients are scarce and formal clinical studies addressing the effect of various treatments are lacking. We present an ongoing trial on the potential usefulness of chiropractic diagnosis and treatment in patients dismissed from an acute chest pain clinic without a diagnosis of acute coronary syndrome. The aims are to determine the proportion of patients in whom chest pain may be of musculoskeletal rather than cardiac origin and to investigate the decision process of a chiropractor in diagnosing these patients; further, to examine whether chiropractic treatment can reduce pain and improve physical function when compared to advice directed towards promoting self-management, and, finally, to estimate the cost-effectiveness of these procedures. This study will include 300 patients discharged from a university hospital acute chest pain clinic without a diagnosis of acute coronary syndrome or any other obvious cardiac or non-cardiac disease. After completion of the clinic's standard cardiovascular diagnostic procedures, trial patients will be examined according to a standardized protocol including a) a self-report questionnaire; b) a semi-structured interview; c) a general health examination; and d) a specific manual examination of the muscles and joints of the neck, thoracic spine, and thorax in order to determine whether the pain is likely to be of musculoskeletal origin. To describe the patients status with regards to ischemic heart disease, and to compare and

  16. Thermal characteristics of thermobrachytherapy surface applicators for treating chest wall recurrence

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    Arunachalam, K.; Maccarini, P. F.; Craciunescu, O. I.; Schlorff, J. L.; Stauffer, P. R.

    2010-04-01

    The aim of this study was to investigate temperature and thermal dose distributions of thermobrachytherapy surface applicators (TBSAs) developed for concurrent or sequential high dose rate (HDR) brachytherapy and microwave hyperthermia treatment of chest wall recurrence and other superficial diseases. A steady-state thermodynamics model coupled with the fluid dynamics of a water bolus and electromagnetic radiation of the hyperthermia applicator is used to characterize the temperature distributions achievable with TBSAs in an elliptical phantom model of the human torso. Power deposited by 915 MHz conformal microwave array (CMA) applicators is used to assess the specific absorption rate (SAR) distributions of rectangular (500 cm2) and L-shaped (875 cm2) TBSAs. The SAR distribution in tissue and fluid flow distribution inside the dual-input dual-output (DIDO) water bolus are coupled to solve the steady-state temperature and thermal dose distributions of the rectangular TBSA (R-TBSA) for superficial tumor targets extending 10-15 mm beneath the skin surface. Thermal simulations are carried out for a range of bolus inlet temperature (Tb = 38-43 °C), water flow rate (Qb = 2-4 L min-1) and tumor blood perfusion (ωb = 2-5 kg m-3 s-1) to characterize their influence on thermal dosimetry. Steady-state SAR patterns of the R- and L-TBSA demonstrate the ability to produce conformal and localized power deposition inside the tumor target sparing surrounding normal tissues and nearby critical organs. Acceptably low variation in tissue surface cooling and surface temperature homogeneity was observed for the new DIDO bolus at a 2 L min-1 water flow rate. Temperature depth profiles and thermal dose volume histograms indicate bolus inlet temperature (Tb) to be the most influential factor on thermal dosimetry. A 42 °C water bolus was observed to be the optimal choice for superficial tumors extending 10-15 mm from the surface even under significant blood perfusion. Lower bolus

  17. Higher Chest Wall Dose Results in Improved Locoregional Outcome in Patients Receiving Postmastectomy Radiation

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    Panoff, Joseph E.; Takita, Cristiane [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Hurley, Judith [Department of Medicine, Division of Hematology and Oncology, Miller School of Medicine, University of Miami, Miami, Florida (United States); Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Reis, Isildinha M. [Department of Epidemiology and Public Health and Sylvester Division of Biostatistics, University of Miami Miller School of Medicine, Miami, Florida (United States); Sylvester Division of Biostatistics and Bioinformatics Core, University of Miami Miller School of Medicine, Miami, Florida (United States); Zhao, Wei [Sylvester Division of Biostatistics and Bioinformatics Core, University of Miami Miller School of Medicine, Miami, Florida (United States); Rodgers, Steven E. [Department of Medicine, Division of Hematology and Oncology, Miller School of Medicine, University of Miami, Miami, Florida (United States); Department of Surgery, Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Gunaseelan, Vijayalakshmi [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States); Wright, Jean L., E-mail: Jwright3@med.miami.edu [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States)

    2012-03-01

    Purpose: Randomized trials demonstrating decreased locoregional recurrence (LRR) and improved overall survival (OS) in women receiving postmastectomy radiation therapy (PMRT) used up to 50 Gy to the chest wall (CW), but in practice, many centers boost the CW dose to {>=}60 Gy, despite lack of data supporting this approach. We evaluated the relationship between CW dose and clinical outcome. Methods and Materials: We retrospectively reviewed medical records of 582 consecutively treated patients who received PMRT between January 1999 and December 2009. We collected data on patient, disease, treatment characteristics, and outcomes of LRR, progression-free survival (PFS) and OS. Results: Median follow-up from the date of diagnosis was 44.7 months. The cumulative 5-year incidence of LRR as first site of failure was 6.2%. CW dose for 7% (43 patients) was {<=}50.4 Gy (range, 41.4-50.4 Gy) and 93% received >50.4 Gy (range, 52.4-74.4 Gy). A CW dose of >50.4 Gy vs. {<=}50.4 Gy was associated with lower incidence of LRR, a 60-month rate of 5.7% (95% confidence interval [CI], 3.7-8.2) vs. 12.7% (95% CI, 4.5-25.3; p = 0.054). Multivariate hazard ratio (HR) for LRR controlling for race, receptor status, and stage was 2.62 (95% CI, 1.02-7.13; p = 0.042). All LRR in the low-dose group occurred in patients receiving 50 to 50.4 Gy. Lower CW dose was associated with worse PFS (multivariate HR, 2.73; 95% CI, 1.64-4.56; p < 0.001) and OS (multivariate HR, 3.88; 95% CI, 2.16-6.99; p < 0.001). Conclusions: The addition of a CW boost above 50.4 Gy resulted in improved locoregional control and survival in this cohort patients treated with PMRT for stage II-III breast cancer. The addition of a CW boost to standard-dose PMRT is likely to benefit selected high-risk patients. The optimal technique, target volume, and patient selection criteria are unknown. The use of a CW boost should be studied prospectively, as has been done in the setting of breast conservation.

  18. Chest wall bleeding with giant intrathoracic meningocele in neurofibromatosis type 1.

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    Kaneda, Hiroyuki; Saito, Tomohito; Konobu, Toshifumi; Saito, Yukihito

    2011-02-01

    We report the case of a 66-year-old woman with neurofibromatosis type 1 who developed chest wall bleeding with severe scoliosis and a giant intrathoracic meningocele. She was brought to the emergency department with acute-onset of left-sided chest pain and clinical signs of hypovolemia. Bleeding control was difficult in the first operation because the tissue was friable and there were multiple subcutaneous bleeding points. During the first operation, the patient developed disseminated intravascular coagulation, which required immediate management; therefore, the surgery was aborted and a repeat surgery was performed later to stop the bleeding. The major cause of bleeding was presumed to be the mechanical stretching of the intercostal arteries and branches of the internal thoracic artery secondary to the severe deformity of the thoracic vertebra and ribs. The massive bleeding remained as a hematoma and did not lead to development of hemothorax. This was believed to be because the giant intrathoracic meningocele supported the expansion of the hematoma and prevented the perforation of the visceral pleura. After the second operation, the hematoma shrunk gradually; however, the patient required ventilatory support because the decrease in the size of the hematoma was accompanied by the expansion of the meningocele.

  19. Plasma Cell Leukemia Presenting as a Chest Wall Mass: A Case Report

    Directory of Open Access Journals (Sweden)

    Ahmed Ali

    2016-06-01

    Full Text Available Plasma cell leukemia (PCL is an uncommon neoplasm of plasma cells, with an aggressive clinical course and poor outcome, even with current standard of care. It can occur either de novo (primary PCL or as a progression of multiple myeloma (MM. This disease has unique diagnostic criteria but certain genetic markers and clinical features may overlap with MM. Due to the low prevalence of PCL, guidelines on its management are extrapolated from the management of MM and based on small retrospective studies and cases reports/series. We present an interesting case of PCL in a middle-aged African-American male, who was diagnosed incidentally after chest wall imaging for an unrelated complaint. The diagnostic approach, management and outcomes of PCL are discussed.

  20. Lung and chest wall mechanics during exercise: effects of expiratory flow limitation.

    Science.gov (United States)

    Aliverti, Andrea

    2008-11-30

    This short review summarizes how lung and chest wall mechanics can be modelled and which are the mechanical constraints imposed on the ventilatory system and its components during exercise. In healthy humans the structural and functional characteristics of the ventilator pump are able to meet the increased demands of ventilation during exercise and it is rare that arterial blood gas is significantly altered up to maximal exercise. In contrast, exercise is frequently limited by the ventilator system in disease, especially when altered mechanical properties of the airway and lung make expiratory flow limitation (EFL) a common feature. EFL is a phenomenon that can be understood in terms of the viscous effects of gas flowing from the alveoli to the airway opening along a collapsible airway which leads during exercise to dynamic hyperflation and several abnormalities of the ventilatory pump. These, in turn, determine a series of secondary manifestations, namely dyspnoea, exercise limitation and hypercapnia that can cause serious morbidity.

  1. A new alternative for bony chest wall reconstruction using biomaterial artificial rib and pleura: animal experiment and clinical application.

    Science.gov (United States)

    Zhang, Lan-jun; Wang, Wu-ping; Li, Wei-yang; Hao, Chong-li; Li, Zhe; Wu, Qiu-liang; Wu, Rao-pan; Rong, Tie-hua

    2011-10-01

    To evaluate a new method for chest wall reconstruction using porcine-derived artificial rib and pleura in an animal experiment. Further, the clinical application was performed in five patients with large defects in the chest wall as a preliminary observation. In animal experiments, a full-thickness chest wall defect of 7 cm × 8 cm was created in 12 adult mongrel dogs. Six dogs underwent reconstruction with porcine-derived artificial ribs and pleura (test group), and six with methylmethacrylate and double polyester mesh in the form of traditional Marlex sandwich technique (control group). At follow-up of each for 3, 6, and 12 months postoperatively, a general performance assessment and thoracic radiography were performed. Gross and histopathological examinations were carried out following humane euthanasia at the time of last follow-up. In clinical application, five patients with wide tumor resection in the chest wall underwent reconstruction with porcine-derived artificial ribs and pleura as well. In animal experiment, no perioperative death or hyperpyrexia occurred and no difference in either infection or dyspnea was noted between the two groups. Postoperative radiography revealed good thoracic integrity with no evidence of collapse, deformation, or abnormal movement in the test group. In the control group, similar results were observed, except that two dogs had abnormal movement in the chest wall associated with respiration. Severe adhesions between the 'sandwich' complex and the host tissues were identified in the control group, but by contrast, only mild adhesions were noted in the test group. The non-degradable polyester mesh induced fibrous proliferation and rejection, whereas the artificial pleura was absorbed with mild fibrous hyperplasia after 12 months. In clinical application, no thoracic deformity, chronic pain, or respiratory discomfort were observed at 1 or 12 postoperative months. Porcine-derived ribs and pleura can be employed safely to create an

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

    Science.gov (United States)

    Nozoe, Masafumi; Mase, Kyoshi; Ogino, Tomoyuki; Murakami, Shigefumi; Takashima, Sachie; Domen, Kazuhisa

    2016-03-15

    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). To compare the effects of CWC on expiratory flow rates in patients with COPD and asymptomatic controls. 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. 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, pCOPD group (-0.25 L/sec, 95% CI -0.43 to -0.07, pCOPD 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. The effects of chest wall compression on expiratory flow rates was different between COPD patients and asymptomatic controls.

  3. Development and validation of a clinical prediction rule for chest wall syndrome in primary care

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    Ronga Alexandre

    2012-08-01

    Full Text Available Abstract Background Chest wall syndrome (CWS, the main cause of chest pain in primary care practice, is most often an exclusion diagnosis. We developed and evaluated a clinical prediction rule for CWS. Methods Data from a multicenter clinical cohort of consecutive primary care patients with chest pain were used (59 general practitioners, 672 patients. A final diagnosis was determined after 12 months of follow-up. We used the literature and bivariate analyses to identify candidate predictors, and multivariate logistic regression was used to develop a clinical prediction rule for CWS. We used data from a German cohort (n = 1212 for external validation. Results From bivariate analyses, we identified six variables characterizing CWS: thoracic pain (neither retrosternal nor oppressive, stabbing, well localized pain, no history of coronary heart disease, absence of general practitioner’s concern, and pain reproducible by palpation. This last variable accounted for 2 points in the clinical prediction rule, the others for 1 point each; the total score ranged from 0 to 7 points. The area under the receiver operating characteristic (ROC curve was 0.80 (95% confidence interval 0.76-0.83 in the derivation cohort (specificity: 89%; sensitivity: 45%; cut-off set at 6 points. Among all patients presenting CWS (n = 284, 71% (n = 201 had a pain reproducible by palpation and 45% (n = 127 were correctly diagnosed. For a subset (n = 43 of these correctly classified CWS patients, 65 additional investigations (30 electrocardiograms, 16 thoracic radiographies, 10 laboratory tests, eight specialist referrals, one thoracic computed tomography had been performed to achieve diagnosis. False positives (n = 41 included three patients with stable angina (1.8% of all positives. External validation revealed the ROC curve to be 0.76 (95% confidence interval 0.73-0.79 with a sensitivity of 22% and a specificity of 93%. Conclusions This CWS score offers

  4. Synchronous development of breast cancer and chest wall fibrosarcoma after previous mantle radiation for Hodgkin's disease

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    Patlas, Michael [Hamilton General Hospital, Department of Radiology, Hamilton, ON (Canada); McCready, David [University Health Network and Mount Sinai Hospital, Department of Surgery, Toronto, ON (Canada); Kulkarni, Supriya; Dill-Macky, Marcus J. [University Health Network and Mount Sinai Hospital, Department of Medical Imaging, Toronto, ON (Canada)

    2005-09-01

    Survivors of Hodgkin's disease are at increased risk of developing a second malignant neoplasm, including breast carcinoma and sarcoma. We report the first case of synchronous development of chest wall fibrosarcoma and breast carcinoma after mantle radiotherapy for Hodgkin's disease. Mammographic, sonographic and MR features are demonstrated. (orig.)

  5. Chest-wall reconstruction with a customized titanium-alloy prosthesis fabricated by 3D printing and rapid prototyping.

    Science.gov (United States)

    Wen, Xiaopeng; Gao, Shan; Feng, Jinteng; Li, Shuo; Gao, Rui; Zhang, Guangjian

    2018-01-08

    As 3D printing technology emerge, there is increasing demand for a more customizable implant in the repair of chest-wall bony defects. This article aims to present a custom design and fabrication method for repairing bony defects of the chest wall following tumour resection, which utilizes three-dimensional (3D) printing and rapid-prototyping technology. A 3D model of the bony defect was generated after acquiring helical CT data. A customized prosthesis was then designed using computer-aided design (CAD) and mirroring technology, and fabricated using titanium-alloy powder. The mechanical properties of the printed prosthesis were investigated using ANSYS software. The yield strength of the titanium-alloy prosthesis was 950 ± 14 MPa (mean ± SD), and its ultimate strength was 1005 ± 26 MPa. The 3D finite element analyses revealed that the equivalent stress distribution of each prosthesis was unifrom. The symmetry and reconstruction quality contour of the repaired chest wall was satisfactory. No rejection or infection occurred during the 6-month follow-up period. Chest-wall reconstruction with a customized titanium-alloy prosthesis is a reliable technique for repairing bony defects.

  6. Etonogestrel implant migration to the vasculature, chest wall, and distant body sites: cases from a pharmacovigilance database.

    Science.gov (United States)

    Kang, Sarah; Niak, Ali; Gada, Neha; Brinker, Allen; Jones, S Christopher

    2017-12-01

    To describe clinical outcomes of etonogestrel implant patients with migration to the vasculature, chest wall and other distant body sites spontaneously reported to the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. We performed a standardized Medical Dictionary for Regulatory Activities (MedDRA) query in the FAERS database (through November 15, 2015), with reports coded with one or more MedDRA preferred terms that indicate complications with device placement or migration of the device from the original site of insertion to the vasculature, chest wall and other distant body sites. We excluded any cases previously described in the medical literature. We identified 38 cases of pronounced etonogestrel implant migration. Migration locations included the lung/pulmonary artery (n=9), chest wall (n=1), vasculature at locations other than the lung/pulmonary artery (n=14) and extravascular migrations (n=14) to other body sites (e.g., the axilla and clavicle/neck line/shoulder). The majority of cases were asymptomatic and detected when the patient desired implant removal; however, seven cases reported symptoms such as pain, discomfort and dyspnea in association with implant migration. Three cases also describe pulmonary fibrosis and skin reactions as a result of implant migration to the vasculature, chest wall and other distant body sites. Sixteen cases reported surgical removal in an operating room setting. Our FAERS case series demonstrates etonogestrel implant migration to the vasculature, chest wall and other body sites distant from the site of original insertion. As noted by the sponsor in current prescribing information, a key determinant in the risk for etonogestrel contraceptive implant migration appears to be improper insertion technique. Although migration of etonogestrel implants to the vasculature is rare, awareness of migration and education on proper insertion technique may reduce the risk. Published by Elsevier Inc.

  7. Bone and bone marrow function of reconstructed chest wall after surgical correction of pectus excavatum

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    Watanabe, Yoh; Magara, Tatsuo; Kobayashi, Hiroaki; Ichihashi, Takumi; Hikishima, Hiroshi (Kanazawa Univ. (Japan). School of Medicine)

    1984-03-01

    Bone and bone marrow functions of the reconstructed chest wall after surgical correction of the funnel chest deformities were evaluated by scanning method. In our series, three kinds of operative procedures were employed; strut method for adult cases, sternal turnover method with and without muscle pedicle for infant cases. Bone function was scanned by sup(99m)Tc-methylene-diphosphonate and bone marrow function was evaluated by sup(99m)Tc-sulfur-colloid. For the cases undergone each surgical procedure, bone and bone marrow scan were done at short term after surgery (within 30 days), at intermediate stage (one month to 12 months), and at long term stage (beyond one year). The results were as follows: By the evaluation at the long term stage of the cases undergoing strut method, bone as well as bone marrow scan visualized normal view of the reconstructed sternum. Regarding the cases undergone sternal turnover method without muscle pedicle, or free graft implantation of the plastron, the bone scan at the long term follow-up stage showed abnormal finding, i.e. hypo-, or defect-visualization of the inverted sternum, in 11.5% of the cases. Furthermore, bone marrow scan showed abnormality in 33.3% of the cases. On the other hand, the cases undergone sternal turnover method with muscle pedicle, in which blood supply to the plastron were preserved by the connection from superior epigastric artery to internal mammary artery, showed no abnormality as far as at the long term follow-up study neither in bone scan nor bone marrow scan. However, in the evaluation at short term after surgery, 50% of the cases undergoing bone scan showed abnormality. In addition, in this stage 85.7% of the bone marrow scan showed abnormal finding. These abnormality, however, normalized within 6 months for bone scan and 12 months for bone marrow scan, in contrast to the results of the cases undergone sternal turnover without pedicle.

  8. Dysmorphology of chest wall deformities: frequency distribution of subtypes of typical pectus excavatum and rare subtypes.

    Science.gov (United States)

    Kelly, Robert E; Quinn, Amy; Varela, Patricio; Redlinger, Richard E; Nuss, Donald

    2013-05-01

    More than forty percent of patients with pectus excavatum have a family history of chest deformity. However, no studies of the frequency of the different phenotypes of pectus excavatum have been published. A random sample of 300 non-syndromic pectus excavatum patients, from the chest wall deformities clinic at Children's Hospital of The King's Daughters in Norfolk, Va., was studied and classified according to a previously described classification system. Photographs and computed tomography (CT) scans were utilized. Typical pectus excavatum. Photo data: localized deep depression (cup-shaped) deformity occurred in 67%; diffuse (saucer-shaped) 21%, trench-like (furrow-shaped) 10%, and Currarino-Silverman (mixed pectus excavatum/chondromanubrial carinatum) 1%. The deepest point was to the right of midline in 80%, left in 10% and central in 10%. By photo, the deepest point was in the lower sternum in 75%. When asymmetric, the deepest point of the deformity was to the right of midline in 90%. CT data: the average Haller index was 4.9. Severe sternal torsion (>30 degrees) was associated with greater Haller index (6.3) than mild torsion (4.5). The deepest point of the depression was at the mid- or lower sternum in more than 99%. It proved impossible to estimate width or length of the depression because of poorly defined borders. Typical PE is cup-shaped in 67% of cases, to the right of the midline in 80%, and involving the mid-to-lower sternum in 99%. However, other phenotypes, like the saucer and long trench, comprised one-third. Definition of the deformity is more reliable by CT scan. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

  9. High-frequency chest wall oscillation in prolonged mechanical ventilation patients: a randomized controlled trial.

    Science.gov (United States)

    Huang, Wei-Chang; Wu, Pi-Chu; Chen, Chao-Jung; Cheng, Ya-Hua; Shih, Sou-Jen; Chen, Hui-Chen; Wu, Chieh-Liang

    2016-05-01

    Patients with prolonged mechanical ventilation (PMV) often retain airway secretions, which may be cleared with the assistance of high-frequency chest wall oscillation (HFCWO). This study aimed to determine the effectiveness, safety and tolerance/comfort of HFCWO after extubation in PMV patients. This parallel-designed, randomized controlled trial enrolled subjects with both intra-tracheal intubation and mechanical ventilator support continuously for at least 21 days between January 2011 and December 2012. Upon extubation, the participants were randomly assigned to either receive HFCWO for 5 days or not. The effectiveness [based on weaning success rates, daily clearance volume of sputum, serial changes in sputum coloration and chest X-ray (CXR) improvement rates], safety (by physiologic parameters) and tolerance/comfort [using the Modified Borg Scale (MBS) and Hamilton Anxiety Scale (HAS)] of HFCWO were investigated. There were 43 PMV subjects, including 23 in the HFCWO group and 20 in the non-HFCWO group. The weaning success rates were 82.6% (19/23) and 85% (17/20) in the HFCWO and non-HFCWO groups, respectively (P = 1.000). The HFCWO group had persistently greater numbers of daily sputum suctions and higher CXR improvement rates compared with the non-HFCWO group. There was significant sputum coloration lightening in the HFCWO group only. There was no significant difference in the MBS and HAS between the two groups and between pre- and post-HFCWO physiologic parameters. In PMV patients, HFCWO was safe, comfortable and effective in facilitating airway hygiene after removal of endotracheal tubes, but had no positive impact on weaning success. © 2014 John Wiley & Sons Ltd.

  10. 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

  11. Re-irradiation of the chest wall for local breast cancer recurrence. Results of salvage brachytherapy with hyperthermia

    Energy Technology Data Exchange (ETDEWEB)

    Auoragh, A. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Hospital Fuerth, Department of Radiation Oncology, Fuerth (Germany); Strnad, V.; Ott, O.J.; Fietkau, R. [University Hospital Erlangen, Department of Radiation Oncology, Erlangen (Germany); Beckmann, M.W. [University Hospital Erlangen, Department of Gynecology and Obstetrics, Erlangen (Germany)

    2016-09-15

    Following mastectomy and adjuvant external beam radiation therapy in patients with breast cancer, the incidence of local or locoregional recurrence is approximately 9 % (2-20 %). Alongside the often limited possibilities of surgical treatment, radiation therapy combined with superficial hyperthermia is the most effective local therapy. In the present work, a retrospective analysis of salvage brachytherapy combined with superficial hyperthermia for chest wall recurrences is presented. Between 2004 and 2011, 18 patients with a total of 23 target volumes resulting from chest wall recurrences after previously mastectomy and external beam radiation therapy (median 56 Gy, range 50-68 Gy) were treated with superficial brachytherapy as salvage treatment: 8 patients (44 %) had macroscopic tumor, 3 (17 %) had microscopic tumor (R1), and 7 (39 %) had undergone R0 resection and were treated due to risk factors. A dose of 50 Gy was given (high-dose rate [HDR] and pulsed-dose rate [PDR] procedures). In all, 5 of 23 patients (22 %) received additional concurrent chemotherapy, and in 20 of 23 (87 %) target volumes additional superficial hyperthermia was carried out twice weekly. The 5-year local recurrence-free survival was 56 %, the disease-free survival was 28 %, and a 5-year overall survival was 22 %. Late side effects Common Toxicity Criteria (CTC) grade 3 were reported in 17 % of the patients: 2 of 18 (11 %) had CTC grade 3 fibrosis, and 1 of 18 (6 %) had a chronic wound healing disorder. Re-irradiation as salvage brachytherapy with superficial hyperthermia for chest wall recurrences is a feasible and safe treatment with good local control results and acceptable late side effects. (orig.) [German] Nach einer Mastektomie und adjuvanter Strahlentherapie bei Patientinnen mit Mammakarzinom kommt es bei 9 % (2-20 %) zum lokalen bzw. lokoregionaeren Rezidiv. Neben den oft limitierten operativen Behandlungsmoeglichkeiten ist die Strahlentherapie mit Oberflaechenhyperthermie die

  12. 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

  13. SU-F-T-85: Energy Modulated Electron Postmastectomy Unreconstructed (PU) Chest Wall (CW) Irradiation Technique to Achieve Heart Sparing

    Energy Technology Data Exchange (ETDEWEB)

    Hong, L; Ballangrud, A; Mechalakos, J [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); McCormick, B [Memerial Sloan-Kettering Cancer Center, New York, NY (United States)

    2016-06-15

    Purpose: For left-sided PU patients requiring CW and nodal irradiation, sometimes partial wide tangents (PWT) are not feasible due to abnormal chest wall contour or heart position close to the anterior chest wall or unusual wide excision scar. We developed an energy modulated electron chest wall irradiation technique that will achieve heart sparing. Methods: Ten left-sided PU patients were selected for this dosimetry study. If PWT were used, the amount of the ipsilateral lung would be ranged 3.4 to 4.4 cm, and the amount of heart would be ranged 1.3 to 3.8 cm. We used electron paired fields that matched on the skin to achieve dose conformity to the chest wall. The enface electron fields were designed at extended SSD from a single isocenter and gantry angle with different energy beams using different cutout. Lower energy was used in the central chest wall part and higher energy was used in the periphery of the chest wall. Bolus was used for the electron fields to ensure adequate skin dose coverage. The electron fields were matched to the photon supra-clavicle field in the superior region. Daily field junctions were used to feather the match lines between all the fields. Target volumes and normal tissues were drawn according to institutional protocols. Prescription dose was 2Gy per fraction for a total 50Gy. Dose calculations were done with Eclipse EMC-11031 for Electron and AAA-11031 for photons. Results: Six patients were planned using 6/9MeV, three using 9/12MeV and one 6/12MeV. Target volumes achieved adequate coverage. For heart, V30Gy, V20Gy and Mean Dose were 0.6%±0.6%, 2.7%±1.7%, and 3.0Gy±0.8Gy respectively. For ipsilateral lung, V50Gy, V20Gy, V10Gy and V5Gy were 0.9%±1.1%, 34.3%±5.1%, 51.6%±6.3% and 64.1%±7.5% respectively. Conclusion: For left-sided PU patients with unusual anatomy, energy modulated electron CW irradiation technique can achieve heart sparing with acceptable lung dose.

  14. Self- and social perception of physical appearance in chest wall deformity.

    Science.gov (United States)

    Krille, Stefanie; Müller, Astrid; Steinmann, Cornelia; Reingruber, Bertram; Weber, Peter; Martin, Alexandra

    2012-03-01

    This study analyzes self- and social perception of physical appearance in patients with chest wall deformity (CWD), including both pectus carinatum and pectus excavatum. Self-perception of appearance in 76 patients with CWD and social perception of patients' appearance by 20 adult and 20 adolescent raters was assessed using the Appearance Rating Scale (Stangier et al., 2000) and evaluated for agreement and multivariate correlates. Results indicate no agreement between self- and social rating. Based on mean scores patients rated their appearance significantly more negatively than adult raters but only slightly different than adolescent raters. Adolescent raters' judgment of the patients' appearance was related to CWD characteristics, while self-rating rather seems to be related to psychosocial factors. Because adolescents are a relevant peer group for adolescent patients with CWD their evaluation of the appearance might influence patients' self-image and might affect their psychological functioning. Effective interventions focusing on social interactions are needed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  15. Nocturnal mechanical ventilation for chronic hypoventilation in patients with neuromuscular and chest wall disorders.

    Science.gov (United States)

    Annane, Djillali; Orlikowski, David; Chevret, Sylvie

    2014-12-13

    Chronic alveolar hypoventilation is a common complication of many neuromuscular and chest wall disorders. Long-term nocturnal mechanical ventilation is commonly used to treat it. This is a 2014 update of a review first published in 2000 and previously updated in 2007. To examine the effects on mortality of nocturnal mechanical ventilation in people with neuromuscular or chest wall disorders. Subsidiary endpoints were to examine the effects of respiratory assistance on improvement of chronic hypoventilation, sleep quality, hospital admissions and quality of life. We searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE and EMBASE on 10 June 2014. We contacted authors of identified trials and other experts in the field. We searched for quasi-randomised or randomised controlled trials of participants of all ages with neuromuscular or chest wall disorder-related stable chronic hypoventilation of all degrees of severity, receiving any type and any mode of long-term nocturnal mechanical ventilation. The primary outcome measure was one-year mortality and secondary outcomes were unplanned hospital admission, short-term and long-term reversal of hypoventilation-related clinical symptoms and daytime hypercapnia, improvement of lung function and sleep breathing disorders. We used standard Cochrane methodology to select studies, extract data and assess the risk of bias in included studies. The 10 eligible trials included a total of 173 participants. Roughly half of the trials were at low risk of selection, attrition or reporting bias, and almost all were at high risk of performance and detection bias. Four trials reported mortality data in the long term. The pooled risk ratio (RR) of dying was 0.62 (95% confidence interval (CI) 0.42 to 0.91, P value = 0.01) in favour of nocturnal mechanical ventilation compared to spontaneous breathing. There was considerable and significant heterogeneity between the trials, possibly related to differences

  16. MRI of the Chest

    Medline Plus

    Full Text Available ... of the chest. assess disorders of the chest bones (vertebrae, ribs and sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around the heart) ...

  17. MRI of the Chest

    Medline Plus

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

  18. Neurilemmoma showing a unique growth pattern in the lateral chest wall: both inside and outside the thoracic cavity.

    Science.gov (United States)

    Jun Ahn, Sun; Joo Park, Kyung; Sung Sun, Joo; Choi, Ho; Hee Lee, Yong

    2014-01-01

    We report the first case of the intercostal neurilemmoma showing a unique growth pattern in the lateral chest wall (both inside and outside the thoracic cavity). Usually, intrathoracic neurilemmoma is found in the posterior mediastinum and bulge from the inner surface of the bony thorax toward the thoracic cavity. This unique growing pattern of neurilemmoma arising from intercostal nerve was clearly demonstrated by computed tomography and ultrasonography.

  19. SU-E-T-18: A Comparison of Planning Techniques for Bilateral Reconstructed Chest Wall Patients Undergoing Whole Breast Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Volpe, T; Margiasso, R; Saleh, Z; Kuo, L; Hong, L; Ballangrud, A; Gelblum, D; Zinovoy, M; Deasy, J; Tang, X [Memorial Sloan Kettering Cancer Center, New York, NY (United States)

    2015-06-15

    Purpose: As we continuously see more bilateral reconstructed chest wall cases, new challenges are being presented to deliver left-sided breast irradiation. We herein compare three Deep Inspiration Breath Hold (DIBH) planning techniques (tangents, VMAT, and IMRT) and two free breathing techniques (VMAT and IMRT). Methods: Three left-sided chest wall patients with bilateral implants were studied. Tangents, VMAT, and IMRT plans were created for DIBH scans. VMAT and IMRT plans were created for free breathing scans. All plans were normalized so that 95% of the prescription dose was delivered to 95% of the planning target volume (PTV). The maximum point dose was constrained to less than 120% of the prescription dose. Since the success of DIBH delivery largely depends on patient’s ability to perform consistent breath hold during beam on time, smaller number of Monitor Units (MU) is in general desired. For each patient, the following information was collected to compare the planning techniques: heart mean dose, left and right lung V20 Gy, contra-lateral (right) breast mean dose, cord max dose, and MU. Results: The average heart mean dose over all patients are 1561, 692, 985, 1245, and 1121 cGy, for DIBH tangents, VMAT, IMRT, free breathing VMAT and IMRT, respectively. For left lung V20 are 60%, 28%, 26%, 30%, and 29%. For contra-lateral breast mean dose are 244, 687, 616, 783, 438 cGy. MU are 253, 853, 2048, 1035, and 1874 MUs. Conclusion: In the setting of bilateral chest wall reconstruction, opposed tangent beams cannot consistently achieve desired heart and left lung sparing. DIBH consistently achieves better healthy tissue sparing. VMAT appears to be preferential to IMRT for planning and delivering radiation to patients with bilaterally reconstructed chest walls being treated with DIBH.

  20. Complex Reconstruction of a Massive Shoulder and Chest Wall Defect: De-Bone Appétit Flap

    Directory of Open Access Journals (Sweden)

    Lee GK

    2010-05-01

    Full Text Available We report the use of a fillet of upper arm pedicled flap, which has not been previously reported in the literature. The fillet of upper arm flap follows the principle of “spare parts” surgery, and can provide vascularized soft tissue coverage for defects of the shoulder and the chest wall when the upper extremity cannot otherwise be salvaged, such as in cases of radical tumor excision.

  1. Feasibility of Early Diagnosis and Treatment of Acute Chest ...

    African Journals Online (AJOL)

    Acute chest syndrome is a serious complication and one of the causes of mortality in sickle cell disease. Twenty eight year old male was admitted in our hospital with fever, severe chest pain and haemolytic crisis. He was treated with intravenous antibiotics, fluids, parenteral analgesics and blood transfusion. Severe ...

  2. Acute chest pain.

    Science.gov (United States)

    Jindal, Atul; Singhi, Sunit

    2011-10-01

    Chest pain is a worrisome symptom that often causes parents to bring their child to emergency department(ED) for evaluation. In the majority of cases, the etiology of the chest pain is benign, but in one-fourth of the cases symptoms are distressing enough to cause children to miss school. The clinician's primary goal in ED evaluation of chest pain is to identify serious causes and rule out organic pathology. The diagnostic evaluation includes a thorough history and physical examination. Younger children are more likely to have a cardiorespiratory source for their chest pain, whereas an adolescent is more likely to have a psychogenic cause. Children having an organic cause of chest pain are more likely to have acute pain, sleep disturbance due to pain and associated fever or abnormal examination findings, whereas those with non-organic chest pain are more likely to have pain for a longer duration. Chest radiograph is required in some, especially in patients with history of trauma . In children, myocardial ischemia is rare, thus routine ECG is not required on every patient. However, both pericarditis and myocarditis can present with chest pain and fever. Musculoskeletal chest pain, such as caused by costochondritis and trauma, is generally reproducible on palpation and is exaggerated by physical activity or breathing. Pneumonia with or without pleural effusion, usually presents with fever and tachypnea; chest pain may be presenting symptom sometimes. In asthmatic children bronchospasm and persistent coughing can lead to excess use of chest wall muscles and chest pain. Patients' who report acute pain and subsequent respiratory distress should raise suspicion of a spontaneous pneumothorax or pneumomediastinum. ED management includes analgesics, specific treatment directed at underlying etiology and appropriate referral.

  3. Automated chest wall line detection for whole-breast segmentation in sagittal breast MR images.

    Science.gov (United States)

    Wu, Shandong; Weinstein, Susan P; Conant, Emily F; Schnall, Mitchell D; Kontos, Despina

    2013-04-01

    Breast magnetic resonance imaging (MRI) plays an important role in the clinical management of breast cancer. Computerized analysis is increasingly used to quantify breast MRI features in applications such as computer-aided lesion detection and fibroglandular tissue estimation for breast cancer risk assessment. Automated segmentation of the whole-breast as an organ from the other parts imaged is an important step in aiding lesion localization and fibroglandular tissue quantification. For this task, identifying the chest wall line (CWL) is most challenging due to image contrast variations, intensity discontinuity, and bias field. In this work, the authors develop and validate a fully automated image processing algorithm for accurate delineation of the CWL in sagittal breast MRI. The CWL detection is based on an integrated scheme of edge extraction and CWL candidate evaluation. The edge extraction consists of applying edge-enhancing filters and an edge linking algorithm. Increased accuracy is achieved by the synergistic use of multiple image inputs for edge extraction, where multiple CWL candidates are evaluated by the dynamic time warping algorithm coupled with the construction of a CWL reference. Their method is quantitatively validated by a dataset of 60 3D bilateral sagittal breast MRI scans (in total 3360 2D MR slices) that span the full American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) breast density range. Agreement with manual segmentation obtained by an experienced breast imaging radiologist is assessed by both volumetric and boundary-based metrics, including four quantitative measures. In terms of breast volume agreement with manual segmentation, the overlay percentage expressed by the Dice's similarity coefficient is 95.0% and the difference percentage is 10.1%. More specifically, for the segmentation accuracy of the CWL boundary, the CWL overlay percentage is 92.7% and averaged deviation distance is 2.3 mm. Their method

  4. Prehospital chest tube thoracostomy: effective treatment or additional trauma?

    NARCIS (Netherlands)

    Spanjersberg, W.; Bergs, B.; Krijen, P.; Schipper, I.; Ringburg, A.; Steyerberg, E.W.; Edwards, M.J.R.; Schipper, I.B.; Vugt, A.B. van

    2005-01-01

    BACKGROUND: The use of prehospital chest tube thoracostomy (TT) remains controversial because of presumed increased complication risks. This study analyzed infectious complication rates for physician-performed prehospital and emergency department (ED) TT. METHODS: Over a 40-month period, all

  5. Chronic inactive pulmonary tuberculosis and treatment sequelae: chest radiographic features.

    Science.gov (United States)

    Hicks, A; Muthukumarasamy, S; Maxwell, D; Howlett, D

    2014-02-01

    The chest radiograph (CXR) is a key initial tool in the diagnosis of many lung conditions, including pulmonary tuberculosis (TB). With proper use of anti-tuberculosis drugs, TB can be treated effectively and many CXR changes are limited. However, anti-tuberculosis drugs have not always been available, and in some cases they have not been started early in the disease process. The infection has then been able to take hold and cause significant radiologically visible damage, such as calcification and fibrosis. Before the use of anti-tuberculosis drugs, a variety of surgical techniques were employed to control pulmonary infection, including plombage, oleothorax, phrenic nerve crush and thoracoplasty. Each of these led to distinctive CXR features. This article sets out to describe the CXR features of chronic disease and surgical treatments, as their increasing rarity with the passage of time has meant that they can be misinterpreted. However, with increasing life expectancy and the revival of surgery due to the development of anti-tuberculosis drug resistance, the correct interpretation of these CXR changes is still of importance.

  6. Acute effects of volume-oriented incentive spirometry on chest wall volumes in patients after a stroke.

    Science.gov (United States)

    Lima, Illia Ndf; Fregonezi, Guilherme Af; Melo, Rodrigo; Cabral, Elis Ea; Aliverti, Andrea; Campos, Tânia F; Ferreira, Gardênia Mh

    2014-07-01

    The aim of the present study was to assess how volume-oriented incentive spirometry applied to patients after a stroke modifies the total and compartmental chest wall volume variations, including both the right and left hemithoraces, compared with controls. Twenty poststroke patients and 20 age-matched healthy subjects were studied by optoelectronic plethysmography during spontaneous quiet breathing (QB), during incentive spirometry, and during the recovery period after incentive spirometry. Incentive spirometry was associated with an increased chest wall volume measured at the pulmonary rib cage, abdominal rib cage and abdominal compartment (P = .001) and under 3 conditions (P spirometry, and postincentive spirometry, respectively. Under all 3 conditions, the contribution of the abdominal compartment to VT was greater in the stroke subjects (54.1, 43.2, and 48.9%) than in the control subjects (43.7, 40.8, and 46.1%, P = .039). In the vast majority of subjects (13/20 and 18/20 during QB and incentive spirometry, respectively), abdominal expansion precedes rib cage expansion during inspiration. Greater asymmetry between the right and left hemithoracic expansions occurred in stroke subjects compared with control subjects, but it decreased during QB (62.5%, P = .002), during incentive spirometry (19.7%), and postincentive spirometry (67.6%, P = .14). Incentive spirometry promotes increased expansion in all compartments of the chest wall and reduces asymmetric expansion between the right and left parts of the pulmonary rib cage; therefore, it should be considered as a tool for rehabilitation. Copyright © 2014 by Daedalus Enterprises.

  7. Asymmetric evolution of anterior chest wall blood supply in female adolescents with progressive right-convex thoracic idiopathic scoliosis.

    Science.gov (United States)

    Iliopoulos, Panagiotis; Korovessis, Panagiotis; Koureas, Georgios; Zacharatos, Spyridon; Stergiou, Panagiotis

    2007-09-01

    Breast asymmetry was believed to be related to asymmetry of anterior chest wall blood supply and subsequently to aetiology of idiopathic thoracic scoliosis in female adolescents. Recent investigations on the anterior chest wall blood supply with Colour Doppler Ultrasonography (CDU) in such individuals did not show anatomical and hemodynamic abnormalities. The present study investigated the evolution of anterior chest wall blood supply in these individuals over a 2-year period. Twenty female adolescents with progressive right-convex idiopathic thoracic scoliosis (scoliotics), who were during the study in therapy with horacolumbosacral orthosis (TLSO) and 20 age-matched girls, without spine deformity (controls) were studied with CDU [internal mammary artery (IMA)] twice within the 2-year period. IMA-anatomical parameters [lumen diameter (D) and cross sectional area (AR)] as well as hemodynamic flow parameters [time average mean flow velocity and flow volume per minute (FV)] were measured. In the 2-year-period of observation, TLSO prevented scoliosis progression (P = 0.004), while IMA-AR decreased bilaterally in the individuals of both groups (P < 0.03). In the last evaluation: in scoliotics right IMA FV decreased (P < 0.04), while in controls IMA FV decreased bilaterally (P < 0.03); left IMA FV was significantly higher (P < 0.05) in scoliotics than in controls. The significant, within the 2-year period, decrease of IMA-diameter, cross-sectional area, and flow volume seems to be a physiological ageing process because it was observed in all individuals (scoliotics and controls), and thus these anatomic and hemodynamic changes seem not to have been affected by bracing. The maintenance of left flow volume of IMA in the pre-brace levels in scoliotics was the most significant finding of this investigation. In conclusion, this study provided evidence for abnormalities in the evolution of anterior chest wall blood supply in female adolescents with progressive right

  8. Diagnostic performance of reproducible chest wall tenderness to rule out acute coronary syndrome in acute chest pain: a prospective diagnostic study.

