Pulmonary embolism presenting with itinerant chest pain and migratory pleural effusion: A case report.

PubMed

Li, Wei; Chen, Chen; Chen, Mo; Xin, Tong; Gao, Peng

2018-06-01

Pulmonary embolism (PE) presents with complex clinical manifestations ranging from asymptomatic to chest pain, hemoptysis, syncope, shock, or sudden death. To the authors' knowledge, itinerant chest pain has not been reported as sign or symptom of PE. A 41-year-old woman presenting with left chest pain, no hemoptysis, or breathing difficulties. The chest pain was more severe on deep inspiration. Chest computed tomography (CT) and ultrasound imaging showed left pleural effusion. After antibiotic treatment, the left chest pain was alleviated, but a similar pain appeared in the right chest. Electrocardiogram, blood gas analysis, echocardiography, and D-dimer levels were unremarkable. Chest CT showed right pleural effusion. A CT pulmonary angiography (CTPA) unexpectedly revealed a PE in the right pulmonary artery. The patient was administered anticoagulant therapy and made a complete recovery. The use of CTPA to investigate the possible presence of PE in patients with unexplained migratory pleural effusion complaining of itinerant chest pain is important. Lessons should be learned from the early use of CTPA to investigate the possible presence of PE in patients.

Intermittent chest tube clamping may shorten chest tube drainage and postoperative hospital stay after lung cancer surgery: a propensity score matching analysis.

PubMed

Yan, Shi; Wang, Xing; Wang, Yaqi; Lv, Chao; Wang, Yuzhao; Wang, Jia; Yang, Yue; Wu, Nan

2017-12-01

Postoperative pleural drainage markedly influences the length of hospital stay and the financial costs of medical care. The safety of chest tube clamping before removal has been documented. This study aims to determine if intermittent chest tube clamping shortens the duration of chest tube drainage and hospital stay after lung cancer surgery. We retrospectively analyzed 285 consecutive patients with operable lung cancer treated using lobectomy and systematic mediastinal lymphadenectomy. The chest tube management protocol in our institution was changed in January 2014, and thus, 222 patients (clamping group) were managed with intermittent chest tube clamping, while 63 patients (control group) were managed with a traditional protocol. Propensity score matching at a 1:1 ratio was applied to balance variables potentially affecting the duration of chest tube drainage. Analyses were performed to compare drainage duration and postoperative hospital stay between the two groups in the matched cohort. Multivariate logistic regression analyses were performed to predict the factors associated with chest tube drainage duration. The rates of thoracocentesis after chest tube removal were similar between the clamping and control groups in the whole cohort (0.5% vs. 1.6%, P=0.386). The rates of pyrexia were also comparable in the two groups (2.3% vs. 3.2%, P=0.685). After propensity score matching, 61 cases remained in each group. Both chest tube drainage duration (3.9 vs. 4.8 days, P=0.001) and postoperative stay (5.7 vs. 6.4 days, P=0.025) were significantly shorter in the clamping group than in the control group. Factors significantly associated with shorter chest tube drainage duration were female sex, chest tube clamping, left lobectomy, and video-assisted thoracoscopic surgery (VATS) (P<0.05). Intermittent postoperative chest tube clamping may decrease the duration of chest tube drainage and postoperative hospital stay while maintaining patient safety.

Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative.

PubMed

Niles, Dana E; Duval-Arnould, Jordan; Skellett, Sophie; Knight, Lynda; Su, Felice; Raymond, Tia T; Sweberg, Todd; Sen, Anita I; Atkins, Dianne L; Friess, Stuart H; de Caen, Allan R; Kurosawa, Hiroshi; Sutton, Robert M; Wolfe, Heather; Berg, Robert A; Silver, Annemarie; Hunt, Elizabeth A; Nadkarni, Vinay M

2018-05-01

Pediatric in-hospital cardiac arrest cardiopulmonary resuscitation quality metrics have been reported in few children less than 8 years. Our objective was to characterize chest compression fraction, rate, depth, and compliance with 2015 American Heart Association guidelines across multiple pediatric hospitals. Retrospective observational study of data from a multicenter resuscitation quality collaborative from October 2015 to April 2017. Twelve pediatric hospitals across United States, Canada, and Europe. In-hospital cardiac arrest patients (age < 18 yr) with quantitative cardiopulmonary resuscitation data recordings. None. There were 112 events yielding 2,046 evaluable 60-second epochs of cardiopulmonary resuscitation (196,669 chest compression). Event cardiopulmonary resuscitation metric summaries (median [interquartile range]) by age: less than 1 year (38/112): chest compression fraction 0.88 (0.61-0.98), chest compression rate 119/min (110-129), and chest compression depth 2.3 cm (1.9-3.0 cm); for 1 to less than 8 years (42/112): chest compression fraction 0.94 (0.79-1.00), chest compression rate 117/min (110-124), and chest compression depth 3.8 cm (2.9-4.6 cm); for 8 to less than 18 years (32/112): chest compression fraction 0.94 (0.85-1.00), chest compression rate 117/min (110-123), chest compression depth 5.5 cm (4.0-6.5 cm). "Compliance" with guideline targets for 60-second chest compression "epochs" was predefined: chest compression fraction greater than 0.80, chest compression rate 100-120/min, and chest compression depth: greater than or equal to 3.4 cm in less than 1 year, greater than or equal to 4.4 cm in 1 to less than 8 years, and 4.5 to less than 6.6 cm in 8 to less than 18 years. Proportion of less than 1 year, 1 to less than 8 years, and 8 to less than 18 years events with greater than or equal to 60% of 60-second epochs meeting compliance (respectively): chest compression fraction was 53%, 81%, and 78%; chest compression rate was 32%, 50%, and 63%; chest compression depth was 13%, 19%, and 44%. For all events combined, total compliance (meeting all three guideline targets) was 10% (11/112). Across an international pediatric resuscitation collaborative, we characterized the landscape of pediatric in-hospital cardiac arrest chest compression quality metrics and found that they often do not meet 2015 American Heart Association guidelines. Guideline compliance for rate and depth in children less than 18 years is poor, with the greatest difficulty in achieving chest compression depth targets in younger children.

Chest tube insertion

MedlinePlus

... leaks from inside the lung into the chest ( pneumothorax ) Fluid buildup in the chest (called a pleural ... on the reason a chest tube is inserted. Pneumothorax most often improves, but sometimes surgery is needed ...

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

PubMed

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

2018-05-02

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

Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia.

PubMed

Esayag, Yaacov; Nikitin, Irina; Bar-Ziv, Jacob; Cytter, Ruth; Hadas-Halpern, Irith; Zalut, Todd; Yinnon, Amos M

2010-01-01

To assess the diagnostic value of the chest radiograph for the diagnosis of pneumonia in bedridden patients, using non-contrast-enhanced high-resolution chest computed tomography (CT) as the gold standard. We prospectively evaluated bedridden patients hospitalized with moderate to high clinical probability of pneumonia. Chest radiographs were interpreted in a blinded fashion by 3 observers and classified as definite, normal, or uncertain for pneumonia. Chest CT was obtained within 12 hours of chest radiograph. We applied Bayesian analysis to assess the accuracy of chest radiograph in the diagnosis of pneumonia. In a 5-month period, 58 patients were evaluated, 31 (53%) were female. Their chest radiographs were interpreted as negative, uncertain, or positive for pneumonia in 31 (53%), 15 (26%), and 12 (21%) patients, respectively, while CT confirmed pneumonia in 11 (35%), 10 (67%), and in 10 (83%). The sensitivity of the chest radiograph to diagnose pneumonia was 65%, the specificity was 93%, the positive and negative predictive values were, respectively, 83% and 65%, while the overall accuracy was 69% (95% confidence interval, 50%-79%). In bedridden patients with suspected pneumonia, a normal chest radiograph does not rule out the diagnosis, hence, a chest CT scan might provide valuable diagnostic information. Copyright 2010 Elsevier Inc. All rights reserved.

Use of chest sonography in acute-care radiology☆

PubMed Central

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

2008-01-01

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

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Woody, Neil M.; Videtic, Gregory M.M.; Stephans, Kevin L.

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

Calculation of the Cardiothoracic Ratio from Portable Anteroposterior Chest Radiography

PubMed Central

Chon, Sung Bin; Oh, Won Sup; Cho, Jun Hwi; Kim, Sam Soo

2011-01-01

Cardiothoracic ratio (CTR), the ratio of cardiac diameter (CD) to thoracic diameter (TD), is a useful screening method to detect cardiomegaly, but is reliable only on posteroanterior chest radiography (chest PA). We performed this cross-sectional 3-phase study to establish reliable CTR from anteroposterior chest radiography (chest AP). First, CDChest PA/CDChest AP ratios were determined at different radiation distances by manipulating chest computed tomography to simulate chest PA and AP. CDChest PA was inferred from multiplying CDChest AP by this ratio. Incorporating this CD and substituting the most recent TDChest PA, we calculated the 'corrected' CTR and compared it with the conventional one in patients who took both the chest radiographies. Finally, its validity was investigated among the critically ill patients who performed portable chest AP. CDChest PA/CDChest AP ratio was {0.00099 × (radiation distance [cm])} + 0.79 (n = 61, r = 1.00, P < 0.001). The corrected CTR was highly correlated with the conventional one (n = 34, difference: 0.00016 ± 0.029; r = 0.92, P < 0.001). It was higher in congestive than non-congestive patients (0.53 ± 0.085; n = 38 vs 0.49 ± 0.061; n = 46, P = 0.006). Its sensitivity and specificity was 61% and 54%. In summary, reliable CTR can be calculated from chest AP with an available previous chest PA. This might help physicians detect congestive cardiomegaly for patients undergoing portable chest AP. PMID:22065900

Improved drainage with active chest tube clearance.

PubMed

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

2010-05-01

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

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

PubMed

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

2018-03-01

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

The effect of cold application on pain due to chest tube removal.

PubMed

Ertuğ, Nurcan; Ulker, Saadet

2012-03-01

The aim of the research is to determine the effect of cold application on the pain owing to chest tube removal for patients with single pleural chest tube. Removal of chest tubes causes patients to feel pain and interventions used for reducing the pain owing to the removal of chest tubes are not sufficient. Controlled clinical trial with repeated measures. This study was conducted with 140 patients, of whom 70 patients were in the experimental group and 70 patients were in the control group, in a thoracic hospital in Turkey. Data were collected using a data collection form consisting of patients' demographic and health history and Visual Analogue Scale. Cold was applied to patients in the experimental group prior to chest tube removal. In the experimental group, skin temperature and pain intensity was measured for each patient at four time points. In the control group, pain intensity was evaluated for each patient at three time points. Data were evaluated using Chi-square and Repeated Measurements two-way anova tests. The Visual Analogue Scale score was measured immediately after the chest tube removal in the experimental group was 3·85, compared with 5·60 in the control group. There were significant differences on pain with cold application between the two groups prior and after the intervention. Age, gender, the number of days the chest tube was inserted and the chest tube insertion indication had no effect on the pain owing to chest tube removal. Cold application is effective in reducing the pain owing to chest tube removal. Cold application was recommended prior to chest tube removal to reduce the pain owing to removal of chest tube. © 2011 Blackwell Publishing Ltd.

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

PubMed

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.

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

PubMed

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

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

Small-bore chest tubes seem to perform better than larger tubes in treatment of spontaneous pneumothorax.

PubMed

Iepsen, Ulrik Winning; Ringbæk, Thomas

2013-06-01

The aim of this study was to compare the efficacy and complications of surgical (large-bore) chest tube drainage with smaller and less invasive chest tubes in the treatment of non-traumatic pneumothorax (PT).  This was a retrospective study of 104 cases (94 patients) of non-traumatic PT treated with chest tubes - either by pulmonary physicians (daytime and weekdays) using small-bore chest tubes, or by orthopaedic surgeons (remaining time slots) using large-bore chest tubes.  A total of 62 had primary spontaneous PT, 30 had secondary spontaneous PT and 12 had iatrogenic PT. A total of 62 patients were treated with large-bore (20-28 Fr) chest tubes placed with traditional thoracotomy, 42 patients were treated by a pulmonary physician, and in 30 of these cases a True-Close thoracic vent (11-13 Fr) was inserted. Patients treated with surgical chest tubes were comparable with patients treated with smaller chest tubes in terms of demographic data and type and size of PT. Compared with patients treated with smaller chest tubes, patients with surgical large-bore tubes had more complications (27.4% versus 9.5%; p = 0.026), a lower success rate (56.5% versus 85.7%; p = 0.002), and longer duration of chest tube (8.3 versus 4.9 days; p = 0.001) and of hospitalisation (11.8 versus 6.9 days; p = 0.004).  We found small chest tubes to be superior to large-bore chest tubes with regard to short-term outcomes in the treatment of non-traumatic PT.  not relevant. The project was approved by the Danish Data Protection Agency, file no. 2012-41-0554. 

Costochondritis

MedlinePlus

Chest wall pain; Costosternal syndrome; Costosternal chondrodynia; Chest pain - costochondritis ... The most common symptom of costochondritis is pain and tenderness in the chest. You may feel: Sharp pain at the front of your chest wall, which may move to your back ...

Retrospective Cohort Analysis of Chest Injury Characteristics and Concurrent Injuries in Patients Admitted to Hospital in the Wenchuan and Lushan Earthquakes in Sichuan, China

PubMed Central

Yuan, Yong; Zhao, Yong-Fan

2014-01-01

Background The aim of this study was to compare retrospectively the characteristics of chest injuries and frequencies of other, concurrent injuries in patients after earthquakes of different seismic intensity. Methods We compared the cause, type, and body location of chest injuries as well as the frequencies of other, concurrent injuries in patients admitted to our hospital after the Wenchuan and Lushan earthquakes in Sichuan, China. We explored possible relationships between seismic intensity and the causes and types of injuries, and we assessed the ability of the Injury Severity Score, New Injury Severity Score, and Chest Injury Index to predict respiratory failure in chest injury patients. Results The incidence of chest injuries was 9.9% in the stronger Wenchuan earthquake and 22.2% in the less intensive Lushan earthquake. The most frequent cause of chest injuries in both earthquakes was being accidentally struck. Injuries due to falls were less prevalent in the stronger Wenchuan earthquake, while injuries due to burial were more prevalent. The distribution of types of chest injury did not vary significantly between the two earthquakes, with rib fractures and pulmonary contusions the most frequent types. Spinal and head injuries concurrent with chest injuries were more prevalent in the less violent Lushan earthquake. All three trauma scoring systems showed poor ability to predict respiratory failure in patients with earthquake-related chest injuries. Conclusions Previous studies may have underestimated the incidence of chest injury in violent earthquakes. The distributions of types of chest injury did not differ between these two earthquakes of different seismic intensity. Earthquake severity and interval between rescue and treatment may influence the prevalence and types of injuries that co-occur with the chest injury. Trauma evaluation scores on their own are inadequate predictors of respiratory failure in patients with earthquake-related chest injuries. PMID:24816485

Retrospective cohort analysis of chest injury characteristics and concurrent injuries in patients admitted to hospital in the Wenchuan and Lushan earthquakes in Sichuan, China.

PubMed

Zheng, Xi; Hu, Yang; Yuan, Yong; Zhao, Yong-Fan

2014-01-01

The aim of this study was to compare retrospectively the characteristics of chest injuries and frequencies of other, concurrent injuries in patients after earthquakes of different seismic intensity. We compared the cause, type, and body location of chest injuries as well as the frequencies of other, concurrent injuries in patients admitted to our hospital after the Wenchuan and Lushan earthquakes in Sichuan, China. We explored possible relationships between seismic intensity and the causes and types of injuries, and we assessed the ability of the Injury Severity Score, New Injury Severity Score, and Chest Injury Index to predict respiratory failure in chest injury patients. The incidence of chest injuries was 9.9% in the stronger Wenchuan earthquake and 22.2% in the less intensive Lushan earthquake. The most frequent cause of chest injuries in both earthquakes was being accidentally struck. Injuries due to falls were less prevalent in the stronger Wenchuan earthquake, while injuries due to burial were more prevalent. The distribution of types of chest injury did not vary significantly between the two earthquakes, with rib fractures and pulmonary contusions the most frequent types. Spinal and head injuries concurrent with chest injuries were more prevalent in the less violent Lushan earthquake. All three trauma scoring systems showed poor ability to predict respiratory failure in patients with earthquake-related chest injuries. Previous studies may have underestimated the incidence of chest injury in violent earthquakes. The distributions of types of chest injury did not differ between these two earthquakes of different seismic intensity. Earthquake severity and interval between rescue and treatment may influence the prevalence and types of injuries that co-occur with the chest injury. Trauma evaluation scores on their own are inadequate predictors of respiratory failure in patients with earthquake-related chest injuries.

Safety and efficacy of 2,790-nm laser resurfacing for chest photoaging.

PubMed

Grunebaum, Lisa D; Murdock, Jennifer; Cofnas, Paul; Kaufman, Joely

2015-01-01

Chest photodamage is a common cosmetic complaint. Laser treatment of the chest may be higher risk than other areas. The objective of this study was to assess the safety and efficacy of 2,790-nm chest resurfacing for photodamage. Twelve patients with Fitzpatrick skin types I-III were enrolled in this university IRB-approved study. Photo documentation was obtained at baseline and each visit. A test spot with the 2,790-nm resurfacing laser was performed on the chest. Patients who did not have adverse effects from the test spot went on to have a full chest resurfacing procedure. Patients were instructed on standardized aftercare, including sunscreen. A 5-point healing and photodamage improvement scale was used to rate improvement by both investigators and the patients and was obtained at 2 weeks, 1 month, 2 months, and 3 months. One pass chest treatment with the 2,790-nm resurfacing laser at fluences greater than or equal to 3.0 mJ with 10% overlap leads to unacceptable rates of hyperpigmentation. Double pass chest treatment at fluences less than or equal to 2.5 mJ with 10% overlap leads to mild improvement in chest photodamage parameters without significant or persistent adverse effects. Laser treatment of aging/photodamaged chest skin remains a challenge due to the delicacy of chest skin. Mild improvement may be obtained with double pass resurfacing with the 2,790-nm wavelength.

[Chest pain units or chest pain algorithm?].

PubMed

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.

A System Approach to Navy Medical Education and Training. Appendix 37. Competency Curricula for Respiratory Therapy Assistant and Respiratory Therapy Technician.

DTIC Science & Technology

1974-08-31

of Intermittent Positive Pressure Breathing Treatment . . . . . . . . ... 13 5. Chest Physiotherapy ...... . .. . . . . . 14 6. Respiratory Exercises...12 4 Administration of Intermittent Positive Pressure Breathing Treatment . . .. .. . . . 13 5 Chest Physiotherapy ................... 14...MODULE 5- CHEST PHYSIOTHERAPY TASK(S a. Perform chest vibration and cupping treatmen~t, i.e., chest physiotherapy b. Place patient in postural

A Novel Method of Newborn Chest Compression: A Randomized Crossover Simulation Study.

PubMed

Smereka, Jacek; Szarpak, Lukasz; Ladny, Jerzy R; Rodriguez-Nunez, Antonio; Ruetzler, Kurt

2018-01-01

Objective: To compare a novel two-thumb chest compression technique with standard techniques during newborn resuscitation performed by novice physicians in terms of median depth of chest compressions, degree of full chest recoil, and effective compression efficacy. Patients and Methods: The total of 74 novice physicians with less than 1-year work experience participated in the study. They performed chest compressions using three techniques: (A) The new two-thumb technique (nTTT). The novel method of chest compressions in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist. (B) TFT. With this method, the rescuer compresses the sternum with the tips of two fingers. (C) TTHT. Two thumbs are placed over the lower third of the sternum, with the fingers encircling the torso and supporting the back. Results: The median depth of chest compressions for nTTT was 3.8 (IQR, 3.7-3.9) cm, for TFT-2.1 (IQR, 1.7-2.5) cm, while for TTHT-3.6 (IQR, 3.5-3.8) cm. There was a significant difference between nTTT and TFT, and TTHT and TFT ( p < 0.001) for each time interval during resuscitation. The degree of full chest recoil was 93% (IQR, 91-97) for nTTT, 99% (IQR, 96-100) for TFT, and 90% (IQR, 74-91) for TTHT. There was a statistically significant difference in the degree of complete chest relaxation between nTTT and TFT ( p < 0.001), between nTTT and TTHT ( p = 0.016), and between TFT and TTHT ( p < 0.001). Conclusion: The median chest compression depth for nTTT and TTHT is significantly higher than that for TFT. The degree of full chest recoil was highest for TFT, then for nTTT and TTHT. The effective compression efficiency with nTTT was higher than for TTHT and TFT. Our novel newborn chest compression method in this manikin study provided adequate chest compression depth and degree of full chest recoil, as well as very good effective compression efficiency. Further clinical studies are necessary to confirm these initial results.

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

PubMed

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

2016-02-01

The chest response of the human body has been studied for several load conditions, but is not well known in the case of steering wheel rim-to-chest impact in heavy goods vehicle frontal collisions. The aim of this study was to determine the response of the human chest in a set of simulated steering wheel impacts. PMHS tests were carried out and analysed. The steering wheel load pattern was represented by a rigid pendulum with a straight bar-shaped front. A crash test dummy chest calibration pendulum was utilised for comparison. In this study, a set of rigid bar impacts were directed at various heights of the chest, spanning approximately 120mm around the fourth intercostal space. The impact energy was set below a level estimated to cause rib fracture. The analysed results consist of responses, evaluated with respect to differences in the impacting shape and impact heights on compression and viscous criteria chest injury responses. The results showed that the bar impacts consistently produced lesser scaled chest compressions than the hub; the Middle bar responses were around 90% of the hub responses. A superior bar impact provided lesser chest compression; the average response was 86% of the Middle bar response. For inferior bar impacts, the chest compression response was 116% of the chest compression in the middle. The damping properties of the chest caused the compression to decrease in the high speed bar impacts to 88% of that in low speed impacts. From the analysis it could be concluded that the bar impact shape provides lower chest criteria responses compared to the hub. Further, the bar responses are dependent on the impact location of the chest. Inertial and viscous effects of the upper body affect the responses. The results can be used to assess the responses of human substitutes such as anthropomorphic test devices and finite element human body models, which will benefit the development process of heavy goods vehicle safety systems. Copyright © 2015 Elsevier Ltd. All rights reserved.

Sexual signalling in Propithecus verreauxi: male "chest badge" and female mate choice.

PubMed

Dall'Olio, Stefania; Norscia, Ivan; Antonacci, Daniela; Palagi, Elisabetta

2012-01-01

Communication, an essential prerequisite for sociality, involves the transmission of signals. A signal can be defined as any action or trait produced by one animal, the sender, that produces a change in the behaviour of another animal, the receiver. Secondary sexual signals are often used for mate choice because they may inform on a potential partner's quality. Verreaux's sifaka (Propithecus verreauxi) is characterized by the presence of two different morphs of males (bimorphism), which can show either a stained or clean chest. The chest becomes stained by secretions of the sternal gland during throat marking (rubbing throat and chest on a vertical substrate while smearing the scent deposition). The role of the chest staining in guiding female mate choice was previously hypothesized but never demonstrated probably due to the difficulty of observing sifaka copulations in the wild. Here we report that stained-chested males had a higher throat marking activity than clean-chested males during the mating season, but not during the birth season. We found that females copulated more frequently with stained-chested males than the clean-chested males. Finally, in agreement with the biological market theory, we found that clean-chested males, with a lower scent-releasing potential, offered more grooming to females. This "grooming for sex" tactic was not completely unsuccessful; in fact, half of the clean-chested males copulated with females, even though at low frequency. In conclusion, the chest stain, possibly correlated with different cues targeted by females, could be one of the parameters which help females in selecting mates.

Sexual Signalling in Propithecus verreauxi: Male “Chest Badge” and Female Mate Choice

PubMed Central

Dall'Olio, Stefania; Norscia, Ivan; Antonacci, Daniela; Palagi, Elisabetta

2012-01-01

Communication, an essential prerequisite for sociality, involves the transmission of signals. A signal can be defined as any action or trait produced by one animal, the sender, that produces a change in the behaviour of another animal, the receiver. Secondary sexual signals are often used for mate choice because they may inform on a potential partner's quality. Verreaux's sifaka (Propithecus verreauxi) is characterized by the presence of two different morphs of males (bimorphism), which can show either a stained or clean chest. The chest becomes stained by secretions of the sternal gland during throat marking (rubbing throat and chest on a vertical substrate while smearing the scent deposition). The role of the chest staining in guiding female mate choice was previously hypothesized but never demonstrated probably due to the difficulty of observing sifaka copulations in the wild. Here we report that stained-chested males had a higher throat marking activity than clean-chested males during the mating season, but not during the birth season. We found that females copulated more frequently with stained-chested males than the clean-chested males. Finally, in agreement with the biological market theory, we found that clean-chested males, with a lower scent-releasing potential, offered more grooming to females. This “grooming for sex” tactic was not completely unsuccessful; in fact, half of the clean-chested males copulated with females, even though at low frequency. In conclusion, the chest stain, possibly correlated with different cues targeted by females, could be one of the parameters which help females in selecting mates. PMID:22615982

Optimal control of CPR procedure using hemodynamic circulation model

DOEpatents

Lenhart, Suzanne M.; Protopopescu, Vladimir A.; Jung, Eunok

2007-12-25

A method for determining a chest pressure profile for cardiopulmonary resuscitation (CPR) includes the steps of representing a hemodynamic circulation model based on a plurality of difference equations for a patient, applying an optimal control (OC) algorithm to the circulation model, and determining a chest pressure profile. The chest pressure profile defines a timing pattern of externally applied pressure to a chest of the patient to maximize blood flow through the patient. A CPR device includes a chest compressor, a controller communicably connected to the chest compressor, and a computer communicably connected to the controller. The computer determines the chest pressure profile by applying an OC algorithm to a hemodynamic circulation model based on the plurality of difference equations.

Herniation of unruptured tuberculous lung abscess into chest wall without pleural or bronchial spillage

PubMed Central

Magazine, Rahul; Mohapatra, Aswini K.; Manu, Mohan K.; Srivastava, Rajendra K.

2011-01-01

A 22-year-old unmarried man presented to the chest outpatient department with a history of productive cough of two-month duration. He also complained of pain and swelling on the anterior aspect of right side of chest of one-month duration. Imaging studies of the thorax, including chest roentgenography and computerized tomography, revealed an unruptured lung abscess which had herniated into the chest wall. Culture of pus aspirated from the chest wall swelling grew Mycobacterium tuberculosis. He was diagnosed to have a tuberculous lung abscess which had extended into the chest wall, without spillage into the pleural cavity or the bronchial tree. Antituberculosis drugs were prescribed, and he responded to the treatment with complete resolution of the lesion. PMID:22084547

Update on mechanical cardiopulmonary resuscitation devices.

PubMed

Rubertsson, Sten

2016-06-01

The aim of this review is to update and discuss the use of mechanical chest compression devices in treatment of cardiac arrest. Three recently published large multicenter randomized trials have not been able to show any improved outcome in adult out-of-hospital cardiac arrest patients when compared with manual chest compressions. Mechanical chest compression devices have been developed to better deliver uninterrupted chest compressions of good quality. Prospective large randomized studies have not been able to prove a better outcome compared to manual chest compressions; however, latest guidelines support their use when high-quality manual chest compressions cannot be delivered. Mechanical chest compressions can also be preferred during transportation, in the cath-lab and as a bridge to more invasive support like extracorporeal membrane oxygenation.

Group A beta-haemolytic streptococcal acute chest event in a child with sickle cell anaemia.

PubMed

Suara, R O

2001-06-01

Acute chest syndrome is a major cause of death and hospitalisation in children with sickle cell anaemia. It is often initiated by an infection, particularly pneumonia. Microbial agents previously not associated with acute chest syndrome are becoming increasingly important. Group A beta-haemolytic Streptococcus (GABHS) is thought to be an uncommon cause of pneumonia in children with sickle cell anaemia. We report a 15-year-old African-American girl who presented with an acute chest event characterised by fever, cough, chest pain, shortness of breath, right upper abdominal quadrant pain, jaundice and otitis media. Chest radiograph showed multi-lobar pneumonia with left pleural effusion. Group A beta-haemolytic Streptococcus was isolated from culture of pleural and middle ear fluids. She responded to therapy that included antibiotics, exchange blood transfusion, oxygen, thoracotomy chest tube drainage and decortication. In a child with sickle cell anaemia presenting with fever and an acute chest event, pneumonia should be considered and GABHS recognised as a possible aetiological agent. In addition, a chest X-ray should be obtained and antibiotics against agents causing community-acquired pneumonia instituted.

Reconstruction of chest wall using a two-layer prolene mesh and bone cement sandwich.

PubMed

Aghajanzadeh, Manouchehr; Alavi, Ali; Aghajanzadeh, Gilda; Ebrahimi, Hannan; Jahromi, Sina Khajeh; Massahnia, Sara

2015-02-01

Wide surgical resection is the most effective treatment for the vast majority of chest wall tumors. This study evaluated the clinical success of chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich. The records of all patients undergoing chest wall resection and reconstruction were reviewed. Surgical indications, the location and size of the chest wall defect, diaphragm resection, pulmonary performance, postoperative complications, and survival of each patient were recorded. From 1998 to 2008, 43 patients (27 male, 16 female; mean age of 48 years) underwent surgery in our department to treat malignant chest wall tumors: chondrosarcoma (23), osteosarcoma (8), spindle cell sarcoma (6), Ewing's sarcoma (2), and others (4). Nine sternectomies and 34 antero-lateral and postero-lateral chest wall resections were performed. Postoperatively, nine patients experienced respiratory complications, and one patient died because of respiratory failure. The overall 4-year survival rate was 60 %. Chest wall reconstruction using a Prolene mesh and bone cement prosthetic sandwich is a safe and effective surgical procedure for major chest wall defects.

Chest Fat Quantification via CT Based on Standardized Anatomy Space in Adult Lung Transplant Candidates

PubMed Central

Tong, Yubing; Udupa, Jayaram K.; Torigian, Drew A.; Odhner, Dewey; Wu, Caiyun; Pednekar, Gargi; Palmer, Scott; Rozenshtein, Anna; Shirk, Melissa A.; Newell, John D.; Porteous, Mary; Diamond, Joshua M.

2017-01-01

Purpose Overweight and underweight conditions are considered relative contraindications to lung transplantation due to their association with excess mortality. Yet, recent work suggests that body mass index (BMI) does not accurately reflect adipose tissue mass in adults with advanced lung diseases. Alternative and more accurate measures of adiposity are needed. Chest fat estimation by routine computed tomography (CT) imaging may therefore be important for identifying high-risk lung transplant candidates. In this paper, an approach to chest fat quantification and quality assessment based on a recently formulated concept of standardized anatomic space (SAS) is presented. The goal of the paper is to seek answers to several key questions related to chest fat quantity and quality assessment based on a single slice CT (whether in the chest, abdomen, or thigh) versus a volumetric CT, which have not been addressed in the literature. Methods Unenhanced chest CT image data sets from 40 adult lung transplant candidates (age 58 ± 12 yrs and BMI 26.4 ± 4.3 kg/m2), 16 with chronic obstructive pulmonary disease (COPD), 16 with idiopathic pulmonary fibrosis (IPF), and the remainder with other conditions were analyzed together with a single slice acquired for each patient at the L5 vertebral level and mid-thigh level. The thoracic body region and the interface between subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in the chest were consistently defined in all patients and delineated using Live Wire tools. The SAT and VAT components of chest were then segmented guided by this interface. The SAS approach was used to identify the corresponding anatomic slices in each chest CT study, and SAT and VAT areas in each slice as well as their whole volumes were quantified. Similarly, the SAT and VAT components were segmented in the abdomen and thigh slices. Key parameters of the attenuation (Hounsfield unit (HU) distributions) were determined from each chest slice and from the whole chest volume separately for SAT and VAT components. The same parameters were also computed from the single abdominal and thigh slices. The ability of the slice at each anatomic location in the chest (and abdomen and thigh) to act as a marker of the measures derived from the whole chest volume was assessed via Pearson correlation coefficient (PCC) analysis. Results The SAS approach correctly identified slice locations in different subjects in terms of vertebral levels. PCC between chest fat volume and chest slice fat area was maximal at the T8 level for SAT (0.97) and at the T7 level for VAT (0.86), and was modest between chest fat volume and abdominal slice fat area for SAT and VAT (0.73 and 0.75, respectively). However, correlation was weak for chest fat volume and thigh slice fat area for SAT and VAT (0.52 and 0.37, respectively), and for chest fat volume for SAT and VAT and BMI (0.65 and 0.28, respectively). These same single slice locations with maximal PCC were found for SAT and VAT within both COPD and IPF groups. Most of the attenuation properties derived from the whole chest volume and single best chest slice for VAT (but not for SAT) were significantly different between COPD and IPF groups. Conclusions This study demonstrates a new way of optimally selecting slices whose measurements may be used as markers of similar measurements made on the whole chest volume. The results suggest that one or two slices imaged at T7 and T8 vertebral levels may be enough to estimate reliably the total SAT and VAT components of chest fat and the quality of chest fat as determined by attenuation distributions in the entire chest volume. PMID:28046024

Chest Fat Quantification via CT Based on Standardized Anatomy Space in Adult Lung Transplant Candidates.

PubMed

Tong, Yubing; Udupa, Jayaram K; Torigian, Drew A; Odhner, Dewey; Wu, Caiyun; Pednekar, Gargi; Palmer, Scott; Rozenshtein, Anna; Shirk, Melissa A; Newell, John D; Porteous, Mary; Diamond, Joshua M; Christie, Jason D; Lederer, David J

2017-01-01

Overweight and underweight conditions are considered relative contraindications to lung transplantation due to their association with excess mortality. Yet, recent work suggests that body mass index (BMI) does not accurately reflect adipose tissue mass in adults with advanced lung diseases. Alternative and more accurate measures of adiposity are needed. Chest fat estimation by routine computed tomography (CT) imaging may therefore be important for identifying high-risk lung transplant candidates. In this paper, an approach to chest fat quantification and quality assessment based on a recently formulated concept of standardized anatomic space (SAS) is presented. The goal of the paper is to seek answers to several key questions related to chest fat quantity and quality assessment based on a single slice CT (whether in the chest, abdomen, or thigh) versus a volumetric CT, which have not been addressed in the literature. Unenhanced chest CT image data sets from 40 adult lung transplant candidates (age 58 ± 12 yrs and BMI 26.4 ± 4.3 kg/m2), 16 with chronic obstructive pulmonary disease (COPD), 16 with idiopathic pulmonary fibrosis (IPF), and the remainder with other conditions were analyzed together with a single slice acquired for each patient at the L5 vertebral level and mid-thigh level. The thoracic body region and the interface between subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) in the chest were consistently defined in all patients and delineated using Live Wire tools. The SAT and VAT components of chest were then segmented guided by this interface. The SAS approach was used to identify the corresponding anatomic slices in each chest CT study, and SAT and VAT areas in each slice as well as their whole volumes were quantified. Similarly, the SAT and VAT components were segmented in the abdomen and thigh slices. Key parameters of the attenuation (Hounsfield unit (HU) distributions) were determined from each chest slice and from the whole chest volume separately for SAT and VAT components. The same parameters were also computed from the single abdominal and thigh slices. The ability of the slice at each anatomic location in the chest (and abdomen and thigh) to act as a marker of the measures derived from the whole chest volume was assessed via Pearson correlation coefficient (PCC) analysis. The SAS approach correctly identified slice locations in different subjects in terms of vertebral levels. PCC between chest fat volume and chest slice fat area was maximal at the T8 level for SAT (0.97) and at the T7 level for VAT (0.86), and was modest between chest fat volume and abdominal slice fat area for SAT and VAT (0.73 and 0.75, respectively). However, correlation was weak for chest fat volume and thigh slice fat area for SAT and VAT (0.52 and 0.37, respectively), and for chest fat volume for SAT and VAT and BMI (0.65 and 0.28, respectively). These same single slice locations with maximal PCC were found for SAT and VAT within both COPD and IPF groups. Most of the attenuation properties derived from the whole chest volume and single best chest slice for VAT (but not for SAT) were significantly different between COPD and IPF groups. This study demonstrates a new way of optimally selecting slices whose measurements may be used as markers of similar measurements made on the whole chest volume. The results suggest that one or two slices imaged at T7 and T8 vertebral levels may be enough to estimate reliably the total SAT and VAT components of chest fat and the quality of chest fat as determined by attenuation distributions in the entire chest volume.

Chest X-Ray (Chest Radiography)

MedlinePlus

... may be necessary to clarify the results of a chest x-ray or to look for abnormalities not visible on the chest x-ray. top of page Additional Information and Resources RTAnswers.org Radiation Therapy for Lung Cancer top of page This page ...

Tube thoracostomy; chest tube implantation and follow up

PubMed Central

Kuhajda, Ivan; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Huang, Haidong; Li, Qiang; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Papaiwannou, Antonis; Lampaki, Sofia; Papaiwannou, Antonis; Zaric, Bojan; Branislav, Perin; Porpodis, Konstantinos

2014-01-01

Pneumothorax is an urgent medical situation that requires urgent treatment. We can divide this entity based on the etiology to primary and secondary. Chest tube implantation can be performed either in the upper chest wall or lower. Both thoracic surgeons and pulmonary physicians can place a chest tube with minimal invasive techniques. In our current work, we will demonstrate chest tube implantation to locations, methodology and tools. PMID:25337405

Advances in chest drain management in thoracic disease

PubMed Central

George, Robert S.

2016-01-01

An adequate chest drainage system aims to drain fluid and air and restore the negative pleural pressure facilitating lung expansion. In thoracic surgery the post-operative use of the conventional underwater seal chest drainage system fulfills these requirements, however they allow great variability amongst practices. In addition they do not offer accurate data and they are often inconvenient to both patients and hospital staff. This article aims to simplify the myths surrounding the management of chest drains following chest surgery, review current experience and explore the advantages of modern digital chest drain systems and address their disease-specific use. PMID:26941971

Management of Congenital Chest Wall Deformities

PubMed Central

Blanco, Felix C.; Elliott, Steven T.; Sandler, Anthony D.

2011-01-01

Congenital chest wall deformities are considered to be anomalies in chest wall growth. These can be categorized as either rib cage overgrowth or deformities related to inadequate growth (aplasia or dysplasia). Rib cage overgrowth leads to depression of the sternum (pectus excavatum) or protuberance of the sternum (pectus carinatum) and accounts for greater than 90% of congenital chest wall deformities. The remaining deformities are a result of inadequate growth. Evolution in the management of congenital chest wall deformities has made significant progress over the past 25 years. This article will review chest wall deformities and the current management strategies of these interesting anomalies. PMID:22294949

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

PubMed

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

2011-09-27

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

Sound transmission in the chest under surface excitation - An experimental and computational study with diagnostic applications

PubMed Central

Peng, Ying; Dai, Zoujun; Mansy, Hansen A.; Sandler, Richard H.; Balk, Robert A; Royston, Thomas. J

2014-01-01

Chest physical examination often includes performing chest percussion, which involves introducing sound stimulus to the chest wall and detecting an audible change. This approach relies on observations that underlying acoustic transmission, coupling, and resonance patterns can be altered by chest structure changes due to pathologies. More accurate detection and quantification of these acoustic alterations may provide further useful diagnostic information. To elucidate the physical processes involved, a realistic computer model of sound transmission in the chest is helpful. In the present study, a computational model was developed and validated by comparing its predictions with results from animal and human experiments which involved applying acoustic excitation to the anterior chest while detecting skin vibrations at the posterior chest. To investigate the effect of pathology on sound transmission, the computational model was used to simulate the effects of pneumothorax on sounds introduced at the anterior chest and detected at the posterior. Model predictions and experimental results showed similar trends. The model also predicted wave patterns inside the chest, which may be used to assess results of elastography measurements. Future animal and human tests may expand the predictive power of the model to include acoustic behavior for a wider range of pulmonary conditions. PMID:25001497

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

PubMed

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

2018-05-01

Transmasculine youth, who are assigned female at birth but have a gender identity along the masculine spectrum, often report considerable distress after breast development (chest dysphoria). Professional guidelines lack clarity regarding referring minors (defined as people younger than 18 years) for chest surgery because there are no data documenting the effect of chest surgery on minors. To examine the amount of chest dysphoria in transmasculine youth who had had chest reconstruction surgery compared with those who had not undergone this surgery. Using a novel measure of chest dysphoria, this cohort study at a large, urban, hospital-affiliated ambulatory clinic specializing in transgender youth care collected survey data about testosterone use and chest distress among transmasculine youth and young adults. Additional information about regret and adverse effects was collected from those who had undergone surgery. Eligible youth were 13 to 25 years old, had been assigned female at birth, and had an identified gender as something other than female. Recruitment occurred during clinical visits and via telephone between June 2016 and December 2016. Surveys were collected from participants who had undergone chest surgery at the time of survey collection and an equal number of youth who had not undergone surgery. Outcomes were chest dysphoria composite score (range 0-51, with higher scores indicating greater distress) in all participants; desire for chest surgery in patients who had not had surgery; and regret about surgery and complications of surgery in patients who were postsurgical. Of 136 completed surveys, 68 (50.0%) were from postsurgical participants, and 68 (50.0%) were from nonsurgical participants. At the time of the survey, the mean (SD) age was 19 (2.5) years for postsurgical participants and 17 (2.5) years for nonsurgical participants. Chest dysphoria composite score mean (SD) was 29.6 (10.0) for participants who had not undergone chest reconstruction, which was significantly higher than mean (SD) scores in those who had undergone this procedure (3.3 [3.8]; P < .001). Among the nonsurgical cohort, 64 (94%) perceived chest surgery as very important, and chest dysphoria increased by 0.33 points each month that passed between a youth initiating testosterone therapy and undergoing surgery. Among the postsurgical cohort, the most common complication of surgery was loss of nipple sensation, whether temporary (59%) or permanent (41%). Serious complications were rare and included postoperative hematoma (10%) and complications of anesthesia (7%). Self-reported regret was near 0. Chest dysphoria was high among presurgical transmasculine youth, and surgical intervention positively affected both minors and young adults. Given these findings, professional guidelines and clinical practice should consider patients for chest surgery based on individual need rather than chronologic age.

Riociguat for the treatment of chronic thromboembolic pulmonary hypertension: a long-term extension study (CHEST-2).

PubMed

Simonneau, Gérald; D'Armini, Andrea M; Ghofrani, Hossein-Ardeschir; Grimminger, Friedrich; Hoeper, Marius M; Jansa, Pavel; Kim, Nick H; Wang, Chen; Wilkins, Martin R; Fritsch, Arno; Davie, Neil; Colorado, Pablo; Mayer, Eckhard

2015-05-01

Riociguat is a soluble guanylate cyclase stimulator approved for the treatment of inoperable and persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH). In the 16-week CHEST-1 study, riociguat showed a favourable benefit-risk profile and improved several clinically relevant end-points in patients with CTEPH. The CHEST-2 open-label extension evaluated the long-term safety and efficacy of riociguat. Eligible patients from CHEST-1 received riociguat individually adjusted up to a maximum dose of 2.5 mg three times daily. The primary objective was the safety and tolerability of riociguat; exploratory efficacy end-points included 6-min walking distance (6MWD) and World Health Organization (WHO) functional class (FC). Overall, 237 patients entered CHEST-2 and 211 (89%) were ongoing at this interim analysis (March 2013). The safety profile of riociguat in CHEST-2 was similar to CHEST-1, with no new safety signals. Improvements in 6MWD and WHO FC observed in CHEST-1 persisted for up to 1 year in CHEST-2. In the observed population at 1 year, mean±sd 6MWD had changed by +51±62 m (n=172) versus CHEST-1 baseline (n=237), and WHO FC had improved/stabilised/worsened in 47/50/3% of patients (n=176) versus CHEST-1 baseline (n=236). Long-term riociguat had a favourable benefit-risk profile and apparently showed sustained benefits in exercise and functional capacity for up to 1 year. Copyright ©ERS 2015.

The effect of a chest imaging lecture on emergency department doctors' ability to interpret chest CT images: a randomized study.

PubMed

Keijzers, Gerben; Sithirasenan, Vasugi

2012-02-01

To assess the chest computed tomography (CT) imaging interpreting skills of emergency department (ED) doctors and to study the effect of a CT chest imaging interpretation lecture on these skills. Sixty doctors in two EDs were randomized, using computerized randomization, to either attend a chest CT interpretation lecture or not to attend this lecture. Within 2 weeks of the lecture, the participants completed a questionnaire on demographic variables, anatomical knowledge, and diagnostic interpretation of 10 chest CT studies. Outcome measures included anatomical knowledge score, diagnosis score, and the combined overall score, all expressed as a percentage of correctly answered questions (0-100). Data on 58 doctors were analyzed, of which 27 were randomized to attend the lecture. The CT interpretation lecture did not have an effect on anatomy knowledge scores (72.9 vs. 70.2%), diagnosis scores (71.2 vs. 69.2%), or overall scores (71.4 vs. 69.5%). Twenty-nine percent of doctors stated that they had a systematic approach to chest CT interpretation. Overall self-perceived competency for interpreting CT imaging (brain, chest, abdomen) was low (between 3.2 and 5.2 on a 10-point Visual Analogue Scale). A single chest CT interpretation lecture did not improve chest CT interpretation by ED doctors. Less than one-third of doctors had a systematic approach to chest CT interpretation. A standardized systematic approach may improve interpretation skills.

Chest pain in patients with arterial hypertension, angiographically normal coronary arteries and stiff aorta: the aortic pain syndrome.

PubMed

Stakos, Dimitrios A; Tziakas, Dimitrios N; Chalikias, George; Mitrousi, Konstantina; Tsigalou, Christina; Boudoulas, Harisios

2013-01-01

Arterial hypertension is often associated with a stiff aorta as a result of collagen accumulation in the aortic wall and may produce chest pain. In the present study, possible interrelationships between aortic function, collagen turnover and exercise-induced chest pain in patients with arterial hypertension and angiographically normal coronary arteries were investigated. Ninety-seven patients with arterial hypertension, angiographically normal coronary arteries and no evidence of myocardial ischemia on nuclear cardiac imaging during exercise test were studied. Of these, 43 developed chest pain during exercise (chest pain group) while 54 did not (no chest pain group). Carotid femoral pulse-wave velocity (PWVc-f) was used to assess the elastic properties of the aorta. Amino-terminal pro-peptides of pro-collagen type I, (PINP, reflecting collagen synthesis), serum telopeptides of collagen type I (CITP, reflecting collagen degradation), pro-metalloproteinase 1 (ProMMP-1), and tissue inhibitor of metalloproteinase 1 (TIMP-1, related to collagen turnover) were measured in plasma by immunoassay. The chest pain group had higher PWVc-f, higher and /CITP ratio, and lower proMMP-1/ TIMP-1 ratio compared to the no chest pain group. PWVc-f (t=2.53, p=0.02) and PINP (t=2.42, p=0.02) were independently associated with the presence of chest pain in multiple regression analysis. Patients with arterial hypertension, exercise-induced chest pain and angiographically normal coronary arteries, without evidence of exercise-induced myocardial ischemia, had a stiffer aorta compared to those without chest pain. Alterations in collagen type I turnover that favor collagen accumulation in the aortic wall may contribute to aortic stiffening and chest pain in these patients.

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

PubMed

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

2016-12-01

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

The single chest tube versus double chest tube application after pulmonary lobectomy: A systematic review and meta-analysis.

PubMed

Zhang, Xuefei; Lv, Desheng; Li, Mo; Sun, Ge; Liu, Changhong

2016-12-01

Draining of the chest cavity with two chest tubes after pulmonary lobectomy is a common practice. The objective of this study was to evaluate whether using two tubes after a pulmonary lobectomy is more effective than using a single tube. We performed a meta-analysis of five randomized studies that compared the single chest tube with double chest tube application after pulmonary lobectomy. The primary end-point was amount of drainage and duration of chest tube drainage. The secondary end-points were the patient's numbers of new drain insertion after operation, hospital stay after operation, the patient's numbers of subcutaneous emphysema after operation, the patient's numbers of residual pleural air space, pain score, the number of patients who need thoracentesis, and cost. Five randomized controlled trials totaling 502 patients were included. Meta-analysis results are as follows: There were statistically significant differences in amount of drainage (risk ratio [RR] = -0.15; 95% confidence interval [CI] = -3.17, -0.12, P = 0. 03), duration of chest tube drainage (RR = -0.43; 95% CI = -0.57, -0.19, P = 0.02), pain score (P < 0.05). Compared with patients receiving the double chest tube group, there were no statistically significant differences between the two groups with regard to the patient's numbers of new drain insertion after operation. Compared with the double chest tube, the single chest tube significantly decreases amount of drainage, duration of chest tube drainage, pain score, the number of patients who need thoracentesis, and cost. Although there is convincing evidence to confirm the results mentioned herein, they still need to be confirmed by large-sample, multicenter, randomized, controlled trials.

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

PubMed

Park, Sang-Sub

2014-01-01

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

Conceptus radiation dose and risk from chest screen-film radiography.

PubMed

Damilakis, John; Perisinakis, Kostas; Prassopoulos, Panos; Dimovasili, Evangelia; Varveris, Haralambos; Gourtsoyiannis, Nicholas

2003-02-01

The objectives of the present study were to (a) estimate the conceptus radiation dose and risks for pregnant women undergoing posteroanterior and anteroposterior (AP) chest radiographs, (b) study the conceptus dose as a function of chest thickness of the patient undergoing chest radiograph, and (c) investigate the possibility of a conceptus to receive a dose of more than 10 mGy, the level above which specific measurements of conceptus doses may be necessary. Thermoluminescent dosimeters were used for dose measurements in anthropomorphic phantoms simulating pregnancy at the three trimesters of gestation. The effect of chest thickness on conceptus dose and risk was studied by adding slabs of lucite on the anterior and posterior surface of the phantom chest. The conceptus risk for radiation-induced childhood fatal cancer and hereditary effects was calculated based on appropriate risk factors. The average AP chest dimension (d(a)) was estimated for 51 women of childbearing age from chest CT examinations. The value of d(a) was estimated to be 22.3 cm (17.4-27.2 cm). The calculated maximum conceptus dose was 107 x 10(-3) mGy for AP chest radiographs performed during the third trimester of pregnancy with maternal chest thickness of 27.2 cm. This calculation was based on dose data obtained from measurements in the phantoms and d(a) estimated from the patient group. The corresponding average excess of childhood cancer was 10.7 per million patients. The risk for hereditary effects was 1.1 per million births. Radiation dose for a conceptus increases exponentially as chest thickness increases. The conceptus dose at the third trimester is higher than that of the second and first trimesters. The results of the current study suggest that chest radiographs carried out in women at any time during gestation will result in a negligible increase in risk of radiation-induced harmful effects to the unborn child. After a properly performed maternal chest X-ray, there is no need for individual conceptus dose estimations.

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

PubMed Central

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

2014-01-01

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

Adherence evaluation of vented chest seals in a swine skin model.

PubMed

Arnaud, Françoise; Maudlin-Jeronimo, Eric; Higgins, Adam; Kheirabadi, Bijan; McCarron, Richard; Kennedy, Daniel; Housler, Greggory

2016-10-01

Perforation of the chest (open pneumothorax) with and without lung injury can cause air accumulation in the chest, positive intrapleural pressure and lead to tension pneumothorax if untreated. The performance of chest seals to prevent tension physiology depends partially on their ability to adhere to the skin and seal the chest wound. Novel non-occlusive vented chest seals were assessed for their adhesiveness on skin of live swine under normal and extreme environmental conditions to simulate austere battlefield conditions. Chest seals were applied on the back of the swine on skin that was soiled by various environmental contaminants to represent battlefield situations. A peeling (horizontal rim peeling) and detachment and breaching (vertical pulling) techniques were used to quantify the adhesive performance of vented chest seals. Among eight initially selected vented seals, five (Bolin, Russell, Fast breathe, Hyfin and SAM) were further down-selected based on their superior adherence scores at ambient temperatures. The adherence of these seals was then assessed after approximately 17h storage at extreme cold (-19.5°C) and hot (71.5°C) temperatures. Adherence scores for peeling (above 90%) and detachment scores (less than 25%) were comparable for four vented chest seals when tested at ambient temperature, except for the Bolin seal which had higher breaching. Under extreme storage temperatures, adherence peeling scores were comparable to those at ambient temperatures for four chest seals. Scores were significantly lower for the Bolin seal at extreme temperatures. This seal also had the highest detachment and breaching scores. In contrast, the Russell, Fast breathe, Hyfin and SAM seals showed similar ability to stay air tight without breaching after hot storage. No significant difference was found in skin adherence of the five vented chest seals at ambient temperature and the four seals (Russell, Fast breathe, Hyfin and SAM) maintained superior adherence even after exposure to extreme temperatures compared to the Bolin. To select the most effective product from the 5 selected vented chest seals, further functional evaluation of the valve of these chest seals on a chest wound with the potential for tension in the pneumothorax or hemopneumothorax is warranted. Copyright © 2016 Elsevier Ltd. All rights reserved.

Induction of a shorter compression phase is correlated with a deeper chest compression during metronome-guided cardiopulmonary resuscitation: a manikin study.

PubMed

Chung, Tae Nyoung; Bae, Jinkun; Kim, Eui Chung; Cho, Yun Kyung; You, Je Sung; Choi, Sung Wook; Kim, Ok Jun

2013-07-01

Recent studies have shown that there may be an interaction between duty cycle and other factors related to the quality of chest compression. Duty cycle represents the fraction of compression phase. We aimed to investigate the effect of shorter compression phase on average chest compression depth during metronome-guided cardiopulmonary resuscitation. Senior medical students performed 12 sets of chest compressions following the guiding sounds, with three down-stroke patterns (normal, fast and very fast) and four rates (80, 100, 120 and 140 compressions/min) in random sequence. Repeated-measures analysis of variance was used to compare the average chest compression depth and duty cycle among the trials. The average chest compression depth increased and the duty cycle decreased in a linear fashion as the down-stroke pattern shifted from normal to very fast (p<0.001 for both). Linear increase of average chest compression depth following the increase of the rate of chest compression was observed only with normal down-stroke pattern (p=0.004). Induction of a shorter compression phase is correlated with a deeper chest compression during metronome-guided cardiopulmonary resuscitation.

Rib fixation for severe chest deformity due to multiple rib fractures.

PubMed

Igai, Hitoshi; Kamiyoshihara, Mitsuhiro; Nagashima, Toshiteru; Ohtaki, Yoichi

2012-01-01

The operative indications for rib fracture repair have been a matter of debate. However, several reports have suggested that flail chest, pain on respiration, and chest deformity/defect are potential conditions for rib fracture repair. We describe our experience of rib fixation in a patient with severe chest deformity due to multiple rib fractures. A 70-year-old woman was admitted with right-sided multiple rib fractures (2nd to 7th) and marked chest wall deformity without flailing caused by an automobile accident. Collapse of the chest wall was observed along the middle anterior axillary line. At 11 days after the injury, surgery was performed to repair the chest deformity, as it was considered to pose a risk of restrictive impairment of pulmonary function or chronic intercostal pain in the future. Operative findings revealed marked displacement of the superior 4 ribs, from the 2nd to the 5th, and collapse of the osseous chest wall towards the thoracic cavity. After exposure of the fracture regions, ribs fixations were performed using rib staplers. The total operation time was 90 minutes, and the collapsed portion of the chest wall along the middle anterior axillary line was reconstructed successfully.

Management of chest drainage tubes after lung surgery.

PubMed

Satoh, Yukitoshi

2016-06-01

Since chest tubes have been routinely used to drain the pleural space, particularly after lung surgery, the management of chest tubes is considered to be essential for the thoracic surgeon. The pleural drainage system requires effective drainage, suction, and water-sealing. Another key point of chest tube management is that a water seal is considered to be superior to suction for most air leaks. Nowadays, the most common pleural drainage device attached to the chest tube is the three-bottle system. An electronic chest drainage system has been developed that is effective in standardizing the postoperative management of chest tubes. More liberal use of digital drainage devices in the postoperative management of the pleural space is warranted. The removal of chest tubes is a common procedure occurring almost daily in hospitals throughout the world. Extraction of the tube is usually done at the end of full inspiration or at the end of full expiration. The tube removal technique is not as important as how it is done and the preparation for the procedure. The management of chest tubes must be based on careful observation, the patient's characteristics, and the operative procedures that had been performed.

A study on the evaluation of pneumothorax by imaging methods in patients presenting to the emergency department for blunt thoracic trauma.

PubMed

Kaya, Şeyhmus; Çevik, Arif Alper; Acar, Nurdan; Döner, Egemen; Sivrikoz, Cumhur; Özkan, Ragıp

2015-09-01

Pneumothorax (PNX) is the collection of air between parietal and visceral pleura, and collapsed lung develops as a complication of the trapped air. PNX is likely to develop spontaneously in people with risk factors. However, it is mostly seen with blunt or penetrating trauma. Diagnosis is generally confirmed by chest radiography [posteroanterior chest radiography (PACR)]. Chest ultrasound (US) is also a promising technique for the detection of PNX in trauma patients. There is not much literature on the evaluation of blunt thoracic trauma (BTT) and pneumothorax (PNX) in the emergency department (ED). The aim of this study was to investigate the effectiveness of chest US for the diagnosis of PNX in patients presenting to ED with BTT. This study was carried out for a period of nine months in the ED of a university hospital. The chest US of patients was performed by emergency physicians trained in the field. The results were compared with anteroposterior chest radiography and/or CT scan of the chest. The APCR and chest CT results were evaluated by a radiology specialist blind to US findings. The evaluation of the radiology specialist was taken as the gold standard for diagnosis by imaging methods. Clinical follow-up was taken into consideration for the diagnosis of PNX in patients on whom CT scan was not performed. Chest US was performed on all two hundred and twelve patients (144 female and 68 male patients; mean age 45.8) who participated in this study. The supine APCR was performed on two hundred and ten (99%) patients and chest CT was performed on one hundred and twenty (56.6%). Out of the twenty-five (11.8%) diagnosed cases of PNX, 22 (88%) were diagnosed by chest US and 8 were diagnosed by APCR. For the detection of PNX, compared to clinical follow-up and chest CT, the sensitivity of chest US was 88%, specificity 99.5%, positive predictive value 95.7% and negative predictive value 98.4%. Chest US has not superseded supine and standing chest radiography for PNX diagnosis yet in many healthcare centers, but it is performed by emergency physicians and it is an effective and important method for early and bedside diagnosis of PNX.

[Chest Injury and its Surgical Treatment in Polytrauma Patients. Five-Year Experience].

PubMed

Vodička, J; Doležal, J; Vejvodová, Š; Šafránek, J; Špidlen, V; Třeška, V

2016-01-01

PURPOSE OF THE STUDY Thoracic trauma, one of the most frequent injuries in patients with multiple traumata, is found in 50 to 80% of these patients and it is crucial for the patient's prognosis. It accounts for 25% of all death from polytraumatic injuries. The aim of this retrospective study was an analysis of the occurrence of chest injuries in polytrauma patients and their surgical treatment in the Trauma Centre or Department of Surgery of the University Hospital Pilsen in a five-year period. MATERIAL AND METHODS Patients with injuries meeting the definition of polytrauma and an Injury Severity Score (ISS) ≥16 were included. The demographic characteristics, mechanism of multiple trauma, ISS value and chest injury were recorded in each patient. The number of injured patients in each year of the study was noted. In the patients with chest injury, the type of injury and method of treatment were assessed. The therapy was further analysed including its timing. The number of deaths due to polytrauma involving chest injury, the cause of death and its time in relation to the patient's admission to the Trauma Centre were evaluated. RESULTS In the period 2010-14, 513 polytrauma patients were treated; of them 371 (72.3%) were men with an average age of 40.5 years. The most frequent cause of injury was a traffic accident (74%). The average ISS of the whole group was 35 points. Chest injury was diagnosed in 469 patients (91.4%) of whom only five (1.1%) had penetrating injury. Pulmonary contusion was most frequent (314 patients; 67%). A total of 212 patients with chest injury underwent surgery (45.2%); urgent surgery was performed in 143 (67.5%), acute surgery in 49 (23.1%) and delayed surgery in 63 (29.7%) patients. Chest drainage was the major surgical procedure used in the whole group. Of 61 patients who died, 52 had chest injury. In this subgroup the most frequent cause of death was decompensated traumatic shock (26 patients; 50%). In the whole group, 32 polytrauma patients died within 24 hours of injury (61.5%). CONCLUSIONS Chest injury, almost always blunt, is often diagnosed in polytrauma patients. A prevalent cause of multiple trauma is a traffic accident. Chest injury most frequently involves pulmonary contusion. Nearly half of chest injuries require surgery, of which 2/3 are urgent procedures. The procedure most frequently performed in polytrauma patients with chest injury is chest drainage and this is also a sufficient procedure in 75% of surgically treated patients. polytrauma, chest injury, pulmonary contusion, surgical treatment, chest drainage.

A higher chest compression rate may be necessary for metronome-guided cardiopulmonary resuscitation.

PubMed

Chung, Tae Nyoung; Kim, Sun Wook; You, Je Sung; Cho, Young Soon; Chung, Sung Phil; Park, Incheol

2012-01-01

Metronome guidance is a simple and economical feedback system for guiding cardiopulmonary resuscitation (CPR). However, a recent study showed that metronome guidance reduced the depth of chest compression. The results of previous studies suggest that a higher chest compression rate is associated with a better CPR outcome as compared with a lower chest compression rate, irrespective of metronome use. Based on this finding, we hypothesized that a lower chest compression rate promotes a reduction in chest compression depth in the recent study rather than metronome use itself. One minute of chest compression-only CPR was performed following the metronome sound played at 1 of 4 different rates: 80, 100, 120, and 140 ticks/min. Average compression depths (ACDs) and duty cycles were compared using repeated measures analysis of variance, and the values in the absence and presence of metronome guidance were compared. Both the ACD and duty cycle increased when the metronome rate increased (P = .017, <.001). Average compression depths for the CPR procedures following the metronome rates of 80 and 100 ticks/min were significantly lower than those for the procedures without metronome guidance. The ACD and duty cyle for chest compression increase as the metronome rate increases during metronome-guided CPR. A higher rate of chest compression is necessary for metronome-guided CPR to prevent suboptimal quality of chest compression. Copyright © 2012 Elsevier Inc. All rights reserved.

[Tension Pneumothorax Developing Hemothorax after Chest Tube Drainage].

PubMed

Sakai, Takehiro; Sawada, Masahiro; Sato, Yutaka; Kimura, Futoshi; Yagihashi, Nobuo; Iwabuchi, Tadashi; Kimura, Daisuke; Tsushima, Takao; Hatanaka, Ryo

2016-11-01

A 61-year-old man visited a physician complaining of progressive chest pain and dyspnea. The chest radiography showed complete collapse of the right lung suggesting tension pneumothorax. The patient was transferred to our hospital. A small amount of the right pleural effusion was also seen in addition to pulmonary collapse on the chest radiography. Chest drainage was performed, and continuous air leakage was seen. At 2 hours later, air leakage was disappeared but the bloody effusion was noted. The chest radiography revealed massive effusion and the enhanced computed tomography showed active bleeding. The emergency surgery was conducted. The bleeding point was a ruptured vessel between the apical parietal pleura and the pulmonary bulla. Hemostasis and the resection of the bullae was performed. Careful observation after chest drainage is necessary to prepare unexpected hemothorax in case of tension pneumothorax with pleural effusion.

Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan.

PubMed

Nagarsheth, Khanjan; Kurek, Stanley

2011-04-01

Pneumothorax after trauma can be a life threatening injury and its care requires expeditious and accurate diagnosis and possible intervention. We performed a prospective, single blinded study with convenience sampling at a Level I trauma center comparing thoracic ultrasound with chest X-ray and CT scan in the detection of traumatic pneumothorax. Trauma patients that received a thoracic ultrasound, chest X-ray, and chest CT scan were included in the study. The chest X-rays were read by a radiologist who was blinded to the thoracic ultrasound results. Then both were compared with CT scan results. One hundred and twenty-five patients had a thoracic ultrasound performed in the 24-month period. Forty-six patients were excluded from the study due to lack of either a chest X-ray or chest CT scan. Of the remaining 79 patients there were 22 positive pneumothorax found by CT and of those 18 (82%) were found on ultrasound and 7 (32%) were found on chest X-ray. The sensitivity of thoracic ultrasound was found to be 81.8 per cent and the specificity was found to be 100 per cent. The sensitivity of chest X-ray was found to be 31.8 per cent and again the specificity was found to be 100 per cent. The negative predictive value of thoracic ultrasound for pneumothorax was 0.934 and the negative predictive value for chest X-ray for pneumothorax was found to be 0.792. We advocate the use of chest ultrasound for detection of pneumothorax in trauma patients.

42 CFR 37.50 - Interpreting and classifying chest radiographs-film.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 1 2013-10-01 2013-10-01 false Interpreting and classifying chest radiographs-film. 37.50 Section 37.50 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Radiographs § 37.50 Interpreting and classifying chest radiographs—film. (a) Chest radiographs must be...

42 CFR 37.50 - Interpreting and classifying chest radiographs-film.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 1 2014-10-01 2014-10-01 false Interpreting and classifying chest radiographs-film. 37.50 Section 37.50 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Interpreting and classifying chest radiographs—film. (a) Chest radiographs must be interpreted and classified...

46 CFR 108.651 - Portable magazine chests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Portable magazine chests. 108.651 Section 108.651... AND EQUIPMENT Equipment Markings and Instructions § 108.651 Portable magazine chests. Each portable magazine chest must be marked: “PORTABLE MAGAZINE CHEST—FLAMMABLE—KEEP LIGHTS AND FIRE AWAY” in letters at...

20 CFR 718.102 - Chest roentgenograms (X-rays).

Code of Federal Regulations, 2011 CFR

2011-04-01

... 20 Employees' Benefits 3 2011-04-01 2011-04-01 false Chest roentgenograms (X-rays). 718.102... roentgenograms (X-rays). (a) A chest roentgenogram (X-ray) shall be of suitable quality for proper classification of pneumoconiosis and shall conform to the standards for administration and interpretation of chest X...

20 CFR 718.102 - Chest roentgenograms (X-rays).

Code of Federal Regulations, 2013 CFR

2013-04-01

... 20 Employees' Benefits 4 2013-04-01 2013-04-01 false Chest roentgenograms (X-rays). 718.102... roentgenograms (X-rays). (a) A chest roentgenogram (X-ray) shall be of suitable quality for proper classification of pneumoconiosis and shall conform to the standards for administration and interpretation of chest X...

20 CFR 718.102 - Chest roentgenograms (X-rays).

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false Chest roentgenograms (X-rays). 718.102... roentgenograms (X-rays). (a) A chest roentgenogram (X-ray) shall be of suitable quality for proper classification of pneumoconiosis and shall conform to the standards for administration and interpretation of chest X...

20 CFR 718.102 - Chest roentgenograms (X-rays).

Code of Federal Regulations, 2012 CFR

2012-04-01

... 20 Employees' Benefits 4 2012-04-01 2012-04-01 false Chest roentgenograms (X-rays). 718.102... roentgenograms (X-rays). (a) A chest roentgenogram (X-ray) shall be of suitable quality for proper classification of pneumoconiosis and shall conform to the standards for administration and interpretation of chest X...

CT detection of occult pneumothorax in head trauma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Tocino, I.M.; Miller, M.H.; Frederick, P.R.

1984-11-01

A prospective evaluation for occult pneumothorax was performed in 25 consecutive patients with serious head trauma by combining a limited chest CT examination with the emergency head CT examination. Of 21 pneuomothoraces present in 15 patients, 11 (52%) were found only by chest CT and were not identified clinically or by supine chest radiograph. Because of pending therapeutic measures, chest tubes were placed in nine of the 11 occult pneumothoraces, regardless of the volume. Chest CT proved itself as the most sensitive method for detection of occult pneumothorax, permitting early chest tube placement to prevent transition to a tension pneumothoraxmore » during subsequent mechanical ventilation or emergency surgery under general anesthesia.« less

A Community-acquired Lung Abscess Attributable to Streptococcus pneumoniae which Extended Directly into the Chest Wall

PubMed Central

Ko, Yuki; Tobino, Kazunori; Yasuda, Yuichiro; Sueyasu, Takuto; Nishizawa, Saori; Yoshimine, Kouhei; Munechika, Miyuki; Asaji, Mina; Yamaji, Yoshikazu; Tsuruno, Kosuke; Miyajima, Hiroyuki; Mukasa, Yosuke; Ebi, Noriyuki

2017-01-01

We herein report the case of 75-year-old Japanese female with a community-acquired lung abscess attributable to Streptococcus pneumoniae (S. penumoniae) which extended into the chest wall. The patient was admitted to our hospital with a painful mass on the left anterior chest wall. A contrast-enhanced chest computed tomography scan showed a lung abscess in the left upper lobe which extended into the chest wall. Surgical debridement of the chest wall abscess and percutaneous transthoracic tube drainage of the lung abscess were performed. A culture of the drainage specimen yielded S. pneumoniae. The patient showed a remarkable improvement after the initiation of intravenous antibiotic therapy. PMID:28049987

A Community-acquired Lung Abscess Attributable to Streptococcus pneumoniae which Extended Directly into the Chest Wall.

PubMed

Ko, Yuki; Tobino, Kazunori; Yasuda, Yuichiro; Sueyasu, Takuto; Nishizawa, Saori; Yoshimine, Kouhei; Munechika, Miyuki; Asaji, Mina; Yamaji, Yoshikazu; Tsuruno, Kosuke; Miyajima, Hiroyuki; Mukasa, Yosuke; Ebi, Noriyuki

We herein report the case of 75-year-old Japanese female with a community-acquired lung abscess attributable to Streptococcus pneumoniae (S. penumoniae) which extended into the chest wall. The patient was admitted to our hospital with a painful mass on the left anterior chest wall. A contrast-enhanced chest computed tomography scan showed a lung abscess in the left upper lobe which extended into the chest wall. Surgical debridement of the chest wall abscess and percutaneous transthoracic tube drainage of the lung abscess were performed. A culture of the drainage specimen yielded S. pneumoniae. The patient showed a remarkable improvement after the initiation of intravenous antibiotic therapy.

Direct 2-D reconstructions of conductivity and permittivity from EIT data on a human chest.

PubMed

Herrera, Claudia N L; Vallejo, Miguel F M; Mueller, Jennifer L; Lima, Raul G

2015-01-01

A novel direct D-bar reconstruction algorithm is presented for reconstructing a complex conductivity distribution from 2-D EIT data. The method is applied to simulated data and archival human chest data. Permittivity reconstructions with the aforementioned method and conductivity reconstructions with the previously existing nonlinear D-bar method for real-valued conductivities depicting ventilation and perfusion in the human chest are presented. This constitutes the first fully nonlinear D-bar reconstructions of human chest data and the first D-bar permittivity reconstructions of experimental data. The results of the human chest data reconstructions are compared on a circular domain versus a chest-shaped domain.

Nonspecific motility disorders, irritable esophagus, and chest pain.

PubMed

Krarup, Anne Lund; Liao, Donghua; Gregersen, Hans; Drewes, Asbjørn Mohr; Hejazi, Reza A; McCallum, Richard W; Vega, Kenneth J; Frazzoni, Marzio; Frazzoni, Leonardo; Clarke, John O; Achem, Sami R

2013-10-01

This paper presents commentaries on whether Starling's law applies to the esophagus; whether erythromycin affects esophageal motility; the relationship between hypertensive lower esophageal sphincter and vigorous achalasia; whether ethnic- and gender-based norms affect diagnosis and treatment of esophageal motor disorders; health care and epidemiology of chest pain; whether normal pH excludes esophageal pain; the role of high-resolution manometry in noncardiac chest pain; whether pH-impedance should be included in the evaluation of noncardiac chest pain; whether there are there alternative therapeutic options to PPI for treating noncardiac chest pain; and the usefulness of psychological treatment and alternative medicine in noncardiac chest pain. © 2013 New York Academy of Sciences.

The value of routine chest radiographs in acute asthma admissions.

PubMed

Ismail, Y; Loo, C S; Zahary, M K

1994-04-01

We reviewed 116 chest radiographs done in 70 adult asthmatic patients who were admitted to the Hospital Universiti Sains Malaysia from January to December 1989. The chest radiographs were abnormal in 23% of cases. Twelve percent showed hyperinflation and 7% had pneumonia. Eight patients diagnosed clinically to have pneumonia had normal chest radiographs. Seven patients had radiographic findings of conditions which were unsuspected clinically. These included two cases of pneumonia, one case each of fibrosing alveolitis, pneumothorax, pneumomediastinum, mitral stenosis with left ventricular failure and right pleural effusion. In conclusion, we found that significant chest radiograph abnormalities in adult patients admitted for asthma were uncommon although chest radiographs were helpful in detecting complications or coincidental conditions. Chest radiograph is therefore an important investigation in adult asthmatic patients who are admitted. However, considering the cost and the risk of radiation, it should be done only in selective cases rather than as a routine procedure.

Anxiety and depressive symptoms and anxiety sensitivity in youngsters with noncardiac chest pain and benign heart murmurs.

PubMed

Lipsitz, Joshua D; Masia-Warner, Carrie; Apfel, Howard; Marans, Zvi; Hellstern, Beth; Forand, Nicholas; Levenbraun, Yosef; Fyer, Abby J

2004-12-01

Chest pain in children and adolescents is rarely associated with cardiac disease. We sought to examine psychological symptoms in youngsters with medically unexplained chest pain. We hypothesized that children and adolescents with medically unexplained chest pain would have high rates of anxiety and depressive symptoms. We assessed 65 youngsters with noncardiac chest pain (NCCP) and 45 comparison youngsters with benign heart murmurs using self-report measures of anxiety and depressive symptoms and anxiety sensitivity. Compared with the asymptomatic benign-murmur group, youngsters with NCCP had higher levels of some anxiety symptoms and anxiety sensitivity. Differences on depressive symptoms were not significant. Though preliminary, results suggest that youngsters with chest pain may experience increased levels of some psychological symptoms. Future studies of noncardiac chest pain in youngsters should include larger samples and comprehensive diagnostic assessments as well as long-term follow-up evaluations.

46 CFR 78.47-70 - Portable magazine chests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 3 2010-10-01 2010-10-01 false Portable magazine chests. 78.47-70 Section 78.47-70... Fire and Emergency Equipment, Etc. § 78.47-70 Portable magazine chests. (a) Portable magazine chest shall be marked in letters of at least 3 inches high “PORTABLE MAGAZINE CHEST—FLAMMABLE—KEEP LIGHTS AND...

46 CFR 97.37-47 - Portable magazine chests.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 46 Shipping 4 2010-10-01 2010-10-01 false Portable magazine chests. 97.37-47 Section 97.37-47... OPERATIONS Markings for Fire and Emergency Equipment, Etc. § 97.37-47 Portable magazine chests. (a) Portable magazine chests shall be marked in letters at least 3 inches high: “PORTABLE MAGAZINE CHEST—FLAMMABLE—KEEP...

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

PubMed Central

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

A method to detect occult pneumothorax with chest radiography.

PubMed

Matsumoto, Shokei; Kishikawa, Masanobu; Hayakawa, Koichi; Narumi, Atsushi; Matsunami, Katsutoshi; Kitano, Mitsuhide

2011-04-01

Small pneumothoraces are often not visible on supine screening chest radiographs because they develop anteriorly to the lung. These pneumothoraces are termed occult. Occult pneumothoraces account for an astonishingly high 52% to 63% of all traumatic pneumothoraces. A 19-year-old obese woman was involved in a head-on car accident. The admission anteroposterior chest radiographs were unremarkable. Because of the presence of right chest tenderness and an abrasion, we suspected the presence of a pneumothorax. Thus, we decided to take a supine oblique chest radiograph of the right side of the thorax, which clearly revealed a visceral pleural line, consistent with a diagnosis of traumatic pneumothorax. A pneumothorax may be present when a supine chest radiograph reveals either an apparent deepening of the costophrenic angle (the "deep sulcus sign") or the presence of 2 diaphragm-lung interfaces (the "double diaphragm sign"). However, in practice, supine chest radiographs have poor sensitivity for occult pneumothoraces. Oblique chest radiograph is a useful and fast screening tool that should be considered for cases of blunt chest trauma, especially when transport of critically ill patients to the computed tomographic suite is dangerous or when imminent transfer to another hospital is being arranged and early diagnosis of an occult pneumothorax is essential. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

Chest tube management following pulmonary lobectomy: change of protocol results in fewer air leaks.

PubMed

Bertholet, Joost W M; Joosten, Joris J A; Keemers-Gels, Mariël E; van den Wildenberg, Frits J H; Barendregt, Wouter B

2011-01-01

Much controversy exists regarding the management of chest tubes following pulmonary lobectomy. The objective of this study was to analyse the effect of a new chest tube management protocol on clinical features, such as postoperative air leak, drain characteristics, 30-day postoperative complications and length of hospital stay. We retrospectively analysed 133 patients who underwent pulmonary lobectomy, from January 2005 to December 2008. A new chest tube protocol was introduced on 1 January 2007 and included placement of a single chest tube and early conversion to water seal. The chest tube was removed when air leak had resolved and (non-chylous) fluid drainage was <400 ml/day. The results of patients in the old (n=68) and the new protocol (n=65) were compared. In the new protocol group the median duration of air leak and duration of chest tube drainage declined significantly. Also the length of hospital stay decreased significantly to a median of eight days. The number of reinterventions and 30-day morbidity and mortality rates did not differ significantly. Our data suggest that placement of a single chest tube and early conversion to water seal decreases the duration of air leak and chest tube drainage and length of hospital stay.

Place Atrium to Water Seal (PAWS): Assessing Wall Suction Versus No Suction for Chest Tubes After Open Heart Surgery.

PubMed

Kruse, Tamara; Wahl, Sharon; Guthrie, Patricia Finch; Sendelbach, Sue

2017-08-01

Traditionally chest tubes are set to -20 cm H 2 O wall suctioning until removal to facilitate drainage of blood, fluid, and air from the pleural or mediastinal space in patients after open heart surgery. However, no clear evidence supports using wall suction in these patients. Some studies in patients after pulmonary surgery indicate that using chest tubes with a water seal is safer, because this practice decreases duration of chest tube placement and eliminates air leaks. To show that changing chest tubes to a water seal after 12 hours of wall suction (intervention) is a safe alternative to using chest tubes with wall suction until removal of the tubes (usual care) in patients after open heart surgery. A before-and-after quality improvement design was used to evaluate the differences between the 2 chest tube management approaches in chest tube complications, output, and duration of placement. A total of 48 patients received the intervention; 52 received usual care. The 2 groups (intervention vs usual care) did not differ significantly in complications (0 vs 2 events; P = .23), chest tube output (H 1 = 0.001, P = .97), or duration of placement (median, 47 hours for both groups). Changing chest tubes from wall suction to water seal after 12 hours of wall suction is a safe alternative to using wall suctioning until removal of the tubes. ©2017 American Association of Critical-Care Nurses.

Real-time feedback can improve infant manikin cardiopulmonary resuscitation by up to 79%--a randomised controlled trial.

PubMed

Martin, Philip; Theobald, Peter; Kemp, Alison; Maguire, Sabine; Maconochie, Ian; Jones, Michael

2013-08-01

European and Advanced Paediatric Life Support training courses. Sixty-nine certified CPR providers. CPR providers were randomly allocated to a 'no-feedback' or 'feedback' group, performing two-thumb and two-finger chest compressions on a "physiological", instrumented resuscitation manikin. Baseline data was recorded without feedback, before chest compressions were repeated with one group receiving feedback. Indices were calculated that defined chest compression quality, based upon comparison of the chest wall displacement to the targets of four, internationally recommended parameters: chest compression depth, release force, chest compression rate and compression duty cycle. Baseline data were consistent with other studies, with <1% of chest compressions performed by providers simultaneously achieving the target of the four internationally recommended parameters. During the 'experimental' phase, 34 CPR providers benefitted from the provision of 'real-time' feedback which, on analysis, coincided with a statistical improvement in compression rate, depth and duty cycle quality across both compression techniques (all measures: p<0.001). Feedback enabled providers to simultaneously achieve the four targets in 75% (two-finger) and 80% (two-thumb) of chest compressions. Real-time feedback produced a dramatic increase in the quality of chest compression (i.e. from <1% to 75-80%). If these results transfer to a clinical scenario this technology could, for the first time, support providers in consistently performing accurate chest compressions during infant CPR and thus potentially improving clinical outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

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

PubMed Central

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

2006-01-01

Background To ascertain current chest radiography practice in intensive care units (ICUs) in the Netherlands. Methods Postal survey: a questionnaire was sent to all ICUs with > 5 beds suitable for mechanical ventilation; pediatric ICUs were excluded. When an ICU performed daily-routine chest radiographs in any group of patients it was considered to be a "daily-routine chest radiography" ICU. Results From the number of ICUs responding, 63% practice a daily-routine strategy, in which chest radiographs are obtained on a daily basis without any specific reason. A daily-routine chest radiography strategy is practiced less frequently in university-affiliated ICUs (50%) as compared to other ICUs (68%), as well as in larger ICUs (> 20 beds, 50%) as compared to smaller ICUs (< 20 beds, 65%) (P > 0.05). Remarkably, physicians that practice a daily-routine strategy consider daily-routine radiographs helpful in guiding daily practice in less than 30% of all performed radiographs. Chest radiographs are considered essential for verification of the position of invasive devices (81%) and for diagnosing pneumothorax, pneumonia or acute respiratory distress syndrome (82%, 74% and 69%, respectively). On demand chest radiographs are obtained after introduction of thoracic drains, central venous lines and endotracheal tubes in 98%, 84% and 75% of responding ICUs, respectively. Chest films are also obtained in case of ventilatory deterioration (49% of responding ICUs), and after cardiopulmonary resuscitation (59%), tracheotomy (58%) and mini-tracheotomy (23%). Conclusion There is notable lack of consensus on chest radiography practice in the Netherlands. This survey suggests that a large number of intensivists may doubt the value of daily-routine chest radiography, but still practice a daily-routine strategy. PMID:16848892

Average chest wall thickness at two anatomic locations in trauma patients.

PubMed

Schroeder, Elizabeth; Valdez, Carrie; Krauthamer, Andres; Khati, Nadia; Rasmus, Jessica; Amdur, Richard; Brindle, Kathleen; Sarani, Babak

2013-09-01

Needle thoracostomy is the emergent treatment for tension pneumothorax. This procedure is commonly done using a 4.5cm catheter, and the optimal site for chest wall puncture is controversial. We hypothesize that needle thoracostomy cannot be performed using this catheter length irrespective of the site chosen in either gender. A retrospective review of all chest computed tomography (CT) scans obtained on trauma patients from January 1, 2011 to December 31, 2011 was performed. Patients aged 18 and 80 years were included and patients whose chest wall thickness exceeded the boundary of the images acquired were excluded. Chest wall thickness was measured at the 2nd intercostal (ICS), midclavicular line (MCL) and the 5th ICS, anterior axillary line (AAL). Injury severity score (ISS), chest wall thickness, and body mass index (BMI) were analyzed. 201 patients were included, 54% male. Average (SD) BMI was 26 (7)kg/m(2). The average chest wall thickness in the overall cohort was 4.08 (1.4)cm at the 2nd ICS/MCL and 4.55 (1.7)cm at the 5th ICS/AAL. 29% of the overall cohort (27 male and 32 female) had a chest wall thickness greater than 4.5cm at the 2nd ICS/MCL and 45% (54 male and 36 female) had a chest wall thickness greater than 4.5cm at the 5th ICS/AAL. There was no significant interaction between gender and chest wall thickness at either site. BMI was positively associated with chest wall thickness at both the 2nd and 5th ICS/AAL. A 4.5cm catheter is inadequate for needle thoracostomy in most patients regardless of puncture site or gender. Copyright © 2013 Elsevier Ltd. All rights reserved.

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

PubMed

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

2017-03-03

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

2017 American Heart Association Focused Update on Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

PubMed

Atkins, Dianne L; de Caen, Allan R; Berger, Stuart; Samson, Ricardo A; Schexnayder, Stephen M; Joyner, Benny L; Bigham, Blair L; Niles, Dana E; Duff, Jonathan P; Hunt, Elizabeth A; Meaney, Peter A

2018-01-02

This focused update to the American Heart Association guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care follows the Pediatric Task Force of the International Liaison Committee on Resuscitation evidence review. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, and updates are published when the International Liaison Committee on Resuscitation completes a literature review based on new science. This update provides the evidence review and treatment recommendation for chest compression-only CPR versus CPR using chest compressions with rescue breaths for children <18 years of age. Four large database studies were available for review, including 2 published after the "2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care." Two demonstrated worse 30-day outcomes with chest compression-only CPR for children 1 through 18 years of age, whereas 2 studies documented no difference between chest compression-only CPR and CPR using chest compressions with rescue breaths. When the results were analyzed for infants <1 year of age, CPR using chest compressions with rescue breaths was better than no CPR but was no different from chest compression-only CPR in 1 study, whereas another study observed no differences among chest compression-only CPR, CPR using chest compressions with rescue breaths, and no CPR. CPR using chest compressions with rescue breaths should be provided for infants and children in cardiac arrest. If bystanders are unwilling or unable to deliver rescue breaths, we recommend that rescuers provide chest compressions for infants and children. © 2017 American Heart Association, Inc.

Aortic valve calcifications on chest films: how much calcium do I need?

PubMed

Mahnken, Andreas H; Dohmen, Guido; Koos, Ralf

2011-08-01

Aortic valve calcifications (AVC) as seen on conventional chest films or on CT are associated with aortic valve stenosis (AVS). The absence of AVC on chest films does not exclude high grade AVS. The aim of this study was to analyse if there is a threshold for the detection of AVC from conventional chest films in patients suffering from high grade AVS. The explanted aortic valves of 29 patients (16 male, mean age 72.3 +/- 11.5 years) with high grade AVS were examined by dual-source CT. AVC were quantified using the Agatston AVC score. In all patients conventional chest films obtained the day before surgery were evaluated for the presence of AVC. Results were analysed with students t-test, Spearman's rank correlation and ROC analysis. On conventional chest films AVC were visible in 18 patients. On CT all specimen presented with AVC with an Agatston AVC score ranging from 40.7 to 1870 (mean 991.3 +/- 463.1). In patients with AVC visible on chest films the AVC score was significantly higher (1264.0 +/- 318.2) when compared with patients without visible calcifications (544.9 +/- 274.4; P < 0.0001). There was a strong correlation between the AVC score and the visibility of AVC on chest films (r = 0.781). ROC analysis identified an ideal threshold of 718 for AVC score to separate conventional chest films with and without visible AVC. Unlike in coronary calcifications, there is a threshold for identifying AVC from conventional chest films. This finding may be of diagnostic value, as conventional chest films may be used to semiquantitatively evaluate the extent of AVC.

Electronic versus traditional chest tube drainage following lobectomy: a randomized trial.

PubMed

Lijkendijk, Marike; Licht, Peter B; Neckelmann, Kirsten

2015-12-01

Electronic drainage systems have shown superiority compared with traditional (water seal) drainage systems following lung resections, but the number of studies is limited. As part of a medico-technical evaluation, before change of practice to electronic drainage systems for routine thoracic surgery, we conducted a randomized controlled trial (RCT) investigating chest tube duration and length of hospitalization. Patients undergoing lobectomy were included in a prospective open label RCT. A strict algorithm was designed for early chest tube removal, and this decision was delegated to staff nurses. Data were analysed by Cox proportional hazard regression model adjusting for lung function, gender, age, BMI, video-assisted thoracic surgery (VATS) or open surgery and presence of incomplete fissure or pleural adhesions. Time was distinguished as possible (optimal) and actual time for chest tube removal, as well as length of hospitalization. A total of 105 patients were randomized. We found no significant difference between the electronic group and traditional group in optimal chest tube duration (HR = 0.83; 95% CI: 0.55-1.25; P = 0.367), actual chest tube duration (HR = 0.84; 95% CI: 0.55-1.26; P = 0.397) or length of hospital stay (HR = 0.91; 95% CI: 0.59-1.39; P = 0.651). No chest tubes had to be reinserted. Presence of pleural adhesions or an incomplete fissure was a significant predictor of chest tube duration (HR = 1.72; 95% CI: 1.15-2.77; P = 0.014). Electronic drainage systems did not reduce chest tube duration or length of hospitalization significantly compared with traditional water seal drainage when a strict algorithm for chest tube removal was used. This algorithm allowed delegation of chest tube removal to staff nurses, and in some patients chest tubes could be removed safely on the day of surgery. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Evaluation of a newly developed infant chest compression technique

PubMed Central

Smereka, Jacek; Bielski, Karol; Ladny, Jerzy R.; Ruetzler, Kurt; Szarpak, Lukasz

2017-01-01

Abstract Background: Providing adequate chest compression is essential during infant cardio-pulmonary-resuscitation (CPR) but was reported to be performed poor. The “new 2-thumb technique” (nTTT), which consists in using 2 thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist, was recently introduced. Therefore, the aim of this study was to compare 3 chest compression techniques, namely, the 2-finger-technique (TFT), the 2-thumb-technique (TTHT), and the nTTT in an randomized infant-CPR manikin setting. Methods: A total of 73 paramedics with at least 1 year of clinical experience performed 3 CPR settings with a chest compression:ventilation ratio of 15:2, according to current guidelines. Chest compression was performed with 1 out of the 3 chest compression techniques in a randomized sequence. Chest compression rate and depth, chest decompression, and adequate ventilation after chest compression served as outcome parameters. Results: The chest compression depth was 29 (IQR, 28–29) mm in the TFT group, 42 (40–43) mm in the TTHT group, and 40 (39–40) mm in the nTTT group (TFT vs TTHT, P < 0.001; TFT vs nTTT, P < 0.001; TTHT vs nTTT, P < 0.01). The median compression rate with TFT, TTHT, and nTTT varied and amounted to 136 (IQR, 133–144) min–1 versus 117 (115–121) min–1 versus 111 (109–113) min–1. There was a statistically significant difference in the compression rate between TFT and TTHT (P < 0.001), TFT and nTTT (P < 0.001), as well as TTHT and nTTT (P < 0.001). Incorrect decompressions after CC were significantly increased in the TTHT group compared with the TFT (P < 0.001) and the nTTT (P < 0.001) group. Conclusions: The nTTT provides adequate chest compression depth and rate and was associated with adequate chest decompression and possibility to adequately ventilate the infant manikin. Further clinical studies are necessary to confirm these initial findings. PMID:28383397

Evaluation of a newly developed infant chest compression technique: A randomized crossover manikin trial.

PubMed

Smereka, Jacek; Bielski, Karol; Ladny, Jerzy R; Ruetzler, Kurt; Szarpak, Lukasz

2017-04-01

Providing adequate chest compression is essential during infant cardio-pulmonary-resuscitation (CPR) but was reported to be performed poor. The "new 2-thumb technique" (nTTT), which consists in using 2 thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist, was recently introduced. Therefore, the aim of this study was to compare 3 chest compression techniques, namely, the 2-finger-technique (TFT), the 2-thumb-technique (TTHT), and the nTTT in an randomized infant-CPR manikin setting. A total of 73 paramedics with at least 1 year of clinical experience performed 3 CPR settings with a chest compression:ventilation ratio of 15:2, according to current guidelines. Chest compression was performed with 1 out of the 3 chest compression techniques in a randomized sequence. Chest compression rate and depth, chest decompression, and adequate ventilation after chest compression served as outcome parameters. The chest compression depth was 29 (IQR, 28-29) mm in the TFT group, 42 (40-43) mm in the TTHT group, and 40 (39-40) mm in the nTTT group (TFT vs TTHT, P < 0.001; TFT vs nTTT, P < 0.001; TTHT vs nTTT, P < 0.01). The median compression rate with TFT, TTHT, and nTTT varied and amounted to 136 (IQR, 133-144) min versus 117 (115-121) min versus 111 (109-113) min. There was a statistically significant difference in the compression rate between TFT and TTHT (P < 0.001), TFT and nTTT (P < 0.001), as well as TTHT and nTTT (P < 0.001). Incorrect decompressions after CC were significantly increased in the TTHT group compared with the TFT (P < 0.001) and the nTTT (P < 0.001) group. The nTTT provides adequate chest compression depth and rate and was associated with adequate chest decompression and possibility to adequately ventilate the infant manikin. Further clinical studies are necessary to confirm these initial findings.

Use of a Real-Time Training Software (Laerdal QCPR®) Compared to Instructor-Based Feedback for High-Quality Chest Compressions Acquisition in Secondary School Students: A Randomized Trial.

PubMed

Cortegiani, Andrea; Russotto, Vincenzo; Montalto, Francesca; Iozzo, Pasquale; Meschis, Roberta; Pugliesi, Marinella; Mariano, Dario; Benenati, Vincenzo; Raineri, Santi Maurizio; Gregoretti, Cesare; Giarratano, Antonino

2017-01-01

High-quality chest compressions are pivotal to improve survival from cardiac arrest. Basic life support training of school students is an international priority. The aim of this trial was to assess the effectiveness of a real-time training software (Laerdal QCPR®) compared to a standard instructor-based feedback for chest compressions acquisition in secondary school students. After an interactive frontal lesson about basic life support and high quality chest compressions, 144 students were randomized to two types of chest compressions training: 1) using Laerdal QCPR® (QCPR group- 72 students) for real-time feedback during chest compressions with the guide of an instructor who considered software data for students' correction 2) based on standard instructor-based feedback (SF group- 72 students). Both groups had a minimum of a 2-minute chest compressions training session. Students were required to reach a minimum technical skill level before the evaluation. We evaluated all students at 7 days from the training with a 2-minute chest compressions session. The primary outcome was the compression score, which is an overall measure of chest compressions quality calculated by the software expressed as percentage. 125 students were present at the evaluation session (60 from QCPR group and 65 from SF group). Students in QCPR group had a significantly higher compression score (median 90%, IQR 81.9-96.0) compared to SF group (median 67%, IQR 27.7-87.5), p = 0.0003. Students in QCPR group performed significantly higher percentage of fully released chest compressions (71% [IQR 24.5-99.0] vs 24% [IQR 2.5-88.2]; p = 0.005) and better chest compression rate (117.5/min [IQR 106-123.5] vs 125/min [115-135.2]; p = 0.001). In secondary school students, a training for chest compressions based on a real-time feedback software (Laerdal QCPR®) guided by an instructor is superior to instructor-based feedback training in terms of chest compression technical skill acquisition. Australian New Zealand Clinical Trials Registry ACTRN12616000383460.

Follow-up chest radiographic findings in patients with MERS-CoV after recovery

PubMed Central

Das, Karuna M; Lee, Edward Y; Singh, Rajvir; Enani, Mushira A; Al Dossari, Khalid; Van Gorkom, Klaus; Larsson, Sven G; Langer, Ruth D

2017-01-01

Purpose: To evaluate the follow-up chest radiographic findings in patients with Middle East respiratory syndrome coronavirus (MERS-CoV) who were discharged from the hospital following improved clinical symptoms. Materials and Methods: Thirty-six consecutive patients (9 men, 27 women; age range 21–73 years, mean ± SD 42.5 ± 14.5 years) with confirmed MERS-CoV underwent follow-up chest radiographs after recovery from MERS-CoV. The 36 chest radiographs were obtained at 32 to 230 days with a median follow-up of 43 days. The reviewers systemically evaluated the follow-up chest radiographs from 36 patients for lung parenchymal, airway, pleural, hilar and mediastinal abnormalities. Lung parenchyma and airways were assessed for consolidation, ground-glass opacity (GGO), nodular opacity and reticular opacity (i.e., fibrosis). Follow-up chest radiographs were also evaluated for pleural thickening, pleural effusion, pneumothorax and lymphadenopathy. Patients were categorized into two groups: group 1 (no evidence of lung fibrosis) and group 2 (chest radiographic evidence of lung fibrosis) for comparative analysis. Patient demographics, length of ventilations days, number of intensive care unit (ICU) admission days, chest radiographic score, chest radiographic deterioration pattern (Types 1-4) and peak lactate dehydrogenase level were compared between the two groups using the student t-test, Mann-Whitney U test and Fisher's exact test. Results: Follow-up chest radiographs were normal in 23 out of 36 (64%) patients. Among the patients with abnormal chest radiographs (13/36, 36%), the following were found: lung fibrosis in 12 (33%) patients GGO in 2 (5.5%) patients, and pleural thickening in 2 (5.5%) patients. Patients with lung fibrosis had significantly greater number of ICU admission days (19 ± 8.7 days; P value = 0.001), older age (50.6 ± 12.6 years; P value = 0.02), higher chest radiographic scores [10 (0-15.3); P value = 0.04] and higher peak lactate dehydrogenase levels (315-370 U/L; P value = 0.001) when compared to patients without lung fibrosis. Conclusion: Lung fibrosis may develop in a substantial number of patients who have recovered from Middle East respiratory syndrome coronavirus (MERS-CoV). Significantly greater number of ICU admission days, older age, higher chest radiographic scores, chest radiographic deterioration patterns and peak lactate dehydrogenase levels were noted in the patients with lung fibrosis on follow-up chest radiographs after recovery from MERS-CoV. PMID:29089687

75 FR 15448 - Notice of Issuance of Final Determination Concerning a Wood Chest

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-29

... Determination Concerning a Wood Chest AGENCY: U.S. Customs and Border Protection, Department of Homeland... certain wood chest. Based upon the facts presented, CBP has concluded in the final determination that the U.S. is the country of origin of the wood chest for purposes of U.S. government procurement. DATES...

Pediatric chest imaging.

PubMed

Gross, G W

1992-10-01

The highlight of recent articles published on pediatric chest imaging is the potential advantage of digital imaging of the infant's chest. Digital chest imaging allows accurate determination of functional residual capacity as well as manipulation of the image to highlight specific anatomic features. Reusable photostimulable phosphor imaging systems provide wide imaging latitude and lower patient dose. In addition, digital radiology permits multiple remote-site viewing on monitor displays. Several excellent reviews of the imaging features of various thoracic abnormalities and the application of newer imaging modalities, such as ultrafast CT and MR imaging to the pediatric chest, are additional highlights.

Surgical Management of Lung Cancer Involving the Chest Wall.

PubMed

Lanuti, Michael

2017-05-01

The prevalence of chest wall invasion by non-small cell lung cancer is < 10% in published surgical series. The role of radiation or chemotherapy around the complete resection of lung cancer invading the chest wall, excluding the superior sulcus of the chest, is poorly defined. Survival of patients with lung cancer invading the chest wall is dependent on lymph node involvement and completeness of en-bloc resection. In some patients harboring T3N0 disease, 5-year survival in excess of 50% can be achieved. Offering en-bloc resection of lung cancer invading chest wall to patients with T3N1 or T3N2 disease is controversial. Copyright © 2017 Elsevier Inc. All rights reserved.

Computer-aided detection system for chest radiography: reducing report turnaround times of examinations with abnormalities.

PubMed

Kao, E-Fong; Liu, Gin-Chung; Lee, Lo-Yeh; Tsai, Huei-Yi; Jaw, Twei-Shiun

2015-06-01

The ability to give high priority to examinations with pathological findings could be very useful to radiologists with large work lists who wish to first evaluate the most critical studies. A computer-aided detection (CAD) system for identifying chest examinations with abnormalities has therefore been developed. To evaluate the effectiveness of a CAD system on report turnaround times of chest examinations with abnormalities. The CAD system was designed to automatically mark chest examinations with possible abnormalities in the work list of radiologists interpreting chest examinations. The system evaluation was performed in two phases: two radiologists interpreted the chest examinations without CAD in phase 1 and with CAD in phase 2. The time information recorded by the radiology information system was then used to calculate the turnaround times. All chest examinations were reviewed by two other radiologists and were divided into normal and abnormal groups. The turnaround times for the examinations with pathological findings with and without the CAD system assistance were compared. The sensitivity and specificity of the CAD for chest abnormalities were 0.790 and 0.697, respectively, and use of the CAD system decreased the turnaround time for chest examinations with abnormalities by 44%. The turnaround times required for radiologists to identify chest examinations with abnormalities could be reduced by using the CAD system. This system could be useful for radiologists with large work lists who wish to first evaluate the most critical studies. © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Accuracy of transthoracic ultrasound for the prediction of chest wall infiltration by lung cancer and of lung infiltration by chest wall tumours.

PubMed

Caroli, Guido; Dell'Amore, Andrea; Cassanelli, Nicola; Dolci, Giampiero; Pipitone, Emanuela; Asadi, Nizar; Stella, Franco; Bini, Alessandro

2015-10-01

We wanted to determine the accuracy of transthoracic ultrasound in the prediction of chest wall infiltration by lung cancer or lung infiltration by chest wall tumours. Patients having preoperative CT-scan suspect for lung/chest wall infiltration were prospectively enrolled. Inclusion criteria for lung cancer were: obliteration of extrapleural fat, obtuse angle between tumour and chest wall, associated pleural thickening. The criteria for chest wall tumours were: rib destruction and intercostal muscles infiltration with extrapleural fat obliteration and intrathoracic extension. Lung cancer patients with evident chest wall infiltration were excluded. Transthoracic ultrasound was preoperatively performed. Predictions were checked during surgical intervention. Twenty-three patients were preoperatively examined. Sensitivity, specificity, positive and negative predictive values of transthoracic ultrasound were 88.89%, 100%, 100% and 93.3%, respectively. Youden index was used to determine the best cut-off for tumour size in predicting lung/chest wall infiltration: 4.5cm. At univariate logistic regression, tumour size (<4.5 vs ≥ 4.5cm) (p=0.0072) was significantly associated with infiltration. Transthoracic ultrasound is a useful instrument for predicting neoplastic lung or chest wall infiltration in cases of suspect CT-scans and could be used as part of the preoperative workup to assess tumour staging and to plan the best surgical approach. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

Usefulness of Chest Radiographs for Scoliosis Screening: A Comparison with Thoraco-Lumbar Standing Radiographs

PubMed Central

Oh, Chang Hyun; Kim, Chan Gyu; Lee, Myoung Seok; Park, Hyeong-Chun; Park, Chong Oon

2012-01-01

Purpose The purposes of this study were to evaluate the usefulness and limitations of chest radiographs in scoliosis screening and to compare these results with those of thoraco-lumbar standing radiographs (TLSR). Materials and Methods During Korean conscription, 419 males were retrospectively examined using both chest radiographs and TLSR to confirm the scoliosis and Cobb angle at the Regional Military Manpower. We compared the types of spinal curves and Cobb angles as measured from different radiographs. Results In the pattern of spinal curves, the overall matching rate of chest radiographs using TLSR was about 58.2% (244 of 419 cases). Cobb angle differences between chest radiographs and TLSR with meaningful difference was observed in 156 cases (37.2%); a relatively high proportion (9.5%) of Cobb angle differences more than 10 degrees was also observed. The matching rate of both spinal curve types and Cobb angle accuracy between chest radiographs and TLSR was 27.9% (117 among 419 cases). Chest radiographs for scoliosis screening were observed with 93.94% of sensitivity and 61.67% of specificity in thoracic curves; however, less than 40% of sensitivity (38.27%, 20.00%, and 25.80%) and more than 95% of specificity (97.34%, 99.69%, and 98.45%) were observed in thoraco-lumbar, lumbar, and double major curves, respectively. Conclusion The accuracy of chest radiographs for scoliosis screening was low. The incidence of thoracic curve scoliosis was overestimated and lumbar curve scoliosis was easily missed by chest radiography. Scoliosis screening using chest radiography has limited values, nevertheless, it is useful method for detecting thoracic curve scoliosis. PMID:23074120

Evaluation of chest compression effect on airway management with air-Q, aura-i, i-gel, and Fastrack intubating supraglottic devices by novice physicians: a randomized crossover simulation study.

PubMed

Komasawa, Nobuyasu; Ueki, Ryusuke; Kaminoh, Yoshiroh; Nishi, Shin-Ichi

2014-10-01

In the 2010 American Heart Association guidelines, supraglottic devices (SGDs) such as the laryngeal mask are proposed as alternatives to tracheal intubation for cardiopulmonary resuscitation. Some SGDs can also serve as a means for tracheal intubation after successful ventilation. The purpose of this study was to evaluate the effect of chest compression on airway management with four intubating SGDs, aura-i (aura-i), air-Q (air-Q), i-gel (i-gel), and Fastrack (Fastrack), during cardiopulmonary resuscitation using a manikin. Twenty novice physicians inserted the four intubating SGDs into a manikin with or without chest compression. Insertion time and successful ventilation rate were measured. For cases of successful ventilation, blind tracheal intubation via the intubating SGD was performed with chest compression and success or failure within 30 s was recorded. Chest compression did not decrease the ventilation success rate of the four intubating SGDs (without chest compression (success/total): air-Q, 19/20; aura-i, 19/20; i-gel, 18/20; Fastrack, 19/20; with chest compression: air-Q, 19/20; aura-i, 19/20; i-gel, 16/20; Fastrack, 18/20). Insertion time was significantly lengthened by chest compression in the i-gel trial (P < 0.05), but not with the other three devices. The blind intubation success rate with chest compression was the highest in the air-Q trial (air-Q, 15/19; aura-i, 14/19; i-gel, 12/16; Fastrack, 10/18). This simulation study revealed the utility of intubating SGDs for airway management during chest compression.

Omitting chest tube drainage after thoracoscopic major lung resection.

PubMed

Ueda, Kazuhiro; Hayashi, Masataro; Tanaka, Toshiki; Hamano, Kimikazu

2013-08-01

Absorbable mesh and fibrin glue applied to prevent alveolar air leakage contribute to reducing the length of chest tube drainage, length of hospitalization and the rate of pulmonary complications. This study investigated the feasibility of omitting chest tube drainage in selected patients undergoing thoracoscopic major lung resection. Intraoperative air leakages were sealed with fibrin glue and absorbable mesh in patients undergoing thoracoscopic major lung resection. The chest tube was removed just after tracheal extubation if no air leakages were detected in a suction-induced air leakage test, which is an original technique to confirm pneumostasis. Patients with bleeding tendency or extensive thoracic adhesions were excluded. Chest tube drainage was omitted in 29 (58%) of 50 eligible patients and was used in 21 (42%) on the basis of suction-induced air leakage test results. Male gender and compromised pulmonary function were significantly associated with the failure to omit chest tube drainage (both, P < 0.05). Regardless of omitting the chest tube drainage, there were no adverse events during hospitalization, such as subcutaneous emphysema, pneumothorax, pleural effusion or haemothorax, requiring subsequent drainage. Furthermore, there was no prolonged air leakage in any patients: The mean length of chest tube drainage was only 0.9 days. Omitting the chest tube drainage was associated with reduced pain on the day of the operation (P = 0.046). The refined strategy for pneumostasis allowed the omission of chest tube drainage in the majority of patients undergoing thoracoscopic major lung resection without increasing the risk of adverse events, which may contribute to a fast-track surgery.

[Development of a digital chest phantom for studies on energy subtraction techniques].

PubMed

Hayashi, Norio; Taniguchi, Anna; Noto, Kimiya; Shimosegawa, Masayuki; Ogura, Toshihiro; Doi, Kunio

2014-03-01

Digital chest phantoms continue to play a significant role in optimizing imaging parameters for chest X-ray examinations. The purpose of this study was to develop a digital chest phantom for studies on energy subtraction techniques under ideal conditions without image noise. Computed tomography (CT) images from the LIDC (Lung Image Database Consortium) were employed to develop a digital chest phantom. The method consisted of the following four steps: 1) segmentation of the lung and bone regions on CT images; 2) creation of simulated nodules; 3) transformation to attenuation coefficient maps from the segmented images; and 4) projection from attenuation coefficient maps. To evaluate the usefulness of digital chest phantoms, we determined the contrast of the simulated nodules in projection images of the digital chest phantom using high and low X-ray energies, soft tissue images obtained by energy subtraction, and "gold standard" images of the soft tissues. Using our method, the lung and bone regions were segmented on the original CT images. The contrast of simulated nodules in soft tissue images obtained by energy subtraction closely matched that obtained using the gold standard images. We thus conclude that it is possible to carry out simulation studies based on energy subtraction techniques using the created digital chest phantoms. Our method is potentially useful for performing simulation studies for optimizing the imaging parameters in chest X-ray examinations.

Nurses’ knowledge of care of chest drain: A survey in a Nigerian semiurban university hospital

PubMed Central

Kesieme, Emeka Blessius; Essu, Ifeanyichukwu Stanley; Arekhandia, Bruno Jeneru; Welcker, Katrin; Prisadov, Georgi

2016-01-01

Background/Objective: Inefficient nursing care of chest drains may associated with unacceptable and sometimes life-threatening complications. This report aims to ascertain the level of knowledge of care of chest drains among nurses working in wards in a teaching hospital in Nigeria. Methods: A cross-sectional study among nurses at teaching hospital using pretested self-administered questionnaires. Results: The majority were respondents aged between 31 and 40 years (45.4%) and those who have nursing experience between 6 and 10 years. Only 37 respondents (26.2%) had a good knowledge of nursing care of chest drains. Knowledge was relatively higher among nurses who cared for chest drains daily, nurses who have a work experience of <10 years, low-rank nurses and those working in the female medical ward; however, the relationship cant (P > 0.05). Performance was poor on the questions on position of drainage system were not statistically significant with relationship to waist level while mobilizing the patient, application of suction to chest drains, daily changing of dressing over chest drain insertion site, milking of tubes and drainage system with dependent loop. Conclusion: The knowledge of care of chest drains among nurses is poor, especially in the key post procedural care. There is an urgent need to train them so as to improve the nursing care of patients managed with chest drains. PMID:26857934

The safe volume threshold for chest drain removal following pulmonary resection.

PubMed

Yap, Kok Hooi; Soon, Jia Lin; Ong, Boon Hean; Loh, Yee Jim

2017-11-01

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'In patients undergoing pulmonary resection, is there a safe drainage volume threshold for chest drain removal?' Altogether 1054 papers were found, of which 5 papers represented the best evidence. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Chest drainage threshold, where used, ranged from 250 to 500 ml/day. Both randomized controlled trials showed no significant difference in reintervention rates with a higher chest drainage volume threshold. Four studies that performed analysis on other complications showed no statistical significant difference with a higher chest drainage volume threshold. Four studies evaluating length of hospital stay showed reduced or no difference in the length of stay with a higher chest drainage volume threshold. Two cohort studies reported the mortality rate of 0-0.01% with a higher chest drainage volume threshold. We conclude that early chest drain removal after pulmonary resection, accepting a higher chest drainage volume threshold of 250-500 ml/day is safe, and may result in shorter hospital stay without increasing reintervention, morbidity or mortality. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Application of Deconvolution Algorithm of Point Spread Function in Improving Image Quality: An Observer Preference Study on Chest Radiography.

PubMed

Chae, Kum Ju; Goo, Jin Mo; Ahn, Su Yeon; Yoo, Jin Young; Yoon, Soon Ho

2018-01-01

To evaluate the preference of observers for image quality of chest radiography using the deconvolution algorithm of point spread function (PSF) (TRUVIEW ART algorithm, DRTECH Corp.) compared with that of original chest radiography for visualization of anatomic regions of the chest. Prospectively enrolled 50 pairs of posteroanterior chest radiographs collected with standard protocol and with additional TRUVIEW ART algorithm were compared by four chest radiologists. This algorithm corrects scattered signals generated by a scintillator. Readers independently evaluated the visibility of 10 anatomical regions and overall image quality with a 5-point scale of preference. The significance of the differences in reader's preference was tested with a Wilcoxon's signed rank test. All four readers preferred the images applied with the algorithm to those without algorithm for all 10 anatomical regions (mean, 3.6; range, 3.2-4.0; p < 0.001) and for the overall image quality (mean, 3.8; range, 3.3-4.0; p < 0.001). The most preferred anatomical regions were the azygoesophageal recess, thoracic spine, and unobscured lung. The visibility of chest anatomical structures applied with the deconvolution algorithm of PSF was superior to the original chest radiography.

Evaluation of a Noise Reduction Procedure for Chest Radiography

PubMed Central

Fukui, Ryohei; Ishii, Rie; Kodani, Kazuhiko; Kanasaki, Yoshiko; Suyama, Hisashi; Watanabe, Masanari; Nakamoto, Masaki; Fukuoka, Yasushi

2013-01-01

Background The aim of this study was to evaluate the usefulness of noise reduction procedure (NRP), a function in the new image processing for chest radiography. Methods A CXDI-50G Portable Digital Radiography System (Canon) was used for X-ray detection. Image noise was analyzed with a noise power spectrum (NPS) and a burger phantom was used for evaluation of density resolution. The usefulness of NRP was evaluated by chest phantom images and clinical chest radiography. We employed the Bureau of Radiological Health Method for scoring chest images while carrying out our observations. Results NPS through the use of NRP was improved compared with conventional image processing (CIP). The results in image quality showed high-density resolution through the use of NRP, so that chest radiography examination can be performed with a low dose of radiation. Scores were significantly higher than for CIP. Conclusion In this study, use of NRP led to a high evaluation in these so we are able to confirm the usefulness of NRP for clinical chest radiography. PMID:24574577

Headaches

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Cough

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Fever

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Diarrhea

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The intersection between asthma and acute chest syndrome in children with sickle-cell anaemia

PubMed Central

DeBaun, Michael R; Strunk, Robert C

2016-01-01

Acute chest syndrome is a frequent cause of acute lung disease in children with sickle-cell disease. Asthma is common in children with sickle-cell disease and is associated with increased incidence of vaso-occlusive pain events, acute chest syndrome episodes, and earlier death. Risk factors for asthma exacerbation and an acute chest syndrome episode are similar, and both can present with shortness of breath, chest pain, cough, and wheezing. Despite overlapping risk factors and symptoms, an acute exacerbation of asthma or an episode of acute chest syndrome are two distinct entities that need disease-specific management strategies. Although understanding has increased about asthma as a comorbidity in sickle-cell disease and its effects on morbidity, substantial gaps remain in knowledge about best management. PMID:27353685

Regionally adaptive histogram equalization of the chest.

PubMed

Sherrier, R H; Johnson, G A

1987-01-01

Advances in the area of digital chest radiography have resulted in the acquisition of high-quality images of the human chest. With these advances, there arises a genuine need for image processing algorithms specific to the chest, in order to fully exploit this digital technology. We have implemented the well-known technique of histogram equalization, noting the problems encountered when it is adapted to chest images. These problems have been successfully solved with our regionally adaptive histogram equalization method. With this technique histograms are calculated locally and then modified according to both the mean pixel value of that region as well as certain characteristics of the cumulative distribution function. This process, which has allowed certain regions of the chest radiograph to be enhanced differentially, may also have broader implications for other image processing tasks.

Chest injuries related to surfing.

PubMed

Sano, Atsushi; Yotsumoto, Takuma

2015-09-01

Surfing is a popular sport in coastal areas, which can be associated with chest injuries. Between 2008 and 2013, 6 patients were referred to our hospital with chest injuries sustained during surfing. Clinical data were collected from their medical records and analyzed retrospectively. Patient age ranged from 35 to 52 years. Five of the 6 patients were male. Four patients were injured in August, and the other two were injured in September and October. Rib fractures were observed in 3 of the 6 patients. The other 3 patients were diagnosed with chest contusions only. Hemothorax occurred in one patient. No lacerations were observed in any of the 6 patients. Chest injuries associated with surfing are usually blunt chest injuries; however, they may occasionally be life-threatening. © The Author(s) 2015.

Chest Wall Trauma.

PubMed

Majercik, Sarah; Pieracci, Fredric M

2017-05-01

Chest wall trauma is common, and contributes significantly to morbidity and mortality of trauma patients. Early identification of major chest wall and concomitant intrathoracic injuries is critical. Generalized management of multiple rib fractures and flail chest consists of adequate pain control (including locoregional modalities); management of pulmonary dysfunction by invasive and noninvasive means; and, in some cases, surgical fixation. Multiple studies have shown that patients with flail chest have substantial benefit (decreased ventilator and intensive care unit days, improved pulmonary function, and improved long-term functional outcome) when they undergo surgery compared with nonoperative management. Copyright © 2017 Elsevier Inc. All rights reserved.