    Science.gov (United States)

    Gräni, Christoph; Senn, Oliver; Bischof, Manuel; Cippà, Pietro E; Hauffe, Till; Zimmerli, Lukas; Battegay, Edouard; Franzen, Daniel

    2015-01-28

    Acute chest pain (ACP) is a leading cause of hospital emergency unit consultation. As there are various underlying conditions, ranging from musculoskeletal disorders to acute coronary syndrome (ACS), thorough clinical diagnostics are warranted. The aim of this prospective study was to assess whether reproducible chest wall tenderness (CWT) on palpation in patients with ACP can help to rule out ACS. In this prospective, double-blinded diagnostic study, all consecutive patients assessed in the emergency unit at the University Hospital Zurich because of ACP between July 2012 and December 2013 were included when a member of the study team was present. Reproducible CWT on palpation was the initial step and was recorded before further examinations were initiated. The final diagnosis was adjudicated by a study-independent physician. 121 patients (60.3% male, median age 47 years, IQR 34-66.5 years) were included. The prevalence of ACS was 11.6%. Non-reproducible CWT had a high sensitivity of 92.9% (95% CI 66.1% to 98.8%) for ACS and the presence of reproducible CWT ruled out ACS (p=0.003) with a high negative predictive value (98.1%, 95% CI 89.9% to 99.7%). Conversely non-reproducible CWT ruled in ACS with low specificity (48.6%, 95% CI 38.8% to 58.5%) and low positive predictive value (19.1%, 95% CI 10.6% to 30.5%). This prospective diagnostic study supports the concept that reproducible CWT helps to rule out ACS in patients with ACP in an early stage of the evaluation process. However, ACS and other diagnoses should be considered in patients with a negative CWT test. ClinicalTrial.gov: NCT01724996. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  9. Highly sensitive monitoring of chest wall dynamics and acoustics provides diverse valuable information for evaluating ventilation and diagnosing pneumothorax.

    Science.gov (United States)

    Pesin, Jimy; Faingersh, Anna; Waisman, Dan; Landesberg, Amir

    2014-06-15

    Current practice of monitoring lung ventilation in neonatal intensive care units, utilizing endotracheal tube pressure and flow, end-tidal CO2, arterial O2 saturation from pulse oximetry, and hemodynamic indexes, fails to account for asymmetric pathologies and to allow for early detection of deteriorating ventilation. This study investigated the utility of bilateral measurements of chest wall dynamics and sounds, in providing early detection of changes in the mechanics and distribution of lung ventilation. Nine healthy New Zealand rabbits were ventilated at a constant pressure, while miniature accelerometers were attached to each side of the chest. Slowly progressing pneumothorax was induced by injecting 1 ml/min air into the pleural space on either side of the chest. The end of the experiment (tPTX) was defined when arterial O2 saturation from pulse oximetry dropped acoustics provide novel information that is sensitive to asymmetric changes in ventilation, enabling early detection and localization of pneumothorax. Copyright © 2014 the American Physiological Society.

  10. [Basic lung ultrasound. Part 1. Normal lung ultrasound and diseases of the chest wall and the pleura].

    Science.gov (United States)

    de la Quintana Gordon, F B; Nacarino Alcorta, B

    2015-01-01

    Lung ultrasound has become part of the diagnostic armamentarium in Resuscitation and Recovery Units with an enormous potential due to its many advantages: capacity to diagnose more precisely than conventional radiology, earlier diagnosis, convenience due to being able to performed at the bedside, possibility of being performed by one person, absence of ionising radiation, and, due to its dynamic character, is capable of transforming into physiological processes that were once static images. However, lung ultrasound also has its limitations and has a learning curve. The aim of this review is to provide sufficient information that may help the specialist starting in this field to approach the technique with good possibilities of success. To do this, the review is structured into two parts. In the first, the normal ultrasound of the chest wall is presented, as well as the pleura, diaphragm, and lung parenchyma, and the most important pathologies of the chest wall (rib fractures and hematomas), the pleura (pleural effusion and its different types, and pneumothorax), and the diaphragm (hypokinesia and paralysis). In the second part, parenchymal diseases will be approached and will include, atelectasis, pneumonia and abscess, lung oedema, respiratory distress, and pulmonary thromboembolism. Copyright © 2014 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Third generation anthropomorphic physical phantom for mammography and DBT: incorporating voxelized 3D printing and uniform chest wall QC region

    Science.gov (United States)

    Zhao, Christine; Solomon, Justin; Sturgeon, Gregory M.; Gehm, Michael E.; Catenacci, Matthew; Wiley, Benjamin J.; Samei, Ehsan; Lo, Joseph Y.

    2017-03-01

    Physical breast phantoms provide a standard method to test, optimize, and develop clinical mammography systems, including new digital breast tomosynthesis (DBT) systems. In previous work, we produced an anthropomorphic phantom based on 500x500x500 μm breast CT data using commercial 3D printing. We now introduce an improved phantom based on a new cohort of virtual models with 155x155x155 μm voxels and fabricated through voxelized 3D printing and dithering, which confer higher resolution and greater control over contrast. This new generation includes a uniform chest wall extension for evaluating conventional QC metrics. The uniform region contains a grayscale step wedge, chest wall coverage markers, fiducial markers, spheres, and metal ink stickers of line pairs and edges to assess contrast, resolution, artifact spread function, MTF, and other criteria. We also experimented with doping photopolymer material with calcium, iodine, and zinc to increase our current contrast. In particular, zinc was discovered to significantly increase attenuation beyond 100% breast density with a linear relationship between zinc concentration and attenuation or breast density. This linear relationship was retained when the zinc-doped material was applied in conjunction with 3D printing. As we move towards our long term goal of phantoms that are indistinguishable from patients, this new generation of anthropomorphic physical breast phantom validates our voxelized printing process, demonstrates the utility of a uniform QC region with features from 3D printing and metal ink stickers, and shows potential for improved contrast via doping.

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

    Science.gov (United States)

    Broggio, D; Lechaftois, X; Franck, D

    2015-03-01

    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 (241)Am 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 (241)Am, 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 (241)Am, 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.

  13. Automated quantification of bronchiectasis, airway wall thickening and lumen tapering in chest CT

    DEFF Research Database (Denmark)

    Perez-Rovira, Adria; Kuo, Wieying; Petersen, Jens

    Purpose: To automatically quantify airway structural properties visualised on CT in children with cystic fibrosis (CF) and controls, including: bronchiectasis, airway wall thickening, and lumen tapering. Methods and materials: The 3D surface of the airway lumen, outer wall, and bronchial arteries...

  14. Radiation-induced squamous cell carcinoma of the chest wall seven years after adjuvant radiotherapy following the surgery of breast cancer. A case report

    Energy Technology Data Exchange (ETDEWEB)

    Yokota, Tohru; Roppongi, Takashi; Kanno, Keiichi; Tsutsumi, Hiroyuki; Sakamoto, Ichiro; Fujii, Takanao [Numata National Hospital, Shibukawa, Gunma (Japan)

    2000-12-01

    A 54-year-old woman, who had underwent an adjuvant radiotherapy following the modified radical mastectomy in the left primary breast cancer in June 1988. She underwent second surgery and adjuvant radiotherapy (electronic radiotherapy) for recurrent breast cancer in the major pectoral muscle and received chemoimmunotherapy in May 1989. In May 1996 she complained of two ulcers of the chest wall. The ulcer biopsy findings was squamous cell carcinoma, and we diagnosed she fell the radiation-induced skin cancer. She underwent chest wall resection and reconstruction with vertical rectal abdominal musculocutaneous flap (V-RAM). However two months later her chest wall resection, she again got the recurrent squamous cell carcinoma in the right axillary lymph nodes and left pleura. The third radiotherapy and the chemotherapy with pepleomycin were uneffective on her recurrent cancer. And she died in March 1997. (author)

  15. Chest radiation - discharge

    Science.gov (United States)

    Radiation - chest - discharge; Cancer - chest radiation; Lymphoma - chest radiation ... When you have radiation treatment for cancer, your body goes through changes. About 2 weeks after your first treatment: It may be hard ...

  16. Single-incision video-assisted thoracoscopic evaluation and emergent surgery for severe lung and chest wall injury after thoracic trauma in a water park.

    Science.gov (United States)

    Sesma, Julio; Alvarez, Melodie; Lirio, Francisco; Galvez, Carlos; Galiana, Maria; Baschwitz, Benno; Fornes, Francisca; Bolufer, Sergio

    2017-08-01

    Thoracic trauma is a challenging situation with potential severe chest wall and intrathoracic organ injuries. We present a case of emergent surgery in a 23-year-old man with hemorrhagic shock due to massive lung and chest wall injury after thoracic trauma in a water slide. We performed a SI-VATS approach in order to define intrathoracic and chest wall injuries, and once checked the extension of the chest wall injury, we added a middle size thoracotomy just over the affected area in order to stabilize rib fractures with Judet plates, that had caused massive laceration in left lower lobe (LLL) and injured the pericardium causing myocardical tear. After checking bronchial and vascular viability of LLL we suggested a lung parenchyma preserving technique with PTFE protected pulmonary primary suture in order to avoid a lobectomy. Chest tubes were removed on 3(rd) postoperative day and patient was discharged on 14(th) postoperative day. He has already recovered his normal activity 6 months after surgery.

  17. Revision breast and chest wall reconstruction in Poland and pectus excavatum following implant complication using free deep inferior epigastric perforator flap

    Directory of Open Access Journals (Sweden)

    Dimitrios Dionyssiou

    2015-01-01

    Full Text Available This study aims to present the case of a female patient with Poland′s syndrome and pectus excavatum deformity who underwent breast and chest wall reconstruction with a pre-shaped free deep inferior epigastric perforator flap. A 57-year-old female patient with Poland′s syndrome and pectus excavatum presented with a Baker III capsular contracture following a previously performed implant-based right breast reconstruction. After a chest and abdominal CT angiography, she was staged as 2A1 chest wall deformity according to Park′s classification and underwent implant removal and capsulectomy, followed by a pre-shaped free abdominal flap transfer, providing both breast reconstruction and chest wall deformity correction in a single stage operation. Post-operative course was uneventful, and the aesthetic result remains highly satisfactory 24 months after surgery. Deep inferior epigastric free flap represents an interesting reconstructive solution when treating Poland′s syndrome female patients with chest wall and breast deformities.

  18. Simultaneous seeding of follicular thyroid adenoma both around the operative bed and along the subcutaneous tunnel of the upper chest wall after endoscopic thyroidectomy

    Energy Technology Data Exchange (ETDEWEB)

    Jung, Jo Sung; Kim, Shin Young; Jung, Hae Yeon; Han, Seon Wook; Lee, Jong Eun [Soonchunhyang University Cheonan Hospital, Cheonan (Korea, Republic of); Lee, Deuk Young [Dept. of Surgery, YonseiAngelot Hospital, Cheonan (Korea, Republic of)

    2017-02-15

    Endoscopic thyroidectomy is considered appropriate for follicular neoplasms, but on occasion, it leads to unexpected complications such as seeding along the port insertion site. Only 4 cases of operative track seeding after endoscopic thyroidectomy have been reported. Furthermore, simultaneous seeding at both operative track of upper chest wall and operative bed is also very rare. We present a case of thyroid follicular adenoma seeding at both the subcutaneous tunnel of the upper chest wall and the operative bed after endoscopic thyroidectomy, with an emphasis on magnetic resonance imaging and ultrasonography with pathologic correlations.

  19. MRI of the Chest

    Medline Plus

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

  20. Chest X-Ray

    Medline Plus

    Full Text Available ... evaluate the lungs, heart and chest wall and may be used to help evaluate shortness of breath, persistent cough, fever, chest pain or injury. It may also be useful to help diagnose and monitor ...

  1. Comparison of the effects of core stabilization and chest mobilization exercises on lung function and chest wall expansion in stroke patients.

    Science.gov (United States)

    Park, Shin-Jun; Lee, Ju-Hwan; Min, Kyung-Ok

    2017-07-01

    [Purpose] The main purpose of this study was to compare the effects of core stabilization and chest mobilization exercises on pulmonary function and chest expansion in chronic stroke patients. [Subjects and Methods] Thirty stroke patients were randomly divided into two groups: a core stabilization exercise group (n=15) and a chest mobilization exercise group (n=15). Each exercise was performed 3 times per week for 30 minutes for 4 weeks, and pulmonary function and chest expansion when breathing were measured for both groups. [Results] There were significant increases in both forced vital capacity and forced expiratory volume in 1 second before and after intervention. Core stabilization exercise resulted in a significant increase in peak expiratory flow, and significant increases in upper and lower chest expansion were detected with chest mobilization exercise. However, no significant difference was revealed between the two groups. [Conclusion] This study suggested that both exercises were effective in some aspects of pulmonary function while core stabilization can help increase peak expiratory flow and chest mobilization can assist with chest expansion.

  2. SU-E-T-632: A Dosimetric Comparison of the 3D-CRT Planning of Chest Wall in Post-Mastectomy Breast Cancer Patients, with and Without Breast Board Setup

    Energy Technology Data Exchange (ETDEWEB)

    Muzaffar, Ambreen; Masood, Asif; Ullah, Haseeb; Mehmood, Kashif; Qasim, Uzma; Afridi, M. Ali; Khan, Salim; Hameed, Abdul [Radiation Oncology Department, Shifa International Hospitals Ltd. Sector H-8/4 Islamabad (Pakistan)

    2014-06-15

    Purpose: Breast boards are used in breast radiation which increases normal lung and heart doses, when supraclavicular field is included. Therefore, in this study through dose volume histogram (DVHs), lung and heart doses comparison was done between two different setups i.e. with and without breast board, for the treatment of left chest wall and supraclavicular fossa in postmastectomy left breast cancer. Methods: In this study, CT-Simulation scans of ten breast cancer patients were done with and without breast board, at Shifa International Hospitals Islamabad, to investigate the differences between the two different setups of the irradiation of left chest wall in terms of lung and heart doses. For immobilization, support under the neck, shoulders and arms was used. Precise PLAN 2.15 treatment planning system (TPS) was used for 3D-CRT planning. The total prescribed dose for both the plans was 5000 cGy/25 fractions. The chest wall was treated with a pair of tangential photon fields and the upper supraclavicular nodal regions were treated with an anterior photon field. A mono-isocentric technique was used to match the tangential fields with the anterior field at the isocentre. The dose volume histogram was used to compare the doses of heart and ipsilateral lung. Results: Both the plans of each patient were generated and compared. DVH results showed that for the same PTV dose coverage, plans without breast board resulted in a reduction of lung and heart doses compared with the plans with breast board. There was significant reductions in V20, V<25 and mean doses for lung and V<9 and mean doses for heart. Conclusion: In comparison of both the plans, setup without breast board significantly reduced the dose-volume of the ipsilateral lung and heart in left chest wall patients. Waived registration request has been submitted.

  3. Influence of the Pectoralis Major Muscle Sling in Chest Wall-Based Flap Suspension After Vertical Mammaplasty: Ten-Year Follow-Up.

    Science.gov (United States)

    Graf, Ruth; Ricardo Dall Oglio Tolazzi, André; Balbinot, Priscilla; Pazio, André; Miguel Valente, Pedro; da Silva Freitas, Renato

    2016-11-01

    The pectoralis muscle sling has proven to be a suitable alternative technique for long-term results in breast parenchyma suspension. Although the pectoralis muscle sling has been subjectively observed to reduce the bottoming-out effect with a bipedicled muscle flap (muscular loop), there has not been a study to objectively or numerically prove it. This study aimed to radiologically evaluate the influence of a pectoralis muscle sling in supporting the chest wall-based flap after a vertical breast-reduction technique. Twenty-one female patients underwent a vertical breast reduction with the chest wall-based flap and were randomly divided into two subgroups. Ten patients were in subgroup (S), which consisted of patients with a muscle sling. Eleven patients without the muscle sling technique were assigned as a control group (C). Periodic radiological examinations were performed at 1, 3, 6, and 12 months and then at 10 years postoperatively to analyze the breast flap and any migration with respect to three titanium clips placed intraoperatively on the chest wall parenchyma flap. Patients in subgroup S had a significantly higher difference in migration of the chest wall-based flaps between the first day and 10 years postoperatively when compared with patients in subgroup C (P follow-up, there were changes in chest wall-based flap bottoming-out in patients in whom a pectoralis major muscle sling was utilized compared with those patients without it. Thus, a pectoralis major muscle sling seems to provide greater and longer-lasting support to the flap position on the patient's chest. 2 Therapeutic. © 2016 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  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

    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.

  6. High frequency chest wall oscillation plus Mechanical In-Exsufflation in Duchenne muscular dystrophy with respiratory complications related to pandemic Influenza A/H1N1

    Directory of Open Access Journals (Sweden)

    G. Crescimanno

    2010-11-01

    Full Text Available Two young boys with Duchenne muscular dystrophy, who had contracted 2009 pandemic influenza A/H1N1 (pH1N1, had been treated with antibiotics and steroids without significant improvement. One of them showed severe scoliosis. After hospitalization chest CT scan revealed extensive pulmonary bilateral segmental atelectasis. Their clinical and radiological findings rapidly improved when a sequential respiratory physiotherapy protocol was adopted that consisted of the application of multiple sessions of high-frequency chest wall oscillations, each one followed by mechanically assisted coughing manoeuvres. The protocol was well tolerated, effective, easy to apply and special positioning was not required. Fifteen days after treatment initiation both patients clinically recovered. This treatment can be very helpful for neuromuscular patients, particularly when scoliosis prevents conventional respiratory physiotherapy. Resumo: Duas crianças do sexo masculino com distrofia muscular de Duchenne que contraíram o vírus da gripe pandémica A/H1N1(pH1N1 de 2009 foram tratados com antibióticos e esteróides sem melhoria significativa.Um deles revelou escoliose severa. Depois da hospitalização, um TAC ao peito revelou uma atelectasia pulmonar segmentar bilateral extensa. Os seus resultados clínicos e radiológicos melhoraram rapidamente quando foi adoptado um tratamento de fisioterapia respiratória sequencial, consistente na aplicação de múltiplas sessões de oscilações torácicas de alta frequência, cada uma seguida por exercícios de tosse mecanicamente assistidos. O tratamento foi bem tolerado, eficaz e fácil de aplicar, sendo que não foi necessário um posicionamento especial. Quinze dias depois do início do tratamento, ambos os pacientes se encontravam clinicamente recuperados. Este tratamento pode ser muito útil em pacientes com doenças neuromusculares, particularmente quando a escoliose

  7. High frequency chest wall oscillation plus Mechanical In-Exsufflation in Duchenne muscular dystrophy with respiratory complications related to pandemic Influenza A/H1N1

    Directory of Open Access Journals (Sweden)

    G. Crescimanno

    2010-11-01

    Full Text Available Two young boys with Duchenne muscular dystrophy, who had contracted 2009 pandemic influenza A/H1N1 (pH1N1, had been treated with antibiotics and steroids without significant improvement. One of them showed severe scoliosis. After hospitalization chest CT scan revealed extensive pulmonary bilateral segmental atelectasis. Their clinical and radiological findings rapidly improved when a sequential respiratory physiotherapy protocol was adopted that consisted of the application of multiple sessions of high-frequency chest wall oscillations each one followed by mechanically assisted coughing manoeuvres. The protocol was well tolerated, effective, easy to apply and special positioning was not required. Fifteen days after treatment initiation both patients clinically recovered. This treatment can be very helpful for neuromuscular patients, particularly when scoliosis prevents conventional respiratory physiotherapy. Resumo: Duas crianças do sexo masculino com distrofia muscular de Duchenne que contraíram o vírus da gripe pandémica A/H1N1(pH1N1 de 2009 foram tratados com antibióticos e esteróides sem melhoria significativa.Um deles revelou escoliose severa. Depois da hospitalização, um TAC ao peito revelou uma atelectasia pulmonar segmentar bilateral extensa. Os seus resultados clínicos e radiológicos melhoraram rapidamente quando foi adoptado um tratamento de fisioterapia respiratória sequencial, consistente na aplicação de múltiplas sessões de oscilações torácicas de alta frequência, cada uma seguida por exercícios de tosse mecanicamente assistidos. O tratamento foi bem tolerado, eficaz e fácil de aplicar, sendo que não foi necessário um posicionamento especial. Quinze dias depois do início do tratamento, ambos os pacientes se encontravam clinicamente recuperados. Este tratamento pode ser muito útil em pacientes com doenças neuromusculares, particularmente quando a escoliose

  8. 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.

  9. Chest wall restriction limits high airway pressure-induced lung injury in young rabbits.

    Science.gov (United States)

    Hernandez, L A; Peevy, K J; Moise, A A; Parker, J C

    1989-05-01

    High peak inspiratory pressures (PIP) during mechanical ventilation can induce lung injury. In the present study we compare the respective roles of high tidal volume with high PIP in intact immature rabbits to determine whether the increase in capillary permeability is the result of overdistension of the lung or direct pressure effects. New Zealand White rabbits were assigned to one of three protocols, which produced different degrees of inspiratory volume limitation: intact closed-chest animals (CC), closed-chest animals with a full-body plaster cast (C), and isolated excised lungs (IL). The intact animals were ventilated at 15, 30, or 45 cmH2O PIP for 1 h, and the lungs of the CC and C groups were placed in an isolated lung perfusion system. Microvascular permeability was evaluated using the capillary filtration coefficient (Kfc). Base-line Kfc for isolated lungs before ventilation was 0.33 +/- 0.31 ml.min-1.cmH2O-1.100g-1 and was not different from the Kfc in the CC group ventilated with 15 cmH2O PIP. Kfc increased by 850% after ventilation with only 15 cmH2O PIP in the unrestricted IL group, and in the CC group Kfc increased by 31% after 30 cmH2O PIP and 430% after 45 cmH2O PIP. Inspiratory volume limitation by the plaster cast in the C group prevented any significant increase in Kfc at the PIP values used. These data indicate that volume distension of the lung rather than high PIP per se produces microvascular damage in the immature rabbit lung.

  10. Simultaneous measurement of instantaneous heart rate and chest wall plethysmography in short-term, metronome guided heart rate variability studies: suitability for assessment of autonomic dysfunction.

    Science.gov (United States)

    Perring, S; Jones, E

    2003-08-01

    Instantaneous heart rate and chest wall motion were measured using a 3-lead ECG and an air pressure chest wall plethysmography system. Chest wall plethysmography traces were found to accurately represent the breathing pattern as measured by spirometry (average correlation coefficient 0.944); though no attempt was made to calibrate plethysmography voltage output to tidal volume. Simultaneous measurements of heart rate and chest wall motion were made for short periods under metronome guided breathing at 6 breaths per minute. The average peak to trough heart rate change per breath cycle (AVEMAX) and maximum correlation between heart rate and breathing cycle (HRBRCORR) were measured. Studies of 44 normal volunteers indicated clear inverse correlation of heart rate variability parameters with age (AVEMAX R = -0.502, P heart rate variability in diabetics (P = 0.005 for AVEMAX) and significantly worse correlation between heart rate and breathing (P measurement of heart rate and breathing offers the possibility of more sensitive diagnosis of autonomic failure in a simple bedside test and gives further insight into the nature of cardio-ventilatory coupling.

  11. Effect of volume-oriented versus flow-oriented incentive spirometry on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly.

    Science.gov (United States)

    Lunardi, Adriana C; Porras, Desiderio C; Barbosa, Renata Cc; Paisani, Denise M; Marques da Silva, Cibele C B; Tanaka, Clarice; Carvalho, Celso R F

    2014-03-01

    Aging causes physiological and functional changes that impair pulmonary function. Incentive spirometry is widely used for lung expansion, but the effects of volume-oriented incentive spirometry (VIS) versus flow-oriented incentive spirometry (FIS) on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly are poorly understood. We compared VIS and FIS in elderly subjects and healthy adult subjects. Sixteen elderly subjects (9 women, mean ± SD age 70.6 ± 3.9 y, mean ± SD body mass index 23.8 ± 2.5 kg/m(2)) and 16 healthy adults (8 women, mean ± age 25.9 ± 4.3 y, mean ± body mass index 23.6 ± 2.4 kg/m(2)) performed quiet breathing, VIS, and FIS in randomized sequence. Chest wall kinematics (via optoelectronic plethysmography) and inspiratory muscle activity (via surface electromyography) were assessed simultaneously. Synchrony between the superior thorax and abdominal motion was calculated (phase angle). In the elderly subjects both types of incentive spirometry increased chest wall volumes similarly, whereas in the healthy adult subjects VIS increased the chest wall volume more than did FIS. FIS and VIS triggered similar lower thoracoabdominal synchrony in the elderly subjects, whereas in the healthy adults FIS induced lower synchrony than did VIS. FIS required more muscle activity in the elderly subjects to create an increase in chest wall volume. Incentive spirometry performance is influenced by age, and the differences between elderly and healthy adults response should be considered in clinical practice.

  12. Effect of asbestos-related pleural fibrosis on excursion of the lower chest wall and diaphragm.

    Science.gov (United States)

    Singh, B; Eastwood, P R; Finucane, K E; Panizza, J A; Musk, A W

    1999-11-01

    To examine mechanisms responsible for reduced lung volumes (restriction) in asbestos-related pleural fibrosis (APF), we studied diaphragm function and lower rib-cage excursion in 26 subjects with previous asbestos exposure and no evidence of asbestosis. Using posteroanterior (PA) and lateral chest radiographs taken at residual volume and at 25%, 70%, and 100% vital capacity (VC) during a slow inspiratory maneuver, we measured fractional expansion of the lower rib cage (FErc), fractional shortening of the diaphragm (FSdi), and changes (Delta) in diaphragm dome height (Hdo) and subphrenic volume (Vdi). Vdi was estimated by measuring the major and minor axes of the subphrenic space at 1-cm intervals, assuming an elliptical cross-sectional shape, and correcting for the volume of spinal and paraspinal tissues. Seven subjects had no evidence of APF (control), 12 had pleural plaques (PP), and seven had diffuse pleural thickening with costophrenic obliteration (DPT). Over the range of VC, results (mean +/- SEM, normalized for height) in control subjects were VC = 101.2 +/- 4.0 % predicted and DeltaVdi = 326 +/- 8 ml/m(3), and for the right hemithorax and hemidiaphragm on the PA film, FErc = 0.07 +/- 0.02, FSdi = 0.32 +/- 0.02 and DeltaHdo = 0.8 +/- 0.2 cm/m. Relative to controls: DPT subjects had reduced VC (77.4 +/- 4.9%, p dome.

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

    DEFF Research Database (Denmark)

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

    2008-01-01

    will be elucidated and reconstructed using the CART method. Out of the 300 patients 120 intended patients with suspected musculoskeletal chest pain will be randomized into one of two groups: a) a course of chiropractic treatment (therapy group) of up to ten treatment sessions focusing on high velocity, low amplitude...

  14. Association of aortic wall thickness on contrast-enhanced chest CT with major cerebro-cardiac events.

    Science.gov (United States)

    Tresoldi, Silvia; Di Leo, Giovanni; Zoffoli, Elena; Munari, Alice; Primolevo, Alessandra; Cornalba, Gianpaolo; Sardanelli, Francesco

    2014-11-01

    There is a significant association between aortic atherosclerosis and previous major cardiovascular events. Particularly, thoracic aortic atherosclerosis is closely related to the degree of coronary and carotid artery disease. Thus, there is a rationale for screening the thoracic aorta in patients who undergo a chest computed tomography (CT) for any clinical question, in order to detect patients at increased risk of cerebro-cardiovascular (CCV) events. To estimate the association between either thoracic aortic wall thickness (AWT) or aortic total calcium score (ATCS) and CCV events. One hundred and forty-eight non-cardiac patients (78 men; 67 ± 12 years) underwent chest contrast-enhanced multidetector CT (MDCT). The AWT was measured at the level of the left atrium (AWTref) and at the maximum AWT (AWTmax). Correlation with clinical CCV patients' history was estimated. The value of AWTmax and of a semi-quantitative ATCS as a marker for CCV events was assessed using receiver-operating characteristic curve (ROC) analysis and multivariate regression analysis. Out of 148 patients, 59% reported sedentary lifestyle, 44% hypertension, 32% smoking, 23% hypercholesterolemia, 13% family history of cardiac disease, 12% diabetes, and 10% BMI ≥ 30 kg/m(2); 9% reported myocardial infarction, 8% aortic aneurism, 8% myocardial revascularization, and 2% ischemic stroke. Twenty-six percent of patients had a medium-to-high ATCS. Both AWTmax and AWTref correlated with hypertension and age (P < 0.002). At the ROC analysis, a 4.8 mm threshold was associated to a 90% specificity and an odds ratio of 6.3 (AUC = 0.735). Assuming as threshold the AWTmax median value (4.3 mm) of patients who suffered from at least one CCV event in their history, a negative predictive value of 90%, a RR of 3.6 and an OR of 6.3 were found. At the multivariate regression analysis, AWTmax was the only independent variable associated to the frequency of CCV events. Patients with increased thoracic

  15. 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.

  16. 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. Copyright © 2015 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  17. 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.

  18. Reliability of the diaphragmatic compound muscle action potential evoked by cervical magnetic stimulation and recorded via chest wall surface EMG.

    Science.gov (United States)

    Welch, Joseph F; Mildren, Robyn L; Zaback, Martin; Archiza, Bruno; Allen, Grayson P; Sheel, A William

    2017-09-01

    Stimulation of the phrenic nerve via cervical magnetic stimulation (CMS) elicits a compound muscle action potential (CMAP) that allows for assessment of diaphragm activation. The reliability of CMS to evoke the CMAP recorded by chest wall surface EMG has yet to be comprehensively examined. CMS was performed on healthy young males (n=10) and females (n=10). Surface EMG electrodes were placed on the right and left hemi-diaphragm between the 6-8th intercostal spaces. CMAPs were analysed for: latency, duration, peak-to-peak amplitude, and area. Reliability within and between experimental sessions was assessed using intraclass correlation coefficients (ICC). Bilateral (right-left) and sex-based (male-female) comparisons were also made (independent samples t-test). All CMAP characteristics demonstrated high reproducibility within (ICCs>0.96) and between (ICCs>0.89) experimental sessions. No statistically significant bilateral or sex-based differences were found (p>0.05). CMS is a reliable and non-invasive method to evaluate phrenic nerve conduction. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Vanishing bone disease of chest wall and spine with kyphoscoliosis and neurological deficit: A case report and review of literature

    Directory of Open Access Journals (Sweden)

    Sudhir Kumar Srivastava

    2017-01-01

    Full Text Available Vanishing bone disease is an extremely rare disorder of unknown etiology characterized by idiopathic osteolysis of bone. We describe a case of vanishing bone disease of chest wall and spine with kyphoscoliosis and neurological deficit. A 17-year-old male presented with gradually progressive deformity of back and dorsal compressive myelopathy with nonambulatory power in lower limbs. Radiographs revealed absent 4 th-7 th ribs on the right side with dorsal kyphoscoliosis and severe canal narrowing at the apex. The patient was given localized radiotherapy and started on a monthly infusion of 4 mg zoledronic acid. Posterior instrumented fusion with anterior reconstruction via posterolateral approach was performed. The patient had a complete neurological recovery at 5 weeks following surgery. At 1 year, anterior nonunion was noted for which transthoracic tricortical bone grafting was done. Bone graft from the patient′s mother was used both times. At 7 months following anterior grafting, the alignment was maintained and the patient was asymptomatic; however, fusion at graft-host interface was not achieved. Bisphosphonates and radiotherapy were successful in halting the progress of osteolysis.

  20. A novel approach to simulate chest wall micro-motion for bio-radar life detection purpose

    Science.gov (United States)

    An, Qiang; Li, Zhao; Liang, Fulai; Chen, Fuming; Wang, Jianqi

    2016-10-01

    Volunteers are often recruited to serve as the detection targets during the research process of bio-radar life detection technology, in which the experiment results are highly susceptible to the physical status of different individuals (shape, posture, etc.). In order to objectively evaluate the radar system performance and life detection algorithms, a standard detection target is urgently needed. The paper first proposed a parameter quantitatively controllable system to simulate the chest wall micro-motion caused mainly by breathing and heart beating. Then, the paper continued to analyze the material and size selection of the scattering body mounted on the simulation system from the perspective of back scattering energy. The computational electromagnetic method was employed to determine the exact scattering body. Finally, on-site experiments were carried out to verify the reliability of the simulation platform utilizing an IR UWB bioradar. Experimental result shows that the proposed system can simulate a real human target from three aspects: respiration frequency, amplitude and body surface scattering energy. Thus, it can be utilized as a substitute for a human target in radar based non-contact life detection research in various scenarios.

  1. 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.

  2. Treatment of posterior wall fractures of acetabulum.

    Science.gov (United States)

    Qi, Xin; Liu, Jian-Guo; Gong, Yu-Bao; Yang, Chen; Li, Shu-Qiang; Feng, Wei

    2009-04-01

    To explore the treatment methods and outcome of posterior wall fractures of the acetabulum. The data of 31 patients (25 males and 6 females, aged 19-59 years, mean: 40.5 years) with posterior wall fractures of the acetabulum hospitalized in our department from 2002 to 2006 were analyzed retrospectively in this study. The types of fractures, number of fragments, combined dislocations, and sciatic nerve function were documented before admission. All the fractures were treated with open reduction and internal fixation. Based on the fracture type and site, either screws alone or reconstructive plates were used. The patients were immobilized for an average of 12 weeks before partial weight bearing was permitted. After follow-up for 12-70 months (43.6 months on average), modified Merle d'Aubigne score was adopted to evaluate the outcomes of the operations. The percentages of the excellent, good, fair and poor results were 48.4%, 41.9%, 6.5%, and 3.3%, respectively, with a good to excellent rate of 90.2%. Idiopathic sciatic nerve injury occurred in only one case. The sciatic nerve should be routinely exposed and protected during the surgery. The type of fixation should be based on the fracture type and site. Prolonged immobilization may be helpful in improving the final outcomes.

  3. 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.

  4. Radiologic images of an aggressive implant-associated fibromatosis of the breast and chest wall: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Lourdes Alanis, MD, MPH

    2017-09-01

    Full Text Available Fibromatosis of the breast is a rare benign disease compromising <0.2% of all primary breast tumors. Although the chest wall is a common location, occurrences of implant-associated fibromatosis of the breast are extremely rare; only 33 cases have been reported. We present a case of a 42-year-old female who underwent breast augmentation with silicone breast implants, and 2 years later developed an aggressive implant-associated fibromatosis of the breast and chest wall. On imaging studies, the tumor mimicked breast carcinoma, and despite chemotherapy, the fibromatosis rapidly enlarged and was locally invasive requiring wide surgical excision. Unlike previously reported imaging findings, magnetic resonance imaging revealed an oval circumscribed mass with fringe-like internal architecture. We provide a review of the literature and discuss the imaging features of implant-associated fibromatosis of the breast.

  5. Designing living walls for greywater treatment.

    Science.gov (United States)

    Fowdar, Harsha S; Hatt, Belinda E; Breen, Peter; Cook, Perran L M; Deletic, Ana

    2017-03-01

    Greywater is being increasingly used as an alternative water source to reduce potable water demand and to alleviate pressure on sewerage systems. This paper presents the development of a low energy and low maintenance greywater treatment technology: a living wall system, employing ornamental plants (including vines) grown in a sand filter on a side of a building to treat shower, bath, and washing basin wastewaters. The system can, at the same time, provide critical amenity and micro-climate benefits to our cities. A large scale column study was conducted in Melbourne, Australia, to investigate the following design and operational factors of the proposed system: plant species, saturated zone design, rest period, hydraulic loading rate and pollutant inflow concentration. The results indicate that the use of ornamental species (e.g. Canna lilies, Lonicera japonica, ornamental grape vine) can contribute to pollutant removal. Vegetation selection was found to be particularly important for nutrient removal. While a wider range of tested plant species was effective for nitrogen removal (>80%), phosphorus removal was more variable (-13% to 99%) over the study period, with only a few tested plants being effective - Carex appressa and Canna lilies were the best performers. It was also found that phosphorus removal can be compromised over the longer term as a result of leaching. Excellent suspended solids and organics removal efficiencies can be generally achieved in these systems (>80% for TSS and >90% for BOD) with plants having a relatively small impact. Columns had an acceptable infiltration capacity after one year of operation. When planted with effective species (e.g. Carex appressa and Canna lilies), it is expected that performance will not be significantly affected by longer rest periods and higher pollutant concentrations in the early years of system operation. The results of this study, thus, demonstrate that innovative and aesthetically pleasing living walls can be

  6. Effect of a combined surgery, re-irradiation and hyperthermia therapy on local control rate in radio-induced angiosarcoma of the chest wall

    Energy Technology Data Exchange (ETDEWEB)

    Linthorst, M.; Rhoon, G.C. van; Zee, J. van der [Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam (Netherlands). Dept. of Radiation Oncology; Geel, A.N. van [Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam (Netherlands). Dept. of Surgical Oncology; Baartman, E.A. [Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam (Netherlands). Dept. of Radiation Oncology; Oei, S.B. [Bernard Verbeeten Institute, Tilburg (Netherlands). Dept. of Radiation Oncology; Ghidey, W. [Erasmus MC-Daniel den Hoed Cancer Center, Rotterdam (Netherlands). Dept. of Trial and Medical Statistics

    2013-05-15

    Purpose: Radiation-induced angiosarcoma (RAS) of the chest wall/breast has a poor prognosis due to the high percentage of local failures. The efficacy and side effects of re-irradiation plus hyperthermia (reRT + HT) treatment alone or in combination with surgery were assessed in RAS patients. Patients and methods: RAS was diagnosed in 23 breast cancer patients and 1 patient with melanoma. These patients had previously undergone breast conserving therapy (BCT, n = 18), mastectomy with irradiation (n=5) or axillary lymph node dissection with irradiation (n = 1). Treatment consisted of surgery followed by reRT + HT (n = 8), reRT + HT followed by surgery (n = 3) or reRT + HT alone (n = 13). Patients received a mean radiation dose of 35 Gy (32-54 Gy) and 3-6 hyperthermia treatments (mean 4). Hyperthermia was given once or twice a week following radiotherapy (RT). Results: The median latency interval between previous radiation and diagnosis of RAS was 106 months (range 45-212 months). Following reRT + HT, the complete response (CR) rate was 56 %. In the subgroup of patients receiving surgery, the 3-month, 1- and 3-year actuarial local control (LC) rates were 91, 46 and 46 %, respectively. In the subgroup of patients without surgery, the rates were 54, 32 and 22 %, respectively. Late grade 4 RT toxicity was seen in 2 patients. Conclusion: The present study shows that reRT + HT treatment - either alone or combined with surgery - improves LC rates in patients with RAS. (orig.)

  7. An improved near-wall treatment for turbulent channel flows

    Science.gov (United States)

    El Gharbi, Najla; Absi, Rafik; Benzaoui, Ahmed; Bennacer, Rachid

    2011-01-01

    The success of predictions of wall-bounded turbulent flows requires an accurate description of the flow in the near-wall region. This article presents a comparative study between different near-wall treatments and presents an improved method. The study is applied to fully developed plane channel flow (i.e. the flow between two infinitely large plates). Simulations were performed using Fluent. Near-wall treatments available in Fluent were tested: standard wall functions, non-equilibrium wall function and enhanced wall treatment. A user defined function (UDF), based on an analytical profile for the turbulent kinetic energy (Absi, R., 2008. Analytical solutions for the modeled k-equation. ASME Journal of Applied Mechanics, 75 (4), 044501), is developed and implemented. Predicted turbulent kinetic energy profiles are presented and validated by DNS data.

  8. Pharmacologic and Nonpharmacologic Treatment for Acute Cough Associated With the Common Cold: CHEST Expert Panel Report.

    Science.gov (United States)

    Malesker, Mark A; Callahan-Lyon, Priscilla; Ireland, Belinda; Irwin, Richard S

    2017-11-01

    Acute cough associated with the common cold (CACC) causes significant impairment in quality of life. Effective treatment approaches are needed for CACC. We conducted a systematic review on the management of CACC to update the recommendations and suggestions of the CHEST 2006 guideline on this topic. This systematic review of randomized controlled trials (RCTs) asked the question: Is there evidence of clinically relevant treatment effects for pharmacologic or nonpharmacologic therapies in reducing the duration/severity of acute CACC? Studies of adults and pediatric patients with CACC were included and assessed for relevance and quality. Based on the systematic review, guideline suggestions were developed and voted on using the American College of Chest Physicians organization methodology. Six systematic reviews and four primary studies identified from updated literature searches for each of the reviews or from hand searching were included and reported data on 6,496 participants with CACC who received one or more of a variety of interventions. The studies used an assortment of descriptors and assessments to identify CACC. The evidence supporting the management of CACC is overall of low quality. This document provides treatment suggestions based on the best currently available evidence and identifies gaps in our knowledge and areas for future research. Copyright © 2017 American College of Chest Physicians. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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.

  10. Dosimetric feasibility of using tungsten-based functional paper for flexible chest wall protectors in intraoperative electron radiotherapy for breast cancer

    Science.gov (United States)

    Kamomae, Takeshi; Monzen, Hajime; Kawamura, Mariko; Okudaira, Kuniyasu; Nakaya, Takayoshi; Mukoyama, Takashi; Miyake, Yoshikazu; Ishihara, Yoshitomo; Itoh, Yoshiyuki; Naganawa, Shinji

    2018-01-01

    Intraoperative electron radiotherapy (IOERT), which is an accelerated partial breast irradiation method, has been used for early-stage breast cancer treatment. In IOERT, a protective disk is inserted behind the target volume to minimize the dose received by normal tissues. However, to use such a disk, the surgical incision must be larger than the field size because the disk is manufactured from stiff and unyielding materials. In this study, the applicability of newly developed tungsten-based functional paper (TFP) was assessed as an alternative to the existing protective disk. The radiation-shielding performance of the TFP was verified through experimental measurements and Monte Carlo simulations. Percentage depth dose curves and lateral dose profiles with and without TFPs were measured and simulated on a dedicated IOERT accelerator. The number of piled-up TFPs was changed from 1 to 40. In the experimental measurements, the relative doses at the exit plane of the TFPs for 9 MeV were 42.7%, 9.2%, 0.2%, and 0.1% with 10, 20, 30, and 40 TFPs, respectively, whereas those for 12 MeV were 63.6%, 27.1%, 8.6%, and 0.2% with 10, 20, 30, and 40 TFPs, respectively. Slight dose enhancements caused by backscatter radiation from the TFPs were observed at the entrance plane of the TFPs at both beam energies. The results of the Monte Carlo simulation indicated the same tendency as the experimental measurements. Based on the experimental and simulated results, the radiation-shielding performances of 30 TFPs for 9 MeV and 40 TFPs for 12 MeV were confirmed to be acceptable and close to those of the existing protective disk. The findings of this study suggest the feasibility of using TFPs as flexible chest wall protectors in IOERT for breast cancer treatment.