Chest Wall Diseases: Respiratory Pathophysiology.

PubMed

Tzelepis, George E

2018-06-01

The chest wall consists of various structures that function in an integrated fashion to ventilate the lungs. Disorders affecting the bony structures or soft tissues of the chest wall may impose elastic loads by stiffening the chest wall and decreasing respiratory system compliance. These alterations increase the work of breathing and lead to hypoventilation and hypercapnia. Respiratory failure may occur acutely or after a variable period of time. This review focuses on the pathophysiology of respiratory function in specific diseases and disorders of the chest wall, and highlights pathogenic mechanisms of respiratory failure. Copyright © 2018 Elsevier Inc. All rights reserved.

Improving Hybrid III injury assessment in steering wheel rim to chest impacts using responses from finite element Hybrid III and human body model.

PubMed

Holmqvist, Kristian; Davidsson, Johan; Mendoza-Vazquez, Manuel; Rundberget, Peter; Svensson, Mats Y; Thorn, Stefan; Törnvall, Fredrik

2014-01-01

The main aim of this study was to improve the quality of injury risk assessments in steering wheel rim to chest impacts when using the Hybrid III crash test dummy in frontal heavy goods vehicle (HGV) collision tests. Correction factors for chest injury criteria were calculated as the model chest injury parameter ratios between finite element (FE) Hybrid III, evaluated in relevant load cases, and the Total Human Model for Safety (THUMS). This is proposed to be used to compensate Hybrid III measurements in crash tests where steering wheel rim to chest impacts occur. The study was conducted in an FE environment using an FE-Hybrid III model and the THUMS. Two impactor shapes were used, a circular hub and a long, thin horizontal bar. Chest impacts at velocities ranging from 3.0 to 6.0 m/s were simulated at 3 impact height levels. A ratio between FE-Hybrid III and THUMS chest injury parameters, maximum chest compression C max, and maximum viscous criterion VC max, were calculated for the different chest impact conditions to form a set of correction factors. The definition of the correction factor is based on the assumption that the response from a circular hub impact to the middle of the chest is well characterized and that injury risk measures are independent of impact height. The current limits for these chest injury criteria were used as a basis to develop correction factors that compensate for the limitations in biofidelity of the Hybrid III in steering wheel rim to chest impacts. The hub and bar impactors produced considerably higher C max and VC max responses in the THUMS compared to the FE-Hybrid III. The correction factor for the responses of the FE-Hybrid III showed that the criteria responses for the bar impactor were consistently overestimated. Ratios based on Hybrid III and THUMS responses provided correction factors for the Hybrid III responses ranging from 0.84 to 0.93. These factors can be used to estimate C max and VC max values when the Hybrid III is used in crash tests for which steering wheel rim to chest interaction occurs. For the FE-Hybrid III, bar impacts caused higher chest deflection compared to hub impacts, although the contrary results were obtained with the more humanlike THUMS. Correction factors were developed that can be used to correct the Hybrid III chest responses. Higher injury criteria capping limits for steering wheel impacts are acceptable. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Facial Swelling

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Tooth Problems

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Mouth Problems

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Hip Problems

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Ankle Problems

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Knee Problems

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Leg Problems

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Collapsed lung (pneumothorax)

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... provider will listen to your breathing with a stethoscope. If you have a collapsed lung, there are ... rupture, chest x-ray Pneumothorax - chest x-ray Respiratory system Chest tube insertion - series Pneumothorax - series References ...

Comparison of patient specific dose metrics between chest radiography, tomosynthesis, and CT for adult patients of wide ranging body habitus

PubMed Central

Zhang, Yakun; Li, Xiang; Segars, W. Paul; Samei, Ehsan

2014-01-01

Purpose: Given the radiation concerns inherent to the x-ray modalities, accurately estimating the radiation doses that patients receive during different imaging modalities is crucial. This study estimated organ doses, effective doses, and risk indices for the three clinical chest x-ray imaging techniques (chest radiography, tomosynthesis, and CT) using 59 anatomically variable voxelized phantoms and Monte Carlo simulation methods. Methods: A total of 59 computational anthropomorphic male and female extended cardiac-torso (XCAT) adult phantoms were used in this study. Organ doses and effective doses were estimated for a clinical radiography system with the capability of conducting chest radiography and tomosynthesis (Definium 8000, VolumeRAD, GE Healthcare) and a clinical CT system (LightSpeed VCT, GE Healthcare). A Monte Carlo dose simulation program (PENELOPE, version 2006, Universitat de Barcelona, Spain) was used to mimic these two clinical systems. The Duke University (Durham, NC) technique charts were used to determine the clinical techniques for the radiographic modalities. An exponential relationship between CTDIvol and patient diameter was used to determine the absolute dose values for CT. The simulations of the two clinical systems compute organ and tissue doses, which were then used to calculate effective dose and risk index. The calculation of the two dose metrics used the tissue weighting factors from ICRP Publication 103 and BEIR VII report. Results: The average effective dose of the chest posteroanterior examination was found to be 0.04 mSv, which was 1.3% that of the chest CT examination. The average effective dose of the chest tomosynthesis examination was found to be about ten times that of the chest posteroanterior examination and about 12% that of the chest CT examination. With increasing patient average chest diameter, both the effective dose and risk index for CT increased considerably in an exponential fashion, while these two dose metrics only increased slightly for radiographic modalities and for chest tomosynthesis. Effective and organ doses normalized to mAs all illustrated an exponential decrease with increasing patient size. As a surface organ, breast doses had less correlation with body size than that of lungs or liver. Conclusions: Patient body size has a much greater impact on radiation dose of chest CT examinations than chest radiography and tomosynthesis. The size of a patient should be considered when choosing the best thoracic imaging modality. PMID:24506654

"Anterior convergent" chest probing in rapid ultrasound transducer positioning versus formal chest ultrasonography to detect pneumothorax during the primary survey of hospital trauma patients: a diagnostic accuracy study.

PubMed

Ziapour, Behrad; Haji, Houman Seyedjavady

2015-01-01

Occult pneumothorax represents a diagnostic pitfall during the primary survey of trauma patients, particularly if these patients require early positive pressure ventilation. This study investigated the accuracy of our proposed rapid model of ultrasound transducer positioning during the primary survey of trauma patients after their arrival at the hospital. This diagnostic trial was conducted over 12 months and was based on the results of 84 ultrasound (US) exams performed on patients with severe multiple trauma. Our index test (US) was used to detect pneumothorax in four pre-defined locations on the anterior of each hemi-thorax using the "Anterior Convergent" approach, and its performance was limited to the primary survey. Consecutively, patients underwent chest-computed tomography (CT) with or without chest radiography. The diagnostic findings of both chest radiography and chest ultrasounds were compared to the gold-standard test (CT). The diagnostic sensitivity was 78 % for US and 36.4 % for chest radiography (p < 0.001); the specificity was 92 % for US and 98 % for chest radiography (not significant); the positive predictive values were 74 % for US and 80 % for chest radiography (not significant); the negative predictive values were 94 % for US and 87 % for chest radiography (not significant); the positive likelihood ratio was 10 for US and 18 for chest radiography (p = 0.007); and the negative likelihood ratio was 0.25 for US and 0.65 for chest radiography (p = 0.001). The mean required time for performing the new method was 64 ± 10 s. An absence of the expected diffused dynamic view among ultrasound images obtained from patients with pneumothorax was also observed. We designated this phenomenon "Gestalt Lung Recession." "Anterior convergent" chest US probing represents a brief but efficient model that provides clinicians a safe and accurate exam and adequate resuscitation during critical minutes of the primary survey without interrupting other medical staff activities taking place around the trauma patient. The use of the new concept of "Gestalt Lung Recession" instead of the absence of "lung sliding" might improve the specificity of US in detecting pneumothorax.

Cold and Flu

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Shortness of Breath

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Non-Cardiac Chest Pain

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Microsurgical Chest Wall Reconstruction After Oncologic Resections

PubMed Central

Sauerbier, Michael; Dittler, S.; Kreutzer, C.

2011-01-01

Defect reconstruction after radical oncologic resection of malignant chest wall tumors requires adequate soft tissue reconstruction with function, stability, integrity, and an aesthetically acceptable result of the chest wall. The purpose of this article is to describe possible reconstructive microsurgical pathways after full-thickness oncologic resections of the chest wall. Several reliable free flaps are described, and morbidity and mortality rates of patients are discussed. PMID:22294944

Occult pneumomediastinum in blunt chest trauma: clinical significance.

PubMed

Rezende-Neto, J B; Hoffmann, J; Al Mahroos, M; Tien, H; Hsee, L C; Spencer Netto, F; Speers, V; Rizoli, S B

2010-01-01

Thoracic injuries are potentially responsible for 25% of all trauma deaths. Chest X-ray is commonly used to screen patients with chest injury. However, the use of computed tomography (CT) scan for primary screening is increasing, particularly for blunt trauma. CT scans are more sensitive than chest X-ray in detecting intra-thoracic abnormalities such as pneumothoraces and pneumomediastinums. Pneumomediastinum detected by chest X-ray or "overt pneumomediastinum", raises the concern of possible aerodigestive tract injuries. In contrast, there is scarce information on the clinical significance of pneumomediastinum diagnosed by CT scan only or "occult pneumomediastinum". Therefore we investigated the clinical consequences of occult pneumomediastinum in our blunt trauma population. A 2-year retrospective chart review of all blunt chest trauma patients with initial chest CT scan admitted to a level I trauma centre. Data extracted from the medical records include; demographics, occult, overt, or no pneumomediastinum, the presence of intra-thoracic aerodigestive tract injuries (trachea, bronchus, and/or esophagus), mechanism and severity of injury, endotracheal intubation, chest thoracostomy, operations and radiological reports by an attending radiologist. All patients with intra-thoracic aerodigestive tract injuries from 1994 to 2004 were also investigated. Of 897 patients who met the inclusion criteria 839 (93.5%) had no pneumomediastinum. Five patients (0.6%) had overt pneumomediastinum and 53 patients (5.9%) had occult pneumomediastinum. Patients with occult pneumomediastinum had significantly higher ISS and AIS chest (p<0.0001) than patients with no pneumomediastinum. A chest thoracostomy tube was more common (p<0.0001) in patients with occult pneumomediastinum (47.2%) than patients with no pneumomediastinum (10.4%), as well as occult pneumothorax. None of the patients with occult pneumomediastinum had aerodigestive tract injuries (95%CI 0-0.06). Follow up CT scan of patients with occult pneumomediastinum showed complete resolution in all cases, in average 3 h after the initial exam. Occult pneumomediastinum occurred in approximately 6% of all trauma patients with blunt chest injuries in our institution. Patients who had occult pneumomediastinum were more severely injured than those who without. However, none of the patients with occult pneumomediastinum had aerodigestive tract injuries and follow up chest CT scans demonstrated their complete and spontaneous resolution.

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

PubMed

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

2017-06-01

Gunshot wounds (GSW) to the chest are common presentations to trauma centres in South Africa. The clinical management and outcome of GSW to the chest are significantly altered by missile trajectory and the associated anatomical structures injured making them challenging injuries to treat. Currently, the management of GSW chest is based on scant evidence and treatment is typically according to algorithms based largely on the anecdotal experience of high volume institutions and experienced clinicians. Ethical approval was obtained for this study. The Electronic Trauma Health Registry (eTHR) Application of the Trauma Centre at Groote Schuur Hospital in Cape Town was interrogated for the year 2015 for all patients with GSW chest. The data was then analysed using descriptive statistics. A total of 141 patients with GSW to the chest were admitted to the Trauma Centre with a median age of 26 years. More than half of the patients, 53. 2% (n = 75) sustained an isolated GSW to the chest. Overall, 29.1% (n = 41) patients sustained a thoracoabdominal injury, which accounts for a significant higher amount of emergency surgeries compared to patients with non thoracoabdominal injuries (54% vs 15%, p = < 0.01). 9.2% (n = 13) of all patients required an emergency thoracotomy or emergency chest surgery of which 5 patients survived. Overall mortality was 7.1% (n = 10) of which 5 patients died from a thoracic cause. Civilian GSW to the chest are common injuries seen in Cape Town, often with concomitant injuries leading to increased morbidity. Significantly more emergency surgeries were done in patients with thoracoabdominal injury. Overall few patients needed chest-related emergency operative intervention (9.2%) with a survival rate of 38.5%. Overall mortality of patients with GSW chest who reached the hospital was 7.1% of whom 50% died from a thoracic cause.

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

PubMed

Meijering, V M; Hattam, A T

2017-06-01

Gunshot wounds (GSW) to the chest are common presentations to trauma centres both in South Africa and internationally. The clinical management and outcome of GSW to the chest are significantly altered by missile trajectory and the associated anatomical structures injured making them challenging injuries to treat. Currently, the management of GSW chest is based on scant evidence and treatment is typically according to algorithms based largely on the anecdotal experience of high volume institutions and experienced clinicians. Ethical approval was obtained for this study. The Electronic Trauma Health Registry (eTHR) Application of the Trauma Centre at Groote Schuur Hospital in Cape Town was interrogated for the year 2015 for all patients with GSW chest. The data was then analysed using descriptive statistics. A total of 141 patients with GSW to the chest were admitted to the Trauma Centre with a median age of 26 years . More than half of the patients, 53.2% (n = 75), sustained an isolated GSW to the chest. Overall, 29.1% (n = 41) patients sustained thoraco-abdominal injury, which accounts for a significant higher number of emergency surgeries compared to patients with non thoraco-abdominal injury (54% vs 15%, p = < 0.01). 9.2% (n = 13) of all patients required an emergency thoracotomy or emergency chest surgery (resp. 3.5% and 5.7%) of which 5 patients survived. Overall mortality was 7.1% (n = 10) of which 5 patients died from a thoracic cause. Civilian GSW to the chest are common injuries seen in Cape Town, often with concomitant injuries leading to increased morbidity. Significantly more emergency surgeries were done in patients with thoraco-abdominal injury. Overall few patients needed chest-related emergency operative intervention (9.2%) with a survival rate of 38.5%. Overall mortality of patients with GSW chest who reached the hospital was 7.1% of whom 50% died from a thoracic cause.

NCAP test improvements with pretensioners and load limiters.

PubMed

Walz, Marie

2004-03-01

New Car Assessment Program (NCAP) test scores, measured by the United States Department of Transportation's (USDOT) National Highway Traffic Safety Administration (NHTSA), were analyzed in order to assess the benefits of equipping safety belt systems with pretensioners and load limiters. Safety belt pretensioners retract the safety belt almost instantly in a crash to remove excess slack. They tie the occupant to the vehicle's deceleration early during the crash, reducing the peak load experienced by the occupant. Load limiters and other energy management systems allow safety belts to yield in a crash, preventing the shoulder belt from directing too much energy on the chest of the occupant. In NCAP tests, vehicles are crashed into a fixed barrier at 35 mph. During the test, instruments measure the accelerations of the head and chest, as well as the force on the legs of anthropomorphic dummies secured in the vehicle by safety belts. NCAP data from model year 1998 through 2001 cars and light trucks were examined. The combination of pretensioners and load limiters is estimated to reduce Head Injury Criterion (HIC) by 232, chest acceleration by an average of 6.6 g's, and chest deflection (displacement) by 10.6 mm, for drivers and right front passengers. The unit used to measure chest acceleration (g) is defined as a unit of force equal to the force exerted by gravity. All of these reductions are statistically significant. When looked at individually, pretensioners are more effective in reducing HIC scores for both drivers and right front passengers, as well as chest acceleration and chest deflection scores for drivers. Load limiters show greater reductions in chest acceleration and chest deflection scores for right front passengers. By contrast, in make-models for which neither load limiters nor pretensioners have been added, there is little change during 1998 to 2001 in HIC, chest acceleration, or chest deflection values in NCAP tests.

Genital Problems in Women

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Neck Swelling (Symptom Checker)

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Hand/Wrist/Arm Problems

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

CT angiography - chest

MedlinePlus

... aortic aneurysm - CTA chest; Venous thromboembolism - CTA lung; Blood clot - CTA lung; Embolus - CTA lung; CT pulmonary angiogram ... angiogram may be done: For symptoms that suggest blood clots in the lungs, such as chest pain, rapid ...

The transverse diameter of the chest on routine radiographs reliably estimates gestational age and weight in premature infants.

PubMed

Dietz, Kelly R; Zhang, Lei; Seidel, Frank G

2015-08-01

Prior to digital radiography it was possible for a radiologist to easily estimate the size of a patient on an analog film. Because variable magnification may be applied at the time of processing an image, it is now more difficult to visually estimate an infant's size on the monitor. Since gestational age and weight significantly impact the differential diagnosis of neonatal diseases and determine the expected size of kidneys or appearance of the brain by MRI or US, this information is useful to a pediatric radiologist. Although this information may be present in the electronic medical record, it is frequently not readily available to the pediatric radiologist at the time of image interpretation. To determine if there was a correlation between gestational age and weight of a premature infant with their transverse chest diameter (rib to rib) on admission chest radiographs. This retrospective study was approved by the institutional review board, which waived informed consent. The maximum transverse chest diameter outer rib to outer rib was measured on admission portable chest radiographs of 464 patients admitted to the neonatal intensive care unit (NICU) during the 2010 calendar year. Regression analysis was used to investigate the association between chest diameter and gestational age/birth weight. Quadratic term of chest diameter was used in the regression model. Chest diameter was statistically significantly associated with both gestational age (P < 0.0001) and birth weight (P < 0.0001). An infant's gestational age and birth weight can be reliably estimated by comparing a simple measurement of the transverse chest diameter on digital chest radiograph with the tables and graphs in our study.

The uniform chest compression depth of 50 mm or greater recommended by current guidelines is not appropriate for all adults.

PubMed

Lee, Soo Hoon; Kim, Dong Hoon; Kang, Tae-Sin; Kang, Changwoo; Jeong, Jin Hee; Kim, Seong Chun; Kim, Dong Seob

2015-08-01

This study was conducted to evaluate the appropriateness of the chest compression (CC) depth recommended in the current guidelines and simulated external CCs, and to characterize the optimal CC depth for an adult by body mass index (BMI). Adult patients who underwent chest computed tomography as a screening test for latent pulmonary diseases in the health care center were enrolled in this study. We calculated the internal anteroposterior (AP) diameter (IAPD) and external AP diameter (EAPD) of the chest across BMIs (<18.50, 18.50-24.99, 25.00-29.99, and ≥30.00 kg/m(2)) for simulated CC depth. We also calculated the residual chest depths less than 20 mm for simulated CC depth. There was a statistically significant difference in the chest EAPD and IAPD measured at the lower half of the sternum for each BMI groups (EAPD: R(2) = 0.638, P < .001; IAPD: R(2) = 0.297, P < .001). For one-half external AP CC, 100% of the patients, regardless of BMI, had a calculated residual internal chest depth less than 20 mm. For one-fourth external AP CC, no patients had a calculated residual internal chest depth less than 20 mm. For one-third external AP CC, only 6.48% of the patients had a calculated residual internal chest depth less than 20 mm. It is not appropriate that the current CC depth (≥50 mm), expressed only as absolute measurement without a fraction of the depth of the chest, is applied uniformly in all adults. In addition, in terms of safety and efficacy, simulated CC targeting approximately between one-third and one-fourth EAPD CC depth might be appropriate. Copyright © 2015 Elsevier Inc. All rights reserved.

The Interest of Performing "On-Demand Chest X-rays" after Lung Resection by Minimally Invasive Surgery.

PubMed

Haddad, Laura; Bubenheim, Michael; Bernard, Alain; Melki, Jean; Peillon, Christophe; Baste, Jean-Marc

2017-10-01

Background  There is a lack of consensus in hospital centers regarding costly daily routine chest X-rays after lung resection by minimally invasive surgery. Indeed, there is no evidence that performing daily chest X-rays prevents postoperative complications. Our objective was to compare chest X-rays performed on demand when there was clinical suspicion of postoperative complications and chest X-rays performed systematically in daily routine practice. Methods  This prospective single-center study compared 55 patients who had on-demand chest X-rays and patients in the literature who had daily routine chest X-rays. Our primary evaluation criterion was length of hospitalization. Results  The length of hospitalization was 5.3 ± 3.3 days for patients who had on-demand X-rays, compared with 4 to 9.7 days for patients who had daily routine X-rays. Time to chest tube removal (4.34 days), overall complication rate (27.2%), reoperation rate (3.6%), and mortality rate (1.8%) were comparable to those in the literature. On average, our patients only had 1.22 ± 1.8 on-demand X-rays, compared with 3.3 X-rays if daily routine protocol had been applied. Patients with complications had more X-rays (3.4 ± 1.8) than patients without complications (0.4 ± 0.7). Conclusion  On-demand chest X-rays do not seem to delay the diagnosis of postoperative complications or increase morbidity-mortality rates. Performing on-demand chest X-rays could not only simplify surgical practice but also have a positive impact on health care expenses. However, a broader randomized study is warranted to validate this work and ultimately lead to national consensus. Georg Thieme Verlag KG Stuttgart · New York.

Chest CT in children: anesthesia and atelectasis.

PubMed

Newman, Beverley; Krane, Elliot J; Gawande, Rakhee; Holmes, Tyson H; Robinson, Terry E

2014-02-01

There has been an increasing tendency for anesthesiologists to be responsible for providing sedation or anesthesia during chest CT imaging in young children. Anesthesia-related atelectasis noted on chest CT imaging has proven to be a common and troublesome problem, affecting image quality and diagnostic sensitivity. To evaluate the safety and effectiveness of a standardized anesthesia, lung recruitment, controlled-ventilation technique developed at our institution to prevent atelectasis for chest CT imaging in young children. Fifty-six chest CT scans were obtained in 42 children using a research-based intubation, lung recruitment and controlled-ventilation CT scanning protocol. These studies were compared with 70 non-protocolized chest CT scans under anesthesia taken from 18 of the same children, who were tested at different times, without the specific lung recruitment and controlled-ventilation technique. Two radiology readers scored all inspiratory chest CT scans for overall CT quality and atelectasis. Detailed cardiorespiratory parameters were evaluated at baseline, and during recruitment and inspiratory imaging on 21 controlled-ventilation cases and 8 control cases. Significant differences were noted between groups for both quality and atelectasis scores with optimal scoring demonstrated in the controlled-ventilation cases where 70% were rated very good to excellent quality scans compared with only 24% of non-protocol cases. There was no or minimal atelectasis in 48% of the controlled ventilation cases compared to 51% of non-protocol cases with segmental, multisegmental or lobar atelectasis present. No significant difference in cardiorespiratory parameters was found between controlled ventilation and other chest CT cases and no procedure-related adverse events occurred. Controlled-ventilation infant CT scanning under general anesthesia, utilizing intubation and recruitment maneuvers followed by chest CT scans, appears to be a safe and effective method to obtain reliable and reproducible high-quality, motion-free chest CT images in children.

Correlation of B-Lines on Ultrasonography With Interstitial Lung Disease on Chest Radiography and CT Imaging.

PubMed

Dubinsky, Theodore J; Shah, Hardik; Sonneborn, Rachelle; Hippe, Daniel S

2017-11-01

We prospectively identified B-lines in patients undergoing ultrasonographic (US) examinations following liver transplantation who also had chest radiography (CXR) or chest CT imaging, or both, on the same day to determine if an association between the presence of B-lines from the thorax on US images correlates with the presence of lung abnormalities on CXR. Following institutional review board (IRB) approval, patients who received liver transplants and underwent routine US examinations and chest radiography or CT imaging, or both, on the same day between January 1, 2015 through July 1, 2016 were prospectively identified. Two readers who were blinded to chest films and CT images and reports independently reviewed the US interreader agreement for the presence or absence of B-lines and performed an evaluation for the presence or absence of diffuse parenchymal lung disease (DPLD) on chest films and CT images as well as from clinical evaluation. Receiver operating characteristic (ROC) curves were constructed. There was good agreement between the two readers on the presence of absence of B-lines (kappa = 0.94). The area under the ROC curve for discriminating between positive DPLD and negative DPLD for both readers was 0.79 (95% CI, 0.71-0.87). There is an association between the presence of extensive B-lines to the point of confluence and "dirty shadowing" on US examinations of the chest and associated findings on chest radiographs and CT scans of DPLD. Conversely, isolated B-lines do not always correlate with abnormalities on chest films and in fact sometimes appear to be a normal variant. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Evaluation of a new chest tube removal protocol using digital air leak monitoring after lobectomy: a prospective randomised trial.

PubMed

Brunelli, Alessandro; Salati, Michele; Refai, Majed; Di Nunzio, Luca; Xiumé, Francesco; Sabbatini, Armando

2010-01-01

The objective of this randomised trial was to assess the effectiveness of a new fast-track chest tube removal protocol taking advantage of digital monitoring of air leak compared to a traditional protocol using visual and subjective assessment of air leak (bubbles). One hundred and sixty-six patients submitted to pulmonary lobectomy for lung cancer were randomised in two groups with different chest tube removal protocols: (1) in the new protocol, chest tube was removed based on digitally recorded measurements of air leak flow; (2) in the traditional protocol, the chest tube removal was based on an instantaneous assessment of air leak during daily rounds. The two groups were compared in terms of chest tube duration, hospital stay and costs. The two groups were well matched for several preoperative and operative variables. Compared to the traditional protocol, the new digital recording protocol showed mean reductions in chest tube duration (p=0.0007), hospital stay (p=0.007) of 0.9 day, and a mean cost saving of euro 476 per patient (p=0.008). In the new chest tube removal protocol, 51% of patients had their chest tube removed by the second postoperative day versus only 12% of those in the traditional protocol. The application of a chest tube removal protocol using a digital drainage unit featuring a continuous recording of air leak was safe and cost effective. Although future studies are warranted to confirm these results in other settings, the use of this new protocol is now routinely applied in our practice. Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

Comparative study evaluating the role of color Doppler sonography and computed tomography in predicting chest wall invasion by lung tumors.

PubMed

Sripathi, Smiti; Mahajan, Abhishek

2013-09-01

To analyze qualitative and quantitative parameters of lung tumors by color Doppler sonography, determine the role of color Doppler sonography in predicting chest wall invasion by lung tumors using spectral waveform analysis, and compare color Doppler sonography and computed tomography (CT) for predicting chest wall invasion by lung tumors. Between March and September 2007, 55 patients with pleuropulmonary lesions on chest radiography were assessed by grayscale and color Doppler sonography for chest wall invasion. Four patients were excluded from the study because of poor acoustic windows. Quantitative and qualitative sonographic examinations of the lesions were performed using grayscale and color Doppler imaging. The correlation between the color Doppler and CT findings was determined, and the final outcomes were correlated with the histopathologic findings. Of a total of 51 lesions, 32 were malignant. Vascularity was present on color Doppler sonography in 28 lesions, and chest wall invasion was documented in 22 cases. Computed tomography was performed in 24 of 28 evaluable malignant lesions, and the findings were correlated with the color Doppler findings for chest wall invasion. Of the 24 patients who underwent CT, 19 showed chest wall invasion. The correlation between the color Doppler and CT findings revealed that color Doppler sonography had sensitivity of 95.6% and specificity of 100% for assessing chest wall invasion, whereas CT had sensitivity of 85.7% and specificity of 66.7%. Combined qualitative and quantitative color Doppler sonography can predict chest wall invasion by lung tumors with better sensitivity and specificity than CT. Although surgery is the reference standard, color Doppler sonography is a readily available, affordable, and noninvasive in vivo diagnostic imaging modality that is complementary to CT and magnetic resonance imaging for lung cancer staging.

Chest MR imaging in the follow-up of pulmonary alterations in paediatric patients with middle lobe syndrome: comparison with chest X-ray.

PubMed

Fraioli, F; Serra, G; Ciarlo, G; Massaccesi, V; Liberali, S; Fiorelli, A; Macrì, F; Catalano, C

2013-04-01

The authors evaluated the role of magnetic resonance (MR) imaging of the chest in comparison with chest X-ray in the follow-up of pulmonary abnormalities detected by computed tomography (CT) in paediatric patients with middle lobe syndrome. Seventeen patients with middle lobe syndrome (mean age 6.2 years) underwent chest CT at the time of diagnosis (100 kV, CARE dose with quality reference of 70 mAs; collimation 24×1.2 mm; rotation time 0.33 s; scan time 5 s); at follow-up after a mean of 15.3 months, all patients were evaluated with chest MR imaging with a respiratory-triggered T2-weighted BLADE sequence (TR 2,000; TE 27 ms; FOV 400 mm; flip angle 150°; slice thickness 5 mm) and chest X-ray. Images from each modality were assessed for the presence of pulmonary consolidations, bronchiectases, bronchial wall thickening and mucous plugging. Hilar and mediastinal lymphadenopathies were assessed on CT and MR images. Baseline CT detected consolidations in 100% of patients, bronchiectases in 35%, bronchial wall thickening in 53% and mucous plugging in 35%. MR imaging and chest X-ray identified consolidations in 65% and 35%, bronchiectases in 35% and 29%, bronchial wall thickening in 59% and 6% and mucous plugging in 25% and 0%, respectively. Lymphadenopathy was seen in 64% of patients at CT and in 47% at MR imaging. Patients with middle lobe syndrome show a wide range of parenchymal and bronchial abnormalities at diagnosis. Compared with MR imaging, chest X-ray seems to underestimate these changes. Chest MR imaging might represent a feasible and radiation-free option for an overall assessment of the lung in the follow-up of patients with middle lobe syndrome.

Intergenerational changes in chest size and proportions in children and adolescents aged 3-18 from Kraków (Poland), within the last 70 years.

PubMed

Kryst, Łukasz; Woronkowicz, Agnieszka; Kowal, Małgorzata; Sobiecki, Jan

2017-03-01

The size and proportions of the human body change continuously in response to social change and economic development. As reported by papers on intergenerational changes in chest size, this part of the human body is also influenced by environmental factors. The aim of this study was to assess changes in the dimensions and proportions of the chest of children and adolescents over a span of 70 years. In 2010 an anthropological study was conducted on 3878 children and adolescents aged 3-18 years living in Kraków (Poland). Data on chest dimensions (breadth, depth, circumference, chest index) were compared to data from 1938 (3719 children) and 1983 (6464 children). In boys, chests became increasingly deep; in boys 18 years of age, the chest index increased by 4.8 units, unlike girls, whose chests markedly flattened. The chest index in girls 18 years of age decreased by 4.2 units. In almost all age categories these differences were statistically significant. Also, in all age categories, children studied in 2010 had a significantly bigger chest circumference than boys and girls surveyed in 1983, respectively, by averages of 3.6 cm and 3 cm. The main reason for these changes may be the socio-economic transformation, which has been especially strong in recent decades. These results may have practical importance in many areas of knowledge, including medicine, nutritional science, and sports. They can also be important for informing preventive measures that should be taken in order to increase the physical activity of children and youth, especially boys. © 2016 Wiley Periodicals, Inc.

Chest Tube Thoracostomy

MedlinePlus

... outside the lung, causing its collapse (called a pneumothorax ). Chest tube thoracostomy involves placing a hollow plastic ... a chest tube is needed include: ■ ■ Collapsed lung (pneumothorax)— This occurs when air has built up in ...

Eye Problems: Symptom Checker Flowchart

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Shoulder Problems: Symptom Checker Flowchart

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Elimination Problems in Infants and Children

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Feeding Problems in Infants and Children

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Abdominal Pain (Stomach Pain), Short-Term

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Mouth Problems in Infants and Children

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Genital Problems in Infants (Female)

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

[How to do - the chest tube drainage].

PubMed

Klopp, Michael; Hoffmann, Hans; Dienemann, Hendrik

2015-03-01

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

Outcomes of Complete Versus Partial Surgical Stabilization of Flail Chest.

PubMed

Nickerson, Terry P; Thiels, Cornelius A; Kim, Brian D; Zielinski, Martin D; Jenkins, Donald H; Schiller, Henry J

2016-01-01

Rib fractures are common after chest wall trauma. For patients with flail chest, surgical stabilization is a promising technique for reducing morbidity. Anatomical difficulties often lead to an inability to completely repair the flail chest; thus, the result is partial flail chest stabilization (PFS). We hypothesized that patients with PFS have outcomes similar to those undergoing complete flail chest stabilization (CFS). A prospectively collected database of all patients who underwent rib fracture stabilization procedures from August 2009 until February 2013 was reviewed. Abstracted data included procedural and complication data, extent of stabilization, and pulmonary function test results. Of 43 patients who underwent operative stabilization of flail chest, 23 (53%) had CFS and 20 (47%) underwent PFS. Anterior location of the fracture was the most common reason for PFS (45%). Age, sex, operative time, pneumonia, intensive care unit and hospital length of stay, and narcotic use were the same in both groups. Total lung capacity was significantly improved in the CFS group at 3 months. No chest wall deformity was appreciated on follow-up, and no patients underwent additional stabilization procedures following PFS. Despite advances in surgical technique, not all fractures are amenable to repair. There was no difference in chest wall deformity, narcotic use, or clinically significant impairment in pulmonary function tests among patients who underwent PFS compared with CFS. Our data suggest that PFS is an acceptable strategy and that extending or creating additional incisions for CFS is unnecessary.

Assessing astronaut injury potential from suit connectors using a human body finite element model.

PubMed

Danelson, Kerry A; Bolte, John H; Stitzel, Joel D

2011-02-01

The new Orion space capsule requires additional consideration of possible injury during landing due to the dynamic nature of the impact. The purpose of this parametric study was to determine changes in the injury response of a human body finite element model with a suit connector (SC). The possibility of thoracic bony injury, thoracic soft tissue injury, and femur injury were assessed in 24 different model configurations. These simulations had two SC placements and two SC types, a 2.27-kg rectangular and a 3.17-kg circular SC. A baseline model was tested with the same acceleration pulses and no SC for comparison. Further simulations were conducted to determine the protective effect of SC location changes and adding small and large rigid chest plates. The possibilities of rib, chest soft tissue, and femur injury were evaluated using sternal deflection, chest deflection, viscous criterion, and strain values. The results indicated a higher likelihood of chest injury than femur injury. The mean first principal strain in the femur was 0.136 +/- 0.007%, which is well below the failure limit for cortical bone. The placement of chest plates had a protective effect and reduced the sternal deflection, chest deflection, and viscous criterion values. If possible, the SC should be placed on the thigh to minimize injury risk metrics. Chest plates appear to offer some protective value; therefore, a large rigid chest plate or similar countermeasure should be considered for chest SC placement.

Totally implanted ports: the trapezius approach in practice.

PubMed

Hill, Steve

Implanted ports (IPs) are an essential device for many patients who require long-term vascular access. IPs offer some advantages over other central venous access devices, such as lifestyle, body image benefits and lower infection rates. A typical implantation site for a port is the anterior chest wall. For some patients with breast cancer who have metastatic chest wall disease this site may lead to problems with the function of the device if disease spreads to the port site. One option for this patient group is to place the implanted port over the trapezius muscle. This article discusses six patients, all of whom had metastatic breast cancer with some degree of subcutaneous disease on the anterior chest wall. Three patients had received trapezius port placements and three had anterior chest wall placements. A retrospective review of the patients' medical records was undertaken from the time of insertion until removal or until the patient died. The anterior chest wall group of patients had their devices in for an average of 368 days vs 214 in the trapezius group. The total complications were higher in the anterior chest wall group (7 vs 2 in the trapezius group). Disease spread to two of the devices in the anterior chest wall group meaning the devices could no longer be used. The trapezius approach appears to be a safe and a reliable form of vascular access and may offer fewer complications than the traditional method of anterior chest wall placement when standard anterior chest wall approach is not suitable.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Welsh, James, E-mail: jwelsh@mdanderson.org; Thomas, Jimmy; Shah, Deep

Purpose: Stereotactic body radiation therapy (SBRT) is increasingly being used to treat thoracic tumors. We attempted here to identify dose-volume parameters that predict chest wall toxicity (pain and skin reactions) in patients receiving thoracic SBRT. Patients and Methods: We screened a database of patients treated with SBRT between August 2004 and August 2008 to find patients with pulmonary tumors within 2.5 cm of the chest wall. All patients received a total dose of 50 Gy in four daily 12.5-Gy fractions. Toxicity was scored according to the NCI-CTCAE V3.0. Results: Of 360 patients in the database, 265 (268 tumors) had tumorsmore » within <2.5 cm of the chest wall; 104 (39%) developed skin toxicity (any grade); 14 (5%) developed acute pain (any grade), and 45 (17%) developed chronic pain (Grade 1 in 22 cases [49%] and Grade 2 or 3 in 23 cases [51%]). Both skin toxicity and chest wall pain were associated with the V{sub 30}, or volume of the chest wall receiving 30 Gy. Body mass index (BMI) was also strongly associated with the development of chest pain: patients with BMI {>=}29 had almost twice the risk of chronic pain (p = 0.03). Among patients with BMI >29, diabetes mellitus was a significant contributing factor to the development of chest pain. Conclusion: Safe use of SBRT with 50 Gy in four fractions for lesions close to the chest wall requires consideration of the chest wall volume receiving 30 Gy and the patient's BMI and diabetic state.« less

ANMCO-SIMEU Consensus Document: in-hospital management of patients presenting with chest pain.

PubMed

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.

ANMCO-SIMEU Consensus Document: in-hospital management of patients presenting with chest pain

PubMed Central

Zuin, Guerrino; 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

2017-01-01

Abstract 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. PMID:28751843

[ANMCO/SIMEU Consensus document: In-hospital management of patients presenting with chest pain].

PubMed

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.

Rib fracture after stereotactic radiotherapy on follow-up thin-section computed tomography in 177 primary lung cancer patients

PubMed Central

2011-01-01

Background Chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer has recently been reported. However, its detailed imaging findings are not clarified. So this study aimed to fully characterize the findings on computed tomography (CT), appearance time and frequency of chest wall injury after stereotactic radiotherapy (SRT) for primary lung cancer Materials and methods A total of 177 patients who had undergone SRT were prospectively evaluated for periodical follow-up thin-section CT with special attention to chest wall injury. The time at which CT findings of chest wall injury appeared was assessed. Related clinical symptoms were also evaluated. Results Rib fracture was identified on follow-up CT in 41 patients (23.2%). Rib fractures appeared at a mean of 21.2 months after the completion of SRT (range, 4 -58 months). Chest wall edema, thinning of the cortex and osteosclerosis were findings frequently associated with, and tending to precede rib fractures. No patients with rib fracture showed tumors > 16 mm from the adjacent chest wall. Chest wall pain was seen in 18 of 177 patients (10.2%), of whom 14 patients developed rib fracture. No patients complained of Grade 3 or more symptoms. Conclusion Rib fracture is frequently seen after SRT for lung cancer on CT, and is often associated with chest wall edema, thinning of the cortex and osteosclerosis. However, related chest wall pain is less frequent and is generally mild if present. PMID:21995807

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial.

PubMed

Mirmohammad-Sadeghi, Mohsen; Pourazari, Pejman; Akbari, Mojtaba

2017-01-01

Chest tubes are used in every case of coronary artery bypass grafting (CABG) to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG. This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum. The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group ( P = 0.001), but the trend of pain score between groups was not significantly different ( P = 0.097). The frequency of tamponade and atrial fibrillation (AF) were significantly lower in Jackson-Pratt drain group ( P < 0.05). The Jackson-Pratt drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF.

Comparison of Small Bore Catheter Aspiration and Chest Tube Drainage in the Management of Spontaneous Pneumothorax.

PubMed

Korczyński, P; Górska, K; Nasiłowski, J; Chazan, R; Krenke, R

2015-01-01

Beside standard chest tube drainage other less invasive techniques have been used in the management of patients with an acute episode of spontaneous pneumothorax. The aim of the study was to evaluate the short term effect of spontaneous pneumothorax treatment with small-bore pleural catheter and manual aspiration as compared to large-bore chest tube drainage. Patients with an episode of pneumothorax who required pleural intervention were enrolled in the study and randomly assigned to one of the treatment arms: (1) small-bore pleural catheter (8 Fr) with manual aspiration; (2) standard chest tube drainage (20-24 Fr). Success rate of the first line treatment, duration of catheter or chest tube drainage, and the need for surgical intervention were the outcome measures. The study group included 49 patients (mean age 46.9±21.3 years); with 22 and 27 allocated to small bore manual aspiration and chest tube drainage groups, respectively. There were no significant differences in the baseline characteristics of patients in both therapeutic arms. First line treatment success rates were 64% and 82% in the manual aspiration and chest tube drainage groups, respectively; the difference was insignificant. Median time of treatment with small bore catheter was significantly shorter than conventional chest tube drainage (2.0 vs. 6.0 days; p<0.05). Our results show that treatment of spontaneous pneumothorax with small-bore pleural catheter and manual aspiration might be similarly effective as is chest tube drainage in terms of immediate lung re-expansion.

Chest physiotherapy during immediate postoperative period among patients undergoing upper abdominal surgery: randomized clinical trial.

PubMed

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 < 0.03) that did not last until the second 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.

Surgical management of chest wall trauma.

PubMed

Molnar, Tamas F

2010-11-01

Recent paradigm shift in major trauma profile elevates chest wall injuries among the most important topics of the specialty. Due to mass casualties of terror attacks and asymmetric warfare, civilian and military trauma care challenges thoracic surgery, traumatology, intensive anesthesiology, and related specialties. Contemporary advances of the main issues are systemically presented and discussed, such as soft tissue and bony structure injuries, complex traumas like flail chest, and extensively destroyed chest wall.

Routine Chest Radiographs After Central Line Insertion: Mandatory Postprocedural Evaluation or Unnecessary Waste of Resources?

DOE Office of Scientific and Technical Information (OSTI.GOV)

Lucey, Brian; Varghese, Jose C.; Haslam, Philip

1999-09-15

Purpose: To study the cost and impact on patient management of the routine performance of chest radiographs in patients undergoing imaged-guided central venous catheter insertion. Methods: Six hundred and twenty-one catheters placed in 489 patients over a 42-month period formed the study group. Catheters were placed in the right internal jugular vein (425), left internal jugular vein (133), and subclavian veins (63). At the end of the procedure fluoroscopy was used to assess catheter position and check for complications. A postprocedural chest radiograph was obtained in all patients. Results: Postprocedural chest fluoroscopy showed no evidence of pneumothorax, hemothorax, or mediastinalmore » hematoma. Inappropriate catheter tip position or catheter kinks were noted with 90 catheters. These problems were all corrected while the patient was on the interventional table. Postprocedural chest radiographs showed no complications but proximal catheter tip migration was noted in six of 621 catheters (1%). These latter six catheters required further manipulation. The total technical and related charges for the postprocedural chest radiographs in this series were estimated at Pounds 15,525. Conclusion: Postprocedural chest radiographs after image-guided central venous catheter insertion are not routinely required. A postprocedural chest radiograph can be performed on a case-by-case basis at the discretion of the interventional radiologist.« less

[A case of group G Streptococcus sepsis, chest wall abscess, and vertebral osteomyelitis mimicking a primary lung cancer with bone metastasis].

PubMed

Hayashi, Yumeko; Ishii, Yoshiki; Arai, Ryo; Obara, Kazuki; Kamada, Aya; Takizawa, Hidenori; Hase, Isano; Mashio, Kazuki; Yamada, Issei; Takemasa, Akihiro; Sugiyama, Kumiya; Fukushima, Yasutsugu; Fukuda, Takeshi

2007-01-01

A 73-year-old woman who had been followed in our department of gynecology because of ovarian cancer since 2002, was admitted with liver dysfunction and complaining of back pain and light precordial chest pain. The chest radiograph on admission revealed a tumor in her left upper lung field, and chest CT revealed a tumor adjacent to the chest wall and mediastinum. FDG-positron emission tomography (PET) showed abnormal uptake in the tumor and Th6/7, and the subaortic lymph nodes. On the basis of these findings, primary lung cancer with bone metastasis was suspected. She had a high grade fever on admission, and blood cultures were positive for group G streptococcus. The treatment with intravenous penicillin was started. Percutaneous biopsy of the tumor in her left chest showed an abscess wall in the chest wall, but no evidence of malignancy. Transbronchial lung biopsy and CT-guided biopsy also showed no malignant cells. Since the tumor decreased in size and back pain improved gradually by only antibiotic treatment, a diagnosis of sepsis of group G streptococcus, chest wall abscess, and vertebral osteomyelitis was made. She was treated with intravenous penicillin for 4 weeks and oral amoxicillin for another 4 weeks. After 60 days of antibiotic treatment, the tumor vanished.

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

PubMed

Epstein, Erica; Jayathissa, Sisira; Dee, Stephen

2012-05-11

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

Anxiety, depression, suicidal ideation, and stressful life events in non-cardiac adolescent chest pain: a comparative study about the hidden part of the iceberg.

PubMed

Eliacik, Kayi; Kanik, Ali; Bolat, Nurullah; Mertek, Hilal; Guven, Baris; Karadas, Ulas; Dogrusoz, Buket; Bakiler, Ali Rahmi

2017-08-01

Chest pain in adolescents is rarely associated with cardiac disease. Adolescents with medically unexplained chest pain usually have high levels of anxiety and depression. Psychological stress may trigger non-cardiac chest pain. This study evaluated risk factors that particularly characterise adolescence, such as major stressful events, in a clinical population. The present study was conducted on 100 adolescents with non-cardiac chest pain and 76 control subjects. Stressful life events were assessed by interviewing patients using a 36-item checklist, along with the Children's Depression Inventory and Spielberger's State-Trait Anxiety Inventory for children, in both groups. Certain stressful life events, suicidal thoughts, depression, and anxiety were more commonly observed in adolescents with non-cardiac chest pain compared with the control group. Moreover, binary logistic regression analysis showed that trouble with bullies, school-related problems, and depression may trigger non-cardiac chest pain in adolescents. Non-cardiac chest pain on the surface may point to the underlying psychosocial health problems such as depression, suicidal ideas, or important life events such as academic difficulties or trouble with bullies. The need for a psychosocial evaluation that includes assessment of negative life events and a better management have been discussed in light of the results.

A computerized method for automated identification of erect posteroanterior and supine anteroposterior chest radiographs

NASA Astrophysics Data System (ADS)

Kao, E.-Fong; Lin, Wei-Chen; Hsu, Jui-Sheng; Chou, Ming-Chung; Jaw, Twei-Shiun; Liu, Gin-Chung

2011-12-01

A computerized scheme was developed for automated identification of erect posteroanterior (PA) and supine anteroposterior (AP) chest radiographs. The method was based on three features, the tilt angle of the scapula superior border, the tilt angle of the clavicle and the extent of radiolucence in lung fields, to identify the view of a chest radiograph. The three indices Ascapula, Aclavicle and Clung were determined from a chest image for the three features. Linear discriminant analysis was used to classify PA and AP chest images based on the three indices. The performance of the method was evaluated by receiver operating characteristic analysis. The proposed method was evaluated using a database of 600 PA and 600 AP chest radiographs. The discriminant performances Az of Ascapula, Aclavicle and Clung were 0.878 ± 0.010, 0.683 ± 0.015 and 0.962 ± 0.006, respectively. The combination of the three indices obtained an Az value of 0.979 ± 0.004. The results indicate that the combination of the three indices could yield high discriminant performance. The proposed method could provide radiologists with information about the view of chest radiographs for interpretation or could be used as a preprocessing step for analyzing chest images.

Thoracic Trauma: Which Chest Tube When and Where?

PubMed

Molnar, Tamas F

2017-02-01

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

Late clotted haemothorax after blunt chest trauma.

PubMed Central

Sinha, P; Sarkar, P

1998-01-01

A clotted haemothorax can develop any time after blunt chest trauma. Two cases are described in which late clotted haemothoraces developed which were treated by limited thoracotomy and evacuation of clots. Late clotted haemothorax may occur even in the absence of any abnormal initial clinical findings. Early detection and treatment is important to avoid the complications of fibrothorax and empyema with permanent pulmonary dysfunction. After blunt chest trauma patients should be advised to return to the accident and emergency department for assessment on development of any new chest symptom. Under these circumstances a chest x ray is mandatory to exclude a haemothorax. Images Figure 1 PMID:9639184

Multidetector Computer Tomography: Evaluation of Blunt Chest Trauma in Adults

PubMed Central

Matos, António P.; Mascarenhas, Vasco; Herédia, Vasco

2014-01-01

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. PMID:25295188

Multidetector computer tomography: evaluation of blunt chest trauma in adults.

PubMed

Palas, João; Matos, António P; Mascarenhas, Vasco; Herédia, Vasco; Ramalho, Miguel

2014-01-01

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.

Nausea and Vomiting in Infants and Children

MedlinePlus

... Long-term Abdominal Pain (Stomach Pain), Short-term Ankle Problems Breast Problems in Men Breast Problems in Women Chest Pain in Infants and Children Chest Pain, Acute Chest Pain, Chronic Cold and Flu Cough Diarrhea ...

Can Chest Computed Tomography Be Replaced by Lung Ultrasonography With or Without Plain Chest Radiography in Pediatric Pneumonia?

PubMed

Hajalioghli, Parisa; Nemati, Masoud; Dinparast Saleh, Leila; Fouladi, Daniel F

2016-07-01

The purpose of this study was to answer the following question: can chest computed tomography (CT) requested by pediatricians be replaced by lung ultrasonography (US) with or without chest radiography in pediatric pneumonia? A total of 98 children with suspected pneumonia who were referred by pediatricians for CT examinations were prospectively studied. Levels of agreement between CT findings and plain radiography, lung US, and chest radiography plus lung US results were investigated. CT defined pneumonia in 84 patients, among which 26 cases were complicated. κ values between radiography and CT findings were 0.82 in complicated cases, 0.67 in uncomplicated cases, and 0.72 overall. The corresponding values between US and CT findings were 1, 0.52, and 0.62, respectively, and between radiography plus US and CT findings were 1, 0.86, and 0.88, respectively. CT can be replaced by US when complex effusions are present in children with pneumonia. In case of an ambiguous diagnosis of pediatric pneumonia with or without complex effusions, a combination of chest radiography and US is a reliable surrogate for chest CT.

Impacted thoracic foreign bodies after penetrating chest trauma.

PubMed

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.

Prevalence of chest trauma, associated injuries and mortality: a level I trauma centre experience.

PubMed

Veysi, Veysi T; Nikolaou, Vassilios S; Paliobeis, Christos; Efstathopoulos, Nicolas; Giannoudis, Peter V

2009-10-01

A review of prospectively collected data in our trauma unit for the years 1998-2003 was undertaken. Adult patients who suffered multiple trauma with an Injury Severity Score (ISS) of >/=16, admitted to hospital for more than 72 hours and with sustained blunt chest injuries were included in the study. Demographic details including pre-hospital care, trauma history, admission vital signs, blood transfusions, details of injuries and their abbreviated injury scores (AIS), operations, length of intensive care unit and hospital stays, Injury Severity Score (ISS) and mortality were analysed. Fulfilling the inclusion criteria with at least one chest injury were 1,164 patients. The overall mortality reached 18.7%. As expected, patients in the higher AIS groups had both a higher overall ISS and mortality rate with one significant exception; patients with minor chest injuries (AIS(chest) = 1) were associated with mortality comparable to injuries involving an AIS(chest) = 3. Additionally, the vast majority of polytraumatised patients with an AIS(chest) = 1 died in ICU sooner than patients of groups 2-5.

Derivation and validation of two decision instruments for selective chest CT in blunt trauma: a multicenter prospective observational study (NEXUS Chest CT).

PubMed

Rodriguez, Robert M; Langdorf, Mark I; Nishijima, Daniel; Baumann, Brigitte M; Hendey, Gregory W; Medak, Anthony J; Raja, Ali S; Allen, Isabel E; Mower, William R

2015-10-01

Unnecessary diagnostic imaging leads to higher costs, longer emergency department stays, and increased patient exposure to ionizing radiation. We sought to prospectively derive and validate two decision instruments (DIs) for selective chest computed tomography (CT) in adult blunt trauma patients. From September 2011 to May 2014, we prospectively enrolled blunt trauma patients over 14 y of age presenting to eight US, urban level 1 trauma centers in this observational study. During the derivation phase, physicians recorded the presence or absence of 14 clinical criteria before viewing chest imaging results. We determined injury outcomes by CT radiology readings and categorized injuries as major or minor according to an expert-panel-derived clinical classification scheme. We then employed recursive partitioning to derive two DIs: Chest CT-All maximized sensitivity for all injuries, and Chest CT-Major maximized sensitivity for only major thoracic injuries (while increasing specificity). In the validation phase, we employed similar methodology to prospectively test the performance of both DIs. We enrolled 11,477 patients-6,002 patients in the derivation phase and 5,475 patients in the validation phase. The derived Chest CT-All DI consisted of (1) abnormal chest X-ray, (2) rapid deceleration mechanism, (3) distracting injury, (4) chest wall tenderness, (5) sternal tenderness, (6) thoracic spine tenderness, and (7) scapular tenderness. The Chest CT-Major DI had the same criteria without rapid deceleration mechanism. In the validation phase, Chest CT-All had a sensitivity of 99.2% (95% CI 95.4%-100%), a specificity of 20.8% (95% CI 19.2%-22.4%), and a negative predictive value (NPV) of 99.8% (95% CI 98.9%-100%) for major injury, and a sensitivity of 95.4% (95% CI 93.6%-96.9%), a specificity of 25.5% (95% CI 23.5%-27.5%), and a NPV of 93.9% (95% CI 91.5%-95.8%) for either major or minor injury. Chest CT-Major had a sensitivity of 99.2% (95% CI 95.4%-100%), a specificity of 31.7% (95% CI 29.9%-33.5%), and a NPV of 99.9% (95% CI 99.3%-100%) for major injury and a sensitivity of 90.7% (95% CI 88.3%-92.8%), a specificity of 37.9% (95% CI 35.8%-40.1%), and a NPV of 91.8% (95% CI 89.7%-93.6%) for either major or minor injury. Regarding the limitations of our work, some clinicians may disagree with our injury classification and sensitivity thresholds for injury detection. We prospectively derived and validated two DIs (Chest CT-All and Chest CT-Major) that identify blunt trauma patients with clinically significant thoracic injuries with high sensitivity, allowing for a safe reduction of approximately 25%-37% of unnecessary chest CTs. Trauma evaluation protocols that incorporate these DIs may decrease unnecessary costs and radiation exposure in the disproportionately young trauma population.

Blunt chest trauma.

PubMed

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.

CPDX (Chest Pain Diagnostic Program) - A Decision Support System for the Management of Acute Chest Pain (User’s Manual)

DTIC Science & Technology

1988-02-25

chest pain and/or dyspnea are present. a. Musculoskeletal pain b. Pleurisy c. Pulmonary embolus d. Spontaneous mediastinal emphysema a...Treatment includes mild analgesics, heat therapy, and, perhaps, rest. b) Pleurisy denotes inflammation of the pleura. It is seen in the setting of...bronchitis or pneumonia; the symptoms of both assist in differentiating pleurisy from pneumothorax. Chest discomfort is pleuristic. Unless there are

Chest wall myositis in a patient with acute coronary syndrome

PubMed Central

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 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. PMID:25312897

Is it adequate to carry out a chest-CT in patients with mild-moderate chest trauma?

PubMed

García de Pereda de Blas, V; Carreras Aja, M; Carbajo Azabal, S; Arana-Arri, E

2017-10-12

Mild-moderate blunt chest trauma is defined as a blunt chest trauma that is not caused by a high-energy mechanism, causing thoracic tenderness with or without rib fractures and that has no immediate life-threatening consequences for the patient. It is a frequent clinical situation in the emergency department. The most common radiological techniques that are used in this context are chest X-ray and thoracic computed tomography (CT). The CT scan is set as the gold standard. However, there are no current clinical-radiological guidelines that establish the adequacy of the requests of the CT scan. Therefore, we decided to search for evidence-based recommendations to improve the adequacy of the chest X-ray and CT scan in our daily practice in order to reduce the costs and avoid unnecessary radiation exposure. Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

[Musculoskeletal-related chest pain].

PubMed

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.

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

PubMed

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

2008-01-01

Penetrating chest trauma is common in this part of the world due to present situation in tribal areas. The first line of management after resuscitation in these patients is tube thoracostomy combined with analgesia and incentive spirometry. After tube thoracostomy following surgery or trauma there are two schools of thought one favours application of continuous low pressure suction to the chest tubes beyond the water seal while other are against it. We studied the application of continuous low pressure suction in patients with penetrating chest trauma. This Randomized clinical controlled trial was conducted in the department of thoracic surgery Post Graduate Medical Institute Lady Reading Hospital Peshawar from July 2007 to March 2008. The objectives of study were to evaluate the effectiveness of continuous low pressure suction in patients with penetrating chest trauma for evacuation of blood, expansion of lung and prevention of clotted Haemothorax. One hundred patients who underwent tube thoracostomy after penetrating chest trauma from fire arm injury or stab wounds were included in the study. Patients with multiple trauma, blunt chest trauma and those intubated for any pulmonary or pleural disease were excluded from the study. After resuscitation, detailed examination and necessary investigations patients were randomized to two groups. Group I included patients who had continuous low pressure suction applied to their chest drains. Group II included those patients whose chest drains were placed on water seal only. Lung expansion development of pneumothorax or clotted Haemothorax, time to removal of chest drain and hospital stay was noted in each group. There were fifty patients in each group. The two groups were not significantly different from each other regarding age, sex, pre-intubation haemoglobin and pre intubation nutritional status. Full lung expansion was achieved in forty six (92%) patients in group I and thirty seven (74%) in group II. Partial lung expansion or pneumothorax was present in three (60%) in group I and 10 (20%) in group II. One patient in group I and three (6%) patients in group II had no response. The mean time to removal of chest drains were 8.2 +/- 3.14 days in group I and 12.6 +/- 4.20 days in group II. The length of hospital stay was 7.2 +/- 2.07 days and 12.4 +/- 3.63 days in group I and II respectively. Clotted Haemothorax requiring surgery developed in three (6%) patients in group I and 8 (16%) patients in group II. Placing chest tubes on continuous low pressure suction after penetrating chest trauma helps evacuation of blood, expansion of lung and prevents the development of clotted Haemothorax. It also reduces the time to removal of chest drains, the hospital stay and the chances of surgery for clotted Haemothorax or Empyema.

Comparison of patient specific dose metrics between chest radiography, tomosynthesis, and CT for adult patients of wide ranging body habitus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zhang, Yakun; Li, Xiang; Segars, W. Paul

2014-02-15

Purpose: Given the radiation concerns inherent to the x-ray modalities, accurately estimating the radiation doses that patients receive during different imaging modalities is crucial. This study estimated organ doses, effective doses, and risk indices for the three clinical chest x-ray imaging techniques (chest radiography, tomosynthesis, and CT) using 59 anatomically variable voxelized phantoms and Monte Carlo simulation methods. Methods: A total of 59 computational anthropomorphic male and female extended cardiac-torso (XCAT) adult phantoms were used in this study. Organ doses and effective doses were estimated for a clinical radiography system with the capability of conducting chest radiography and tomosynthesis (Definiummore » 8000, VolumeRAD, GE Healthcare) and a clinical CT system (LightSpeed VCT, GE Healthcare). A Monte Carlo dose simulation program (PENELOPE, version 2006, Universitat de Barcelona, Spain) was used to mimic these two clinical systems. The Duke University (Durham, NC) technique charts were used to determine the clinical techniques for the radiographic modalities. An exponential relationship between CTDI{sub vol} and patient diameter was used to determine the absolute dose values for CT. The simulations of the two clinical systems compute organ and tissue doses, which were then used to calculate effective dose and risk index. The calculation of the two dose metrics used the tissue weighting factors from ICRP Publication 103 and BEIR VII report. Results: The average effective dose of the chest posteroanterior examination was found to be 0.04 mSv, which was 1.3% that of the chest CT examination. The average effective dose of the chest tomosynthesis examination was found to be about ten times that of the chest posteroanterior examination and about 12% that of the chest CT examination. With increasing patient average chest diameter, both the effective dose and risk index for CT increased considerably in an exponential fashion, while these two dose metrics only increased slightly for radiographic modalities and for chest tomosynthesis. Effective and organ doses normalized to mAs all illustrated an exponential decrease with increasing patient size. As a surface organ, breast doses had less correlation with body size than that of lungs or liver. Conclusions: Patient body size has a much greater impact on radiation dose of chest CT examinations than chest radiography and tomosynthesis. The size of a patient should be considered when choosing the best thoracic imaging modality.« less

Detection failure rate of chest radiography for the identification of nursing and healthcare-associated pneumonia.

PubMed

Miyashita, Naoyuki; Kawai, Yasuhiro; Tanaka, Takaaki; Akaike, Hiroto; Teranishi, Hideto; Wakabayashi, Tokio; Nakano, Takashi; Ouchi, Kazunobu; Okimoto, Niro

2015-07-01

To clarify the detection failure rate of chest radiography for the identification of nursing and healthcare-associated pneumonia (NHCAP), we compared high-resolution computed tomography (HRCT) with chest radiography simultaneously for patients with clinical symptoms and signs leading to a suspicion of NHCAP. We analyzed 208 NHCAP cases and compared them based on four groups defined using NHCAP criteria, patients who were: Group A) resident in an extended care facility or nursing home; Group B) discharged from a hospital within the preceding 90 days; Group C) receiving nursing care and had poor performance status; and Group D) receiving regular endovascular treatment. Chest radiography was inferior to HRCT for the identification of pneumonia (149 vs 208 cases, p < 0.0001). Among the designated NHCAP criteria, chest radiography identified pneumonia cases at a significantly lower frequency than HRCT in Group A (70 vs 97 cases, p = 0.0190) and Group C (86 vs 136 cases, p < 0.0001). The detection failure rate of chest radiography differed among NHCAP criteria; 27.8% in Group A, 26.5% in Group B, 36.7% in Group C and 5.8% in Group D. Cerebrovascular disease and poor functional status were significantly more frequent in patients in Groups A and C compared with those in Groups B and D. Physicians may underestimate pneumonia shadow in chest radiographs in patients with NHCAP, and the detection failure rate of chest radiography differed among NHCAP criteria. Poor functional status may correlate with the low accuracy of chest radiography in diagnosing pneumonia. Copyright © 2015. Published by Elsevier Ltd.

Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital

PubMed Central

Hefny, Ashraf F; Kunhivalappil, Fathima T; Matev, Nikolay; Avila, Norman A; Bashir, Masoud O; Abu-Zidan, Fikri M

2018-01-01

INTRODUCTION Diagnoses of pneumothorax, especially occult pneumothorax, have increased as the use of computed tomography (CT) for imaging trauma patients becomes near-routine. However, the need for chest tube insertion remains controversial. We aimed to study the management of pneumothorax detected on CT among patients with blunt trauma, including the decision for tube thoracostomy, in a community-based hospital. METHODS Chest CT scans of patients with blunt trauma treated at Al Rahba Hospital, Abu Dhabi, United Arab Emirates, from October 2010 to October 2014 were retrospectively studied. Variables studied included demography, mechanism of injury, endotracheal intubation, pneumothorax volume, chest tube insertion, Injury Severity Score, hospital length of stay and mortality. RESULTS CT was performed in 703 patients with blunt trauma. Overall, pneumothorax was detected on CT for 74 (10.5%) patients. Among the 65 patients for whom pneumothorax was detected before chest tube insertion, 25 (38.5%) needed chest tube insertion, while 40 (61.5%) did not. Backward stepwise likelihood regression showed that independent factors that significantly predicted chest tube insertion were endotracheal intubation (p = 0.01), non-United Arab Emirates nationality (p = 0.01) and pneumothorax volume (p = 0.03). The receiver operating characteristic curve showed that the best pneumothorax volume that predicted chest tube insertion was 30 mL. CONCLUSION Chest tube was inserted in less than half of the patients with blunt trauma for whom pneumothorax was detected on CT. Pneumothorax volume should be considered in decision-making regarding chest tube insertion. Conservative treatment may be sufficient for pneumothorax of volume < 30 mL. PMID:28741012

Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital.

PubMed

Hefny, Ashraf F; Kunhivalappil, Fathima T; Matev, Nikolay; Avila, Norman A; Bashir, Masoud O; Abu-Zidan, Fikri M

2018-03-01

Diagnoses of pneumothorax, especially occult pneumothorax, have increased as the use of computed tomography (CT) for imaging trauma patients becomes near-routine. However, the need for chest tube insertion remains controversial. We aimed to study the management of pneumothorax detected on CT among patients with blunt trauma, including the decision for tube thoracostomy, in a community-based hospital. Chest CT scans of patients with blunt trauma treated at Al Rahba Hospital, Abu Dhabi, United Arab Emirates, from October 2010 to October 2014 were retrospectively studied. Variables studied included demography, mechanism of injury, endotracheal intubation, pneumothorax volume, chest tube insertion, Injury Severity Score, hospital length of stay and mortality. CT was performed in 703 patients with blunt trauma. Overall, pneumothorax was detected on CT for 74 (10.5%) patients. Among the 65 patients for whom pneumothorax was detected before chest tube insertion, 25 (38.5%) needed chest tube insertion, while 40 (61.5%) did not. Backward stepwise likelihood regression showed that independent factors that significantly predicted chest tube insertion were endotracheal intubation (p = 0.01), non-United Arab Emirates nationality (p = 0.01) and pneumothorax volume (p = 0.03). The receiver operating characteristic curve showed that the best pneumothorax volume that predicted chest tube insertion was 30 mL. Chest tube was inserted in less than half of the patients with blunt trauma for whom pneumothorax was detected on CT. Pneumothorax volume should be considered in decision-making regarding chest tube insertion. Conservative treatment may be sufficient for pneumothorax of volume < 30 mL. Copyright: © Singapore Medical Association.

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

PubMed

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

2008-06-14

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

The utility of computed tomography as a screening tool for the evaluation of pediatric blunt chest trauma.

PubMed

Markel, Troy A; Kumar, Rajiv; Koontz, Nicholas A; Scherer, L R; Applegate, Kimberly E

2009-07-01

There is a growing concern that computed tomography (CT) is being unnecessarily overused for the evaluation of pediatric patients. The purpose of this study was to analyze the trends and utility of chest CT use compared with chest X-ray (CXR) for the evaluation of children with blunt chest trauma. A 4-year retrospective review was performed for pediatric patients who underwent chest CT within 24 hours of sustaining blunt trauma at a Level-I trauma center. Trends in the use of CT and CXR were documented, and results of radiology reports were analyzed and compared with clinical outcomes. Three hundred thirty-three children, mean age 11 years, had chest CTs, increasing from 5.5% in 2001-2002 to 10.5% in 2004-2005 (p < 0.001). Conversely, in those children who underwent chest CT, the rate of initial CXR use decreased from 84% to 56% during the same period (p < 0.001). Twenty percent of chest CTs had significant positive findings. Six patients underwent emergency surgery for cardiac or arterial injuries, and all demonstrated abnormal findings on CXR or CT scout imaging. When compared with the CT, only 5% of initial CXRs falsely reported normal findings that may have altered management. CT use in children has increased rapidly for the initial evaluation of chest trauma, whereas CXR use has decreased. Despite this trend, CXR remains an acceptable screening tool to analyze which patients may require CT evaluation. A multidisciplinary approach is warranted to develop guidelines that standardize the use of CT and thereby decreases unnecessary radiation exposure to pediatric patients.

Longest delayed hemothorax reported after blunt chest injury.

PubMed

Yap, Darren; Ng, Miane; Chaudhury, Madhu; Mbakada, Nik

2018-01-01

Blunt chest injury is a common presentation to the emergency department. However, a delayed hemothorax after blunt trauma is rare; current literature reports a delay of up to 30days. We present a case of 44-day delay in hemothorax which has not been previously reported in current literature. A 52-year-old Caucasian male first presented to the emergency department complaining of persistent right sided chest pain 2weeks after having slipped on a wet surface at home. His initial chest X-ray showed fractures of the right 7th and 8th ribs without a hemothorax or pneumothorax. He returned 30days after the initial consultation (44days post-trauma) having increasing shortness of breath. A chest X-ray this time revealed a large right hemothorax and 1850ml of blood drained from his chest. There was a complete resolution of the hemothorax within 48h and the patient was discharged after a 6-week follow-up with the chest physicians. Delayed hemothorax after blunt trauma is a rare clinical occurrence but associated with significant morbidity and mortality. The management of delayed hemothorax includes draining the hemothorax and controlling the bleeding. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians should be vigilant and weary that hemothorax could be a possibility after a chest injury despite a delay in presentation. A knowledge of delayed hemothorax will prompt physicians in providing important advice, warning signs and information to patients after a chest injury to avoid a delay in seeking medical attention. Copyright © 2017 Elsevier Inc. All rights reserved.

Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain.

PubMed

Lee, Jea-Geun; Choi, Joon Hyouk; Kim, Song-Yi; Kim, Ki-Seok; Joo, Seung-Jae

2016-03-01

A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R(2)=0.092, p=0.004; β= -0.525, R(2)=0.290, p=0.010). No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group.

Rib Radiography versus Chest Computed Tomography in the Diagnosis of Rib Fractures.

PubMed

Sano, Atsushi

2018-05-01

 The accurate diagnosis of rib fractures is important in chest trauma. Diagnostic images following chest trauma are usually obtained via chest X-ray, chest computed tomography, or rib radiography. This study evaluated the diagnostic characteristics of rib radiography and chest computed tomography.  Seventy-five rib fracture patients who underwent both chest computed tomography and rib radiography between April 2008 and December 2013 were included. Rib radiographs, centered on the site of pain, were taken from two directions. Chest computed tomography was performed using a 16-row multidetector scanner with 5-mm slice-pitch without overlap, and axial images were visualized in a bone window.  In total, 217 rib fractures were diagnosed in 75 patients. Rib radiography missed 43 rib fractures in 24 patients. The causes were overlap with organs in 15 cases, trivial fractures in 21 cases, and injury outside the imaging range in 7 cases. Left lower rib fractures were often missed due to overlap with the heart, while middle and lower rib fractures were frequently not diagnosed due to overlap with abdominal organs. Computed tomography missed 21 rib fractures in 17 patients. The causes were horizontal fractures in 10 cases, trivial fractures in 9 cases, and insufficient breath holding in 1 case.  In rib radiography, overlap with organs and fractures outside the imaging range were characteristic reasons for missed diagnoses. In chest computed tomography, horizontal rib fractures and insufficient breath holding were often responsible. We should take these challenges into account when diagnosing rib fractures. Georg Thieme Verlag KG Stuttgart · New York.

Comparison consequences of Jackson-Pratt drain versus chest tube after coronary artery bypass grafting: A randomized controlled clinical trial

PubMed Central

Mirmohammad-Sadeghi, Mohsen; Pourazari, Pejman; Akbari, Mojtaba

2017-01-01

Background: Chest tubes are used in every case of coronary artery bypass grafting (CABG) to evacuate shed blood from around the heart and lungs. This study was designed to assess the effective of Jackson-Pratt drain in compare with conventional chest drains after CABG. Materials and Methods: This was a randomized controlled trial that conducted on 218 patients in Chamran hospital from February to December 2016. Eligible patients were randomized in a 1:1 ratio. Jackson-Pratt drain group had 109 patients who received a chest tube insertion in the pleural space of the left lung and a Jackson-Pratt drain in mediastinum, and Chest tube drainage group had 109 patients who received double chest tube insertion in the pleural space of the left lung and the mediastinum. Results: The incidence of pleural effusions in Jackson-Pratt drain group and chest tube group were not statistically different. The pain score at 2-h in Drain group was significantly higher than chest tube group (P = 0.001), but the trend of pain score between groups was not significantly different (P = 0.097). The frequency of tamponade and atrial fibrillation (AF) were significantly lower in Jackson-Pratt drain group (P < 0.05). Conclusion: The Jackson-Pratt drain is equally effective for preventing cardiac tamponade, pleural effusions, and pain intensity in patients after CABG when compared with conventional chest tubes, but was significantly superior regarding efficacy to hospital and Intensive Care Unit length of stay and the incidence of AF. PMID:29387121

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

PubMed

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

2011-03-01

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

Should chest examination be reinstated in the early diagnosis of chronic obstructive pulmonary disease?

PubMed Central

Oshaug, Katja; Halvorsen, Peder A; Melbye, Hasse

2013-01-01

Background Although proven to be associated with bronchial obstruction, chest signs are not listed among cues that should prompt spirometry in the early diagnosis of chronic obstructive pulmonary disease (COPD) in established guidelines. Aims We aimed to explore how chest findings add to respiratory symptoms and a history of smoking in the diagnosis of COPD. Methods In a cross-sectional study, patients aged 40 years or older, previously diagnosed with either asthma or COPD in primary care, answered questionnaires and underwent physical chest examination and spirometry. Results Among the 375 patients included, 39.7% had forced expiratory volume in 1 second/forced vital capacity <0.7. Hyperresonance to percussion was the strongest predictor of COPD, with a sensitivity of 20.8, a specificity of 97.8, and likelihood ratio of 9.5. In multivariate logistic regression, where pack-years, shortness of breath, and chest findings were among the explanatory variables, three physical chest findings were independent predictors of COPD. Hyperresonance to percussion yielded the highest odds ratio (OR = 6.7), followed by diminished breath sounds (OR = 5.0), and thirdly wheezes (OR = 2.3). These three chest signs also gave significant diagnostic information when added to shortness of breath and pack-years in receiver operating-characteristic curve analysis. Conclusion We found that chest signs may add to respiratory symptoms and a history of smoking in the diagnosis of COPD, and we conclude that chest signs should be reinstated as cues to early diagnosis of COPD in patients 40 years or older. PMID:23983462

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

PubMed

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

2017-10-01

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

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

PubMed

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

2017-01-01

Purpose To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods In this binational, institutional review board-approved, HIPAA-compliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device. Three experienced thoracic radiologists identified true locations of nodules (n = 516, 3-20-mm diameters) with CT and recommended case management by using Fleischner Society guidelines. Five other radiologists marked nodules and indicated case management by using images from conventional chest radiography, conventional chest radiography plus DE imaging, tomosynthesis, and tomosynthesis plus DE imaging. Sensitivity, specificity, and overall accuracy were measured by using the free-response receiver operating characteristic method and the receiver operating characteristic method for nodule detection and case management, respectively. Results were further analyzed according to nodule diameter categories (3-4 mm, >4 mm to 6 mm, >6 mm to 8 mm, and >8 mm to 20 mm). Results Maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography in all nodule size categories (3.55-fold for all nodules, P < .001; 95% confidence interval [CI]: 2.96, 4.15). Case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules (1.49-fold, P < .001; 95% CI: 1.25, 1.73). Case management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P < .001; 95% CI: 1.15, 1.32). There were no differences in any specificity measures. DE imaging did not significantly affect nodule detection when paired with either conventional chest radiography or tomosynthesis. Conclusion Tomosynthesis outperformed conventional chest radiography for lung nodule detection and determination of case management; DE imaging did not show significant differences over conventional chest radiography or tomosynthesis alone. These findings indicate performance likely achievable with a range of reader expertise. © RSNA, 2016 Online supplemental material is available for this article.

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

PubMed Central

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

2017-01-01

Purpose To conduct a multi-institutional, multireader study to compare the performance of digital tomosynthesis, dual-energy (DE) imaging, and conventional chest radiography for pulmonary nodule detection and management. Materials and Methods In this binational, institutional review board–approved, HIPAA-compliant prospective study, 158 subjects (43 subjects with normal findings) were enrolled at four institutions. Informed consent was obtained prior to enrollment. Subjects underwent chest computed tomography (CT) and imaging with conventional chest radiography (posteroanterior and lateral), DE imaging, and tomosynthesis with a flat-panel imaging device. Three experienced thoracic radiologists identified true locations of nodules (n = 516, 3–20-mm diameters) with CT and recommended case management by using Fleischner Society guidelines. Five other radiologists marked nodules and indicated case management by using images from conventional chest radiography, conventional chest radiography plus DE imaging, tomosynthesis, and tomosynthesis plus DE imaging. Sensitivity, specificity, and overall accuracy were measured by using the free-response receiver operating characteristic method and the receiver operating characteristic method for nodule detection and case management, respectively. Results were further analyzed according to nodule diameter categories (3–4 mm, >4 mm to 6 mm, >6 mm to 8 mm, and >8 mm to 20 mm). Results Maximum lesion localization fraction was higher for tomosynthesis than for conventional chest radiography in all nodule size categories (3.55-fold for all nodules, P < .001; 95% confidence interval [CI]: 2.96, 4.15). Case-level sensitivity was higher with tomosynthesis than with conventional chest radiography for all nodules (1.49-fold, P < .001; 95% CI: 1.25, 1.73). Case management decisions showed better overall accuracy with tomosynthesis than with conventional chest radiography, as given by the area under the receiver operating characteristic curve (1.23-fold, P < .001; 95% CI: 1.15, 1.32). There were no differences in any specificity measures. DE imaging did not significantly affect nodule detection when paired with either conventional chest radiography or tomosynthesis. Conclusion Tomosynthesis outperformed conventional chest radiography for lung nodule detection and determination of case management; DE imaging did not show significant differences over conventional chest radiography or tomosynthesis alone. These findings indicate performance likely achievable with a range of reader expertise. © RSNA, 2016 Online supplemental material is available for this article. PMID:27439324

Intramammary Findings on CT of the Chest – a Review of Normal Anatomy and Possible Findings

PubMed Central

Gossner, Johannes

2016-01-01

Summary Computed tomography (CT) is a frequently performed examination in women of all ages. In all thoracic CT examinations of the chest at least parts of the breasts are included. Therefore incidental breast pathology may be observed. It has been suggested that one out of 250 women undergoing chest CT will show a malignant incidental breast lesion. Given the high number of performed chest CT examinations, this contributes to a significant number of malignancies. In this review, after a brief discussion of the value of computed tomography in breast imaging, normal and pathologic findings are discussed to create awareness of this potential “black box” on chest CT. PMID:28058068

Spontaneous pneumomediastinum: A rare complication of methamphetamine use.

PubMed

Albanese, Jessica; Gross, Cole; Azab, Mohamed; Mahalean, Sinziana; Makar, Ranjit

2017-01-01

To present an unusual case of spontaneous pneumomediastinum subsequent to recreational amphetamine use. A young African American adult male was admitted to internal medicine service for treatment of rhabdomyolysis secondary to methamphetamine use. On admission, he was complaining of chest pain in addition to nausea and generalized muscle aches. By his second hospital day, chest pain had resolved yet physical exam demonstrated crepitation of the anterior chest and left axilla. Portable chest x-ray revealed subcutaneous emphysema in addition to pneumomediastinum. Spontaneous pneumomediastinum is a rare complication of amphetamine use that is often associated with subcutaneous emphysema and can be diagnosed with chest x-ray. Management is conservative, with observation, pain control, and supplemental oxygen as needed.

Chest drainage systems in use

PubMed Central

Zisis, Charalambos; Tsirgogianni, Katerina; Lazaridis, George; Lampaki, Sofia; Baka, Sofia; Mpoukovinas, Ioannis; Karavasilis, Vasilis; Kioumis, Ioannis; Pitsiou, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Rapti, Aggeliki; Trakada, Georgia; Karapantzos, Ilias; Karapantzou, Chrysanthi; Zissimopoulos, Athanasios; Zarogoulidis, Konstantinos

2015-01-01

A chest tube is a flexible plastic tube that is inserted through the chest wall and into the pleural space or mediastinum. It is used to remove air in the case of pneumothorax or fluid such as in the case of pleural effusion, blood, chyle, or pus when empyema occurs from the intrathoracic space. It is also known as a Bülau drain or an intercostal catheter. Insertion of chest tubes is widely performed by radiologists, pulmonary physicians and thoracic surgeons. Large catheters or small catheters are used based on each situation that the medical doctor encounters. In the current review we will focus on the chest drain systems that are in use. PMID:25815304

Pulmonary effects of synthetic marijuana: chest radiography and CT findings.

PubMed

Berkowitz, Eugene A; Henry, Travis S; Veeraraghavan, Srihari; Staton, Gerald W; Gal, Anthony A

2015-04-01

The purpose of this article is to present the first chest radiographic and CT descriptions of organizing pneumonia in response to smoking synthetic marijuana. Chest radiographs showed a diffuse miliary-micronodular pattern. Chest CT images showed diffuse centrilobular nodules and tree-in-bud pattern and a histopathologic pattern of organizing pneumonia with or without patchy acute alveolar damage. This distinct imaging pattern should alert radiologists to include synthetic marijuana abuse in the differential diagnosis.

Chest pain of gastrointestinal origin.

PubMed Central

Berezin, S; Medow, M S; Glassman, M S; Newman, L J

1988-01-01

Twenty seven children who had been diagnosed as having idiopathic chest pain were investigated to find out if the pain was of gastrointestinal origin. The symptoms had lasted from two weeks to eight months. In 21 of the 27 children (78%) the chest pain had a gastrointestinal cause: 16 had oesophagitis, four had gastritis, and one had diffuse oesophageal spasm. All patients responded to medical treatment of their gastrointestinal symptoms, resulting in disappearance of the chest pain. PMID:3232993

Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02.

PubMed

Butler, Frank K; Dubose, Joseph J; Otten, Edward J; Bennett, Donald R; Gerhardt, Robert T; Kheirabadi, Bijan S; Gross, Kriby R; Cap, Andrew P; Littlejohn, Lanny F; Edgar, Erin P; Shackelford, Stacy A; Blackbourne, Lorne H; Kotwal, Russ S; Holcomb, John B; Bailey, Jeffrey A

2013-01-01

During the recent United States Central Command (USCENTCOM) and Joint Trauma System (JTS) assessment of prehospital trauma care in Afghanistan, the deployed director of the Joint Theater Trauma System (JTTS), CAPT Donald R. Bennett, questioned why TCCC recommends treating a nonlethal injury (open pneumothorax) with an intervention (a nonvented chest seal) that could produce a lethal condition (tension pneumothorax). New research from the U.S. Army Institute of Surgical Research (USAISR) has found that, in a model of open pneumothorax treated with a chest seal in which increments of air were added to the pleural space to simulate an air leak from an injured lung, use of a vented chest seal prevented the subsequent development of a tension pneumothorax, whereas use of a nonvented chest seal did not. The updated TCCC Guideline for the battlefield management of open pneumothorax is: ?All open and/ or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vente chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.? This recommendation was approved by the required two-thirds majority of the Committee on TCCC in June 2013. 2013.

Convolution neural-network-based detection of lung structures

NASA Astrophysics Data System (ADS)

Hasegawa, Akira; Lo, Shih-Chung B.; Freedman, Matthew T.; Mun, Seong K.

1994-05-01

Chest radiography is one of the most primary and widely used techniques in diagnostic imaging. Nowadays with the advent of digital radiology, the digital medical image processing techniques for digital chest radiographs have attracted considerable attention, and several studies on the computer-aided diagnosis (CADx) as well as on the conventional image processing techniques for chest radiographs have been reported. In the automatic diagnostic process for chest radiographs, it is important to outline the areas of the lungs, the heart, and the diaphragm. This is because the original chest radiograph is composed of important anatomic structures and, without knowing exact positions of the organs, the automatic diagnosis may result in unexpected detections. The automatic extraction of an anatomical structure from digital chest radiographs can be a useful tool for (1) the evaluation of heart size, (2) automatic detection of interstitial lung diseases, (3) automatic detection of lung nodules, and (4) data compression, etc. Based on the clearly defined boundaries of heart area, rib spaces, rib positions, and rib cage extracted, one should be able to use this information to facilitate the tasks of the CADx on chest radiographs. In this paper, we present an automatic scheme for the detection of lung field from chest radiographs by using a shift-invariant convolution neural network. A novel algorithm for smoothing boundaries of lungs is also presented.

Analysis of actual pressure point using the power flexible capacitive sensor during chest compression.

PubMed

Minami, Kouichiro; Kokubo, Yota; Maeda, Ichinosuke; Hibino, Shingo

2017-02-01

In chest compression for cardiopulmonary resuscitation (CPR), the lower half of the sternum is pressed according to the American Heart Association (AHA) guidelines 2010. These have been no studies which identify the exact location of the applied by individual chest compressions. We developed a rubber power-flexible capacitive sensor that could measure the actual pressure point of chest compression in real time. Here, we examined the pressure point of chest compression by ambulance crews during CPR using a mannequin. We included 179 ambulance crews. Chest compression was performed for 2 min. The pressure position was monitored, and the quality of chest compression was analyzed by using a flexible pressure sensor (Shinnosukekun™). Of the ambulance crews, 58 (32.4 %) pressed the center and 121 (67.6 %) pressed outside the proper area of chest compression. Many of them pressed outside the center; 8, 7, 41, and 90 pressed on the caudal, left, right, and cranial side, respectively. Average compression rate, average recoil, average depth, and average duty cycle were 108.6 counts per minute, 0.089, 4.5 cm, and 48.27 %, respectively. Many of the ambulance crews did not press on the sternal lower half definitely. This new device has the potential to improve the quality of CPR during training or in clinical practice.

Improvement of the clinical use of computed radiography for mobile chest imaging: Image quality and patient dose

NASA Astrophysics Data System (ADS)

Rill, Lynn Neitzey

Chest radiography is technically difficult because of the wide variation of tissue attenuations in the chest and limitations of screen-film systems. Mobile chest radiography, performed bedside on hospital inpatients, presents additional difficulties due to geometrical and equipment limitations inherent to mobile x-ray procedures and the severity of illness in patients. Computed radiography (CR) offers a new approach for mobile chest radiography by utilizing a photostimulable phosphor. Photostimulable phosphors are more efficient in absorbing lower-energy x-rays than standard intensifying screens and overcome some image quality limitations of mobile chest imaging, particularly because of the inherent latitude. This study evaluated changes in imaging parameters for CR to take advantage of differences between CR and screen-film radiography. Two chest phantoms, made of acrylic and aluminum, simulated x-ray attenuation for average-sized and large- sized adult chests. The phantoms contained regions representing the lungs, heart and subdiaphragm. Acrylic and aluminum disks (1.9 cm diameter) were positioned in the chest regions to make signal-to-noise ratio (SNR) measurements for different combinations of imaging parameters. Disk thicknesses (contrast) were determined from disk visibility. Effective dose to the phantom was also measured for technique combinations. The results indicated that using an anti-scatter grid and lowering x- ray tube potential improved the SNR significantly; however, the dose to the phantom also increased. An evaluation was performed to examine the clinical applicability of the observed improvements in SNR. Parameter adjustments that improved phantom SNRs by more than 50% resulted in perceived image quality improvements in the lung region of clinical mobile chest radiographs. Parameters that produced smaller improvements in SNR had no apparent effect on clinical image quality. Based on this study, it is recommended that a 3:1 grid be used for mobile chest radiography with CR in order to improve image quality. Using a higher kVp (+15 kVp) did not have a detrimental effect on image quality and offered a patient dose savings, including effective dose and breast dose. Higher kVp techniques should be considered when using a grid is not possible.

Flail chest injuries: a review of outcomes and treatment practices from the National Trauma Data Bank.

PubMed

Dehghan, Niloofar; de Mestral, Charles; McKee, Michael D; Schemitsch, Emil H; Nathens, Avery

2014-02-01

Flail chest injuries are associated with severe pulmonary restriction, a requirement for intubation and mechanical ventilation, and high rates of morbidity and mortality. Our goals were to investigate the prevalence, current treatment practices, and outcomes of flail chest injuries in polytrauma patients. The National Trauma Data Bank was used for a retrospective analysis of the injury patterns, management, and clinical outcomes associated with flail chest injuries. Patients with a flail chest injury admitted from 2007 to 2009 were included in the analysis. Outcomes included the number of days on mechanical ventilation, days in the intensive care unit (ICU), days in the hospital, and rates of pneumonia, sepsis, tracheostomy, chest tube placement, and death. Flail chest injury was identified in 3,467 patients; the mean age was 52.5 years, and 77% of the patients were male. Significant head injury was present in 15%, while 54% had lung contusions. Treatment practices included epidural catheters in 8% and surgical fixation of the chest wall in 0.7% of the patients. Mechanical ventilation was required in 59%, for a mean of 12.1 days. ICU admission was required in 82%, for a mean of 11.7 days. Chest tubes were used in 44%, and 21% required a tracheostomy. Complications included pneumonia in 21%, adult respiratory distress syndrome in 14%, sepsis in 7%, and death in 16%. Patients with concurrent severe head injury had higher rates of ventilatory support and ICU stay and had worse outcomes in every category compared with those without a head injury. Patients who have sustained a flail chest have significant morbidity and mortality. More than 99% of these patients were treated nonoperatively, and only a small proportion (8%) received aggressive pain management with epidural catheters. Given the high rates of morbidity and mortality in patients with a flail chest injury, alternate methods of treatment including more consistent use of epidural catheters for pain or surgical fixation need to be investigated with large randomized controlled trials. Epidemiologic/prognostic study, level IV.

Lung nodule detection by microdose CT versus chest radiography (standard and dual-energy subtracted).

PubMed

Ebner, Lukas; Bütikofer, Yanik; Ott, Daniel; Huber, Adrian; Landau, Julia; Roos, Justus E; Heverhagen, Johannes T; Christe, Andreas

2015-04-01

The purpose of this study was to investigate the feasibility of microdose CT using a comparable dose as for conventional chest radiographs in two planes including dual-energy subtraction for lung nodule assessment. We investigated 65 chest phantoms with 141 lung nodules, using an anthropomorphic chest phantom with artificial lung nodules. Microdose CT parameters were 80 kV and 6 mAs, with pitch of 2.2. Iterative reconstruction algorithms and an integrated circuit detector system (Stellar, Siemens Healthcare) were applied for maximum dose reduction. Maximum intensity projections (MIPs) were reconstructed. Chest radiographs were acquired in two projections with bone suppression. Four blinded radiologists interpreted the images in random order. A soft-tissue CT kernel (I30f) delivered better sensitivities in a pilot study than a hard kernel (I70f), with respective mean (SD) sensitivities of 91.1%±2.2% versus 85.6%±5.6% (p=0.041). Nodule size was measured accurately for all kernels. Mean clustered nodule sensitivity with chest radiography was 45.7%±8.1% (with bone suppression, 46.1%±8%; p=0.94); for microdose CT, nodule sensitivity was 83.6%±9% without MIP (with additional MIP, 92.5%±6%; p<10(-3)). Individual sensitivities of microdose CT for readers 1, 2, 3, and 4 were 84.3%, 90.7%, 68.6%, and 45.0%, respectively. Sensitivities with chest radiography for readers 1, 2, 3, and 4 were 42.9%, 58.6%, 36.4%, and 90.7%, respectively. In the per-phantom analysis, respective sensitivities of microdose CT versus chest radiography were 96.2% and 75% (p<10(-6)). The effective dose for chest radiography including dual-energy subtraction was 0.242 mSv; for microdose CT, the applied dose was 0.1323 mSv. Microdose CT is better than the combination of chest radiography and dual-energy subtraction for the detection of solid nodules between 5 and 12 mm at a lower dose level of 0.13 mSv. Soft-tissue kernels allow better sensitivities. These preliminary results indicate that microdose CT has the potential to replace conventional chest radiography for lung nodule detection.

Breathlessness during daily activity: The psychometric properties of the London Chest Activity of Daily Living Scale in patients with advanced disease and refractory breathlessness.

PubMed

Reilly, Charles C; Bausewein, Claudia; Garrod, Rachel; Jolley, Caroline J; Moxham, John; Higginson, Irene J

2017-10-01

The London Chest Activities of Daily Living Scale measures the impact of breathlessness on both activity and social functioning. However, the London Chest Activities of Daily Living Scale is not routinely used in patients with advanced disease. To assess the psychometric properties of the London Chest Activities of Daily Living Scale in patients with refractory breathlessness due to advanced disease. A cross-sectional secondary analysis of data from a randomised controlled parallel-group, pragmatic, single-blind fast-track trial (randomised controlled trial) investigating the effectiveness of an integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness, known as the Breathlessness Support Service (NCT01165034). All patients completed the following questionnaires: the London Chest Activities of Daily Living Scale, Chronic Respiratory Questionnaire, the Palliative care Outcome Scale, Palliative care Outcome Scale-symptoms, the Hospital Anxiety and Depression Scale and breathlessness measured on a numerical rating scale. Data quality, scaling assumptions, acceptability, internal consistency and construct validity of the London Chest Activities of Daily Living Scale were determined using standard psychometric approaches. Breathless patients with advanced malignant and non-malignant disease. A total of 88 patients were studied, primary diagnosis included; chronic obstructive pulmonary disease = 53, interstitial lung disease = 17, cancer = 18. Median (range) London Chest Activities of Daily Living Scale total score was 46.5 (14-67). No floor or ceiling effect was observed for the London Chest Activities of Daily Living Scale total score. Internal consistency was good, and Cronbach's alpha for the London Chest Activities of Daily Living Scale total score was 0.90. Construct validity was good with 13 out of 15 a priori hypotheses met. Psychometric analyses suggest that the London Chest Activities of Daily Living Scale is acceptable, reliable and valid in patients with advanced disease and refractory breathlessness.

Breathlessness during daily activity: The psychometric properties of the London Chest Activity of Daily Living Scale in patients with advanced disease and refractory breathlessness

PubMed Central

Reilly, Charles C; Bausewein, Claudia; Garrod, Rachel; Jolley, Caroline J; Moxham, John; Higginson, Irene J

2016-01-01

Background: The London Chest Activities of Daily Living Scale measures the impact of breathlessness on both activity and social functioning. However, the London Chest Activities of Daily Living Scale is not routinely used in patients with advanced disease. Aim: To assess the psychometric properties of the London Chest Activities of Daily Living Scale in patients with refractory breathlessness due to advanced disease. Design: A cross-sectional secondary analysis of data from a randomised controlled parallel-group, pragmatic, single-blind fast-track trial (randomised controlled trial) investigating the effectiveness of an integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness, known as the Breathlessness Support Service (NCT01165034). All patients completed the following questionnaires: the London Chest Activities of Daily Living Scale, Chronic Respiratory Questionnaire, the Palliative care Outcome Scale, Palliative care Outcome Scale–symptoms, the Hospital Anxiety and Depression Scale and breathlessness measured on a numerical rating scale. Data quality, scaling assumptions, acceptability, internal consistency and construct validity of the London Chest Activities of Daily Living Scale were determined using standard psychometric approaches. Setting/participants: Breathless patients with advanced malignant and non-malignant disease. Results: A total of 88 patients were studied, primary diagnosis included; chronic obstructive pulmonary disease = 53, interstitial lung disease = 17, cancer = 18. Median (range) London Chest Activities of Daily Living Scale total score was 46.5 (14–67). No floor or ceiling effect was observed for the London Chest Activities of Daily Living Scale total score. Internal consistency was good, and Cronbach’s alpha for the London Chest Activities of Daily Living Scale total score was 0.90. Construct validity was good with 13 out of 15 a priori hypotheses met. Conclusion: Psychometric analyses suggest that the London Chest Activities of Daily Living Scale is acceptable, reliable and valid in patients with advanced disease and refractory breathlessness. PMID:27932629

Factors that influence chest injuries in rollovers.

PubMed

Digges, Kennerly; Eigen, Ana; Tahan, Fadi; Grzebieta, Raphael

2014-01-01

The design of countermeasures to reduce serious chest injuries for belted occupants involved in rollover crashes requires an understanding of the cause of these injuries and of the test conditions to assure the effectiveness of the countermeasures. This study defines rollover environments and occupant-to-vehicle interactions that cause chest injuries for belted drivers. The NASS-CDS was examined to determine the frequency and crash severity for belted drivers with serious (Abbreviated Injury Scale [AIS] 3+) chest injuries in rollovers. Case studies of NASS crashes with serious chest injuries sustained by belted front occupants were undertaken and damage patterns were determined. Vehicle rollover tests with dummies were examined to determine occupant motion in crashes with damage similar to that observed in the NASS cases. Computer simulations were performed to further explore factors that could contribute to chest injury. Finite element model (FEM) vehicle models with both the FEM Hybrid III dummy and THUMS human model were used in the simulations. Simulation of rollovers with 6 quarter-turns or less indicated that increases in the vehicle pitch, either positive or negative, increased the severity of dummy chest loadings. This finding was consistent with vehicle damage observations from NASS cases. For the far-side occupant, the maximum chest loadings were caused by belt and side interactions during the third quarter-turn and by the center console loading during the fourth quarter-turn. The results showed that the THUMS dummy produced more realistic kinematics and improved insights into skeletal and chest organ loadings compared to the Hybrid III dummy. These results suggest that a dynamic rollover test to encourage chest injury reduction countermeasures should induce a roll of at least 4 quarter-turns and should also include initial vehicle pitch and/or yaw so that the vehicle's axis of rotation is not aligned with its inertial roll axis during the initial stage of the rollover.

Clinical value of chest pain presentation and prodromes on the assessment of cardiovascular disease: a cohort study.

PubMed

Robson, John; Ayerbe, Luis; Mathur, Rohini; Addo, Juliet; Wragg, Andrew

2015-04-15

The recognition of coronary artery disease (CAD) among patients who report chest pain remains difficult in primary care. This study investigates the association between chest pain (specified, unspecified or musculoskeletal) and prodromes (dyspepsia, fatigue or dyspnoea), with first-ever acute CAD, and increased longer term cardiovascular risk. Cohort study. Anonymised clinical data recorded electronically by general practitioners from 140 primary care surgeries in London (UK) between April 2008 and April 2013. Data were extracted for all patients aged 30 years and over at the beginning of the study period, registered in the surgeries. Clinical data included chest pain, dyspepsia, dyspnoea and fatigue, first-ever CAD and long-term cardiovascular risk (QRisk2). Regression models were used to analyse the association between chest pain together with prodromes and CAD and QRisk2≥20%. 354,052 patients were included in the study. 4842 patients had first-ever CAD of which 270 reported chest pain in the year before the acute event. 257,019 patients had QRisk2 estimations. Chest pain was associated with a higher risk of CAD. HRs: 21.12 (16.68 to 26.76), p<0.001; 7.51 (6.49 to 8.68), p<0.001; and 1.84 (1.14 to 3.00), p<0.001 for specified, unspecified and musculoskeletal chest pain. Dyspepsia, dyspnoea or fatigue was also associated with a higher risk of CAD. Chest pain of all subtypes, dyspepsia and dyspnoea were also associated with an increased 10-year cardiovascular risk of 20% or more. All patients with chest pain, including those with atypical symptoms, require careful assessment for acute and longer term cardiovascular risk. Prodromes may have independent diagnostic value in the estimation of cardiovascular disease risk. 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.

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

PubMed

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

2015-12-01

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

The effect of correct cross-chest clip use on injury outcomes in young children during motor vehicle crashes.

PubMed

Woodford, Evangeline; Brown, Julie; Bilston, Lynne E

2018-05-19

Traffic crashes have high mortality and morbidity for young children. Though many specialized child restraint systems improve injury outcomes, no large-scale studies have investigated the cross-chest clip's role during a crash, despite concerns in some jurisdictions about the potential for neck contact injuries from the clips. This study aimed to investigate the relationship between cross-chest clip use and injury outcomes in children between 0 and 4 years of age. Child passengers between 0 and 4 years of age were selected from the NASS-CDS data sets (2003-2014). Multiple regression analysis was used to model injury outcomes while controlling for age, crash severity, crash direction, and restraint type. The primary outcomes were overall Abbreviated Injury Score (AIS) 2+ injury, and the presence of any neck injury. Across all children aged 0-4 years, correct chest clip use was associated with decreased Abbreviated Injury Scale (AIS) 2+ injury (odds ratio [OR] = 0.44, 95% confidence interval [CI], 0.21-0.91) and was not associated with neck injury. However, outcomes varied by age. In children <12 months old, chest clip use was associated with decreased AIS 2+ injury (OR = 0.09, 95% CI, 0.02-0.44). Neck injury (n = 7, all AIS 1) for this age group only occurred with correct cross-chest clip use. For 1- to 4-year-old children, cross-chest clip use had no association with AIS 2+ injury, and correct use significantly decreased the odds of neck injury (OR = 0.49; 95% CI, 0.27-0.87) compared to an incorrectly used or absent cross-chest clip. No serious injuries were directly caused by the chest clips. Correct cross-chest clip use appeared to reduce injury in crashes, and there was no evidence of serious clip-induced injury in children in 5-point harness restraints.

Dynamic chest radiography: flat-panel detector (FPD) based functional X-ray imaging.

PubMed

Tanaka, Rie

2016-07-01

Dynamic chest radiography is a flat-panel detector (FPD)-based functional X-ray imaging, which is performed as an additional examination in chest radiography. The large field of view (FOV) of FPDs permits real-time observation of the entire lungs and simultaneous right-and-left evaluation of diaphragm kinetics. Most importantly, dynamic chest radiography provides pulmonary ventilation and circulation findings as slight changes in pixel value even without the use of contrast media; the interpretation is challenging and crucial for a better understanding of pulmonary function. The basic concept was proposed in the 1980s; however, it was not realized until the 2010s because of technical limitations. Dynamic FPDs and advanced digital image processing played a key role for clinical application of dynamic chest radiography. Pulmonary ventilation and circulation can be quantified and visualized for the diagnosis of pulmonary diseases. Dynamic chest radiography can be deployed as a simple and rapid means of functional imaging in both routine and emergency medicine. Here, we focus on the evaluation of pulmonary ventilation and circulation. This review article describes the basic mechanism of imaging findings according to pulmonary/circulation physiology, followed by imaging procedures, analysis method, and diagnostic performance of dynamic chest radiography.

The phrenic nerve with accompanying vessels: a silent cause of cardiovascular border obliteration on chest radiography.

PubMed

Farhana, Shiri; Ashizawa, Kazuto; Hayashi, Hideyuki; Ogihara, Yukihiro; Aso, Nobuya; Hayashi, Kuniaki; Uetani, Masataka

2015-12-01

Our aim was to clarify the frequency of cardiovascular border obliteration on frontal chest radiography and to prove that the phrenic nerve with accompanying vessels can be considered as a cause of obliteration of cardiovascular border on an otherwise normal chest radiography. Two radiologists reviewed chest radiographs and computed tomography (CT) images of 100 individuals. CT confirmed the absence of intrapulmonary or extrapulmonary abnormalities in all of them. We examined the frequency of cardiovascular border obliteration on frontal chest radiography and summarized the causes of obliteration as pericardial fat pad, phrenic nerve, intrafissure fat, pulmonary vessels, and others, comparing them with CT in each case. Cardiovascular border was obliterated on frontal chest radiography in 46 cases on the right and in 61 on the left. The phrenic nerve with accompanying vessels was found to be a cause of obliteration in 34 of 46 cases (74%) on the right and 29 of 61 (48%) cases on the left. The phrenic nerve was the most frequent cause of cardiovascular border obliteration on both sides. The phrenic nerve with accompanying vessels, forming a prominent fold of parietal pleura, can be attributed as a cause of cardiovascular border obliteration on frontal chest radiography.

Prevalence and Diagnostic Performance of Isolated and Combined NEXUS Chest CT Decision Criteria.

PubMed

Raja, Ali S; Mower, William R; Nishijima, Daniel K; Hendey, Gregory W; Baumann, Brigitte M; Medak, Anthony J; Rodriguez, Robert M

2016-08-01

The use of chest computed tomography (CT) to evaluate emergency department patients with adult blunt trauma is rising. The NEXUS Chest CT decision instruments are highly sensitive identifiers of adult blunt trauma patients with thoracic injuries. However, many patients without injury exhibit one of more of the criteria so cannot be classified "low risk." We sought to determine screening performance of both individual and combined NEXUS Chest CT criteria as predictors of thoracic injury to inform chest CT imaging decisions in "non-low-risk" patients. This was a secondary analysis of data on patients in the derivation and validation cohorts of the prospective, observational NEXUS Chest CT study, performed September 2011 to May 2014 in 11 Level I trauma centers. Institutional review board approval was obtained at all study sites. Adult blunt trauma patients receiving chest CT were included. The primary outcome was injury and major clinical injury prevalence and screening performance in patients with combinations of one, two, or three of seven individual NEXUS Chest CT criteria. Across the 11 study sites, rates of chest CT performance ranged from 15.5% to 77.2% (median = 43.6%). We found injuries in 1,493/5,169 patients (28.9%) who had chest CT; 269 patients (5.2%) had major clinical injury (e.g., pneumothorax requiring chest tube). With sensitivity of 73.7 (95% confidence interval [CI] = 68.1 to 78.6) and specificity of 83.9 (95% CI = 83.6 to 84.2) for major clinical injury, abnormal chest-x-ray (CXR) was the single most important screening criterion. When patients had only abnormal CXR, injury and major clinical injury prevalences were 60.7% (95% CI = 52.2% to 68.6%) and 12.9% (95% CI = 8.3% to 19.4%), respectively. Injury and major clinical injury prevalences when any other single criterion alone (other than abnormal CXR) was present were 16.8% (95% CI = 15.2% to 18.6%) and 1.1% (95% CI = 0.1% to 1.8%), respectively. Injury and major clinical injury prevalences among patients when two and three criteria (not abnormal CXR) were present were 25.5% (95% CI = 23.1% to 28.0%) and 3.2% (95% CI = 2.3% to 4.4%) and 34.9% (95% CI = 31.0% to 39.0%) and 2.7% (95% CI = 1.6% to 4.5%), respectively. We recommend that clinicians check for the six clinical NEXUS Chest CT criteria and review the CXR (if obtained). If patients have one clinical criterion (other than abnormal CXR), they will have a very low risk of clinically major injury. We recommend that clinicians discuss the potential risks and benefit of chest CT in these cases. The risks of injury and major clinical injury rise incrementally with more criteria, rendering the risk/benefit ratio toward performing CT in most cases. If the patient has an abnormal CXR, the risks of major clinical injury and minor injury are considerably higher than with the other criteria-chest CT may be indicated in cases requiring greater anatomic detail and injury characterization. © 2016 by the Society for Academic Emergency Medicine.

Derivation and Validation of Two Decision Instruments for Selective Chest CT in Blunt Trauma: A Multicenter Prospective Observational Study (NEXUS Chest CT)

PubMed Central

Rodriguez, Robert M.; Langdorf, Mark I.; Nishijima, Daniel; Baumann, Brigitte M.; Hendey, Gregory W.; Medak, Anthony J.; Raja, Ali S.; Allen, Isabel E.; Mower, William R.

2015-01-01

Background Unnecessary diagnostic imaging leads to higher costs, longer emergency department stays, and increased patient exposure to ionizing radiation. We sought to prospectively derive and validate two decision instruments (DIs) for selective chest computed tomography (CT) in adult blunt trauma patients. Methods and Findings From September 2011 to May 2014, we prospectively enrolled blunt trauma patients over 14 y of age presenting to eight US, urban level 1 trauma centers in this observational study. During the derivation phase, physicians recorded the presence or absence of 14 clinical criteria before viewing chest imaging results. We determined injury outcomes by CT radiology readings and categorized injuries as major or minor according to an expert-panel-derived clinical classification scheme. We then employed recursive partitioning to derive two DIs: Chest CT-All maximized sensitivity for all injuries, and Chest CT-Major maximized sensitivity for only major thoracic injuries (while increasing specificity). In the validation phase, we employed similar methodology to prospectively test the performance of both DIs. We enrolled 11,477 patients—6,002 patients in the derivation phase and 5,475 patients in the validation phase. The derived Chest CT-All DI consisted of (1) abnormal chest X-ray, (2) rapid deceleration mechanism, (3) distracting injury, (4) chest wall tenderness, (5) sternal tenderness, (6) thoracic spine tenderness, and (7) scapular tenderness. The Chest CT-Major DI had the same criteria without rapid deceleration mechanism. In the validation phase, Chest CT-All had a sensitivity of 99.2% (95% CI 95.4%–100%), a specificity of 20.8% (95% CI 19.2%–22.4%), and a negative predictive value (NPV) of 99.8% (95% CI 98.9%–100%) for major injury, and a sensitivity of 95.4% (95% CI 93.6%–96.9%), a specificity of 25.5% (95% CI 23.5%–27.5%), and a NPV of 93.9% (95% CI 91.5%–95.8%) for either major or minor injury. Chest CT-Major had a sensitivity of 99.2% (95% CI 95.4%–100%), a specificity of 31.7% (95% CI 29.9%–33.5%), and a NPV of 99.9% (95% CI 99.3%–100%) for major injury and a sensitivity of 90.7% (95% CI 88.3%–92.8%), a specificity of 37.9% (95% CI 35.8%–40.1%), and a NPV of 91.8% (95% CI 89.7%–93.6%) for either major or minor injury. Regarding the limitations of our work, some clinicians may disagree with our injury classification and sensitivity thresholds for injury detection. Conclusions We prospectively derived and validated two DIs (Chest CT-All and Chest CT-Major) that identify blunt trauma patients with clinically significant thoracic injuries with high sensitivity, allowing for a safe reduction of approximately 25%–37% of unnecessary chest CTs. Trauma evaluation protocols that incorporate these DIs may decrease unnecessary costs and radiation exposure in the disproportionately young trauma population. PMID:26440607

Stress Tests for Chest Pain: When You Need an Imaging Test -- and When You Don't

MedlinePlus

... Resources Adult , Geriatric Stress Tests for Chest Pain Stress Tests for Chest Pain When you need an ... pain isn’t from heart disease. A cardiac stress test makes the heart work hard so your ...

46 CFR 160.038-5 - Marking.

Code of Federal Regulations, 2010 CFR

2010-10-01

...: SPECIFICATIONS AND APPROVAL LIFESAVING EQUIPMENT Magazine Chests, Portable, for Merchant Vessels § 160.038-5 Marking. (a) Portable magazine chests used for the stowage of pyrotechnic signals, rockets, and powder for...: “Portable Magazine Chest, Inflammable—Keep Lights and Fire Away.” (b) [Reserved] ...

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

PubMed

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

2015-10-12

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

Male chest enhancement: pectoral implants.

PubMed

Benito-Ruiz, J; Raigosa, J M; Manzano-Surroca, M; Salvador, L

2008-01-01

The authors present their experience with the pectoral muscle implant for male chest enhancement in 21 patients. The markings and technique are thoroughly described. The implants used were manufactured and custom made. The candidates for implants comprised three groups: group 1 (18 patients seeking chest enhancement), group 2 (1 patient with muscular atrophy), and group 3 (2 patients with muscular injuries). Because of the satisfying results obtained, including significant enhancement of the chest contour and no major complications, this technique is used for an increasing number of male cosmetic surgeries.

Medic - Chest Pain: A Decision Support Program for the Management of Acute Chest Pain (User’s Manual)

DTIC Science & Technology

1989-10-05

musculoskeletal chest pain; b) pleurisy ; c) pulmonary erbolus; d) mediastinal emphysema a) Musculoskeletal chest pain and the pain of costochondritis denote muscle...includes mild A-22 analgesics/anti-inflammatory drugs, heat therapy, and rest. b) Pleurisy denotes inflammation of the pleura. It may be seen in the...setting of bronchitis or pneumonia. The symptoms of both assist in differentiating pleurisy fru pneumothorax. In the absence of signs of pneumonia or

DOE Office of Scientific and Technical Information (OSTI.GOV)

Miyamoto, Y.; Hattori, T.; Niimoto, M.

In 15 patients chest walls were excised because of recurrent breast cancer, radiation ulcer, or rib tumor. In most cases the full-thickness defect of the chest wall was about 10 x 10 cm. Reconstruction was performed using only a rectus abdominis musculocutaneous flap. No patient developed circulation problems in the flap or severe flail chest, and we had successful results in all our cases. These results show that the rectus abdominis musculocutaneous flap is quite effective and safe to use in the reconstruction of chest wall defects.

Quality assessment of digital X-ray chest images using an anthropomorphic chest phantom

NASA Astrophysics Data System (ADS)

Vodovatov, A. V.; Kamishanskaya, I. G.; Drozdov, A. A.; Bernhardsson, C.

2017-02-01

The current study is focused on determining the optimal tube voltage for the conventional X-ray digital chest screening examinations, using a visual grading analysis method. Chest images of an anthropomorphic phantom were acquired in posterior-anterior projection on four digital X-ray units with different detector types. X-ray images obtained with an anthropomorphic phantom were accepted by the radiologists as corresponding to a normal human anatomy, hence allowing using phantoms in image quality trials without limitations.

The role of chest computed tomography (CT) as a surveillance tool in children with high-risk neuroblastoma.

PubMed

Federico, Sara M; Brady, Samuel L; Pappo, Alberto; Wu, Jianrong; Mao, Shenghua; McPherson, Valerie J; Young, Alison; Furman, Wayne L; Kaufman, Robert; Kaste, Sue

2015-06-01

Standardization of imaging obtained in children with neuroblastoma is not well established. This study examines chest CT in pediatric patients with high-risk neuroblastoma. Medical records and imaging from 88 patients with high-risk neuroblastoma, diagnosed at St. Jude Children's Research Hospital between January, 2002 and December, 2009, were reviewed. Surveillance imaging was conducted through 2013. Ten patients with thoracic disease at diagnosis were excluded. Event free survival (EFS) and overall survival (OS) were estimated. Size specific dose estimates for CT scans of the chest, abdomen, and pelvis were used to estimate absolute organ doses to 23 organs. Organ dosimetry was used to calculate cohort effective dose. The 5 year OS and EFS were 51.9% ± 6.5% and 42.6% ± 6.5%, respectively. Forty-six (58.9%) patients progressed/recurred and 41 (52.6%) died of disease. Eleven patients (14%) developed thoracic disease progression/recurrence identified by chest CT (1 paraspinal mass, 1 pulmonary nodules, and 9 nodal). MIBG (metaiodobenzylguanidine) scans identified thoracic disease in six patients. Five of the 11 had normal chest MIBG scans; three were symptomatic and two were asymptomatic with normal chest MIBG scans but avid bone disease. The estimated radiation dose savings from surveillance without CT chest imaging was 42%, 34% when accounting for modern CT acquisition (2011-2013). Neuroblastoma progression/recurrence in the chest is rare and often presents with symptoms or is identified using standard non-CT imaging modalities. For patients with non-thoracic high-risk neuroblastoma at diagnosis, omission of surveillance chest CT imaging can save 35-42% of the radiation burden without compromising disease detection. © 2015 Wiley Periodicals, Inc.

Personality subtypes and chest pain in patients with nonobstructive coronary artery disease from the TweeSteden Mild Stenosis study: mediating effect of anxiety and depression.

PubMed

Mommersteeg, P M C; Widdershoven, J W; Aarnoudse, W; Denollet, J

2016-03-01

Patients presenting with chest pain in nonobstructive coronary artery disease (CAD, luminal narrowing <60%) are at risk for emotional distress and future events. We aimed to examine the association of personality subtypes with persistent chest pain, and investigated the potential mediating effects of negative mood states. Any chest pain in the past month was the primary outcome measure reported by 523 patients with nonobstructive CAD (mean age 61.4 years, SD = 9.4; 48% men), who participate in the TweeSteden Mild Stenosis (TWIST) observational cohort. Personality was categorized into a 'reference group', a high social inhibition ('SI only'), a high negative affectivity ('NA only') and a 'Type D' (NA and SI) group. Negative mood states included symptoms of depression and anxiety (Hospital Anxiety and Depression Scale) and cognitive and somatic depression (Beck Depression Inventory). The PROCESS macro was used to examine the relation between personality subtypes and chest pain presence, with the negative mood states as potential mediators. Persistent chest pain was present in 44% of the patients with nonobstructive CAD. Type D personality (OR = 1.91, 95% CI 1.24-2.95), but not the 'NA only' (OR = 1.48, 95% CI 0.89-2.44) or the 'SI only' (OR = 0.93, 95% CI 0.53-1.64) group was associated with chest pain, adjusted for age and sex. Negative mood states mediated the association between personality and chest pain. Type D personality, but not negative affectivity or social inhibition, was related to chest pain in nonobstructive CAD, which was mediated by negative mood states. © 2015 European Pain Federation - EFIC®

Discharge of Non-Acute Coronary Syndrome Chest Pain Patients From Emergency Care to an Advanced Nurse Practitioner-Led Chest Pain Clinic: A Cross-Sectional Study of Referral Source and Final Diagnosis.