  11. Comparison of Fentanyl and Morphine in the Prehospital Treatment of Ischemic Type Chest Pain.

    Science.gov (United States)

    Weldon, Erin R; Ariano, Robert E; Grierson, Robert A

    2016-01-01

    In the treatment of acute coronary syndromes, reduction of sympathetic stress and catecholamine release is an important therapeutic goal. One method used to achieve this goal is pain reduction through the systemic administration of analgesia. Historically, morphine has been the analgesic of choice in ischemic cardiac pain. This randomized double-blind controlled trial seeks to prove the utility of fentanyl as an alternate first-line analgesic for ischemic-type chest pain in the prehospital setting. Successive patients who were treated for suspected ischemic chest pain in the emergency medical services system were considered eligible. Once chest pain was confirmed, patients received oxygen, aspirin, and nitroglycerin therapy. If the ischemic-type chest pain continued the patient was randomized in a double-blinded fashion to treatment with either morphine or fentanyl. Pain scale scores, necessity for additional dosing, and rate of adverse events between the groups were assessed every 5 minutes and were compared using t-testing, Fisher's Exact test, or Analysis of Variance (ANOVA) where appropriate. The primary outcome of the study was incidence of hypotension and the secondary outcome was pain reduction as measured by the visual analog score and numeric rating score. A total of 207 patients were randomized with 187 patients included in the final analysis. Of the 187 patients, 99 were in the morphine group and 88 in the fentanyl group. No statistically significant difference between the two groups with respect to hypotension was found (morphine 5.1% vs. fentanyl 0%, p = 0.06). Baseline characteristics, necessity for additional dosing, and other adverse events between the two groups were not statistically different. There were no significant differences between the changes in visual analog scores and numeric rating scale scores for pain between the two groups (p = 0.16 and p = 0.15, respectively). This study supports that fentanyl and morphine are comparable in

  12. Long-Term Results of a Highly Performing Conformal Electron Therapy Technique for Chest Wall Irradiation After Mastectomy

    Energy Technology Data Exchange (ETDEWEB)

    Grellier Adedjouma, Noemie, E-mail: grellier.noemie@gmail.com [Department of Radiation Oncology, Institut Curie, Paris (France); Chevrier, Marion [Department of Biostatistics, Institut Curie, Paris (France); Fourquet, Alain; Costa, Emilie; Xu, Haoping [Department of Radiation Oncology, Institut Curie, Paris (France); Berger, Frederique [Department of Biostatistics, Institut Curie, Paris (France); Campana, Francois [Department of Radiation Oncology, Institut Curie, Paris (France); Laki, Fatima [Department of Surgical Oncology, Institut Curie, Paris (France); Beuzeboc, Philippe [Department of Medical Oncology, Institut Curie, Paris (France); Lefeuvre, Delphine [Department of Biostatistics, Institut Curie, Paris (France); Fournier-Bidoz, Nathalie; Kirova, Youlia M. [Department of Radiation Oncology, Institut Curie, Paris (France)

    2017-05-01

    Purpose: To evaluate locoregional control and survival after mastectomy, as well as toxicity, in patients irradiated by a previously described postmastectomy highly conformal electron beam radiation therapy technique (PMERT). Methods and Materials: We included all women irradiated by postmastectomy electron beam radiation therapy for nonmetastatic breast cancer between 2007 and 2011 in our department. Acute and late toxicities were retrospectively assessed using Common Terminology Criteria for Adverse Events version 3.0 criteria. Results: Among the 796 women included, 10.1% were triple-negative, 18.8% HER2-positive, and 24.6% received neoadjuvant chemotherapy (CT). Multifocal lesions were observed in 51.3% of women, and 64.6% had at least 1 involved lymph node (LN). Internal mammary chain, supraclavicular, infraclavicular, and axillary LNs were treated in 85.6%, 88.3%, 77.9%, and 14.9% of cases, respectively. With a median follow-up of 64 months (range, 6-102 months), 5-year locoregional recurrence–free survival and overall survival were 90% (95% confidence interval 88.1%-92.4%) and 90.9% (95% confidence interval 88.9%-93%), respectively. Early skin toxicity was scored as grade 1 in 58.5% of patients, grade 2 in 35.9%, and grade 3 in 4.5%. Concomitant CT was associated with increased grade 3 toxicity (P<.001). At long-term follow-up, 29.8% of patients presented temporary or permanent hyperpigmentation or telangiectasia or fibrosis (grade 1: 23.6%; grade 2: 5.2%; grade 3: 1%), with higher rates among smokers (P=.06); 274 patients (34.4%) underwent breast reconstruction. Only 24 patients (3%) had early esophagitis of grade 1. Only 3 patients developed ischemic heart disease: all had been treated by anthracycline-based CT with or without trastuzumab, all had been irradiated to the left chest wall and LN, and all presented numerous cardiovascular risk factors (2-4 factors). Conclusions: This study demonstrated the good efficacy of this technique in terms of

  13. Computed tomography (CT)-guided interstitial permanent implantation of (125)I seeds for refractory chest wall metastasis or recurrence.

    Science.gov (United States)

    Jiang, Ping; Liu, Chen; Wang, Junjie; Yang, Ruijie; Jiang, Yuliang; Tian, Suqing

    2015-02-01

    To evaluate the efficacy and safety of 125I seeds implantation for refractory chest wall (CW) metastasis or recurrence under CT guidance. In addition we assessed initial data obtained on the therapeutic response for refractory CW metastasis or recurrence. Twenty consecutive patients underwent permanent implantation of 125I seeds (from Jul. 2004 to Jan. 2011) under computed tomography (CT) guidance. Postoperative dosimetry was routinely performed for all patients. The actuarial D90 of the implanted 125I seeds ranged from 100 Gy to 160 Gy (median: 130 Gy). The activity of 125I seeds ranged from 0.5 mCi to 0.78 mCi (median: 0.71 mCi). The total number of seeds implanted ranged from 8 to 269 (median: 53). The follow-up period ranged from 3 to 54 months (median: 11.5 months). The survival and local control probabilities were calculated by the Kaplan-Meier method. Among all the 20 patients, 3 patients had complete remission CR (15%), 12 patients had partial remission PR (60%), 5 patients had stable disease SD. The 1-, 2-, 3- and 4-year tumor control rates were all 88.7% respectively. The 1- and 2-, 3-, 4-year cancer specific survival rates were 56.5% and 47.1%, 47.1%, 47.1% respectively. The 1- and 2-, 3-, 4-year overall survival rates were 53.3% and 35.6%, 35.6%, 35.6% respectively, with a median survival of 15 months (95% CI, 7.0-22.9). Mild brachial plexus injury was seen in one patient; grade 1 or 2 skin reactions were seen in 6 patients (30%) who had received external beam radiation therapy (EBRT) before. No grade 3 and 4 skin side effects were found. Rib fracture, ulceration, pneumothorax or hemopneumothorax were not seen. Interstitial permanent implantation of 125I seeds under CT guidance is feasible, efficacious and safe for refractory CW metastasis or recurrence. © The Author(s) 2014.

  14. Gastroscopic treatment of gastric band penetrating the gastric wall

    DEFF Research Database (Denmark)

    Jess, Per; Fonnest, G

    1999-01-01

    Gastric wall penetration of a gastric band after operation for morbid obesity is a well known late complication. The treatment is usually reoperation. In this case report we show that a band penetrating the gastric wall can be successfully treated by gastroscopic operation. This technique is more...

  15. Chest X-Ray

    Medline Plus

    Full Text Available ... Site Index A-Z Spotlight February is American Heart Month Recently posted: Carotid Intima-Media Thickness Test ... x-ray is used to evaluate the lungs, heart and chest wall and may be used to ...

  16. MRI of the Chest

    Medline Plus

    Full Text Available ... heart) and myocardial infarct (scar in the heart muscle due to prior obstruction of blood flow). determine ... ribs and sternum) and chest wall soft tissue (muscles and fat). assess for pericardial (thin sac around ...

  17. 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.).

  18. Treatment efficacy for non-cardiovascular chest pain: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Jakob M Burgstaller

    Full Text Available BACKGROUND: Non-cardiovascular chest pain (NCCP leads to impaired quality of life and is associated with a high disease burden. Upon ruling out cardiovascular disease, only vague recommendations exist for further treatment. OBJECTIVES: To summarize treatment efficacy for patients presenting with NCCP. METHODS: Systematic review and meta-analysis. In July 2013, Medline, Web of Knowledge, Embase, EBSCOhost, Cochrane Reviews and Trials, and Scopus were searched. Hand and bibliography searches were also conducted. Randomized controlled trials (RCTs evaluating non-surgical treatments in patients with NCCP were included. Exclusion criteria were poor study quality and small sample size (<10 patients per group. RESULTS: Thirty eligible RCT's were included. Most studies assessed PPI efficacy for gastroesophageal reflux disorders (GERD, n = 10. Two RCTs included musculoskeletal chest pain, seven psychotropic drugs, and eleven various psychological interventions. Study quality was high in five RCTs and acceptable in 25. PPI treatment in patients with GERD (5 RCTs, 192 patients was more effective than placebo [pooled OR 11.7 (95% CI 5.5 to 25.0, heterogeneity I2 = 6.1%]. The pooled OR in GERD negative patients (4 RCTs, 156 patients was 0.8 (95% CI 0.2 to 2.8, heterogeneity I2 = 50.4%. In musculoskeletal NCCP (2 RCTs, 229 patients manual therapy was more effective than usual care but not than home exercise [pooled mean difference 0.5 (95% CI -0.3 to 1.3, heterogeneity I2 = 46.2%]. The findings for cognitive behavioral treatment, serotonin reuptake inhibitors, tricyclic antidepressants were mixed. Most evidence was available for cognitive behavioral treatment interventions. LIMITATIONS: Only a small number of studies were available. CONCLUSIONS: Timely diagnostic evaluation and treatment of the disease underlying NCCP is important. For patients with suspected GERD, high-dose treatment with PPI is effective. Only limited evidence was available

  19. Decompression of tension pneumothoraces in Asian trauma patients: greater success with lateral approach and longer catheter lengths based on computed tomography chest wall measurements.

    Science.gov (United States)

    Goh, S; Xu, W R; Teo, L T

    2017-10-03

    Our study aims to compare the anterior and lateral approaches for needle thoracostomy (NT) and determine the adequacy of catheter lengths used for NT in Asian trauma patients based on computed tomography chest wall measurements. A retrospective review of chest computed tomography scans of 583 Singaporean trauma patients during period of 2011-2015 was conducted. Four measurements of chest wall thickness (CWT) were taken at the second intercostal space, midclavicular line and fifth intercostal space, midaxillary line bilaterally. Measurements were from the superficial skin layer of the chest wall to the pleural space. Successful NT was defined radiologically as CWT ≤ 5 cm. There were 593 eligible subjects. Mean age was 49.1 years (49.1 ± 21.0). Majority were males (77.0%) and Chinese (70.2%). Mean CWT for the anterior approach was 4.04 cm (CI 3.19-4.68) on the left and 3.92 cm (CI 3.17-4.63) on the right. Mean CWT for the lateral approach was 3.52 cm (CI 2.52-4.36) on the left, and 3.62 cm (CI 3.65-4.48) on the right. Mean CWT was shorter in the lateral approach by 0.52 cm on the left and 0.30 cm on the right (p = 0.001). With a 5.0 cm catheter in the anterior approach, 925 out of 1186 sites (78.8%) will have adequate NT as compared to 98.2% with a 7.0 cm catheter. Similarly, in the lateral approach 1046 out of 1186 (88.2%) will have adequate NT as compared to 98.5% with a 7.0 cm catheter. Obese subjects had significantly higher mean CWT in both approaches (p = 0.001). There was moderate correlation between BMI and CWT in the anterior approach, r 2 = 0.529 as compared to the lateral approach, r 2 = 0.244. Needle decompression using the lateral approach or a longer catheter is more likely to succeed in Asian trauma patients. A high BMI is an independent predictor of failure of NT, especially for the anterior as compared to lateral approach.

  20. Randomised controlled trial of non-invasive ventilation (NIV) for nocturnal hypoventilation in neuromuscular and chest wall disease patients with daytime normocapnia.

    Science.gov (United States)

    Ward, S; Chatwin, M; Heather, S; Simonds, A K

    2005-12-01

    Long term non-invasive ventilation (NIV) reduces morbidity and mortality in patients with neuromuscular and chest wall disease with hypercapnic ventilatory failure, but preventive use has not produced benefit in normocapnic patients with Duchenne muscular dystrophy. Individuals with nocturnal hypercapnia but daytime normocapnia were randomised to a control group or nocturnal NIV to examine whether nocturnal hypoventilation is a valid indication for NIV. Forty eight patients with congenital neuromuscular or chest wall disease aged 7-51 years and vital capacitytension (Tcco2) did not differ between the groups, but the mean (SD) percentage of the night during which Tcco2 was >6.5 kPa decreased in the NIV group (-57.7 (26.1)%) but not in controls (-11.75 (46.1)%; p=0.049, 95% CI -91.5 to -0.35). Mean (SD) arterial oxygen saturation increased in the NIV group (+2.97 (2.57)%) but not in controls (-1.12 (2.02)%; p=0.024, 95% CI 0.69 to 7.5). Nine of the 10 controls failed non-intervention by fulfilling criteria to initiate NIV after a mean (SD) of 8.3 (7.3) months. Patients with neuromuscular disease with nocturnal hypoventilation are likely to deteriorate with the development of daytime hypercapnia and/or progressive symptoms within 2 years and may benefit from the introduction of nocturnal NIV before daytime hypercapnia ensues.

  1. A randomized clinical trial of chiropractic treatment and self-management in patients with acute musculoskeletal chest pain

    DEFF Research Database (Denmark)

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

    2012-01-01

    We have previously reported short-term follow-up from a pragmatic randomized clinical trial comparing 2 treatments for acute musculoskeletal chest pain: (1) chiropractic treatment and (2) self-management. Results indicated a positive effect in favor of the chiropractic treatment after 4 and 12...

  2. Evaluation of ECG changes after Radiotherapy of left chest wall by Electron in patients with left breast cancer who receive Anthracycline based chemotherapy following mastectomy

    Directory of Open Access Journals (Sweden)

    J Emami

    2005-03-01

    Full Text Available Background: Cardiovascular damage after Radiotherapy of left chest wall for left breast cancer is a potential fear, therefore studing both the possible causes of radiation-induced heart damage and preventive measures are crucial issues in radiation therapy of breast cancer. The present study investigates noninvasively the possible acute and chronic ECG changes and their incidences after Radiotherapy in patients with left sided breast cancer who have received 6-8 courses of Anthracycline based chemotherapy following mastectomy. Methods: 56 patients with breast cancer (invasive ductal carcinoma who had been undergone modified radical mastectomy, adjuvant Anthracycline based chemotherapy, and left sided chest wall electron therapy with direct field, have been evaluated. All patients investigated with physical examination and standard 12 leads ECG before, and immediately after completion of radiation therapy, and 6 months afterward. Results: New electrocardiographic changes after therapy were seen in 3 patients (5.35% and reduced to 2 cases (3.57% after 6 months. there was no significant difference in T wave findings before and after radiation therapy(P=0.521.Also there wasn’t any correlation between stage of cancer and any changes in ECG findings after radiation therapy (P=0.56. Conclusion: There were no clinical cardiac symptoms or signs after Radiotherapy. Most affected leads in ECG were V1-V4 and the main abnormality was Inverted T wave. This findings suggest that the most acute and chronic electrocardiographic effect of irradiation on heart is repolarization abnormality. This study suggests that there are no significant ECG changes after Radiotherapy of left chest wall by electron beam in patients with left sided breast cancer who has received Anthracycline based chemotherapy following mastectomy. Also Radiotherapy by electron doesn't induce any clinical cardiac symptoms and signs in these patients. Therefore, we recommend

  3. 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

  4. Green Walls as an Approach in Grey Water Treatment

    Science.gov (United States)

    Rysulova, Martina; Kaposztasova, Daniela; Vranayova, Zuzana

    2017-10-01

    Grey water contributes significantly to waste water parameters such as biochemical oxygen demand (BOD), chemical oxygen demand (COD), total suspended solids (TSS), total phosphorus (Ptotal), total nitrogen (Ntotal), ammonium, boron, metals, salts, surfactants, synthetic chemicals, oils and greases, xenobiotic substances and microorganisms. Concentration of these pollutants and the water quality highlights the importance of treatment process in grey water systems. Treatment technologies operating under low energy and maintenance are usually preferred, since they are more cost effective for users. Treatment technologies based on natural processes represent an example of such technology including vegetated wall. Main aim of this paper is to introduce the proposal of vegetated wall managing grey water and brief characteristic of proposed system. Is expected that prepared experiment will establish the purifying ability and the potential of green wall application as an efficient treatment technology.

  5. Blunt chest trauma.

    Science.gov (United States)

    Stewart, Daphne J

    2014-01-01

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

  6. 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 ...

  7. Instantaneous responses to high-frequency chest wall oscillation in patients with acute pneumonic respiratory failure receiving mechanical ventilation: A randomized controlled study.

    Science.gov (United States)

    Chuang, Ming-Lung; Chou, Yi-Ling; Lee, Chai-Yuan; Huang, Shih-Feng

    2017-03-01

    Endotracheal intubation and prolonged immobilization of patients receiving mechanical ventilation may reduce expectoration function. High-frequency chest wall oscillation (HFCWO) may ameliorate airway secretion movement; however, the instantaneous changes in patients' cardiopulmonary responses are unknown. Moreover, HFCWO may influence ventilator settings by the vigorous oscillation. The aim of this study was to investigate these issues. Seventy-three patients (52 men) aged 71.5 ± 13.4 years who were intubated with mechanical ventilation for pneumonic respiratory failure were recruited and randomly classified into 2 groups (HFCWO group, n = 36; and control group who received conventional chest physical therapy (CCPT, n = 37). HFCWO was applied with a fixed protocol, whereas CCPT was conducted using standard protocols. Both groups received sputum suction after the procedure. Changes in ventilator settings and the subjects' responses were measured at preset intervals and compared within groups and between groups. Oscillation did not affect the ventilator settings (all P > 0.05). The mean airway pressure, breathing frequency, and rapid shallow breathing index increased, and the tidal volume and SpO2 decreased (all P ventilation decreased (all P ventilator settings, whereas CCPT maintains a steadier condition. After sputum suction, HFCWO slightly improved Ppeak compared to CCPT, suggesting that the study extends the indications of HFCWO for these patients in intensive care unit. (ClinicalTrials.gov number NCT02758106, retrospectively registered.).

  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. Quantitative evaluation of interstitial pneumonia using 3D-curved high-resolution CT imaging parallel to the chest wall: A pilot study.

    Directory of Open Access Journals (Sweden)

    Hiroyasu Umakoshi

    Full Text Available To quantify the imaging findings of patients with interstitial pneumonia (IP and emphysema using three-dimensional curved high-resolution computed tomography (3D-cHRCT at a constant depth from the chest wall, and compare the results to visual assessment of IP and each patient's diffusing capacity of the lungs for carbon monoxide (DLco.We retrospectively reviewed the axial CT findings and pulmonary function test results of 95 patients with lung cancer (72 men and 23 women, aged 45-84 years with or without IP, as follows: non-IP (n = 47, mild IP (n = 31, and moderate IP (n = 17. The 3D-cHRCT images of the lung at a 1-cm depth from the chest wall were reconstructed automatically using original software; total area (TA, high-attenuation area (HAA >-500 HU, and low-attenuation area (LAA <-950 HU were calculated on a workstation. The %HAA and %LAA were calculated as follows: [Formula: see text], and [Formula: see text].The %HAA and %LAA respective values were 3.2±0.9 and 27.7±8.2, 3.9±1.2 and 27.6±5.9, and 6.9±2.2 and 25.4±8.7 in non-IP, mild IP, and moderate IP patients, respectively. There were significant differences in %HAA between the 3 groups of patients (P<0.001, but no differences in %LAA (P = 0.558. Multiple linear regression analysis revealed that %HAA and %LAA were negatively correlated with predicted DLco (standard partial regression coefficient [b*] = -0.453, P<0.001; b* = -0.447, P<0.001, respectively.The %HAA and %LAA values computed using 3D-cHRCT were significantly correlated with DLco and may be important quantitative parameters for both IP and emphysema.

  10. Treatment of acute, severe epigastric/chest pain in a patient with stomach cancer following gastrectomy: A case report.

    Science.gov (United States)

    Zaporowska-Stachowiak, Iwona; Gorzelińska, Lidia; Sopata, Maciej; Łuczak, Jacek

    2015-03-01

    The treatment of acute chest pain can be a challenge in palliative care. Firstly, because acute chest pain is a symptom of a paucity of diseases, which makes diagnosis difficult and time consuming, while there is also a time constraint, due to the extreme suffering of the patient. Secondly, the condition of a patient with advanced cancer disease and co-morbidities does not always allow for required diagnostic procedures. The present report describes a case of acute, severe epigastric/chest pain in a patient with dynamic disease progression, who was receiving palliative care. This study also demonstrates that the pathophysiology of pain in a terminal patient may determine the treatment strategy. The patient in the present case was a 41-year-old male, who had previously undergone gastrectomy for stomach cancer, followed by postoperative chemotherapy. The patient was treated with palliative chemotherapy for metastases to the lungs, liver and lymph nodes, which led to the development of iatrogenic peripheral neuropathy. The patient was subsequently admitted to the Palliative Medicine In-patient Unit of the University Hospital of Lord's Transfiguration (Poznan, Poland) with the complaint of acute epigastric and chest pain. An electrocardiogram, echocardiogram, chest and abdomen computerized tomography scan, esophagoduodenoscopy and laboratory analyses were performed to determine the source of the pain. The patient was treated with morphine sulfate, metoclopramide, midazolam, diazepam, acetaminophen, ketamine, hyoscine butylbromide, propofol, dexamethasone and amoxycillin, and received parenteral nutrition. As the source of pain remained unclear, a second esophagoduodenoscopy was performed to determine a diagnosis, resulting in pain relief. Thus, in the present case, esophagoduodenoscopy was diagnostic and therapeutic. Furthermore, although the treatment of acute chest pain may be a challenge in palliative care, the present study indicates that pain treatment should be

  11. [Chest pain units or chest pain algorithm?].

    Science.gov (United States)

    Christ, M; Dormann, H; Enk, R; Popp, S; Singler, K; Müller, C; Mang, H

    2014-10-01

    A large number of patients present to the emergency department (ED) for evaluation of acute chest pain. About 10-15% are caused by acute myocardial infarction (MI), and over 50% of cases are due to noncardiac reasons. Further improvement for chest pain evaluation appears necessary. What are current options to improve chest pain evaluation in Germany? A selective literature search was performed using the following terms: "chest pain", "emergency department", "acute coronary syndrome" and "chest pain evaluation". A working group of the German Society of Cardiology published recommendations for infrastructure, equipment and organisation of chest pain units in Germany, which should be separated from the ED of hospitals and be under the leadership of a cardiologist. A symptom-based decision for acute care would be preferable if all differential diagnoses of diseases could be managed by one medical specialty: However, all four main symptoms of patients with acute MI (chest pain, acute dyspnea, abdominal pain, dizziness) are also caused by diseases of different specialties. Evaluation and treatment of acute chest pain by representatives of one specialty would lead to over- or undertreatment of affected patients. Therefore we suggest a multidisciplinary evaluation of patients with acute chest pain including representatives of emergency and critical care physicians, cardiologists, internists, geriatricians, family physicians, premedics and emergency nurses. Definition of key indicators of performance and institutionalized feedback will help to further improve quality of care.

  12. Physical Therapy Treatment of Impaired Chest Mobility in Patients with Airway Sensory Hyperreactivity.

    Science.gov (United States)

    Johansson, Ewa-Lena; Ternestén-Hasseus, Ewa; Olsén, Monika Fagevik; Millqvist, Eva

    2017-04-01

    In sensory hyperreactivity (SHR), patients have symptoms from the airways and the chest induced by environmental irritants like scenting products and cigarette smoke. They are characterized by increased cough reaction to inhaled capsaicin compared with healthy controls. Lung function tests are normal, and asthma medications have no or little effect. In a recent published article, patients with SHR were found to have impaired chest mobility and increased pain sensitivity. The purpose of this study was to evaluate if a physiotherapeutic intervention can increase chest mobility in SHR, influence these patients' symptoms and reduce capsaicin cough sensitivity. Forty-one SHR patients were initially randomized in to groups, one for training and one for symptom registration in this controlled training study. It consisted of a daily training programme containing simple movements to increase the flexibility of the chest, a breathing exercise and a relaxation session as well as symptom registration. Chest expansion was measured with a measuring tape and thoracic and abdominal movement with light sensors. Pain sensitivity was assessed using pressure algometry and a standardized capsaicin inhalation threshold provocation-evaluated cough sensitivity. Twenty seven patients were left for analyses after 12 weeks and 26 patients after 24 weeks. Chest mobility and upper thoracic respiratory movements improved (p < 0.01), feeling of chest pressure and the capsaicin cough sensitivity decreased (p < 0.01). The patients also showed of significantly lowered pain pressure thresholds measured with algometry, compared with healthy controls (p < 0.001). Improvement of chest mobility after physiotherapeutic intervention indicates that these patients may have acquired a dysfunctional breathing pattern. The regular use of a training programme and structural breathing instructions can be used to improve chest mobility, chest symptoms and capsaicin cough sensitivity in patients

  13. Treatment of ankylosing spondylitis with biologics and targeted physical therapy: positive effect on chest pain, diminished chest mobility, and respiratory function.

    Science.gov (United States)

    Gyurcsik, Z; Bodnár, N; Szekanecz, Z; Szántó, S

    2013-12-01

    Biologics are highly effective in ankylosing spondylitis (AS). In this self-controlled study, we assessed the additive value of complex physiotherapy in decreasing chest pain and tenderness and improving respiratory function in AS patients treated with tumor necrosis factor α (TNF-α) inhibitors. The trial consisted of 2 parts. In study I, clinical data of AS patients with (n=55) or without biological therapy (n=20) were retrospectively analyzed and compared. Anthropometrical data, duration since diagnosis and patient assessment of disease activity, pain intensity, tender points, sacroiliac joint involvement determined by X-ray, functional condition, and physical activity level were recorded. Subjective, functional, and physical tests were performed. In study II, 10 voluntary patients (6 men and 4 women, age 52.4 ± 13.6 years) with definite AS and receiving anti-TNF therapy were recruited. It was a prospective, non-randomized physiotherapeutic trial. BASFI (Bath Ankylosing Spondylitis Functional Index), BASDAI (Bath Ankylosing Spondylitis Disease Activity Index), modified Schober Index, occiput-to-wall distance, and fingertip-to-floor distance were evaluated. Forced vital capacity, forced 1-s expiratory volume, peak expiratory flow, and maximum voluntary ventilation were recorded. Furthermore, typical tender points were recorded. A targeted physiotherapy program was conducted twice a week for 12 weeks and all above parameters were recorded at baseline and after 12 weeks. Differences in patient assessment of disease activity (p=0.019) and pain intensity (p=0.017) were found in study I. Pain and tenderness of the thoracic spine were observed in both groups. Back pain without biologic therapy was slightly higher than other group. In study II, we found that patient assessment of disease activity and pain intensity significantly improved after the physical therapy program (p=0.002 and pfunctional parameters showed a tendency towards improvement. AS patients already

  14. A carbon nanotube wall membrane for water treatment.

    Science.gov (United States)

    Lee, Byeongho; Baek, Youngbin; Lee, Minwoo; Jeong, Dae Hong; Lee, Hong H; Yoon, Jeyong; Kim, Yong Hyup

    2015-05-14

    Various forms of carbon nanotubes have been utilized in water treatment applications. The unique characteristics of carbon nanotubes, however, have not been fully exploited for such applications. Here we exploit the characteristics and corresponding attributes of carbon nanotubes to develop a millimetre-thick ultrafiltration membrane that can provide a water permeability that approaches 30,000 l m(-2) h(-1) bar(-1), compared with the best water permeability of 2,400 l m(-2) h(-1) bar(-1) reported for carbon nanotube membranes. The developed membrane consists only of vertically aligned carbon nanotube walls that provide 6-nm-wide inner pores and 7-nm-wide outer pores that form between the walls of the carbon nanotubes when the carbon nanotube forest is densified. The experimental results reveal that the permeance increases as the pore size decreases. The carbon nanotube walls of the membrane are observed to impede bacterial adhesion and resist biofilm formation.

  15. Corrosion Resistance, EIS and Wettability of the Implants Made of 316 LVM Steel Used in Chest Deformation Treatment

    Directory of Open Access Journals (Sweden)

    Kajzer A.

    2016-06-01

    Full Text Available The paper presents the influence of mechanical surface damage on the physicochemical properties of plates after implantation made of CrNiMo stainless steel, used in the treatment of anterior surface deformity of the chest. Analysis of the data allowed us to investigate the effect of implant design and condition of their surface on the results of chest deformation treatment. Results of electrochemical, impedance and surface wettability tests and SEM observations were compared with clinical observations. When removing the plates we found only slight inflammatory-periosteal reactions. On the basis of obtained results, it can be stated that plates, in spite of mechanical damage of the surface, were characterized by good corrosion resistance, a fact which is confirmed by the results of clinical evaluation.

  16. Comparison of Flutter device and chest physical therapy in the treatment of cystic fibrosis pulmonary exacerbation.

    Science.gov (United States)

    Gondor, M; Nixon, P A; Mutich, R; Rebovich, P; Orenstein, D M

    1999-10-01

    Chest physiotherapy (CPT) is recommended for the clearance of bronchial secretions in the management of patients with cystic fibrosis (CF). The Flutter valve (Scandipharm, Birmingham, AL) has been introduced as an alternative method to CPT for airway mucus clearance. The objective of this study was to compare the short-term effects of CPT and the Flutter valve on pulmonary function and exercise tolerance in patients with cystic fibrosis. Twenty-three patients, 5 to 21 years of age, were randomized to receive one of two interventions: CPT or the Flutter valve, upon admission to the hospital for a 2-week treatment of pulmonary exacerbation. Pulmonary function testing (PFTs) and the 6-min walk test were performed on admission, day 7, and day 14 of hospitalization. Data analysis indicated no significant differences between the two groups on admission. Both groups showed improvement in pulmonary function test results, but the Flutter group had a higher mean forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV(1)) compared to the CPT group after 1 week of intervention. Both groups continued to improve during the 2-week intervention, with no significant difference in FVC or FEV(1) between groups by the end of 2 weeks. Mean forced expiratory flow rate between 25-75% of vital capacity (FEF(25-75)), 6-min walk distance, and resting arterial oxyhemoglobin saturation (SaO(2)) showed little change by day 7, but improved significantly (P< 0.05) by day 14 of hospitalization in both groups, with no significant difference between groups. This study demonstrated that patients using the Flutter device had better pulmonary function after 1 week of therapy and similar improvement in pulmonary function and exercise tolerance compared to CPT after 2 weeks of therapy, suggesting that Flutter valve therapy is an acceptable alternative to standard CPT during in-hospital care of patients with CF. Copyright 1999 Wiley-Liss, Inc.

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

    Science.gov (United States)

    Maher, Lesley; Jayathissa, Sisira

    2016-12-01

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

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

    DEFF Research Database (Denmark)

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

    2012-01-01

    OBJECTIVE: The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of 2 treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation and (2......) self-management as an example of minimal intervention. METHODS: In a nonblinded, randomized, controlled trial set at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were...... included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to 4 weeks of chiropractic treatment or self-management, with posttreatment questionnaire follow-up 4 and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical...

  19. The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial.

    Science.gov (United States)

    Goldstein, James A; Chinnaiyan, Kavitha M; Abidov, Aiden; Achenbach, Stephan; Berman, Daniel S; Hayes, Sean W; Hoffmann, Udo; Lesser, John R; Mikati, Issam A; O'Neil, Brian J; Shaw, Leslee J; Shen, Michael Y H; Valeti, Uma S; Raff, Gilbert L

    2011-09-27

    The purpose of this study was to compare the efficiency, cost, and safety of a diagnostic strategy employing early coronary computed tomographic angiography (CCTA) to a strategy employing rest-stress myocardial perfusion imaging (MPI) in the evaluation of acute low-risk chest pain. In the United States, >8 million patients require emergency department evaluation for acute chest pain annually at an estimated diagnostic cost of >$10 billion. This multicenter, randomized clinical trial in 16 emergency departments ran between June 2007 and November 2008. Patients were randomly allocated to CCTA (n = 361) or MPI (n = 338) as the index noninvasive test. The primary outcome was time to diagnosis; the secondary outcomes were emergency department costs of care and safety, defined as freedom from major adverse cardiac events in patients with normal index tests, including 6-month follow-up. The CCTA resulted in a 54% reduction in time to diagnosis compared with MPI (median 2.9 h [25th to 75th percentile: 2.1 to 4.0 h] vs. 6.3 h [25th to 75th percentile: 4.2 to 19.0 h], p acute, low-risk chest pain patients, the use of CCTA results in more rapid and cost-efficient safe diagnosis than rest-stress MPI. Further studies comparing CCTA to other diagnostic strategies are needed to optimize evaluation of specific patient subsets. (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment [CT-STAT]; NCT00468325). Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  20. Treatment of non-cardiac chest pain: a controlled trial of hypnotherapy.

    Science.gov (United States)

    Jones, H; Cooper, P; Miller, V; Brooks, N; Whorwell, P J

    2006-10-01

    Non-cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting. This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with angina-like chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory. Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication. Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores. Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder.

  1. [Chest pain].

    Science.gov (United States)

    Horn, Benedikt

    2015-01-01

    Chest pain in ambulatory setting is predominantly not heart-associated. Most patients suffer from muskuloskeletal or functional (psychogenic) chest pain. Differential diagnosis covers aortic dissection, rib-fracture, shingles, GERD, Tietze-Syndrome, pulmonary embolism, pleuritis, pneumothorax, pleurodynia and metastatic disease. In most cases history, symptoms and signs allow a clinical diagnosis of high pretest-probability.

  2. Chest Pain

    Science.gov (United States)

    ... or tightness in your chest Crushing or searing pain that radiates to your back, neck, jaw, shoulders, and one or both arms Pain that lasts ... com. Accessed Sept. 6, 2017. Yelland MJ. Outpatient evaluation of the adult with chest pain. https://www.uptodate.com/contents/search. Accessed Sept. ...

  3. [Experimental treatment of acute lung injury caused by inundation of thoracic cavity by seawater following open chest wound].

    Science.gov (United States)

    Duan, Yun-You; Xue, Zhi-Qiang; Meng, Ji-Guang; Ding, Xin-Min; Peng, Chao-Sheng; Wang, Da-Peng

    2007-04-01

    To study the effects of lung protective ventilation and pentoxifylline (PTX) on acute lung injury (ALI) caused by open chest wound with seawater inundation of the thoracic cavity. A model of ALI caused by open chest wound and seawater inundation of thoracic cavity was reproduced in dogs. Twenty-four healthy dogs were randomly divided into four groups: no-treatment group (group A), ordinary treatment group (group B), lung protective ventilation treatment group (group C), and lung protective ventilation and PTX treatment group (group D). The parameters of hemodynamics, arterial blood gas analysis, plasma osmotic pressure and serum electrolytes in dogs were determined at 0 and 6 hours after injury and at 2 and 4 hours after treatment. Blood samples and bronchoalveolar lavage fluid (BALF) were collected to assess the changes in cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6) and IL-8. The arterial oxygen partial pressure (PaO(2)) and oxygenation index (PaO(2)/FiO(2)) in group B were still lower than normal values at 2 and 4 hours after treatment, but those parameters in group C and group D distinctly recovered. The parameters of hemodynamics, plasma osmotic pressure and serum electrolytes were all normalized in group B, C and D at 2 and 4 hours after treatment compared with those in group A. The levels of TNF-alpha in peripheral blood in group C and the TNF-alpha and IL-8 levels in peripheral blood and IL-6, IL-8 levels in BALF in group D were significantly lower than those in group A and group B after treatment. The TNF-alpha in peripheral blood and IL-8 levels in BALF in group D were also significantly lower than those in group C after treatment. Lung protective ventilation is an effective method in the treatment of ALI caused by open chest wound with inundation of seawater in thoracic cavity. PTX can inhibit inflammatory reaction in the lung and peripheral blood.

  4. Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study.

    Science.gov (United States)

    Grosen, Kasper; Vase, Lene; Pilegaard, Hans K; Pfeiffer-Jensen, Mogens; Drewes, Asbjørn M

    2014-01-01

    Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2-5. Pain was reevaluated at six months postoperatively. Patients reporting persistent pain at six months follow-up (n = 15) were not significantly different from pain-free patients (n = 16) concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3) or level of catastrophizing (Z = 0.4, P = 1.0). In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007) whereas conditioned pain modulation predicted morphine consumption (β = -0.005, P = 0.001). Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute postoperative phase. These findings may have important

  5. Conditioned pain modulation and situational pain catastrophizing as preoperative predictors of pain following chest wall surgery: a prospective observational cohort study.

    Directory of Open Access Journals (Sweden)

    Kasper Grosen

    Full Text Available Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency.Preoperatively, 42 healthy males undergoing funnel chest surgery completed the Spielberger's State-Trait Anxiety Inventory and Beck's Depression Inventory before undergoing a sequential conditioned pain modulation paradigm. Subsequently, the Pain Catastrophizing Scale was introduced and patients were instructed to reference the conditioning pain while answering. Ratings of movement-evoked pain and consumption of morphine equivalents were obtained during postoperative days 2-5. Pain was reevaluated at six months postoperatively.Patients reporting persistent pain at six months follow-up (n = 15 were not significantly different from pain-free patients (n = 16 concerning preoperative conditioned pain modulation response (Z = 1.0, P = 0.3 or level of catastrophizing (Z = 0.4, P = 1.0. In the acute postoperative phase, situational pain catastrophizing predicted movement-evoked pain, independently of anxiety and depression (β = 1.0, P = 0.007 whereas conditioned pain modulation predicted morphine consumption (β = -0.005, P = 0.001.Preoperative conditioned pain modulation and situational pain catastrophizing were not associated with the development of persistent postoperative pain following funnel chest repair. Secondary outcome analyses indicated that conditioned pain modulation predicted morphine consumption and situational pain catastrophizing predicted movement-evoked pain intensity in the acute postoperative phase. These findings may have

  6. SU-E-T-95: An Alternative Option for Reducing Lung Dose for Electron Scar Boost Irradiation in Post-Mastectomy Breast Cancer Patients with a Thin Chest Wall

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Y; Kumar, P; Mitchell, M [University of Kansas Medical Center, Kansas City, KS (United States)

    2015-06-15

    Purpose: Breast cancer patients who undergo a mastectomy often require post-mastectomy radiation therapy (PMRT) due to high risk disease characteristics. PMRT usually accompanies scar boost irradiation (10–16Gy in 5–8 fractions) using en face electrons, which often results in increased dose to the underlying lungs, thereby potentially increasing the risk of radiation pneumonitis. Hence, this study evaluated water-equivalent phantoms as energy degraders and as an alternative to a bolus to reduce radiation dose to the underlying lungs for electron scar boost irradiation. Methods: Percent depth dose (PDD) profiles of 6 MeV (the lowest electron energy available in most clinics) were obtained without and with commercial solid water phantoms (1 to 5mm by 1mm increments) placed on top of electron cones. Phantom attenuation was measured by taking a ratio of outputs with to without the phantoms in 10×10cm2 cone size for monitor unit (MU) calculation. In addition, scatter dose to contralateral breast was measured on a human-like phantom using two selected scar (short and long) boost patient setups. Results: The PDD plots showed that the solid water phantoms and the bolus had similar dosimetric effects for the same thickness. Lower skin dose (up to 3%) to ipsilateral breast was observed with a 5mm phantom compared with a 5mm bolus (up to 10%) for all electron cones. Phantom attenuation was increased by 50% with about a 4.5mm phantom. Also, the energy degraders caused scatter dose to contralateral breast by a factor of 3 with a 5mm phantom. Conclusion: Our results demonstrate the feasibility of using water-equivalent phantoms to reduce lung dose using en face electrons in patients with a thin chest wall undergoing PMRT. The disadvantages of this treatment approach (i.e., the increase in MUs and treatment time, and clinically insignificant scatter dose to the contralateral breast given usually 10Gy) are outweighed by its above clinical benefits.

  7. 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.

  8. Reconstrucción de defectos torácicos de espesor total: Presentación de 8 casos de especial complejidad Reconstruction of full thickness defects on the chest wall: Presentation of 8 complex cases

    Directory of Open Access Journals (Sweden)

    J.M. Lasso

    2009-12-01

    treatment require wide resection of the tumor or ischaemic or radiated tissue and control of the infection, but these principles could not be safely faced without the multiple reconstructive techniques that can afford the use of well vascularized, large or bulky tissues to reconstruct this anatomical area in combination with alloplastic materials, in order to give a solid stabilization. Thanks to these advances, we can actually perform our objectives in only one procedure. We present a selection of complex chest wall defects that have been operated in the last years by our surgical team. We will describe the solutions and the results obtained by means of a variety of possible flaps and synthetic materials.

  9. Treatment of non‐cardiac chest pain: a controlled trial of hypnotherapy

    Science.gov (United States)

    Jones, H; Cooper, P; Miller, V; Brooks, N; Whorwell, P J

    2006-01-01

    Background Non‐cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting. Aims This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with angina‐like chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory. Patients and methods Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication. Results Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores. Conclusion Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder. PMID:16627548

  10. [Hemodynamic changes of pregnant rats with pre-eclampsia after treatment with low-energy laser irradiation of the chest].

    Science.gov (United States)

    Sun, Li; Liu, Ping; Quan, Song

    2010-10-01

    To observe the hemodynamic changes and liver and kidney function variations in pregnant rats with pre-eclampsia after treatment with low-energy laser irradiation. Forty pregnant SD rats were randomly divided into the experimental group (group A), experimental control group (group B), blank control group (group C) and blank exposure group (group D) (n=10). The rats in groups A and B were injected with 1 µg/kg endotoxin via the tail vein at the 14th day of gestation, and those in groups C and D received normal saline injections. In groups A and B, low-energy laser irradiation of the chest was carried out since day 16 of gestation. Blood pressure, urine protein, liver and kidney function and the hemodynamic changes in the rats were observed. After the treatment, blood pressure, urine protein, ALT, BUN and Cr of group A were lower than those of group B (P0.05). The blood and plasma viscosity and hematocrit of group A were also lower than those of group B (Plaser irradiation in the chest area may improve the hemodynamic indices, decrease blood pressure and urine protein, and ameliorate liver and kidney functions in pregnant rats with pre-eclampsia.