PubMed

Ingram, Shirley J; McKee, Gabrielle; Quirke, Mary B; Kelly, Niamh; Moloney, Ashling

Chest pain is a common presentation to emergency departments (EDs). Pathways for patients with non-acute coronary syndrome (ACS) chest pain are not optimal. An advanced cardiology nurse-led chest pain service was commenced to address this. The aim of the study was to assess the outcomes of non-ACS patients discharged from ED to an advanced cardiology nurse-led chest pain clinic and compare by referral type (nurse or ED physician). The service consisted of advanced cardiology nurse or ED physician consultation in the ED and discharge to advanced nurse-led chest pain clinic review less than 72 hours after discharge. Referrals were by the advanced nurses during consult hours and out-of-hours were by the ED physicians. Data were extracted from case notes. This was a 1-site cross-sectional study of patients attending the chest pain clinic over 2 years. Confirmed coronary disease was diagnosed in 24% of patients. Of the 1041 patients, 45% were referred by the advanced nurses, who referred significantly more patients who were older (56.5 years/52.3 years), had positive exercise stress test results (21%/12%), and were diagnosed with stable coronary artery disease (19%/11%) and less patients with musculoskeletal diagnosis (5%/13%) and other noncardiac pain (36%/45%). The study fills a gap in the literature on the follow up of non-ACS patients who present to ED and used advanced cardiology nursing expertise in the ED and chest pain clinic. The advanced nurse referred more patients who were diagnosed with coronary disease, reflecting the expertise, experience, and efficiency of the advanced cardiology nurse-led service.

Poster – 41: External marker block placement on the breast or chest wall for left-sided deep inspiration breath-hold radiotherapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Conroy, Leigh; Guebert, Alexandra; Smith, Wendy

Purpose: We investigate DIBH breast radiotherapy using the Real-time Position Management (RPM) system with the marker-block placed on the target breast or chest wall. Methods: We measured surface dose for three different RPM marker-blocks using EBT3 Gafchromic film at 0° and 30° incidence. A registration study was performed to determine the breast surface position that best correlates with overall internal chest wall position. Surface and chest wall contours from MV images of the medial tangent field were extracted for 15 patients. Surface contours were divided into three potential marker-block positions on the breast: Superior, Middle, and Inferior. Translational registration wasmore » used to align the partial contours to the first-fraction contour. Each resultant transformation matrix was applied to the chest wall contour, and the minimum distance between the reference chest wall contour and the transformed chest wall contour was evaluated for each pixel. Results: The measured surface dose for the 2-dot, 6-dot, and 4-dot marker-blocks at 0° incidence were 74%, 71%, and 77% of dose to dmax respectively. At 30° beam incidence this increased to 76%, 72%, and 81%. The best external surface position was patient and fraction dependent, with no consistent best choice. Conclusions: The increase in surface dose directly under the RPM block is approximately equivalent to 3 mm of bolus. No marker-block position on the breast surface was found to be more representative of overall chest wall motion; therefore block positional stability and reproducibility can be used to determine optimal placement on the breast or chest wall.« less

Psychiatric Characteristics of the Cardiac Outpatients with Chest Pain

PubMed Central

Lee, Jea-Geun; Kim, Song-Yi; Kim, Ki-Seok; Joo, Seung-Jae

2016-01-01

Background and Objectives A cardiologist's evaluation of psychiatric symptoms in patients with chest pain is rare. This study aimed to determine the psychiatric characteristics of patients with and without coronary artery disease (CAD) and explore their relationship with the intensity of chest pain. Subjects and Methods Out of 139 consecutive patients referred to the cardiology outpatient department, 31 with atypical chest pain (heartburn, acid regurgitation, dyspnea, and palpitation) were excluded and 108 were enrolled for the present study. The enrolled patients underwent complete numerical rating scale of chest pain and the symptom checklist for minor psychiatric disorders at the time of first outpatient visit. The non-CAD group consisted of patients with a normal stress test, coronary computed tomography angiogram, or coronary angiogram, and the CAD group included those with an abnormal coronary angiogram. Results Nineteen patients (17.6%) were diagnosed with CAD. No differences in the psychiatric characteristics were observed between the groups. "Feeling tense", "self-reproach", and "trouble falling asleep" were more frequently observed in the non-CAD (p=0.007; p=0.046; p=0.044) group. In a multiple linear regression analysis with a stepwise selection, somatization without chest pain in the non-CAD group and hypochondriasis in the CAD group were linearly associated with the intensity of chest pain (β=0.108, R2=0.092, p=0.004; β= -0.525, R2=0.290, p=0.010). Conclusion No differences in psychiatric characteristics were observed between the groups. The intensity of chest pain was linearly associated with somatization without chest pain in the non-CAD group and inversely linearly associated with hypochondriasis in the CAD group. PMID:27014347

Indirect detection of pulmonary nodule on low-pass filtered and original x-ray images during limited and unlimited display times

NASA Astrophysics Data System (ADS)

Pietrzyk, Mariusz W.; McEntee, Mark; Evanoff, Michael G.; Brennan, Patrick C.

2012-02-01

Aim: This study evaluates the assumption that global impression is created based on low spatial frequency components of posterior-anterior chest radiographs. Background: Expert radiologists precisely and rapidly allocate visual attention on pulmonary nodules chest radiographs. Moreover, the most frequent accurate decisions are produced in the shortest viewing time, thus, the first hundred milliseconds of image perception seems be crucial for correct interpretation. Medical image perception model assumes that during holistic analysis experts extract information based on low spatial frequency (SF) components and creates a mental map of suspicious location for further inspection. The global impression results in flagged regions for detailed inspection with foveal vision. Method: Nine chest experts and nine non-chest radiologists viewed two sets of randomly ordered chest radiographs under 2 timing conditions: (1) 300ms; (2) free search in unlimited time. The same radiographic cases of 25 normal and 25 abnormal digitalized chest films constituted two image sets: low-pass filtered and unfiltered. Subjects were asked to detect nodules and rank confidence level. MRMC ROC DBM analyses were conducted. Results: Experts had improved ROC AUC while high SF components are displayed (p=0.03) or while low SF components were viewed under unlimited time (p=0.02) compared with low SF 300mSec viewings. In contrast, non-chest radiologists showed no significant changes when high SF are displayed under flash conditions compared with free search or while low SF components were viewed under unlimited time compared with flash. Conclusion: The current medical image perception model accurately predicted performance for non-chest radiologists, however chest experts appear to benefit from high SF features during the global impression.

Chest Radiographic Screening for Sarcoidosis in the Diagnosis of Patients with Active Uveitis.

PubMed

Groen, Fahriye; van Laar, Jan A M; Rothova, Aniki

2017-06-01

Although chest radiography is currently recommended for the initial evaluation of patients with new-onset uveitis, the efficacy of this diagnostic screening modality is not known. To evaluate the diagnostic value of chest radiographs in patients with active uveitis of recent onset in a tertiary center in Western Europe. A retrospective cross-sectional study was conducted by reviewing all chest imaging for adults with new-onset (<1 yr) uveitis of unknown origin undergoing initial evaluation in the Department of Ophthalmology at Erasmus University Medical Center (Rotterdam, the Netherlands). Radiographic findings were related to clinical and other imaging characteristics and to final diagnoses. Screening chest radiographs were abnormal for 30 of 200 patients (15%) included in this study. Twenty-two of the 200 patients (11%) had biopsy-confirmed sarcoidosis, and an additional 12 patients were presumed to have sarcoidosis. The finding of chest radiographic abnormalities interpreted as typical of sarcoidosis was specific (91%; 95% confidence interval, 85.9-94.4%) but not sensitive (64%; 95% confidence interval, 43.0-80.3%) for biopsy-confirmed sarcoidosis. The combination of elevated serum angiotensin-converting enzyme level and chest radiographic findings typical of sarcoidosis increased the sensitivity to 79%. Biopsy-confirmed sarcoidosis was more common in patients with panuveitis (17 of 84; 20%) compared to patients with other anatomical locations of uveitis (5 of 116, 4%; P < 0.001). One patient was diagnosed with active pulmonary and ocular tuberculosis. Abnormal chest radiographs were found in 15% of patients with active uveitis of unknown origin and onset within 1 year of referral to a tertiary center in the Netherlands. A majority of the abnormal chest radiographs showed findings compatible with a diagnosis of sarcoidosis.

Positive and Negative Affect Is Related to Experiencing Chest Pain During Exercise-Induced Myocardial Ischemia.

PubMed

Stébenne, Philippe; Bacon, Simon L; Austin, Anthony; Paine, Nicola J; Arsenault, André; Laurin, Catherine; Meloche, Bernard; Gordon, Jennifer; Dupuis, Jocelyn; Lavoie, Kim L

2017-05-01

Silent myocardial ischemia is thought to be associated with worse cardiovascular outcomes due to a lack of perception of pain cues that initiate treatment seeking. Negative affect (NA) has been associated with increased pain reporting and positive affect (PA) with decreased pain reporting, but these psychological factors have not been examined within the context of myocardial ischemia. This study evaluated the associations between PA, NA, and chest pain reporting in patients with and without ischemia during exercise testing. A total of 246 patients referred for myocardial perfusion single-photon emission computed tomography exercise stress testing completed the positive and negative affect schedule-expanded version, a measure of PA and NA. Presence of chest pain and myocardial ischemia were evaluated using standardized protocols. Logistic regression analyses revealed that for every 1-point increase in NA, there was a 13% higher chance for ischemic patients (odds ratio [OR] = 1.13; 95% confidence interval [CI] = 1.02 to 1.26) and an 11% higher chance in nonischemic patients (OR = 1.11; 95% CI = 1.03 to 1.19) to report chest pain. A significant interaction of PA and NA on chest pain reporting (β = 0.02; 95% CI = 0.002 to 0.031) was also observed; nonischemic patients with high NA and PA reported more chest pain (57%) versus patients with low NA and low PA (13%), with high NA and low PA (17%), and with high PA and low NA (7%). Patients who experience higher NA are more likely to report experiencing chest pain. In patients without ischemia, high NA and PA was also associated with a higher likelihood of reporting chest pain. Results suggest that high levels of PA as well as NA may increase the experience and/or reporting of chest pain.

High pitch third generation dual-source CT: Coronary and Cardiac Visualization on Routine Chest CT

PubMed Central

Sandfort, Veit; Ahlman, Mark; Jones, Elizabeth; Selwaness, Mariana; Chen, Marcus; Folio, Les; Bluemke, David A.

2016-01-01

Background Chest CT scans are frequently performed in radiology departments but have not previously contained detailed depiction of cardiac structures. Objectives To evaluate myocardial and coronary visualization on high-pitch non-gated CT of the chest using 3rd generation dual-source computed tomography (CT). Methods Cardiac anatomy of patients who had 3rd generation, non-gated high pitch contrast enhanced chest CT and who also had prior conventional (low pitch) chest CT as part of a chest abdomen pelvis exam was evaluated. Cardiac image features were scored by reviewers blinded to diagnosis and pitch. Paired analysis was performed. Results 3862 coronary segments and 2220 cardiac structures were evaluated by two readers in 222 CT scans. Most patients (97.2%) had chest CT for oncologic evaluation. The median pitch was 2.34 (IQR 2.05, 2.65) in high pitch and 0.8 (IQR 0.8, 0.8) in low pitch scans (p<0.001). High pitch CT showed higher image visualization scores for all cardiovascular structures compared with conventional pitch scans (p<0.0001). Coronary arteries were visualized in 9 coronary segments per exam in high pitch scans versus 2 segments for conventional pitch (p<0.0001). Radiation exposure was lower in the high pitch group compared with the conventional pitch group (median CTDIvol 10.83 vs. 12.36 mGy and DLP 790 vs. 827 mGycm respectively, p <0.01 for both) with comparable image noise (p=0.43). Conclusion Myocardial structure and coronary arteries are frequently visualized on non-gated 3rd generation chest CT. These results raise the question of whether the heart and coronary arteries should be routinely interpreted on routine chest CT that is otherwise obtained for non-cardiac indications. PMID:27133589

Mechanical versus manual chest compressions for cardiac arrest.

PubMed

Brooks, Steven C; Hassan, Nizar; Bigham, Blair L; Morrison, Laurie J

2014-02-27

This is the first update of the Cochrane review on mechanical chest compression devices published in 2011 (Brooks 2011). Mechanical chest compression devices have been proposed to improve the effectiveness of cardiopulmonary resuscitation (CPR). To assess the effectiveness of mechanical chest compressions versus standard manual chest compressions with respect to neurologically intact survival in patients who suffer cardiac arrest. We searched the Cochrane Central Register of Controlled Studies (CENTRAL; 2013, Issue 12), MEDLINE Ovid (1946 to 2013 January Week 1), EMBASE (1980 to 2013 January Week 2), Science Citation abstracts (1960 to 18 November 2009), Science Citation Index-Expanded (SCI-EXPANDED) (1970 to 11 January 2013) on Thomson Reuters Web of Science, biotechnology and bioengineering abstracts (1982 to 18 November 2009), conference proceedings Citation Index-Science (CPCI-S) (1990 to 11 January 2013) and clinicaltrials.gov (2 August 2013). We applied no language restrictions. Experts in the field of mechanical chest compression devices and manufacturers were contacted. We included randomised controlled trials (RCTs), cluster RCTs and quasi-randomised studies comparing mechanical chest compressions versus manual chest compressions during CPR for patients with atraumatic cardiac arrest. Two review authors abstracted data independently; disagreement between review authors was resolved by consensus and by a third review author if consensus could not be reached. The methodologies of selected studies were evaluated by a single author for risk of bias. The primary outcome was survival to hospital discharge with good neurological outcome. We planned to use RevMan 5 (Version 5.2. The Nordic Cochrane Centre) and the DerSimonian & Laird method (random-effects model) to provide a pooled estimate for risk ratio (RR) with 95% confidence intervals (95% CIs), if data allowed. Two new studies were included in this update. Six trials in total, including data from 1166 participants, were included in the review. The overall quality of included studies was poor, and significant clinical heterogeneity was observed. Only one study (N = 767) reported survival to hospital discharge with good neurological function (defined as a Cerebral Performance Category score of one or two), demonstrating reduced survival with mechanical chest compressions when compared with manual chest compressions (RR 0.41, 95% CI 0.21 to 0.79). Data from four studies demonstrated increased return of spontaneous circulation, and data from two studies demonstrated increased survival to hospital admission with mechanical chest compressions as compared with manual chest compressions, but none of the individual estimates reached statistical significance. Marked clinical heterogeneity between studies precluded any pooled estimates of effect. Evidence from RCTs in humans is insufficient to conclude that mechanical chest compressions during cardiopulmonary resuscitation for cardiac arrest are associated with benefit or harm. Widespread use of mechanical devices for chest compressions during cardiac events is not supported by this review. More RCTs that measure and account for the CPR process in both arms are needed to clarify the potential benefit to be derived from this intervention.

[Primary spontaneous pneumomediastinum].

PubMed

Togashi, K; Hosaka, Y

2007-12-01

We report 5 cases of spontaneous pneumomediastinum. They were 4 men and 1 female with a mean age of 17 (14-25). Four patients developed sport-related pneumomediastinum and 1 patient had a karaoke-related condition. Primary spontaneous pneumomediasinum is a rare condition. In addition, there is no previous report describing karaoke-related spontaneous pneumomediastinum. Each of the patients experienced chest pain and/or neck pain before consulting our hospital. Chest roentgenogram and chest computed tomography showed pneumomediastinum without esophageal or tracheal injury. Four patients did not require hospitalization, but 1 patient was necessary to hospitalize for 7 days because of severe chest and neck pain. None of these 5 patients has had any recurrence for more than 1 year. Differentiating this entity from other diseases involving anterior chest pain is important.

[Development of image quality assurance support system using image recognition technology in radiography in lacked images of chest and abdomen].

PubMed

Shibuya, Toru; Kato, Kyouichi; Eshima, Hidekazu; Sumi, Shinichirou; Kubo, Tadashi; Ishida, Hideki; Nakazawa, Yasuo

2012-01-01

In order to provide a precise radiography for diagnosis, it is required that we avoid radiography with defects by having enough evaluation. Conventionally, evaluation was performed only by observation of a radiological technologist (RT). The evaluation support system was developed for providing a high quality assurance without depending on RT observation only. The evaluation support system, called as the Image Quality Assurance Support System (IQASS), is characterized in that "image recognition technology" for the purpose of diagnostic radiography of chest and abdomen areas. The technique of the system used in this study. Of the 259 samples of posterior-anterior (AP) chest, lateral chest, and upright abdominal x-rays, the sensitivity and specificity was 93.1% and 91.8% in the chest AP, 93.3% and 93.6% in the chest lateral, and 95.0% and 93.8% in the upright abdominal x-rays. In the light of these results, it is suggested that AIQAS could be applied to practical usage for the RT.

Flail Chest Following Failed Cardiopulmonary Resuscitation.

PubMed

Thompson, Melissa; Langlois, Neil E I; Byard, Roger W

2017-09-01

Following the death of a woman with blunt force chest trauma, the question was asked how common was the finding at autopsy of a flail chest in decedents after failed cardiopulmonary resuscitation. It was suggested in court that this was an uncommon occurrence. To address this issue, autopsy cases in adults (>18 years) with rib fractures attributable to cardiopulmonary resuscitation were taken from the files of Forensic Science SA over a 7-year period from 2008 to 2014. Flail chest injuries were defined as those arising from fractures at two sites in at least three consecutive ribs. From 236 cases with rib fractures attributed to resuscitation, a total of 43 flail chest injuries were found in 35 cases (14.8%). The majority occurred in the 60-79-year-old age group. These data suggest that flail chest injuries are a more common sequelae of cardiopulmonary resuscitation than has been previously appreciated in autopsy cases, particularly in the elderly. © 2017 American Academy of Forensic Sciences.

Spontaneous Recanalization of the Obstructed Right Coronary Artery Caused by Blunt Chest Trauma.

PubMed

Haraguchi, Yumiko; Sakakura, Kenichi; Yamamoto, Kei; Taniguchi, Yousuke; Nakashima, Ikue; Wada, Hiroshi; Sanui, Masamitsu; Momomura, Shin-Ichi; Fujita, Hideo

2018-03-30

Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.

Crush asphyxia and ride-on lawn mowers.

PubMed

Byard, Roger W; Langlois, Neil Ei

2017-07-01

Search of files at Forensic Science SA, Australia, over the past 20 years (1997-2016) revealed three cases of death due to crush asphyxia associated with the use of ride-on lawn mowers. (1) A 61-year-old man was trapped under a ride-on mower that had rolled over. Autopsy examination revealed congestion and petechial haemorrhages of the face and chest, and markings on the chest associated with underlying rib fractures. (2) A 78-year-old man was trapped under a ride-on mower that had also rolled over. Autopsy examination revealed petechial haemorrhages of the face and chest and markings on the chest. (3) A 72-year-old man was found wedged between a ride-on mower and a tree, with petechial haemorrhages of the face and chest, and markings on the front and back of the chest. These cases demonstrate a rare cause of crush asphyxia, often in older males in the domestic environment, which may arise from more than one mechanism.

Imaging of congenital chest wall deformities

PubMed Central

Bhaludin, Basrull N; Naaseri, Sahar; Di Chiara, Francesco; Jordan, Simon; Padley, Simon

2016-01-01

To identify the anatomy and pathology of chest wall malformations presenting for consideration for corrective surgery or as a possible chest wall “mass”, and to review the common corrective surgical procedures. Congenital chest wall deformities are caused by anomalies of chest wall growth, leading to sternal depression or protrusion, or are related to failure of normal spine or rib development. Cross-sectional imaging allows appreciation not only of the involved structures but also assessment of the degree of displacement or deformity of adjacent but otherwise normal structures and differentiation between anatomical deformity and neoplasia. In some cases, CT is also useful for surgical planning. The use of three-dimensional reconstructions, utilizing a low-dose technique, provides important information for the surgeon to discuss the nature of anatomical abnormalities and planned corrections with the patient and often with their parents. In this pictorial essay, we discuss the radiological features of the commonest congenital chest wall deformities and illustrate pre- and post-surgical appearances for those undergoing surgical correction. PMID:26916279

Thoracic injury rule out criteria and NEXUS chest in predicting the risk of traumatic intra-thoracic injuries: A diagnostic accuracy study.

PubMed

Safari, Saeed; Radfar, Fatemeh; Baratloo, Alireza

2018-05-01

This study aimed to compare the diagnostic accuracy of NEXUS chest and Thoracic Injury Rule out criteria (TIRC) models in predicting the risk of intra-thoracic injuries following blunt multiple trauma. In this diagnostic accuracy study, using the 2 mentioned models, blunt multiple trauma patients over the age of 15 years presenting to emergency department were screened regarding the presence of intra-thoracic injuries that are detectable via chest x-ray and screening performance characteristics of the models were compared. In this study, 3118 patients with the mean (SD) age of 37.4 (16.9) years were studied (57.4% male). Based on TIRC and NEXUS chest, respectively, 1340 (43%) and 1417 (45.4%) patients were deemed in need of radiography performance. Sensitivity, specificity, and positive and negative predictive values of TIRC were 98.95%, 62.70%, 21.19% and 99.83%. These values were 98.61%, 59.94%, 19.97% and 99.76%, for NEXUS chest, respectively. Accuracy of TIRC and NEXUS chest models were 66.04 (95% CI: 64.34-67.70) and 63.50 (95% CI: 61.78-65.19), respectively. TIRC and NEXUS chest models have proper and similar sensitivity in prediction of blunt traumatic intra-thoracic injuries that are detectable via chest x-ray. However, TIRC had a significantly higher specificity in this regard. Copyright © 2018 Elsevier Ltd. All rights reserved.

Diagnostic Evaluation of Nontraumatic Chest Pain in Athletes.

PubMed

Moran, Byron; Bryan, Sean; Farrar, Ted; Salud, Chris; Visser, Gary; Decuba, Raymond; Renelus, Deborah; Buckley, Tyler; Dressing, Michael; Peterkin, Nicholas; Coris, Eric

This article is a clinically relevant review of the existing medical literature relating to the assessment and diagnostic evaluation for athletes complaining of nontraumatic chest pain. The literature was searched using the following databases for the years 1975 forward: Cochrane Database of Systematic Reviews; CINAHL; PubMed (MEDLINE); and SportDiscus. The general search used the keywords chest pain and athletes. The search was revised to include subject headings and subheadings, including chest pain and prevalence and athletes. Cross-referencing published articles from the databases searched discovered additional articles. No dissertations, theses, or meeting proceedings were reviewed. The authors discuss the scope of this complex problem and the diagnostic dilemma chest pain in athletes can provide. Next, the authors delve into the vast differential and attempt to simplify this process for the sports medicine physician by dividing potential etiologies into cardiac and noncardiac conditions. Life-threatening causes of chest pain in athletes may be cardiac or noncardiac in origin, which highlights the need for the sports medicine physician to consider pathology in multiple organ systems simultaneously. This article emphasizes the importance of ruling out immediately life threatening diagnoses, while acknowledging the most common causes of noncardiac chest pain in young athletes are benign. The authors propose a practical algorithm the sports medicine physician can use as a guide for the assessment and diagnostic work-up of the athlete with chest pain designed to help the physician arrive at the correct diagnosis in a clinically efficient and cost-effective manner.

Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial

PubMed Central

Bae, Jinkun; Chung, Tae Nyoung; Je, Sang Mo

2016-01-01

Objectives To assess how the quality of metronome-guided cardiopulmonary resuscitation (CPR) was affected by the chest compression rate familiarised by training before the performance and to determine a possible mechanism for any effect shown. Design Prospective crossover trial of a simulated, one-person, chest-compression-only CPR. Setting Participants were recruited from a medical school and two paramedic schools of South Korea. Participants 42 senior students of a medical school and two paramedic schools were enrolled but five dropped out due to physical restraints. Intervention Senior medical and paramedic students performed 1 min of metronome-guided CPR with chest compressions only at a speed of 120 compressions/min after training for chest compression with three different rates (100, 120 and 140 compressions/min). Friedman's test was used to compare average compression depths based on the different rates used during training. Results Average compression depths were significantly different according to the rate used in training (p<0.001). A post hoc analysis showed that average compression depths were significantly different between trials after training at a speed of 100 compressions/min and those at speeds of 120 and 140 compressions/min (both p<0.001). Conclusions The depth of chest compression during metronome-guided CPR is affected by the relative difference between the rate of metronome guidance and the chest compression rate practised in previous training. PMID:26873050

Use of the omentum in chest-wall reconstruction

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fix, R.J.; Vasconez, L.O.

1989-10-01

Increased use of the omentum in chest-wall reconstruction has paralleled the refinement of anatomic knowledge and the development of safe mobilization techniques. Important anatomic points are the omental attachments to surrounding structures, the major blood supply from the left and right gastroepiploic vessels, and the collateral circulation via the gastroepiploic arch and Barkow's marginal artery. Mobilization of the omentum to the thorax involves division of its attachments to the transverse colon and separation from the greater curvature to fabricate a bipedicled flap. Most anterior chest wounds and virtually all mediastinal wounds can be covered with the omentum based on bothmore » sets of gastroepiploic vessels. The arc of transposition is increased when the omentum is based on a single pedicle, allowing coverage of virtually all chest-wall defects. The final method of increasing flap length involves division of the gastroepiploic arch and reliance on Barkow's marginal artery as collateral circulation to maintain flap viability. With regard to chest-wall reconstruction, we have included the omentum in the armamentarium of flaps used to cover mediastinal wounds. The omentum is our flap of choice for the reconstruction of most radiation injuries of the chest wall. The omentum may also be used to provide protection to visceral anastomoses, vascular conduits, and damaged structures in the chest, as well as to cover defects secondary to tumor excision or trauma. In brief, the omentum has proved to be a most dependable and versatile flap, particularly applicable to chest-wall reconstruction.« less

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

PubMed

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

1997-01-01

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

Evidence basis for management of spine and chest wall deformities in children.

PubMed

Sponseller, Paul D; Yazici, Muharrem; Demetracopoulos, Constantine; Emans, John B

2007-09-01

: Review of relevant studies, including levels of evidence. : To review research on growth of the spine and chest wall and treatment of deformities. To place this knowledge in context of evidence-based assessment. : Knowledge of the growth of the spine, chest wall, and lung in the normal and deformity states has evolved among independent specialties over the past 60 years. Interest in the interrelationship has blossomed as more tools for assessment and treatment have developed. Spine-based and chest wall-based treatment options now exist, as well as options of resection versus gradual distraction. : Peer-reviewed research published on the growth of the spine, lung, chest wall, and treatment of their deformities was reviewed. Treatment methods and outcomes were compared. Ranking of the levels of evidence was performed where possible. : Most studies of these topics are Level III and IV studies, consisting of case-control studies and case series. This limitation arises because of the rarity and heterogeneity of the disorders affecting the growing spine and chest wall. The natural history of most types of spinal/chest wall deformities is not known with accuracy. Some experimental evidence informs the treatments which involve modulation of the growth of the spine. However, accurate models of the deformities themselves are lacking. Improvements in imaging and measurement offer options for more accurate patient comparison. : The natural history and results of treatment of deformities of the spine and chest wall offer much opportunity for further evidence-based research.

The combined effects of cold therapy and music therapy on pain following chest tube removal among patients with cardiac bypass surgery.

PubMed

Yarahmadi, Sajad; Mohammadi, Nooredin; Ardalan, Arash; Najafizadeh, Hassan; Gholami, Mohammad

2018-05-01

Chest tube removal is an extremely painful procedure and patients may not respond well to palliative therapies. This study aimed to examine the effect of cold and music therapy individually, as well as a combination of these interventions on reducing pain following chest tube removal. A factorial randomized-controlled clinical trial was performed on 180 patients who underwent cardiac surgery. Patients were randomized into four groups of 45. Group A used ice packs for 20 minutes prior to chest tube removal. Group B was assigned to listen to music for a total length of 30 minutes which started 15 minutes prior to chest tube removal. Group C received a combination of both interventions; and Group D received no interventions. Pain intensity was measured in each group every 15 minutes for a total of 3 readings. Analysis of variance, Tukey and Bonferroni post hoc tests, as well as repeated measures ANOVA were employed for data analysis. Cold therapy and combined method intervention effectively reduced the pain caused by chest tube removal (P < 0.001). Additionally, there were no statistically significant difference in pain intensity scores between groups at 15 minutes following chest tube removal (P = 0.07). Cold and music therapy can be used by nursing staff in clinical practice as a combined approach to provide effective pain control following chest tube removal. Copyright © 2018 Elsevier Ltd. All rights reserved.

Optical Fiber Sensors For Monitoring Joint Articulation And Chest Expansion Of A Human Body

DOEpatents

Muhs, Jeffrey D.; Allison, Stephen W.

1997-12-23

Fiber-optic sensors employing optical fibers of elastomeric material are incorporated in devices adapted to be worn by human beings in joint and chest regions for the purpose of monitoring and measuring the extent of joint articulation and chest expansion especially with respect to time.

Two cases of acute chest discomfort and the Central Italy earthquake.

PubMed

Pannarale, Giuseppe; Torromeo, Concetta; Acconcia, Maria Cristina; Moretti, Andrea; De Angelis, Valentina; Tanzilli, Alessandra; Paravati, Vincenzo; Barillà, Francesco; Gaudio, Carlo

2017-03-01

We present the cases of two postmenopausal women presenting to our emergency department with acute chest discomfort soon after the Central Italy earthquake. Different diagnoses were made in the two patients. The role of the earthquake as a stressful event triggering diverse chest pain syndromes is discussed.

42 CFR 37.51 - Interpreting and classifying chest radiographs-digital radiography systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... chest radiographic images provided for use with the Guidelines for the Use of the ILO International... standard digital images may be used for classifying digital chest images for pneumoconiosis. Modification of the appearance of the standard images using software tools is not permitted. (d) Viewing systems...

42 CFR 37.51 - Interpreting and classifying chest radiographs-digital radiography systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... standard digital chest radiographic images provided for use with the Guidelines for the Use of the ILO... NIOSH-approved standard digital images may be used for classifying digital chest images for pneumoconiosis. Modification of the appearance of the standard images using software tools is not permitted. (d...

A study of mid-arm and chest circumferences as predictors of low birthweight.

PubMed

Rogo, K; Nyagudi, O; Ferguson, A

1991-02-01

Nine hundred ninety-nine newborns were examined in order to determine the relationship between birthweight and mid-arm and chest circumstances. An early neonatal mortality rate of 51/1000 was recorded, being much higher for preterm (301/1000) than term babies (2.5/1000). Both mid-arm and chest circumference showed highly significant correlations with birthweight (r = 0.872, P less than 0.0001 and r = 0.918, P less than 0.0001, respectively). The correlation between weight and chest circumstances was upheld even for very small babies.

Improved chest expansion in idiopathic scoliosis after intensive, multiple-modality, nonsurgical treatment in an adult.

PubMed

Hawes, M C; Brooks, W J

2001-08-01

This case report documents a substantial increase in chest wall expansion in a middle-aged woman with stable right thoracic spinal curvature due to idiopathic scoliosis. Treatment involved intensive psychological and mobilization therapies, including comprehensive manipulative medicine treatments and daily manual traction. Over an 8-year period, a 6-cm increase in resting chest circumference (in the absence of weight gain) and a 7.5-cm increase in chest expansion were correlated with a substantial reduction of incidence of respiratory infections.

Technique for repair of fractures and separations involving the cartilaginous portions of the anterior chest wall.

PubMed

Bonne, Stephanie L; Turnbull, Isaiah R; Southard, Robert E

2015-06-01

Internal fixation of the ribs has been shown in numerous studies to decrease complications following traumatic rib fractures. Anterior injuries to the chest wall causing cartilaginous fractures, although rare, can cause significant disability and can lead to a variety of complications and, therefore, pose a unique clinical problem. Here, we report the surgical technique used for four patients with internal fixation of injuries to the cartilaginous portions of the chest wall treated at our center. All patients had excellent clinical outcomes and reported improvement in symptoms, with no associated complications. Patients who have injuries to the anterior portions of the chest wall should be considered for internal fixation of the chest wall when the injuries are severe and can lead to clinical disability.

Yield of chest radiography after removal of esophageal foreign bodies.

PubMed

Fisher, Jeremy; Mittal, Rohit; Hill, Sarah; Wulkan, Mark L; Clifton, Matthew S

2013-05-01

The aim of this study was to determine the benefit of routine postoperative chest radiography after removal of esophageal foreign bodies in children. Medical records were reviewed of all patients evaluated with an esophageal foreign body at a single children's hospital over 10 years. Operative records and imaging reports were reviewed for evidence of esophageal injury. Of 803 records identified, 690 were included. All underwent rigid esophagoscopy and foreign body removal. The most common items removed were coins (94%), food boluses (3%), and batteries (2%). The rate of esophageal injury was 1.3% (9 patients). No injuries were identified on chest radiographs done as routine or for concern of injury. Patients with operative findings suggestive of an esophageal injury (n = 105) were significantly more likely to have an injury (8.6% vs 0%, P = .0001). Of the 585 children who did not have physical evidence of injury, 40% (n = 235) received a routine chest radiograph. Regardless of the indication, no injuries were identified on chest films. We conclude that intraoperative findings during rigid esophagoscopy suggestive of an injury are predictive of esophageal perforation. Routine chest radiography is not warranted in children who do not meet this criterion. In patients with a concern for injury, we suggest that chest radiography should be deferred in favor of esophagram.

DEVELOPMENT AND EVALUATION OF A NOVEL TAEKWONDO CHEST PROTECTOR TO IMPROVE MOBILITY WHEN PERFORMING AXE KICKS

PubMed Central

Woo, J.H.; Ko, J.Y.; Choi, E.Y.; O'Sullivan, D.M.

2013-01-01

The axe kick, in Olympic style taekwondo, has been identified as the most popular scoring technique aimed to the head during full contact competition. The first purpose of this study was to identify and investigate design issues with the current World Taekwondo Federation approved chest protector. A secondary purpose was to develop a novel chest protector addressing the identified design issues and to conduct a biomechanical analysis. Fifteen male elite Taekwondo players were selected to perform three different styles of the axe kick, i.e., front, in-out, and out-in axe kick five times each for a total of 45 kicks. Two-way repeated measures ANOVA showed significant differences between the novel and existing chest protector conditions for vertical height of the toe, downward kicking foot speed, hip flexion angle and ipsilateral shoulder flexion extension range of motion (ROM) (p < 0.05). There were no significant differences between the control condition (no chest protector) and the novel chest protector condition for these variables (p > 0.05). These results indicate that the novel chest protector interferes less with both the lower and upper limbs during the performance of the axe kick and provides a more natural, free-moving alternative to the current equipment used. PMID:24744466

How to remove a chest drain.

PubMed

Allibone, Elizabeth

2015-10-07

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

Chest injuries associated with earthquakes: an analysis of injuries sustained during the 2008 Wen-Chuan earthquake in China.

PubMed

Hu, Jia; Guo, Ying-Qiang; Zhang, Er-Yong; Tan, Jin; Shi, Ying-Kang

2010-08-01

The goal of this study was to analyze the patterns, therapeutic modalities, and short-term outcomes of patients with chest injuries in the aftermath of the Wen-Chuan earthquake, which occurred on May 12, 2008 and registered 8.0 on the Richter scale. Of the 1522 patients who were referred to the West China Hospital of Sichuan University from May 12 to May 27, 169 patients (11.1%) had suffered major chest injuries. The type of injury, the presence of infection, Abbreviated Injury Score (AIS 2005), New Injury Severity Score (NISS), treatment, and short-term outcome were all documented for each case. Isolated chest injuries were diagnosed in 129 patients (76.3%), while multiple injuries with a major chest trauma were diagnosed in 40 patients (23.7%). The mean AIS and the median NISS of the hospitalized patients with chest injuries were 2.5 and 13, respectively. The mortality rate was 3.0% (5 patients). Most of the chest injuries were classified as minor to moderate trauma; however, coexistent multiple injuries and subsequent infection should be carefully considered in medical response strategies. Coordinated efforts among emergency medical support groups and prior training in earthquake preparedness and rescue in earthquake-prone areas are therefore necessary for efficient evacuation and treatment of catastrophic casualties.

Cardiac output increases prior to development of pulmonary edema after re-expansion of spontaneous pneumothorax.

PubMed

Tan, H C; Mak, K H; Johan, A; Wang, Y T; Poh, S C

2002-06-01

Pulmonary edema following reexpansion of spontaneous pneumothorax is an uncommon complication. The underlying mechanism of this condition is unclear. We report the hemodynamic characteristics in a series of 7 male patients with spontaneous large (>50%) pneumothoraces of > or = 24 h and correlate the changes with reexpansion pulmonary edema (REPE). A pulmonary artery floatation catheter was inserted and hemodynamic data were obtained before therapeutic chest tube insertion, 1 h after chest tube insertion and the following day. Four (57%) patients developed REPE. There was a tendency for larger pneumothorax to develop REPE. Capillary wedge pressure did not change significantly 1 h after the insertion of chest tube in all our patients. Cardiac output increased significantly in patients who developed REPE compared to those who did not (+ 1.06 l/min vs -0.27 l/min; P = 0.03) 1 h after insertion of chest tube. One patient did not develop pulmonary edema despite having a large (> 80%) pneumothorax. His cardiac output did not rise 1 h after chest tube insertion. REPE is not an uncommon complication following chest tube drainage in patients with large and long-standing pneumothorax. The increase in cardiac output after chest tube insertion may be associated with subsequent development of REPE.

The “dirty chest”—correlations between chest radiography, multislice CT and tobacco burden

PubMed Central

Kirchner, J; Goltz, J P; Lorenz, F; Obermann, A; Kirchner, E M; Kickuth, R

2012-01-01

Objectives Cigarette smoking-induced airway disease commonly results in an overall increase of non-specific lung markings on chest radiography. This has been described as “dirty chest”. As the morphological substrate of this condition is similar to the anthracosilicosis of coal workers, we hypothesised that it is possible to quantify the radiological changes using the International Labour Organization (ILO) classification of pneumoconiosis. The aims of this study were to evaluate whether there is a correlation between the extent of cigarette smoking and increased lung markings on chest radiography and to correlate the chest radiographic scores with findings on CT studies. Methods In a prospective analysis a cohort of 85 smokers was examined. The cigarette consumption was evaluated in pack years (defined as 20 cigarettes per day over 1 year). Film reading was performed by two board-certified radiologists. Chest radiographs were evaluated for the presence of thickening of bronchial walls, the presence of linear or nodular opacities, and emphysema. To correlate the smoking habits with the increase of overall lung markings in chest radiography, the ILO profusion score was converted to numbers ranging from zero to nine. Chest radiographs were rated according to the complete set of standard films of the revised ILO classification. Results 63/85 (74%) of the smokers showed an increase in overall lung markings on chest radiography; 32 (37%) had an ILO profusion score of <1/1, 29 (34%) had an ILO profusion score of <2/2 and 2 (2%) had an ILO score of ≥2/2. There was a significant positive linear correlation between the increase of overall lung markings on chest radiography and the cigarette consumption quantified as pack years (r=0.68). The majority of the heavy smokers (>40 pack years) showed emphysema; there was no significant difference between the prevalence of emphysema as diagnosed by CT (62%) or chest radiography (71%) (p<0.05).The most common findings in CT were thickening of bronchial walls (64%) and the presence of emphysema (62%) and of intralobular opacities (61%). Ground-glass opacities were seen in only 7% of our patients. Conclusion Bronchial wall thickening and intralobular opacities as seen in CT showed a positive linear correlation with the increase of overall lung markings on chest radiography. PMID:21937617

Continuous chest compression cardiopulmonary resuscitation training promotes rescuer self-confidence and increased secondary training: a hospital-based randomized controlled trial*.

PubMed

Blewer, Audrey L; Leary, Marion; Esposito, Emily C; Gonzalez, Mariana; Riegel, Barbara; Bobrow, Bentley J; Abella, Benjamin S

2012-03-01

Recent work suggests that delivery of continuous chest compression cardiopulmonary resuscitation is an acceptable layperson resuscitation strategy, although little is known about layperson preferences for training in continuous chest compression cardiopulmonary resuscitation. We hypothesized that continuous chest compression cardiopulmonary resuscitation education would lead to greater trainee confidence and would encourage wider dissemination of cardiopulmonary resuscitation skills compared to standard cardiopulmonary resuscitation training (30 compressions: two breaths). Prospective, multicenter randomized study. Three academic medical center inpatient wards. Adult family members or friends (≥ 18 yrs old) of inpatients admitted with cardiac-related diagnoses. In a multicenter randomized trial, family members of hospitalized patients were trained via the educational method of video self-instruction. Subjects were randomized to continuous chest compression cardiopulmonary resuscitation or standard cardiopulmonary resuscitation educational modes. Cardiopulmonary resuscitation performance data were collected using a cardiopulmonary resuscitation skill-reporting manikin. Trainee perspectives and secondary training rates were assessed through mixed qualitative and quantitative survey instruments. Chest compression performance was similar in both groups. The trainees in the continuous chest compression cardiopulmonary resuscitation group were significantly more likely to express a desire to share their training kit with others (152 of 207 [73%] vs. 133 of 199 [67%], p = .03). Subjects were contacted 1 month after initial enrollment to assess actual sharing, or "secondary training." Kits were shared with 2.0 ± 3.4 additional family members in the continuous chest compression cardiopulmonary resuscitation group vs. 1.2 ± 2.2 in the standard cardiopulmonary resuscitation group (p = .03). As a secondary result, trainees in the continuous chest compression cardiopulmonary resuscitation group were more likely to rate themselves "very comfortable" with the idea of using cardiopulmonary resuscitation skills in actual events than the standard cardiopulmonary resuscitation trainees (71 of 207 [34%] vs. 57 of 199 [28%], p = .08). Continuous chest compression cardiopulmonary resuscitation education resulted in a statistically significant increase in secondary training. This work suggests that implementation of video self-instruction training programs using continuous chest compression cardiopulmonary resuscitation may confer broader dissemination of life-saving skills and may promote rescuer comfort with newly acquired cardiopulmonary resuscitation knowledge. URL: http://clinicaltrials.gov. Unique identifier: NCT01260441.

Continuous chest compression cardiopulmonary resuscitation training promotes rescuer self-confidence and increased secondary training: A hospital-based randomized controlled trial

PubMed Central

Blewer, Audrey L.; Leary, Marion; Esposito, Emily C.; Gonzalez, Mariana; Riegel, Barbara; Bobrow, Bentley J.; Abella, Benjamin S.

2013-01-01

Objective Recent work suggests that delivery of continuous chest compression cardiopulmonary resuscitation is an acceptable layperson resuscitation strategy, although little is known about layperson preferences for cardiopulmonary resuscitation training in continuous chest compression cardiopulmonary resuscitation. We hypothesized that continuous chest compression cardiopulmonary resuscitation education would lead to greater trainee confidence and would encourage wider dissemination of cardiopulmonary resuscitation skills compared to standard cardiopulmonary resuscitation training (30 compressions: two breaths). Design Prospective, multicenter cohort study. Setting Three academic medical center inpatient wards. Subjects Adult family members or friends (≥18 yrs old) of inpatients admitted with cardiac-related diagnoses. Interventions In a multicenter randomized trial, family members of hospitalized patients were trained via the educational method of video self-instruction. Subjects were randomized to continuous chest compression cardiopulmonary resuscitation or standard cardiopulmonary resuscitation educational modes. Measurements Cardiopulmonary resuscitation performance data were collected using a cardiopulmonary resuscitation skill-reporting manikin. Trainee perspectives and secondary training rates were assessed through mixed qualitative and quantitative survey instruments. Main Results Chest compression performance was similar in both groups. The trainees in the continuous chest compression cardiopulmonary resuscitation group were significantly more likely to express a desire to share their training kit with others (152 of 207 [73%] vs. 133 of 199 [67%], p = .03). Subjects were contacted 1 month after initial enrollment to assess actual sharing, or “secondary training.” Kits were shared with 2.0 ± 3.4 additional family members in the continuous chest compression cardiopulmonary resuscitation group vs. 1.2 ± 2.2 in the standard cardiopulmonary resuscitation group (p = .03). As a secondary result, trainees in the continuous chest compression cardiopulmonary resuscitation group were more likely to rate themselves “very comfortable” with the idea of using cardiopulmonary resuscitation skills in actual events than the standard cardiopulmonary resuscitation trainees (71 of 207 [34%] vs. 57 of 199 [28%], p = .08). Conclusions Continuous chest compression cardiopulmonary resuscitation education resulted in a statistically significant increase in secondary training. This work suggests that implementation of video self-instruction training programs using continuous chest compression cardiopulmonary resuscitation may confer broader dissemination of life-saving skills and may promote rescuer comfort with newly acquired cardiopulmonary resuscitation knowledge. Clinical Trial Registration URL: http://clinicaltrials.gov. Unique identifier: NCT01260441. PMID:22080629

Physiological effects of a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates.

PubMed

Mehta, Y; Shetye, J; Nanavati, R; Mehta, A

2016-01-01

To assess the changes on various physiological cardio-respiratory parameters with a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates with respiratory distress syndrome. This is a prospective observational study in a neonatal intensive care unit setting. Sixty preterm neonates with respiratory distress syndrome, thirty mechanically ventilated and thirty extubated preterm neonates requiring chest physiotherapy were enrolled in the study. Parameters like heart rate (HR), respiratory rate (RR), Silverman Anderson score (SA score in extubated), oxygen saturation (SpO2) and auscultation findings were noted just before, immediately after chest physiotherapy but before suctioning, immediately after suctioning and after 5 minutes of the session. The mean age of neonates was 9.55±5.86 days and mean birth weight was 1550±511.5 g. As there was no significant difference in the change in parameters on intergroup comparison, further analysis was done considering two groups together (n = 60) except for SA score. As SA score was measured only in extubated neonates. HR did not change significantly during chest physiotherapy compared to the baseline but significantly decreased after 15 minutes (p = 0.01). RR and SA score significantly increased after suctioning (p = 0.014) but reduced after 15 minutes (p = <0.0001). SpO2 significantly reduced post-suctioning compared to the baseline and increased after positioning and 15 minutes of chest physiotherapy (p = <0.0001). Clinically, there was a reduction in HR, RR and SA score with an improvement in SpO2. This signifies that chest physiotherapy may help facilitate the overall well-being of a fragile preterm neonate. Lung auscultation finding suggests that after suctioning, there was a significant reduction in crepitation (p = 0.0000) but significant increase in crepitation after 15 minutes (p = <0.01), suggesting the importance of around-the-clock chest physiotherapy. Chest physiotherapy is safe in preterm neonates. Suctioning causes significant cardio-respiratory parameter changes, but within normal physiological range. Thus, chest physiotherapy should be performed with continuous monitoring only when indicated and not as a routine procedure. More research is needed to study the long term effects of chest physical therapy.

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

PubMed

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

2015-03-01

This review aims to answer the most common questions in routine surgical practice during the first 48 h of blunt chest trauma (BCT) management. Two authors identified relevant manuscripts published since January 1994 to January 2014. Using preferred reporting items for systematic reviews and meta-analyses statement, they focused on the surgical management of BCT, excluded both child and vascular injuries and selected 80 studies. Tension pneumothorax should be promptly diagnosed and treated by needle decompression closely followed with chest tube insertion (Grade D). All traumatic pneumothoraces are considered for chest tube insertion. However, observation is possible for selected patients with small unilateral pneumothoraces without respiratory disease or need for positive pressure ventilation (Grade C). Symptomatic traumatic haemothoraces or haemothoraces >500 ml should be treated by chest tube insertion (Grade D). Occult pneumothoraces and occult haemothoraces are managed by observation with daily chest X-rays (Grades B and C). Periprocedural antibiotics are used to prevent chest-tube-related infectious complications (Grade B). No sign of life at the initial assessment and cardiopulmonary resuscitation duration >10 min are considered as contraindications of Emergency Department Thoracotomy (Grade C). Damage Control Thoracotomy is performed for either massive air leakage or refractive shock or ongoing bleeding enhanced by chest tube output >1500 ml initially or >200 ml/h for 3 h (Grade D). In the case of haemodynamically stable patients, early video-assisted thoracic surgery is performed for retained haemothoraces (Grade B). Fixation of flail chest can be considered if mechanical ventilation for 48 h is probably required (Grade B). Fixation of sternal fractures is performed for displaced fractures with overlap or comminution, intractable pain or respiratory insufficiency (Grade D). Lung herniation, traumatic diaphragmatic rupture and pericardial rupture are life-threatening situations requiring prompt diagnosis and surgical advice. (Grades C and D). Tracheobronchial repair is mandatory in cases of tracheal tear >2 cm, oesophageal prolapse, mediastinitis or massive air leakage (Grade C). These evidence-based surgical indications for BCT management should support protocols for chest trauma management. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Correlation of the clinical and physical image quality in chest radiography for average adults with a computed radiography imaging system.

PubMed

Moore, C S; Wood, T J; Beavis, A W; Saunderson, J R

2013-07-01

The purpose of this study was to examine the correlation between the quality of visually graded patient (clinical) chest images and a quantitative assessment of chest phantom (physical) images acquired with a computed radiography (CR) imaging system. The results of a previously published study, in which four experienced image evaluators graded computer-simulated postero-anterior chest images using a visual grading analysis scoring (VGAS) scheme, were used for the clinical image quality measurement. Contrast-to-noise ratio (CNR) and effective dose efficiency (eDE) were used as physical image quality metrics measured in a uniform chest phantom. Although optimal values of these physical metrics for chest radiography were not derived in this work, their correlation with VGAS in images acquired without an antiscatter grid across the diagnostic range of X-ray tube voltages was determined using Pearson's correlation coefficient. Clinical and physical image quality metrics increased with decreasing tube voltage. Statistically significant correlations between VGAS and CNR (R=0.87, p<0.033) and eDE (R=0.77, p<0.008) were observed. Medical physics experts may use the physical image quality metrics described here in quality assurance programmes and optimisation studies with a degree of confidence that they reflect the clinical image quality in chest CR images acquired without an antiscatter grid. A statistically significant correlation has been found between the clinical and physical image quality in CR chest imaging. The results support the value of using CNR and eDE in the evaluation of quality in clinical thorax radiography.

Reader characteristics linked to detection of pulmonary nodules on radiographs: ROC vs. JAFROC analyses of performance

NASA Astrophysics Data System (ADS)

Kohli, Akshay; Robinson, John W.; Ryan, John; McEntee, Mark F.; Brennan, Patrick C.

2011-03-01

The purpose of this study is to explore whether reader characteristics are linked to heightened levels of diagnostic performance in chest radiology using receiver operating characteristic (ROC) and jackknife free response ROC (JAFROC) methodologies. A set of 40 postero-anterior chest radiographs was developed, of which 20 were abnormal containing one or more simulated nodules, of varying subtlety. Images were independently reviewed by 12 boardcertified radiologists including six chest specialists. The observer performance was measured in terms of ROC and JAFROC scores. For the ROC analysis, readers were asked to rate their degree of suspicion for the presence of nodules by using a confidence rating scale (1-6). JAFROC analysis required the readers to locate and rate as many suspicious areas as they wished using the same scale and resultant data were used to generate Az and FOM scores for ROC and JAFROC analyses respectively. Using Pearson methods, scores of performance were correlated with 7 reader characteristics recorded using a questionnaire. JAFROC analysis showed that improved reader performance was significantly (p<=0.05) linked with chest specialty (p<0.03), hours per week reading chest radiographs (p<0.03) and chest readings per year (p<0.04). ROC analyses demonstrated only one significant relationship, hours per week reading chest radiographs (p<0.02).The results of this study have shown that radiologist's performance in the detection of pulmonary nodules on radiographs is significantly linked to chest specialty, hours reading per week and number of radiographs read per year. Also, JAFROC is a more powerful predictor of performance as compared to ROC.

Influence of chest compression rate guidance on the quality of cardiopulmonary resuscitation performed on manikins.

PubMed

Jäntti, H; Silfvast, T; Turpeinen, A; Kiviniemi, V; Uusaro, A

2009-04-01

The adequate chest compression rate during CPR is associated with improved haemodynamics and primary survival. To explore whether the use of a metronome would affect also chest compression depth beside the rate, we evaluated CPR quality using a metronome in a simulated CPR scenario. Forty-four experienced intensive care unit nurses participated in two-rescuer basic life support given to manikins in 10min scenarios. The target chest compression to ventilation ratio was 30:2 performed with bag and mask ventilation. The rescuer performing the compressions was changed every 2min. CPR was performed first without and then with a metronome that beeped 100 times per minute. The quality of CPR was analysed with manikin software. The effect of rescuer fatigue on CPR quality was analysed separately. The mean compression rate between ventilation pauses was 137+/-18compressions per minute (cpm) without and 98+/-2cpm with metronome guidance (p<0.001). The mean number of chest compressions actually performed was 104+/-12cpm without and 79+/-3cpm with the metronome (p<0.001). The mean compression depth during the scenario was 46.9+/-7.7mm without and 43.2+/-6.3mm with metronome guidance (p=0.09). The total number of chest compressions performed was 1022 without metronome guidance, 42% at the correct depth; and 780 with metronome guidance, 61% at the correct depth (p=0.09 for difference for percentage of compression with correct depth). Metronome guidance corrected chest compression rates for each compression cycle to within guideline recommendations, but did not affect chest compression quality or rescuer fatigue.

Usefulness and Limitation of Manual Aspiration Immediately After Pneumothorax Complicating Interventional Radiological Procedures with the Transthoracic Approach

DOE Office of Scientific and Technical Information (OSTI.GOV)

Yamagami, Takuji, E-mail: yamagami@koto.kpu-m.ac.jp; Kato, Takeharu; Hirota, Tatsuya

2006-12-15

The goal of this study was to evaluate the efficacy of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following interventional radiological procedures performed under computed tomography fluoroscopic guidance with the transthoracic percutaneous approach. While still on the scanner table, 102 cases underwent percutaneous manual aspiration of a moderate or large pneumothorax that had developed during mediastinal, lung, and transthoracic liver biopsies and ablations of lung and hepatic tumors (independent of symptoms). Air was aspirated from the pleural space by an 18- or 20-gauge intravenous catheter attachedmore » to a three-way stopcock and 20- or 50-mL syringe. We evaluated the management of each such case during and after manual aspiration. In 87 of the 102 patients (85.3%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement, but chest tube placement was required in 15 patients. Requirement of chest tube insertion significantly increased in parallel with the increased volume of aspirated air. When receiver-operating characteristic curves were applied retrospectively, the optimal cutoff level of aspirated air on which to base a decision to abandon manual aspiration alone and resort to chest tube placement was 670 mL. Percutaneous manual aspiration of the pneumothorax performed immediately after the procedure might prevent progressive pneumothorax and eliminate the need for chest tube placement. However, when the amount of aspirated air is large (such as more than 670 mL), chest tube placement should be considered.« less

Outcome of penetrating chest injuries in an urban level I trauma center in the Netherlands.

PubMed

Heus, C; Mellema, J J; Giannakopoulos, G F; Zuidema, W P

2015-04-25

Most patients with penetrating chest injuries benefit from early treatment with chest tube drainage or surgery. Although penetrating chest injury is not uncommon, few descriptive studies are published, especially in Europe. The aim of this study was to review our experience and further improve our management of penetrating chest injuries in a level I trauma center in the Netherlands. All patients with penetrating chest injury between August 2004 and December 2012 were included. Demographics, mechanism of injury, physiological parameters, Injury Severity Scores (ISS), surgical and non-surgical treatment, length of intensive care unit (ICU) stay, length of hospital stay (LOS), complications and rate of mortality were collected. A total of 159 patients were analyzed. Patients included 116 (73 %) stab wounds and 34 (21 %) gunshot wounds. In 27 patients (17 %), cardiac injury was seen. The mean ISS was 12. Almost half of all patients (49 %) were treated with only chest tube drainage. Alternatively, surgical treatment was performed in 24 % of all cases. Anterolateral incision was most frequently used to gain access to the thoracic cavity. The mean LOS was 9 days. Among all patients, 17 % were admitted to the ICU with a mean stay of 3 days. In 18 (11 %) patients, one or more complications occurred. The 30-day mortality was 7.5 %. Patients presenting with penetrating chest injury are not uncommon in the Netherlands and can mostly be treated conservatively. In one-fourth of the patients, surgical treatment is performed. A structural and vigorous approach is needed for good clinical outcome.

Effect of the rate of chest compression familiarised in previous training on the depth of chest compression during metronome-guided cardiopulmonary resuscitation: a randomised crossover trial.

PubMed

Bae, Jinkun; Chung, Tae Nyoung; Je, Sang Mo

2016-02-12

To assess how the quality of metronome-guided cardiopulmonary resuscitation (CPR) was affected by the chest compression rate familiarised by training before the performance and to determine a possible mechanism for any effect shown. Prospective crossover trial of a simulated, one-person, chest-compression-only CPR. Participants were recruited from a medical school and two paramedic schools of South Korea. 42 senior students of a medical school and two paramedic schools were enrolled but five dropped out due to physical restraints. Senior medical and paramedic students performed 1 min of metronome-guided CPR with chest compressions only at a speed of 120 compressions/min after training for chest compression with three different rates (100, 120 and 140 compressions/min). Friedman's test was used to compare average compression depths based on the different rates used during training. Average compression depths were significantly different according to the rate used in training (p<0.001). A post hoc analysis showed that average compression depths were significantly different between trials after training at a speed of 100 compressions/min and those at speeds of 120 and 140 compressions/min (both p<0.001). The depth of chest compression during metronome-guided CPR is affected by the relative difference between the rate of metronome guidance and the chest compression rate practised in previous training. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Accuracy of remote chest X-ray interpretation using Google Glass technology.

PubMed

Spaedy, Emily; Christakopoulos, Georgios E; Tarar, Muhammad Nauman J; Christopoulos, Georgios; Rangan, Bavana V; Roesle, Michele; Ochoa, Cristhiaan D; Yarbrough, William; Banerjee, Subhash; Brilakis, Emmanouil S

2016-09-15

We sought to explore the accuracy of remote chest X-ray reading using hands-free, wearable technology (Google Glass, Google, Mountain View, California). We compared interpretation of twelve chest X-rays with 23 major cardiopulmonary findings by faculty and fellows from cardiology, radiology, and pulmonary-critical care via: (1) viewing the chest X-ray image on the Google Glass screen; (2) viewing a photograph of the chest X-ray taken using Google Glass and interpreted on a mobile device; (3) viewing the original chest X-ray on a desktop computer screen. One point was given for identification of each correct finding and a subjective rating of user experience was recorded. Fifteen physicians (5 faculty and 10 fellows) participated. The average chest X-ray reading score (maximum 23 points) as viewed through the Google Glass, Google Glass photograph on a mobile device, and the original X-ray viewed on a desktop computer was 14.1±2.2, 18.5±1.5 and 21.3±1.7, respectively (p<0.0001 between Google Glass and mobile device, p<0.0001 between Google Glass and desktop computer and p=0.0004 between mobile device and desktop computer). Of 15 physicians, 11 (73.3%) felt confident in detecting findings using the photograph taken by Google Glass as viewed on a mobile device. Remote chest X-ray interpretation using hands-free, wearable technology (Google Glass) is less accurate than interpretation using a desktop computer or a mobile device, suggesting that further technical improvements are needed before widespread application of this novel technology. Published by Elsevier Ireland Ltd.

Cost and morbidity analysis of chest port insertion in adults: Outpatient clinic versus operating room placement.

PubMed

Feo, Claudio F; Ginesu, Giorgio C; Bellini, Alessandro; Cherchi, Giuseppe; Scanu, Antonio M; Cossu, Maria Laura; Fancellu, Alessandro; Porcu, Alberto

2017-09-01

Totally implantable venous access devices (TIVADs) represent a convenient way for the administration of medications or nutrients. Traditionally, chest ports have been positioned by surgeons in the operating room, however there has been a transition over the years to port insertion by interventional radiologists in the radiology suite. The optimal method for chest port placement is still under debate. Data on all adult patients undergoing isolated chest port placement at our institution in a 12-year period were retrospectively reviewed. The aim of this cohort study was to compare cost and morbidity for chest port insertion in two different settings: outpatient clinic and operating room. Between 2003 and 2015 a total of 527 chest ports were placed in adult patients. Of them, 262 procedures were performed in the operating room and 265 procedures were undertaken in the outpatient clinic. Patient characteristics were similar and there was no significant difference in early (<30 days, p = 0.54) and late complications (30-120 days, p = 0.53). The average charge for placement of a chest port was 1270 Euros in the operating room versus 620 Euros in the outpatient clinic. Our results suggest that chest ports can be safely placed in most patients under local anesthesia in the office setting without fluoroscopy or ultrasound guidance. Future randomized controlled studies may evaluate if surgeons or interventional radiologists should routinely perform these procedures in a dedicated office setting and reserve more sophisticated facilities only for patients at high risk of technical failure.

Influence of chest compression artefact on capnogram-based ventilation detection during out-of-hospital cardiopulmonary resuscitation.

PubMed

Leturiondo, Mikel; Ruiz de Gauna, Sofía; Ruiz, Jesus M; Julio Gutiérrez, J; Leturiondo, Luis A; González-Otero, Digna M; Russell, James K; Zive, Dana; Daya, Mohamud

2018-03-01

Capnography has been proposed as a method for monitoring the ventilation rate during cardiopulmonary resuscitation (CPR). A high incidence (above 70%) of capnograms distorted by chest compression induced oscillations has been previously reported in out-of-hospital (OOH) CPR. The aim of the study was to better characterize the chest compression artefact and to evaluate its influence on the performance of a capnogram-based ventilation detector during OOH CPR. Data from the MRx monitor-defibrillator were extracted from OOH cardiac arrest episodes. For each episode, presence of chest compression artefact was annotated in the capnogram. Concurrent compression depth and transthoracic impedance signals were used to identify chest compressions and to annotate ventilations, respectively. We designed a capnogram-based ventilation detection algorithm and tested its performance with clean and distorted episodes. Data were collected from 232 episodes comprising 52 654 ventilations, with a mean (±SD) of 227 (±118) per episode. Overall, 42% of the capnograms were distorted. Presence of chest compression artefact degraded algorithm performance in terms of ventilation detection, estimation of ventilation rate, and the ability to detect hyperventilation. Capnogram-based ventilation detection during CPR using our algorithm was compromised by the presence of chest compression artefact. In particular, artefact spanning from the plateau to the baseline strongly degraded ventilation detection, and caused a high number of false hyperventilation alarms. Further research is needed to reduce the impact of chest compression artefact on capnographic ventilation monitoring. Copyright © 2017 Elsevier B.V. All rights reserved.

Instructions to "push as hard as you can" improve average chest compression depth in dispatcher-assisted cardiopulmonary resuscitation.

PubMed

Mirza, Muzna; Brown, Todd B; Saini, Devashish; Pepper, Tracy L; Nandigam, Hari Krishna; Kaza, Niroop; Cofield, Stacey S

2008-10-01

Cardiopulmonary resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol. Data from two randomized, double-blinded, controlled trials with identical methodology were combined to obtain 332 records for this analysis. Subjects were randomized to either modified Medical Priority Dispatch System (MPDS) v11.2 protocol or a new simplified protocol. The main difference between the protocols was the instruction to "push as hard as you can" in the simplified protocol, compared to "push down firmly 2in. (5cm)" in MPDS. Data were recorded via a Laerdal ResusciAnne SkillReporter manikin. Primary outcome measures included: chest compression depth, proportion of compressions without error, with adequate depth and with total release. Instructions to "push as hard as you can", compared to "push down firmly 2in. (5cm)", resulted in improved chest compression depth (36.4 mm vs. 29.7 mm, p<0.0001), and improved median proportion of chest compressions done to the correct depth (32% vs. <1%, p<0.0001). No significant difference in median proportion of compressions with total release (100% for both) and average compression rate (99.7 min(-1) vs. 97.5 min(-1), p<0.56) was found. Modifying dispatcher-assisted CPR instructions by changing "push down firmly 2in. (5cm)" to "push as hard as you can" achieved improvement in chest compression depth at no cost to total release or average chest compression rate.

Tuberculosis of the Chest Wall with Massive Tuberculous Pleural Effusion.

PubMed

Monteiro, Mongressa V; Keny, Sanjivani J; Lawande, Durga J; Kakodkar, Uday C

2016-01-01

Primary tuberculosis of components of the chest wall is a rare entity. Involvement of skeletal muscle by tuberculosis without any primary focus is also rare. Here, we report a case of tuberculosis of chest wall without pulmonary or bone involvement, that invaded into the pleural space leading to a massive pleural effusion.

42 CFR 37.44 - Approval of radiographic facilities that use digital radiography systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... effective management, safety, and proper performance of chest image acquisition, digitization, processing... digital chest radiographs by submitting to NIOSH digital radiographic image files of a test object (e.g... radiographic image files from six or more sample chest radiographs that are of acceptable quality to one or...

Evaluation of Chest Ultrasound Integrated Teaching of Respiratory System Physiology to Medical Students

ERIC Educational Resources Information Center

Paganini, Matteo; Bondì, Michela; Rubini, Alessandro

2017-01-01

Ultrasound imaging is a widely used diagnostic technique, whose integration in medical education is constantly growing. The aim of this study was to evaluate chest ultrasound usefulness in teaching respiratory system physiology, students' perception of chest ultrasound integration into a traditional lecture in human physiology, and short-term…

Sexual, Physical, Verbal/Emotional Abuse and Unexplained Chest Pain

ERIC Educational Resources Information Center

Eslick, Guy D.; Koloski, Natasha A.; Talley, Nicholas J.

2011-01-01

Objectives: Approximately one third of patients with non cardiac chest pain (NCCP) report a history of abuse, however no data exists on the prevalence of abuse among people with unexplained chest pain in the general population. We aimed to determine if there is a relationship between childhood sexual, physical, emotional abuse and unexplained…

Coping in Chest Pain Patients with and without Psychiatric Disorders.

ERIC Educational Resources Information Center

Vitaliano, Peter P.; And Others

1989-01-01

Examined relations between psychiatric disorder and coronary heart disease (CHD) in 77 patients with chest pain, and compared coping profiles of chest pain patients with and without psychiatric disorders and CHD. Psychiatric patients with no medical disease were also studied. Results are discussed in the context of illness behavior and…

Two cases of acute chest discomfort and the Central Italy earthquake

PubMed Central

Pannarale, Giuseppe; Torromeo, Concetta; Acconcia, Maria Cristina; Moretti, Andrea; De Angelis, Valentina; Tanzilli, Alessandra; Paravati, Vincenzo; Barillà, Francesco; Gaudio, Carlo

2017-01-01

Abstract We present the cases of two postmenopausal women presenting to our emergency department with acute chest discomfort soon after the Central Italy earthquake. Different diagnoses were made in the two patients. The role of the earthquake as a stressful event triggering diverse chest pain syndromes is discussed. PMID:29744121

Cannabis-induced bullous lung disease leading to pneumothorax: Case report and literature review.

PubMed

Mishra, Rashmi; Patel, Ravi; Khaja, Misbahuddin

2017-05-01

Marijuana use has been increasing in the United States among college students and young adults. Marijuana use has been associated with bullous lung disease which can lead to pneumothorax. There are other recreational drugs like methylphenidate, cocaine and heroin which have been associated with pneumothorax. We present a case of a 30-year-old man with spontaneous pneumothorax associated with marijuana use. The patient had no medical conditions and presented to the emergency room with chest pain. The physical examination revealed decreased breath sound on the right side of the chest. Bed side ultrasound of chest showed stratosphere sign, absent lung sliding; consistent with right-sided pneumothorax. The patient underwent placement of a chest tube. Computed tomography chest scans performed on day two also showed bullous lung disease in the right lung. Serial x-rays of the chest showed re-expansion of the lung. Despite the beneficial effects of Marijuana there are deleterious effects which are emphasized here. This case highlights the need for further studies to establish the relationship between marijuana use and lung diseases in the absence of nicotine use.

Chest Computed Tomography (CT) Immediately after CT-Guided Transthoracic Needle Aspiration Biopsy as a Predictor of Overt Pneumothorax

PubMed Central

Noh, Tae June; Lee, Chang Hoon; Kang, Young Ae; Kwon, Sung-Youn; Yoon, Ho-Il; Kim, Tae Jung; Lee, Kyung Won; Lee, Jae Ho

2009-01-01

Background/Aims This study examined the correlation between pneumothorax detected by immediate post-transthoracic needle aspiration-biopsy (TTNB) chest computed tomography (CT) and overt pneumothorax detected by chest PA, and investigated factors that might influence the correlation. Methods Adult patients who had undergone CT-guided TTNB for lung lesions from May 2003 to June 2007 at Seoul National University Bundang Hospital were included. Immediate post-TTNB CT and chest PA follow-up at 4 and 16 hours after CT-guided TTNB were performed in 934 patients. Results Pneumothorax detected by immediate chest CT (CT-pneumothorax) was found in 237 (25%) and overt pneumothorax was detected by chest PA follow-up in 92 (38.8%) of the 237 patients. However, overt pneumothorax was found in 18 (2.6%) of the 697 patients without CT-pneumothorax. The width and depth of CT-pneumothorax were predictive risk factors for overt pneumothorax. Conclusions CT-pneumothorax is very sensitive for predicting overt pneumothorax, and the width and depth on CT-pneumothorax are reliable risk factors for predicting overt pneumothorax. PMID:19949733

Muscle activation when performing the chest press and shoulder press on a stable bench vs. a Swiss ball.

PubMed

Uribe, Brandon P; Coburn, Jared W; Brown, Lee E; Judelson, Daniel A; Khamoui, Andy V; Nguyen, Diamond

2010-04-01

The aim of this study was to examine the effects of a stable surface (bench) vs. an unstable surface (Swiss ball) on muscle activation when performing the dumbbell chest press and shoulder press. Sixteen healthy men (24.19 +/- 2.17 years) performed 1 repetition maximum (1RM) tests for the chest press and shoulder press on a stable surface. A minimum of 48 hours post 1RM, subjects returned to perform 3 consecutive repetitions each of the chest press and shoulder press at 80% 1RM under 4 different randomized conditions (chest press on bench, chest press on Swiss ball, shoulder press on bench, shoulder press on Swiss ball). Electromyography was used to assess muscle activation of the anterior deltoid, pectoralis major, and rectus abdominus. The results revealed no significant difference in muscle activation between surface types for either exercise. This suggests that using an unstable surface neither improves nor impairs muscle activation under the current conditions. Coaches and other practitioners can expect similar muscle activation when using a Swiss ball vs. a bench.

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

PubMed

Kawashima, A; Kuhlman, J E; Fishman, E K; Tempany, C M; Magid, D; Lederman, H M; Winkelstein, J A; Zerhouni, E A

1991-01-01

Pulmonary Aspergillus infection in patients with chronic granulomatous disease tends to involve the chest wall and consequently carries a high mortality rate. We report the findings of computed tomography (CT) and magnetic resonance imaging (MRI) in three such cases. One patient underwent both CT and MRI, one, CT only, and one, MRI only. In all three, both CT and MRI demonstrated pulmonary consolidations with direct extension to the adjacent chest wall. In both patients who were examined by CT, scans revealed permeative osteolytic changes of adjacent rib or spine compatible with osteomyelitis. In both patients who were examined by MRI, adjacent chest wall involvement was depicted on T1-weighted images and showed increased signal intensity on T2-weighted images. In one of these patients, the chest wall lesion was well defined on T2-weighted images, an appearance compatible with abscess. Epidural extension was demonstrated on MRI in the other patient, who later developed paraparesis. We suggest that CT and MRI have a complementary role in evaluating chest wall invasion by pulmonary Aspergillus infection in chronic granulomatous disease.

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

PubMed

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.

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

PubMed Central

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

2017-01-01

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 3rd postoperative day and patient was discharged on 14th postoperative day. He has already recovered his normal activity 6 months after surgery. PMID:28861425

The operating surgeon is an independent predictor of chest tube drainage following cardiac surgery.

PubMed

Dixon, Barry; Reid, David; Collins, Marnie; Newcomb, Andrew E; Rosalion, Alexander; Yap, Cheng-Hon; Santamaria, John D; Campbell, Duncan J

2014-04-01

Bleeding into the chest is a major cause of blood transfusion and adverse outcomes following cardiac surgery. The authors investigated predictors of bleeding following cardiac surgery to identify potentially correctable factors. Data were retrieved from the medical records of patients undergoing cardiac surgery over the period of 2002 to 2008. Multivariate analysis was used to identify the independent predictors of chest tube drainage. Tertiary hospital. Two thousand five hundred seventy-five patients. Cardiac surgery. The individual operating surgeon was independently associated with the extent of chest tube drainage. Other independent factors included internal mammary artery grafting, cardiopulmonary bypass time, urgency of surgery, tricuspid valve surgery, redo surgery, left ventricular impairment, male gender, lower body mass index and higher preoperative hemoglobin levels. Both a history of diabetes and administration of aprotinin were associated with reduced levels of chest tube drainage. The individual operating surgeon was an independent predictor of the extent of chest tube drainage. Attention to surgeon-specific factors offers the possibility of reduced bleeding, fewer transfusions, and improved patient outcomes. © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

The approach to patients with possible cardiac chest pain.

PubMed

Parsonage, William A; Cullen, Louise; Younger, John F

2013-07-08

Chest pain is a common reason for presentation in hospital emergency departments and general practice. Some patients presenting with chest pain to emergency departments and, to a lesser extent, general practice will be found to have a life-threatening cause, but most will not. The challenge is to identify those who do in a safe, timely and cost-effective manner. An acute coronary syndrome cannot be excluded on clinical grounds alone. In patients with ongoing symptoms of chest pain, without an obvious other cause, ST-segment-elevation myocardial infarction should be excluded with a 12-lead electrocardiogram at the first available opportunity. Significant recent advances in the clinical approach to patients with acute chest pain, including better understanding of risk stratification, increasingly sensitive cardiac biomarkers and new non-invasive tests for coronary disease, can help clinicians minimise the risk of unexpected short-term adverse cardiac events. An approach that integrates these advances is needed to deliver the best outcomes for patients with chest pain. All hospital emergency departments should adopt such a strategic approach, and general practitioners should be aware of when and how to access these facilities.

[Influence of chest physiotherapy on gastro-œsophageal reflux in children].

PubMed

Reychler, G; Jacques, L; Arnold, D; Scheers, I; Smets, F; Sokal, E; Stephenne, X

2015-05-01

Chest physiotherapy is regularly prescribed for children, particularly in cystic fibrosis. Gastro-oesophageal reflux is common in this disease and is associated with certain chest physiotherapy manoeuvres. To evaluate the influence of two chest physiotherapy techniques on gastro-oesophageal reflux in children. Twenty-nine children were investigated by routine pHmetry. During the examination, they performed two chest physiotherapy manoeuvres in a seated position for 10 minutes each with a 5 minutes rest between them. The two manoeuvres used were a slow expiration technique (ELPr) and positive expiratory pressure (PEP). It was a prospective study and the order of manoeuvres was randomised. The pH traces were analysed blindly when all the studies had been completed. In the sample, 21% of children had gastro-oesophageal reflux during the physiotherapy session. No relationship was found between reflux during physiotherapy and pathological reflux (P=0.411) nor the physiotherapy technique used (P=0.219). The use of these two chest physiotherapy techniques in children in a seated position can produce gastro-oesophageal reflux. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Chest wall reconstruction with methacrylate prosthesis in Poland syndrome.

PubMed

Arango Tomás, Elisabet; Baamonde Laborda, Carlos; Algar Algar, Javier; Salvatierra Velázquez, Angel

2013-10-01

Poland syndrome is a rare congenital malformation. This syndrome was described in 1841 by Alfred Poland at Guy's Hospital in London. It is characterized by hypoplasia of the breast and nipple, subcutaneous tissue shortages, lack of the costosternal portion of the pectoralis major muscle and associated alterations of the fingers on the same side. Corrective treatment of the chest and soft tissue abnormalities in Poland syndrome varies according to different authors. We report the case of a 17-year-old adolescent who underwent chest wall reconstruction with a methyl methacrylate prosthesis. This surgical procedure is recommended for large anterior chest wall defects, and it prevents paradoxical movement. Moreover it provides for individual remodeling of the defect depending on the shape of the patient's chest. Copyright © 2012 SEPAR. Published by Elsevier Espana. All rights reserved.

Inhalation of the propeller from a spinhaler.

PubMed

Polosa, R; Finnerty, J P

1991-02-01

A 39 yr old man with a 5 yr history of asthma opened his spinhaler to inspect it. He sucked at the capsule to see if its contents were damp. The capsule and propeller came off the spindle, and he aspirated them. He attended a casualty department. The chest radiogram was normal. Over the next three months he developed dypnoea and pain in his chest. He also noticed a whistling noise from his chest, more marked when he lay on his right side. On renewed examination, expiration was prolonged over the right side of the chest, and an occasional whistling wheeze could be heard on that side. A renewed chest radiogram was normal. By means of rigid bronchoscopy, the spindle was removed from its lodged position in the right intermediary bronchus just beyond the orifice to the right upper lobe.

Etiopathology and management challenges of blunt chest trauma in Nigeria.

PubMed

Thomas, Martins Oluwafemi; Ogunleye, Ezekiel O

2009-12-01

Blunt chest trauma had not been roundly studied in Nigeria. This study was conducted to determine the etiopathological and management challenges of chest trauma in a developing country. In a prospective multicenter hospital-based study of 10-years duration in the city of Lagos, the data of 896 patients were recorded. The male-to-female ratio was 8 : 1, and the mean age was 27.1 years. The majority of patients (76.9%) were aged 20-39 years. Road traffic accidents caused 98.1% of the injuries. Lung parenchymal injuries occurred in 66% of patients, and cardiac trauma in 0.1%. Isolated chest trauma was found in 85% of patients, and 134 had associated injuries. The incidence of blunt chest trauma could be reduced if the number of road traffic accidents in Nigeria is reduced.

A closer look at the relationships between panic attacks, emergency department visits and non-cardiac chest pain.

PubMed

Foldes-Busque, Guillaume; Denis, Isabelle; Poitras, Julien; Fleet, Richard P; Archambault, Patrick; Dionne, Clermont E

2017-01-01

This study examined the prevalence of emergency department visits prompted by panic attacks in patients with non-cardiac chest pain. A validated structured telephone interview was used to assess panic attacks and their association with the emergency department consultation in 1327 emergency department patients with non-cardiac chest pain. Patients reported at least one panic attack in the past 6 months in 34.5 per cent (95% confidence interval: 32.0%-37.1%) of cases, and 77.1 per cent (95% confidence interval: 73.0%-80.7%) of patients who reported panic attacks had visited the emergency department with non-cardiac chest pain following a panic attack. These results indicate that panic attacks may explain a significant proportion of emergency department visits for non-cardiac chest pain.

Vocal-fold collision mass as a differentiator between registers in the low-pitch range.

PubMed

Vilkman, E; Alku, P; Laukkanen, A M

1995-03-01

Register shift between the chest and falsetto register is generally studied in the higher-than-speaking pitch range. However, a similar difference can also be produced at speaking pitch level. The shift from breathy "falsetto" phonation to normal chest voice phonation was studied in normal female (pitch range 170-180 Hz) and male (pitch range 94-110 Hz) subjects. The phonations gliding from falsetto to normal chest voice were analyzed using iterative adaptive inverse filtering and electroglottography. Both trained and untrained, as well as female and male subjects, were able to produce an abrupt register shift from soft falsetto to soft chest register phonation. The differences between male and female speakers in the glottal flow waveforms were smaller than expected. The register shift is interpreted in terms of a "critical mass" concept of chest register phonation.

Osteoradionecrosis of the chest wall. Management of postresection defects using Marlex mesh and a rotated latissimus dorsi myocutaneous flap

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hines, G.L.; Lee, G.

1983-11-01

Full thickness chest wall resection and single stage reconstruction for osteoradionecrosis of the chest wall was performed on five patients. All patients had undergone radical mastectomy and radiation therapy from 5 to 18 years prior to chest wall resection. Defects varied from 12 X 5 cm to 15 X 15 cm, and included from two to four ribs. Reconstruction was performed using Marlex mesh to reconstruct the bony thorax and a rotated latissimus dorsi myocutaneous flap. Coverage was successfully performed in all cases, and no patient experienced postoperative pulmonary dysfunction. There were no complications related to either the bony thoraxmore » reconstruction or the latissimus flap. The use of this technique has provided a safe, convenient, and reliable method of chest wall reconstruction.« less

Inflammation and Rupture of a Congenital Pericardial Cyst Manifesting Itself as an Acute Chest Pain Syndrome.

PubMed

Aertker, Robert A; Cheong, Benjamin Y C; Lufschanowski, Roberto

2016-12-01

We present the case of a 63-year-old woman with a remote history of supraventricular tachycardia and hyperlipidemia, who presented with recurrent episodes of acute-onset chest pain. An electrocardiogram showed no evidence of acute coronary syndrome. A chest radiograph revealed a prominent right-sided heart border. A suspected congenital pericardial cyst was identified on a computed tomographic chest scan, and stranding was noted around the cyst. The patient was treated with nonsteroidal anti-inflammatory drugs, and the pain initially abated. Another flare-up was treated similarly. Cardiac magnetic resonance imaging was then performed after symptoms had resolved, and no evidence of the cyst was seen. The suspected cause of the patient's chest pain was acute inflammation of a congenital pericardial cyst with subsequent rupture and resolution of symptoms.

Congenital Complete Absence of Pericardium Masquerading as Pulmonary Embolism

PubMed Central

Tariq, Saad; Mahmood, Sultan; Madeira, Samuel; Tarasov, Ethan

2013-01-01

Congenital absence of the pericardium is a rare cardiac condition, which can be either isolated or associated with other cardiac and extracardiac anomalies. There are six different types, depending on the severity of the involvement. Most of the patients with this defect are asymptomatic, especially the ones with complete absence of the pericardium. However, some patients are symptomatic, reporting symptoms that include chest pain, palpitations, dyspnea, and syncope. Diagnosis is established by the characteristic features on chest X-ray, echocardiogram, chest computed tomography (CT), and/or cardiac magnetic resonance imging (MRI). We present here a case of a 23 year-old-male, who presented to our hospital with complaints of pleuritic chest pain and exertional dyspnea, of a two-week duration. He was physically active and his past history was otherwise insignificant. His chest CT with contrast was interpreted as showing evidence of multiple emboli, predominantly in the left lung, and he was started on a heparin and warfarin therapy. A repeat chest CT with contrast three weeks later showed no significant change from the previous CT scan. Both scans showed that the heart was abnormally rotated to the left side of the chest. An echocardiogram raised the suspicion of congenital absence of the pericardium, with a posteriorly displaced heart. In retrospect, motion artifact on the left lung, attributed to cardiac pulsations and the lack of pericardium, resulted in a CT chest appearance, mimicking findings of pulmonary embolism. The misdiagnosis of pulmonary embolism was attributed to the artifact caused by excessive cardiac motion artifact on the chest CT scan. In non-gated CT angiograms, excessive motion causes an artifact that blurs the pulmonary vessels, reminiscent of a ′seagull′ or a ′boomerang′. Physicians need to be aware of this phenomenon, as well as the characteristic radiological features of this congenital anomaly, to enable them to make a correct diagnosis. PMID:23580923

Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis.

PubMed

Alrajab, Saadah; Youssef, Asser M; Akkus, Nuri I; Caldito, Gloria

2013-09-23

Ultrasonography is being increasingly utilized in acute care settings with expanding applications. Pneumothorax evaluation by ultrasonography is a fast, safe, easy and inexpensive alternative to chest radiographs. In this review, we provide a comprehensive analysis of the current literature comparing ultrasonography and chest radiography for the diagnosis of pneumothorax. We searched English-language articles in MEDLINE, EMBASE and Cochrane Library dealing with both ultrasonography and chest radiography for diagnosis of pneumothorax. In eligible studies that met strict inclusion criteria, we conducted a meta-analysis to evaluate the diagnostic accuracy of pleural ultrasonography in comparison with chest radiography for the diagnosis of pneumothorax. We reviewed 601 articles and selected 25 original research articles for detailed review. Only 13 articles met all of our inclusion criteria and were included in the final analysis. One study used lung sliding sign alone, 12 studies used lung sliding and comet tail signs, and 6 studies searched for lung point in addition to the other two signs. Ultrasonography had a pooled sensitivity of 78.6% (95% CI, 68.1 to 98.1) and a specificity of 98.4% (95% CI, 97.3 to 99.5). Chest radiography had a pooled sensitivity of 39.8% (95% CI, 29.4 to 50.3) and a specificity of 99.3% (95% CI, 98.4 to 100). Our meta-regression and subgroup analyses indicate that consecutive sampling of patients compared to convenience sampling provided higher sensitivity results for both ultrasonography and chest radiography. Consecutive versus nonconsecutive sampling and trauma versus nontrauma settings were significant sources of heterogeneity. In addition, subgroup analysis showed significant variations related to operator and type of probe used. Our study indicates that ultrasonography is more accurate than chest radiography for detection of pneumothorax. The results support the previous investigations in this field, add new valuable information obtained from subgroup analysis, and provide accurate estimates for the performance parameters of both bedside ultrasonography and chest radiography for pneumothorax evaluation.

Air Trapping on Chest CT Is Associated with Worse Ventilation Distribution in Infants with Cystic Fibrosis Diagnosed following Newborn Screening

PubMed Central

Hall, Graham L.; Logie, Karla M.; Parsons, Faith; Schulzke, Sven M.; Nolan, Gary; Murray, Conor; Ranganathan, Sarath; Robinson, Phil; Sly, Peter D.; Stick, Stephen M.

2011-01-01

Background In school-aged children with cystic fibrosis (CF) structural lung damage assessed using chest CT is associated with abnormal ventilation distribution. The primary objective of this analysis was to determine the relationships between ventilation distribution outcomes and the presence and extent of structural damage as assessed by chest CT in infants and young children with CF. Methods Data of infants and young children with CF diagnosed following newborn screening consecutively reviewed between August 2005 and December 2009 were analysed. Ventilation distribution (lung clearance index and the first and second moment ratios [LCI, M1/M0 and M2/M0, respectively]), chest CT and airway pathology from bronchoalveolar lavage were determined at diagnosis and then annually. The chest CT scans were evaluated for the presence or absence of bronchiectasis and air trapping. Results Matched lung function, chest CT and pathology outcomes were available in 49 infants (31 male) with bronchiectasis and air trapping present in 13 (27%) and 24 (49%) infants, respectively. The presence of bronchiectasis or air trapping was associated with increased M2/M0 but not LCI or M1/M0. There was a weak, but statistically significant association between the extent of air trapping and all ventilation distribution outcomes. Conclusion These findings suggest that in early CF lung disease there are weak associations between ventilation distribution and lung damage from chest CT. These finding are in contrast to those reported in older children. These findings suggest that assessments of LCI could not be used to replace a chest CT scan for the assessment of structural lung disease in the first two years of life. Further research in which both MBW and chest CT outcomes are obtained is required to assess the role of ventilation distribution in tracking the progression of lung damage in infants with CF. PMID:21886842

Kinetic therapy in multiple trauma patients with severe blunt chest trauma: an analysis at a level-1 trauma center.

PubMed

Zeckey, C; Wendt, K; Mommsen, P; Winkelmann, M; Frömke, C; Weidemann, J; Stübig, T; Krettek, C; Hildebrand, F

2015-01-01

Chest trauma is a relevant risk factor for mortality after multiple trauma. Kinetic therapy (KT) represents a potential treatment option in order to restore pulmonary function. Decision criteria for performing kinetic therapy are not fully elucidated. The purpose of this study was to investigate the decision making process to initiate kinetic therapy in a well defined multiple trauma cohort. A retrospective analysis (2000-2009) of polytrauma patients (age > 16 years, ISS ⩾ 16) with severe chest trauma (AIS(Chest) ⩾ 3) was performed. Patients with AIS(Head) ⩾ 3 were excluded. Patients receiving either kinetic (KT+) or lung protective ventilation strategy (KT-) were compared. Chest trauma was classified according to the AIS(Chest), Pulmonary Contusion Score (PCS), Wagner Jamieson Score and Thoracic Trauma Severity Score (TTS). There were multiple outcome parameters investigated included mortality, posttraumatic complications and clinical data. A multivariate regression analysis was performed. Two hundred and eighty-three patients were included (KT+: n=160; KT-: n=123). AIS(Chest), age and gender were comparable in both groups. There were significant higher values of the ISS, PCS, Wagner Jamieson Score and TTS in group KT+. The incidence of posttraumatic complications and mortality was increased compared to group KT- (p< 0.05). Despite that, kinetic therapy failed to be an independent risk factor for mortality in multivariate logistic regression analysis. Kinetic therapy is an option in severely injured patients with severe chest trauma. Decision making is not only based on anatomical aspects such as the AIS(Chest), but on overall injury severity, pulmonary contusions and physiological deterioration. It could be assumed that the increased mortality in patients receiving KT is primarily caused by these factors and does not reflect an independent adverse effect of KT. Furthermore, KT was not shown to be an independent risk factor for mortality.

Cough in Ambulatory Immunocompromised Adults: CHEST Expert Panel Report.

PubMed

Rosen, Mark J; Ireland, Belinda; Narasimhan, Mangala; French, Cynthia; Irwin, Richard S

2017-11-01

Cough is a common symptom prompting patients to seek medical care. Like patients in the general population, patients with compromised immune systems also seek care for cough. However, it is unclear whether the causes of cough in immunocompromised patients who are deemed unlikely to have a life-threating condition and a normal or unchanged chest radiograph are similar to those in persons with cough and normal immune systems. We conducted a systematic review to answer the question: What are the most common causes of cough in ambulatory immunodeficient adults with normal chest radiographs? Studies of patients ≥ 18 years of age with immune deficiency, cough of any duration, and normal or unchanged chest radiographs were included and assessed for relevance and quality. Based on the systematic review, suggestions were developed and voted on using the American College of Chest Physicians (CHEST) methodology framework. The results of the systematic review revealed no high-quality evidence to guide the clinician in determining the likely causes of cough specifically in immunocompromised ambulatory patients with normal chest radiographs. Based on a systematic review, we found no evidence to assess whether or not the proper initial evaluation of cough in immunocompromised patients is different from that in immunocompetent persons. A consensus of the panel suggested that the initial diagnostic algorithm should be similar to that for immunocompetent persons but that the context of the type and severity of the immune defect, geographic location, and social determinants be considered. The major modifications to the 2006 CHEST Cough Guidelines are the suggestions that TB should be part of the initial evaluation of patients with cough and HIV infection who reside in regions with a high prevalence of TB, regardless of the radiographic findings, and that specific causes and immune defects be considered in all patients in whom the initial evaluation is unrevealing. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Response of unexplained chest pain to proton pump inhibitor treatment in patients with and without objective evidence of gastro-oesophageal reflux disease.

PubMed

Kahrilas, Peter J; Hughes, Nesta; Howden, Colin W

2011-11-01

Unexplained chest pain is potentially attributable to gastro-oesophageal reflux disease (GORD) or oesophageal motility disorders. Reflux chest pain may occur without heartburn. We explored the response of unexplained chest pain to proton pump inhibitor (PPI) therapy in randomised clinical trials (RCTs), differentiating patients with and without objective evidence of GORD. PubMed and Embase were systematically searched for RCTs that reported chest pain response to PPIs in patients who had had pH-monitoring and/or endoscopy to differentiate GORD-positive from GORD-negative subpopulations. Heterogeneity among studies was assessed using the Cochran Q and I(2) statistics, and a fixed effect model was applied. Possible publication bias was assessed by Egger's test. Six RCTs met the inclusion criteria. All used 24 h pH monitoring and/or endoscopy to define GORD-positive patients and improvement in chest pain to define response (five used ≥50%; one used ≥ 20%). The therapeutic gain of >50% improvement with PPIs relative to placebo was 56-85% in GORD-positive and 0-17% in GORD-negative patients. The RR of >50% improvement in chest pain with PPI versus placebo was 4.3 (95% CI 2.8 to 6.7; p<0.0001) for GORD-positive and 0.4 (95% CI 0.3 to 0.7; p=0.0004) for GORD-negative patients. Concomitant heartburn varied among trials from being an exclusion criterion to being essentially concordant with GORD-positive status. Unexplained chest pain in patients with endoscopic or pH-monitoring evidence of GORD tends to improve, but not resolve, with PPI therapy, whereas GORD-negative patients have little or no response. Heartburn was a poor predictor of whether patients with chest pain were GORD-positive or GORD-negative by objective testing.

Clinical and Laboratory Findings in Patients With Acute Respiratory Symptoms That Suggest the Necessity of Chest X-ray for Community-Acquired Pneumonia.

PubMed

Ebrahimzadeh, Azadeh; Mohammadifard, Mahyar; Naseh, Godratallah; Mirgholami, Alireza

2015-01-01

Pneumonia is a common illness in all parts of the world and is considered as a major cause of death among all age groups. Nevertheless, only about 5% of patients referring to their primary care physicians with acute respiratory symptoms will develop pneumonia. This study was performed to derive practical criteria for performing chest radiographs for the evaluation of community-acquired pneumonia (CAP). A total of 420 patients with acute respiratory symptoms and positive findings on chest radiograph were evaluated from December 2008 to December 2009. The subjects were referred to outpatient clinics or emergency departments of Birjand's medical university hospitals, Iran, and were enrolled as positive cases. A checklist was completed for each patient including their demographic information, clinical signs and symptoms (cough, sputum production, dyspnea, chest pain, fever, tachycardia, and tachypnea), abnormal findings in pulmonary auscultation and laboratory findings (erythrocyte sedimentation rate, C-reactive protein levels, and white blood cell count). An equal number of age-matched individuals with acute respiratory symptoms, but insignificant findings on chest radiography, were included as the control group. Finally, the diagnostic values of different findings were compared. The data showed that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings. Therefore, by implementing a prediction rule, we would be able to determine which patients would benefit from a chest X-Ray (sensitivity, 94% and specificity, 57%). This study's findings suggest that requesting chest radiographs might not be necessary in patients with acute respiratory symptoms unless the vital signs and/or physical examination findings are abnormal. Considering the 94% sensitivity of this rule for predicting CAP, a chest radiograph is required for patients with unreliable follow-ups or moderate to high likelihood of morbidity if CAP is not initially detected.

Cost and Morbidity Analysis of Chest Port Insertion: Interventional Radiology Suite Versus Operating Room.

PubMed

LaRoy, Jennifer R; White, Sarah B; Jayakrishnan, Thejus; Dybul, Stephanie; Ungerer, Dirk; Turaga, Kiran; Patel, Parag J

2015-06-01

To compare complications and cost, from a hospital perspective, of chest port insertions performed in an interventional radiology (IR) suite versus in surgery in an operating room (OR). This study was approved by an institutional review board and is HIPAA compliant. Medical records were retrospectively searched on consecutive chest port placement procedures, in the IR suite and the OR, between October 22, 2010 and February 26, 2013, to determine patients' demographic information and chest port-related complications and/or infections. A total of 478 charts were reviewed (age range: 21-85 years; 309 women, 169 men). Univariate and bivariate analyses were performed to identify risk factors associated with an increased complication rate. Cost data on 149 consecutive Medicare outpatients (100 treated in the IR suite; 49 treated in the OR) who had isolated chest port insertions between March 2012 and February 2013 were obtained for both the operative services and pharmacy. Nonparametric tests for heterogeneity were performed using the Kruskal-Wallis method. Early complications occurred in 9.2% (22 of 239) of the IR patients versus 13.4% (32 of 239) of the OR patients. Of the 478 implanted chest ports, 9 placed in IR and 18 placed in surgery required early removal. Infections from the ports placed in IR versus the OR were 0.25 versus 0.18 infections per 1000 catheters, respectively. Overall mean costs for chest port insertion were significantly higher in the OR, for both room and pharmacy costs (P < .0001). Overall average cost to place chest ports in an OR setting was almost twice that of placement in the IR suite. Hospital costs to place a chest port were significantly lower in the IR suite than in the OR, whereas radiology and surgery patients did not show a significantly different rate of complications and/or infections. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

Life-threatening hemothorax due to azygos vein rupture after chest compression during cardiopulmonary resuscitation.

PubMed

Yang, Euiseok; Jeong, WonJoon; Lee, JunWan; Kim, SeungWhan

2014-11-01

Hemothorax is not an uncommon cardiopulmonary resuscitation(CPR)–related complication. But hemothorax related to azygos vein injury (AVI) is a rare condition following blunt chest trauma, with no report of CPR-related AVI in the literature. We present a case of azygosve in rupture in a middle-aged woman after repeated chest compression during 1 hour of CPR. She eventually presented with massive hemothorax due to azygos vein rupture diagnosed by computed tomography (CT). When faced with a patient with massive hemothorax after chest compression, azygos vein rupture should be considered as a complication.

Management of Chest Drains After Thoracic Resections.

PubMed

Filosso, Pier Luigi; Sandri, Alberto; Guerrera, Francesco; Roffinella, Matteo; Bora, Giulia; Solidoro, Paolo

2017-02-01

Immediately after lung resection, air tends to collect in the retrosternal part of the chest wall (in supine position), and fluids in its lower part (costodiaphragmatic sinus). Several general thoracic surgery textbooks currently recommend the placement of 2 chest tubes after major pulmonary resections, one anteriorly, to remove air, and another into the posterior and basilar region, to drain fluids. Recently, several authors advocated the placement of a single chest tube. In terms of air and fluid drainage, this technique demonstrated to be as effective as the conventional one after wedge resection or uncomplicated lobectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

Comparing posteroanterior with lateral and anteroposterior chest radiography in the initial detection of parapneumonic effusions.

PubMed

Moffett, Bryan K; Panchabhai, Tanmay S; Nakamatsu, Raul; Arnold, Forest W; Peyrani, Paula; Wiemken, Timothy; Guardiola, Juan; Ramirez, Julio A

2016-12-01

It is unclear whether anteroposterior (AP) or posteroanterior with lateral (PA/Lat) chest radiographs are superior in the early detection of clinically relevant parapneumonic effusions (CR-PPEs). The objective of this study was to identify which technique is preferred for detection of PPEs using chest computed tomography (CCT) as a reference standard. A secondary analysis of a pneumonia database was conducted to identify patients who received a CCT within 24 hours of presentation and also received AP or PA/Lat chest radiographs within 24 hours of CCT. Sensitivity and specificity were then calculated by comparing the radiographic diagnosis of PPEs of both types of radiographs compared with CCT by using the existing attending radiologist interpretation. Clinical relevance of effusions was determined by CCT effusion measurement of >2.5 cm or presence of loculation. There was a statistically significant difference between the sensitivity of AP (67.3%) and PA/Lat (83.9%) chest radiography for the initial detection of CR-PPE. Of 16 CR-PPEs initially missed by AP radiography, 7 either required drainage initially or developed empyema within 30 days, whereas no complicated PPE or empyema was found in those missed by PA/Lat radiography. PA/Lat chest radiography should be the initial imaging of choice in pneumonia patients for detection of PPEs because it appears to be statistically superior to AP chest radiography. Published by Elsevier Inc.

Chest wall segmentation in automated 3D breast ultrasound scans.

PubMed

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

2013-12-01

In this paper, we present an automatic method to segment the chest wall in automated 3D breast ultrasound images. Determining the location of the chest wall in automated 3D breast ultrasound images is necessary in computer-aided detection systems to remove automatically detected cancer candidates beyond the chest wall and it can be of great help for inter- and intra-modal image registration. We show that the visible part of the chest wall in an automated 3D breast ultrasound image can be accurately modeled by a cylinder. We fit the surface of our cylinder model to a set of automatically detected rib-surface points. The detection of the rib-surface points is done by a classifier using features representing local image intensity patterns and presence of rib shadows. Due to attenuation of the ultrasound signal, a clear shadow is visible behind the ribs. Evaluation of our segmentation method is done by computing the distance of manually annotated rib points to the surface of the automatically detected chest wall. We examined the performance on images obtained with the two most common 3D breast ultrasound devices in the market. In a dataset of 142 images, the average mean distance of the annotated points to the segmented chest wall was 5.59 ± 3.08 mm. Copyright © 2012 Elsevier B.V. All rights reserved.

[Differential diagnosis "non-cardiac chest pain"].

PubMed

Frieling, Thomas

2015-07-01

Non cardiac chest pain (NCCP) are recurrent angina pectoris like pain without evidence of coronary heart diesease in conventional diagnostic evaluation. The prevalence of NCCP is up to 70% and may be detected in this order at all levels of the medical health care system (general practitioner, emergency department, chest pain unit, coronary care). Reduction of quality of life in NCCP is comparable, partially even higher compared to cardiac chest pain. Reasons for psychological strain are symptom recurrence in app. 50%, nonspecific diagnosis with resulting uncertainty and insufficient integration of other medical disciplines in diagnostic work-up. Managing of patients with NCCP has to be interdisciplinary because non cardiac causes of chest pain may be found frequently. This are musculosceletal in app. 40%, gastrointestinal in app. 20%, psychiatric in app. 10% and pulmonary and mediastinal diseases in app. 5% of cases. Also gastroenterological expertise is required because here gastroesophageal reflux disease (GERD) in app. 60%, hypercontractile esophageal motility disorders with nutcracker, jackhammer esophagus or distal esophageal spasmus or achalasia in app. 20% and other esophageal alterations (e. g. infectious esophageal inflammation, drug-induced ulcer, rings, webs, eosinophilic esophagits) in app. 30% of cases may be detected as cause of chest pain may. This implicates that regular interdisciplinary round wards and interdisciplinary management of chest pain units are mandatory. © Georg Thieme Verlag KG Stuttgart · New York.

Functional chest pain responds to biofeedback treatment but functional heartburn does not: what is the difference?

PubMed

Shapiro, Michael; Shanani, Ram; Taback, Hanna; Abramowich, Dov; Scapa, Eitan; Broide, Efrat

2012-06-01

Patients with functional esophageal disorders represent a challenging treatment group. The purpose of this study was to evaluate the role of biofeedback in the treatment of patients with functional esophageal disorders. In this prospective study, patients with typical/atypical symptoms of gastroesophageal reflux disease underwent upper endoscopy and 24-h pH monitoring. All patients filled out gastroesophageal Reflux Disease Symptom, Hospital Anxiety and Depression, and Symptom Stress Rating questionnaires. Patients with functional heartburn and those with functional chest pain were offered biofeedback treatment. A global assessment questionnaire was filled out at the end of treatment and then 2.8 (range 1-4) years later. From January 2006 to December 2009, 22 patients with functional esophageal diseases were included in the study. Thirteen had functional heartburn and nine had functional chest pain. Six patients from each group received biofeedback treatment. After treatment for 1-4 years, patients with functional chest pain showed significant improvements in symptoms compared with those who were not treated. Patients with functional heartburn showed no improvement. Patients with functional chest pain had a longer time of esophageal acid exposure than those with functional heartburn. Patients with functional chest pain have different central and intraesophageal factors associated with symptom generation in comparison with patients with functional heartburn. Biofeedback is a useful tool in the treatment of patients with functional chest pain, but not for those with functional heartburn.

Yield of diagnostic procedures for invasive fungal infections in neutropenic febrile patients with chest computed tomography abnormalities.

PubMed

Ho, Dora Y; Lin, Margaret; Schaenman, Joanna; Rosso, Fernando; Leung, Ann N C; Coutre, Steven E; Sista, Ramachandra R; Montoya, Jose G

2011-01-01

Haematological patients with neutropenic fever are frequently evaluated with chest computed tomography (CT) to rule out invasive fungal infections (IFI). We retrospectively analysed data from 100 consecutive patients with neutropenic fever and abnormal chest CT from 1998 to 2005 to evaluate their chest CT findings and the yield of diagnostic approaches employed. For their initial CTs, 79% had nodular opacities, with 24.1% associated with the halo sign. Other common CT abnormalities included pleural effusions (48%), ground glass opacities (37%) and consolidation (31%). The CT findings led to a change in antifungal therapy in 54% of the patients. Fifty-six patients received diagnostic procedures, including 46 bronchoscopies, 25 lung biopsies and seven sinus biopsies, with a diagnostic yield for IFI of 12.8%, 35.0% and 83.3%, respectively. In conclusion, chest CT plays an important role in the evaluation of haematological patients with febrile neutropenia and often leads to a change in antimicrobial therapy. Pulmonary nodules are the most common radiological abnormality. Sinus or lung biopsies have a high-diagnostic yield for IFI as compared to bronchoscopy. Patients with IFI may not have sinus/chest symptoms, and thus, clinicians should have a low threshold for performing sinus/chest imaging, and if indicated and safe, a biopsy of the abnormal areas. © 2009 Blackwell Verlag GmbH.

Spontaneous esophageal-pleural fistula.

PubMed

Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

2011-10-01

Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed.

It's Not Your Heart: Group Treatment for Non-Cardiac Chest Pain

ERIC Educational Resources Information Center

Hess, Sherry M.

2011-01-01

This article presents a brief group psychoeducational treatment for non-cardiac chest pain, supplemented with a composite case study. Patients present to emergency rooms for chest pain they believe is a heart attack symptom. When cardiac testing is negative, this pain is usually a panic symptom, often occurring with a cluster of other panic…

46 CFR 194.10-20 - Magazine chest construction.

Code of Federal Regulations, 2012 CFR

2012-10-01

... lid shall have a minimum thickness of 1/8 inch. (b) Permanent sun shields shall be provided for sides... distance of 11/2 inches. Sun shields may be omitted when chests are installed “on deck protected,” shielded from direct exposure to the sun. (c) Chests shall be limited to a gross capacity of 100 cubic feet. (d...

46 CFR 194.10-20 - Magazine chest construction.

Code of Federal Regulations, 2010 CFR

2010-10-01

... lid shall have a minimum thickness of 1/8 inch. (b) Permanent sun shields shall be provided for sides... distance of 11/2 inches. Sun shields may be omitted when chests are installed “on deck protected,” shielded from direct exposure to the sun. (c) Chests shall be limited to a gross capacity of 100 cubic feet. (d...

46 CFR 194.10-20 - Magazine chest construction.

Code of Federal Regulations, 2014 CFR

2014-10-01

... lid shall have a minimum thickness of 1/8 inch. (b) Permanent sun shields shall be provided for sides... distance of 11/2 inches. Sun shields may be omitted when chests are installed “on deck protected,” shielded from direct exposure to the sun. (c) Chests shall be limited to a gross capacity of 100 cubic feet. (d...

46 CFR 194.10-20 - Magazine chest construction.

Code of Federal Regulations, 2011 CFR

2011-10-01

... lid shall have a minimum thickness of 1/8 inch. (b) Permanent sun shields shall be provided for sides... distance of 11/2 inches. Sun shields may be omitted when chests are installed “on deck protected,” shielded from direct exposure to the sun. (c) Chests shall be limited to a gross capacity of 100 cubic feet. (d...

46 CFR 194.10-20 - Magazine chest construction.

Code of Federal Regulations, 2013 CFR

2013-10-01

... lid shall have a minimum thickness of 1/8 inch. (b) Permanent sun shields shall be provided for sides... distance of 11/2 inches. Sun shields may be omitted when chests are installed “on deck protected,” shielded from direct exposure to the sun. (c) Chests shall be limited to a gross capacity of 100 cubic feet. (d...

20 CFR Appendix A to Part 718 - Standards for Administration and Interpretation of Chest Roentgenograms (X-Rays)

Code of Federal Regulations, 2014 CFR

2014-04-01

... Interpretation of Chest Roentgenograms (X-Rays) A Appendix A to Part 718 Employees' Benefits OFFICE OF WORKERS... Appendix A to Part 718—Standards for Administration and Interpretation of Chest Roentgenograms (X-Rays) The... procedures are used in administering and interpreting X-rays and that the best available medical evidence...

20 CFR Appendix A to Part 718 - Standards for Administration and Interpretation of Chest Roentgenograms (X-Rays)

Code of Federal Regulations, 2013 CFR

2013-04-01

... Interpretation of Chest Roentgenograms (X-Rays) A Appendix A to Part 718 Employees' Benefits OFFICE OF WORKERS... Appendix A to Part 718—Standards for Administration and Interpretation of Chest Roentgenograms (X-Rays) The... procedures are used in administering and interpreting X-rays and that the best available medical evidence...

75 FR 77936 - 60-Day Notice of Proposed Information Collection: Forms DS-2053, DS-2054; Medical Examination for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-14

... DS-2053, DS-2054; Medical Examination for Immigrant or Refugee Applicant; DS- 3024, DS-3030, Chest X... Instructions); Form DS- 3024, Chest X-Ray and Classification Worksheet (1991 Technical Instructions); Form DS-3030, Chest X-Ray and Classification Worksheet (2007 Technical Instructions); Form DS-3025, Vaccination...

20 CFR Appendix A to Part 718 - Standards for Administration and Interpretation of Chest Roentgenograms (X-Rays)

Code of Federal Regulations, 2011 CFR

2011-04-01

... Interpretation of Chest Roentgenograms (X-Rays) A Appendix A to Part 718 Employees' Benefits OFFICE OF WORKERS... Appendix A to Part 718—Standards for Administration and Interpretation of Chest Roentgenograms (X-Rays) The... procedures are used in administering and interpreting X-rays and that the best available medical evidence...

20 CFR Appendix A to Part 718 - Standards for Administration and Interpretation of Chest Roentgenograms (X-Rays)

Code of Federal Regulations, 2012 CFR

2012-04-01

... Interpretation of Chest Roentgenograms (X-Rays) A Appendix A to Part 718 Employees' Benefits OFFICE OF WORKERS... Appendix A to Part 718—Standards for Administration and Interpretation of Chest Roentgenograms (X-Rays) The... procedures are used in administering and interpreting X-rays and that the best available medical evidence...

Rib Fracture Diagnosis in the Panscan Era.

PubMed

Murphy, Charles E; Raja, Ali S; Baumann, Brigitte M; Medak, Anthony J; Langdorf, Mark I; Nishijima, Daniel K; Hendey, Gregory W; Mower, William R; Rodriguez, Robert M

2017-12-01

With increased use of chest computed tomography (CT) in trauma evaluation, traditional teachings in regard to rib fracture morbidity and mortality may no longer be accurate. We seek to determine rates of rib fracture observed on chest CT only; admission and mortality of patients with isolated rib fractures, rib fractures observed on CT only, and first or second rib fractures; and first or second rib fracture-associated great vessel injury. We conducted a planned secondary analysis of 2 prospectively enrolled cohorts of the National Emergency X-Radiography Utilization Study chest studies, which evaluated patients with blunt trauma who were older than 14 years and received chest imaging in the emergency department. We defined rib fractures and other thoracic injuries according to CT reports and followed patients through their hospital course to determine outcomes. Of 8,661 patients who had both chest radiograph and chest CT, 2,071 (23.9%) had rib fractures, and rib fractures were observed on chest CT only in 1,368 cases (66.1%). Rib fracture patients had higher admission rates (88.7% versus 45.8%; mean difference 42.9%; 95% confidence interval [CI] 41.4% to 44.4%) and mortality (5.6% versus 2.7%; mean difference 2.9%; 95% CI 1.8% to 4.0%) than patients without rib fracture. The mortality of patients with rib fracture observed on chest CT only was not statistically significantly different from that of patients with fractures also observed on chest radiograph (4.8% versus 5.7%; mean difference -0.9%; 95% CI -3.1% to 1.1%). Patients with first or second rib fractures had significantly higher mortality (7.4% versus 4.1%; mean difference 3.3%; 95% CI 0.2% to 7.1%) and prevalence of concomitant great vessel injury (2.8% versus 0.6%; mean difference 2.2%; 95% CI 0.6% to 4.9%) than patients with fractures of ribs 3 to 12, and the odds ratio of great vessel injury with first or second rib fracture was 4.4 (95% CI 1.8 to 10.4). Under trauma imaging protocols that commonly incorporate chest CT, two thirds of rib fractures were observed on chest CT only. Patients with rib fractures had higher admission rates and mortality than those without rib fractures. First or second rib fractures were associated with significantly higher mortality and great vessel injury. Copyright © 2017 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study.

PubMed

Touw, H R; Parlevliet, K L; Beerepoot, M; Schober, P; Vonk, A; Twisk, J W; Elbers, P W; Boer, C; Tuinman, P R

2018-03-12

Postoperative pulmonary complications are common after cardiothoracic surgery and are associated with adverse outcomes. The ability to detect postoperative pulmonary complications using chest X-rays is limited, and this technique requires radiation exposure. Little is known about the diagnostic accuracy of lung ultrasound for the detection of postoperative pulmonary complications after cardiothoracic surgery, and we therefore aimed to compare lung ultrasound with chest X-ray to detect postoperative pulmonary complications in this group of patients. We performed this prospective, observational, single-centre study in a tertiary intensive care unit treating adult patients who had undergone cardiothoracic surgery. We recorded chest X-ray findings upon admission and on postoperative days 2 and 3, as well as rates of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications that required therapy according to the treating physician as part of their standard clinical practice. Lung ultrasound was performed by an independent researcher at the time of chest X-ray. We compared lung ultrasound with chest X-ray for the detection of postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications. We also assessed inter-observer agreement for lung ultrasound, and the time to perform both imaging techniques. Subgroup analyses were performed to compare the time to detection of clinically-relevant postoperative pulmonary complications by both modalities. We recruited a total of 177 patients in whom both lung ultrasound and chest X-ray imaging were performed. Lung ultrasound identified 159 (90%) postoperative pulmonary complications on the day of admission compared with 107 (61%) identified with chest X-ray (p < 0.001). Lung ultrasound identified 11 out of 17 patients (65%) and chest X-ray 7 out of 17 patients (41%) with clinically-relevant postoperative pulmonary complications (p < 0.001). The clinically-relevant postoperative pulmonary complications were detected earlier using lung ultrasound compared with chest X-ray (p = 0.024). Overall inter-observer agreement for lung ultrasound was excellent (κ = 0.907, p < 0.001). Following cardiothoracic surgery, lung ultrasound detected more postoperative pulmonary complications and clinically-relevant postoperative pulmonary complications than chest X-ray, and at an earlier time-point. Our results suggest lung ultrasound may be used as the primary imaging technique to search for postoperative pulmonary complications after cardiothoracic surgery, and will enhance bedside decision making. © 2018 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists of Great Britain and Ireland.

Patient-specific Radiation Dose and Cancer Risk for Pediatric Chest CT

PubMed Central

Samei, Ehsan; Segars, W. Paul; Sturgeon, Gregory M.; Colsher, James G.; Frush, Donald P.

2011-01-01

Purpose: To estimate patient-specific radiation dose and cancer risk for pediatric chest computed tomography (CT) and to evaluate factors affecting dose and risk, including patient size, patient age, and scanning parameters. Materials and Methods: The institutional review board approved this study and waived informed consent. This study was HIPAA compliant. The study included 30 patients (0–16 years old), for whom full-body computer models were recently created from clinical CT data. A validated Monte Carlo program was used to estimate organ dose from eight chest protocols, representing clinically relevant combinations of bow tie filter, collimation, pitch, and tube potential. Organ dose was used to calculate effective dose and risk index (an index of total cancer incidence risk). The dose and risk estimates before and after normalization by volume-weighted CT dose index (CTDIvol) or dose–length product (DLP) were correlated with patient size and age. The effect of each scanning parameter was studied. Results: Organ dose normalized by tube current–time product or CTDIvol decreased exponentially with increasing average chest diameter. Effective dose normalized by tube current–time product or DLP decreased exponentially with increasing chest diameter. Chest diameter was a stronger predictor of dose than weight and total scan length. Risk index normalized by tube current–time product or DLP decreased exponentially with both chest diameter and age. When normalized by DLP, effective dose and risk index were independent of collimation, pitch, and tube potential (<10% variation). Conclusion: The correlations of dose and risk with patient size and age can be used to estimate patient-specific dose and risk. They can further guide the design and optimization of pediatric chest CT protocols. © RSNA, 2011 Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101900/-/DC1 PMID:21467251

Location of the Central Venous Catheter Tip With Bedside Ultrasound in Young Children: Can We Eliminate the Need for Chest Radiography?