  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. Chiropractic treatment vs self-management in patients with acute chest pain: a randomized controlled trial of patients without acute coronary syndrome.

    Science.gov (United States)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner; Høilund-Carlsen, Poul F; Haghfelt, Torben; Hartvigsen, Jan

    2012-01-01

    The musculoskeletal system is a common but often overlooked cause of chest pain. The purpose of the present study is to evaluate the relative effectiveness of 2 treatment approaches for acute musculoskeletal chest pain: (1) chiropractic treatment that included spinal manipulation and (2) self-management as an example of minimal intervention. In a nonblinded, randomized, controlled trial set at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain and no clear medical diagnosis at initial presentation were included. After a baseline evaluation, patients with musculoskeletal chest pain were randomized to 4 weeks of chiropractic treatment or self-management, with posttreatment questionnaire follow-up 4 and 12 weeks later. Primary outcome measures were numeric change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (7-point ordinal scale). Both groups experienced decreases in pain, self-perceived positive changes, and increases in Medical Outcomes Study Short Form 36-Item Health Survey scores. Observed between-group significant differences were in favor of chiropractic treatment at 4 weeks regarding the primary outcome of self-perceived change in chest pain and at 12 weeks with respect to the primary outcome of numeric change in pain intensity. To the best of our knowledge, this is the first randomized trial assessing chiropractic treatment vs minimal intervention in patients without acute coronary syndrome but with musculoskeletal chest pain. Results suggest that chiropractic treatment might be useful; but further research in relation to patient selection, standardization of interventions, and identification of potentially active ingredients is needed. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  13. [Treatment of pyriform sinus carcinoma involving the lateral wall].

    Science.gov (United States)

    Song, Xi-cheng; Zhang, Qing-quan; Wang, Li; Sun, Yan; Zhang, Hua; Chen, Xiu-mei; Wang, Qiang; Liu, Zhong-lu; Song, Yi-peng

    2013-04-01

    To present and discuss the clinical features, treatment, and efficacy of pyriform sinus carcinoma involving the lateral wall. Seventy-seven patients with pyriform sinus cancer involving the lateral wall (stage I 8, stage II 10, stage III 32, stage IV 27, according to UICC 2002 staging) were treated from Jun 1997 to Jun 2009 in the department of otorhinolaryngology head and neck surgery, Yuhuangding Hospital. The patients were divided into two groups: Group one 17 cases, simply underwent radiation therapy (R group); Group two 60 cases underwent surgery plus postoperative radiation (SR group). All patients underwent radiotherapy 50-75 Gy. In SR group, hyoid area and lateral pharyngeal approaches were taken according to the lesions for resection. To repair the defects and reconstruct the functions of larynx and pharynx, regional roping in suture, fascial flap/muscular- fascial of strap muscles, glosso-flap, musculocutaneous flap of major pectoral muscle, joint split graft or heterologous (bovine) acellular dermal matrix were used respectively. In group R, the primary tumor and neck lymph node metastasis disappeared at the end of radiotherapy in 15 cases. For one case, the N3 cervical lymph nodes shrank, but failed in local control and died of systemic metastases after 7 months. For another case, the N2 neck lymph nodes significantly reduced after the full course of radiation, PET-CT and biopsy did not find the cancer, but the tumor grew again after 6 months, and died of a neck bleeding 11 months later. All repairing materials used were alive in SR group. Two cases developed postoperative wound infection, and 2 cases suffered from pharyngeal fistula. All patients retained laryngeal functions, and all patients in SR group recovered diet 12 - 30 days, the mean time was 15.6 days. Three and 5 year survival rates for all 77 patients were 59.1% and 41.4%. For stage I + stage II cases in SR group and R group, 3 and 5 year survival rates were 63.6%, 53.0% and 66.7%, 50

  14. Is the Deep Inspiration Breath-Hold Technique Superior to the Free Breathing Technique in Cardiac and Lung Sparing while Treating both Left-Sided Post-Mastectomy Chest Wall and Supraclavicular Regions

    Directory of Open Access Journals (Sweden)

    Anupama Darapu

    2017-01-01

    Full Text Available Aims: To evaluate the efficacy of the deep inspirational breath-hold (DIBH technique and its dosimetric advantages over the free breathing (FB technique in cardiac (heart and left anterior descending artery [LAD] and ipsilateral lung sparing in left-sided post-mastectomy field-in-field conformal radiotherapy. DIBH is highly reproducible, and this study aims to find out its dosimetric benefits over FB. Materials and Methods: Nineteen left-sided mastectomy patients were immobilized using breast boards with both arms positioned above the head. All patients had 2 sets of planning CT images (one in FB and another in DIBH with a Biograph TruePoint HD CT scanner in the same setup. DIBH was performed by tracking the respiratory cycles using a Varian Real-Time Position Management system. The target (chest wall and supraclavicular region, organs at risk (OARs; ipsilateral lung, contralateral lung, heart, LAD, and contralateral breast, and other organs of interests were delineated as per the RTOG (Radiation Therapy Oncology Group contouring guidelines. The single-isocenter conformal fields in the field treatment plans were generated with the Eclipse Treatment Planning System (Varian Medical Systems for both FB and DIBH images, and the doses to the target and OARs were compared. The standard fractionation regimen of 50 Gy in 25 fractions over a period of 5 weeks was used for all patients in this study. Results and Discussion: The target coverage parameters (V95, V105, V107, and Dmean were found to be 97.8 ± 0.9, 6.1 ± 3.4, 0.2 ± 0.3, and 101.9 ± 0.5% in the FB plans and 98.1 ± 0.8, 6.1 ± 3.2, 0.2 ± 0.3, and 101.9 ± 0.4% in the DIBH plans, respectively. The plan quality indices (conformity index and homogeneity index also showed 1.3 ± 0.2 and 0.1 for the FB plans and 1.2 ± 0.3 and 0.1 for the DIBH plans, respectively. There was a significant reduction in dose to the heart in the DIBH plans compared to the FB plans, with p values of nearly 0 for the

  15. Uso de placas de ácido poli-L-láctico en reconstrucción de pared torácica Use of poly-L-lactic plates in chest wall reconstruction

    Directory of Open Access Journals (Sweden)

    J. Vilà Poyatos

    2011-12-01

    Full Text Available La reconstrucción de la pared torácica exige un amplio conocimiento de las técnicas reconstructivas y un buen plan operatorio. Por una parte es necesario mantener la estabilidad de la caja torácica y por otro proporcionar una buena base para la cobertura dérmica o musculocutánea que confiera buenos resultados funcionales y plásticos. En este trabajo describimos 2 casos clínicos en los que la reconstrucción de la pared torácica anterior se realizó con placas de ácido poli-L-láctico sobre las que se colocaron sendos colgajos musculocutáneos.Chest wall reconstruction requires an extensive knowledge of reconstructive techniques and a good surgical plan. On one hand, it is necessary to maintain stability of the rib cage and, on the other, provide a good foundation for dermal coverage or musculocutaneous flaps which confers good functional and plastic results. In this article we describe 2 cases in which anterior chest wall reconstruction was performed with plates of poly-L-lactic acid, on which were placed the musculocutaneous flaps.

  16. 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.

  17. 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.

    Science.gov (United States)

    Hoffmann, Andrew; Gill, Harjit

    2012-11-12

    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. 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. LFVP - HS only samples (vs. controls) showed; a) development of clot length fluid channels absent in the control group (p dissolution (23.0% vs. 1.8% respectively, p dissolution more than doubled (51.0% vs. 3.0%, p< 9.8 E- 6). Diastolic timed LFVP (50 Hz) engaged across a chest wall sized barrier enhances clot disruptive effects to an underlying coronary like system.

  18. Findings from the MATREX study: a treatment protocol for the delivery of manual chest therapy in respiratory care.

    Science.gov (United States)

    Cross, Jane; Elender, Frances

    2012-08-01

    One of the difficulties in comparing the numerous studies on manual chest therapy (MCT) is the wide variety of techniques used and terms employed to describe the intervention. This lack of consistency in therapeutic approach and the absence of defined tools for evaluation have led to a continued air of skepticism about its true value. This paper presents a treatment protocol used in a large randomized controlled trial examining the efficacy and cost effectiveness of MCT for patients hospitalized with exacerbations of COPD. Consensus development meetings with key physical therapists were held to identify the essential elements of MCT, address potential areas of ambiguity, and provide a set of clear parameters within which treatment would be based and recorded. This iterative approach resulted in a treatment protocol that combined best clinical practice with the research evidence available to date. In the Management of Exacerbations of COPD (MATREX) trial, 658 sessions of MCT were delivered by physical therapists over a 3 year period. A high level of adherence to the treatment protocol was seen for all but one of the protocol elements. With respect to the essential elements of MCT, the treatment protocol used in the MATREX trial offers sufficient flexibility to the therapist, while being robust enough to maintain clinical trial integrity. The level of adherence by therapists indicates its professional acceptability with respect to delivering and evaluating this therapy.

  19. 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...... overlapping conditions and syndromes of focal disorders, including Tietze syndrome, costochondritis, chest wall syndrome, muscle tenderness, slipping rib, cervical angina, and segmental dysfunction of the cervical and thoracic spine, have been reported to cause pain. For most of these syndromes, evidence...

  20. A randomized clinical trial of chiropractic treatment and self-management in patients with acute musculoskeletal chest pain: 1-year follow-up.

    Science.gov (United States)

    Stochkendahl, Mette J; Christensen, Henrik W; Vach, Werner; Høilund-Carlsen, Poul F; Haghfelt, Torben; Hartvigsen, Jan

    2012-05-01

    We have previously reported short-term follow-up from a pragmatic randomized clinical trial comparing 2 treatments for acute musculoskeletal chest pain: (1) chiropractic treatment and (2) self-management. Results indicated a positive effect in favor of the chiropractic treatment after 4 and 12 weeks. The current article investigates the hypothesis that the advantage observed at 4 and 12 weeks would be sustained after 1 year. In addition, we describe self-reported consequences of acute musculoskeletal chest pain at 1-year follow-up. In a nonblinded, randomized controlled trial undertaken at an emergency cardiology department and 4 outpatient chiropractic clinics, 115 consecutive patients with acute chest pain of musculoskeletal origin were included. After the baseline evaluation, patients were randomized to 4 weeks of either chiropractic treatment or self-management, with posttreatment questionnaire follow-up 52 weeks later. The primary outcome measures were change in pain intensity (11-point box numerical rating scale) and self-perceived change in pain (7-point ordinal scale). Both groups experienced decreases in pain, positive global, self-perceived treatment effect, and increases in the 36-Item Short Form Health Survey scores. No statistically significant differences were observed between groups at the 1-year follow-up, and we could not deduce a common trend in favor of either intervention. At the 1-year follow-up, we found no difference between groups in terms of pain intensity and self-perceived change in chest pain in the first randomized clinical trial assessing chiropractic treatment vs minimal intervention for patients with acute musculoskeletal chest pain. Further research into health care utilization and use of prescriptive medication is warranted. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  1. Clinical presentation and chiropractic treatment of Tietze syndrome: A 34-year-old female with left-sided chest pain

    National Research Council Canada - National Science Library

    Gijsbers, Eefje; Knaap, Simone F.C

    2011-01-01

    ... of chiropractic care in managing this patient with Tietze syndrome. Case report A 34-year-old woman presented with chest pain of 2 months' duration, which started while driving. In the car, the patient experienced a sudden onset of left-sided chest pain, which felt as a knife stabbing along with a crushing sensation, unlike any pain she experienced befor...

  2. Thoracic wall reconstruction after tumor resection

    Directory of Open Access Journals (Sweden)

    Kamran eHarati

    2015-10-01

    Full Text Available 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 wall improves life quality and mitigates functional impairment after extensive resection. The aim of this article is to illustrate the various plastic surgery treatment options in the multimodal therapy of patients with malignant thoracic wall tumors.Material und methods: This article is based on a review of the current literature and the evaluation of a patient database.Results: Several plastic surgical treatment options can be implemented in the curative and palliative therapy of patients with malignant solid tumors of the chest wall. Large soft tissue defects after tumor resection can be covered by local, pedicled or free flaps. In cases of large full-thickness defects, flaps can be combined with polypropylene mesh to improve chest wall stability and to maintain pulmonary function. The success of modern medicine has resulted in an increasing number of patients with prolonged survival suffering from locally advanced tumors that can be painful, malodorous or prone to bleeding. Resection of these tumors followed by thoracic wall reconstruction with viable tissue can substantially enhance the life quality of these patients. Discussion: In curative treatment regimens, chest wall reconstruction enables complete resection of locally advanced tumors and subsequent adjuvant radiotherapy. In palliative disease treatment, stadium plastic surgical techniques of thoracic wall reconstruction provide palliation of tumor-associated morbidity and can therefore improve

  3. MRI of the Chest

    Science.gov (United States)

    ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Chest Magnetic resonance imaging (MRI) of the chest ... limitations of MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging (MRI) is ...

  4. [Musculoskeletal-related chest pain].

    Science.gov (United States)

    Sturm, C; Witte, T

    2017-01-01

    Approximately 10-50% of chest pains are caused by musculoskeletal disorders. The association is twice as frequent in primary care as in emergency admissions. This article provides an overview of the most important musculoskeletal causes of chest pain and on the diagnostics and therapy. A selective search and analysis of the literature related to the topic of musculoskeletal causes of chest pain were carried out. Non-inflammatory diseases, such as costochondritis and fibromyalgia are frequent causes of chest pain. Inflammatory diseases, such as rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus are much less common but are more severe conditions and therefore have to be diagnosed and treated. The diagnostics and treatment often necessitate interdisciplinary approaches. Chest pain caused by musculoskeletal diseases always represents a diagnosis by exclusion of other severe diseases of the heart, lungs and stomach. Physiotherapeutic and physical treatment measures are particularly important, including manual therapy, transcutaneous electrical stimulation and stabilization exercises, especially for functional myofascial disorders.

  5. "Acute postoperative open abdominal wall": Nosological concept and treatment implications.

    Science.gov (United States)

    López-Cano, Manuel; Pereira, José A; Armengol-Carrasco, Manuel

    2013-12-27

    The so-called "burst abdomen" has been described for many years and is a well-known clinical condition, whereas the concept of the "open abdomen" is relatively new. In clinical practice, both nosological entities are characterized by a complex spectrum of symptoms apparently disconnected, which in many cases poses a great challenge for surgical repair. In order to assess the management of these disorders in a more comprehensive and integral fashion, the concept of "acute postoperative open abdominal wall" (acute POAW) is presented, which in turn can be divided into "intentional" or planned acute POAW and "unintentional" or unplanned POAW. The understanding of the acute POAW as a single clinical process not only allows a better optimization of the therapeutic approach in the surgical repair of abdominal wall-related disorders, but also the stratification and collection of data in different patient subsets, favoring a better knowledge of the wide spectrum of conditions involved in the surgical reconstruction of the abdominal wall.

  6. A combination of methylprednisolone and quercetin is effective for the treatment of cardiac contusion following blunt chest trauma in rats

    Energy Technology Data Exchange (ETDEWEB)

    Demir, F. [Department of Pediatric Cardiology, Faculty of Medicine, Dicle University, Diyarbakır (Turkey); Güzel, A. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Katı, C. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Karadeniz, C. [Pediatric Cardiology Services, Behçet Uz Children' s Hospital, İzmir (Turkey); Akdemir, U. [Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Okuyucu, A. [Department of Medical Biochemistry, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Gacar, A. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey); Özdemir, S. [Department of Pediatrics, Faculty of Medicine, Ondokuz Mayıs University, Samsun (Turkey); Güvenç, T. [Department of Pathology, Faculty of Veterinary Medicine, Ondokuz Mayıs University, Samsun (Turkey)

    2014-08-01

    Cardiac contusion is a potentially fatal complication of blunt chest trauma. The effects of a combination of quercetin and methylprednisolone against trauma-induced cardiac contusion were studied. Thirty-five female Sprague-Dawley rats were divided into five groups (n=7) as follows: sham, cardiac contusion with no therapy, treated with methylprednisolone (30 mg/kg on the first day, and 3 mg/kg on the following days), treated with quercetin (50 mg·kg{sup −1}·day{sup −1}), and treated with a combination of methylprednisolone and quercetin. Serum troponin I (Tn-I) and tumor necrosis factor-alpha (TNF-α) levels and cardiac histopathological findings were evaluated. Tn-I and TNF-α levels were elevated after contusion (P=0.001 and P=0.001). Seven days later, Tn-I and TNF-α levels decreased in the rats treated with methylprednisolone, quercetin, and the combination of methylprednisolone and quercetin compared to the rats without therapy, but a statistical significance was found only with the combination therapy (P=0.001 and P=0.011, respectively). Histopathological degeneration and necrosis scores were statistically lower in the methylprednisolone and quercetin combination group compared to the group treated only with methylprednisolone (P=0.017 and P=0.007, respectively). However, only degeneration scores were lower in the combination therapy group compared to the group treated only with quercetin (P=0.017). Inducible nitric oxide synthase positivity scores were decreased in all treatment groups compared to the untreated groups (P=0.097, P=0.026, and P=0.004, respectively). We conclude that a combination of quercetin and methylprednisolone can be used for the specific treatment of cardiac contusion.

  7. CHEST SONOGRAPHY IN COMMON PAEDIATRIC CHEST DISEASES

    Directory of Open Access Journals (Sweden)

    Pradeep Raghavendra Kulkarni

    2017-03-01

    Full Text Available BACKGROUND The aim of the study is to determine the utility of chest sonography in common paediatric diseases and to present chest sonography images with possible explanation for the same. MATERIALS AND METHODS This retrospective study was conducted in Department of Paediatric Medicine, Bharati Medical College, Sangli. The patients admitted in paediatric ward, NICU, PICU with respiratory complaints and findings were subjected to chest sonography after chest x-ray. The chest sonography images were interpreted and an attempt was made to correlate with findings of chest xray. The information given by chest sonography was analysed and possible cause of image was evaluated. RESULTS The chest sonography appearances were found to be specific and in certain instances more informative than chest x-ray. It can differentiate between collapse and consolidation easily. The limitation of chest sonography was- it can assess only peripheral lung regions with inability to assess deeper lesions, especially with aerated peripheral lung. CONCLUSION The chest sonography is superior to chest x-ray in diagnosing minimal effusion and minimal pneumothorax. Also, when there is difficulty in differentiating pulmonary from pleural pathology. Though, chest sonography cannot replace chest x-ray, it is very useful additional investigation and often times very helpful with additional diagnostic information.

  8. Chest pain

    Science.gov (United States)

    ... pain. The pain may spread to the arm, shoulder, jaw, or back. A tear in the wall of the aorta, the large blood vessel that takes blood from the heart to the rest of the body ( aortic dissection ) causes sudden, severe ...

  9. MRI of the Chest

    Medline Plus

    Full Text Available ... the limitations of MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging (MRI) is a noninvasive ... top of page What are some common uses of the procedure? MR imaging of the chest is ...

  10. MRI of the Chest

    Medline Plus

    Full Text Available ... MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging (MRI) is a noninvasive ... of page What are some common uses of the procedure? MR imaging of the chest is performed ...

  11. Preoperative embolization of a giant neurofibroma of the chest in a patient with neurofibromatosis type II: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Suk Hyun [Dept. of Radiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang (Korea, Republic of); Shin, Jong Soo [Dept. of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul (Korea, Republic of)

    2017-01-15

    Giant plexiform neurofibromas, which are rare in patients with neurofibromatosis type II (NFII), are difficult to manage surgically, as they are extensively infiltrative and highly vascularized. Preoperative embolization is performed to reduce intraoperative blood loss and operative time, increase resectability of lesions, and improve visualization of the operative field during surgery of hypervascular tumors such as renal cell carcinoma and intracranial meningioma. Preoperative intravascular embolization of a giant chest wall neurofibroma has not been reported in the English literature. We report successful treatment of a giant chest wall neurofibroma in a 45-year-old male with NFII by preoperative intravascular embolization followed by surgical resection.

  12. 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

    Directory of Open Access Journals (Sweden)

    Ziacchi Vigilio

    2004-03-01

    Full Text Available 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 polyunsaturated fatty acids (PUFAs have been reported to possess several properties that may positively influence vascular function. The present study's hypothesis is that a 4 month-course of oral supplementation with n-3 PUFAs can reverse endothelial dysfunction. Methods Subjects were selected on the basis of the following criteria: 1 reported chest pain syndrome, 2 significant ST-segment depression during an otherwise normal SE, 3 absence of angiographically-significant CAD. Subjects underwent a 4-month course of oral supplementation with commercially available n-3 PUFA, 1 g once a day. Normalization of endothelial dysfunction was defined, at the end of the supplementation period, by the absence of significant ST-segment depression during repeat SE. We tested the aforementioned hypothesis in a very small series of consecutive subjects, with the intent to produce a hypothesis-generating study. Results Seven out of the total nine subjects enrolled (77.8% had normal ST-segment during repeat SE performed after the 4 month course of therapy. Conclusions A striking rate of reversion of SE-induced ST-segment depression after oral n-3 PUFAs suggests reversion of coronary endothelial dysfunction; nonetheless these data need to be validated in larger, placebo-controlled studies.

  13. Preparation of Nano Tourmaline Surface Treatment Agent and Its Application on Functional Wall fabrics

    Directory of Open Access Journals (Sweden)

    Lan Fangxing

    2016-01-01

    Full Text Available In this paper, a kind of surface treatment agent and its application on the functional wall fabrics that can produce negative ion was reported. This surface treatment agent was prepared by using nano tourmaline powder dispersion with water as solvent produced by sand milling. The parameters of sand milling process, as well as powder diameter and its distribution, and the negative ion releasing behavior of the functional wall fabrics were discussed. The results showed that nano tourmaline had good dispersity stability with the number average diameter (d50 achieved 190nm and the polydispersity index reached to 0.220. The treated wall fabrics showed good performance in high adsorption with nano powder and high negative ions releasing ability. The negative ions releasing amount changes depending on the different surface treatment process of tourmaline dispersion and three-proofing agent. This facility technics could be widely used as industrial application.

  14. 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.

  15. Admission heart rate in relation to presentation and prognosis in patients with acute myocardial infarction. Treatment regimens in German chest pain units.

    Science.gov (United States)

    Perne, A; Schmidt, F P; Hochadel, M; Giannitsis, E; Darius, H; Maier, L S; Schmitt, C; Heusch, G; Voigtländer, T; Mudra, H; Gori, T; Senges, J; Münzel, T

    2016-05-01

    Higher heart rates on admission have been associated with poor outcomes in patients with an acute coronary syndrome in previous cohorts. Whether such a linear relationship still exists in contemporary high-level care is unclear. Prospectively collected data from patients presenting with myocardial infarction (MI) in centers participating in the Chest Pain Unit (CPU) Registry between December 2008 and July 2014 were analyzed. Patients were classified according to their initial heart rate (I:  90 bpm experience reduced survival at 3 months despite optimal treatment. Patients with bradycardia also seem to be at increased risk for cardiovascular events despite much earlier presentation and treatment.

  16. Chest wall reconstruction following axillary breast augmentation and desmoid tumor resection using capsular flaps and a form-stable silicone implant: A case report, diagnosis and surgical technique

    Directory of Open Access Journals (Sweden)

    Alexandre Mendonça Munhoz

    2017-01-01

    Conclusion: Knowledge of this rare post-operative evolution is crucial, and early surgical intervention is warranted in order to avoid more aggressive treatment. This case report provides general knowledge of CDT, and may be used as guidance for early diagnosis and treatment.

  17. Interpretation of neonatal chest radiography

    Energy Technology Data Exchange (ETDEWEB)

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

    2016-05-15

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

  18. 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, ... d like to talk with you about chest radiography also known as chest x-rays. Chest x- ...

  19. MRI of the Chest

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Chest Magnetic resonance imaging (MRI) of the chest ... limitations of MRI of the Chest? What is MRI of the Chest? Magnetic resonance imaging (MRI) is ...

  20. MRI of the Chest

    Medline Plus

    Full Text Available ... Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Chest Magnetic resonance imaging (MRI) of the chest uses a powerful ... Chest? What is MRI of the Chest? Magnetic resonance imaging (MRI) is a noninvasive medical test that ...

  1. Aneurysmal wall enhancement and perianeurysmal edema after endovascular treatment of unruptured cerebral aneurysms.

    LENUS (Irish Health Repository)

    Su, I-Chang

    2014-06-01

    Perianeurysmal edema and aneurysm wall enhancement are previously described phenomenon after coil embolization attributed to inflammatory reaction. We aimed to demonstrate the prevalence and natural course of these phenomena in unruptured aneurysms after endovascular treatment and to identify factors that contributed to their development.

  2. Conditioned Pain Modulation and Situational Pain Catastrophizing as Preoperative Predictors of Pain following Chest Wall Surgery: A Prospective Observational Cohort Study

    OpenAIRE

    Kasper Grosen; Lene Vase; Pilegaard, Hans K.; Mogens Pfeiffer-Jensen; Drewes, Asbjørn M

    2014-01-01

    BACKGROUND: Variability in patients' postoperative pain experience and response to treatment challenges effective pain management. Variability in pain reflects individual differences in inhibitory pain modulation and psychological sensitivity, which in turn may be clinically relevant for the disposition to acquire pain. The aim of this study was to investigate the effects of conditioned pain modulation and situational pain catastrophizing on postoperative pain and pain persistency. METHODS: P...

  3. Malignant transformation in von recklinghausen disease in a rural farmer presenting as huge metastatic soft tissue chest wall tumour: a case report.

    Science.gov (United States)

    Ekpe, E E

    2014-01-01

    Although von Recklinghausen disease is relatively common at an incidence of 1 in 4000 live births, malignant transformation in a neurofibromatosis is quite rare estimated at about 5% therefore the importance of life-long follow up of all patients von Recklinghausen disease. This is a case report of a 45-year old Nigerian-Ibibio male farmer who presented with six months history of rapid growth in one of the numerous skin nodules which had been present since his teenage age. The clinical diagnosis of malignant change in von Recklinghausen's disease was confirmed by histopathologic examination of an incisional biopsy specimen. Radiological investigations also showed the metastatic status of the disease. The patient could not afford the cytotoxic chemotherapeutic agents prescribed. He therefore left the hospital and failed to return when a free-treatment voucher was ready for treatment in the following two days. He is assumed dead at home. Lifelong follow up for von Recklinghausen disease is emphasized to enable early detection of malignant change and also expansion of the national health insurance scheme to benefit the unemployed citizens.

  4. Medical treatment and long-term outcome of chronic atrial fibrillation in the aged with chest distress: a retrospective analysis versus sinus rhythm

    Directory of Open Access Journals (Sweden)

    Guo Y

    2011-07-01

    Full Text Available Yutao Guo, Lu Zhang, Chunjiang Wang, Yuexiang Zhao, Weiren Chen, Meng Gao, Ping Zhu, Tingshu Yang, Yutang WangDepartment of Geriatric Cardiology, General Hospital of The Chinese PLA, Beijing, 100853, People’s Republic of ChinaAbstract: Although “chest distress” is the most frequent complication in the aged with chronic atrial frbrillation (AF in clinical practice, there are few data on the association between chronic AF and coronary artery disease (CAD in the aged in terms of medical treatment and long-term outcome. We assessed coronary artery lesions in such patients and evaluated the efficacy of medical treatment in long-term follow-ups. Of 315 elderly patients (mean age: 77.39 ± 6.33 years who had undergone coronary angiography for chest distress, 297 exhibited sinus rhythm (SR, whereas 18 patients exhibited chronic AF. Patients with AF were followed for 4.22 ± 2.21 years. Average diastolic blood pressure (DBP of AF patients was observed to be markedly less than that of patients with SR (57.33 ± 6.87 mmHg vs 71.08 ± 10.54 mmHg, t-test: P < 0.01. Compared with SR patients, severe stenosis of the coronary artery in AF patients was reduced (73.06% vs 44.44%, Chi-square test: P < 0.01. AF patients with chest distress had high CHADS2 score (3.72 ± 1.27, but only 33.3% patients received oral anticoagulants, and such patients had a significantly lower rate of revascularization (21.43% vs 55.63%, Chi-square test: P < 0.01, and higher rate of all-cause death (22.22% vs 4.38%, Chi-square test: P < 0.01 and thromboembolism (16.67% vs 1.68%, Chi-square test: P < 0.01 in the long-term follow-ups compared with SR patients. Chest distress in the aged with AF was related to insufficient coronary blood supply that was primarily due to a reduced DBP rather than to occult CAD. Adequate and safe medical therapy was difficult to achieve in these patients. Such patients typically have a poor prognosis, and optimal therapeutic strategies to treat them

  5. SU-F-T-337: Accounting for Patient Motion During Volumetric Modulated Ac Therapy (VMAT) Planning for Post Mastectomy Chest Wall Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Hernandez, M; Fontenot, J [Mary Bird Perkins Cancer Center, Baton Rouge, LA (United States); Heins, D [Louisiana State University, Baton Rouge, LA (United States)

    2016-06-15

    Purpose: To evaluate two dose optimization strategies for maintaining target volume coverage of inversely-planned post mastectomy radiotherapy (PMRT) plans during patient motion. Methods: Five patients previously treated with VMAT for PMRT at our clinical were randomly selected for this study. For each patient, two plan optimization strategies were compared. Plan 1 was optimized to a volume that included the physician’s planning target volume (PTV) plus an expansion up to 0.3 cm from the bolus surface. Plan 2 was optimized to the PTV plus an expansion up to 0.3 cm from the patient surface (i.e., not extending into the bolus). VMAT plans were optimized to deliver 95% of the prescription to 95% of the PTV while sparing organs at risk based on clinical dose limits. PTV coverage was then evaluated following the simulation of patient shifts by 1.0 cm in the anterior and posterior directions using the treatment planning system. Results: Posterior patient shifts produced a difference in D95% of around 11% in both planning approaches from the non-shifted dose distributions. Coverage of the medial and lateral borders of the evaluation volume was reduced in both the posteriorly shifted plans (Plan 1 and Plan 2). Anterior patient shifts affected Plan 2 more than Plan 1 with a difference in D95% of 1% for Plan 1 versus 6% for Plan 2 from the non-shifted dose distributions. The least variation in PTV dose homogeneity for both shifts was obtained with Plan 1. However, all posteriorly shifted plans failed to deliver 95% of the prescription to 95% of the PTV. Whereas, only a few anteriorly shifted plans failed this criteria. Conclusion: The results of this study suggest both planning volume methods are sensitive to patient motion, but that a PTV extended into a bolus volume is slightly more robust for anterior patient shifts.

  6. [Prophylactics and treatment of postoperative hernias of the lateral abdominal walls using polypropylene endoprosthesis].

    Science.gov (United States)

    Sukovatykh, B S; Valuĭskaia, N M; Pravednikova, N V; Netiaga, A A; Kas'ianova, M A; Zhukovskiĭ, V A

    2011-01-01

    An analysis of complex examination and treatment of 151 patients after planned and performed surgical interventions on organs of the retroperitoneal space was made. The patients were divided into 4 groups. The first group (of comparison) included 46 patients who were treated by lumbotomy for different diseases of organs of the urinary system. In 35 patients of the second group (prophylactics) the indications were determined and in 20 patients preventive endoprosthesis of the lateral abdominal wall using polypropylene endoprosthesis was fulfilled. Herniotomy with plasty of the lateral abdominal wall using local tissues was fulfilled in 30 patients. Prosthesing hernioplasty of the lateral abdominal wall was fulfilled in 40 patients of the main group. It was found that preventive endoprosthesis of the lateral abdominal wall allowed prevention of progressing anatomo-functional i/isufficiency and the appearance of postoperative hernias. The application of polypropylene endoprosthesis for the treatment of postoperative hernias allows obtaining 36.4% more good results as compared with the control group, 21.7% decreased number of satisfactory results and no recurrent hernias.

  7. Criptococoma pulmonar con invasión torácica en un varón inmunocompetente Pulmonary cryptococcoma with involvement of the chest wall in an immunocompetent patient

    Directory of Open Access Journals (Sweden)

    Ana A. Pisarevsky

    2010-04-01

    Full Text Available La criptococosis pulmonar en pacientes inmunocompetentes es una entidad poco habitual y su presentación como masas de gran tamaño, con compromiso de la pared torácica y de los tejidos blandos vecinos, no la encontramos descriptas en nuestra revisión bibliográfica. La variedad gattii (serotipoB/C está acotada geográficamente a regiones tropicales y subtropicales y parece afectar preferentemente a individuos inmunocompetentes. Presentamos el caso de un hombre de 51 años proveniente del noreste de la Argentina, fumador de 10 atados/año que consulta por aumento del volumen del hombro izquierdo e impotencia funcional por intenso dolor de seis meses de evolución. Mediante una biopsia percutánea de la masa, se diagnostica Cryptococcus neoformans, variedad gattii. El paciente recibe terapéutica antifúngica, mostrando una evolución favorable con disminución progresiva de la masa.The pulmonary cryptococcosis in immunocompetent patients is unusual, and its presentation as large masses with involvement of the chest wall and the neighboring soft tissues has not been found in our bibliographic research. The variety gattii (serotype B/C is limited geographically to tropical and subtropical regions and appears to affect particularly immunocompetent individuals. We describe the case of a 51-year-old man from the Northeast of Argentina, with a history of smoking 10 pack/year. He presented an increased volume of the left shoulder and reported that for the last six months he had been unable to move it due to the pain. A percutaneous biopsy of the mass provided a diagnosis of Cryptococcus neoformans, variety gattii. The patient was treated with antifungal therapy showing a favourable outcome with a progressive decrease of the mass.

  8. Chest Injuries and Disorders

    Science.gov (United States)

    ... of tissue, lines the inside of the chest cavity. Chest injuries and disorders include Heart diseases Lung diseases and collapsed lung Pleural disorders Esophagus disorders Broken ribs Thoracic aortic aneurysms Disorders of the mediastinum, the space ...

  9. MRI of the Chest

    Medline Plus

    Full Text Available ... News Physician Resources Professions Site Index A-Z Magnetic Resonance Imaging (MRI) - Chest Magnetic resonance imaging (MRI) of the chest uses a powerful magnetic field, radio waves and a computer to produce ...

  10. MRI of the Chest

    Medline Plus

    Full Text Available ... to a CD or uploaded to a digital cloud server. MRI of the chest gives detailed pictures ... as chest x-ray or CT. A special form of MRI called magnetic resonance angiography (MRA) is ...

  11. Chest X-Ray

    Medline Plus

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

  12. MRI of the Chest

    Medline Plus

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

  13. MRI of the Chest

    Medline Plus

    Full Text Available ... chest. It is primarily used to assess abnormal masses such as cancer and determine the size, extent ... of the chest is performed to: assess abnormal masses, including cancer of the lungs or other tissues, ...

  14. Chest X-Ray

    Medline Plus

    Full Text Available ... Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. ... University in Durham, North Carolina. I’d like to talk with you about chest radiography also known ...

  15. Examination of musculoskeletal chest pain

    DEFF Research Database (Denmark)

    Brunse, Mads Hostrup; Stochkendahl, Mette Jensen; Vach, Werner

    2010-01-01

    using a standardized examination protocol, (2) to determine inter-observer reliability of single components of the protocol, and (3) to determine the effect of observer experience. Eighty patients were recruited from an emergency cardiology department. Patients were eligible if an obvious cardiac or non......-cardiac diagnosis could not be established at the cardiology department. Four observers (two chiropractors and two chiropractic students) performed general health and manual examination of the spine and chest wall. Percentage agreement, Cohen's Kappa and ICC were calculated for observer pairs (chiropractors...... and students) and all. Musculoskeletal chest pain was diagnosed in 45 percent of patients. Inter-observer kappa values were substantial for the chiropractors and overall (0.73 and 0.62, respectively), and moderate for the students (0.47). For single items of the protocol, the overall kappa ranged from 0...

  16. Chest Radiographic Findings in Newly Diagnosed Pulmonary ...

    African Journals Online (AJOL)

    Five hundred newly diagnosed cases of Pulmonary Tuberculosis were treated with directly observed short-course treatment and 100 of them had chest radiographic examination done. The various chest radiographic patterns in the 100 subjects were studied and included: Fluffy exudative changes 80(80%), fibrosis 70(70%) ...

  17. Paper-based 1-MCP treatment suppresses cell wall metabolism and delays softening of Huanghua pears during storage.

    Science.gov (United States)

    Chen, Yihui; Sun, Junzheng; Lin, Hetong; Hung, Yen-Con; Zhang, Shen; Lin, Yifen; Lin, Ting

    2017-06-01

    Huanghua pear will lose its firmness quickly during postharvest storage at ambient temperature, and hence has limited storage and marketing potential. In this study, Huanghua pears treated with paper containing 0 (control) or 0.9 μL L-1 1-methylcyclopropene (1-MCP) for 12 h, and then stored at (25 ± 1) °C for 30 days, were investigated for the effect on fruit firmness, cell wall composition and activities of cell wall-degrading enzymes. Huanghua pears without 1-MCP treatment softened rapidly during room-temperature storage and cell wall composition analyses showed an increase in water-soluble pectin (WSP) and decreases in cell wall materials (CWM) and cell wall components such as Na2 CO3 -soluble pectin (NSP), cellulose and hemicellulose. In contrast, the 1-MCP-treated fruits maintained higher firmness than the control; also, the treatment prevented the formation of WSP and reduced the degradation of CWM and cell wall components including NSP, cellulose and hemicellulose. 1-MCP treatment also significantly lowered the activities of cell wall-degrading enzymes such as pectinesterase, polygalacturonase, β-galactosidase and cellulase during storage. 1-MCP treatment can slow down the softening of Huanghua pears through reducing cell wall-degrading enzyme activities and hence maintain the integrity of the cell wall structure. © 2016 Society of Chemical Industry. © 2016 Society of Chemical Industry.

  18. Chest computed tomography

    DEFF Research Database (Denmark)

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

    2013-01-01

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

  19. Changes of wood cell walls in response to hygro-mechanical steam treatment.

    Science.gov (United States)

    Guo, Juan; Song, Kunlin; Salmén, Lennart; Yin, Yafang

    2015-01-22

    The effects of compression combined with steam treatment (CS-treatment), i.e. a hygro-mechanical steam treatment on Spruce wood were studied on a cell-structure level to understand the chemical and physical changes of the secondary cell wall occurring under such conditions. Specially, imaging FT-IR microscopy, nanoindentation and dynamic vapour absorption were used to track changes in the chemical structure, in micromechanical and hygroscopic properties. It was shown that CS-treatment resulted in different changes in morphological, chemical and physical properties of the cell wall, in comparison with those under pure steam treatment. After CS-treatment, the cellular structure displayed significant deformations, and the biopolymer components, e.g. hemicellulose and lignin, were degraded, resulting in decreased hygroscopicity and increased mechanical properties of the wood compared to both untreated and steam treated wood. Moreover, CS-treatment resulted in a higher degree of degradation especially in earlywood compared to a more uniform behaviour of wood treated only by steam. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Device and method for treatment of openings in vascular and septal walls

    Science.gov (United States)

    Singhal, Pooja; Wilson, Thomas S.; Cosgriff-Hernandez, Elizabeth; Maitland, Duncan J.

    2017-06-06

    A device, system and method for treatment of an opening in vascular and/or septal walls including patent foramen ovale. The device has wings/stops on either end, an axis core covered in a shape memory foam and is deliverable via a catheter to the affected opening, finally expanding into a vascular or septal opening where it is held in place by the expandable shape memory stops or wings.

  1. Non-Cardiac Chest Pain

    Science.gov (United States)

    ... it: “atypical chest pain, chest pain of undetermined origin, unexplained chest pain, functional chest pain, soldier’s heart, ... Return to Top GI Health Centers Colorectal Cancer Hepatitis C Inflammatory Bowel Disease Irritable Bowel Syndrome Obesity ...

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

    Science.gov (United States)

    Pauzé, Denis R; Pauzé, Daniel K

    2013-11-01

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

  3. Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome. For the Rapid Early Action for Coronary Treatment (REACT) Study.

    Science.gov (United States)

    Siepmann, D B; Mann, N C; Hedges, J R; Daya, M R

    2000-06-01

    Cost concerns may inhibit emergency medical services (EMS) use. Novel tax-based and subscription prepayment programs indemnify patients against the cost of EMS treatment and transport. We determine whether the presence of (or enrollment in) prepayment plans increase EMS use among patients with acute chest discomfort, particularly those residing in low-income areas, those lacking private insurance, or both. This study uses a subset of baseline data from the REACT trial, a multicenter, randomized controlled community trial designed, in part, to increase EMS use. The sample includes 860 consecutive noninstitutionalized patients (>30 years old) presenting with nontraumatic chest discomfort to hospital emergency departments in 4 Oregon/Washington communities. The association between prepayment systems and EMS use was analyzed using multivariable logistic regression. Overall EMS use was 52% (n=445). Among EMS users, 338 (75%) were subsequently admitted to the hospital and 110 (25%) were released from the ED. Prepayment was not associated with increased EMS use in the overall patient sample. However, patients residing in low-income census block groups (median annual income Economic considerations may affect EMS system utilization among underinsured and low-income patients experiencing a cardiac event. Prepayment systems may increase EMS utilization among these groups.

  4. Basis for treatment of tuberculosis among HIV-infected patients in Tanzania: the role of chest x-ray and sputum culture

    Directory of Open Access Journals (Sweden)

    Tvaroha Susan

    2008-03-01

    Full Text Available Abstract Background Active tuberculosis (TB is common among HIV-infected persons living in tuberculosis endemic countries, and screening for tuberculosis (TB is recommended routinely. We sought to determine the role of chest x-ray and sputum culture in the decision to treat for presumptive TB using active case finding in a large cohort of HIV-infected patients. Methods Ambulatory HIV-positive subjects with CD4 counts ≥ 200/mm3 entering a Phase III TB vaccine study in Tanzania were screened for TB with a physical examination, standard interview, CD4 count, chest x-ray (CXR, blood culture for TB, and three sputum samples for acid fast bacillus (AFB smear and culture. Results Among 1176 subjects 136 (12% were treated for presumptive TB. These patients were more frequently male than those without treatment (34% vs. 25%, respectively; p = 0.049 and had lower median CD4 counts (319/μL vs. 425/μL, respectively; p Conclusion Many ambulatory HIV-infected patients with CD4 counts ≥ 200/mm3 are treated for presumptive TB. Our data suggest that optimal detection requires comprehensive evaluation, including CXR and sputum culture on both symptomatic and asymptomatic subjects.

  5. [A pulsating tumor in the chest wall].

    Science.gov (United States)

    Rienmüller, R; Hahn, D; Manz, M

    1983-06-01

    A pericardial constriction with calcification and a pulsating cyst is an unusual outcome after a pericardial windowing. The application of cardiac computed tomography evaluating the morphological parameters of the heart chambers and the adjacent vessels is an appropriate noninvasive method in the diagnostics of pericardial constriction.