PubMed

Alonso-Quintela, Paula; Oulego-Erroz, Ignacio; Rodriguez-Blanco, Silvia; Muñiz-Fontan, Manoel; Lapeña-López-de Armentia, Santiago; Rodriguez-Nuñez, Antonio

2015-11-01

To compare the use of bedside ultrasound and chest radiography to verify central venous catheter tip positioning. Prospective observational study. PICU of a university hospital. Patients aged 0-14 who required a central venous catheter. None. Central venous catheter tip location was confirmed by ultrasound and chest radiography. Central venous catheters were classified as intra-atrial or extra-atrial according to their positions in relation to the cavoatrial junction. Central venous catheters located outside the vena cava were considered malpositioned. The distance between the catheter tip and the cavoatrial junction was measured. The time elapsed from image capture to interpretation was recorded. Fifty-one central venous catheters in 40 patients were analyzed. Chest radiography and ultrasound results agreed 94% of the time (κ coefficient, 0.638; p < 0.001) in determining intra-atrial and extra-atrial locations and 92% of the time in determining the diagnosis of central venous catheter malposition (κ coefficient, 0.670; p < 0.001). Chest radiography indicated a greater distance between the central venous catheter tip and the cavoatrial junction than measured by ultrasound, with a mean difference of 0.38 cm (95% CI, +0.27, +0.48 cm). Three central venous catheters were classified as extra-atrial by chest radiography but as intra-atrial by ultrasound. To locate the central venous catheter tip, ultrasound required less time than chest radiography (22.96 min [20.43 min] vs 2.23 min [1.06 min]; p < 0.001). Bedside ultrasound showed a good agreement with chest radiography in detecting central venous catheter tip location and revealing incorrect positions. Ultrasound could be a preferable method for routine verification of central venous catheter tip and can contribute to increased patient safety.

Correlation of the clinical and physical image quality in chest radiography for average adults with a computed radiography imaging system

PubMed Central

Wood, T J; Beavis, A W; Saunderson, J R

2013-01-01

Objective: The purpose of this study was to examine the correlation between the quality of visually graded patient (clinical) chest images and a quantitative assessment of chest phantom (physical) images acquired with a computed radiography (CR) imaging system. Methods: The results of a previously published study, in which four experienced image evaluators graded computer-simulated postero-anterior chest images using a visual grading analysis scoring (VGAS) scheme, were used for the clinical image quality measurement. Contrast-to-noise ratio (CNR) and effective dose efficiency (eDE) were used as physical image quality metrics measured in a uniform chest phantom. Although optimal values of these physical metrics for chest radiography were not derived in this work, their correlation with VGAS in images acquired without an antiscatter grid across the diagnostic range of X-ray tube voltages was determined using Pearson’s correlation coefficient. Results: Clinical and physical image quality metrics increased with decreasing tube voltage. Statistically significant correlations between VGAS and CNR (R=0.87, p<0.033) and eDE (R=0.77, p<0.008) were observed. Conclusion: Medical physics experts may use the physical image quality metrics described here in quality assurance programmes and optimisation studies with a degree of confidence that they reflect the clinical image quality in chest CR images acquired without an antiscatter grid. Advances in knowledge: A statistically significant correlation has been found between the clinical and physical image quality in CR chest imaging. The results support the value of using CNR and eDE in the evaluation of quality in clinical thorax radiography. PMID:23568362

Patient-specific radiation dose and cancer risk for pediatric chest CT.

PubMed

Li, Xiang; Samei, Ehsan; Segars, W Paul; Sturgeon, Gregory M; Colsher, James G; Frush, Donald P

2011-06-01

To estimate patient-specific radiation dose and cancer risk for pediatric chest computed tomography (CT) and to evaluate factors affecting dose and risk, including patient size, patient age, and scanning parameters. The institutional review board approved this study and waived informed consent. This study was HIPAA compliant. The study included 30 patients (0-16 years old), for whom full-body computer models were recently created from clinical CT data. A validated Monte Carlo program was used to estimate organ dose from eight chest protocols, representing clinically relevant combinations of bow tie filter, collimation, pitch, and tube potential. Organ dose was used to calculate effective dose and risk index (an index of total cancer incidence risk). The dose and risk estimates before and after normalization by volume-weighted CT dose index (CTDI(vol)) or dose-length product (DLP) were correlated with patient size and age. The effect of each scanning parameter was studied. Organ dose normalized by tube current-time product or CTDI(vol) decreased exponentially with increasing average chest diameter. Effective dose normalized by tube current-time product or DLP decreased exponentially with increasing chest diameter. Chest diameter was a stronger predictor of dose than weight and total scan length. Risk index normalized by tube current-time product or DLP decreased exponentially with both chest diameter and age. When normalized by DLP, effective dose and risk index were independent of collimation, pitch, and tube potential (<10% variation). The correlations of dose and risk with patient size and age can be used to estimate patient-specific dose and risk. They can further guide the design and optimization of pediatric chest CT protocols. http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11101900/-/DC1. RSNA, 2011

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

DOE Office of Scientific and Technical Information (OSTI.GOV)

Brown, Sheree, E-mail: shereedst32@hotmail.com; Vicini, Frank; Vanapalli, Jyotsna R.

2012-07-01

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

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

PubMed

Verdon, François; Burnand, Bernard; Herzig, Lilli; Junod, Michel; Pécoud, Alain; Favrat, Bernard

2007-09-12

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). 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. 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. 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.

Chest wall syndrome among primary care patients: a cohort study

PubMed Central

Verdon, François; Burnand, Bernard; Herzig, Lilli; Junod, Michel; Pécoud, Alain; Favrat, Bernard

2007-01-01

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. PMID:17850647

[Cough induction by high-frequency chest percussion in healthy volunteers and patients with common cold].

PubMed

Lee, P C L; Eccles, R

2004-08-01

In patients with chronic obstructive pulmonary disease, chest percussion is often used to facilitate the drainage of respiratory secretions which may be removed from the airway by coughing. The cough reflex is believed to be mediated by mechanically sensitive rapidly adapting receptors (RARs). Chest percussion stimulation may stimulate RAR cough receptors, but there is no evidence that mechanical airway stimulation in man induces cough. The aim of this study was to determine if cough can be induced by high-frequency chest percussion in healthy subjects and in patients with acute upper respiratory tract infection (URTI). Two groups were studied: 15 healthy subjects and 29 subjects with URTI, mean age 22 years. Percussion stimulation (70 Hz) was applied to the chest. Cough frequency and latency were recorded. All subjects were asked to complete a questionnaire about how they felt after the chest percussion by questionnaires. The results demonstrate that high-frequency chest percussion causes cough in human subjects with a recent history of URTI, but induces relatively little cough in healthy subjects. In URTI subjects there was a significant increase in the number of coughs after three periods of airway vibration, whereas in healthy subjects there was no change in cough. Furthermore, analysis of the questionnaires showed that more of the subjects with URTI felt an urge to cough compared to the healthy subjects in the subjective questionnaires. This study demonstrates that cough can be induced in subjects with URTI by chest percussion. This method of inducing cough in subjects with URTI may be useful for studies on the mechanism of cough and for studies on antitussive medicines.

Resuscitation quality of rotating chest compression providers at one-minute vs. two-minute intervals: A mannequin study.

PubMed

Kılıç, D; Göksu, E; Kılıç, T; Buyurgan, C S

2018-05-01

The aim of this randomized cross-over study was to compare one-minute and two-minute continuous chest compressions in terms of chest compression only CPR quality metrics on a mannequin model in the ED. Thirty-six emergency medicine residents participated in this study. In the 1-minute group, there was no statistically significant difference in the mean compression rate (p=0.83), mean compression depth (p=0.61), good compressions (p=0.31), the percentage of complete release (p=0.07), adequate compression depth (p=0.11) or the percentage of good rate (p=51) over the four-minute time period. Only flow time was statistically significant among the 1-minute intervals (p<0.001). In the 2-minute group, the mean compression depth (p=0.19), good compression (p=0.92), the percentage of complete release (p=0.28), adequate compression depth (p=0.96), and the percentage of good rate (p=0.09) were not statistically significant over time. In this group, the number of compressions (248±31 vs 253±33, p=0.01) and mean compression rates (123±15 vs 126±17, p=0.01) and flow time (p=0.001) were statistically significant along the two-minute intervals. There was no statistically significant difference in the mean number of chest compressions per minute, mean chest compression depth, the percentage of good compressions, complete release, adequate chest compression depth and percentage of good compression between the 1-minute and 2-minute groups. There was no statistically significant difference in the quality metrics of chest compressions between 1- and 2-minute chest compression only groups. Copyright © 2017 Elsevier Inc. All rights reserved.

Number of Ribs Resected is Associated with Respiratory Complications Following Lobectomy with en bloc Chest Wall Resection.

PubMed

Geissen, Nicole M; Medairos, Robert; Davila, Edgar; Basu, Sanjib; Warren, William H; Chmielewski, Gary W; Liptay, Michael J; Arndt, Andrew T; Seder, Christopher W

2016-08-01

Pulmonary lobectomy with en bloc chest wall resection is a common strategy for treating lung cancers invading the chest wall. We hypothesized a direct relationship exists between number of ribs resected and postoperative respiratory complications. An institutional database was queried for patients with non-small cell lung cancer that underwent lobectomy with en bloc chest wall resection between 2003 and 2014. Propensity matching was used to identify a cohort of patients who underwent lobectomy via thoracotomy without chest wall resection. Patients were propensity matched on age, gender, smoking history, FEV1, and DLCO. The relationship between number of ribs resected and postoperative respiratory complications (bronchoscopy, re-intubation, pneumonia, or tracheostomy) was examined. Sixty-eight patients (34 chest wall resections; 34 without chest wall resection) were divided into 3 cohorts: cohort A = 0 ribs resected (n = 34), cohort B = 1-3 ribs resected (n = 24), and cohort C = 4-6 ribs resected (n = 10). Patient demographics were similar between cohorts. The 90-day mortality rate was 2.9 % (2/68) and did not vary between cohorts. On multivariate analysis, having 1-3 ribs resected (OR 19.29, 95 % CI (1.33, 280.72); p = 0.03), 4-6 ribs resected [OR 26.66, (1.48, 481.86); p = 0.03), and a lower DLCO (OR 0.91, (0.84, 0.99); p = 0.02) were associated with postoperative respiratory complications. In patients undergoing lobectomy with en bloc chest wall resection for non-small cell lung cancer, the number of ribs resected is directly associated with incidence of postoperative respiratory complications.

Masculine Chest-Wall Contouring in FtM Transgender: a Personal Approach.

PubMed

Lo Russo, Giulia; Tanini, Sara; Innocenti, Marco

2017-04-01

Chest-wall contouring surgery is one of the first steps in sexual reassignment in female-to-male (FtM) transsexuals that contributes to strengthening of the self-image and facilitates living in the new gender role. The main goal is to masculinize the chest by removing the female contour. Chest contour, scar placement, scar shape, scar length, nipple-areola position, nipple size and the areola size are the key points. Between July 2013 and June 2016, 25 FtM transgender patients underwent surgical procedures to create a masculine chest-wall contour. In our study, we just considered 16 patients who have undergone chest surgery with the double incision method. The patients' survey revealed a high satisfaction rate with the aesthetic result. In our group, no complications occurred, and two patients have undergone supplementary surgery for axillary dog-ear revision and nipple reconstruction. The authors propose a new technical approach and indications for FtM transgender patients' surgery. A longer scar that emphasizes the pectoralis muscle, a smaller nipple and a resized and refaced areola are the key points of our technique to give a masculine appearance to the chest. The scars are permanent, but most of them will fade and the patients are enthusiastic with their new "male" chest appearance. The high level of satisfaction, the great aesthetic result and the low rate of complications suggest to us the use of this technique in medium- and large-size breasts. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Instructions to “push as hard as you can” improve average chest compression depth in dispatcher-assisted Cardiopulmonary Resuscitation

PubMed Central

Mirza, Muzna; Brown, Todd B.; Saini, Devashish; Pepper, Tracy L; Nandigam, Hari Krishna; Kaza, Niroop; Cofield, Stacey S.

2008-01-01

Background and Objective Cardiopulmonary Resuscitation (CPR) with adequate chest compression depth appears to improve first shock success in cardiac arrest. We evaluate the effect of simplification of chest compression instructions on compression depth in dispatcher-assisted CPR protocol. Methods Data from two randomized, double-blinded, controlled trials with identical methodology were combined to obtain 332 records for this analysis. Subjects were randomized to either modified Medical Priority Dispatch System (MPDS) v11.2 protocol or a new simplified protocol. The main difference between the protocols was the instruction to “push as hard as you can” in the simplified protocol, compared to “push down firmly 2 inches (5cm)” in MPDS. Data were recorded via a Laerdal® ResusciAnne® SkillReporter™ manikin. Primary outcome measures included: chest compression depth, proportion of compressions without error, with adequate depth and with total release. Results Instructions to “push as hard as you can”, compared to “push down firmly 2 inches (5cm)”, resulted in improved chest compression depth (36.4 vs 29.7 mm, p<0.0001), and improved median proportion of chest compressions done to the correct depth (32% vs <1%, p<0.0001). No significant difference in median proportion of compressions with total release (100% for both) and average compression rate (99.7 vs 97.5 per min, p<0.56) was found. Conclusions Modifying dispatcher-assisted CPR instructions by changing “push down firmly 2 inches (5cm)” to “push as hard as you can” achieved improvement in chest compression depth at no cost to total release or average chest compression rate. PMID:18635306

Quality of Basic Life Support - A Comparison between Medical Students and Paramedics.

PubMed

Körber, Maria Isabel; Köhler, Thomas; Weiss, Verena; Pfister, Roman; Michels, Guido

2016-07-01

Poor survival rates after cardiac arrest can partly be explained by poor basic life support skills in medical professionals. This study aimed to assess quality of basic life support in medical students and paramedics. We conducted a prospective observational study with 100 early medical students (group A), 100 late medical students (group B) and 100 paramedics (group C), performing a 20-minute basic life support simulation in teams of two. Average frequency and absolute number of chest compressions per minute (mean (±SD)), chest decompression (millimetres of compression remaining, mean (±SD)), hands-off-time (seconds/minute, mean (±SD)), frequency of switching positions between ventilation and chest compression (per 20 minutes) and rate of sufficient compressions (depth ≥50mm) were assessed as quality parameters of CPR. In groups A, B and C the rates of sufficiently deep chest compressions were 56%, 42% and 52%, respectively, without significant differences. Male gender and real-life CPR experience were significantly associated with deeper chest compression. Frequency and number of chest compressions were within recommended goals in at least 96% of all groups. Remaining chest compressions were 6 mm (±2), 6 mm (±2) and 5 mm (±2) with a significant difference between group A and C (p=0.017). Hands-off times were 6s/min (±1), 5s/min (±1) and 4s/min (±1), which was significantly different across all three groups. Overall, paramedics tended to show better quality of CPR compared to medical students. Though, chest compression depth as an important quality characteristic of CPR was insufficient in almost 50% of participants, even in well trained paramedics. Therefore, we suggest that an effort should be made to find better ways to educate health care professionals in BLS.

Radiation therapy for breast cancer: Literature review

DOE Office of Scientific and Technical Information (OSTI.GOV)

Balaji, Karunakaran, E-mail: karthik.balaji85@gmail.com; School of Advanced Sciences, VIT University, Vellore; Subramanian, Balaji

Concave shape with variable size target volume makes treatment planning for the breast/chest wall a challenge. Conventional techniques used for the breast/chest wall cancer treatment provided better sparing of organs at risk (OARs), with poor conformity and uniformity to the target volume. Advanced technologies such as intensity modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) improve the target coverage at the cost of higher low dose volumes to OARs. Novel hybrid techniques present promising results in breast/chest wall irradiation in terms of target coverage as well as OARs sparing. Several published data compared these technologies for the benefit ofmore » the breast/chest wall with or without nodal volumes. The aim of this article is to review relevant data and identify the scope for further research in developing optimal treatment plan for breast/chest wall cancer treatment.« less

Automated method and system for the alignment and correlation of images from two different modalities

DOEpatents

Giger, Maryellen L.; Chen, Chin-Tu; Armato, Samuel; Doi, Kunio

1999-10-26

A method and system for the computerized registration of radionuclide images with radiographic images, including generating image data from radiographic and radionuclide images of the thorax. Techniques include contouring the lung regions in each type of chest image, scaling and registration of the contours based on location of lung apices, and superimposition after appropriate shifting of the images. Specific applications are given for the automated registration of radionuclide lungs scans with chest radiographs. The method in the example given yields a system that spatially registers and correlates digitized chest radiographs with V/Q scans in order to correlate V/Q functional information with the greater structural detail of chest radiographs. Final output could be the computer-determined contours from each type of image superimposed on any of the original images, or superimposition of the radionuclide image data, which contains high activity, onto the radiographic chest image.

Spontaneous pneumomediastinum and subcutaneous emphysema in systemic lupus erythematosus

PubMed Central

Ahmed, AlaEldin H; Awouda, Elrasheid A

2010-01-01

We report a case of a 29-year-old woman who is known to have systemic lupus erythematosus and idiopathic interstitial pneumonia; she presented with a 1-day history of substernal chest pain and increasing shortness of breath. On examination, she was found breathless, but was not distressed or afebrile or normotensive. Auscultation of the heart revealed a positive Hamman's sign. There was chest-wall crepitus, and auscultation of the lung showed bilateral crepitations. Full blood count and biochemical profile were unremarkable. Chest x-ray showed signs of idiopathic interstitial pneumonia in addition to pneumomediastinum (linear band of air within mediastinal planes and continuous diaphragm sign) and chest-wall subcutaneous emphysema. She was treated with high-concentration oxygen. A repeat chest x-ray 5 days later showed complete resolution of the pneumomediastinum and subcutaneous emphysema, but signs of idiopathic interstitial pneumonia continued to persist. PMID:22767622

A new chest pain strategy in Thunder Bay.

PubMed

Mutrie, D

1999-04-01

Thunder Bay Regional Hospital (TBRH) developed a chest pain strategy (CPS) to support its emergency physicians in making the difficult clinical decisions required to properly evaluate and manage ED "chest pain" patients. This strategy was developed to ensure excellent patient care in a setting of diminished inpatient bed availability and increasing ED congestion. It focuses on rapid risk stratification, using history, electrocardiogram, physical examination and 3 new point-of-care cardiac markers: myoglobin, CK-MB mass, and cardiac troponin I. Following the introduction of the CPS in 1997, TBRH realized significant ($500 000/yr) institutional resource savings through a 60% decrease in the admission rate of non-myocardial infarction, non-unstable angina chest pain patients, a 30% decrease in ED chest pain evaluation time, and improved ED availability of monitored stretchers. The CPS has allowed TBRH to simultaneously decrease costs and improve patient care.

The Role of Echocardiography in Coronary Artery Disease and Acute Myocardial Infarction

PubMed Central

Esmaeilzadeh, Maryam; Parsaee, Mozhgan; Maleki, Majid

2013-01-01

Echocardiography is a non-invasive diagnostic technique which provides information regarding cardiac function and hemodynamics. It is the most frequently used cardiovascular diagnostic test after electrocardiography and chest X-ray. However, in a patient with acute chest pain, Transthoracic Echocardiography is essential both for diagnosing acute coronary syndrome, zeroing on the evaluation of ventricular function and the presence of regional wall motion abnormalities, and for ruling out other etiologies of acute chest pain or dyspnea, including aortic dissection and pericardial effusion. Echocardiography is a versatile imaging modality for the management of patients with chest pain and assessment of left ventricular systolic function, diastolic function, and even myocardial and coronary perfusion and is, therefore, useful in the diagnosis and triage of patients with acute chest pain or dyspnea. This review has focused on the current applications of echocardiography in patients with coronary artery disease and myocardial infarction. PMID:23646042

Tension bulla: a cause of reversible pulmonary hypertension.

PubMed

Waxman, Michael J; Waxman, Jacob D; Forman, John M

2015-01-01

A tension pneumothorax represents a medical emergency warranting urgent diagnosis and treatment. A rapidly expanding bulla may resemble the same clinical presentation but requires an entirely different treatment. A 53-year-old woman presented with increasing shortness of breath and her physical examination and chest x-ray were interpreted as showing a tension pneumothorax. A chest tube was placed which did not resolve the process. Placement of a second chest tube was likewise unsuccessful. A chest CT was then performed and was interpreted as showing an unresolved tension pneumothorax, despite seemingly adequate placement of the 2 chest tubes. Further review of the CT showed the border of a giant bulla and a tentative diagnosis was made of a rapidly expanding bulla with tension physiology. Echocardiogram revealed significant pulmonary hypertension. The bulla was surgically excised, the patient had marked improvement in her clinical symptoms and signs, and echocardiographic follow-up showed complete resolution of the pulmonary hypertension.

Loculated pneumothorax due to a rare combination resulting in an interesting chest radiograph.

PubMed

Isaac, Barney Thomas Jesudason; Samuel, Johnson Thamarathu; Mukherjee, Dipak K; Pittman, Marcus

2017-11-01

A 35 years old man presented with acute onset left sided pleuritic chest pain and shortness of breath. On evaluation, he was found to have an interesting chest radiograph which showed a loculated pneumothorax with collapse of the left upper lobe and lingula but fully expanded left lower lobe. He is a known asthmatic who had allergic broncho pulmonary aspergillosis (ABPA) previously with left upper lobe and lingular collapse secondary to mucous plugging. This resolved on treatment with steroids and itraconazole. An interesting combination of events is proposed to explain the current presentation. CT scan chest and blood tests confirmed this sequence of events. He was appropriately treated resulting in complete clinical and radiological recovery. The events leading to the presentation and the likely physiological background for this interesting chest radiograph are discussed. © 2016 John Wiley & Sons Ltd.

Estimated Probabililty of Chest Injury During an International Space Station Mission

NASA Technical Reports Server (NTRS)

Lewandowski, Beth E.; Milo, Eric A.; Brooker, John E.; Weaver, Aaron S.; Myers, Jerry G., Jr.

2013-01-01

The Integrated Medical Model (IMM) is a decision support tool that is useful to spaceflight mission planners and medical system designers when assessing risks and optimizing medical systems. The IMM project maintains a database of medical conditions that could occur during a spaceflight. The IMM project is in the process of assigning an incidence rate, the associated functional impairment, and a best and a worst case end state for each condition. The purpose of this work was to develop the IMM Chest Injury Module (CIM). The CIM calculates the incidence rate of chest injury per person-year of spaceflight on the International Space Station (ISS). The CIM was built so that the probability of chest injury during one year on ISS could be predicted. These results will be incorporated into the IMM Chest Injury Clinical Finding Form and used within the parent IMM model.

Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial

PubMed Central

Ober, Julian; Walker, Tilman; Bergdolt, Christian; Friedrich, Mirco; Müller-Stich, Beat Peter; Forchheim, Franziska; Fischer, Christian; Schmidmaier, Gerhard; Tanner, Michael C

2018-01-01

Background The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. Objective The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). Methods In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module “Thoracocentesis” discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants’ performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their individual training level, as well as previous experiences, gender, and hobbies. Primary end point was operative performance during chest tube insertion by direct observance. Results A total of 183 students enrolled, 116 students participated (63.4%), and 21 were excluded because of previous experiences in chest tube insertion. Students were randomized to the intervention group (49/95, 52%) and control group (46/95, 48%). The intervention group performed significantly better than the control group (Intervention group: 38.0 [I50=7.0] points; control group: 30.5 [I50=8.0] points; P<.001). The intervention group showed significantly improved economy of time and motion (P=.004), needed significantly less help (P<.001), and was more confident in handling of instruments (P<.001) than the control group. Conclusions The results from this study show that serious games are a valid and effective tool in education of operative performance in chest tube insertion. We believe that serious games should be implemented in the surgical curriculum, as well as residency programs, in addition to traditional learning methods. Trial Registration German Clinical Trials Register (DRKS) DRKS00009994; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009994 (Archived by Webcite at http://www.webcitation.org/6ytWF1CWg) PMID:29784634

Spontaneous esophageal-pleural fistula

PubMed Central

Vyas, Sameer; Prakash, Mahesh; Kaman, Lileshwar; Bhardwaj, Nidhi; Khandelwal, Niranjan

2011-01-01

Spontaneous esophageal-pleural fistula (EPF) is a rare entity. We describe a case in a middle-aged female who presented with severe retrosternal chest pain and shortness of breadth. Chest computed tomography showed right EPF and hydropneumothorax. She was managed conservatively keeping the chest tube drainage and performing feeding jejunostomy. A brief review of the imaging finding and management of EPF is discussed. PMID:22084548

Chest Wall Motion during Speech Production in Patients with Advanced Ankylosing Spondylitis

ERIC Educational Resources Information Center

Kalliakosta, Georgia; Mandros, Charalampos; Tzelepis, George E.

2007-01-01

Purpose: To test the hypothesis that ankylosing spondylitis (AS) alters the pattern of chest wall motion during speech production. Method: The pattern of chest wall motion during speech was measured with respiratory inductive plethysmography in 6 participants with advanced AS (5 men, 1 woman, age 45 plus or minus 8 years, Schober test 1.45 plus or…

Subperitoneal extension of disease processes between the chest, abdomen, and the pelvis.

PubMed

Osman, Sherif; Moshiri, Mariam; Robinson, Tracy J; Gunn, Martin; Lehnert, Bruce; Sundarkumar, Dinesh; Katz, Douglas S

2015-08-01

The subserous space is a large, anatomically continuous potential space that interconnects the chest, abdomen, and pelvis. The subserous space is formed from areolar and adipose tissue, and contains branches of the vascular, lymphatic, and nervous systems. As such, it provides one large continuous space in which many disease processes can spread between the chest, abdomen, and the pelvis.

Diagnosis of Grave's disease with pulmonary hypertension on chest CT.

PubMed

Lee, Hwa Yeon; Yoo, Seung Min; Kim, Hye Rin; Chun, Eun Ju; White, Charles S

To evaluate the diagnostic accuracy of chest CT findings to diagnose Grave's disease in pulmonary hypertension. We retrospectively evaluated chest CT and the medical records of 13 patients with Grave's disease with (n=6) or without pulmonary hypertension (n=7) and in 17 control patients. Presence of iso-attenuation of diffusely enlarged thyroid glands compared with adjacent neck muscle on non-enhanced CT as a diagnostic clue of Grave's disease, and assessment of pulmonary hypertension on CT has high diagnostic accuracy. Chest CT has the potential to diagnose Grave's disease with pulmonary hypertension in the absence of other information. Copyright © 2017 Elsevier Inc. All rights reserved.

Liposarcoma of the chest wall. Transformation of dedifferentiated liposarcoma from a recurrent lipoma.

PubMed

Bicakcioglu, Pinar; Sak, Serpil D; Tastepe, Abdullah I

2012-08-01

Liposarcoma is the second most common soft tissue sarcoma after malignant fibrous histiocytoma in adults. It is frequently found in the extremities and retroperitoneum; rarely it can be seen in the chest wall. We report a rare case of giant liposarcoma originating from the chest wall representing a transformation of a relapsing lipoma in the same region. We performed chest wall resection, reconstruction with latissimus dorsi muscle transposition via posterolateral thoracotomy. The patient received 4 series of adjuvant chemotherapy after the postoperative diagnosis of dedifferentiated liposarcoma. The patient had no postoperative complication and has remained disease-free for 30 months.

An accelerated diagnostic protocol for the early, safe discharge of low-risk chest pain patients.

PubMed

Altherwi, Tawfeeq; Grad, Willis B

2015-07-01

Can an accelerated 2-hour diagnostic protocol using the cardiac troponin I (cTnI) measurement as the only biomarker be implemented to allow an earlier and safe discharge of low-risk chest pain patients? Than M, Cullen L, Aldous S, et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol 2012;59(23):2091-8. To determine whether an accelerated diagnostic protocol (ADP) for possible cardiac chest pain could identify low-risk patients suitable for early discharge using cTnI as the sole biomarker.

The floating cardiac fat pad-sign of occult pneumothorax.

PubMed

Kaufman, Claire; Bokhari, S A Jamal

2016-08-01

Pneumothoraces are a possible sequela of chest trauma with potential morbidity and mortality if not recognized and treated promptly. A portable supine chest radiograph is frequently the first radiologic study performed in the setting of trauma. While large pneumothoraces can be readily recognized on these radiographs, smaller pneumothoraces are missed in up to 15 % of trauma patients. There are many radiographic signs of occult pneumothoraces, and we are presenting a new radiographic sign of occult pneumothorax. The floating cardiac fat pad sign occurs when pleural air collects anteriorly and superiorly in the most non-dependent portion of the chest lifting the pericardial fat pad off the diaphragm. Lung markings are still seen surrounding the pericardial fat pad due to the inflated lower lobe of the lung resting dependently. Rapid and accurate identification of pneumothoraces is critical but often difficult on chest radiographs. Although there are many existing radiographic signs for identification of pneumothorax, prospective identification of small pneumothoraces is still relatively poor. Here, we describe an additional sign which aides in the detection of pneumothoraces, the floating cardiac fat pad. When present, this should prompt further evaluation with chest CT or upright chest radiograph.

A study of the complications of small bore 'Seldinger' intercostal chest drains.

PubMed

Davies, Helen E; Merchant, Shairoz; McGown, Anne

2008-06-01

Use of small bore chest drains (<14F), inserted via the Seldinger technique, has increased globally over the last few years. They are now used as first line interventions in most acute medical situations when thoracostomy is required. Limited data are available on the associated complications. In this study, the frequency of complications associated with 12F chest drains, inserted using the Seldinger technique, was quantified. A retrospective case note audit was performed of consecutive patients requiring pleural drainage over a 12-month period. One hundred consecutive small bore Seldinger (12F) chest drain insertions were evaluated. Few serious complications occurred. However, 21% of the chest drains were displaced ('fell out') and 9% of the drains became blocked. This contributed to high morbidity rates, with 13% of patients requiring repeat pleural procedures. The frequency of drain blockage in pleural effusion was reduced by administration of regular normal saline drain flushes (odds ratio for blockage in flushed drains compared with non-flushed drains 0.04, 95% CI: 0.01-0.37, P < 0.001). Regular chest drain flushes are advocated in order to reduce rates of drain blockage, and further studies are needed to determine optimal fixation strategies that may reduce associated patient morbidity.

Toward the detection of abnormal chest radiographs the way radiologists do it

NASA Astrophysics Data System (ADS)

Alzubaidi, Mohammad; Patel, Ameet; Panchanathan, Sethuraman; Black, John A., Jr.

2011-03-01

Computer Aided Detection (CADe) and Computer Aided Diagnosis (CADx) are relatively recent areas of research that attempt to employ feature extraction, pattern recognition, and machine learning algorithms to aid radiologists in detecting and diagnosing abnormalities in medical images. However, these computational methods are based on the assumption that there are distinct classes of abnormalities, and that each class has some distinguishing features that set it apart from other classes. However, abnormalities in chest radiographs tend to be very heterogeneous. The literature suggests that thoracic (chest) radiologists develop their ability to detect abnormalities by developing a sense of what is normal, so that anything that is abnormal attracts their attention. This paper discusses an approach to CADe that is based on a technique called anomaly detection (which aims to detect outliers in data sets) for the purpose of detecting atypical regions in chest radiographs. However, in order to apply anomaly detection to chest radiographs, it is necessary to develop a basis for extracting features from corresponding anatomical locations in different chest radiographs. This paper proposes a method for doing this, and describes how it can be used to support CADe.

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

PubMed

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

2017-01-01

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

A Review of Esophageal Chest Pain

PubMed Central

Coss-Adame, Enrique

2015-01-01

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

Chest circumference and birth weight are good predictors of lung function in preschool children from an e-waste recycling area.

PubMed

Zeng, Xiang; Xu, Xijin; Zhang, Yuling; Li, Weiqiu; Huo, Xia

2017-10-01

The purpose of this study was to investigate the associations between birth weight, chest circumference, and lung function in preschool children from e-waste exposure area. A total of 206 preschool children from Guiyu (an e-waste recycling area) and Haojiang and Xiashan (the reference areas) in China were recruited and required to undergo physical examination, blood tests, and lung function tests during the study period. Birth outcome such as birth weight and birth height were obtained by questionnaire. Children living in the e-waste-exposed area have a lower birth weight, chest circumference, height, and lung function when compare to their peers from the reference areas (all p value <0.05). Both Spearman and partial correlation analyses showed that birth weight and chest circumference were positively correlated with lung function levels including forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV 1 ). After adjustment for the potential confounders in further linear regression analyses, birth weight, and chest circumference were positively associated with lung function levels, respectively. Taken together, birth weight and chest circumference may be good predictors for lung function levels in preschool children.

Chest physical therapy: comparative efficacy of preoperative and postoperative in the elderly.

PubMed

Castillo, R; Haas, A

1985-06-01

Although chest physical therapy (PT) immediately after surgery lowers the risk of postoperative pulmonary complications, several reports indicate preoperative chest PT results in further improvement. This study compares the effects of initiating chest PT either before and/or after chest surgery in patients over age 65. We studied two groups: 130 patients (the PRE group) undergoing both pre- and postoperative therapy and 150 patients (the POST group) undergoing only postoperative therapy, dividing them into four surgical subgroups: lung, cardiac and other thoracic surgery, upper abdominal, and lower abdominal (considered low risk compared with the other three). Overall complication rates and atelectasis rates were significantly lower in the PRE high-risk subgroups. PRE and POST pneumonia rates, however, were statistically equivalent in all surgical subgroups. Since the low rate of pulmonary complications for PRE-group patients undergoing thoracic or upper abdominal procedures is comparable to that for PRE-group therapy in much younger populations, advanced age alone does not appear to be a significant risk factor. The lack of effect on incidence of pneumonia indicates that preoperative chest PT only counters the altered pulmonary mechanics responsible for atelectasis, but has no effect on pulmonary complications due to infection.

Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma.

PubMed

Wilkerson, R Gentry; Stone, Michael B

2010-01-01

Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from 86% to 98% and 97% to 100%, respectively. The sensitivity of supine AP chest radiographs for the detection of pneumothorax ranged from 28% to 75%. The specificity of supine AP chest radiographs was 100% in all included studies. This evidence-based review suggests that bedside thoracic US is a more sensitive screening test than supine AP chest radiography for the detection of pneumothorax in adult patients with blunt chest trauma. (c) 2010 by the Society for Academic Emergency Medicine.

[Radiation exposure of children in pediatric radiology. Part 5: organ doses in chest radiography].

PubMed

Seidenbusch, M C; Schneider, K

2009-05-01

Reconstruction of organ doses of selected organs and tissues from radiographic settings and exposure data collected during chest X-ray examinations of children of various age groups performed in Dr. von Hauner's Kinderspital (children's hospital of the University of Munich, DvHK) between 1976 and 2007. The dosimetric data of all X-ray examinations performed since 1976 at DvHK were stored electronically in a database. After 30 years of data collection, the database now includes 305 107 radiological examinations (radiographs and fluoroscopies), especially 119 150 chest radiographs of all age groups. Reconstruction of organ doses in 40 organs and tissues in X-ray examinations of the chest was performed based on the conversion factor concept. The radiation exposure of organs in projection radiography is determined by the exact site of the organs relative to the edges of the X-ray field and the beam direction of X-rays. Optimal collimation in chest radiography can reduce the exposure of organs located at the periphery of the X-ray field, e. g. thyroid gland, stomach and partially the liver, by a factor of 2 to 3, while organs located in the center of the X-ray-field, e. g. thymus, breasts, lungs, esophagus and red bone marrow, are not affected by exact collimation. The high frequency of the roentgen examination of the chest in early age groups increases the collective radiation burden to radiosensitive organs. Therefore, radiation protection of the patient during chest radiographies remains of great importance.

The frequency of various indications for plain chest radiography in Nnamdi Azikiwe University Teaching Hospital, Nnewi (NAUTH).

PubMed

Okpala, O C; Okafor, C; Aronu, M E

2013-01-01

With soaring advances in the field of medicine, the place of older radiologic imaging modalities is being reduced to basic screening tools. Yet the modern imaging modalities like computerized tomography (CT), magnetic resonance imaging (MRI), ultrasound and nuclear medicine are hardly available. To study the frequency of various indications of plain chest radiography, remind us of its uses and to enhance the preparedness of the department to maximally accomplish the ideals of this investigation. A total of 1476 consecutive patients for chest radiography in the department of radiology, NAUTH, Nnewi from the period of February 2009 and whose request form contain adequate data were recruited for this study. These data were analyzed using SSPS. A total of 1476 patient were included in this study. There was female preponderance with male to female ratio of 1.3:1. Mean Age of the patients is 39.32 years (std19.56). The most frequent indication for chest radiography is certain infections and parasitic diseases (40.9% and the greatest source of referral for this study is General outpatient (GOPD)/family medicine department. The most frequent indications for chest radiography in the study are certain infection and parasitic diseases. Chest Radiography is the most frequent plain radiography study in our environment where infectious diseases are still very rampant. This makes chest radiography an important study for screening patient for possible diagnosis and classifying the need for further radiographic investigation of our patients.

Impact of chest radiography for children with lower respiratory tract infection: a propensity score approach.

PubMed

Ecochard-Dugelay, Emmanuelle; Beliah, Muriel; Boisson, Caroline; Perreaux, Francis; de Laveaucoupet, Jocelyne; Labrune, Philippe; Epaud, Ralph; Ducou-Lepointe, Hubert; Bouyer, Jean; Gajdos, Vincent

2014-01-01

Management of acute respiratory tract infection varies substantially despite this being a condition frequently encountered in pediatric emergency departments. Previous studies have suggested that the use of antibiotics was higher when chest radiography was performed. However none of these analyses had considered the inherent indication bias of observational studies. The aim of this work was to assess the relationship between performing chest radiography and prescribing antibiotics using a propensity score analysis to address the indication bias due to non-random radiography assignment. We conducted a prospective study of 697 children younger than 2 years of age who presented during the winter months of 2006-2007 for suspicion of respiratory tract infection at the Pediatric Emergency Department of an urban general hospital in France (Paris suburb). We first determined the individual propensity score (probability of having a chest radiography according to baseline characteristics). Then we assessed the relation between radiography and antibiotic prescription using two methods: adjustment and matching on the propensity score. We found that performing a chest radiography lead to more frequent antibiotic prescription that may be expressed as OR = 2.3, CI [1.3-4.1], or as an increased use of antibiotics of 18.6% [0.08-0.29] in the group undergoing chest radiography. Chest radiography has a significant impact on the management of infants admitted for suspicion of respiratory tract infection in a pediatric emergency department and may lead to unnecessary administration of antibiotics.

Outcome of recommendations for radiographic follow-up of pneumonia on outpatient chest radiography.

PubMed

Little, Brent P; Gilman, Matthew D; Humphrey, Kathryn L; Alkasab, Tarik K; Gibbons, Fiona K; Shepard, Jo-Anne O; Wu, Carol C

2014-01-01

Follow-up chest radiographs are frequently recommended by radiologists to document the clearing of radiographically suspected pneumonia. However, the clinical utility of follow-up radiography is not well understood. The purpose of this study was to examine the incidence of important pulmonary pathology revealed during follow-up imaging of suspected pneumonia on outpatient chest radiography. Reports of 29,138 outpatient chest radiography examinations performed at an academic medical center in 2008 were searched to identify cases in which the radiologist recommended follow-up chest radiography for presumed community-acquired pneumonia (n = 618). Descriptions of index radiographic abnormalities were recorded. Reports of follow-up imaging (radiography and CT) performed during the period from January 2008 to January 2010 were reviewed to assess the outcome of the index abnormality. Clinical history, demographics, microbiology, and pathology reports were reviewed and recorded. Compliance with follow-up imaging recommendations was 76.7%. In nine of 618 cases (1.5%), a newly diagnosed malignancy corresponded to the abnormality on chest radiography initially suspected to be pneumonia. In 23 of 618 cases (3.7%), an alternative nonmalignant disease corresponded with the abnormality on chest radiography initially suspected to be pneumonia. Therefore, in 32 of 618 patients (5.2%), significant new pulmonary diagnoses were established during follow-up imaging of suspected pneumonia. Follow-up imaging of radiographically suspected pneumonia leads to a small number of new diagnoses of malignancy and important nonmalignant diseases, which may alter patient management.

Radiation risk assessment in neonatal radiographic examinations of the chest and abdomen: a clinical and Monte Carlo dosimetry study

NASA Astrophysics Data System (ADS)

Makri, T.; Yakoumakis, E.; Papadopoulou, D.; Gialousis, G.; Theodoropoulos, V.; Sandilos, P.; Georgiou, E.

2006-10-01

Seeking to assess the radiation risk associated with radiological examinations in neonatal intensive care units, thermo-luminescence dosimetry was used for the measurement of entrance surface dose (ESD) in 44 AP chest and 28 AP combined chest-abdominal exposures of a sample of 60 neonates. The mean values of ESD were found to be equal to 44 ± 16 µGy and 43 ± 19 µGy, respectively. The MCNP-4C2 code with a mathematical phantom simulating a neonate and appropriate x-ray energy spectra were employed for the simulation of the AP chest and AP combined chest-abdominal exposures. Equivalent organ dose per unit ESD and energy imparted per unit ESD calculations are presented in tabular form. Combined with ESD measurements, these calculations yield an effective dose of 10.2 ± 3.7 µSv, regardless of sex, and an imparted energy of 18.5 ± 6.7 µJ for the chest radiograph. The corresponding results for the combined chest-abdominal examination are 14.7 ± 7.6 µSv (males)/17.2 ± 7.6 µSv (females) and 29.7 ± 13.2 µJ. The calculated total risk per radiograph was low, ranging between 1.7 and 2.9 per million neonates, per film, and being slightly higher for females. Results of this study are in good agreement with previous studies, especially in view of the diversity met in the calculation methods.

Diagnosing pulmonary edema: lung ultrasound versus chest radiography.

PubMed

Martindale, Jennifer L; Noble, Vicki E; Liteplo, Andrew

2013-10-01

Diagnosing the underlying cause of acute dyspnea can be challenging. Lung ultrasound may help to identify pulmonary edema as a possible cause. To evaluate the ability of residents to recognize pulmonary edema on lung ultrasound using chest radiographs as a comparison standard. This is a prospective, blinded, observational study of a convenience sample of resident physicians in the Departments of Emergency Medicine (EM), Internal Medicine (IM), and Radiology. Residents were given a tutorial on interpreting pulmonary edema on both chest radiograph and lung ultrasound. They were then shown both ultrasounds and chest radiographs from 20 patients who had presented to the emergency department with dyspnea, 10 with a primary diagnosis of pulmonary edema, and 10 with alternative diagnoses. Cohen's κ values were calculated to describe the strength of the correlation between resident and gold standard interpretations. Participants included 20 EM, 20 IM, and 20 Radiology residents. The overall agreement with gold standard interpretation of pulmonary edema on lung ultrasound (74%, κ = 0.51, 95% confidence interval 0.46-0.55) was superior to chest radiographs (58%, κ = 0.25, 95% confidence interval 0.20-0.30) (P < 0.0001). EM residents interpreted lung ultrasounds more accurately than IM residents. Radiology residents interpreted chest radiographs more accurately than did EM and IM residents. Residents were able to more accurately identify pulmonary edema with lung ultrasound than with chest radiograph. Physicians with minimal exposure to lung ultrasound may be able to correctly recognize pulmonary edema on lung ultrasound.

[Pectus excavatum: what treatment in plastic surgery? About 10 cases].

PubMed

Poupon, M; Duteille, F; Casanova, D; Caye, N; Magalon, G; Pannier, M

2008-06-01

Several controversial issues concern pectus excavatum (funnel chest), the most common chest wall deformity. The pathogenesis of this deformity is uncertain, and there is no agreement as to its psychological, cardiac and pulmonary effects. An even more debatable point is the choice of surgical treatment among the more or less radical proposals made by different teams. No consensus exists concerning the indications for surgery, the technique to be used, or the suitable age of the patient. This retrospective study concerns 10 patients with funnel chest who underwent reconstruction surgery in our unit between 1989 and 2002. Nine patients received a silicone chest implant made to measure, and one a single breast implant. Each patient was interviewed and examined to obtain information and provide a basis for evaluation. The effects of possible associated abnormalities were evidenced by complementary cardiopulmonary examinations, and the severity of funnel chest was evaluated according to the Haller pectus index. The mean period after surgery was 5 years. The effects of funnel chest deformity were essentially psychological, relating to aesthetic disgrace. Although two-thirds of the deformities were considered severe, cardiopulmonary repercussions were minor. All 10 patients were satisfied with the repair performed, and this judgment was independent of surgical assessment. Acute complications concerned 5 seromas and one minimal scar separation. The indications for surgery and the means of surgical treatment for funnel chest are considered after comparison of our results with those in the literature and a survey of the different existing possibilities for treatment (implant, chondrosternoplasty, fat transplant).

Comparison of pigtail catheter with chest tube for drainage of parapneumonic effusion in children.

PubMed

Lin, Chien-Heng; Lin, Wei-Ching; Chang, Jeng-Sheng

2011-12-01

The use of thoracostomy tube for drainage of parapneumonic effusion is an important therapeutic measure. In this study, we compared the effectiveness and complications between chest tube and pigtail catheter thoracostomy for drainage of parapneumonic pleural effusion in children. We retrospectively reviewed the medical records of children with parapneumonic effusion during the period of July 2001 through December 2003. Patients who received thoracostomy with either chest tube or pigtail catheter were enrolled into this study. Medical records, such as age, sex, clinical presentation, subsequent therapies, hospital stay, laboratory data, and complications, were collected and compared between these two methods of intervention. A total of 32 patients (17 boys and 15 girls; age range, 2-17 years; mean age, 14 years) were enrolled into the study. Twenty patients were treated with traditional chest tubes, whereas 12 patients were treated with pigtail catheters. In the chest tube group, drainage failure occurred in one patient and pneumothorax occurred in two patients. In the pigtail catheter group, drainage failure occurred in two patients, but no case was complicated with pneumothorax. There were no significant differences in either drainage days or hospitalization days between the chest tube group and pigtail catheter group (6.0 ± 2.6 vs. 5.9 ± 3.8, p=0.66; 12.5 ± 5.6 vs. 17.3 ± 8.5, p=0.13). The effectiveness and complications of the pigtail catheter were comparable to those of the chest tubes. Copyright © 2011. Published by Elsevier B.V.

Ineffective and prolonged apical contraction is associated with chest pain and ischaemia in apical hypertrophic cardiomyopathy.

PubMed

Stephenson, Edward; Monney, Pierre; Pugliese, Francesca; Malcolmson, James; Petersen, Steffen E; Knight, Charles; Mills, Peter; Wragg, Andrew; O'Mahony, Constantinos; Sekhri, Neha; Mohiddin, Saidi A

2018-01-15

To investigate the hypothesis that persistence of apical contraction into diastole is linked to reduced myocardial perfusion and chest pain. Apical hypertrophic cardiomyopathy (HCM) is defined by left ventricular (LV) hypertrophy predominantly of the apex. Hyperdynamic contractility resulting in obliteration of the apical cavity is often present. Apical HCM can lead to drug-refractory chest pain. We retrospectively studied 126 subjects; 76 with apical HCM and 50 controls (31 with asymmetrical septal hypertrophy (ASH) and 19 with non-cardiac chest pain and culprit free angiograms and structurally normal hearts). Perfusion cardiac magnetic resonance imaging (CMR) scans were assessed for myocardial perfusion reserve index (MPRi), late gadolinium enhancement (LGE), LV volumes (muscle and cavity) and regional contractile persistence (apex, mid and basal LV). In apical HCM, apical MPRi was lower than in normal and ASH controls (p<0.05). In apical HCM, duration of contractile persistence was associated with lower MPRi (p<0.01) and chest pain (p<0.05). In multivariate regression, contractile persistence was independently associated with chest pain (p<0.01) and reduced MPRi (p<0.001). In apical HCM, regional contractile persistence is associated with impaired myocardial perfusion and chest pain. As apical myocardium makes limited contributions to stroke volume, apical contractility is also largely ineffective. Interventions to reduce apical contraction and/or muscle mass are potential therapies for improving symptoms without reducing cardiac output. Copyright © 2017 Elsevier B.V. All rights reserved.

Relationship between the surrogate anthropometric measures, foot length and chest circumference and birth weight among newborns of Sarlahi, Nepal.

PubMed

Mullany, L C; Darmstadt, G L; Khatry, S K; Leclerq, S C; Tielsch, J M

2007-01-01

Classification of infants into low birth weight (LBW, <2500 g) or very low birth weight (VLBW, <2000 g) categories is a crucial step in targeting interventions to high-risk infants. To compare the validity of chest circumference and foot length as surrogate anthropometric measures for the identification of LBW and VLBW infants. Newborn infants (n=1640) born between March and June 2004 in 30 Village Development Committees of Sarlahi district, Nepal. Chest circumference, foot length and weight (SECA 727, precise to 2 g) of newborns were measured within 72 h after birth. The sensitivity, specificity and predictive values for a range of cutoff points of the anthropometric measures were estimated using the digital scale measurements as the gold standard. Among LBW infants (469/1640, 28.6%), chest circumference measures <30.3 cm were 91% sensitive and 83% specific. Similar levels of sensitivity for foot length were achieved only with considerable loss of specificity (<45%). Foot length measurements <6.9 cm were 88% sensitive and 86% specific for the identification of VLBW infants. Chest circumference was superior to foot length in classification of infants into birth weight categories. For the identification of VLBW infants, foot length performed well, and may be preferable to chest circumference, as the former measure does not require removal of infant swaddling clothes. In the absence of more precise direct measures of birth weight, chest circumference is recommended over foot length for the identification of LBW infants.

Mechanical versus manual chest compressions for out-of-hospital cardiac arrest: a meta-analysis of randomized controlled trials

PubMed Central

Tang, Lu; Gu, Wan-Jie; Wang, Fei

2015-01-01

Recent evidence regarding mechanical chest compressions in out-of-hospital cardiac arrest (OHCA) is conflicting. The objective of this study was to perform a meta-analysis of randomized controlled trials (RCTs) to compare the effect of mechanical versus manual chest compressions on resuscitation outcomes in OHCA. PubMed, Embase, the Cochrane Central Register of Controlled Trials, and the ClinicalTrials.gov registry were searched. In total, five RCTs with 12,510 participants were included. Compared with manual chest compressions, mechanical chest compressions did not significantly improve survival with good neurological outcome to hospital discharge (relative risks (RR) 0.80, 95% CI 0.61–1.04, P = 0.10; I2 = 65%), return of spontaneous circulation (RR 1.02, 95% CI 0.95–1.09, P = 0.59; I2 = 0%), or long-term (≥6 months) survival (RR 0.96, 95% CI 0.79–1.16, P = 0.65; I2 = 16%). In addition, mechanical chest compressions were associated with worse survival to hospital admission (RR 0.94, 95% CI 0.89–1.00, P = 0.04; I2 = 0%) and to hospital discharge (RR 0.88, 95% CI 0.78–0.99, P = 0.03; I2 = 0%). Based on the current evidence, widespread use of mechanical devices for chest compressions in OHCA cannot be recommended. PMID:26503429

Comparison of closed-chest drainage with rib resection closed drainage for treatment of chronic tuberculous empyema

PubMed Central

Fang, Yong; Xiao, Heping; Hu, Haili

2018-01-01

Background This study aimed to compare the efficacy of closed-chest drainage with rib resection closed drainage of chronic tuberculous empyema. Methods This retrospective study reviewed 86 patients with tuberculous empyema in Shanghai Pulmonary Hospital from August 2010 to November 2015. Among these included patients, 22 patients received closed-chest drainage, and 64 patients received rib resection closed drainage. Results The results showed that after intercostal chest closed drain treatment, 2 (9.09%) patients were recovery, 13 (59.09%) patients had significantly curative effect, 6 (27.27%) patients had partly curative effect, and 1 (4.55%) patient had negative effect. After treatment of rib resection closed drainage, 9 (14.06%) patients were successfully recovery, 31 (48.44%) patients had significantly curative effect, 19 (29.69%) patients had partly curative effect, and 5 (7.81%) patients had negative effect. There was no significant difference in the curative effect (P>0.05), while the average catheterization time of rib resection closed drainage (130.05±13.12 days) was significant longer than that (126.14±36.84 days) in course of intercostal chest closed drain (P<0.05). Conclusions This study had demonstrated that closed-chest drainage was an effective procedure for treating empyema in young patients. It was less invasive than rib resection closed drainage and was associated with less severe pain. We advocated closed-chest drainage for the majority of young patients with empyema, except for those with other diseases. PMID:29600066

Relationship between weight of rescuer and quality of chest compression during cardiopulmonary resuscitation

PubMed Central

2014-01-01

Background According to the guidelines for cardiopulmonary resuscitation (CPR), the rotation time for chest compression should be about 2 min. The quality of chest compressions is related to the physical fitness of the rescuer, but this was not considered when determining rotation time. The present study aimed to clarify associations between body weight and the quality of chest compression and physical fatigue during CPR performed by 18 registered nurses (10 male and 8 female) assigned to light and heavy groups according to the average weight for each sex in Japan. Methods Five-minute chest compressions were then performed on a manikin that was placed on the floor. Measurement parameters were compression depth, heart rate, oxygen uptake, integrated electromyography signals, and rating of perceived exertion. Compression depth was evaluated according to the ratio (%) of adequate compressions (at least 5 cm deep). Results The ratio of adequate compressions decreased significantly over time in the light group. Values for heart rate, oxygen uptake, muscle activity defined as integrated electromyography signals, and rating of perceived exertion were significantly higher for the light group than for the heavy group. Conclusion Chest compression caused increased fatigue among the light group, which consequently resulted in a gradual fall in the quality of chest compression. These results suggested that individuals with a lower body weight should rotate at 1-min intervals to maintain high quality CPR and thus improve the survival rates and neurological outcomes of victims of cardiac arrest. PMID:24957919

Pediatric Chest Pain-Low-Probability Referral: A Multi-Institutional Analysis From Standardized Clinical Assessment and Management Plans (SCAMPs®), the Pediatric Health Information Systems Database, and the National Ambulatory Medical Care Survey.

PubMed

Harahsheh, Ashraf S; O'Byrne, Michael L; Pastor, Bill; Graham, Dionne A; Fulton, David R

2017-11-01

We conducted a study to assess test characteristics of red-flag criteria for identifying cardiac disease causing chest pain and technical charges of low-probability referrals. Accuracy of red-flag criteria was ascertained through study of chest pain Standardized Clinical Assessment and Management Plans (SCAMPs®) data. Patients were divided into 2 groups: Group1 (concerning clinical elements) and Group2 (without). We compared incidence of cardiac disease causing chest pain between these 2 groups. Technical charges of Group 2 were analyzed using the Pediatric Health Information System database. Potential savings for the US population was estimated using National Ambulatory Medical Care Survey data. Fifty-two percent of subjects formed Group 1. Cardiac disease causing chest pain was identified in 8/1656 (0.48%). No heart disease was identified in patients in Group 2 ( P = .03). Applying red-flags in determining need for referral identified patients with cardiac disease causing chest pain with 100% sensitivity. Median technical charges for Group 2, over a 4-year period, were US2014$775 559. Eliminating cardiac testing of low-probability referrals would save US2014$3 775 182 in technical charges annually. Red-flag criteria were an effective screen for children with chest pain. Eliminating cardiac testing in children without red-flags for referral has significant technical charge savings.

A pilot study of pulmonary rehabilitation and chest physiotherapy versus chest physiotherapy alone in bronchiectasis.

PubMed

Mandal, P; Sidhu, M K; Kope, L; Pollock, W; Stevenson, L M; Pentland, J L; Turnbull, K; Mac Quarrie, S; Hill, A T

2012-12-01

The aim of our study was to assess the efficacy of pulmonary rehabilitation in addition to regular chest physiotherapy in non cystic fibrosis bronchiectasis. Thirty patients with clinically significant bronchiectasis and limited exercise tolerance were randomized into either the control group receiving chest physiotherapy (8 weeks) or into the intervention group, receiving pulmonary rehabilitation in addition to chest physiotherapy (8 weeks). Both groups were encouraged to maintain their exercise program and or chest physiotherapy, following completion of the study. End of training (8 weeks) No improvement in control group. In the intervention group, incremental shuttle walk test (ISWT) improved by 56.7 m (p = 0.03), endurance walk test (EWT) by 193.3 m (p = 0.01), Leicester Cough Questionnaire (LCQ) improved by 2.6 units (p < 0.001) and St. George's Respiratory Questionnaire (SGRQ) by 8 units (p < 0.001). At 20 weeks (12 weeks post end of training) No improvement in control group. In the intervention group, ISWT improved by 80 m (p = 0.04) and EWT by 247.5 m (p = 0.003). LCQ improved by 4.4 units (p < 0.001) and SGRQ by 4 units (p < 0.001). Pulmonary rehabilitation in addition to regular chest physiotherapy, improves exercise tolerance and health related quality of life in non cystic fibrosis bronchiectasis and the benefit was sustained at 12 weeks post end of pulmonary rehabilitation. Clinical trials regn no. NCT00868075. Copyright © 2012 Elsevier Ltd. All rights reserved.

The usefulness of Wi-Fi based digital chest drainage system in the post-operative care of pneumothorax.

PubMed

Cho, Hyun Min; Hong, Yoon Joo; Byun, Chun Sung; Hwang, Jung Joo

2016-03-01

Chest drainage systems are usually composed of chest tube and underwater-seal bottle. But this conventional system may restrict patients doing exercise and give clinicians obscure data about when to remove tubes because there is no objective indicator. Recently developed digital chest drainage systems may facilitate interpretation of the grade of air leak and make it easy for clinicians to decide when to remove chest tubes. In addition, with combination of wireless internet devices, monitoring and managing of drainage system distant from the patient is possible. Sixty patients of primary pneumothorax were included in a prospective randomized study and divided into two groups. Group I (study) consisted of digital chest drainage system while in group II (control), conventional underwater-seal chest bottle system was used. Data was collected from January, 2012 to September, 2013 in Eulji University Hospital, Daejeon, Korea. There was no difference in age, sex, smoking history and postoperative pain between two groups. But the average length of drainage was 2.2 days in group I and 3.1 days in group II (P<0.006). And more, about 90% of the patients in group I was satisfied with using new device for convenience. Digital system was beneficial on reducing the length of tube drainage by real time monitoring. It also had advantage in portability, loudness and gave more satisfaction than conventional system. Moreover, internet based digital drainage system will be a good method in thoracic telemedicine area in the near future.