  6. Metastatic Sarcomatoid Squamous Cell Carcinoma of the Cervix Presenting with Chest Mass

    Directory of Open Access Journals (Sweden)

    Lilit Karapetyan

    2017-01-01

    Full Text Available Background. Sarcomatoid squamous cell carcinoma is a rare and aggressive form of cervical cancer. We report a case of metastatic sarcomatoid squamous cell carcinoma (SSCC of cervix that presented with an anterior chest wall mass. Case. A 43-year-old Hispanic female presented with a two-month history of a central chest wall mass. The patient’s only past medical history was SSCC of the cervix, stage IIB, diagnosed two years priorly. She underwent neoadjuvant chemoradiation therapy (CRT with cisplatin followed by radical hysterectomy. Surgical margins were positive which led to adjuvant CRT with carboplatin and paclitaxel. PET scan 4 months after the postoperative treatment was negative for recurrence and metastatic disease. On current presentation, the CT chest revealed anterior mediastinal destructive soft tissue mass involving sternum, and the biopsy showed SSCC. The patient received palliative radiation therapy to her chest with improvement in pain and ability to swallow. After discussing the prognosis she refused further chemotherapy and decided on hospice care. Conclusion. Despite good response to first-line therapy, SSCC tends to recur early and does not respond to second-line therapy. Radiation therapy seems to be the most effective modality for treatment, but randomized controlled trials of therapy are impractical.

  7. 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...

  8. 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.

  9. 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.

  10. Effect of steam treatment on the properties of wood cell walls.

    Science.gov (United States)

    Yin, Yafang; Berglund, Lars; Salmén, Lennart

    2011-01-10

    Steam treatment is a hygrothermal method of potential industrial significance for improving the dimensional stability and durability of wood materials. The steaming results in different chemical and micromechanical changes in the nanostructured biocomposite that comprise a wood cell wall. In this study, spruce wood ( Picea abies Karst.) that had been subjected to high-temperature steaming up to 180 °C was examined, using imaging Fourier Transform Infrared (FT-IR) microscopy and nanoindentation to track changes in the chemical structure and the micromechanical properties of the secondary cell wall. Similar changes in the chemical components, due to the steam treatment, were found in earlywood and latewood. A progressive degradation of the carbonyl groups in the glucuronic acid unit of xylan and a loss of mannose units in the glucomannan backbone, that is, a degradation of glucomannan, together with a loss of the C═O group linked to the aromatic skeleton in lignin, was found. The development of the hygroscopic and micromechanical properties that occurred with an elevation in the steam temperature correlated well with this pattern of degradation in the constituents in the biocomposite matrix in the cell wall (hemicellulose and lignin).

  11. Correlation of bladder wall thickness and treatment success in types of urinary incontinence.

    Science.gov (United States)

    Akselim, Burak; Doğanay, Melike; Özcan, Nilay; Akselim, Sinem; Cavkaytar, Sabri

    2017-03-01

    The aim of the study was to investigate the correlation between mean bladder wall thickness (BWT) and treatment success in patients diagnosed with urinary incontinence, based on urodynamic test results. In this prospective study, patient urinary incontinence type was identified using urodynamic tests. Patients (N = 125) were categorized into three groups: urodynamic stress incontinence (SUI), detrusor over-activity (DO) and mixed urinary incontinence. Measurements from the bladder dome, anterior wall and trigone were averaged to calculate BWT. Student's t test and Mann-Whitney U test were used to compare pre-treatment BWT. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-off values for BWT to predict treatment success. Mean pre-treatment BWT significantly differed between success and non-success groups for each urinary incontinence type (p value for the SUI, DO and MUI groups was 0.043, 0.001 and 0.002 respectively). Using ROC curves to anticipate the treatment success, a threshold was calculated for mean pre-treatment BWT; 5.05 mm for SUI (sensitivity 74 %, specificity 66 %, positive predictive value [PPV] 85 %, negative predictive value [NPV] 50 %), 4.98 mm for DO (sensitivity 73 %, specificity 92 %, PPV 95 %, NPV 63 %) and 5.31 mm for mixed type (sensitivity 88 %, specificity 73 %, PPV 79 %, NPV 85 %). The study results suggest a significant relationship between the pre-treatment BWT and the success of urinary incontinence treatment. The mean BWT may be used as a benchmark in assessing the responsiveness to treatment of urinary incontinence types.

  12. Electrohydrodynamic Nanofluid Hydrothermal Treatment in an Enclosure with Sinusoidal Upper Wall

    Directory of Open Access Journals (Sweden)

    Mohsen Sheikholeslami

    2015-08-01

    Full Text Available The influence of non-uniform electric filed on Fe3O4-Ethylene glycol nanofluid hydrothermal treatment in an enclosure with sinusoidal upper and moving lower walls is investigated in this study. Control Volume based Finite Element Method (CVFEM is utilized to simulate in the presented model. Numerical investigation are conducted for the sundry parameters such as Reynolds number; nanoparticle volume fraction and supplied. Results show that supplied voltage can change the flow shape. Coulomb force causes isotherms denser near the moving wall. Heat transfer rises with augment of supplied voltage and Reynolds number. Effect of electric filed on heat transfer is more pronounced at low Reynolds number. Finally, a comparison with the existing literature is also made.

  13. Endoscopic treatment of multilocular walled-off pancreatic necrosis with the multiple transluminal gateway technique.

    Science.gov (United States)

    Jagielski, Mateusz; Smoczyński, Marian; Adrych, Krystian

    2017-06-01

    The development of minimally invasive techniques allowed access to the necrotic cavity through transperitoneal, retroperitoneal, transmural and transpapillary routes. The choice of access to walled-off pancreatic necrosis (WOPN) should depend not only on the spread of necrosis, but also on the experience of the clinical center. Herein we describe treatment of a patient with multilocular symptomatic walled-off pancreatic necrosis using minimally invasive techniques. The single transmural access (single transluminal gateway technique - SGT) to the necrotic collection of the patient was ineffective. The second gastrocystostomy was performed using the same minimally invasive technique as an extra way of access to the necrosis (multiple transluminal gateway technique - MTGT). In the described case the performance of the new technique consisting in endoscopic multiplexing transmural access (MTGT) was effective enough and led to complete recovery of the patient.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-07-01

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

  15. [Chest radiographs in infants hospitalized for acute bronchiolitis: real information or just irradiation?].

    Science.gov (United States)

    Carsin, A; Gorincour, G; Bresson, V; Oudyi, M; David, M; Mancini, J; Chabrol, B; Devred, P; Bosdure, E; Dubus, J-C

    2012-12-01

    To describe the chest radiographs of infants hospitalized for acute bronchiolitis and to assess whether patient management changed after radiography. All infants hospitalized in our pediatric unit with a first episode of acute bronchiolitis from October 2010 to March 2012 were included in the study. Infants with chronic disease or transferred from a pediatric intensive care unit were excluded. The following data were collected: sex, age, neonatal history, atopy, tobacco exposure, admission criteria, treatment, laboratory parameters, ultrasonography and its outcome, results of chest radiography on admittance, the reason for a second chest radiograph, change in management as a result of the radiograph. The study comprised 232 infants (median age 2.2 months, boys 56%, positive respiratory syncytial virus 73.4%). Among them, 227 children had a routine chest radiograph revealing distension and/or bronchial wall thickening (n=141, 62.4%), focal opacity (19.9%), or atelectasis (17.7%). This radiograph led to the prescription of antibiotics in six patients (2.6%) and allowed the diagnosis of vascular abnormality to be made in one case (0.4%). Thirty-five patients (15.4%) had a second chest radiograph during their hospitalization owing to oxygen dependency (n=21), respiratory distress (n=11), persistent fever (n=2), or no reason specified (n=1). Pneumonia (n=7) and/or atelectasis (n=15) were then found in 62.9%. Patient management (antibiotics, postural maneuvers) was modified in six patients (17.1%). Routine chest radiographs contribute only partially to the treatment of infants hospitalized for acute bronchiolitis. However, radiography is useful when the hospitalized child does not improve at the expected rate or if the disease is severe. The indication of chest radiography in infants hospitalized for acute bronchiolitis should be discussed on a case by a case basis. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  16. Assessments of quaternary ammonium compounds (QAC) for in-water treatment of mussel fouling in vessel internals and sea chests using an experimental seawater pipework system.

    Science.gov (United States)

    Piola, Richard; Grandison, Clare

    2017-01-01

    The primary in-water emergency treatment method for mussel fouling of internal seawater systems of Royal Australian Navy vessels is to flush with a 1% detergent solution containing quaternary ammonium compounds (QAC). Parameters for application of this treatment are based on previous research; however, much of the research has been conducted at small-scales under controlled laboratory conditions. This study examined the efficacy of QAC solutions for treating mussel biofouling under realistic field conditions using experimental seawater piping systems. The efficacy of QAC solutions was highly dependent on the size of mussels present. Chemical treatments comprising 1, 2 and 5% v v(-1) QAC solution were effective at killing large (50-92 mm) mussels in the pipework and sea chest of the system following 24 h exposure. In contrast, small mussels (10-30 mm) appeared resilient to the majority of treatment regimes. Differences in water temperature, DO and pH during dosing had no discernible impact on treatment efficacy.

  17. 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.

  18. A dosimetric study on slab-pinewood-slab phantom for developing the heterogeneous chest phantom mimicking actual human chest

    Directory of Open Access Journals (Sweden)

    Om Prakash Gurjar

    2017-01-01

    Full Text Available The aim is to study the density, isodose depths, and doses at different points in slab-pinewood-slab (SPS phantom, solid phantom SP34 (made up of polystyrene, and chest level of actual patient for developing heterogeneous chest phantom mimicking thoracic region of human body. A 6 MV photon beam of field size of 10 cm×10 cm was directed perpendicular to the surface of computed tomography (CT images of chest level of patient, SPS phantom, and SP34 phantom. Dose was calculated using anisotropic analytical algorithm. Hounsfield units were used to calculate the density of each medium. Isodose depths in all the three sets of CT images were measured. Variations between planned doses on treatment planning system (TPS and measured on linear accelerator (LA were calculated for three points, namely, near slab-pinewood interfaces (6 and 18 cm depths and 10 cm depth in SPS phantom and at the same depths in SP34 phantom. Density of pinewood, SP34 slabs, chest wall, lung, and soft tissue behind lung was measured as 0.329 ± 0.08, 0.999 ± 0.02, 0.898 ± 0.02, 0.291 ± 0.12, and 1.002 ± 0.03 g/cc, respectively. Depths of 100% and 90% isodose curves in all the three sets of CT images were found to be similar. Depths of 80%, 70%, 60%, 50%, and 40% isodose lines in SPS phantom images were found to be equivalent to that in chest images, while it was least in SP34 phantom images. Variations in doses calculated at 6, 10, and 18 cm depths on TPS and measured on LA were found to be 0.36%, 1.65%, and 2.23%, respectively, in case of SPS phantom, while 0.24%, 0.90%, and 0.93%, respectively, in case of SP34 slab phantom. SPS phantom seemed equivalent to the chest level of human body. Dosimetric results of this study indicate that patient-specific quality assurance can be done using chest phantom mimicking thoracic region of human body, which has been fabricated using polystyrene and pinewood.

  19. Estimation of aneurysm wall stresses created by treatment with a shape memory polymer foam device.

    Science.gov (United States)

    Hwang, Wonjun; Volk, Brent L; Akberali, Farida; Singhal, Pooja; Criscione, John C; Maitland, Duncan J

    2012-05-01

    In this study, compliant latex thin-walled aneurysm models are fabricated to investigate the effects of expansion of shape memory polymer foam. A simplified cylindrical model is selected for the in-vitro aneurysm, which is a simplification of a real, saccular aneurysm. The studies are performed by crimping shape memory polymer foams, originally 6 and 8 mm in diameter, and monitoring the resulting deformation when deployed into 4-mm-diameter thin-walled latex tubes. The deformations of the latex tubes are used as inputs to physical, analytical, and computational models to estimate the circumferential stresses. Using the results of the stress analysis in the latex aneurysm model, a computational model of the human aneurysm is developed by changing the geometry and material properties. The model is then used to predict the stresses that would develop in a human aneurysm. The experimental, simulation, and analytical results suggest that shape memory polymer foams have potential of being a safe treatment for intracranial saccular aneurysms. In particular, this work suggests oversized shape memory foams may be used to better fill the entire aneurysm cavity while generating stresses below the aneurysm wall breaking stresses.

  20. Transition of single-walled carbon nanotubes from metallic to semiconducting in field-effect transistors by hydrogen plasma treatment.

    Science.gov (United States)

    Zheng, Gang; Li, Qunqing; Jiang, Kaili; Zhang, Xiaobo; Chen, Jia; Ren, Zheng; Fan, Shoushan

    2007-06-01

    We report hydrogen plasma treatment results on converting the metallic single-walled carbon nanotubes to semiconducting single-walled carbon nanotubes. We found that the as-grown single-walled carbon nanotubes (SWNTs) can be sorted as three groups which behave as metallic, as-metallic, and semiconducting SWNTs. These three groups have different changes under hydrogen plasma treatment and successive annealing process. The SWNTs can be easily hydrogenated in the hydrogen plasma environment and the as-metallic SWNTs can be transformed to semiconducting SWNTs. The successive annealing process can break the C-H bond, so the conversion is reversible.

  1. Purification and Functionalization of Single-Walled Carbon Nanotubes through Different Treatment Procedures

    Directory of Open Access Journals (Sweden)

    Peir-An Tsai

    2013-01-01

    Full Text Available Single-walled carbon nanotubes (SWCNTs were purified by the combined use of ultrasonic- and microwave-assisted acid digestion. The results show that the method efficiently eliminates impurities, reduces solvent consumption, and prevents damage to the structure of the SWCNTs. The purified SWCNTs were given functionalization treatments with a nitric acid/sulfuric acid mixture. These acid-treated SWCNTs (A-SWCNTs were then grafted with 3-isocyanatopropyl triethoxysilane (A-SWCNTs-Si. The A-SWCNTs and A-SWCNTs-Si were used to improve interfacial interactions with polymers and to produce a well-dispersed SWCNT composite.

  2. Permeable sorptive walls for treatment of hydrophobic organic contaminant plumes in groundwater

    Energy Technology Data Exchange (ETDEWEB)

    Grathwohl, P.; Peschik, G. [Univ. of Tuebingen (Germany)

    1997-12-31

    Highly hydrophobic contaminants are easily adsorbed from aqueous solutions. Since for many of these compounds sorption increases with increasing organic carbon content natural materials such as bituminous shales and coals may be used in permeable sorptive walls. This, however, only applies if sorption is at equilibrium, which may not always be the case in groundwater treatment using a funnel-and-gate system. In contrast to the natural solids, granular activated carbons (GACs) have very high sorption capacities and reasonably fast sorption kinetics. The laboratory results show that application of GACs (e.g. F100) is economically feasible for in situ removal of polycyclic aromatic hydrocarbons (PAH) from groundwater at a former manufactured gas plant site (MGP). For less sorbing compounds (such as benzene, toluene, xylenes) a combination of adsorption and biodegradation is necessary (i.e. sorptive + reactive treatment).

  3. MRI of the Chest

    Medline Plus

    Full Text Available ... lesions seen by other imaging modalities, such as chest x-ray or CT. A special form of MRI called ... perform than other imaging modalities. MRI of the chest takes more time than an x-ray or CT exam. Because of the length of ...

  4. Chest X-Ray

    Medline Plus

    Full Text Available ... 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. For more information about chest x-rays, visit Radiology Info dot ...

  5. MRI of the Chest

    Medline Plus

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

  6. MRI of the Chest

    Medline Plus

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

  7. Treatment of Small-Cell Lung Cancer: American Society of Clinical Oncology Endorsement of the American College of Chest Physicians Guideline.

    Science.gov (United States)

    Rudin, Charles M; Ismaila, Nofisat; Hann, Christine L; Malhotra, Narinder; Movsas, Benjamin; Norris, Kim; Pietanza, M Catherine; Ramalingam, Suresh S; Turrisi, Andrew T; Giaccone, Giuseppe

    2015-12-01

    The American College of Chest Physicians (ACCP) produced an evidence-based guideline on treatment of patients with small-cell lung cancer (SCLC). Because of the relevance of this guideline to American Society of Clinical Oncology (ASCO) membership, ASCO reviewed the guideline, applying a set of procedures and policies used to critically examine guidelines developed by other organizations. The ACCP guideline on the treatment of SCLC was reviewed for developmental rigor by methodologists. An ASCO Endorsement Panel updated the literature search, reviewed the content, and considered additional recommendations. The ASCO Endorsement Panel determined that the recommendations from the ACCP guideline, published in 2013, are clear, thorough, and based on current scientific evidence. ASCO endorses the ACCP guideline on the treatment of SCLC, with the addition of qualifying statements. Surgery is indicated for selected stage I SCLC. Limited-stage disease should be treated with concurrent chemoradiotherapy in patients with good performance status. Thoracic radiotherapy should be administered early in the course of treatment, preferably beginning with cycle one or two of chemotherapy. Chemotherapy should consist of four cycles of a platinum agent and etoposide. Extensive-stage disease should be treated primarily with chemotherapy consisting of a platinum agent plus etoposide or irinotecan. Prophylactic cranial irradiation prolongs survival in patients with limited-stage disease who achieve a complete or partial response to initial therapy and may do so in similarly responding patients with extensive-stage disease as well. Additional information is available at http://www.asco.org/endorsements/sclc and http://www.asco.org/guidelineswiki. © 2015 by American Society of Clinical Oncology.

  8. The long-term effects of wall attached microalgal biofilm on algae-based wastewater treatment.

    Science.gov (United States)

    Su, Yanyan; Mennerich, Artur; Urban, Brigitte

    2016-10-01

    The influence of the reactor wall attached biofilm on the nutrient removal performance was investigated in an open photobioreactor during long-term operation. Total nitrogen and phosphorus removal efficiencies were statistically similar between reactor with (reactor A) and without (reactor B) biofilm at the Hydraulic Retention Time (HRT) of 18, 13.5 and 9days. When the HRT reduced to 8days, total nitrogen and phosphorus removal efficiencies in the reactor A were 42.95±5.11% and 97.97±1.12%, respectively, while significant lower removal efficiencies (38.06±5.80% for total nitrogen and 83.14±8.16% for phosphorus) were obtained in the reactor B. The VSS concentrations throughout the test were statistically similar for the two reactors, with a mean value of 0.63±0.25g/l for reactor A and 0.69±0.20g/l for reactor B. This study indicated that the reactor wall attached biofilm supported high phosphorus and nitrogen removal, which may provide insight into the practical implementation of microalgae-based wastewater treatment. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Topical application of Mitomycin C in the treatment of granulation tissue after Canal Wall Down mastoidectomy

    Directory of Open Access Journals (Sweden)

    Alireza Karimi-Yazdi

    2013-03-01

    Full Text Available Introduction: Otorrhea and granulation tissue in Canal Wall Down mastoidectomy (CWD is the common problem in cholesteatoma removal and leads to many discomfort for both the patient and the physician. The main objective in CWD is creating the dry cavity, so the topical antibiotic and acetic acid in variable saturations are used for this purpose. In this study we evaluate the effectiveness of topical MMC and chemical cautery by acetic acid.   Materials and Methods: Study population consists of 50 patients with cholesteatoma whom underwent CWD. All patient allocated randomly in two study groups, MMC and acetic acid. After 3 weeks, the first visit is planned, extension of granulation tissue and dryness of cavity are evaluated and topical drugs are used in blind fashion. MMC in 4% and acetic acid in 12.5% saturation are applied. Other visits are completed at next month and 3 months later.   Results: Both methods are effective in treatment of granulation tissue. In each group both treatment were effective too but MMC was more effective than acid acetic in the treatment of granulation tissue after 4 weeks.   Conclusion: Based on our findings, it is clear that topical MMC is very effective in the treatment of granulation tissue and in CWD. It results in dry cavity much better than acetic acid without any complication. 

  10. Purification of Single-Wall carbon nanotubes by heat treatment and supercritical extraction

    Directory of Open Access Journals (Sweden)

    Mariana Bertoncini

    2011-09-01

    Full Text Available Arc discharge is the most practical method for the synthesis of single wall carbon nanotubes (SWCNT. However, the production of SWCNT by this technique has low selectivity and yield, requiring further purification steps. This work is a study of purification of SWCNT by heat treatment in an inert atmosphere followed by supercritical fluid extraction. The raw arc discharge material was first heat-treated at 1250 °C under argon. The nanotubes were further submitted to an extraction process using supercritical CO2 as solvent. A surfactant (tributylphosphate, TBP and a chelating agent (hexafluoroacetylacetone, HFA were used together to eliminate metallic impurities from the remaining arc discharge catalysts. Analysis of Inductively Coupled Plasma-Atomic Emission Spectrometry (ICP-AES showed an efficient removal of iron and cobalt (>80%. The purified nanotubes were further analyzed by TGA and Raman spectroscopy.

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

    Science.gov (United States)

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

    2017-01-01

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

  12. Ultrasound-guided high-intensity focused ultrasound treatment for abdominal wall endometriosis: Preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Wang Yang [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853 (China); Wang Wei, E-mail: wangyang301301@yahoo.com.cn [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853 (China); Wang Longxia; Wang Junyan; Tang Jie [Department of Ultrasound, Chinese PLA General Hospital, 28 Fuxing Road, Beijing 100853 (China)

    2011-07-15

    Purpose: To evaluate the safety and therapeutic efficacy of ultrasound (US)-guided high-intensity focused ultrasound (HIFU) ablation for the treatment of abdominal wall endometriosis (AWE). Materials and methods: Twenty-one consecutive patients with AWE were treated as outpatients by US-guided HIFU ablation under conscious sedation. The median size of the AWE was 2.4 cm (range 1.0-5.3 cm). An acoustic power of 200-420 W was used, intermittent HIFU exposure of 1 s was applied. Treatment was considered complete when the entire nodule and its nearby 1 cm margin become hyperechoic on US. Pain relief after HIFU ablation was observed and the treated nodule received serial US examinations during follow-up. Results: All AWE was successfully ablated after one session of HIFU ablation, the ablation time lasted for 5-48 min (median 13 min), no major complications occurred. The cyclic pain disappeared in all patients during a mean follow-up of 18.7 months (range 3-31 months). The treated nodules gradually shank over time, 16 nodules became unnoticeable on US during follow-up. Conclusion: US-guided HIFU ablation appears to be safe and effective for the treatment of AWE.

  13. [Effects of hypotensive treatment on structural-functional properties of the vascular wall in hypertensive patients].

    Science.gov (United States)

    Maslennikova, O M; Romanchuk, S V; Rachkova, S A; Nazarova, O A

    2008-01-01

    To study structural-functional properties of the walls of large and middle-size arteries and changes of these properties in the course of hypotensive therapy in hypertensive patients. Of 609 participants of the trial (233 males and 376 females), 377 patients with essential hypertension stage I-II (mean age 46.9 +/- 7.2 years) entered the study group, 232 healthy subjects (mean age 45.7 +/- 6.9 years)--the control group. Pulse wave velocity (PWV) for vessels of elastic and muscular type was measured in all the examinees. Circadian blood pressure monitoring, echocardiography, duplex scanning of the common carotid artery were performed in hypertensive patients. 76 hypertensive patients were reexamined 6 months after treatment with amlodipin (n = 32) or fixed combination perindopril+indapamide (n = 44). Mean PWV appeared to be higher in hypertensive patients in whom PWV correlated with left ventricular (LV) remodeling and thickness of intima-media complex (IMC). After 6 months of hypotensive therapy PWV significantly lowered for both types of vessels studied. IMC thickness reduced by 10.1%, on the average, LV myocardial mass index--by 6.3%. The link between PWV, LV hypertrophy and IMC allows PWV use as a method of detection of cardiovascular remodeling in hypertension and for follow-up of antihypertensive treatment effect on this remodeling in outpatient treatment of hypertension.

  14. Chest X-Ray

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    Full Text Available ... Imaging Costs Video: Abdominal Ultrasound Video: Pelvic Ultrasound Radiology and You Sponsored by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. Geoffrey ...

  15. MRI of the Chest

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    Full Text Available ... primarily used to assess abnormal masses such as cancer and determine the size, extent and degree of ... chest is performed to: assess abnormal masses, including cancer of the lungs or other tissues, which either ...

  16. Chest X-Ray

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    Full Text Available ... Index A-Z Spotlight March is National Colorectal Cancer Awareness Month Recently posted: Carotid Intima-Media Thickness ... of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray requires no special preparation. ...

  17. MRI of the Chest

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    Full Text Available ... may sense a temporary metallic taste in their mouth after the contrast injection. If you do not ... the iodine-based contrast materials used for conventional x-rays and CT scanning. MRI of the chest is ...

  18. Chest X-Ray

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    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 ...

  19. MRI of the Chest

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    Full Text Available ... etc.). top of page What are some common uses of the procedure? MR imaging of the chest ... gadolinium contrast, it may still be possible to use it after appropriate pre-medication. Patient consent will ...

  20. MRI of the Chest

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    Full Text Available ... determine the presence of certain diseases. The images can then be examined on a computer monitor, transmitted ... of the chest cavity (arteries and veins). MRA can also demonstrate an abnormal ballooning out of the ...

  1. Chest X-Ray

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    Full Text Available ... Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. Geoffrey Rubin, a radiologist at Duke University in Durham, North Carolina. I’d like to talk with you about chest ...

  2. MRI of the Chest

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    Full Text Available ... MRI) of the chest uses a powerful magnetic field, radio waves and a computer to produce detailed ... there’s a possibility you are pregnant. The magnetic field is not harmful, but it may cause some ...

  3. MRI of the Chest

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    Full Text Available ... as chest x-ray or CT. A special form of MRI called magnetic resonance angiography (MRA) is ... not to have an MRI exam during the first trimester unless medically necessary. MRI may not always ...

  4. MRI of the Chest

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    Full Text Available ... to: assess abnormal masses, including cancer of the lungs or other tissues, which either cannot be assessed ... for differentiating and characterizing soft tissues, except for lung abnormalities where Chest CT is a preferred imaging ...

  5. MRI of the Chest

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    Full Text Available ... is not harmful, but it may cause some medical devices to malfunction. Most orthopedic implants pose no ... Chest? Magnetic resonance imaging (MRI) is a noninvasive medical test that physicians use to diagnose medical conditions. ...

  6. Chest Pain: First Aid

    Science.gov (United States)

    ... angina with any of the following signs and symptoms, it may indicate a more serious condition, such as a heart attack: Pain in your arms, neck, jaw, shoulder or back accompanying chest pain Nausea Fatigue Shortness ...

  7. MRI of the Chest

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    Full Text Available ... detailed pictures of the structures within the chest. It is primarily used to assess abnormal masses such ... and determine the size, extent and degree of its spread to adjacent structures. It’s also used to ...

  8. Digital chest radiography

    DEFF Research Database (Denmark)

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

    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...

  9. Chest X-Ray

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    Full Text Available ... accurate diagnosis far outweighs any risk. For more information about chest x-rays, visit Radiology Info dot ... Inc. (RSNA). To help ensure current and accurate information, we do not permit copying but encourage linking ...

  10. MRI of the Chest

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    Full Text Available ... copied to a CD or uploaded to a digital cloud server. MRI of the chest gives detailed ... physicians with expertise in several radiologic areas. Outside links: For the convenience of our users, RadiologyInfo .org ...

  11. MRI of the Chest

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    Full Text Available ... body. Guidelines about eating and drinking before your exam vary between facilities. Unless you are told otherwise, ... doctor for a mild sedative prior to the exam. What is MRI of the Chest? What are ...

  12. MRI of the Chest

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    Full Text Available ... radio waves and a computer to produce detailed pictures of the structures within the chest. It is ... frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all ...

  13. MRI of the Chest

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    Full Text Available ... copied to a CD or uploaded to a digital cloud server. MRI of the chest gives detailed ... type your comment or suggestion into the following text box: Comment: E-mail: Area code: Phone no: ...

  14. Chest X-Ray

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    Full Text Available ... Index A-Z Spotlight November is National Lung Cancer Awareness Month Recently posted: Carotid Intima-Media Thickness ... of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray requires no special preparation. ...

  15. Chest X-Ray

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    Full Text Available ... exams and use a very small dose of ionizing radiation to produce pictures of the inside of the ... chest x-ray use a tiny dose of ionizing radiation, the benefit of an accurate diagnosis far outweighs ...

  16. Chest X-Ray

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    Full Text Available ... and You Take our survey Sponsored by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript ... Carotid Intima-Media Thickness Test Medical Imaging Costs Video: Abdominal Ultrasound Video: Pelvic Ultrasound Radiology and You ...

  17. MRI of the Chest

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    Full Text Available ... a computer to produce detailed pictures of the structures within the chest. It is primarily used to ... extent and degree of its spread to adjacent structures. It’s also used to assess the anatomy and ...

  18. 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.

  19. MRI of the Chest

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    Full Text Available ... the chest uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of ... the body being imaged, send and receive radio waves, producing signals that are detected by the coils. ...

  20. MRI of the Chest

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    Full Text Available ... of the chest uses a powerful magnetic field, radio waves and a computer to produce detailed pictures ... medical conditions. MRI uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed ...

  1. CT angiography - chest

    Science.gov (United States)

    ... A computer creates multiple separate images of the body area, called slices. These images can be stored, viewed on a monitor, or printed on film. Three-dimensional models of the chest area can ...

  2. MRI of the Chest

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    Full Text Available ... This detail makes MRI an invaluable tool in early diagnosis and evaluation of cardiovascular conditions. MRI has ... Magnetic Resonance Imaging (MRI) Safety MRI Safety During Pregnancy Images related to Magnetic Resonance Imaging (MRI) - Chest ...

  3. MRI of the Chest

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    Full Text Available ... or headphones during the exam. MRI scanners are air-conditioned and well-lit. Music may be played ... the limitations of MRI of the Chest? High-quality images are assured only if you are able ...

  4. MRI of the Chest

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    Full Text Available ... for lung abnormalities where Chest CT is a preferred imaging test. MR imaging can assess blood flow ... If you are anxious, confused or in severe pain, you may find it difficult to lie still ...

  5. Chest X-Ray

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    Full Text Available ... Index A-Z Spotlight October is National Breast Cancer Awareness Month Recently posted: Carotid Intima-Media Thickness ... of lung conditions such as pneumonia, emphysema and cancer. A chest x-ray requires no special preparation. ...

  6. MRI of the Chest

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    Full Text Available ... and may add approximately 15 minutes to the total exam time. top of page What will I ... the limitations of MRI of the Chest? High-quality images are assured only if you are able ...

  7. MRI of the Chest

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    Full Text Available ... be examined on a computer monitor, transmitted electronically, printed or copied to a CD or uploaded to a digital cloud server. MRI of the chest gives detailed pictures of structures within ...

  8. 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.

  9. Chest physiotherapy for pneumonia in adults.

    Science.gov (United States)

    Yang, Ming; Yan, Yuping; Yin, Xiangli; Wang, Bin Y; Wu, Taixiang; Liu, Guan J; Dong, Bi Rong

    2013-02-28

    Despite conflicting evidence, chest physiotherapy has been widely used as an adjunctive treatment for adults with pneumonia. To assess the effectiveness and safety of chest physiotherapy for pneumonia in adults. We searched CENTRAL 2012, Issue 11, MEDLINE (1966 to November week 2, 2012), EMBASE (1974 to November 2012), Physiotherapy Evidence Database (PEDro) (1929 to November 2012), CINAHL (2009 to November 2012) and CBM (1978 to November 2012). Randomised controlled trials (RCTs) assessing the efficacy of chest physiotherapy for treating pneumonia in adults. Two authors independently assessed trial eligibility, extracted data and appraised trial quality. Primary outcomes were mortality and cure rate. We used risk ratios (RR) and mean difference (MD) for individual trial results in the data analysis. We performed meta-analysis and measured all outcomes with 95% confidence intervals (CI). Six RCTs (434 participants) appraised four types of chest physiotherapy (conventional chest physiotherapy; osteopathic manipulative treatment (which includes paraspinal inhibition, rib raising and myofascial release); active cycle of breathing techniques (which include active breathing control, thoracic expansion exercises and forced expiration techniques); and positive expiratory pressure).None of the physiotherapies (versus no physiotherapy or placebo) improved mortality rates of adults with pneumonia.Conventional chest physiotherapy (versus no physiotherapy), active cycle of breathing techniques (versus no physiotherapy) and osteopathic manipulative treatment (versus placebo) did not increase the cure rate or chest X-ray improvement rate.Osteopathic manipulative treatment (versus placebo) and positive expiratory pressure (versus no physiotherapy) reduced the mean duration of hospital stay by 2.0 days (mean difference (MD) -2.0 days, 95% CI -3.5 to -0.6) and 1.4 days (MD -1.4 days, 95% CI -2.8 to -0.0), respectively. Conventional chest physiotherapy and active cycle of breathing

  10. Results of surgical treatment of anterior abdominal wall desmoid tumours : 13 cases reviewed with literature.

    Science.gov (United States)

    Yabanoglu, H; Karagulle, E; Aytac, H O; Caliskan, K; Canpolat, T; Koc, Z; Akdur, A C; Moray, G; Haberal, M

    2014-01-01

    We retrospectively evaluated the results of surgical treatment for anterior abdominal wall -desmoid tumours. Records for 13 patients operated on for desmoid tumours from 1997-2013 were searched for age, gender, abdominal/pelvic surgical history, pregnancy, Gardner's syndrome, pre-operative radiological examinations, tumour size, multifocality, surgical procedure, tumour presence at surgical margins, recurrence, morbidity, and mortality. Local recurrence-free survival probabilities were estimated by the Kaplan-Meier method and stratified by various clinicopathological variables. There were 11 female (84,6%) and 2 male (15,4%) patients with a median age of 36 years. Seven (53,8%) -patients had previous abdominal/pelvic surgery, five (38,5%) had a history of pregnancy, and one (7,6%) had Gardner's Syndrome. Two (15,3%) patients had multifocality on their pre-operative radiological examinations. Mean tumour -diameter was 4,6 cm (SD 3,2 cm ; range 2-12 cm). After the excision of the masses in five (38,5%) patients, synthetic materials were used to close the abdominal wall defects. Two (15,3%) patients with positive surgical margins after -surgery were re-operated. Three (23%) patients required a second surgical intervention after the mass excisions were performed. Mean follow-up time was 56,7 months. Recurrence was observed in three patients during follow-up. Increased tumour size, history of previous abdominal/pelvic surgery, and the presence of multifocality had a negative effect on local recurrence-free survival. There was no mortality during follow-up. Desmoid tumours are characterized by high recurrence, even after proper surgical excisions. Preoperative differential diagnoses of these tumours should be done and a post-operative follow-up protocol should be followed. Copyright© Acta Chirurgica Belgica.

  11. Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing

    Energy Technology Data Exchange (ETDEWEB)

    Del Corso, Andrea, E-mail: adelcorso2000@hotmail.com [Universita di Pisa, Division of General and Vascular Surgery, Ospedale Cisanello (Italy); Vergaro, Giuseppe [Fondazione G. Monasterio CNR-Regione Toscana, Division of Cardiovascular Medicine (Italy)

    2013-06-15

    Purpose. Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA. Material and Methods. During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA were asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up. Results. PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 {+-} 22 %. Neuropathy and vein compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary. Conclusion. PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings.

  12. Clinical impact of ' in-treatment' wall motion abnormalities in hypertensive patients with left ventricular hypertrophy: the LIFE study

    DEFF Research Database (Denmark)

    Cicala, S.; Simone, G. de; Wachtell, K.

    2008-01-01

    In hypertensive patients with LVH and no history of cardiovascular disease, ' in- treatment' left ventricular wall motion abnormalities are associated with increased likelihood of subsequent cardiovascular events independent of age, gender, blood pressure lowering, treatment modality, and in- treatment left......, however, never been investigated. We examined whether 'in- treatment' wall motion abnormalities predicted outcome in the Losartan Intervention For Endpoint ( LIFE) reduction in hypertension echocardiographic substudy. Methods We studied 749 patients without coronary artery disease, myocardial infarction...... to analyze the primary composite endpoint of cardiovascular death, MI, or stroke and, separately, for fatal and nonfatal MI and hospitalized heart failure. Results During a mean follow-up of 4.8 years, an event was recorded in 67 ( 9%) patients. In Cox models after adjusting for age, gender, treatment, blood...

  13. Xpand chest drain: assessing equivalence to current standard ...

    African Journals Online (AJOL)

    our current treatment modalities and search for more cost- effective means of treatment. Underwater seal drainage was first described by Playfair1 in 1875 and has become the standard form of chest drainage throughout the world. In South Africa the underwater drain. (UWD) is the most common device used for chest ...

  14. Effect of multimodality chest physiotherapy in prevention of ventilator-associated pneumonia: A randomized clinical trial.

    Science.gov (United States)

    Pattanshetty, Renu B; Gaude, G S

    2010-04-01

    Despite remarkable progress that has been achieved in the recent years in the diagnosis, prevention, and therapy for ventilator-associated pneumonia (VAP), this disease continues to create complication during the course of treatment in a significant proportion of patients while receiving mechanical ventilation. This study was designed to evaluate the effect of multimodality chest physiotherapy in intubated and mechanically ventilated patients undergoing treatment in the intensive care units (ICUs) for prevention of VAP. A total of 101 adult intubated and mechanically ventilated patients were included in this study. Manual hyperinflation (MH) and suctioning were administered to patients in the control group (n = 51), and positioning and chest wall vibrations in addition to MH plus suctioning (multimodality chest physiotherapy) were administered to patients in the study group (n = 50) till they were extubated. Both the groups were subjected to treatment twice a day. Standard care in the form of routine nursing care, pharmacological therapy, inhalation therapy, as advised by the concerned physician/surgeon was strictly implemented throughout the intervention period. Data were analyzed using SPSS window version 9.0. The Clinical Pulmonary infection Score (CPIS) Score showed significant decrease at the end of extubation/successful outcome or discharge in both the groups (P = 0.00). In addition, significant decrease in mortality rate was noted in the study group (24%) as compared to the control group (49%) (P = 0.007). It was observed in this study that twice-daily multimodality chest physiotherapy was associated with a significant decrease in the CPIS Scores in the study group as compared to the control group suggesting a decrease in the occurrence of VAP. There was also a significant reduction in the mortality rates with the use of multimodality chest physiotherapy in mechanically ventilated patients.

  15. Atypical chest pain: evidence of intercostobrachial nerve sensitization in Complex Regional Pain Syndrome.

    Science.gov (United States)

    Rasmussen, Jennifer W; Grothusen, John R; Rosso, Andrea L; Schwartzman, Robert J

    2009-01-01

    Atypical chest pain is a common complaint among Complex Regional Pain Syndrome (CRPS) patients with brachial plexus involvement. Anatomically, the intercostobrachial nerve (ICBN) is connected to the brachial plexus and innervates the axilla, medial arm and anterior chest wall. By connecting to the brachial plexus, the ICBN could become sensitized by CRPS spread and become a source of atypical chest pain. To evaluate the sensitivity of chest areas in CRPS patients and normal controls. Prospective investigation of pressure algometry in chest areas to determine chest wall sensitivity. CRPS patients and normal controls volunteered to participate in our study. Each individual was examined to meet inclusion criteria. Patients' report of chest pain history was collected from every participant. Pressure algometry was used to measure pressure sensitivity in the axilla, anterior axillary line second intercostal space, mid-clavicular third rib, mid-clavicular tenth rib, and midsternal. Each of these measurements were compared to an intra-participant abdominal measure to control for an individuals generalized sensitivity. The ratios of chest wall sensitivities were compared between CRPS patients and normal controls. A history of chest pain was reported by a majority (94%) of CRPS patients and a minority (19%) of normal controls. CRPS patients reported lifting their arm as a major initiating factor for chest pain. To pressure algometry, the ratios of CRPS patients were significantly greater than control subjects (pCRPS patients than normal controls. The ICBN could be the source of this sensitization by CRPS spread from the brachial plexus.

  16. Digital chest radiography

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...... collimations depending on side of radiograph. Results from dose reduction will be presented on the congress Conclusion: Correct positioning and collimation of digital chest radiographs can reduce the radiation dose significant to the patients and by that improve the quality of basic radiography....

  17. Right ventricular free-wall longitudinal speckle tracking strain in patients with pulmonary arterial hypertension under specific treatment.

    Science.gov (United States)

    Kemal, Hatice S; Kayikcioglu, Meral; Kultursay, Hakan; Vuran, Ozcan; Nalbantgil, Sanem; Mogulkoc, Nesrin; Can, Levent

    2017-04-01

    Right ventricular (RV) dysfunction is a major determinant of outcomes in patients with pulmonary arterial hypertension (PAH), although the optimal measure of RV function is poorly defined. We evaluated the utility of RV free-wall speckle tracking strain as an assessment tool for RV function in patients with PAH who are already under specific treatment compared with conventional echocardiographic parameters and investigated the relationship of RV free-wall strain with clinical hemodynamic parameters of RV performance. Right ventricular free-wall strain was evaluated in 92 patients (Group-1 and Group-4 pulmonary hypertension) who were on PAH-specific treatment for at least 3 months. Right atrial (RA) area, RV FAC, TAPSE, tricuspid S, functional class, 6-minute walking distance, and NT-proBNP were studied. The mean duration of follow-up was 222±133 days. All patients were under PAH-specific treatment, and mean RV free-wall strain was -13.16±6.3%. RV free-wall strain correlated well with functional class (r=.312, P=.01), NT-proBNP (r=.423, P=.0001), RA area (r=.427, P=.0001), FAC (r=-.637, P=.0001), TAPSE (r=-.524, P=.0001), tricuspid S (r=-.450, P=.0001), 6-minute walking distance (r=-.333, P=.002). RV free-wall strain significantly correlated with all follow-up adverse events, death, and clinical right heart failure (RHF) (P=.04, P=.03, P=.02, respectively). According to the receiver operator characteristic analysis, the cutoff value for RV free-wall strain for the development of clinical RHF was -12.5% (sensitivity: 71%, specificity: 67%) and for all cardiovascular adverse events (death included) was -12.5% (sensitivity: 54%, specificity: 64%). Assessment of RV free-wall strain is a feasible, easy-to-perform method and may be used as a predictor of RHF, clinical deterioration, and mortality in patients already under PAH-specific treatment. © 2017, Wiley Periodicals, Inc.

  18. [Treatment of deep anal fistulas using a flap from the rectal wall].

    Science.gov (United States)

    Detry, R; Kartheuser, A; Remacle, G

    1994-01-01

    Classic treatment of high anal fistulas by the laying open technique requires total or subtotal section of the sphincter muscles and results in anal incontinence. This study assesses the efficacy of the flap advancement technique in these cases. It entails the resection of the crypt at the origin of the fistula, the area being covered by a mucomuscular flap of the rectal wall. From 1977 to early 1992, 18 patients (13 female and 5 male patients; mean age: 40 years) presenting with a deep anal fistula underwent such an operation. There were 16 suprasphincteric and 2 high transsphincteric tracts. Associated IBD was noted in 7 cases (5 Crohn's colitis, 2 UC). Five fistulas were of obstetrical origin. In 8 cases, patients had undergone previous surgical treatments without success. All patients had a flap advancement. In 2 cases, a colostomy had been previously carried out. Two more diverting stomies were performed (combined abdominal procedures). No mortality or morbidity was encountered. Mean postoperative stay was 8 days. Current status could be established in all patients. Three immediate failures were observed (1 case of Crohn's disease, two recurring cases). All the other patients did well with persistent healing of the fistula after a mean follow-up of 61 months (range, 6-150). Three stomies were closed; one patient delayed the procedure. Functional results were excellent. In the "success" group, all the evaluable patients (14/15) had normal fecal continence. Two female patients are still complaining of mild flatus incontinence. In the failure group, the preoperative anorectal function was maintained.(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Treatment of pleural malignancies by photo-induction combined to systemic chemotherapy: Proof of concept on rodent lung tumors and feasibility study on porcine chest cavities.

    Science.gov (United States)

    Wang, Xingyu; Gronchi, Fabrizio; Bensimon, Michael; Mercier, Thomas; Decosterd, Laurent Arthur; Wagnières, Georges; Debefve, Elodie; Ris, Hans-Beat; Letovanec, Igor; Peters, Solange; Perentes, Jean Yannis

    2015-12-01

    Low-dose, Visudyne®-mediated photodynamic therapy (photo-induction) was shown to selectively enhance tumor vessel transport causing increased uptake of systemically administered chemotherapy in various tumor types grown on rodent lungs. The present experiments explore the efficacy of photo-induced vessel modulation combined to intravenous (IV) liposomal cisplatin (Lipoplatin®) on rodent lung tumors and the feasibility/toxicity of this approach in porcine chest cavities. Three groups of Fischer rats underwent orthotopic sarcoma (n = 14), mesothelioma (n = 14), or adenocarcinoma (n = 12) implantation on the left lung. Half of the animals of each group had photo-induction (0.0625 mg/kg Visudyne®, 10 J/cm(2) ) followed by IV administration of Lipoplatin® (5 mg/kg) and the other half received Lipoplatin® without photo-induction. Then, two groups of minipigs underwent intrapleural thoracoscopic (VATS) photo-induction (0.0625 mg/kg Visudyne®; 30 J/cm(2) hilum; 10 J/cm(2) apex/diaphragm) with in situ light dosimetry in combination with IV Lipoplatin® administration (5 mg/kg). Protocol I (n = 6) received Lipoplatin® immediately after light delivery and Protocol II (n = 9) 90 minutes before light delivery. Three additional animals received Lipoplatin® and VATS pleural biopsies but no photo-induction (controls). Lipoplatin® concentrations were analyzed in blood and tissues before and at regular intervals after photo-induction using inductively coupled plasma mass spectrometry. Photo-induction selectively increased Lipoplatin® uptake in all orthotopic tumors. It significantly increased the ratio of tumor to lung Lipoplatin® concentration in sarcoma (P = 0.0008) and adenocarcinoma (P = 0.01) but not in mesothelioma, compared to IV drug application alone. In minipigs, intrapleural photo-induction combined to systemic Lipoplatin® was well tolerated with no toxicity at 7 days for both treatment protocols. The pleural

  20. MRI of the Chest

    Medline Plus

    Full Text Available ... detail makes MRI an invaluable tool in early diagnosis and evaluation of cardiovascular conditions. MRI has proven ... in diagnosing a broad range of conditions, including cancer, heart and ... tissues, except for lung abnormalities where Chest CT is a preferred imaging ...

  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! Spotlight November is National Lung Cancer Awareness Month Recently posted: Carotid Intima-Media Thickness ...

  2. MRI of the Chest

    Medline Plus

    Full Text Available ... body structures. MRI does not use ionizing radiation (x-rays). Detailed MR images allow physicians to evaluate various ... seen by other imaging modalities, such as chest x-ray or CT. A special form of MRI called ...

  3. MRI of the Chest

    Medline Plus

    Full Text Available ... data suggest that it is safe to continue breastfeeding after receiving intravenous contrast. For further information please consult the ACR Manual on Contrast Media and its references. top of page What are the limitations of MRI of the Chest? High-quality images are assured only if you are able ...

  4. Chest X-Ray

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    Full Text Available ... Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions ... Explains Chest X-ray Transcript Welcome to Radiology Info dot org! Hello, I’m Dr. Geoffrey Rubin, ...

  5. MRI of the Chest

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    Full Text Available ... of which shows a thin slice of the body. The images can then be studied from different angles by ... bear denotes child-specific content. Related Articles and Media MR ... Images related to Magnetic Resonance Imaging (MRI) - Chest Sponsored ...

  6. Chest X-Ray

    Medline Plus

    Full Text Available ... Radiology (IDoR) Radiology and You Sponsored by Image/Video Gallery Your Radiologist Explains Chest X-ray Transcript ... Carotid Intima-Media Thickness Test Medical Imaging Costs Video: Abdominal Ultrasound Video: Pelvic Ultrasound November 8 is ...

  7. MRI of the Chest

    Medline Plus

    Full Text Available ... imaging (MRI) of the chest uses a powerful magnetic field, radio waves and a computer to produce detailed ... whether there’s a possibility you are pregnant. The magnetic field is not harmful, but it may cause some ...

  8. MRI of the Chest

    Medline Plus

    Full Text Available ... transplant, it will be necessary to perform a blood test to determine whether the kidneys are functioning adequately. ... abnormalities where Chest CT is a preferred imaging test. MR imaging can assess blood flow without risking the side effects of conventional ( ...

  9. Chest physiotherapy for pneumonia in children.

    Science.gov (United States)

    Chaves, Gabriela S S; Fregonezi, Guilherme A F; Dias, Fernando A L; Ribeiro, Cibele T D; Guerra, Ricardo O; Freitas, Diana A; Parreira, Veronica F; Mendonca, Karla M P P

    2013-09-20

    Pneumonia is an inflammatory lung disease and it is the greatest cause of deaths in children younger than five years of age worldwide. Chest physiotherapy is widely used in the treatment of pneumonia because it can help to eliminate inflammatory exudates and tracheobronchial secretions, remove airway obstructions, reduce airway resistance, enhance gas exchange and reduce the work of breathing. Thus, chest physiotherapy may contribute to patient recovery as an adjuvant treatment even though its indication remains controversial. To assess the effectiveness of chest physiotherapy in relation to time until clinical resolution in children (from birth up to 18 years old) of either gender with any type of pneumonia. We searched CENTRAL 2013, Issue 4; MEDLINE (1946 to May week 4, 2013); EMBASE (1974 to May 2013); CINAHL (1981 to May 2013); LILACS (1982 to May 2013); Web of Science (1950 to May 2013); and PEDro (1950 to May 2013).We consulted the ClinicalTrials.gov and the WHO ICTRP registers to identify planned, ongoing and unpublished trials. We consulted the reference lists of relevant articles found by the electronic searches for additional studies. We included randomised controlled trials (RCTs) that compared chest physiotherapy of any type with no chest physiotherapy in children with pneumonia. Two review authors independently selected the studies to be included in the review, assessed trial quality and extracted data. Three RCTs involving 255 inpatient children are included in the review. They addressed conventional chest physiotherapy, positive expiratory pressure and continuous positive airway pressure. The following outcomes were measured: duration of hospital stay, time to clinical resolution (observing the following parameters: fever, chest indrawing, nasal flaring, tachypnoea and peripheral oxygen saturation levels), change in adventitious sounds, change in chest X-ray and duration of cough in days. Two of the included studies found a significant improvement in

  10. Estimation of aneurysm wall stresses created by treatment with a shape memory polymer foam device

    OpenAIRE

    Hwang, Wonjun; Volk, Brent L.; Akberali, Farida; Singhal, Pooja; Criscione, John C.; Maitland, Duncan J.

    2011-01-01

    In this study, compliant latex thin-walled aneurysm models are fabricated to investigate the effects of expansion of shape memory polymer foam. A simplified cylindrical model is selected for the in-vitro aneurysm, which is a simplification of a real, saccular aneurysm. The studies are performed by crimping shape memory polymer foams, originally 6 and 8 mm in diameter, and monitoring the resulting deformation when deployed into 4-mm-diameter thin-walled latex tubes. The deformations of the lat...

  11. Determinants of mortality in chest trauma patients

    Directory of Open Access Journals (Sweden)

    Eyo E Ekpe

    2014-01-01

    Full Text Available Background: Chest trauma is an important trauma globally accounting for about 10% of trauma admission and 25-50% of trauma death. Different types and severity of chest trauma in different subsets of patients with varying associated injuries result in differing outcomes measured with mortality. Early mitigation of poor prognostic factors could result in improved outcome, therefore the need to know such factors or determinants of mortality in chest trauma patients. Patients and Methods: Retrospective and prospective analysis of demographic details, socio-economic, clinical details, modified early warning signs (MEWS score on presentation, investigation findings, treatment and outcome of chest trauma patients who presented to our cardiothoracic surgery unit was undertaken. Data were collected and were analyzed using WINPEPI Stone Mountain, Georgia: USD Inc; 1995 statistical software. Results: A total 149 patients with thoracic trauma were studied over a 5 year period constituting 40% of the unit workload. There were 121 males and 28 females (81.2% vs. 18.8%; m: f = 4:1 with age range from 7 to 76 years (mean: 37.42 ± 12.86 years and about 55% aged 45 years or below and more blunt trauma than penetrating trauma (65.1% vs. 34.9%, but no statistical significance amongst the groups on outcome analysis. Sub-grouping of the 149 patients according to their on-admission MEWS score shows that 141 patients had scores of 9 and less and all survived while the remaining eight had scores >9 but all died. As independent variables, age, sex and type of chest injury did not prove to be correlated with mortality with P values of 0.468, 1.000 and 1.000 respectively. However presence of associated extra thoracic organ injury, high on-admission MEWS score >9, delayed presentation with injury to presentation interval longer than 24 h, and severe chest injury as characterized by bilateral chest involvement correlated positively with mortality with P values of 0.0003, 0

  12. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections.

    Science.gov (United States)

    Simonds, A K; Hanak, A; Chatwin, M; Morrell, Mj; Hall, A; Parker, K H; Siggers, J H; Dickinson, R J

    2010-10-01

    Influenza viruses are thought to be spread by droplets, but the role of aerosol dissemination is unclear and has not been assessed by previous studies. Oxygen therapy, nebulised medication and ventilatory support are treatments used in clinical practice to treat influenzal infection are thought to generate droplets or aerosols. Evaluation of the characteristics of droplet/aerosol dispersion around delivery systems during non-invasive ventilation (NIV), oxygen therapy, nebuliser treatment and chest physiotherapy by measuring droplet size, geographical distribution of droplets, decay in droplets over time after the interventions were discontinued. Three groups were studied: (1) normal controls, (2) subjects with coryzal symptoms and (3) adult patients with chronic lung disease who were admitted to hospital with an infective exacerbation. Each group received oxygen therapy, NIV using a vented mask system and a modified circuit with non-vented mask and exhalation filter, and nebulised saline. The patient group had a period of standardised chest physiotherapy treatment. Droplet counts in mean diameter size ranges from 0.3 to > 10 µm were measured with an counter placed adjacent to the face and at a 1-m distance from the subject/patient, at the height of the nose/mouth of an average health-care worker. NIV using a vented mask produced droplets in the large size range (> 10 µm) in patients (p = 0.042) and coryzal subjects (p = 0.044) compared with baseline values, but not in normal controls (p = 0.379), but this increase in large droplets was not seen using the NIV circuit modification. Chest physiotherapy produced droplets predominantly of > 10 µm (p = 0.003), which, as with NIV droplet count in the patients, had fallen significantly by 1 m. Oxygen therapy did not increase droplet count in any size range. Nebulised saline delivered droplets in the small- and medium-size aerosol/droplet range, but did not increase large-size droplet count. NIV and chest physiotherapy

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

    Directory of Open Access Journals (Sweden)

    Serdar Onat

    2008-01-01

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

  14. Encuesta a neumonólogos sobre el diagnóstico y tratamiento de EPOC Survey of chest physicians regarding copd diagnosis and treatment

    Directory of Open Access Journals (Sweden)

    Martín L. Sívori

    2004-04-01

    encuestados indican la vacuna antigripal y el 91.4% la antineumocóccica. Según los encuestados el 37% de los pacientes continúan fumando. Nuestros especialistas utilizan pautas que están de acuerdo con las guías de diagnóstico y tratamiento. Como primera opción en el tratamiento crónico es muy utilizada la asociación de AC + BAAC y escasamente los CI y los BAAL.A survey on COPD diagnostic procedures, treatment and management was conducted in a group of 517 chest physicians randomized from a list of the 1121 affiliates to the Asociación Argentina de Medicina Respiratoria. One hundred eighty-seven responses were obtained (36.2% of the questionnaires mailed. They treat an average of 53.3 COPD patients every month. Twenty-four percent of them had mild, 41.8% moderate and 33.8% severe disease (GOLD criteria. Only clinical criteria for diagnosis of COPD, clinical criteria + spirometry (S, and clinical criteria + S + chest X ray were used by 2.9, 23.4 and 73.7% of responders, respectively. Seventy percent of responders believed that chronic asthma without bronchodilator response must be included in the COPD definition. Only 14.1% of responders performed S in every office visit. Cardiac function was assessed using clinical criteria, electrocardiogram and echocardiogram by 90.6, 80.6 and 73.8% of responders, respectively, while 98.3% stated that they trained most of their patients in the inhalation technique. Metered Dose Inhaled was the first option for bronchodilators administration (64.8% followed by nebulization (16.5%, dry powder inhalation (13.7% and oral administration (4.8%. First option for chronic therapy in severe COPD patients was the association of anticholinergic drug (AC + short acting b2-agonists (SABA (65.5%, AC alone (18.8%, long acting b2-agonists (LABA (9.7%, inhaled corticosteroids (IC (3.5% and SABA alone (2.8%. Corticosteroids and antibiotics were prescribed in severe COPD exacerbation by 92.5 and 70% of responders, respectively. First choice

  15. Changes During Growth in Cell Wall Components of Berseem Clover Under Different Cutting Treatments in a Mediterranean Region

    Directory of Open Access Journals (Sweden)

    Giuditta De Santis

    2007-09-01

    Full Text Available Forage digestibility of berseem clover (Trifolium Alexandrinum L. is influenced by plant cell wall composition. This study was conducted to evaluate the effects of different cutting treatments on cell-wall components of the herbage and plant fractions in two Mediterranean berseem genotypes during growth and to examine the relationship between digestibility and cell wall components in these plant fractions. Cutting treatments were initiated at sixth internode elongation (A and early flowering (B and there was an uncut control treatment (C. Spring growth of genotypes of Egyptian (cv. Giza 10 and Italian (cv. Sacromonte origins was harvested in each of two years beginning 196 days after sowing and thereafter every 6 days (twelve harvests in total to measure cell wall components. Neutral detergent fibre (NDF, acid detergent fibre (ADF and acid detergent lignin (ADL concentrations were determined for leaf, stem, and total forage of each cultivar at each harvest. Without defoliation, NDF, ADF and ADL concentrations of herbage increased linearly to a maximum of 528, 375 and 84 g kg-1 DM, respectively, by 220 days after planting, when plant height reached maximum values, then plateaued until 257 days after planting. Plant parts differed in cell-wall concentration, with stems being of higher fibre components than leaves, in the two cutting treatments. Herbage and plant fraction fibre concentrations were negatively correlated with digestibility for all cutting treatments. Defoliation induced a reduction in fibre concentrations and plant height, although a rapid regrowth was observed after cutting, in both treatments A and B. However, delaying defoliation to the early flowering stage (B increased fibre components concentrations both at cutting time and during the growing season and significantly reduced the regrowth height. Conversely, plants cut at the sixth internode elongation (treatment A showed lower concentrations of fibre fractions than initiating

  16. Treatment of chest burn contracture causing respiratory compromise with island release and grafting using cross-link collagen and Integra™ bilayer dressing

    Directory of Open Access Journals (Sweden)

    Neil Doctor

    2014-04-01

    Full Text Available Post-burn skin contractures of the anterior and lateral abdomen and chest may result in respiratory compromise due to limitation of rib excursion. This case report describes a young man with respiratory compromise limiting his daily activity and function, as a result of a 90% burn sustained 6 years previously. Release of his chest and upper abdomen was achieved using “island” scar releases and a cross-linked bovine tendon collagen and glycosaminoglycan and a semi-permeable polysiloxane bilayer matrix dressing (Integra™ followed by subsequent split thickness skin graft. An immediate increase in maximal inspiratory volume was obtained intra-operatively and in the im­mediate post-operative period, and this improvement was sustained after healing of all wounds with subjective relief of the patient’s symptoms.

  17. Risk stratification in chest pain patients

    NARCIS (Netherlands)

    Poldervaart, J.M.

    2016-01-01

    Yearly, a total of approximately 200,000 patients in The Netherlands present to the emergency department with chest pain. Only 20% of these patients will have an acute coronary syndrome (ACS), and need prompt admission and treatment. However, differentiating between ACS and other, mostly

  18. THE DEADLY DOZEN OF CHEST TRAUMA

    African Journals Online (AJOL)

    Enrique

    treatment is oral analgesics in mild to moderate pain, and consideration of opioids, nerve block, epidural or ... Severe chest injuries are responsible for 25% of all trauma deaths, and in a further 25% they are a contributing cause of ... thoracic cavity without any means of escape, completely collapsing the affected lung.

  19. Respiratory mechanics in the open chest: effects of parietal pleurae.

    Science.gov (United States)

    Barnas, G M; Gilbert, T B; Watson, R J; Sequeira, A J; Roitman, K; Nooroni, R J

    1996-01-01

    To understand how the parietal pleurae affect the mechanical behavior of the human respiratory system after the chest wall is opened by median sternotomy, we studied 18 anesthetized/paralyzed patients immediately before coronary artery bypass grafting surgery. Elastances and resistances of the total respiratory system (ETr, Rrs) were calculated from measurements of airway pressure and flow during mechanical ventilation in the frequency and tidal volume ranges of normal breathing. Elastances and resistances of the lungs (EL, RL), chest wall (Ecw, Rcw) were also estimated from measurements of esophageal pressure. Data were collected in the closed chest, after median sternotomy with the parietal pleurae intact and after the left parietal pleura was opened for internal mammary artery harvest. After sternotomy with pleurae intact (n = 14), Ers did not change but Rrs decreased (p Opening the left pleura (n = 10) decreased Ers (p opened.

  20. Enhanced lipid recovery from Nannochloropsis microalgae by treatment with optimized cell wall degrading enzyme mixtures.

    Science.gov (United States)

    Zuorro, Antonio; Miglietta, Selenia; Familiari, Giuseppe; Lavecchia, Roberto

    2016-07-01

    A statistical mixture design approach was used to investigate the effects of cell wall degrading enzymes on the recovery of lipids from Nannochloropsis sp. A preliminary screening of potentially suitable enzyme preparations, including lysozyme, cellulase and different types of hemicellulases, was carried out. The most effective preparations were then taken as basic components for the formulation of enzyme mixtures. Optimized ternary mixtures consisting of cellulase and two hemicellulases were obtained which allowed the recovery of up to 37.2g of lipids per 100g of dry biomass. SEM and TEM images of the enzymatically treated microalga revealed extensive cell damage, with degradation of the cell wall and release of intracellular material. Overall, the results obtained demonstrate that the mixture design method can be used to prepare cell wall degrading enzyme cocktails that can significantly improve the recovery of lipids or other valuable components from microalgae. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. 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 clinical supervisors. Optimal collimation is determined by European and Regional Danish guidelines. The areal between current and optimal collimation is calculated. The experimental research is performed in September - October 2014 Siemens Axiom Aristos digital radiography system DR using 150 kV, 1,25 -3...

  2. Chest surgical disorders in ancient Egypt: evidence of advanced knowledge.

    Science.gov (United States)

    Jungraithmayr, Wolfgang; Weder, Walter

    2012-03-01

    The ancient Egyptians laid the foundation for the development of the earliest recorded systems of medical treatment. Many specialties such as gynecology, neurosurgery, ophthalmology, and chest disorders were subject to diagnosis, which were followed by an appropriate treatment. Here, we elucidate the remarkable level of their knowledge and understanding of anatomy and physiology in the field of chest medicine. Furthermore, we look at how ancient Egyptian physicians came to a diagnosis and treatment based on the thoracic cases in the Edwin Smith papyrus.

  3. Chest vibration redistributes intra-airway CO2 during tracheal insufflation in ventilatory failure.

    Science.gov (United States)

    Eckmann, D M; Gavriely, N

    1996-03-01

    To determine if high-frequency external chest wall vibration added to low flow intratracheal fresh gas insufflation alters the intra-airway CO2 distribution and the resistance to CO2 transport from the lungs. Prospective study. Experimental laboratory. Six adult anesthesized and paralyzed mongrel dogs (mean weight 24.3+/- 4.4 kg). Dogs were ventilated by three methods: a) intermittent positive pressure ventilation; b) intermittent positive pressure ventilation with tracheal insufflation of fresh gas (FIO2 of 0.4) flowing at 0.15 L/kg/min through a catheter positioned at the carina; and c) intermittent positive pressure ventilation with tracheal insufflation and with external high-frequency chest wall vibration of the dependent hemithorax. We measured arterial blood gas values as an index of global gas exchange, and intrapulmonary airway CO2 concentrations as an index of local gas exchange. Intra-airway CO2 concentrations along the axis of the airways were measured via a sampling catheter. Airway axial concentration profiles were constructed and resistances to gas transport were calculated from the measured data. Vibration increased intraluminal CO2 concentrations from 1.1% to 2.5% mouthward of the insufflation catheter tip. Peak resistance to CO2 transport decreased by 65% during vibration relative to the insufflation-only value. Vibration displaced peak transport resistance from second- to fourth-generation airways. Global gas exchange improves during ventilation by chest wall vibration with low flow insufflation. Local gas exchange in the central airways is also improved due to increased intraluminal mixing and CO2 elimination. This ventilation technique may confer therapeutic advantages over conventional mechanical ventilation in the treatment of ventilatory failure.

  4. The long-term effects of wall attached microalgal biofilm on algae-based wastewater treatment

    DEFF Research Database (Denmark)

    Su, Yanyan; Mennerich, Artur; Urban, Brigitte

    2016-01-01

    The influence of the reactor wall attached biofilm on the nutrient removal performance was investigated in an open photobioreactor during long-term operation. Total nitrogen and phosphorus removal efficiencies were statistically similar between reactor with (reactor A) and without (reactor B) bio...

  5. Targeting single-walled carbon nanotubes for the treatment of breast cancer using photothermal therapy

    Science.gov (United States)

    Neves, Luis Filipe Ferreira

    To develop a therapeutic system with cancer cell selectivity, the present study evaluated a possible specific and localized tumor treatment. Phosphatidylserine (PS) exposure on the external face of the cell membrane is almost completely exclusive to cancer cells and endothelial cells in the tumor vasculature. The human protein annexin V is known to have strong calcium-dependent binding to anionic phospholipids such as PS. This protein was studied for targeting single-walled carbon nanotubes (SWNTs) to the vasculature of breast tumors. The synthesis of the protein annexin V, by a pET vector in Escherichia coli, constitutes the first phase of this study. Recombinant annexin V was purified from the cell lysate supernatant by immobilized metal affinity chromatography. The overall production of purified annexin V protein was 50 mg/L. The binding ability of the protein annexin V was evaluated by determining the dissociation constant when incubated with proliferating human endothelial cells in vitro. The dissociation constant, Kd, was measured to be 0.8 nM, indicating relatively strong binding. This value of Kd is within the range reported in the literature. Single-walled carbon nanotubes (SWNTs) were functionalized with annexin V using two intermediate linkers (containing FMOC and DSPE) resulting in stable suspensions. The SWNT and protein concentrations were 202 mg/L and 515 mg/L, respectively, using the linker with DSPE (average of nine preparations). The conjugation method that used the DSPE-PEG-maleimide linker allowed to successfully conjugate the SWNTs with final concentrations approximately five times higher than the linker containing FMOC. The conjugation method used has a non-covalent nature, and therefore the optical properties of the nanotubes were preserved. The conjugate was also visually observed using atomic force microscopy (AFM), allowing to verify the presence of the protein annexin V on the surface of the nanotubes, with an height ranging between 2

  6. Nonoperative Treatment of Posterior Wall Acetabular Fractures After Dynamic Stress Examination Under Anesthesia: Revisited.

    Science.gov (United States)

    McNamara, Andrew R; Boudreau, John A; Moed, Berton R

    2015-08-01

    Performing an examination under general anesthesia (EUA) using dynamic stress fluoroscopy of patients with posterior wall acetabular fractures has been used as a tool to determine hip stability and the need for surgical intervention. The purpose of this study was to further evaluate the effectiveness of this technique, from a source other than its primary advocates, in patients with posterior wall acetabular fractures less than or equal to 50% who were stable on EUA and treated nonoperatively. Retrospective case series. University Level 1 Trauma Center. Seventeen patients with a posterior wall acetabular fracture stable on EUA treated nonoperatively. The patients were treated nonoperatively as guided by an EUA negative for instability. Patient follow-up averaged 30 months (range, 6-64 months). Outcome evaluation included the modified Merle d'Aubigné clinical score and the Short Musculoskeletal Function Assessment Questionnaire. Radiographic evaluation for subluxation or arthritis consisted of the 3 standard pelvic radiographs. Radiographic evaluation showed all hips to be congruent with a normal joint space. Sixteen of the 17 patients had radiographic outcomes rated as "excellent"; 1 patient was rated "good." The modified Merle d'Aubigné score (obtained in 12 patients) averaged very good, with only 1 having less than a good (graded as fair) clinical outcome. The Short Musculoskeletal Function Assessment Questionnaire scores (from 11 patients) were not significantly different from normal and were within the normal reported values for all indices and categories. There was no correlation between fracture fragment size and outcome. This study further supports the contention that a stable hip joint, as determined by EUA, after posterior wall acetabular fracture treated nonoperatively is predictive of continued joint congruity, an excellent radiographic outcome, and good-to-excellent early clinical and functional outcomes. Therapeutic Level IV. See Instructions for

  7. Chest physiotherapy in primary pneumonia.

    Science.gov (United States)

    Britton, S; Bejstedt, M; Vedin, L

    1985-01-01

    One hundred and seventy one patients with primary pneumonia entered a single blind, placebo controlled trial of physiotherapy. Treatment was allocated at random, physiotherapy consisting of postural drainage, external help with breathing, percussion, and vibration and the controls receiving advice on expectoration, deep breathing, and how to exercise to avoid thrombosis. Principles of pharmaceutical management were the same in the two groups. There was no objective evidence that daily physiotherapy helped during the acute phase of the disease. On the contrary, in younger patients, smokers, and patients with interstitial pneumonia physiotherapy appeared to prolong the duration of fever as well as the hospital stay. It is concluded that chest physiotherapy is at best useless in patients with primary infectious pneumonia. PMID:3924221

  8. MRI of the Chest

    Medline Plus

    Full Text Available ... wall, pleura, heart and vessels, from almost any angle. MRI also provides movie-like sequential imaging of ... The images can then be studied from different angles by the interpreting radiologist. Frequently, the differentiation of ...

  9. 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.

  10. Fractures of the posterior wall of the acetabulum: treatment using internal fixation of two parallel reconstruction plates.

    Science.gov (United States)

    Li, Heng; Yang, Honghang; Wang, Dan; Xu, Yi; Min, Jikang; Xu, Xuchun; Li, Zhanchun; Yuan, Yongjian

    2014-04-01

    Our aim was to evaluate the efficacy of the treatment method using internal fixation of parallel reconstruction plates for the posterior wall of the acetabulum fractures. Randomised, prospective. Level I trauma centre. 57 patients with posterior wall fractures of the acetabulum in our department from 2007 to 2010 were treated operatively using this technique. internal fixation of two parallel reconstruction plates was used in this study. One of the plates was near the border of acetabulum. The other was parallel to the former one and was located to stress concentrated area. The clinical outcome was evaluated using the clinical grading system and radiological outcome was evaluated according to the criteria described by Matta. In addition, complications were researched in this study. The percentages of the clinical excellent-to-good and fair-to-poor results were 93.0% and 7%, respectively. We found that clinical outcome had no correlation with age, operation time from injury to operation, nor had correlation with hip dislocation, comminuted fracture condition and marginal compression fracture. Anatomical reduction was significantly correlated with excellent-to-good clinical outcome. Necrosis of the femoral head and heterotopic ossification were prone to decline the outcome of acetabular fractures despite good fracture reduction. the internal fixation of two parallel reconstruction plates facilitated rigid fixation and avoided fracture fragment injury, was an effective and reliable alternative method to treat fractures of the posterior wall of the acetabulum. Copyright © 2013 Elsevier Ltd. All rights reserved.

  11. Impacted thoracic foreign bodies after penetrating chest trauma.

    Science.gov (United States)

    Sersar, Sameh I; Albohiri, Khalid A; Abdelmohty, Hysam

    2016-10-01

    Retained foreign bodies in the chest may include shell fragments, bullets, shrapnel, pieces of clothing, bones, and rib fragments. The risks of removal of foreign bodies must be weighed against the complications of leaving them inside the chest. We treated 90 cases of retained intrathoracic foreign bodies in patients admitted to 3 tertiary centers in Saudi Arabia between March 2015 and March 2016. Sixty patients were injured by shrapnel, 26 had one or more bullets, 3 had broken rib fragments, and one had a metal screw. The chest wall was site of impaction in 48 cases, the lungs in 24, pleura in 14, and mediastinum in 4. Removal of the retained foreign body was carried out in 12 patients only: bullets in 9 cases, bone fragments in 2, and a metal screw in one. The predictors for removal were bullets, female sex, and mediastinal position with bilateral chest injury, especially with fracture ribs. Retained intrathoracic foreign bodies due to penetrating chest trauma are treated mainly conservatively unless there is another indication for chest exploration. © The Author(s) 2016.

  12. 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.

  13. Effects of nitric oxide treatment on the cell wall softening related enzymes and several hormones of papaya fruit during storage.

    Science.gov (United States)

    Guo, Qin; Wu, Bin; Chen, Weixin; Zhang, Yuli; Wang, Jide; Li, Xueping

    2014-06-01

    Papaya fruits (Carica papaya L. cv 'Sui you 2') harvested with papaya fruits treated with nitric oxide had a significantly lower rate of ethylene production and a lesser loss of firmness during storage. A decrease in polygalacturonase, pectin methyl esterase, pectate lyase and cellulase activities was observed in nitric oxide treated fruit. In addition, the contents of indole acetic acid, abscisic acid and zeatin riboside were reduced in nitric oxide treated fruit, but no significant reduction in the level of gibberellin was found. These results indicate that nitric oxide treatment can effectively delay the softening and ripening of papaya fruit, likely via the regulation of cell wall softening related enzymes and certain hormones.

  14. Myocardial perfusion 320-row multidetector computed tomography-guided treatment strategy for the clinical management of patients with recent acute-onset chest pain

    DEFF Research Database (Denmark)

    Sørgaard, Mathias; Linde, Jesper J; Hove, Jens D

    2016-01-01

    computed tomography perfusion (CTP) has been shown to increase the specificity when added to CCTA, without lowering the sensitivity. This article describes the design of a randomized controlled trial, CATCH-2, comparing a clinical diagnostic management strategy of CCTA alone against CCTA in combination...... with CTP. METHODS: Patients with acute-onset chest pain older than 50 years and with at least one cardiovascular risk factor for CAD are being prospectively enrolled to this study from 6 different clinical sites since October 2013. A total of 600 patients will be included. Patients are randomized 1......:1 to clinical management based on CCTA or on CCTA in combination with CTP, determining the need for further testing with invasive coronary angiography including measurement of the fractional flow reserve in vessels with coronary artery lesions. Patients are scanned with a 320-row multidetector computed...

  15. Minimal-invasive posterior approach in the treatment of the posterior wall fractures of the acetabulum.

    Science.gov (United States)

    Spagnolo, Rosario; Bonalumi, Matteo; Pace, Fabrizio; Capitani, Dario

    2009-05-01

    We examined patients affected by a posterior wall fracture of the acetabulum treated with a minimally invasive posterior approach (from 12 to 18 cm). During 2004-2006 19 patients were treated by this approach. 4 patients had a combined surgery by the ileo-inguinal approach. Fracture fixation was performed using reconstruction plates and screws. All the patients were studied with typical X-rays projection for pelvis and iliac oblique view and obturator oblique view (Judet view) and CT scan with 3D reconstruction. After 3 months a CT scan was performed on about 30% of our patients, which demonstrated the perfect healing of the fractures. The most important advantages we observed using this approach were a lesser split of the gluteus maximus and no risk of damage for the superior gluteal nerve. In the early post-operative rehabilitation we examined the trophism of the gluteus maximus, which was found to be better than in patients treated with the typical Kocher-Langenbeck approach. The only absolute contraindication for this technique is in obese patients. The post-operative complications include one case of heterotypic ossification of the gluteus minimus and one case of peroneal-nerve palsy with the spontaneous and complete recovery within 6 months. According to our experience this kind of approach could be used for posterior wall fracture of the pelvis and it can be extended to transverse fractures. In the post-operative period the greatest advantage is the lesser muscle damage and therefore a most effective rehabilitation.

  16. Effect of Thermal Treatment on the Structure of Multi-walled Carbon Nanotubes

    Energy Technology Data Exchange (ETDEWEB)

    Behler, K.; Osswald, S.; Ye, H.; Dimovski, S.; Gogotsi, Y. [Drexel University, Department of Materials Science and Engineering, and A.J. Drexel Nanotechnology Institute (United States)], E-mail: yg36@drexel.edu

    2006-10-15

    The effects of vacuum annealing and oxidation in air on the structure of multi-walled carbon nanotubes (MWCNTs) produced by a large-scale catalytic chemical vapor deposition (CCVD) process are studied using Raman spectroscopy and transmission electron microscopy (TEM). A detailed Raman spectroscopic study of as-produced nanotubes has also been conducted. While oxidation in air up to 400 deg. C removes disordered carbon, defects in tube walls are produced at higher temperatures. TEM reveals that MWCNTs annealed at 1,800 deg. C and above become more ordered than as-received tubes, while the tubes annealed at 2,000 deg. C exhibit polygonalization, mass transfer and over growth. The change in structure is observable by the separation of the Raman G and D' peaks, a lower R-value (I{sub D}/I{sub G} ratio), and an increase in the intensity of the second order peaks. Using wavelengths from the deep ultraviolet (UV) range (5.08 eV) extending into the visible near infrared (IR) (1.59 eV), the Raman spectra of MWCNTs reveal a dependence of the D-band position proportional to the excitation energy of the incident laser energies.

  17. Simultaneous measurement of force and respiratory profiles during chest physiotherapy in ventilated children.

    Science.gov (United States)

    Gregson, R K; Stocks, J; Petley, G W; Shannon, H; Warner, J O; Jagannathan, R; Main, E

    2007-09-01

    There are currently no objective means of quantifying chest wall vibrations during manual physiotherapy. The aims of the study were to (i) develop a method to quantify physiotherapy-applied forces and simultaneous changes in respiratory flow and pressure, (ii) assess the feasibility of using this method in ventilated children and (iii) characterize treatment profiles delivered by physiotherapists in the paediatric intensive care unit. Customized sensing mats were designed and used in combination with a respiratory profile monitor. Software was developed to align force and flow data streams. Force and respiratory data were successfully collected in 55 children (median age 1.6 years (range 0.02-13.7 years)). Physiotherapists demonstrated distinctive variations in the pattern of force applied and manual lung inflations. The maximum applied force ranged from 15 to 172 N, and was correlated with the child's age (r = 0.76). Peak expiratory flow increased significantly during manual inflations both with and without chest wall vibrations (p manual lung inflations as an essential precursor to developing evidence-based practice.

  18. Cutaneous Metastasis of Medullary Carcinoma Thyroid Masquerading as Subcutaneous Nodules Anterior Chest and Mandibular Region

    Directory of Open Access Journals (Sweden)

    Rahul Mannan

    2014-01-01

    Full Text Available 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.

  19. Chylothorax after Blunt Chest Trauma: A Case Report

    Directory of Open Access Journals (Sweden)

    Pawit Sriprasit

    2017-10-01

    Full Text Available Traumatic chylothorax after blunt chest trauma alone is considered rare. Our patient was a 27-year-old female who was in a motorcycle accident and sustained blunt thoracic and traumatic thoracic aortic injuries with T1–T2 vertebral subluxation. She underwent thoracic endovascular aortic repair from T4 to T9 without any thoracic or spinal surgery. On postoperative day 7, the drainage from her left chest turned into a milky- white fluid indicative of chyle leakage. The patient was treated conservatively for 2 weeks and then the chest drain was safely removed. The results show that traumatic chylothorax can be successfully managed with conservative treatment.

  20. 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

  1. The influence of chest tube size and position in primary spontaneous pneumothorax

    DEFF Research Database (Denmark)

    Riber, Sara S.; Riber, Lars P S; Olesen, Winnie H.

    2017-01-01

    Background: Optimal chest tube position in the pleural cavity is largely unexplored for the treatment of primary spontaneous pneumothorax (PSP). We investigated whether type, size and position of chest tubes influenced duration of treatment for PSP. Methods: A retrospective follow-up study of all...... patients admitted with PSP over a 5-year period. Traumatic, iatrogenic and secondary pneumothoraxes were excluded. Gender, age, smoking habits, type and size of chest tube used (pigtail catheter or surgical chest tube) were recorded from the patients' charts. All chest X-rays upon admittance...... and immediately following chest tube placement were retrieved and re-evaluated for size of pneumothorax (categorized into five groups) and location of the chest tube tip (categorized as upper, middle or lower third of the pleural cavity). All data were analysed in a Cox proportional hazards regression model...

  2. Bifid rib – usefulness of chest ultrasound. A case report

    Directory of Open Access Journals (Sweden)

    Magdalena Kryger

    2013-12-01

    Full Text Available The paper presents the possibility of using ultrasonography in the diagnosis of a congenital rib anomaly in the form of bifid rib. Bifid rib is a rare congenital abnormality of anterior chest wall. It manifests as a chest “lump.” Such lesions are detected during a routine physical examination or chest X-ray which is often performed for other reasons. The overall prevalence of bifid rib is estimated at 0.15% to 3.4% (mean 2% and it accounts for approximately 20% of all congenital rib anomalies. It is usually an unilateral lesion. The cases presented herein constitute the first pediatric cases in the available literature in which bifid rib anomaly was visualized by ultrasound examination.

  3. Treatment of anterior vaginal wall prolapse with and without polypropylene mesh: a prospective, randomized and controlled trial - Part I

    Directory of Open Access Journals (Sweden)

    Jose Tadeu Nunes Tamanini

    2013-07-01

    Full Text Available Objective To compare the use of polypropylene mesh (PM and the traditional anterior vaginal wall colporraphy in women with anterior vaginal wall prolapse (AVWP using objective and subjective tests and evaluation of quality of life (QoL. Materials and Methods One hundred women were randomly distributed in two preoperatory groups. The first group (mesh (n = 45 received a PM implant and the control group (n = 55 was submitted to traditional colporraphy. Postoperatory follow-up was done after 12 months. The primary objective was the correction of the Ba point ≤ -2 POP-Q (Pelvic Organ Prolapse Quantification System and the secondary objective was the improvement of vaginal symptoms and QoL through ICIQ-VS (International Consultation on Incontinence Questionnaire - Vaginal Symptoms. Complications related to the use of PM or not were also described. Results There was a significant difference between all POP-Q measures of pre- and postoperatory periods of each group in particular. There was a significant difference of the Ba point of the postoperatory period between the Mesh and Control group. The mean of Ba point in the Mesh group was statistically lower than of the Control group, depicting the better anatomical result of the first group. Both techniques improved vaginal symptoms and QoL. The most frequent complication of the Mesh group was prepubic hematoma in the perioperative period. In 9.3% of the cases treated with mesh it was observed PM exposition at the anterior vaginal wall after 12 months, being most of them treated clinically. Conclusion The treatment of AVWP significantly improved the Ba point in the Mesh group in comparison to the Control group. There were no differences of the vaginal symptoms and QoL between the two groups after 12 months. There were few and low grade complications on both groups.

  4. Thin-walled nanoscrolls by multi-step intercalation from tubular halloysite-10 Å and its rearrangement upon peroxide treatment

    Energy Technology Data Exchange (ETDEWEB)

    Zsirka, Balázs, E-mail: zsirkab@almos.vein.hu [University of Pannonia, Institute of Environmental Engineering, P.O. Box 158, Veszprém 8201 Hungary (Hungary); Horváth, Erzsébet, E-mail: erzsebet.horvath@gmail.com [University of Pannonia, Institute of Environmental Engineering, P.O. Box 158, Veszprém 8201 Hungary (Hungary); Szabó, Péter, E-mail: xysma@msn.com [University of Pannonia, Department of Analytical Chemistry, P.O. Box 158, Veszprém 8201 Hungary (Hungary); Juzsakova, Tatjána, E-mail: yuzhakova@almos.uni-pannon.hu [University of Pannonia, Institute of Environmental Engineering, P.O. Box 158, Veszprém 8201 Hungary (Hungary); Szilágyi, Róbert K., E-mail: szilagyi@montana.edu [Department of Chemistry and Biochemistry, Montana State University, Bozeman, MT 59717 (United States); Fertig, Dávid, E-mail: fertig.david92@gmail.com [University of Pannonia, Department of Analytical Chemistry, P.O. Box 158, Veszprém 8201 Hungary (Hungary); Makó, Éva, E-mail: makoe@almos.vein.hu [University of Pannonia, Institute of Materials Engineering, P.O. Box 158, Veszprém 8201 Hungary (Hungary); Varga, Tamás, E-mail: vtamas@chem.u-szeged.hu [University of Szeged, Department of Applied and Environmental Chemistry, Rerrich B. tér 1., Szeged H-6720 Hungary (Hungary); and others

    2017-03-31

    Highlights: • Halloysite intercalation/delamination. • Thin-walled nanoscroll preparation. • Oxidative surface cleaning with H{sub 2}O{sub 2} and heating. • X-ray diffraction, TEM, N{sub 2} adsorption, TG/DTG and FT-IR/ATR measurements. • Nanoscroll rearrangement, periodicity along the crystallographic ‘c’-axis. - Abstract: Surface modification of the halloysite-10 Å mineral with tubular morphology can be achieved by slightly modified procedures developed for the delamination of kaolinite minerals. The resulting delaminated halloysite nanoparticles have unexpected surface/morphological properties that display, new potentials in catalyst development. In this work, a four-step intercalation/delamination procedure is described for the preparation of thin-walled nanoscrolls from the multi-layered hydrated halloysite mineral that consists of (1) intercalation of halloysite with potassium acetate, (2) replacement intercalation with ethylene glycol, (3) replacement intercalation with hexylamine, and (4) delamination with toluene. The intercalation steps were followed by X-ray diffraction, transmission electron microscopy, N{sub 2} adsorption-desorption, thermogravimetry, and infrared spectroscopy. Delamination eliminated the crystalline order and the crystallite size along the ‘c’-axis, increased the specific surface area, greatly decreased the thickness of the mineral tubes to a monolayer, and shifted the pore diameter toward the micropore region. Unexpectedly, the removal of residual organics from intercalation steps adsorbed at the nanoscroll surface with a peroxide treatment resulted in partial recovery of crystallinity and increase of crystallite size along the ‘c’-crystal direction. The d(001) value showed a diffuse pattern at 7.4–7.7 Å due to the rearrangement of the thin-walled nanoscrolls toward the initial tubular morphology of the dehydrated halloysite-7 Å mineral.

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

    Science.gov (United States)

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

    2016-09-01

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

  6. [Community acquired pneumonia in children: Treatment of complicated cases and risk patients. Consensus statement by the Spanish Society of Paediatric Infectious Diseases (SEIP) and the Spanish Society of Paediatric Chest Diseases (SENP)].

    Science.gov (United States)

    Moreno-Pérez, D; Andrés Martín, A; Tagarro García, A; Escribano Montaner, A; Figuerola Mulet, J; García García, J J; Moreno-Galdó, A; Rodrigo Gonzalo de Lliria, C; Saavedra Lozano, J

    2015-09-01

    The incidence of community-acquired pneumonia complications has increased during the last decade. According to the records from several countries, empyema and necrotizing pneumonia became more frequent during the last few years. The optimal therapeutic approach for such conditions is still controversial. Both pharmacological management (antimicrobials and fibrinolysis), and surgical management (pleural drainage and video-assisted thoracoscopic surgery), are the subject of continuous assessment. In this paper, the Spanish Society of Paediatric Infectious Diseases and the Spanish Society of Paediatric Chest Diseases have reviewed the available evidence. Consensus treatment guidelines are proposed for complications of community-acquired pneumonia in children, focusing on parapneumonic pleural effusion. Recommendations are also provided for the increasing population of patients with underlying diseases and immunosuppression. Copyright © 2014 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  7. Effects of aspect ratio of multi-walled carbon nanotubes on coal washery waste water treatment.

    Science.gov (United States)

    Aliyu, Ahmed; Kariim, Ishaq; Abdulkareem, Saka Ambali

    2017-11-01

    The dependency of adsorption behaviour on the aspect ratio of multi-walled carbon nanotubes (MWCNTs) has been explored. In this study, effect of growth temperature on yield and aspect ratio of MWCNTs by catalytic chemical vapour deposition (CCVD) method is reported. The result revealed that yield and aspect ratio of synthesised MWCNTs strongly depend on the growth temperature during CCVD operation. The resulting MWCNTs were characterized by High Resolution Transmission Electron Microscope (HRTEM), Dynamic Light Scattering (DLS) and X-ray diffraction (XRD) techniques to determine it diameter, hydrodynamic diameter and crystallinity respectively. Aspect ratio and length of the grown MWCNTs were determined from the HRTEM images with the hydrodynamic diameter using the modified Navier-Stokes and Stokes-Einstein equations. The effect of the prepared MWCNTs dosage were investigated on the Turbidity, Iron (Fe) and Lead (Pb) removal efficiency of coal washery effluent. The MWCNTs with higher length (58.17 μm) and diameter (71 nm) tend to show high turbidity and Fe removal, while MWCNTs with lower length (38.87 μm) and diameter (45 nm) tend to show high removal of Pb. Hence, the growth temperature during CCVD operation shows a great effluence on the aspect ratio of MWCNTs which determines it area of applications. Copyright © 2017 Elsevier Ltd. All rights reserved.

  8. 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.

  9. Failure rate of prehospital chest decompression after severe thoracic trauma.

    Science.gov (United States)

    Kaserer, Alexander; Stein, Philipp; Simmen, Hans-Peter; Spahn, Donat R; Neuhaus, Valentin

    2017-03-01

    Chest decompression can be performed by different techniques, like needle thoracocentesis (NT), lateral thoracostomy (LT), or tube thoracostomy (TT). The aim of this study was to report the incidence of prehospital chest decompression and to analyse the effectiveness of these techniques. In this retrospective case series study, all medical records of adult trauma patients undergoing prehospital chest decompression and admitted to the resuscitation area of a level-1 trauma center between 2009 and 2015 were reviewed and analysed. Only descriptive statistics were applied. In a 6-year period 24 of 2261 (1.1%) trauma patients had prehospital chest decompression. Seventeen patients had NT, six patients TT, one patient NT as well as TT, and no patients had LT. Prehospital successful release of a tension pneumothorax was reported by the paramedics in 83% (5/6) with TT, whereas NT was effective in 18% only (3/17). In five CT scans all thoracocentesis needles were either removed or extrapleural, one patient had a tension pneumothorax, and two patients had no pneumothorax. No NT or TT related complications were reported during hospitalization. Prehospital NT or TT is infrequently attempted in trauma patients. Especially NT is associated with a high failure rate of more than 80%, potentially due to an inadequate ratio between chest wall thickness and catheter length as previously published as well as a possible different pathophysiological cause of respiratory distress. Therefore, TT may be considered already in the prehospital setting to retain sufficient pleural decompression upon admission. Copyright © 2016. Published by Elsevier Inc.

  10. Cell-wall properties contributing to improved deconstruction by alkaline pre-treatment and enzymatic hydrolysis in diverse maize (Zea mays L.) lines.

    Science.gov (United States)

    Li, Muyang; Heckwolf, Marlies; Crowe, Jacob D; Williams, Daniel L; Magee, Timothy D; Kaeppler, Shawn M; de Leon, Natalia; Hodge, David B

    2015-07-01

    A maize (Zea mays L. subsp. mays) diversity panel consisting of 26 maize lines exhibiting a wide range of cell-wall properties and responses to hydrolysis by cellulolytic enzymes was employed to investigate the relationship between cell-wall properties, cell-wall responses to mild NaOH pre-treatment, and enzymatic hydrolysis yields. Enzymatic hydrolysis of the cellulose in the untreated maize was found to be positively correlated with the water retention value, which is a measure of cell-wall susceptibility to swelling. It was also positively correlated with the lignin syringyl/guaiacyl ratio and negatively correlated with the initial cell-wall lignin, xylan, acetate, and p-coumaric acid (pCA) content, as well as pCA released from the cell wall by pre-treatment. The hydrolysis yield following pre-treatment exhibited statistically significant negative correlations to the lignin content after pre-treatment and positive correlations to the solubilized ferulic acid and pCA. Several unanticipated results were observed, including a positive correlation between initial lignin and acetate content, lack of correlation between acetate content and initial xylan content, and negative correlation between each of these three variables to the hydrolysis yields for untreated maize. Another surprising result was that pCA release was negatively correlated with hydrolysis yields for untreated maize and, along with ferulic acid release, was positively correlated with the pre-treated maize hydrolysis yields. This indicates that these properties that may negatively contribute to the recalcitrance in untreated cell walls may positively contribute to their deconstruction by alkaline pre-treatment. © The Author 2015. Published by Oxford University Press on behalf of the Society for Experimental Biology.

  11. [Imaging of pleural diseases: evaluation of imaging methods based on chest radiography].

    Science.gov (United States)

    Poyraz, Necdet; Kalkan, Havva; Ödev, Kemal; Ceran, Sami

    2017-03-01

    The most commonly employed radiologic method in diagnosis of pleural diseases is conventional chest radiograph. The commonest chest- X-Ray findings are the presence of pleural effusion and thickening. Small pleural effusions are not readily identified on posteroanterior chest radiograph. However, lateral decubitus chest radiograph and chest ultrasonography may show small pleural effusions. These are more efficient methods than posteroanterior chest radiograph in the erect position for demonstrating small amounts of free pleural effusions. Chest ultrasonograph may be able to help in distinguishing the pleural pathologies from parenchymal lesions. On chest radiograph pleural effusions or pleural thickening may obscure the visibility of the underlying disease or parenchymal abnormality. Thus, computed tomography (CT) may provide additional information of determining the extent and severity of pleural disease and may help to differentiate malign pleural lesions from the benign ones. Moreover, CT may provide the differentiation of parenchmal abnormalities from pleural pathologies. CT (coronal and sagittal reformatted images) that also show invasion of chest wall, mediastinum and diaphragm, as well as enlarged hilar or mediastinal lymph nodes. Standart non-invasive imaging techniques may be supplemented with magnetic resonans imaging (MRI).

  12. American College of Chest Physicians

    Science.gov (United States)

    ... our 2017 pulmonary, critical care, and sleep medicine review courses. Learn More Latest News All News Sources Blogs CHEST News Healthcare News Press Releases World COPD Day, a look at the many faces of ...

  13. 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.

  14. Effect of compression combined with steam treatment on the porosity, chemical compositon and cellulose crystalline structure of wood cell walls.

    Science.gov (United States)

    Yin, Jiangping; Yuan, Tongqi; Lu, Yun; Song, Kunlin; Li, Hanyin; Zhao, Guangjie; Yin, Yafang

    2017-01-02

    The changes of porosity, chemical composition and cellulose crystalline structure of Spruce (Picea abies Karst.) wood cell walls due to compression combined with steam treatment (CS-treatment) were investigated by nitrogen adsorption, confocal Raman microscopy (CRM) and X-ray diffraction (XRD), respectively. A number of slit-shaped mesopores with a diameter of 3.7nm was formed for the CS-treated wood, and more mesopores were found in the steam-treated wood. CRM results revealed cellulose structure was affected by treatment and β-aryl-ether links associated to guaiacyl units of lignin was depolymerized followed by re-condensation reactions. The crystallinity index (CrI) and crystallite thickness (D200) of cellulose for CS-treated wood were largely increased due to crystallization in the semicrystalline region. Higher degree of increase in both CrI and D200 was observed in both the earlywood and latewood of steam-treated wood, ascribing to the greater amount of mesopores in steam-treated wood than CS-treated wood. Copyright © 2016. Published by Elsevier Ltd.

  15. Single-Walled Carbon Nanotubes Targeted to the Tumor Vasculature for Breast Cancer Treatment

    Science.gov (United States)

    2008-09-01

    and time), three wells were treated. The metabolic activity of the cells before and after laser treatment was evaluated by the Alamar Blue assay... Alamar Blue (or resazurin) is oxidized, blue , and nonfluorescent and is reduced to a pink fluorescent dye in the medium by cell activity (10...There is a direct correlation between the reduction of Alamar Blue in the growth media and the quantity/ proliferation of living organisms, ranging

  16. Hot air treatment reduces postharvest decay and delays softening of cherry tomato by regulating gene expression and activities of cell wall-degrading enzymes.

    Science.gov (United States)

    Wei, Yingying; Zhou, Dandan; Wang, Zhenjie; Tu, Sicong; Shao, Xingfeng; Peng, Jing; Pan, Leiqing; Tu, Kang

    2017-09-25

    Fruit softening facilitates pathogen infection and postharvest decay, leading to the reduction of shelf-life. Hot air (HA) treatment at 38 °C for 12 h is effective in reducing postharvest disease and chilling injury of tomato fruit. To explore the effect and mechanism of HA treatment on reducing postharvest decay and softening of cherry tomato, fruit at the mature green stage were treated with HA and then stored at 20 °C for 15 days. Changes in natural decay incidence, firmness, cell wall compositions, activities and gene expression of cell wall-degrading enzymes of cherry tomatoes were assessed. HA treatment reduced natural decay incidence, postponed the firmness decline, inhibited the respiration rate and ethylene production, and retarded pectin solubilization and cellulose degradation of cherry tomatoes. Enzymatic activities and gene expression of pectin methylesterase, polygalacturonase, cellulase and β-galactosidase were inhibited by HA treatment. In addition, the gene expression of LeEXP1 was reduced, while LeEXT was up-regulated after HA treatment. Our findings suggested that HA treatment could inhibit cell wall degradation and postpone softening of cherry tomatoes by regulating gene expression and activities of cell wall-degrading enzymes, resulting in the reduction of postharvest decay. This article is protected by copyright. All rights reserved.

  17. Necrotizing Fasciitis of the Chest in a Neonate in Southern Nigeria

    Directory of Open Access Journals (Sweden)

    Oluwafemi Olasupo Awe

    2014-01-01

    Full Text Available We discuss the successful saving of a male neonate with necrotizing fasciitis of the chest following a hot fomentation of the umbilicus with exposure of the ribs and the pleural space on the right side. He recovered 5 weeks after admission. We stressed the need to recognize necrotizing fasciitis extending from the upper anterior abdominal wall to the chest following hot fomentation of the umbilicus. The need for multidisciplinary cooperation for excellent outcome is very important, that is, neonatologist, medical microbiologist, and plastic and chest surgeons.

  18. Chest wall abnormalities and their clinical significance in childhood.

    Science.gov (United States)

    Koumbourlis, Anastassios C

    2014-09-01

    The thorax consists of the rib cage and the respiratory muscles. It houses and protects the various intrathoracic organs such as the lungs, heart, vessels, esophagus, nerves etc. It also serves as the so-called "respiratory pump" that generates the movement of air into the lungs while it prevents their total collapse during exhalation. In order to be performed these functions depend on the structural and functional integrity of the rib cage and of the respiratory muscles. Any condition (congenital or acquired) that may affect either one of these components is going to have serious implications on the function of the other. Furthermore, when these abnormalities occur early in life, they may affect the growth of the lungs themselves. The following article reviews the physiology of the respiratory pump, provides a comprehensive list of conditions that affect the thorax and describes their effect(s) on lung growth and function. Copyright © 2014. Published by Elsevier Ltd.

  19. Chest wall contouring for female-to-male transsexuals.

    Science.gov (United States)

    Takayanagi, Susumu; Nakagawa, Chisato

    2006-01-01

    Several techniques for treating the breasts of patients with female-to-male gender identity disorders have been reported. When the patient's breasts do not sag significantly, the authors prefer to remove the breast tissue through a crescent-shaped excision of infraareolar skin in the first operation. In the second operation, reduction of the nipple is performed. Because the periareolar incision may cause a deformity of the areola, the new small nipple should be positioned in the center of the areola. Because breast scars are visible in many Asian patients, the authors believe that the scars should be as small as possible.

  20. Do the Hydatid Cysts Have Unusual Localization and Dissemination Ways in the Chest Cavity?

    Directory of Open Access Journals (Sweden)

    Yucel Akkas

    2016-01-01

    Full Text Available We wanted to report our two cases of intrathoracic extrapulmonary hydatid cyst in pleural cavity due to its rarity. Our first case is a 24-year-old male patient who was admitted with a cystic mass lesion consistent with hydatid cyst which was incidentally detected in inferior lobe of the right lung neighboring to thoracic wall and diaphragm. Our second case is a 32-year-old male patient who was admitted with chest pain and a cystic lesion in apex of the right hemithorax and intercostal field in basal after he had been medically treated due to hydatid cyst of the dome of the liver for two years. The cysts were removed with thoracotomy. Extrapulmonary intrathoracic hydatid cysts were evaluated with regard to invasion ways and treatment indications and methods.

  1. Do the Hydatid Cysts Have Unusual Localization and Dissemination Ways in the Chest Cavity?

    Science.gov (United States)

    Akkas, Yucel; Kaplan, Tevfik; Peri, Neslihan Gulay; Kocer, Bulent

    2016-01-01

    We wanted to report our two cases of intrathoracic extrapulmonary hydatid cyst in pleural cavity due to its rarity. Our first case is a 24-year-old male patient who was admitted with a cystic mass lesion consistent with hydatid cyst which was incidentally detected in inferior lobe of the right lung neighboring to thoracic wall and diaphragm. Our second case is a 32-year-old male patient who was admitted with chest pain and a cystic lesion in apex of the right hemithorax and intercostal field in basal after he had been medically treated due to hydatid cyst of the dome of the liver for two years. The cysts were removed with thoracotomy. Extrapulmonary intrathoracic hydatid cysts were evaluated with regard to invasion ways and treatment indications and methods.

  2. MRI of the Chest

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    Full Text Available ... Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us ... absolutely necessary for medical treatment. See the MRI Safety page for more information about pregnancy and MRI. ...

  3. Radiografia torácica e bacteriologia na fase inicial de tratamento de 800 pacientes masculinos com tuberculose pulmonar Chest X-ray and bacteriology in the initial phase of treatment of 800 male patients with pulmonary tuberculosis

    Directory of Open Access Journals (Sweden)

    Sefa Levent Ozsahin

    2011-06-01

    Full Text Available OBJETIVO: Avaliar radiografias de tórax de pacientes com tuberculose pulmonar e determinar se a extensão das lesões radiográficas correlaciona-se com os parâmetros bacteriológicos. MÉTODOS: Neste estudo descritivo e retrospectivo; foram avaliadas radiografias de tórax, baciloscopias para BAAR e culturas de escarro para Mycobacterium tuberculosis no momento basal e durante os dois primeiros meses de tratamento. A amostra foi composta por 800 pacientes masculinos internados entre 1995 até o presente em um hospital com 250 leitos no noroeste da Turquia. RESULTADOS: A VHS média inicial foi de 58 ± 37 mm/h. Inicialmente, a baciloscopia e as culturas de escarro tiveram resultado positivo em 83,8% e em 89,5% dos pacientes, respectivamente. Após o primeiro mês do tratamento, a proporção de culturas positivas foi maior nos pacientes com doença cavitária do que naqueles sem doença cavitária (53,7% vs. 37,7%; p 0.05 para todos, mas houve correlação positiva com VHS (r = 0,23, p OBJECTIVE: To evaluate chest X-rays of patients with pulmonary tuberculosis and to determine whether the extent of radiographic lesions correlates with bacteriological parameters. METHODS: In this retrospective, descriptive study, we evaluated chest X-rays, as well as AFB detection by smear microscopy and culture for Mycobacterium tuberculosis, initially and during the first two months of treatment, in 800 male patients hospitalized between 1995 and the present at a 250-bed hospital in northwestern Turkey. RESULTS: The initial mean ESR was 58 ± 37 mm/h. Initial sputum smears and cultures were positive in 83.8% and 89.5% of the patients, respectively. After the first month of treatment, the proportion of patients with positive sputum culture was higher among those with cavitary tuberculosis than among those with non-cavitary tuberculosis (53.7% vs. 37.7%, p 0.05 for all but was positively correlated with the ESR (r = 0.23, p < 0.001. During the first and second

  4. Acute fatal chest pain: optimized procedure in emergency department.

    Science.gov (United States)

    Yang, Yang; Zhang, Wei; Peng, Ming; Tong, Lianying; Lin, Shouyu

    2013-01-01

    To explore the diagnostic procedure of acute fatal chest pain in emergency department (ED) in order to decrease the misdiagnosis rate and shorten the definite time to diagnosis. The ultimate aim is to rescue the patients timely and effectively. Three hundreds and two patients (56.9 ± 11.8 Years, 72% men) complained with acute chest pain and chest distress presenting to our ED were recruited. They were divided into two groups according to visiting time (Group I: from October 2010 to March 2011, Group II: from October 2011 to March 2012). The misdiagnosis rate, definite time for diagnosis and medical expense were analyzed. Patients of Group I were diagnosed by initial doctors who made their diagnosis according to personal experience in outpatient service or rescue room in ED. While patients of Group II were all admitted to rescue room and were diagnosed and rescued according to the acute chest pain screening flow-process diagram. Differences inter-group was compared. The misdiagnosis rate of fatal chest pain in Group I and Group II was 6.8% and 0% respectively, and there was statistic difference (P=0.000). The definite time to diagnosis was 65.3 min and 40.1 min in control and Group II respectively, the difference had statistic significance (P=0.000). And the mean cost for treatment was 787.5/124.5 ¥/$ and 905.5/143.2 ¥/$ respectively, and there was statistic difference too (P=0.012). Treating emergency patients with acute chest pain according to the acute chest pain screening flow-process diagram in rescue room will decrease misdiagnosis apparently, and it can also shorten the definite time to correct diagnosis. It has a remarkable positive role in rescuing patients with acute chest pain timely and effectively.

  5. Predictors of abnormal chest CT after blunt trauma: a critical appraisal of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Brink, M. [Department of Radiology, Radboud University Nijmegen Medical Centre (Netherlands)], E-mail: M.Brink@rad.umcn.nl; Kool, D.R.; Dekker, H.M.; Deunk, J.; Jager, G.J.; Kuijk, C. van; Edwards, M.J.R.; Blickman, J.G. [Department of Radiology, Radboud University Nijmegen Medical Centre (Netherlands)

    2009-03-15

    Aim: To identify and to evaluate predictors that determine whether chest computed tomography (CT) is likely to reveal relevant injuries in adult blunt trauma patients. Methods: After a comprehensive literature search for original studies on blunt chest injury diagnosis, two independent observers included studies on the accuracy of parameters derived from history, physical examination, or diagnostic imaging that might predict injuries at (multidetector row) CT in adults and that allowed construction of 2 x 2 contingency tables. For each article, methodological quality was scored and relevant predictors for injuries at CT were extracted. For each predictor, sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio (DOR) including 95% confidence intervals were calculated. Results: Of 147 articles initially identified, the observers included 10 original studies in consensus. Abnormalities at physical examination (abnormal respiratory effort, need for assisted ventilation, reduced airentry, coma, chest wall tenderness) and pelvic fractures were significant predictors (DOR: 2.1-6.7). The presence of any injuries at conventional radiography of the chest (eight articles) was a more powerful significant predictor (DOR: 2.2-37). Abnormal chest ultrasonography (four articles) was the most accurate predictor for chest injury at CT (DOR: 491-infinite). Conclusion: The current literature indicates that in blunt trauma patients with abnormal physical examination, abnormal conventional radiography, or abnormal ultrasonography of the chest, CT was likely to reveal relevant chest injuries. However, there was no strong evidence to suggest that CT could be omitted in patients without these criteria, or whether these findings are beneficial for patients.

  6. [Chest ultrasonography in pleurapulmonary disease].

    Science.gov (United States)

    Gallego Gómez, M P; García Benedito, P; Pereira Boo, D; Sánchez Pérez, M

    2014-01-01

    Although the initial diagnosis and follow-up of pleuropulmonary disease are normally done with plain chest films and the gold standard for chest disease is computed tomography, diverse studies have established the usefulness of chest ultrasonography in the diagnosis of different pleuropulmonary diseases like pleural effusion and lung consolidation, among others. In this article, we show the different ultrasonographic patterns for pleuropulmonary disease. The availability of ultrasonography in different areas (ICU, recovery areas) makes this technique especially important for critical patients because it obviates the need to transfer the patient. Moreover, ultrasonography is noninvasive and easy to repeat. On the other hand, it enables the direct visualization of pleuropulmonary disease that is necessary for interventional procedures. Copyright © 2011 SERAM. Published by Elsevier Espana. All rights reserved.

  7. MRI of the Chest

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    Full Text Available ... blood flow to the heart) and myocardial infarct (scar in the heart muscle due to prior obstruction ... contrast material except when absolutely necessary for medical treatment. See the MRI Safety page for more information ...

  8. MRI of the Chest

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    Full Text Available ... treatment. See the MRI Safety page for more information about pregnancy and MRI. If you have claustrophobia (fear of enclosed spaces) or anxiety, you may want to ask your physician for ...

  9. MRI of the Chest

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    Full Text Available ... MRI. If you have claustrophobia (fear of enclosed spaces) or anxiety, you may want to ask your ... imaging tests, treatments and procedures may vary by geographic region. Discuss the fees associated with your prescribed ...

  10. MRI of the Chest

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    Full Text Available ... imaging (MRI) exam. View full size with caption Pediatric Content Some imaging tests and treatments have special pediatric considerations. The teddy bear denotes child-specific content. ...

  11. MRI of the Chest

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index ...

  12. Chest X-Ray

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  13. MRI of the Chest

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    Full Text Available ... imaging tests, treatments and procedures may vary by geographic region. Discuss the fees associated with your prescribed ... Us | FAQ | Privacy | Terms of Use | Links | Site Map Copyright © 2018 Radiological Society of North America, Inc. ( ...

  14. MRI of the Chest

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    Full Text Available ... patient story here Images × Image Gallery Radiologist preparing patient for magnetic resonance imaging (MRI) exam. View full size with caption Pediatric Content Some imaging tests and treatments have special ...

  15. MRI of the Chest

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  16. Chest X-Ray

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  17. MRI of the Chest

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    Full Text Available ... You may resume your usual activities and normal diet immediately after the exam. On very rare occasions, ... time. Follow-up examinations are sometimes the best way to see if treatment is working or if ...

  18. COMBINED EFFECT OF PNF STRETCHING WITH CHEST MOBILITY EXERCISES ON CHEST EXPANSION AND PULMONARY FUNCTIONS FOR ELDERLY

    Directory of Open Access Journals (Sweden)

    Vinod Babu .K

    2015-06-01

    Full Text Available Background: PNF stretching and chest mobility exercises found to be effective in elder patients, however the combined effectiveness of these techniques were unknown. The purpose of this study is to find the effect of Hold-relax PNF stretching technique for pectoralis muscle combined with chest mobility exercises on improvement of chest expansion and pulmonary function for elderly subjects. Method: An Experimental study design, 30 subjects with age group above 60 years were randomized 15 subjects each into Study and Control group. Control group received Supervised Active Assisted Exercise Program while Study group received Hold-relax PNF Stretching for pectoralis muscle, Chest Mobility Exercises Program and supervised Active Assisted Exercise Program for a period of one week. Outcome measures such as chest expansion at axilla and xiphisternum and pulmonary function test such as FEV1, FVC and FEV1/FVC were measured before and after one week of treatment. Results: Analysis using paired ‘t’ test within the group found that there is no statistically significant difference within control group where as there is a statistical significant difference within study group. Comparative analysis of pre-intervention means shown that there is no statistically significant difference between the groups. Comparative analysis of post-intervention means shown that there is a statistically significant difference in means of Chest expansion, FEV1/FVC and there is no statistical significant difference in FEV1 and FVC between study and control groups. Conclusion: It is concluded that one week of combined Hold-relax PNF stretching for pectoralis muscle with chest mobility exercises shown significant improvement in chest expansion and pulmonary function test such as forced expiratory volume and forced vital capacity than only active assisted exercise program for elderly subjects.

  19. [Isolated chest trauma in elderly patients].

    Science.gov (United States)

    Yersin, Bertrand; Carron, Pierre-Nicolas; Pasquier, Mathieu; Zingg, Tobias

    2015-08-12

    In elderly patients, a blunt trauma of the chest is associated with a significant risk of complications and mortality. The number of ribs fractures (≥ 4), the presence of bilateral rib fractures, of a pulmonary contusion, of existent comorbidities or acute extra-thoracic traumatic lesions, and lastly the severity of thoracic pain, are indeed important risk factors of complications and mortality. Their presence may require hospitalization of the patient. When complications do occur, they are represented by alveolar hypoventilation, pulmonary atelectasia and broncho-pulmonary infections. When hospitalization is required, it may allow for the specific treatment of thoracic pain, including locoregional anesthesia techniques.

  20. Evaluation and Management of Chest Pain in the Elderly.

    Science.gov (United States)

    Gupta, Rohit; Munoz, Robert

    2016-08-01

    Geriatric patients are at increased risk for serious morbidity and mortality from life-threatening causes of chest pain. This article covers 5 life-threatening causes of chest pain in the elderly: acute coronary syndrome, aortic dissection, pulmonary embolism, pneumothorax, and esophageal rupture. Atypical presentations, frailty, and significant comorbidities that characterize the elderly make the diagnosis and treatment of these already complicated conditions even more complicated. The emergency provider must be vigilant and maintain a low threshold to test. When a diagnosis is made, treatment must be aggressive. The elderly benefit from optimal care. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. Optimizing processes of dispersant concentration and post-treatments for fabricating single-walled carbon nanotube transparent conducting films

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    Gao, Jing; Wang, Wen-Yi; Chen, Li-Ting; Cui, Li-Jun; Hu, Xiao-Yan; Geng, Hong-Zhang, E-mail: genghz@tjpu.edu.cn

    2013-07-15

    This study evaluated the effect of sodium dodecyl benzene sulfonate (SDBS) as dispersant for the dispersion of purified single-walled carbon nanotubes (SWCNTs) in water in terms of dispersibility dependence on electrical conductivity of SWCNT transparent conducting film (TCF) performance. SWCNT TCFs were prepared by different proportions of CNTs/SDBS solution to find out the optimum SDBS concentration according to the film resistance of pristine and after post-treatment by nitric acid. TCFs fabricated with the aqueous solution by the ratio of CNTs/SDBS 1:5 gave the lowest sheet resistance and the highest transmittance. The TCFs were then further treated with thionyl chloride to improve their conductivity. Low sheet resistance (86 Ω/□, 80%T) was achieved. The dispersion condition of CNTs/SDBS aqueous solution was characterized by field-emission scanning electron microscopy, while the X-ray photoelectron spectroscopy and Raman spectroscopy confirmed the dispersion and doping mechanism treated with nitric acid and thionyl chloride.

  2. Optimizing processes of dispersant concentration and post-treatments for fabricating single-walled carbon nanotube transparent conducting films

    Science.gov (United States)

    Gao, Jing; Wang, Wen-Yi; Chen, Li-Ting; Cui, Li-Jun; Hu, Xiao-Yan; Geng, Hong-Zhang

    2013-07-01

    This study evaluated the effect of sodium dodecyl benzene sulfonate (SDBS) as dispersant for the dispersion of purified single-walled carbon nanotubes (SWCNTs) in water in terms of dispersibility dependence on electrical conductivity of SWCNT transparent conducting film (TCF) performance. SWCNT TCFs were prepared by different proportions of CNTs/SDBS solution to find out the optimum SDBS concentration according to the film resistance of pristine and after post-treatment by nitric acid. TCFs fabricated with the aqueous solution by the ratio of CNTs/SDBS 1:5 gave the lowest sheet resistance and the highest transmittance. The TCFs were then further treated with thionyl chloride to improve their conductivity. Low sheet resistance (86 Ω/□, 80%T) was achieved. The dispersion condition of CNTs/SDBS aqueous solution was characterized by field-emission scanning electron microscopy, while the X-ray photoelectron spectroscopy and Raman spectroscopy confirmed the dispersion and doping mechanism treated with nitric acid and thionyl chloride.

  3. Chest pain and diarrhea: a case of Campylobacter jejuni-associated myocarditis.

    Science.gov (United States)

    Panikkath, Ragesh; Costilla, Vanessa; Hoang, Priscilla; Wood, Joseph; Gruden, James F; Dietrich, Bob; Gotway, Michael B; Appleton, Christopher

    2014-02-01

    Diarrhea and chest pain are common symptoms in patients presenting to the emergency department (ED). However, rarely is a relationship between these two symptoms established in a single patient. Describe a case of Campylobacter-associated myocarditis. A 43-year-old man with a history of hypertension presented to the ED with angina-like chest pain and a 3-day history of diarrhea. Electrocardiogram revealed ST-segment elevation in the lateral leads. Coronary angiogram revealed no obstructive coronary artery disease. Troponin T rose to 1.75 ng/mL. Cardiac magnetic resonance imaging showed subepicardial and mid-myocardial enhancement, particularly in the anterolateral wall and interventricular septum, consistent with a diagnosis of myocarditis. Stool studies were positive for Campylobacter jejuni. Campylobacter-associated myocarditis is rare, but performing the appropriate initial diagnostic testing, including stool cultures, is critical to making the diagnosis. Identifying the etiology of myocarditis as bacterial will ensure that appropriate treatment with antibiotics occurs in addition to any cardiology medications needed for supportive care. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Inflammatory reaction and tensile strength of the abdominal wall after an implant of polypropylene mesh and polypropylene/poliglecaprone mesh for abdominal wall defect treatment in rats.

    Science.gov (United States)

    Biondo-Simões, Maria de Lourdes Pessole; Moura, Paula Almeida Pamponet; Colla, Kelly; Tocchio, Anna Flávia Zonato; Morais, Camila Gomes de; Miranda, Renata Augusta de; Robes, Rogério Ribeiro; Ioshii, Sérgio Ossamu

    2014-01-01

    To compare the inflammatory reaction and the growing resistance of the abdominal wall with the use of poliglecaprone meshes and polypropylene meshes associated with poliglecaprone in the correction of abdominal defects. Seventy-seven Wistar rats were divided into three groups: CG (non-operated animals: EG (polypropylene mesh) and UG (polypropylene and poliglecaprone mesh). A muscular and aponeurotic defect was formed and treated according to the group. Evaluations were made after 4, 7, 14, 28 and 56 days. The resistance and inflammatory pattern were studied. There was a gradual and significant gain in resistance, regularly in the EG and irregularly in the UG, which was lower on the 14th day (p=0.008). The inflammatory reaction was acute and more intense in the UG on the fourth day. At all other times, the inflammatory pattern was acute to chronic, similar in both groups, with minimum intensity on the 56th day. The greater resistance offered by the polypropylene mesh was regular and ascending, stabilizing on the 28th day, while that of the polypropylene/poliglecaprone was not even. In the end, the resistances were similar. The inflammatory response was greater in the UG on the fourth day and similar at all other times.

  5. Differential points of mediastinal cystic lesion in chest computed tomography

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    Lee, Seung Jin; Baek, Jang Mi; Song, Jang Hyeon; Seon, Hyun Ju [Dept. of Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of); Kim, Yun Hyeon [Dept. of Radiology, Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of)

    2013-10-15

    To find differential diagnostic imaging findings of mediastinal cystic lesions in chest computed tomography. We retrospectively reviewed imaging findings of 70 patients with histopathologically proven mediastinal cystic lesions. They were 33 male and 37 female patients. Among 70 cases, 49 cases were in the anterior mediastinum, 12 cases were in the middle mediastinum, and 9 cases were in the posterior mediastinum. 19 patients had symptoms. Chest discomfort was the most common symptom. When the cystic lesion was located in the anterior mediastinum, and unilocular, the possibility of thymic cyst was the most likely (p < 0.0027). When the cystic lesion was located in the anterior mediastinum and was multilocular with a relatively thick wall, the possibility of a mature cystic teratoma was the most likely (p < 0.001). When the lesion was a high attenuation cystic lesion located around the air-way, the possibility of a bronchogenic cyst was the most likely (p < 0.001). Chest CT gives information about the location, loculation, wall thickness and internal attenuation of mediastinal cystic lesions. And certain details seen on CT imaging can help with the correct diagnosis, especially in the cases of thymic cyst, mature cystic teratoma and bronchogenic cyst.

  6. Chest X-Ray

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Heart Month Recently posted: Carotid Intima-Media Thickness Test Medical Imaging Costs Video: Abdominal Ultrasound Video: Pelvic ...

  7. MRI of the Chest

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Magnetic resonance imaging (MRI) is a noninvasive medical test that physicians use to diagnose medical conditions. MRI ...

  8. MRI of the Chest

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos ... the body and determine the presence of certain diseases. The images can then be examined on a ...

  9. Chest X-Ray

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Awareness Month Recently posted: Carotid Intima-Media Thickness Test Medical Imaging Costs Video: Abdominal Ultrasound Video: Pelvic ...

  10. MRI of the Chest

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us ... Us | FAQ | Privacy | Terms of Use | Links | Site Map Copyright © 2017 Radiological Society of North America, Inc. ( ...

  11. Chest X-Ray

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us ... Us | FAQ | Privacy | Terms of Use | Links | Site Map Copyright © 2017 Radiological Society of North America, Inc. ( ...

  12. MRI of the Chest

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    Full Text Available ... MRI exam is assumed to outweigh the potential risks. Pregnant women should not receive injections of gadolinium contrast material except when absolutely necessary for medical treatment. See the MRI Safety page for more information about pregnancy and MRI. If you have claustrophobia ( ...

  13. Chest X-Ray

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Z Spotlight Recently posted: Carotid Intima-Media Thickness Test Medical Imaging Costs Video: Abdominal Ultrasound Video: Pelvic ...

  14. Chest X-Ray

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician ... Awareness Month Recently posted: Carotid Intima-Media Thickness Test Medical Imaging Costs Video: Coronary CT Angiography Video: ...

  15. Chest X-Ray

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  16. Chest X-Ray

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    Full Text Available Toggle navigation Test/Treatment Patient Type Screening/Wellness Disease/Condition Safety En Español More Info Images/Videos About Us News Physician Resources Professions Site Index A-Z Spotlight February is American Heart Month Recently posted: Carotid Intima-Media Thickness Test ...

  17. Chest physiotherapy in children with acute bacterial pneumonia

    Directory of Open Access Journals (Sweden)

    Lieselotte Corten

    2015-04-01

    Full Text Available Background: Pneumonia is the single leading cause of death in children younger than 5 years of age. Chest physiotherapy is often prescribed as an additional therapy in children with pneumonia. Different chest physiotherapy techniques are available that aim to improve airway clearance, gas exchange and reduce the work of breathing. However, it is unclear if these techniques are effective in this population.Objective: The present review aimed to determine the efficacy of different chest physiotherapy techniques compared with no physiotherapy or other chest physiotherapy treatments in hospitalised children with bacterial pneumonia.Method: Six electronic databases (PubMed, Medline, Cochrane Library, PEDro, CINAHL and Africa-wide information, clinicaltrials.gov and pactr.org were searched for eligible studies.Results: Two randomised controlled trials and one ongoing study were identified. Neither completed trial reported differences between the control and intervention groups, although one study reported a longer duration of coughing (p = 0.04 and rhonchi (p = 0.03 in the intervention group.Conclusion: Because of the limited number of included articles and different presentations of outcome measures, we could not reject or accept chest physiotherapy as either an effective or harmful treatment option in this population.

  18. A rhythmic chest pain

    Directory of Open Access Journals (Sweden)

    Lorenzo Cristoni

    2013-11-01

    Full Text Available A middle-aged man with a history of ischemic heart disease presented at the emergency department having had a forty-minute long precordial pain at home and with an electrocardiogram showing a wide complex tachycardia with left bundle branch block shaped QRS. While preparing for urgent electrical cardioversion, the physician practiced a carotid sinus massage which helped to i unveil the supraventricular origin of the arrhythmia (by slowing down heart frequency and thus displaying p waves previously hidden and ii to exclude that the aberrancy was the expression of a transmural ischemia, thanks to the narrowing of the QRS complex. The final diagnosis was atrial tachycardia. The patient consequently received amiodarone IV and was discharged in normal sinus rhythm. We emphasize the importance of correctly diagnosing any rhythm disorder before administering the treatment, if the patient’s clinical condition permits it, in order to ensure the best treatment in urgency and the most appropriate prophylaxis.

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

    Directory of Open Access Journals (Sweden)

    Shilpa Sharma

    2018-01-01

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

  20. Chest compression pauses during defibrillation attempts

    NARCIS (Netherlands)

    Deakin, Charles D.; Koster, Rudolph W.

    2016-01-01

    Purpose of review This article summarizes current knowledge of the causes and consequences of interruption of chest compressions during cardiopulmonary resuscitation. Recent findings Pauses in chest compressions occur during analysis of the heart rhythm, delivery of ventilation, interventions such

  1. [Airway injuries due to blunt chest trauma].

    Science.gov (United States)

    Okabayashi, Kan; Hamatake, D; Yoshida, Y; Nakajima, H; Shirakusa, T; Yamasaki, S

    2006-10-01

    Although the incidence of blunt chest trauma is very high, the mediastinal tracheobronchial injuries are quite rare. The airway injuries are thought to be one of the most urgent clinical conditions in thoracic surgery, and we are requested to make not only a rapid and sharp diagnosis but also an appropriate treatment plan considering combined injuries. We present 9 cases of tracheobronchial injuries due to blunt chest trauma in recent years. The average age of these patients is 26.1 years, and they are consisted of 6 male and 3 female. The cause of trauma is traffic accident in 7, and occupational crane accident in 2. Bronchoplasty were done in 5 cases (right main bronchus in 2, left main bronchus in 1, trunks intermediate bronchus in 1, and the spur between middle and lower lobe in 1), membranous-tracheoplasty with right pneumonectomy in 1, left pneumonectomy in 1, conservative treatment in 2. Postoperative mortality is occurred in 1 case who was suffering from multiple injuries including severe head injury and contralateral lung contusion. Tracheobronchial plasties should be chosen if possible to preserve lung function for the patient suffering from airway injuries.

  2. Bronchiolitis obliterans following exposure to sulfur mustard: chest high resolution computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Ghanei, Mostafa E-mail: m.ghanei@bmsu.ac.ir; Mokhtari, Majid; Mohammad, Mehdi Mir; Aslani, Jafar

    2004-11-01

    Background: Pulmonary complications are known to occur in over half of the patients exposed to sulfur mustard (SM). Chemical weapons of mass destruction (WMD) including SM were used by Iraq during Iran-Iraq war between 1983 and 1989. We undertook this study to evaluate the chest high resolution computerized tomography (HRCT) as a diagnostic tool in patients with documented exposure to SM and chronic respiratory symptoms. Method: The medical records of 155 patients exposed to SM during Iran-Iraq war and suffered respiratory complications were reviewed. Chest HRCTs of these patients were examined. Ten healthy controls with no history of exposure to HD were matched for age, gender, and chest HRCT protocol applied. Results: Fifty chest HRCTs of these patients were randomly selected for this study. The most frequent findings were; air trapping 38 (76%), bronchiectasis 37 (74%), mosaic parenchymal attenuation (MPA) 36 (72%), irregular and dilated major airways 33 (66%) bronchial wall thickening (BWT) 45 (90%), and interlobular septal wall thickening (SWT) 13 (26%), respectively. Air trapping in one patient (10%) was the only positive finding in the control group. Conclusions: Chest HRCT findings of bronchiectasis, air trapping, MPA, SWT, and BWT were seen in our patients 15 years after exposure to HD. These findings suggest the diagnosis of bronchiolitis obliterans (BO). We did not encounter chest HRCT features consistent with pulmonary fibrosis.

  3. Computer-aided diagnosis in chest radiography

    NARCIS (Netherlands)

    Ginneken, B. van

    2001-01-01

    Chest radiographs account for more than half of all radiological examinations; the chest is the “mirror of health and disease”. This thesis is about techniques for computer analysis of chest radiographs. It describes methods for texture analysis and segmenting the lung fields and rib cage in a

  4. Structural and biochemical changes induced by pulsed electric field treatments on Cabernet Sauvignon grape berry skins: impact on cell wall total tannins and polysaccharides.

    Science.gov (United States)

    Cholet, Céline; Delsart, Cristèle; Petrel, Mélina; Gontier, Etienne; Grimi, Nabil; L'hyvernay, Annie; Ghidossi, Remy; Vorobiev, Eugène; Mietton-Peuchot, Martine; Gény, Laurence

    2014-04-02

    Pulsed electric field (PEF) treatment is an emerging technology that is arousing increasing interest in vinification processes for its ability to enhance polyphenol extraction performance. The aim of this study was to investigate the effects of PEF treatment on grape skin histocytological structures and on the organization of skin cell wall polysaccharides and tannins, which, until now, have been little investigated. This study relates to the effects of two PEF treatments on harvested Cabernet Sauvignon berries: PEF1 (medium strength (4 kV/cm); short duration (1 ms)) and PEF2 (low intensity (0.7 kV/cm); longer duration (200 ms)). Histocytological observations and the study of levels of polysaccharidic fractions and total amounts of tannins allowed differentiation between the two treatments. Whereas PEF1 had little effect on the polyphenol structure and pectic fraction, PEF2 profoundly modified the organization of skin cell walls. Depending on the PEF parameters, cell wall structure was differently affected, providing variable performance in terms of polyphenol extraction and wine quality.

  5. Green walls in Vancouver

    Energy Technology Data Exchange (ETDEWEB)

    Sharp, R. [Sharp and Diamond Landscape Architecture Inc., Vancouver, BC (Canada)

    2007-07-01

    With the renewed interest in design for microclimate control and energy conservation, many cities are implementing clean air initiatives and sustainable planning policies to mitigate the effects of urban climate and the urban heat island effect. Green roofs, sky courts and green walls must be thoughtfully designed to withstand severe conditions such as moisture stress, extremes in temperature, tropical storms and strong desiccating winds. This paper focused on the installation of green wall systems. There are 2 general types of green walls systems, namely facade greening and living walls. Green facades are trellis systems where climbing plants can grow vertically without attaching to the surface of the building. Living walls are part of a building envelope system where plants are actually planted and grown in a wall system. A modular G-SKY Green Wall Panel was installed at the Aquaquest Learning Centre at the Vancouver Aquarium in Stanley Park in September 2006. This green wall panel, which was originally developed in Japan, incorporates many innovative features in the building envelope. It provides an exterior wall covered with 8 species of plants native to the Coastal Temperate Rain Forest. The living wall is irrigated by rainwater collected from the roof, stored in an underground cistern and fed through a drip irrigation system. From a habitat perspective, the building imitates an escarpment. Installation, support systems, irrigation, replacement of modules and maintenance are included in the complete wall system. Living walls reduce the surface temperature of buildings by as much as 10 degrees C when covered with vegetation and a growing medium. The project team is anticipating LEED gold certification under the United States-Canada Green Building Council. It was concluded that this technology of vegetated building envelopes is applicable for acoustical control at airports, biofiltration of indoor air, greywater treatment, and urban agriculture and vertical

  6. Incidental findings in chest X-rays; Zufallsbefunde im Roentgenthorax

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-04-15

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

  7. Strength training versus chest physical therapy on pulmonary ...

    African Journals Online (AJOL)

    Background: Children with Down syndrome clinically show a diminished activity limit at all ages due to muscle weakness and respiratory problems. Purpose: To compare the effect of strength exercises to lower limb muscles and effect of chest physical therapy treatment program on pulmonary functions in Down syndrome ...

  8. Chest pain and behavior in suspected coronary artery disease.

    Science.gov (United States)

    Young, L D; Barboriak, J J; Anderson, A J

    1988-01-01

    This study assessed behavioral activity, dietary and emotional variables among patient cohorts with angina pectoris, atypical chest pain, and no chest pain in whom coronary disease is suspected. Questionnaire responses of 3,899 employed male patients at the time of coronary arteriography were analyzed. Patients with angina pectoris had high levels of coronary-prone and neurotic attitudes, and fatigue variables including feeling unrested on awakening, easy fatiguability, reducing activity at work and arriving home tired. Atypical chest pain patients showed coronary-prone and neurotic attitudes similar to the angina pectoris group but had less coronary occlusion and lower levels of fatigue variables. Compared to the other groups, atypical chest pain patients were more likely to skip breakfast and showed a trend to eat fast. These findings suggest that including assessment of activity levels, fatiguability, eating behavior, neurotic traits and coronary-prone attitudes at time of coronary arteriography can have some limited value for patients with chest pain who may seek cardiac treatment but could benefit from alternative approaches.

  9. Identifying Low-risk Patients for Early Discharge From Emergency Department Without Using Subjective Descriptions of Chest Pain: Insights From Providing Rapid Out of Hospital Acute Cardiovascular Treatment (PROACT) 3 and 4 Trials.

    Science.gov (United States)

    Sepehrvand, Nariman; Zheng, Yinggan; Armstrong, Paul W; Welsh, Robert C; Ezekowitz, Justin A

    2017-06-01

    Several accelerated diagnostic protocols (ADPs) have been developed to allow emergency department (ED) physicians to identify appropriate patients for safe early discharge after presentation with symptom of chest pain. Most ADPs require chest pain to be described and modify the algorithm based on the subjective chest pain characteristics. We investigated the performance of three established major ADPs simplified by eliminating the need for chest pain as a descriptor. We pooled patients from PROACT-3 and -4 trials, in which patients presenting to emergency medical services with chest pain or dyspnea were enrolled. The simplified Vancouver Chest Pain Rule (sVCPR), the simplified Emergency Department Assessment of Chest Pain Score (sEDACS) ADP and the Accelerated Diagnostic protocol to Assess Patients with chest pain using contemporary troponins as the only biomarker (ADAPT-ADP) were compared using the sensitivity, specificity, and positive and negative predictive values (NPV). The primary outcome of interest was 30-day major adverse cardiac events (MACE); the diagnosis of acute coronary syndrome (ACS) occurring within 30 days after ED presentation was also explored. A total of 1,081 patients were included (median age = 67 years, 53% male, median GRACE score = 113) of which 222 ACS diagnoses and 150 cardiac events occurred within 30 days after index ED presentation. The sVCPR, sEDACS ≥ 3, and ADAPT-ADP, respectively, identified 9.7, 13.3, and 4.1% of patients as low risk with a sensitivity and NPV of 100% for the primary outcome of 30-day MACE. The sEDACS-ADP identified 24.2% of patients as low risk with a cut-point score of 4 (sensitivity of 98.0% and NPV of 98.8%). The sVCPR, sEDACS ≥ 3, and ADAPT-ADP, respectively, had NPVs of 98.1, 95.8, and 93.3% in identifying patients at higher risk of ACS diagnosis within 30 days after index ED visit. The diagnostic protocols performed well without their chest pain characteristics component. Further studies are

  10. Effects of prosthetic reconstruction of the abdominal wall on respiratory mechanics in rats.

    Science.gov (United States)

    Rocco, P R; Fonseca, S M; Pinto, A P; Medeiros, A S; Contador, R S; Zin, W A

    1999-01-01

    Respiratory mechanics and thoracoabdominal morphometry were determined in four sets of animal experiments before and after surgery. In group RRA the rectus abdominus muscles were removed; in RRAH rats the muscle resection was followed by lung hyperinflation; in PPM animals the defect was repaired by suturing a polypropylene mesh (Marlex); and in PPMH lung hyperinflation was performed after abdominal wall reconstruction. Lung and chest wall elastances, and chest wall viscoelastic/inhomogeneous pressures increased in RRA, RRAH and PPM groups. Static lung elastance was progressively smaller in the following order: RRA, PPM, and PPMH. In conclusion, removal of the rectus abdominus muscles and abdominal wall reconstruction could account for higher energy losses against viscoelastic and elastic forces acting on the chest wall, and these are related to a cephalad deviation of the diaphragm. Furthermore, hyperinflation reverses lung elastic modification after abdominal wall reconstruction with PPM, without beneficial effects in the presence of abdominal wall defect.

  11. Novel computed tomographic chest metrics to detect pulmonary hypertension.

    Science.gov (United States)

    Chan, Andrew L; Juarez, Maya M; Shelton, David K; MacDonald, Taylor; Li, Chin-Shang; Lin, Tzu-Chun; Albertson, Timothy E

    2011-03-29

    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. © 2011 Chan et al; licensee BioMed Central Ltd.

  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. ENDOSURGICAL TECHNOLOGY FOR CHEST WOUNDS

    Directory of Open Access Journals (Sweden)

    O. V. Voskresensky

    2016-01-01

    Full Text Available BACKGROUND Penetrating chest injuries are a common cause of hospitalization for young patients.Various types of thoracotomy prevails over the other surgical approaches performed both under absolute and relative indications, depending on the location of wounds.PURPOSE To analyze the tactics and evaluate the possibility of thoracoscopy in order to reduce the number of unreasonable thoracotomies and reduce trauma due to surgical intervention.MATERIAL AND METHODS We studied 596 medical histories of victims who had been operated in 2002–2012. Thoracoscopy was performed in 236 patients, traditional tactics was applied in 360 victims. Wounds in the diaphragmatic area of the chest were in 210 victims, in the “heart” area — in 172 patients, in the intersection of these two zones — 44 cases, in the projection of the lung peripheral part — 49 cases and paravertebral area of the chest — in 52 patients. Typical thoracotomy (TT was performed in 27% of cases, atypical thoracotomy (AT — 42.5%, and drainage of the pleural space (DPS — 30.3% of cases.RESULT Thoracoscopy (TS could be carried out in 42.2% of patients who had undergone TT, and in 79.4% of patients who had undergone AT. Overall performance of the TS was possible in 70% of patients with penetrating chest wounds (PCW. Absolute contraindications for TS occurred in 29.1% of the victims.

  14. A pilot study to determine whether external stabilisation of the chest ...

    African Journals Online (AJOL)

    Objectives. This was a pilot study to determine whether external stabilisation of the chest wall with a splint reduces the need for mechanical ventilation in preterm infants, within the first 7 days after study entry. Design. This was a non-blinded prospective randomised controlled study. After consent was obtained, babies were ...

  15. Two cases of Chest Heating Sensation treated by Hwangryunhaedok-tang Herbal-Acupuncture

    Directory of Open Access Journals (Sweden)

    Gwon-Il Cho

    2003-06-01

    Full Text Available The purpose of this study is to evaluate the clinical effect of Hwangryunhaedok-tang Herbal-Acupuncture. Hwangryunhaedok-tang is used in all heating diseases. Chest Heating Sensation is a unique concept in Oriental Medicine. So we applied Hwangryunhaedok-tang Herbal-Acupuncture to treat the Chest Heating Sensation. We used DITI(Digital Infrared Thermographic Imaging to estimate the temperatures of chest surface for the outcome assessment. We came to know that the chest surface temperatures were all reduced in both cases after Herbal-Acupuncture treatment. The reduced average temperature was 1.5℃ in case 1 and 0.9℃ in case 2. The above result indicates that Hwangryunhaedok-tang Herbal-Acupuncture treatment has an effect on Chest Heating Sensation, thus continuous Hwangryunhaedok-tang Herbal-Acupuncture study will be needed for more clinical applications.

  16. The application of MDCT in the diagnosis of chest trauma.

    Science.gov (United States)

    Błasińska-Przerwa, Katarzyna; Pacho, Ryszard; Bestry, Iwona

    2013-01-01

    Traumas are the third most common cause of death worldwide, after cardiovascular diseases and neoplasms, and the main cause of death of patients under 40 years of age. Contemporary image diagnosis of chest trauma uses chest X-ray (CXR), multidetector computed tomography (MDCT), transthoracic and transoesophageal ultrasound (USG), X-ray angiography and magnetic resonance. The aim of the present study was to evaluate MDCT results in the examination of posttraumatic chest injuries and to compare the results of CXR and MDCT in chosen chest traumatic injuries. The sixty patients with chest trauma included in the study were diagnosed at the Department of Radiology of the Institute of Tuberculosis and Lung Diseases between May 2004 and October 2007. MDCT was performed in all patients. Two groups with different types of injury (blunt or penetrating chest trauma) were distinguished. The analysis of injuries in both groups was conducted depending on the mechanism of trauma. The detection of 20 selected injuries at CXR and MDCT was compared. Moreover, the compatibility of MDCT with the results of intraoperative assessment and bronchoscopy was analysed. The influence of MDCT on the treatment modality was also assessed. History of blunt chest trauma was found in 51 patients (group 1) and of penetrating trauma in 9 patients (group 2). The most frequent injuries among group 1 were lung contusion and rib fractures, and among group 2 it was pericardial hematoma. Compared to MDCT, the sensitivity and specificity of CXR were 66.7 and 58%, respectively. Change of treatment modality was observed after MDCT in 83% of patients. The sensitivity and specificity of MDCT in diagnosing tracheobronchial injury, compared to bronchoscopy, were 72.7% and 100%, respectively. Compatibility of MDCT results and intraoperative assessment was observed in 43% of patients, and the main reason for discrepancy was underdiagnosis of diaphragm injury in MDCT. MDCT was a valuable diagnostic method in

  17. Anterior Abdominal Wall Desmoids Tumor in a Five Year Old Girl – A ...

    African Journals Online (AJOL)

    xp

    usually affecting the mesentery of the intestine or it could be extra-abdominal in which they may affect the popliteal region, the chest wall or the anterior abdominal wall. Reports in children less than ... anterior abdominal wall muscles are tensed. Rectal examination was essentially normal. An assessment of subcutaneous ...

  18. Numerical analysis of friction factor for a fully developed turbulent flow using k–ε turbulence model with enhanced wall treatment

    Directory of Open Access Journals (Sweden)

    Muhammad Ahsan

    2014-12-01

    Full Text Available The aim of this study is to formulate a computational fluid dynamics (CFD model that can illustrate the fully turbulent flow in a pipe at higher Reynolds number. The flow of fluids in a pipe network is an important and widely studied problem in any engineering industry. It is always significant to see the development of a fluid flow and pressure drop in a pipe at higher Reynolds number. A finite volume method (FVM solver with k–ε turbulence model and enhanced wall treatment is used first time to investigate the flow of water at different velocities with higher Reynolds number in a 3D pipe. Numerical results have been presented to illustrate the effects of Reynolds number on turbulence intensity, average shear stress and friction factor. Friction factor is used to investigate the pressure drop along the length of the pipe. The contours of wall function are also presented to investigate the effect of enhanced wall treatment on a fluid flow. A maximum Reynolds number is also found for which the selected pipe length is sufficient to find a full developed turbulent flow at outlet. The results of CFD modeling are validated by comparing them with available data in literature. The model results have been shown good agreement with experimental and co-relation data.

  19. Hepatic hydrothorax after blunt chest trauma

    Directory of Open Access Journals (Sweden)

    Shang-Chiung Wang

    2012-08-01

    Full Text Available We report a successful treatment result in a rare case of hepatitis C virus-related cirrhosis, who had sustained hydrothorax after blunt thoracoabdominal trauma. This was a female patient with liver cirrhosis, Child–Turcotte–Pugh class A, without ascites before injury. She sustained blunt thoracoabdominal trauma with a left clavicle fracture dislocation and right rib fractures. There was no hemopneumothorax at initial presentation. However, dyspnea and right pleural effusion developed gradually. We inserted a chest tube to relieve the patient's symptoms, and the daily drainage amount remained consistent. Hepatic hydrothorax was confirmed by the intraperitoneal injection of radioisotope 99mTc-sulfur colloid that demonstrated one-way transdiaphragmatic flow of fluid from the peritoneal cavity to pleural cavities. Finally, the hydrothorax was treated successfully by minocycline-induced pleural symphysis. To the best of our knowledge, this is the first case of hepatic hydrothorax developed after thoracoabdominal trauma.

  20. An Atypical Cause of Atypical Chest Pain

    Directory of Open Access Journals (Sweden)

    Ahmad Zaheen

    2014-01-01

    Full Text Available The present report describes a case involving a 57-year-old HIV-positive man who presented with acute retrosternal chest pain accompanied by 24 h of fever. Septic arthritis of the manubriosternal joint was diagnosed based on magnetic resonance imaging findings in addition to Staphylococcus aureus bacteremia. To the authors’ knowledge, the present case is only the 12th reported case of manubriosternal septic arthritis, and the first in an HIV-positive patient. Early diagnosis and treatment can circumvent the need for surgical intervention. Based on the present case report and review of the literature, the authors summarize the epidemiology, appropriate imaging and suggestions for antibiotic therapy for this rare presentation.

  1. Ambiguous walls

    DEFF Research Database (Denmark)

    Mody, Astrid

    2012-01-01

    of “ambiguous walls” as a more “critical” approach to design [1]. The concept of ambiguous walls refers to the diffuse status a lumious and possibly responsive wall will have. Instead of confining it can open up. Instead of having a static appearance, it becomes a context over time. Instead of being hard...... and flat, “ambiguous walls” combine softness, tectonics and three-dimensionality. The paper considers a selection of luminious surfaces and reflects on the extent of their ambiguous qualities. Initial ideas for new directions for the wall will be essayed through the discussion....

  2. [Combination of chest physiotherapy and intermittent non-invasive mechanical ventilation for chronic obstructive pulmonary disease patients with respiratory failure].

    Science.gov (United States)

    Qu, Yunzhong; Peng, Hong; Chen, Ping; Xiang, Xudong

    2009-07-01

    To determine the effect of combination of chest physiotherapy (CPT) and intermittent non-invasive ventilation for chronic obstructive pulmonary disease (COPD) patients with respiratory failure. Ninety COPD patients with intermittent bi-level positive airway pressure (BiPAP) ventilation were randomly divided into 2 groups: control group (n=45) received BiPAP treatment after conventional anti-infection, phlegm treatment and support treatment; CPT group (n=45) received CPT before BiPAP treatment. Clinical symptoms, chest signs,chest X-ray,time of BiPAP therapy, PaO2, and PaCO ) after the treatment were evaluated. Compared with with the control group, patients in the CPT group significantly improved in clinical symptoms, chest signs, chest X-ray absorption as well as shorter BiPAP therapy time, PaO2 increase and PaCO2 decrease(Prespiratory failure.

  3. Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial.

    Science.gov (United States)

    Manzano, Roberta Munhoz; Carvalho, Celso Ricardo Fernandes de; Saraiva-Romanholo, Beatriz Mangueira; Vieira, Joaquim Edson

    2008-09-01

    Abdominal surgical procedures increase pulmonary complication risks. The aim of this study was to evaluate the effectiveness of chest physiotherapy during the immediate postoperative period among patients undergoing elective upper abdominal surgery. This randomized clinical trial was performed in the post-anesthesia care unit of a public university hospital. Thirty-one adults were randomly assigned to control (n = 16) and chest physiotherapy (n = 15) groups. Spirometry, pulse oximetry and anamneses were performed preoperatively and on the second postoperative day. A visual pain scale was applied on the second postoperative day, before and after chest physiotherapy. The chest physiotherapy group received treatment at the post-anesthesia care unit, while the controls did not. Surgery duration, length of hospital stay and postoperative pulmonary complications were gathered from patients' medical records. The control and chest physiotherapy groups presented decreased spirometry values after surgery but without any difference between them (forced vital capacity from 83.5 +/- 17.1% to 62.7 +/- 16.9% and from 95.7 +/- 18.9% to 79.0 +/- 26.9%, respectively). In contrast, the chest physiotherapy group presented improved oxygen-hemoglobin saturation after chest physiotherapy during the immediate postoperative period (p postoperative day. The medical record data were similar between groups. Chest physiotherapy during the immediate postoperative period following upper abdominal surgery was effective for improving oxygen-hemoglobin saturation without increased abdominal pain. Breathing exercises could be adopted at post-anesthesia care units with benefits for patients.

  4. ANMCO-SIMEU Consensus Document: in-hospital management of patients presenting with chest pain.

    Science.gov (United States)

    Zuin, Guerrino; Parato, Vito Maurizio; Groff, Paolo; Gulizia, Michele Massimo; Di Lenarda, Andrea; Cassin, Matteo; Cibinel, Gian Alfonso; Del Pinto, Maurizio; Di Tano, Giuseppe; Nardi, Federico; Rossini, Roberta; Ruggieri, Maria Pia; Ruggiero, Enrico; Scotto di Uccio, Fortunato; Valente, Serafina

    2017-05-01

    Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. However, the evaluation of acute chest pain remains challenging, despite many new insights over the past two decades. The percentage of patients presenting to the emergency departments because of acute chest pain appears to be increasing. Nowadays, there are two essential chest pain-related issues: (i) the missed diagnoses of acute coronary syndromes with a poor short-term prognosis; and (ii) the increasing percentage of hospitalizations of low-risk cases. It is well known that hospitalization of a low-risk chest pain patient can lead to unnecessary tests and procedures, with an increasing trend of complications and burden of costs. Therefore, the significantly reduced financial resources of healthcare systems induce physicians and administrators to improve the efficiency of care protocols for patients with acute chest pain. Despite the efforts of the Scientific Societies in producing statements on this topic, in Italy there is still a significant difference between emergency physicians and cardiologists in managing patients with chest pain. For this reason, the aim of the present consensus document is double: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the critical pathways (describing key steps) that need to be implemented in order to standardize the management of chest pain patients, making a correct diagnosis and treatment as uniform as possible across the entire country.

  5. [ANMCO/SIMEU Consensus document: In-hospital management of patients presenting with chest pain].

    Science.gov (United States)

    Zuin, Guerrino; Parato, Vito Maurizio; Groff, Paolo; Gulizia, Michele Massimo; Di Lenarda, Andrea; Cassin, Matteo; Cibinel, Gian Alfonso; Del Pinto, Maurizio; Di Tano, Giuseppe; Nardi, Federico; Rossini, Roberta; Ruggieri, Maria Pia; Ruggiero, Enrico; Scotto Di Uccio, Fortunato; Valente, Serafina

    2016-06-01

    Chest pain is a common general practice presentation that requires careful diagnostic assessment because of its diverse and potentially serious causes. However, the evaluation of acute chest pain remains challenging, despite many new insights over the past two decades. The percentage of patients presenting to the emergency departments because of acute chest pain appears to be increasing. Nowadays, there are two essential chest pain-related issues: 1) the missed diagnoses of acute coronary syndromes with a poor short-term prognosis; 2) the increasing percentage of hospitalizations of low-risk cases.It is well known that hospitalization of a low-risk chest pain patient can lead to unnecessary tests and procedures, with an increasing trend of complications and burden of costs. Therefore, the significantly reduced financial resources of healthcare systems induce physicians and administrators to improve the efficiency of care protocols for patients with acute chest pain. Despite the efforts of the Scientific Societies in producing statements on this topic, in Italy there is still a significant difference between emergency physicians and cardiologists in managing patients with chest pain. For this reason, the aim of the present consensus document is double: first, to review the evidence-based efficacy and utility of various diagnostic tools, and, second, to delineate the critical pathways (describing key steps) that need to be implemented in order to standardize the management of chest pain patients, making a correct diagnosis and treatment as uniform as possible across the entire country.

  6. Assessment of potential confounders when imaging pectus excavatum with chest radiography alone.

    Science.gov (United States)

    McHugh, Michael A; Poston, Patrick M; Rossi, Nicholas O; Turek, Joseph W

    2016-09-01

    Chest radiography (CXR) has emerged as an attractive alternative imaging option for objective pre-operative assessment of pectus excavatum (PE) with comparable accuracy, reduced cost, and less radiation exposure when compared to computed tomography (CT). This study asked whether image quality, scoliosis, and asymmetry of the PE deformity would decrease the accuracy of CXR as compared to CT. A database of PE patients receiving preoperative CXR and CT was created, and Haller-indices (HI) and correction-indices (CI) were calculated using each imaging modality. Each potential confounding variable were analyzed using Spearman correlations the Fisher r-to-z transformation test. The database was comprised of 77 patients. Image quality, scoliosis and the 'eccentric type' of asymmetry did not demonstrate any significant worsening of measurement accuracy. However, the correlation coefficients for CIs for those with and without the 'unbalanced type' of asymmetry were 0.593 and 0.890, respectively, with a Fisher r-to-z of 2.16 (p=.031). The accuracy of CXR-derived pectus indices remains quite favorable despite the heterogeneity from radiographic quality, scoliosis and chest wall asymmetry. Nonetheless, the unbalanced type of chest wall asymmetry did emerge as a significant confounder. As such, use of CXR alone in cases of gross chest wall asymmetry should be cautioned. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Duration of Twice-Daily Thoracic Radiotherapy and Time From the Start of Any Treatment to the End of Chest Irradiation as Significant Predictors of Outcomes in Limited-Disease Small-Cell Lung Cancer.

    Science.gov (United States)

    Morimoto, Masahiro; Okishio, Kyoichi; Akira, Masanori; Omachi, Naoki; Tamiya, Akihiro; Asami, Kazuhiro; Kawaguchi, Tomoya; Atagi, Shinji

    2017-03-01

    The hypothesis of this retrospective study was that the duration of twice-daily (BID) thoracic radiotherapy (TRT) and time from the start of any treatment to the end of chest irradiation (SER) would predict outcomes in limited-disease small-cell lung cancer. All 81 patients received 45 Gy in 30 fractions BID with a ≥ 6-hour interval and concurrent chemotherapy of platinum and etoposide. The median radiotherapy duration was 25 days (range, 21-38 days). The 5-year overall survival rates were 26.2% (95% confidence interval [CI], 14.3%-38.0%), and the median survival time was 30 months (95% CI, 15.5-44.5 months). Using multivariate regression analysis, the significant predictors of survival were the sum of the diameters of the primary tumor and metastatic lymph nodes, male gender, age ≥ 60 years, and the duration of BID-TRT (hazard ratio [HR], 1.15; 95% CI, 1.06-1.25; HR, 2.38; 95% CI, 1.13-5.02; HR, 2.38; 95% CI, 1.10-5.17; and HR, 1.08; 95% CI, 1.01-1.15, respectively). A total of 70 of 81 patients (86%) received radiotherapy during the first chemotherapy cycle. The median SER was 29 days (range, 21-109 days). The 5-year local control rate was 48.7% (95% CI, 33.9%-63.6%). The significant predictors of local control were the sum of the diameters of the primary tumor and metastatic lymph nodes, age ≥ 60 years, and SER (HR, 1.18; 95% CI, 1.06-1.31; HR, 4.18; 95% CI, 1.23-14.24; and HR, 1.02; 95% CI, 1-1.04, respectively). The duration of BID-TRT and SER were identified as one of the significant predictors of survival and local control in limited-disease small-cell lung cancer treated with concurrent chemoradiotherapy at 45 Gy in 30 fractions, respectively. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Clinical Databases for Chest Physicians.

    Science.gov (United States)

    Courtwright, Andrew M; Gabriel, Peter E

    2018-01-10

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

  9. Assessment of asbestos-induced pleural disease by computed tomography--correlation with chest radiograph and lung function.

    Science.gov (United States)

    al Jarad, N; Poulakis, N; Pearson, M C; Rubens, M B; Rudd, R M

    1991-05-01

    We compared computed tomography (CT) scanning with chest radiography in the assessment of asbestos-induced pleural disease (AIPD) in 20 patients (17 men and 3 women, mean age 55 years, range 43-74 years). Involved pleura was scored on plain chest radiographs according to the International Labour Office (ILO) method of evaluating AIPD. A CT score was calculated from the measurement, using a digital length probe, of the circumference of the chest wall involved by pleural disease in each slice. The maximum width of pleural disease was taken into account in a way analogous to the ILO method for the chest radiograph. The CT score correlated with the chest radiograph score (r = +0.82, P less than 0.0006). CT demonstrated discrete plaques in 95% of patients but these were identified only in 59% patients on the radiograph. Diffuse pleural thickening was evident on the CT scan in all patients and in 70% on the radiograph. There was more inter-reader agreement about the type of pleural disease on the CT scans than on the chest radiographs. CT and chest radiograph scores inversely correlated with all lung function measurements except KCO. We conclude that increasingly extensive pleural disease is associated with increasingly severe impairment of lung function. CT scanning demonstrates the type of AIPD better than plain chest radiography.

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

    Energy Technology Data Exchange (ETDEWEB)

    Sinner, W.N. von [Dept. of Radiology MBC28, King Faisal Specialist Hospital and Research Centre, Riyadh (Saudi Arabia)

    1993-01-01

    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.)

  11. Non-Acute Coronary Syndrome Anginal Chest Pain

    Science.gov (United States)

    Agarwal, Megha; Mehta, Puja K.; Merz, C. Noel Bairey

    2010-01-01

    Anginal chest pain is one of the most common complaints in the outpatient setting. While much of the focus has been on identifying obstructive atherosclerotic coronary artery disease (CAD) as the cause of anginal chest pain, it is clear that microvascular coronary dysfunction (MCD) can also cause anginal chest pain as a manifestation of ischemic heart disease (IHD), and carries an increased cardiovascular risk. Epicardial coronary vasospasm, aortic stenosis, left ventricular hypertrophy, congenital coronary anomalies, mitral valve prolapse and abnormal cardiac nociception can also present as angina of cardiac origin. For non-acute coronary syndrome (ACS) stable chest pain, exercise treadmill testing (ETT) remains the primary tool for diagnosis of ischemia and cardiac risk stratification; however, in certain subsets of patients, such as women, ETT has a lower sensitivity and specificity for identifying obstructive CAD. When combined with an imaging modality, such as nuclear perfusion or echocardiography testing, the sensitivity and specificity of stress testing for detection of obstructive CAD improves significantly. Advancements in stress cardiac magnetic resonance imaging (MRI) enables detection of perfusion abnormalities in a specific coronary artery territory, as well as subendocardial ischemia associated with MCD. Coronary computed tomography angiography (CCTA) enables visual assessment of obstructive CAD, albeit with a higher radiation dose. Invasive coronary angiography (CA) remains the gold standard for diagnosis and treatment of obstructive lesions that cause medically refractory stable angina. Furthermore, in patients with normal coronary angiograms, the addition of coronary reactivity testing (CRT) can help diagnose endothelial dependent and independent microvascular dysfunction. Life-style modification and pharmacologic intervention remains the cornerstone of therapy to reduce morbidity and mortality in patients with stable angina. This review focuses on

  12. Rethinking cocaine-associated chest pain and acute coronary syndromes.

    Science.gov (United States)

    Finkel, Jonathan B; Marhefka, Gregary D

    2011-12-01

    Every year more than 500,000 patients present to the emergency department with cocaine-associated complications, most commonly chest pain. Many of these patients undergo extensive work-up and treatment. Much of the evidence regarding cocaine's cardiovascular effects, as well as the current management of cocaine-associated chest pain and acute coronary syndromes, is anecdotally derived and based on studies written more than 2 decades ago that involved only a few patients. Newer studies have brought into question many of the commonly held theories and practices regarding the etiology, diagnosis, and treatment of this common clinical scenario. However, there continues to be a paucity of prospective, randomized trials addressing this topic as it relates to clinical outcomes. We searched PubMed for English-language articles from 1960 to 2011 using the keywords cocaine, chest pain, coronary arteries, myocardial infarction, emergency department, cardiac biomarkers, electrocardiogram, coronary computed tomography, observation unit, β-blockers, benzodiazepines, nitroglycerin, calcium channel blockers, phentolamine, and cardiomyopathy; including various combinations of these terms. We reviewed the abstracts to confirm relevance, and then full articles were extracted. References from extracted articles were also reviewed for relevant articles. In this review, we critically evaluate the limited historical evidence underlying the current teachings on cocaine's cardiovascular effects and management of cocaine-associated chest pain. We aim to update the reader on more recent, albeit small, studies on the emergency department evaluation and clinical and pharmacologic management of cocaine-associated chest pain. Finally, we summarize recent guidelines and review an algorithm based on the current best evidence.

  13. Enhanced graphitization of c-CVD grown multi-wall carbon nanotube arrays assisted by removal of encapsulated iron-based phases under thermal treatment in argon

    Energy Technology Data Exchange (ETDEWEB)

    Boncel, Slawomir, E-mail: slawomir.boncel@polsl.pl [Department of Organic Chemistry, Biochemistry and Biotechnology, Silesian University of Technology, Krzywoustego 4, 44-100 Gliwice (Poland); Koziol, Krzysztof K.K., E-mail: kk292@cam.ac.uk [Department of Materials Science and Metallurgy, University of Cambridge, 27 Charles Babbage Road, CB3 0FS Cambridge (United Kingdom)

    2014-05-01

    Graphical abstract: - Highlights: • Annealing of the c-CVD MWCNT arrays toward complete removal of iron nanoparticles. • The ICP-AES protocol established for quantitative analysis of Fe-content in MWCNTs. • The vertical alignment from the as-grown MWCNT arrays found intact after annealing. • A route to decrease number of defects/imperfections in the MWCNT graphene walls. • A foundation for commercial purification of c-CVD derived MWCNTs. - Abstract: The effect of annealing on multi-walled carbon nanotube (MWCNT) arrays grown via catalytic Chemical Vapour Deposition (c-CVD) was studied. The treatment enabled to decrease number of defects/imperfections in the graphene walls of MWCNTs’, which was reflected in Raman spectroscopy by reduction of the I{sub D}/I{sub G} ratio by 27%. Moreover, the vertical alignment from the as-synthesized nanotube arrays was found intact after annealing. Not only graphitization of the nanotube walls occurred under annealing, but the amount of metal iron-based catalyst residues (interfering with numerous physicochemical properties, and hence applications of MWCNTs) was reduced from 9.00 wt.% (for pristine MWCNTs) to 0.02 wt.% as detected by Inductively Coupled Plasma Atomic Emission Spectroscopy (ICP-AES). This value, established by a new analytical protocol, is the lowest recorded by now for purified c-CVD MWCNTs and, due to operating under atmospheric pressure, medium temperature regime (as for annealing processes), reasonable time-scale and metal residue non-specificity, it could lay the foundation for commercial purification of c-CVD derived MWCNTs.

  14. Echocardiographic Wall Motion Abnormality in Posterior Myocardial Infarction: The Diagnostic Value of Posterior Leads

    Directory of Open Access Journals (Sweden)

    A Darehzereshki

    2008-06-01

    Full Text Available Background: For the purpose of ascertaining myocardial infarction (MI and ischemia, the sensitivity of the initial 12-lead ECG is inadequate. It is risky to diagnose posterior MI using only precordial reciprocal changes, since the other leads may be more optimally positioned for the identification of electrocardiographic changes. In this study, we evaluated the relationship between electrocardiography changes and wall motion abnormalities in patients with posterior MI for earlier and better diagnosis of posterior MI.Methods: In this prospective cross-sectional study, we enrolled patients with posterior MI who had come to the Emergency Department of Shariati Hospital with their first episode of chest pain. A 12-lead surface electrocardiogram using posterior leads (V7-V9 was performed for all participants. Patients with ST elevation >0.05 mV or pathologic Q wave in the posterior leads, as well as those with specific changes indicating posterior MI in V1-V2, were evaluated by echocardiography in terms of wall motion abnormalities. All data were analyzed using SPSS and p<0.05 were considered statistically significant.Results: Of a total 79 patients enrolled, 48 (60.8% were men, and the mean age was 57.35±8.22 years. Smoking (54.4% and diabetes (48% were the most prevalent risk factors. In the echocardiographic evaluation, all patients had wall motion abnormalities in the left ventricle and 19 patients (24.1% had wall motion abnormalities in the right ventricle. The most frequent segment with motion abnormality among the all patients was the mid-posterior. The posterior leads showed better positive predictive value than the anterior leads for posterior wall motion abnormality.Conclusion: Electrocardiography of the posterior leads in patients with acute chest pain can help in earlier diagnosis and in time treatment of posterior MI.

  15. Can radiation therapy treatment planning system accurately predict surface doses in postmastectomy radiation therapy patients?

    Science.gov (United States)

    Wong, Sharon; Back, Michael; Tan, Poh Wee; Lee, Khai Mun; Baggarley, Shaun; Lu, Jaide Jay

    2012-01-01

    Skin doses have been an important factor in the dose prescription for breast radiotherapy. Recent advances in radiotherapy treatment techniques, such as intensity-modulated radiation therapy (IMRT) and new treatment schemes such as hypofractionated breast therapy have made the precise determination of the surface dose necessary. Detailed information of the dose at various depths of the skin is also critical in designing new treatment strategies. The purpose of this work was to assess the accuracy of surface dose calculation by a clinically used treatment planning system and those measured by thermoluminescence dosimeters (TLDs) in a customized chest wall phantom. This study involved the construction of a chest wall phantom for skin dose assessment. Seven TLDs were distributed throughout each right chest wall phantom to give adequate representation of measured radiation doses. Point doses from the CMS Xio® treatment planning system (TPS) were calculated for each relevant TLD positions and results correlated. There were no significant difference between measured absorbed dose by TLD and calculated doses by the TPS (p > 0.05 (1-tailed). Dose accuracy of up to 2.21% was found. The deviations from the calculated absorbed doses were overall larger (3.4%) when wedges and bolus were used. 3D radiotherapy TPS is a useful and accurate tool to assess the accuracy of surface dose. Our studies have shown that radiation treatment accuracy expressed as a comparison between calculated doses (by TPS) and measured doses (by TLD dosimetry) can be accurately predicted for tangential treatment of the chest wall after mastectomy. Copyright © 2012 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  16. [The surgical treatment of the diastasis recti abdominis: an original technique of prosthesis repair of the abdominal wall].

    Science.gov (United States)

    Angiò, L G; Piazzese, E; Pacilè, V; Sfuncia, G; Costantino Scirocco Fana, A; Fiumara, F; Bonsignore, A; Biondo, A

    2007-05-01

    The Authors talk about on the surgical correction of the diastasis recti abdominis and underline its indications and aims. Firstly, they specify the possibilities and define the limits of the traditional surgical method. Secondly, they illustrate the rational of an innovating and original technique of prosthesis repair of the abdominal anterior wall setted up to treat the important diastasis recti abdominis. Particularly, this technique is the result of a kind of eclecticism and integration of some phases of the Quénu's self-plastic surgery and of the Welti-Eudel and Chevrel's technique. Thirdly, the authors describe the sequence of the times of the new technique and present the preliminary clinical experience carried out with it. Therefore, they determine gratifying and encouraging the findings of this method as regards the immediate and enduring curative efficacy (cosmetic and functional), the security and the compliance of the patient. Finally, in accordance with the outcomes, the authors decide to defend the undoubted reliability of the prosthesis repair of the abdominal wall to treat the big diastasis recti abdominis. Moreover, they intend to pass definitive judgement on the method after further clinical experiences on larger series of cases.

  17. Chest radiographic findings in Human Immunodeficiency Virus ...

    African Journals Online (AJOL)

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

  18. Coronary CT angiography in acute chest pain

    OpenAIRE

    Nikhil Goyal; Arthur Stillman

    2017-01-01

    Coronary computed tomographic angiography has become a reliable diagnostic tool in the evaluation of patients with chest pain. Studies have shown this modality to be accurate and safe when compared with conventional methods of assessing patients with chest pain. We review the recent developments with coronary computed tomographic angiography and devote particular attention toward its application to triage patients in the emergency department.

  19. A comparative study on treatment of two and three walled periodontal bony defects utilizing open flap debridement with and without enamel matrix derivatives

    Directory of Open Access Journals (Sweden)

    Soleimani Shayesteh Y.

    2006-08-01

    Full Text Available Background and Aim: Intrabony periodontal defects are important problems in periodontology and up to now several ways have been suggested for their treatment .Treatment with enamel matrix derivatives (EMD has been shown to enhance periodontal regeneration. There is limited information available from clinical trials regarding the performance of EMD in the treatment of periodontal intrabony defects. This study was designed to compare the clinical and radiographic effects of EMD treatment to that of open flap debridment (OFD for two and three walled intrabony defects. Materials and Methods: 18 patients were included in this clinical trial which have 24 two and/ or three intrabony defects. Defects were randomly divided into two groups (test and control. Defects in test group were treated with flap surgery plus EMD and in control group with open flap debridment. At baseline and at 3 and 6 months follow up, clinical and radiographic measurements were performed. Data were analyzed using Greenhouse-Geisser test with p<0.05 as the limit of significance. Results: At 3 and 6 months, mean probing pocket depth reduction was greater in the test group (EMD (4.33 mm and 4.70 mm compared to the OFD group (2.54 mm and 3.09 mm. Mean values for clinical attachment gain in the EMD group after 3 and 6 months were 4.29 mm and 4.98 mm, and in OFD group were 2.83 and 2.82 mm respectively. Radiographic bone gain measured by radiovisiography technique was greater in the EMD group compared to the OFD group (4.66 mm in EMD and 1.11 mm in OFD group after 3 months and 5.78 mm in EMD and 1.39 mm in OFD group after 6 months. Conclusion: Based on the results of this study, treatment with flap surgery and EMD compared to open flap debridment, produced more favorable clinical improvements in two and three walled intrabony defects.

  20. The Scandinavian Sarcoma Group Central Register: 6,000 patients after 25 years of monitoring of referral and treatment of extremity and trunk wall soft-tissue sarcoma.

    Science.gov (United States)

    Trovik, Clement; Bauer, Henrik C F; Styring, Emelie; Sundby Hall, Kirsten; Vult Von Steyern, Fredrik; Eriksson, Sigvard; Johansson, Ingela; Sampo, Mika; Laitinen, Minna; Kalén, Anders; Jónsson, Halldór; Jebsen, Nina; Eriksson, Mikael; Tukiainen, Erkki; Wall, Najme; Zaikova, Olga; Sigurðsson, Helgi; Lehtinen, Tuula; Bjerkehagen, Bodil; Skorpil, Mikael; Egil Eide, Geir; Johansson, Elisabeth; Alvegard, Thor A

    2017-06-01

    Purpose - We wanted to examine the potential of the Scandinavian Sarcoma Group (SSG) Central Register, and evaluate referral and treatment practice for soft-tissue sarcomas in the extremities and trunk wall (STS) in the Nordic countries. Background - Based on incidence rates from the literature, 8,150 (7,000-9,300) cases of STS of the extremity and trunk wall should have been diagnosed in Norway, Finland, Iceland, and Sweden from 1987 through 2011. The SSG Register has 6,027 cases registered from this period, with 5,837 having complete registration of key variables. 10 centers have been reporting to the Register. The 5 centers that consistently report treat approximately 90% of the cases in their respective regions. The remaining centers have reported all the patients who were treated during certain time periods, but not for the entire 25-year period. Results - 59% of patients were referred to a sarcoma center untouched, i.e. before any attempt at open biopsy. There was an improvement from 52% during the first 5 years to 70% during the last 5 years. 50% had wide or better margins at surgery. Wide margins are now achieved less often than 20 years ago, in parallel with an increase in the use of radiotherapy. For the centers that consistently report, 97% of surviving patients are followed for more than 4 years. Metastasis-free survival (MFS) increased from 67% to 73% during the 25-year period. Interpretation - The Register is considered to be representative of extremity and trunk wall sarcoma disease in the population of Scandinavia, treated at the reporting centers. There were no clinically significant differences in treatment results at these centers.