Fat quantification and analysis of lung transplant patients on unenhanced chest CT images based on standardized anatomic space

NASA Astrophysics Data System (ADS)

Tong, Yubing; Udupa, Jayaram K.; Torigian, Drew A.; Wu, Caiyun; Christie, Jason; Lederer, David J.

2016-03-01

Chest fat estimation is important for identifying high-risk lung transplant candidates. In this paper, an approach to chest fat quantification based on a recently formulated concept of standardized anatomic space (SAS) is presented. The goal of this paper is to seek answers to the following questions related to chest fat quantification on single slice versus whole volume CT, which have not been addressed in the literature. What level of correlation exists between total chest fat volume and fat areas measured on single abdominal and thigh slices? What is the anatomic location in the chest where maximal correlation of fat area with fat volume can be expected? Do the components of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) have the same area-to-volume correlative behavior or do they differ? The SAS approach includes two steps: calibration followed by transformation which will map the patient slice locations non-linearly to SAS. The optimal slice locations found for SAT and VAT based on SAS are different and at the mid-level of the T8 vertebral body for SAT and mid-level of the T7 vertebral body for VAT. Fat volume and area on optimal slices for SAT and VAT are correlated with Pearson correlation coefficients of 0.97 and 0.86, respectively. The correlation of chest fat volume with abdominal and thigh fat areas is weak to modest.

Repeat rates in digital chest radiography and strategies for improvement.

PubMed

Fintelmann, Florian; Pulli, Benjamin; Abedi-Tari, Faezeh; Trombley, Maureen; Shore, Mary-Theresa; Shepard, Jo-Anne; Rosenthal, Daniel I

2012-05-01

To determine the repeat rate (RR) of chest radiographs acquired with portable computed radiography (CR) and installed direct radiography (DR) and to develop and assess strategies designed to decrease the RR. The RR and reasons for repeated digital chest radiographs were documented over the course of 16 months while a task force of thoracic radiologists, technologist supervisors, technologists, and information technology specialists continued to examine the workflow for underlying causes. Interventions decreasing the RR were designed and implemented. The initial RR of digital chest radiographs was 3.6% (138/3818) for portable CR and 13.3% (476/3575) for installed DR systems. By combining RR measurement with workflow analysis, targets for technical and teaching interventions were identified. The interventions decreased the RR to 1.8% (81/4476) for portable CR and to 8.2% (306/3748) for installed DR. We found the RR of direct digital chest radiography to be significantly higher than that of computed chest radiography. We believe this is due to the ease with which repeat images can be obtained and discarded, and it suggests the need for ongoing surveillance of RR. We were able to demonstrate that strategies to lower the RR, which had been developed in the era of film-based imaging, can be adapted to the digital environment. On the basis of our findings, we encourage radiologists to assess their own departmental RRs for direct digital chest radiography and to consider similar interventions if necessary to achieve acceptable RRs for this modality.

Comparison between manual and mechanical chest compressions during resuscitation in a pediatric animal model of asphyxial cardiac arrest

PubMed Central

Fernández, Sarah N.; González, Rafael; Solana, María J.; Urbano, Javier; Toledo, Blanca

2017-01-01

Aims Chest compressions (CC) during cardiopulmonary resuscitation are not sufficiently effective in many circumstances. Mechanical CC could be more effective than manual CC, but there are no studies comparing both techniques in children. The objective of this study was to compare the effectiveness of manual and mechanical chest compressions with Thumper device in a pediatric cardiac arrest animal model. Material and methods An experimental model of asphyxial cardiac arrest (CA) in 50 piglets (mean weight 9.6 kg) was used. Animals were randomized to receive either manual CC or mechanical CC using a pediatric piston chest compressions device (Life-Stat®, Michigan Instruments). Mean arterial pressure (MAP), arterial blood gases and end-tidal CO2 (etCO2) values were measured at 3, 9, 18 and 24 minutes after the beginning of resuscitation. Results There were no significant differences in MAP, DAP, arterial blood gases and etCO2 between chest compression techniques during CPR. Survival rate was higher in the manual CC (15 of 30 = 50%) than in the mechanical CC group (3 of 20 = 15%) p = 0.016. In the mechanical CC group there was a non significant higher incidence of haemorrhage through the endotracheal tube (45% vs 20%, p = 0.114). Conclusions In a pediatric animal model of cardiac arrest, mechanical piston chest compressions produced lower survival rates than manual chest compressions, without any differences in hemodynamic and respiratory parameters. PMID:29190801

Acute Middle East Respiratory Syndrome Coronavirus: Temporal Lung Changes Observed on the Chest Radiographs of 55 Patients.

PubMed

Das, Karuna M; Lee, Edward Y; Al Jawder, Suhayla E; Enani, Mushira A; Singh, Rajvir; Skakni, Leila; Al-Nakshabandi, Nizar; AlDossari, Khalid; Larsson, Sven G

2015-09-01

The objective of our study was to describe lung changes on serial chest radiographs from patients infected with the acute Middle East respiratory syndrome corona-virus (MERS-CoV) and to compare the chest radiographic findings and final outcomes with those of health care workers (HCWs) infected with the same virus. Chest radiographic scores and comorbidities were also examined as indicators of a fatal outcome to determine their potential prognostic value. Chest radiographs of 33 patients and 22 HCWs infected with MERS-CoV were examined for radiologic features indicative of disease and for evidence of radiographic deterioration and progression. Chest radiographic scores were estimated after dividing each lung into three zones. The scores (1 [mild] to 4 [severe]) for all six zones per chest radiographic examination were summed to provide a cumulative chest radiographic score (range, 0-24). Serial radiographs were also examined to assess for radiographic deterioration and progression from type 1 (mild) to type 4 (severe) disease. Multivariate logistic regression analysis, Kaplan-Meier survival curve analysis, and the Mann-Whitney U test were used to compare data of deceased patients with those of individuals who recovered to identify prognostic radiographic features. Ground-glass opacity was the most common abnormality (66%) followed by consolidation (18%). Overall mortality was 35% (19/55). Mortality was higher in the patient group (55%, 18/33) than in the HCW group (5%, 1/22). The mean chest radiographic score for deceased patients was significantly higher than that for those who recovered (13 ± 2.6 [SD] vs 5.8 ± 5.6, respectively; p = 0.001); in addition, higher rates of pneumothorax (deceased patients vs patients who recovered, 47% vs 0%; p = 0.001), pleural effusion (63% vs 14%; p = 0.001), and type 4 radiographic progression (63% vs 6%; p = 0.001) were seen in the deceased patients compared with those who recovered. Univariate and logistic regression analyses identified the chest radiographic score as an independent predictor of mortality (odds ratio [OR], 1.38; 95% CI, 1.07-1.77; p = 0.01). The number of comorbidities in the patient group (n = 33) was significantly higher than that in the HCW group (n = 22) (mean number of comorbidities, 1.90 ± 1.27 vs 0.17 ± 0.65, respectively; p = 0.001). The Kaplan-Meier analysis revealed a median survival time of 15 days (95% CI, 4-26 days). Ground-glass opacity in a peripheral location was the most common abnormality noted on chest radiographs. A higher chest radiographic score coupled with a high number of medical comorbidities was associated with a poor prognosis and higher mortality in those infected with MERS-CoV. Younger HCWs with few or no comorbidities had a higher survival rate.

Comparative Effectiveness of a Mnemonic-Use Approach vs. Self-Study to Interpret a Lateral Chest X-Ray

ERIC Educational Resources Information Center

Thompson, Michael; Johansen, Dallin; Stoner, Russell; Jarsted, Allison; Sorrells, Robert; McCarroll, Michele L.; Justice, Wade

2017-01-01

The chest X-ray is the most commonly performed medical imaging study; however, the lateral chest film intimidates many physicians and medical students. The lateral view is more difficult to interpret than the frontal view but provides important information that is either not visible or not as evident on frontal view, and inability to read it may…

Pectus Excavatum: A Review of Diagnosis and Current Treatment Options.

PubMed

Abid, Irfaan; Ewais, MennatAllah M; Marranca, Joseph; Jaroszewski, Dawn E

2017-02-01

Osteopathic medicine places a special emphasis on the musculoskeletal system, and understanding how chest wall structure may influence function is critical. Pectus excavatum is a common congenital chest wall defect in which the sternum is depressed posteriorly. Patients may present with complaints of chest wall discomfort, exercise intolerance, and tachycardia. The medical implications, diagnosis, and treatment options for patients with pectus excavatum are reviewed.

Computer Assisted Diagnosis of Chest Pain. Adjunctive Treatment Protocols

DTIC Science & Technology

1984-07-30

or dyspnea is present. a. Musculöskeletal pain b. Pleurisy c. Pulmonary embolus d. Spontaneous mediastinal emphysema a) Musculoskeletal chest...analgesics, heat therapy, and, perhaps, rest. b) Pleurisy denotes inflammation of the pleura. It is seen in the setting of bronchitis or pneumonia...the symptoms of both assist in differentiating pleurisy from pneumothorax. Chest discomfort is pleuritic. unless there are signs of pneumonia, lung

Predictive Ability of the Medicine Ball Chest Throw and Vertical Jump Tests for Determining Muscular Strength and Power in Adolescents

ERIC Educational Resources Information Center

Hackett, Daniel A.; Davies, Timothy B.; Ibel, Denis; Cobley, Stephen; Sanders, Ross

2018-01-01

This study examined the predictive ability of the medicine ball chest throw and vertical jump for muscular strength and power in adolescents. One hundred and ninety adolescents participated in this study. Participants performed trials of the medicine ball chest throw and vertical jump, with vertical jump peak power calculated via an estimation…

76 FR 7534 - Wooden Bedroom Furniture From the People's Republic of China: Preliminary Results of Antidumping...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-10

... legs or a small chest (often 15 inches or more in height). \\10\\ A lowboy is typically a short chest of drawers, not more than four feet high, normally set on short legs. \\11\\ A chest of drawers is typically a... children's items such as toys, books, and playthings. See Wooden Bedroom Furniture from the People's...

Morbidity of "DSM-IV" Axis I Disorders in Patients with Noncardiac Chest Pain: Psychiatric Morbidity Linked with Increased Pain and Health Care Utilization

ERIC Educational Resources Information Center

White, Kamila S.; Raffa, Susan D.; Jakle, Katherine R.; Stoddard, Jill A.; Barlow, David H.; Brown, Timothy A.; Covino, Nicholas A.; Ullman, Edward; Gervino, Ernest V.

2008-01-01

The present study examined current and lifetime psychiatric morbidity, chest pain, and health care utilization in 229 patients with noncardiac chest pain (NCCP), angina-like pain in the absence of cardiac etiology. Diagnostic interview findings based on the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV"; American…

Oblique Chest Views as a Routine Part of Skeletal Surveys Performed for Possible Physical Abuse--Is This Practice Worthwhile?

ERIC Educational Resources Information Center

Hansen, Karen Kirhofer; Prince, Jeffrey S.; Nixon, G. William

2008-01-01

Objective: To evaluate the utility of oblique chest views in the diagnosis of rib fractures when used as a routine part of the skeletal survey performed for possible physical abuse. Methods: Oblique chest views have been part of the routine skeletal survey protocol at Primary Children's Medical Center since October 2002. Dictated radiology reports…

Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax.

PubMed

Kulvatunyou, N; Erickson, L; Vijayasekaran, A; Gries, L; Joseph, B; Friese, R F; O'Keeffe, T; Tang, A L; Wynne, J L; Rhee, P

2014-01-01

Small pigtail catheters appear to work as well as the traditional large-bore chest tubes in patients with traumatic pneumothorax, but it is not known whether the smaller pigtail catheters are associated with less tube-site pain. This study was conducted to compare tube-site pain following pigtail catheter or chest tube insertion in patients with uncomplicated traumatic pneumothorax. This prospective randomized trial compared 14-Fr pigtail catheters and 28-Fr chest tubes in patients with traumatic pneumothorax presenting to a level I trauma centre from July 2010 to February 2012. Patients who required emergency tube placement, those who refused and those who could not respond to pain assessment were excluded. Primary outcomes were tube-site pain, as assessed by a numerical rating scale, and total pain medication use. Secondary outcomes included the success rate of pneumothorax resolution and insertion-related complications. Forty patients were enrolled. Baseline characteristics of 20 patients in the pigtail catheter group were similar to those of 20 patients in the chest tube group. No patient had a flail chest or haemothorax. Pain scores related to chest wall trauma were similar in the two groups. Patients with a pigtail catheter had significantly lower mean(s.d.) tube-site pain scores than those with a chest tube, at baseline after tube insertion (3.2(0.6) versus 7.7(0.6); P < 0.001), on day 1 (1.9(0.5) versus 6.2(0.7); P < 0.001) and day 2 (2.1(1.1) versus 5.5(1.0); P = 0.040). The decreased use of pain medication associated with pigtail catheter was not significantly different. The duration of tube insertion, success rate and insertion-related complications were all similar in the two groups. For patients with a simple, uncomplicated traumatic pneumothorax, use of a 14-Fr pigtail catheter is associated with reduced pain at the site of insertion, with no other clinically important differences noted compared with chest tubes. NCT01537289 (http://clinicaltrials.gov). © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Effectiveness of a simplified cardiopulmonary resuscitation training program for the non-medical staff of a university hospital.

PubMed

Hirose, Tomoya; Iwami, Taku; Ogura, Hiroshi; Matsumoto, Hisatake; Sakai, Tomohiko; Yamamoto, Kouji; Mano, Toshiaki; Fujino, Yuji; Shimazu, Takeshi

2014-05-10

The 2010 Consensus on Science and Treatment Recommendations Statement recommended that short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered an effective alternative to instructor-led basic life support courses. The purpose of this study was to examine the effectiveness of a simplified cardiopulmonary resuscitation (CPR) training program for non-medical staff working at a university hospital. Before and immediately after a 45-min CPR training program consisting of instruction on chest compression and automated external defibrillator (AED) use with a personal training manikin, CPR skills were automatically recorded and evaluated. Participants' attitudes towards CPR were evaluated by a questionnaire survey. From September 2011 through March 2013, 161 participants attended the program. We evaluated chest compression technique in 109 of these participants. The number of chest compressions delivered after the program versus that before was significantly greater (110.8 ± 13.0/min vs 94.2 ± 27.4/min, p < 0.0001), interruption of chest compressions was significantly shorter (0.05 ± 0.34 sec/30 sec vs 0.89 ± 3.52 sec/30 sec, p < 0.05), mean depth of chest compressions was significantly greater (57.6 ± 6.8 mm vs 52.2 ± 9.4 mm, p < 0.0001), and the proportion of incomplete chest compressions of <5 cm among all chest compressions was significantly decreased (8.9 ± 23.2% vs 38.6 ± 42.9%, p < 0.0001). Of the 159 participants who responded to the questionnaire survey after the program, the proportion of participants who answered 'I can check for a response,' 'I can perform chest compressions,' and 'I can absolutely or I think I can use an AED' increased versus that before the program (81.8% vs 19.5%, 77.4% vs 10.1%, 84.3% vs 23.3%, respectively). A 45-min simplified CPR training program on chest compression and AED use improved CPR quality and the attitude towards CPR and AED use of non-medical staff of a university hospital.

Depression is associated with recurrent chest pain with or without coronary artery disease: A prospective cohort study in the emergency department.

PubMed

Kim, Yeunjung; Soffler, Morgan; Paradise, Summer; Jelani, Qurat-Ul-Ain; Dziura, James; Sinha, Rajita; Safdar, Basmah

2017-09-01

Only a small fraction of acute chest pain in the emergency department (ED) is due to obstructive coronary artery disease (CAD). ED chest pain remains associated with high rates of recidivism, often in the presence of nonobstructive CAD. Psychological states such as depression, anxiety, and elevation of perceived stress may account for this finding. The objective of the study was to determine whether psychological states predict recurrent chest pain (RCP). We conducted a prospective cohort study of low- to moderate-cardiac risk ED patients admitted to the Yale Chest Pain Center with acute chest pain. Depression, anxiety, and perceived stress were assessed in each patient using multistudy-validated screening scales: Patient Health Questionnaire (PHQ8), Clinical Anxiety Scale (CAS), and Perceived Stress Scale (PSS), respectively. All patients ruled out for infarction underwent appropriate cardiac stress testing. Primary outcome was RCP at 30 days evaluated by phone follow-up and medical record. The relationship between each psychological scale and RCP was evaluated using ordinal logistic regressions, controlling for known sociodemographic and cardiac risk factors. Depression (PHQ8≥10), anxiety (CAS≥30), and perceived stress (PSS≥15) were considered positive. Between August 2013 and May 2015, 985 patients were screened at the Yale Chest Pain Center. Of 500 enrolled patients, 483 patients had complete data and 365 (76%) patients completed follow-up. Thirty-six percent (n=131) had RCP within 1 month. On multivariable regression models, depression (odds ratio [OR]=2.11, 95% CI 1.18-3.79) was a significant independent predictor of 30-day chest pain recurrence after adjustment, whereas PSS (OR=0.96, 95% CI 0.60-1.53) and anxiety (OR=1.59, 95% CI 0.80-3.20) were not. Similarly, there was a direct relationship between psychometric evaluation of depression (via PHQ8) and the frequency of chest pain. Depression is independently associated with RCP regardless of significant cardiac ischemia on stress testing. Identification and targeted interventions may curtail recidivism with RCP. Copyright © 2017 Elsevier Inc. All rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goodenough, D; Olafsdottir, H; Olafsson, I

Purpose: To automatically quantify the amount of missing tissue in a digital breast tomosynthesis system using four stair-stepped chest wall missing tissue gauges in the Tomophan™ from the Phantom Laboratory and image processing from Image Owl. Methods: The Tomophan™ phantom incorporates four stair-stepped missing tissue gauges by the chest wall, allowing measurement of missing chest wall in two different locations along the chest wall at two different heights. Each of the four gauges has 12 steps in 0.5 mm increments rising from the chest wall. An image processing algorithm was developed by Image Owl that first finds the two slicesmore » containing the steps then finds the signal through the highest step in all four gauges. Using the signal drop at the beginning of each gauge the distance to the end of the image gives the length of the missing tissue gauge in millimeters. Results: The Tomophan™ was imaged in digital breast tomosynthesis (DBT) systems from various vendors resulting in 46 cases used for testing. The results showed that on average 1.9 mm of 6 mm of the gauges are visible. A small focus group was asked to count the number of visible steps for each case which resulted in a good agreement between observer counts and computed data. Conclusion: First, the results indicate that the amount of missing chest wall can differ between vendors. Secondly it was shown that an automated method to estimate the amount of missing chest wall gauges agreed well with observer assessments. This finding indicates that consistency testing may be simplified using the Tomophan™ phantom and analysis by an automated image processing named Tomo QA. In general the reason for missing chest wall may be due to a function of the beam profile at the chest wall as DBT projects through the angular sampling. Research supported by Image Owl, Inc., The Phantom Laboratory, Inc. and Raforninn ehf; Mallozzi and Healy employed by The Phantom Laboratory, Inc.; Goodenough is a consultant to The Phantom Laboratory, Inc.; Fredriksson, Kristbjornsson, Olafsson, Oskarsdottir and Olafsdottir are employed by Raforninn, Ehf.« less

The effect of time-of-day and chest physiotherapy on multiple breath washout measures in children with clinically stable cystic fibrosis.

PubMed

Voldby, Christian; Green, Kent; Rosthøj, Susanne; Kongstad, Thomas; Philipsen, Lue; Buchvald, Frederik; Skov, Marianne; Pressler, Tania; Gustafsson, Per; Nielsen, Kim G

2018-01-01

In this pilot study we investigated daytime variation of multiple breath nitrogen washout (N2MBW) measures in children with clinically stable cystic fibrosis. To our knowledge the effect of time-of-day on multiple breath washout measures in patients with cystic fibrosis has not previously been reported. Furthermore, we assessed the influence of chest physiotherapy on N2MBW measures. Ten school children with cystic fibrosis performed N2MBW followed by spirometry and plethysmography in the morning and afternoon at three visits that were one month apart. Chest physiotherapy was performed immediately before the afternoon measurements at visit 2 and immediately before morning and afternoon measurements at visit 3. The influence of time-of-day and chest physiotherapy on the measures was evaluated using linear mixed models. There were adequate quality data from 8 children with median age (range) 9.6 (6.0; 15.1) years. Baseline lung clearance index (LCI) (range) was 9.0 (7.1; 13.0) and baseline FEV1% predicted was 97.5 (78.5; 117.9). No N2MBW measures were significantly influenced by time-of-day or chest physiotherapy. LCI (95% confidence interval) decreased non-significantly 0.05 (-0.32; 0.22) during the day and increased non-significantly 0.08 (-0.26; 0.42) after chest physiotherapy. All spirometric measures were unaffected by time-of-day and chest physiotherapy. For plethysmographic measures FRCpleth decreased significantly (p<0.01) 110 mL during the day, whereas a borderline significant (p = 0.046) decrease in ΔFRCpleth-MBW during the day and a borderline significant (p = 0.03) increase in TLC after CPT were observed. This study demonstrated that the time-of-day as well as chest physiotherapy performed immediately prior to N2MBW had no consistent or significant influence on N2MBW measures. However, we emphasize that further studies of the effect of both daytime variation and the effect of chest physiotherapy on multiple breath washout measures are warranted.

A Dosimetric Study on Slab-pinewood-slab Phantom for Developing the Heterogeneous Chest Phantom Mimicking Actual Human Chest

PubMed Central

Gurjar, Om Prakash; Paliwal, Radha Kishan; Mishra, Surendra Prasad

2017-01-01

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. PMID:28706353

Chest Wall Constriction after the Nuss Procedure Identified from Chest Radiograph and Multislice Computed Tomography Shortly after Removal of the Bar.

PubMed

Chang, Pei-Yeh; Zeng, Qi; Wong, Kin-Sun; Wang, Chao-Jan; Chang, Chee-Jen

2016-01-01

This study radiographically examined the changes in the chest walls of patients with pectus excavatum (PE) after Nuss bar removal, to define the deformation caused by the bar and stabilizer. In the first part of the study, we compared the changes in chest radiographs of patients with PE to a preoperation PE control group. In the second part, we used multislice computed tomography (CT) scans to provide three-dimensional reconstructions with which to evaluate the changes to the thoracic wall. Part 1 From June 2006 to August 2011, 1,125 patients with PE who had posteroanterior chest radiographs taken before undergoing the Nuss procedure at four hospitals were enrolled as a preoperative control group. At the same time, 203 patients who had the bar removed were enrolled as the study group. The maximum dimensions of the outer boundary of the first to ninth rib pairs (R1-R9, rib pair width), chest height, and chest width were measured. Part 2 Thirty-one consecutive patients with PE (20 males and 11 females) who underwent Nuss bar removal were evaluated 7 to 30 days after operation. During this period, a further 34 patients with PE who had undergone CT imaging before bar insertion were evaluated and compared with the postoperative group. Part 1 The width of the lower ribs (R4-R9) after bar removal was significantly less than in the age-matched controls. The ribs adjacent to the bar (R5-R7) showed the greatest restriction. The width of the upper ribs (R1-R3) 2 to 3 years after bar placement did not differ significantly from the controls. Patients who were operated on after 10 years of age had less of a restrictive effect. Three years of bar placement resulted in more restriction than a 2-year period, particularly in patients younger than 10 years old. Part 2: A significant constriction of the chest wall was observed in 13 patients after removal of the Nuss bar. Constriction at ribs 5 to 8 was found to be present adjacent to the site of bar insertion. However, constriction of the chest wall was found in only 3 of the 34 patients in the preoperative group. The severity of constriction (as graded by the spline model) also increased in the postoperative group. The growth of the chest wall was restricted after placement of the Nuss bar for PE correction. Long-term follow-up of chest wall growth is needed to clarify whether such constriction resolves with time. Georg Thieme Verlag KG Stuttgart · New York.

[The theory of cardiac lesions from blunt chest injury].

PubMed

Tumanov, E V; Sokolova, Z Iu

2010-01-01

The main theories of myocardial lesions associated with a blunt chest injury proposed starting from the XIXth century till the present time are considered based on the overview of the literature data. It is shown that the theory of selective mechanical activation of ATP-dependent K+ channels is most promising for further investigations into the mechanisms of myocardial dysfunction resulting from blunt chest injuries. The authors emphasize the absence of the universally accepted theory explaining the mechanism behind traumatic cardiac troubles and its fatal outcome despite numerous studies of cardiac lesions in patients with a blunt chest injury. It dictates the necessity of further research, both clinical and experimental, for a deeper insight into the problem.

Improvement in Existing Chest Wall Irregularities During Breast Reconstruction

PubMed Central

Huber, Katherine M.; Zimmerman, Amanda; Dayicioglu, Deniz

2018-01-01

Mastectomies for both cancer resection and risk reduction are becoming more common. Existing chest wall irregularities are found in these women presenting for breast reconstruction after mastectomy and can pose reconstructive challenges. Women who desired breast reconstruction after mastectomy were evaluated preoperatively for existing chest wall irregularities. Case reports were selected to highlight common irregularities and methods for improving cosmetic outcome concurrently with breast reconstruction procedures. Muscular anomalies, pectus excavatum, scoliosis, polythelia case reports are discussed. Relevant data from the literature are presented. Chest wall irregularities are occasionally encountered in women who request breast reconstruction. Correction of these deformities is possible and safe during breast reconstruction and can lead to improved cosmetic outcome and patient satisfaction. PMID:29318956

Improvement in Existing Chest Wall Irregularities During Breast Reconstruction.

PubMed

Huber, Katherine M; Zimmerman, Amanda; Dayicioglu, Deniz

2018-01-01

Mastectomies for both cancer resection and risk reduction are becoming more common. Existing chest wall irregularities are found in these women presenting for breast reconstruction after mastectomy and can pose reconstructive challenges. Women who desired breast reconstruction after mastectomy were evaluated preoperatively for existing chest wall irregularities. Case reports were selected to highlight common irregularities and methods for improving cosmetic outcome concurrently with breast reconstruction procedures. Muscular anomalies, pectus excavatum, scoliosis, polythelia case reports are discussed. Relevant data from the literature are presented. Chest wall irregularities are occasionally encountered in women who request breast reconstruction. Correction of these deformities is possible and safe during breast reconstruction and can lead to improved cosmetic outcome and patient satisfaction.

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

PubMed

Pauzé, Denis R; Pauzé, Daniel K

2013-11-01

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

Chest Trauma in Athletic Medicine.

PubMed

Phillips, Nicholas R; Kunz, Derek E

2018-03-01

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

Use of medical care for chest pain: differences between blacks and whites.

PubMed

Strogatz, D S

1990-03-01

Data from a 1980, community-based survey of adult residents of Edgecombe County, North Carolina were analyzed to examine differences between Blacks and Whites in the reported use of medical care after experiencing chest pain. Of all adults (N = 302) with chest pain in the year prior to interview, 49 percent of Blacks and 27 percent of Whites did not see a physician following the chest pain (difference = 22%, 95% CI = 12, 33). A multivariable analysis found that although the association between race and utilization was reduced at poverty levels of income, it was not explained by differences in demographic characteristics, health status or other dimensions of access to care.

Use of medical care for chest pain: differences between blacks and whites.

PubMed Central

Strogatz, D S

1990-01-01

Data from a 1980, community-based survey of adult residents of Edgecombe County, North Carolina were analyzed to examine differences between Blacks and Whites in the reported use of medical care after experiencing chest pain. Of all adults (N = 302) with chest pain in the year prior to interview, 49 percent of Blacks and 27 percent of Whites did not see a physician following the chest pain (difference = 22%, 95% CI = 12, 33). A multivariable analysis found that although the association between race and utilization was reduced at poverty levels of income, it was not explained by differences in demographic characteristics, health status or other dimensions of access to care. PMID:2305907

Decreasing radiation exposure on pediatric portable chest radiographs.

PubMed

Hawking, Nancy G; Sharp, Ted D

2013-01-01

To determine whether additional shielding designed for pediatric patients during portable chest exams that ascertain endotracheal tube placement would significantly decrease the amount of scatter radiation. Children aged 24 months or younger were intubated and received daily morning chest radiographs to determine endotracheal tube placement. For each measurement, the amount of scatter radiation decreased by more than 20% from a nonshielded exposure to a shielded exposure. There was a significant decrease in scatter radiation when using the lead shielding device along with appropriate collimation vs appropriate collimation alone. These results suggest that applying additional shielding to appropriately collimated chest radiographs could significantly reduce scatter radiation and therefore the overall dose to young children.

[Lateral chest X-rays. Radiographic anatomy].

PubMed

García Villafañe, C; Pedrosa, C S

2014-01-01

Lateral chest views constitute an essential part of chest X-ray examinations, so it is fundamental to know the anatomy on these images and to be able to detect the variations manifested on these images in different diseases. The aim of this article is to review the normal anatomy and main normal variants seen on lateral chest views. For teaching purposes, we divide the thorax into different spaces and analyze each in an orderly way, especially emphasizing the anatomic details that are most helpful for locating lesions that have already been detected in the posteroanterior view or for detecting lesions that can be missed in the posteroanterior view. Copyright © 2013 SERAM. Published by Elsevier Espana. All rights reserved.

Treatment of Morbidity with Atypical Chest Pain

PubMed Central

Cott, Arthur

1987-01-01

The appropriate management of atypical chest pain requires an integration of medical and behavioural treatments. Unnecessary medicalization can increase morbidity. A sensitivity to the behavioural factors contributing to symptoms and disability may reduce both. The purpose of this paper is to provide physicians with a cognitive-behavioural perspective of the nature of morbidity and disability associated with chronic chest discomfort; some strategies for detecting heretofore unsuspected disability associated with chronic chest pain and related discomfort in patients with organic findings (both cardiac and non-cardiac), as well those with no identifiable disease process or organic cause; and some simple behavioural and cognitive-behavioural therapeutic techniques for treating and preventing such problems. PMID:21263912

Evaluation of App-Based Serious Gaming as a Training Method in Teaching Chest Tube Insertion to Medical Students: Randomized Controlled Trial.

PubMed

Haubruck, Patrick; Nickel, Felix; Ober, Julian; Walker, Tilman; Bergdolt, Christian; Friedrich, Mirco; Müller-Stich, Beat Peter; Forchheim, Franziska; Fischer, Christian; Schmidmaier, Gerhard; Tanner, Michael C

2018-05-21

The insertion of a chest tube should be as quick and accurate as possible to maximize the benefit and minimize possible complications for the patient. Therefore, comprehensive training and assessment before an emergency situation are essential for proficiency in chest tube insertion. Serious games have become more prevalent in surgical training because they enable students to study and train a procedure independently, and errors made have no effect on patients. However, up-to-date evidence regarding the effect of serious games on performance in procedures in emergency medicine remains scarce. The aim of this study was to investigate the serious gaming approach in teaching medical students an emergency procedure (chest tube insertion) using the app Touch Surgery and a modified objective structural assessment of technical skills (OSATS). In a prospective, rater-blinded, randomized controlled trial, medical students were randomized into two groups: intervention group or control group. Touch Surgery has been established as an innovative and cost-free app for mobile devices. The fully automatic software enables users to train medical procedures and afterwards self-assess their training effort. The module chest tube insertion teaches each key step in the insertion of a chest tube and enables users the meticulous application of a chest tube. In contrast, the module "Thoracocentesis" discusses a basic thoracocentesis. All students attended a lecture regarding chest tube insertion (regular curriculum) and afterwards received a Touch Surgery training lesson: intervention group used the module chest tube insertion and the control group used Thoracocentesis as control training. Participants' performance in chest tube insertion on a porcine model was rated on-site via blinded face-to-face rating and via video recordings using a modified OSATS tool. Afterwards, every participant received an individual questionnaire for self-evaluation. Here, trainees gave information about their individual training level, as well as previous experiences, gender, and hobbies. Primary end point was operative performance during chest tube insertion by direct observance. A total of 183 students enrolled, 116 students participated (63.4%), and 21 were excluded because of previous experiences in chest tube insertion. Students were randomized to the intervention group (49/95, 52%) and control group (46/95, 48%). The intervention group performed significantly better than the control group (Intervention group: 38.0 [I 50 =7.0] points; control group: 30.5 [I 50 =8.0] points; P<.001). The intervention group showed significantly improved economy of time and motion (P=.004), needed significantly less help (P<.001), and was more confident in handling of instruments (P<.001) than the control group. The results from this study show that serious games are a valid and effective tool in education of operative performance in chest tube insertion. We believe that serious games should be implemented in the surgical curriculum, as well as residency programs, in addition to traditional learning methods. German Clinical Trials Register (DRKS) DRKS00009994; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00009994 (Archived by Webcite at http://www.webcitation.org/6ytWF1CWg). ©Patrick Haubruck, Felix Nickel, Julian Ober, Tilman Walker, Christian Bergdolt, Mirco Friedrich, Beat Peter Müller-Stich, Franziska Forchheim, Christian Fischer, Gerhard Schmidmaier, Michael C Tanner. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 21.05.2018.

[Optimal beam quality for chest digital radiography].

PubMed

Oda, Nobuhiro; Tabata, Yoshito; Nakano, Tsutomu

2014-11-01

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

Unusual Radiographic Presentation of Pneumocystis Pneumonia in a Patient with AIDS.

PubMed

Block, Brian L; Mehta, Tejas; Ortiz, Gabriel M; Ferris, Sean P; Vu, Thienkhai H; Huang, Laurence; Cattamanchi, Adithya

2017-01-01

Pneumocystis jirovecii pneumonia (PCP) typically presents as an interstitial and alveolar process with ground glass opacities on chest computed tomography (CT). The absence of ground glass opacities on chest CT is thought to have a high negative predictive value for PCP in individuals with AIDS. Here, we report a case of PCP in a man with AIDS who presented to our hospital with subacute shortness of breath and a nonproductive cough. While his chest CT revealed diffuse nodular rather than ground glass opacities, bronchoscopy with bronchoalveolar lavage and transbronchial biopsies confirmed the diagnosis of PCP and did not identify additional pathogens. PCP was not the expected diagnosis based on chest CT, but it otherwise fit well with the patient's clinical and laboratory presentation. In the era of combination antiretroviral therapy, routine prophylaxis for PCP, and increased use of computed tomography, it may be that PCP will increasingly present with nonclassical chest radiographic patterns. Clinicians should be aware of this presentation when selecting diagnostic and management strategies.

Unusual Radiographic Presentation of Pneumocystis Pneumonia in a Patient with AIDS

PubMed Central

Mehta, Tejas; Ortiz, Gabriel M.; Ferris, Sean P.; Vu, Thienkhai H.; Huang, Laurence; Cattamanchi, Adithya

2017-01-01

Pneumocystis jirovecii pneumonia (PCP) typically presents as an interstitial and alveolar process with ground glass opacities on chest computed tomography (CT). The absence of ground glass opacities on chest CT is thought to have a high negative predictive value for PCP in individuals with AIDS. Here, we report a case of PCP in a man with AIDS who presented to our hospital with subacute shortness of breath and a nonproductive cough. While his chest CT revealed diffuse nodular rather than ground glass opacities, bronchoscopy with bronchoalveolar lavage and transbronchial biopsies confirmed the diagnosis of PCP and did not identify additional pathogens. PCP was not the expected diagnosis based on chest CT, but it otherwise fit well with the patient's clinical and laboratory presentation. In the era of combination antiretroviral therapy, routine prophylaxis for PCP, and increased use of computed tomography, it may be that PCP will increasingly present with nonclassical chest radiographic patterns. Clinicians should be aware of this presentation when selecting diagnostic and management strategies. PMID:29362681

Detection of pericardial effusion by chest roentgenography and electrocardiography versus echocardiography.

PubMed Central

Manyari, D. E.; Milliken, J. A.; Colwell, B. T.; Burggraf, G. W.

1978-01-01

To determine the sensitivity and specificity of chest roentgenography and electrocardiography in the detection of pericardial effusion, echocardiography was used as the diagnostic standard. Chest roentgenograms and electrocardiograms of 124 patients, 57 of whom had pericardial effusion, were read without knowledge of the echocardiographic interpretation. The sensitivity of roentgenographic diagnosis was low (20%), as was that of diagnosis from decreased voltage on the electrocardiogram (26%). The specificity of the chest roentgenogram was 89% and that of the low-voltage electrocardiogram 97%. The high specificity of the low-voltage electrocardiogram may have been due in part to the exclusion of obese and emphysematous subjects from the study. When cardiomegaly detected roentgenographically or a low-voltage electrocardiogram or both were considered as evidence of pericardial effusion, sensitivity improved to 82% but specificity declined to 29%. It is concluded the chest roentgenography and electrocardiography are unsatisfactory as screening investigations for the detection of pericardial effusion. Images FIG. 1 FIG. 2 FIG. 3 PMID:688146

Traumatic Pulmonary Herniation at the Diaphragmatic Junction in a Pediatric Patient: A Rare Complication of Blunt Chest Trauma.

PubMed

Orlik, Kseniya; Simon, Erin Leslie; Hemmer, Carrie; Ramundo, Maria

2016-07-01

We present a case of traumatic intercostal pulmonary herniation in an 11-year-old boy after blunt trauma to the chest, without associated chest wall disruption or pneumothorax. This condition is especially uncommon in children, with only 5 previously reported cases and most occurring after penetrating chest trauma. To date, there are no reports in literature describing traumatic intercostal lung herniation at the diaphragmatic junction with a closed chest cavity in a child. The number of traumatic lung herniation diagnoses may be expanded by a more liberal use of computed tomography when serious injury is suspected. Computed tomography and advanced imaging should be considered in pediatric trauma patients presenting with concern for intrathoracic injury that may not be seen on plain film. Traumatic blunt intrathoracic and intra-abdominal injuries in the pediatric population that are within proximity of diaphragmatic insertion should be thoroughly evaluated to rule out diaphragmatic injury. As in our case, invasive surgical intervention such as thoracoscopy may be necessary.

Oblique Chest X-Ray: An Alternative Way to Detect Pneumothorax.

PubMed

Tulay, Cumhur Murat; Yaldız, Sadık; Bilge, Adnan

2018-03-16

To identify occult pneumothorax with oblique chest X-ray (OCXR) in clinically suspected patients. In this retrospective study, we examined 1082 adult multitrauma patients who were admitted to our emergency service between January 2016 and January 2017. Clinical findings that suggest occult pneumothorax were rib fracture, flail chest, chest pain, subcutaneous emphysema, abrasion or ecchymosis and moderate to severe hypoxia in clinical parameters. All of these patients underwent anteroposterior chest X-ray (APCXR), but no pneumothorax could be detected. Upon this, OCXR was performed using mobile X-ray equipment. Traumatic pneumothorax was observed in 421 (38.9%) of 1082 patients. We applied OCXR to 26 multitrauma patients. Occult pneumothorax was evaluated at 22 patients (2.03%) in 1082 multitrauma patients. The 22 patients who had multitrauma occult pneumothorax on OCXR were internated at intensive care unit (ICU) and follow-up was done using OCXR and APCXR. OCXR can be an alternative imaging technique to identify occult pneumothorax in some trauma patients at emergency room and also follow period at ICU.

[Value of chest x-ray films in the diagnosis of congenital heart defects in infants].

PubMed

Koczyński, A

1982-01-01

The respiratory distress and suspicion of the heart defects in newborns and infants is indicated by x-ray chest examinations. The right interpretation of the x-ray pictures is very important but it must be followed by other diagnostic procedures. In every child it is possible to take the linear measurements of the great vessels and arteries in parahilar lung areas as well as the heart and chest in two dimensions from x-ray plain films. The measurements let to establish the indices: cardio-thoracic (ICP), vasculo-cardiac (IVC) and sagittal one (IS), which play important role in radiological evaluation of the chest. It results from the investigated material, that the evaluation of the pulmonary vascular pattern and the indices particularly facilitate the diagnosis of heart deformities coexisting with higher blood flow in pulmonary circulation. Nevertheless the measurements and the indices play the relative role in establishing of the final opinion about the chest and should be considered together with clinical and cardiological data.

Effect of shape and size of lung and chest wall on stresses in the lung

NASA Technical Reports Server (NTRS)

Vawter, D. L.; Matthews, F. L.; West, J. B.

1975-01-01

To understand better the effect of shape and size of lung and chest wall on the distribution of stresses, strains, and surface pressures, we analyzed a theoretical model using the technique of finite elements. First we investigated the effects of changing the chest wall shape during expansion, and second we studied lungs of a variety of inherent shapes and sizes. We found that, in general, the distributions of alveolar size, mechanical stresses, and surface pressures in the lungs were dominated by the weight of the lung and that changing the shape of the lung or chest wall had relatively little effect. Only at high states of expansion where the lung was very stiff did changing the shape of the chest wall cause substantial changes. Altering the inherent shape of the lung generally had little effect but the topographical differences in stresses and surface pressures were approximately proportional to lung height. The results are generally consistent with those found in the dog by Hoppin et al (1969).

Clinical Implications From an Exploratory Study of Postural Management of Breech Presentation

PubMed Central

Founds, Sandra A.

2013-01-01

The results from an exploratory study of the effectiveness of maternal knee-chest posture for producing cephalic version of breech presentation are shown. Methods are briefly described and clinical implications are presented. Among 25 women, fewer who performed the maternal knee-chest postural intervention experienced fetal cephalic version than women in the control group who did nothing to influence breech presentation. Despite limitations of the underpowered findings, trends in the data may indicate that parity and gestational age were potentially relevant covariates of version. Postural management is not an evidence-based practice. This exploratory study indicates that maternal knee-chest posture may work opposite to the expected direction, but the small sample size precludes generalizations about efficacy of knee-chest postural management. At least one adequately powered trial that controls for parity and gestational age is needed to determine whether knee-chest postural management results in no effect, a small, or small to moderate clinically significant effect. PMID:16814225

Mitral valve plasty for mitral regurgitation after blunt chest trauma.

PubMed

Kumagai, H; Hamanaka, Y; Hirai, S; Mitsui, N; Kobayashi, T

2001-06-01

A 21 year-old woman was admitted to our hospital because of chest and back pain after blunt chest trauma. On admission, consciousness was clear and a physical examination showed labored breathing. Her vital signs were stable, but her breathing gradually worsened, and artificial respiration was started. The chest roentgenogram and a subsequent chest computed tomographic scans revealed contusions, hemothorax of the left lung and multiple rib fractures. A transthoracic echocardiography (TTE) revealed normal left ventricular wall motion and mild mitral regurgitation (MR). TTE was carried out repeatedly, and revealed gradually progressive MR and prolapse of the posterior medial leaflet, although there was no congestive heart failure. After her general condition had recovered, surgery was performed. Intraoperative transesophageal echocardiography (TEE) revealed torn chordae at the posterior medial leaflet. The leaflet where the chorda was torn was cut and plicated, and posterior mitral annuloplasty was performed using a prosthetic ring. One month later following discharge, the MR had disappeared on TTE.

[Mysteries of a medicine chest ].

PubMed

Lefrère, Bertrand

2017-03-01

This article retraces the history of an old medicine chest, used at the beginning of the 19th century, but probably designed earlier. Possibly made in A ustria, with a two-headed eagle lining the bottom of the lid, this first-aid kit belongs to a small group of related chests. It should be noted that these chests were used for a wide variety of different purposes over time. Also named a «droguier» in French, this light chest, made of walnut, and, according to family lore, found in Normandy, would have belonged to a doctor, as confirmed by a short invoice found among numerous documents. The identity of the supplier of numerous old medicines is shown on the labels on the flasks (many of which are intact) and other boxes (containing, in particular, herbal drugs) : «Clément, Apothicaire. Rue St Onge N°. 42. près le Bd. du Temple A Paris», whose history is recounted here step by step.

Teaching project: a low-cost swine model for chest tube insertion training.

PubMed

Netto, Fernando Antonio Campelo Spencer; Sommer, Camila Garcia; Constantino, Michael de Mello; Cardoso, Michel; Cipriani, Raphael Flávio Fachini; Pereira, Renan Augusto

2016-02-01

to describe and evaluate the acceptance of a low-cost chest tube insertion porcine model in a medical education project in the southwest of Paraná, Brazil. we developed a low-cost and low technology porcine model for teaching chest tube insertion and used it in a teaching project. Medical trainees - students and residents - received theoretical instructions about the procedure and performed thoracic drainage in this porcine model. After performing the procedure, the participants filled a feedback questionnaire about the proposed experimental model. This study presents the model and analyzes the questionnaire responses. seventy-nine medical trainees used and evaluated the model. The anatomical correlation between the porcine model and human anatomy was considered high and averaged 8.1±1.0 among trainees. All study participants approved the low-cost porcine model for chest tube insertion. the presented low-cost porcine model for chest tube insertion training was feasible and had good acceptability among trainees. This model has potential use as a teaching tool in medical education.

Patient doses from chest radiography in Victoria.

PubMed

Cardillo, I; Boal, T J; Einsiedel, P F

1997-06-01

This survey examines doses from PA chest radiography at radiology practices, private hospitals and public hospitals throughout metropolitan and country Victoria. Data were collected from 111 individual X-ray units at 86 different practices. Entrance skin doses in air were measured for exposure factors used by the centre for a 23 cm thick male chest. A CDRH LucA1 chest phantom was used when making these measurements. About half of the centres used grid technique and half used non-grid technique. There was a factor of greater than 10 difference in the entrance dose delivered between the highest dose centre and the lowest dose centre for non-grid centres; and a factor of about 5 for centres using grids. Factors contributing to the high doses recorded at some centres were identified. Guidance levels for chest radiography based on the third quartile value of the entrance doses from this survey have been recommended and compared with guidance levels recommended in other countries.

[Chest trauma: who, how and what?].

PubMed

Molnár, F Tamás

2012-10-01

A chest-trauma management system, tagged as the "Pécs model" in a tertiary referral center is described with extensive references to the state of the art in thoracic trauma. Chest drainage has utmost importance in primary therapy as well as in surgical decision making (diagnosis). Thoracotomy is a general surgical competence, just as damage control is. Definitive treatment and management of sequelae, however, requires competence in thoracic surgery. Multidisciplinarity is underscored.

On-the-Move Nutrient Delivery System Performance Characteristics

DTIC Science & Technology

2008-09-01

types - ranging from simple sugar (monosaccharide fructose or disaccharide sucrose) to more complex sugars (short length maltodextrin (Grain...characteristics of the NOS Position Chest Chest Chest Pressure, Flow Rate, Glucose Conc in Sip-to-Sip Estimated CHO mm Hg Setting Time, s Volume, ml...on the drink produced (Table 2). When the top of the concentrate bag was level with the bite valve, the drink had an estimated carbohydrate

Coil embolization for pulmonary artery injury caused by chest tube drainage.

PubMed

Shigefuku, Shunsuke; Kudo, Yujin; Saguchi, Toru; Maeda, Junichi

2017-05-01

Pulmonary artery injury caused by chest tube drainage is rare, but it requires prompt diagnosis to perform urgent surgical repair. We report that a 53-year-old man who suffered from pulmonary artery injury by chest tube drainage was successfully treated by coil embolization. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

An innovative method of pediatric chest wall reconstruction using Surgisis and swinging rib technique.

PubMed

Oliveira, Carol; Zamakhshary, Mohammed; Alfadda, Tariq; Alhabshan, Fahad; Alshalaan, Hisham; Miller, Stephen; Kim, Peter C W

2012-05-01

Herein, we describe a new surgical approach for chest wall reconstruction using a native supporting rib and Surgisis. A retrospective review of 3 cases from 2 tertiary pediatric health care centers presenting with chest wall defects in the neonatal period was performed. Perioperative data were collected. Two chest wall deformities were diagnosed at birth (Poland syndrome and cleft sternum). One patient was diagnosed prenatally with a mediastinal mass. The first infant had absent ribs 2 through 9. He underwent chest wall reconstruction at 4 weeks of life because of difficulty weaning from ventilation related to paradoxical breathing. The hamartoma of the second asymptomatic patient was removed at 6 weeks. The third patient's V-shaped sternal defect encompassed through the upper two thirds of the sternum and was repaired at 6 months of age with intraoperative transesophageal echocardiogram monitoring. In all cases, Surgisis (collagen matrix) was used as an onlay patch. In 2 cases, a swinging rib acted supportive. Neither patient had intraoperative complications. Surgisis is useful in pediatric chest wall reconstruction, particularly in combination with swinging ribs. The capacity for adaptation to the child's growth of this approach is crucial. Short-term safety is shown, but long-term assessment is required. Copyright © 2012 Elsevier Inc. All rights reserved.

App-based serious gaming for training of chest tube insertion: study protocol for a randomized controlled trial.

PubMed

Friedrich, Mirco; Bergdolt, Christian; Haubruck, Patrick; Bruckner, Thomas; Kowalewski, Karl-Friedrich; Müller-Stich, Beat Peter; Tanner, Michael C; Nickel, Felix

2017-02-06

Chest tube insertion is a standard intervention for management of various injuries of the thorax. Quick and accurate execution facilitates efficient therapy without further complications. Here, we propose a new training concept comprised of e-learning elements as well as continuous rating using an objective structured assessment of technical skills (OSATS) tool. The study protocol is presented for a randomized trial to evaluate e-learning with app-based serious gaming for chest drain insertion. The proposed randomized trial will be carried out at the Department of Orthopedics and Traumatology at Heidelberg University in the context of regular curricular teaching for medical students (n = 90, 3rd to 6th year). The intervention group will use e-learning with the serious gaming app Touch Surgery (TM) for chest drain insertion, whereas the control group uses serious gaming for an unrelated procedure. Primary endpoint is operative performance of chest drain insertion in a porcine cadaveric model according to OSATS. The randomized trial will help determine the value of e-learning with the serious gaming app Touch Surgery (TM) for chest drain insertion by using the OSATS score. The study will improve surgical training for trauma situations. Trial Registration Number, DRKS00009994 . Registered on 27 May 2016.

Satisfaction of Search in Chest Radiography 2015.

PubMed

Berbaum, Kevin S; Krupinski, Elizabeth A; Schartz, Kevin M; Caldwell, Robert T; Madsen, Mark T; Hur, Seung; Laroia, Archana T; Thompson, Brad H; Mullan, Brian F; Franken, Edmund A

2015-11-01

Two decades have passed since the publication of laboratory studies of satisfaction of search (SOS) in chest radiography. Those studies were performed using film. The current investigation tests for SOS effects in computed radiography of the chest. Sixty-four chest computed radiographs half demonstrating various "test" abnormalities were read twice by 20 radiologists, once with and once without the addition of a simulated pulmonary nodule. Receiver-operating characteristic detection accuracy and decision thresholds were analyzed to study the effects of adding the nodule on detecting the test abnormalities. Results of previous studies were reanalyzed using similar modern techniques. In the present study, adding nodules did not influence detection accuracy for the other abnormalities (P = .93), but did induce a reluctance to report them (P < .001). Adding nodules did not affect inspection time (P = .58) so the reluctance to report was not associated with reduced search. Reanalysis revealed a similar decision threshold shift that had not been recognized in the early studies of SOS in chest radiography (P < .01) in addition to reduced detection accuracy (P < .01). The nature of SOS in chest radiography has changed, but it is not clear why. SOS may be changing as a function of changes in radiology education and practice. Copyright © 2015 AUR. Published by Elsevier Inc. All rights reserved.

[Real-time feedback systems for improvement of resuscitation quality].

PubMed

Lukas, R P; Van Aken, H; Engel, P; Bohn, A

2011-07-01

The quality of chest compression is a determinant of survival after cardiac arrest. Therefore, the European Resuscitation Council (ERC) 2010 guidelines on resuscitation strongly focus on compression quality. Despite its impact on survival, observational studies have shown that chest compression quality is not reached by professional rescue teams. Real-time feedback devices for resuscitation are able to measure chest compression during an ongoing resuscitation attempt through a sternal sensor equipped with a motion and pressure detection system. In addition to the electrocardiograph (ECG) ventilation can be detected by transthoracic impedance monitoring. In cases of quality deviation, such as shallow chest compression depth or hyperventilation, feedback systems produce visual or acoustic alarms. Rescuers can thereby be supported and guided to the requested quality in chest compression and ventilation. Feedback technology is currently available both as a so-called stand-alone device and as an integrated feature in a monitor/defibrillator unit. Multiple studies have demonstrated sustainable enhancement in the education of resuscitation due to the use of real-time feedback technology. There is evidence that real-time feedback for resuscitation combined with training and debriefing strategies can improve both resuscitation quality and patient survival. Chest compression quality is an independent predictor for survival in resuscitation and should therefore be measured and documented in further clinical multicenter trials.

Utility of Chest Computed Tomography after a "Normal" Chest Radiograph in Patients with Thoracic Stab Wounds.

PubMed

Nguyen, Brian M; Plurad, David; Abrishami, Sadaf; Neville, Angela; Putnam, Brant; Kim, Dennis Y

2015-10-01

Chest computed tomography (CCT) is used to screen for injuries in hemodynamically stable patients with penetrating injury. We aim to determine the incidence of missed injuries detected on CCT after a negative chest radiograph (CXR) in patients with thoracic stab wounds. A 10-year retrospective review of a Level I trauma center registry was performed on patients with thoracic stab wounds. Patients who were hemodynamically unstable or did not undergo both CXR and CCT were excluded. Patients with a negative CXR were evaluated to determine if additional findings were diagnosed on CCT. Of 386 patients with stab wounds to the chest, 154 (40%) underwent both CXR and CCT. One hundred and fifteen (75%) had a negative screening CXR. CCT identified injuries in 42 patients (37%) that were not seen on CXR. Pneumothorax and/or hemothorax occurred in 40 patients (35%), of which 14 patients underwent tube thoracostomy. Two patients had hemopericardium on CCT and both required operative intervention. Greater than one-third of patients with a normal screening CXR were found to have abnormalities on CCT. Future studies comparing repeat CXR to CCT are required to further define the optimal diagnostic strategy in patients with stab wounds to chest after normal screening CXR.

Multidisciplinary approach to chest wall resection and reconstruction for chest wall tumors, a single center experience

PubMed Central

Liparulo, Valeria; Pica, Alessandra; Guarro, Giuseppe; Alfano, Carmine; Puma, Francesco

2017-01-01

Background Chest wall resection and reconstruction (CWRR) is quite challenging in surgery, due to evolution in techniques. Neoplasms of the chest wall, primary or secondary, have been considered inoperable for a long time. Thanks to evolving surgical techniques, reconstruction after extensive chest wall resection is possible with good functional and aesthetic results. Methods In our single-center experience, seven cases of extensive CWRR for tumors were performed with a multidisciplinary approach by both thoracic and plastic surgeons. Patients have been retrospective analyzed. Results Acceptable clinical and aesthetical results have been recorded, with a smooth post-operative course and a low rate of post-surgical complications. Two early complications and one late complication (asymptomatic bone allograft fracture on the site of the bar implant) were recorded. Neither postoperative deaths nor local recurrences were registered after a median follow-up period of 13 months. Conclusions Surgical planning is most effective when it is tailored to the patient. Specifically, in the treatment of selected chest wall tumors, the multidisciplinary approach is considered mandatory when an extensive demolition is required. Indeed, here, the radical wide en-bloc resection can lead to good results provided that the extent of resection is not influenced by any anticipated problem in reconstruction. PMID:29312715

EIT images of ventilation: what contributes to the resistivity changes?

PubMed

Zhang, Jie; Patterson, Robert P

2005-04-01

One promising application of electrical impedance tomography (EIT) is the monitoring of pulmonary ventilation and edema. Using three-dimensional (3D) finite difference human models as virtual phantoms, the factors that contribute to the observed lung resistivity changes in the EIT images were investigated. The results showed that the factors included not only tissue resistivity or vessel volume changes, but also chest expansion and tissue/organ movement. The chest expansion introduced artifacts in the center of the EIT images, ranging from -2% to 31% of the image magnitude. With the increase of simulated chest expansion, the percentage contribution of chest expansion relative to lung resistivity change in the EIT image remained relatively constant. The averaged resistivity changes in the lung regions caused by chest expansion ranged from 0.65% to 18.31%. Tissue/organ movement resulted in an increased resistivity in the lung region and in the center anterior region of EIT images. The increased resistivity with inspiration observed in the heart region was caused mainly by a drop in the heart position, which reduced the heart area at the electrode level and was replaced by the lung tissue with higher resistivity. This study indicates that for the analysis of EIT, data errors caused by chest expansion and tissue/organ movement need to be considered.

Reduction of adult fingers visualized on pediatric intensive care unit (PICU) chest radiographs after radiation technologist and PICU staff radiation safety education.

PubMed

Tynan, Jennifer R; Duncan, Meghan D; Burbridge, Brent E

2009-10-01

A recent publication from our centre revealed a disturbing finding of a significant incidence of adult fingers seen on the pediatric intensive care unit (PICU) chest radiographs. This is inappropriate occupational exposure to diagnostic radiation. We hypothesized that the incidence of adult fingers on PICU chest radiographs would decline after radiation safety educational seminars were given to the medical radiation technologists and PICU staff. The present study's objectives were addressed by using a pretest-posttest design. Two cross-sectional PICU chest radiograph samples, taken before and after the administration of radiation safety education for our medical radiation technologists and PICU staff, were compared by using a chi2 test. There was a 61.2% and 76.9% reduction in extraneous adult fingers, directly exposed to the x-ray beam and those seen in the coned regions of the film, respectively, on PICU chest radiographs (66.7% reduction overall). This reduction was statistically significant (chi2 = 20.613, P < .001). Limiting unnecessary occupational radiation exposure is a critical issue in radiology. There was a statistically and clinically significant association between radiation safety education and the decreased number of adult fingers seen on PICU chest radiographs. This study provides preliminary evidence in favour of the benefit of radiation safety seminars.

Cardiorespiratory interactions and blood flow generation during cardiac arrest and other states of low blood flow.

PubMed

Sigurdsson, Gardar; Yannopoulos, Demetris; McKnite, Scott H; Lurie, Keith G

2003-06-01

Recent advances in cardiopulmonary resuscitation have shed light on the importance of cardiorespiratory interactions during shock and cardiac arrest. This review focuses on recently published studies that evaluate factors that determine preload during chest compression, methods that can augment preload, and the detrimental effects of hyperventilation and interrupting chest compressions. Refilling of the ventricles, so-called ventricular preload, is diminished during cardiovascular collapse and resuscitation from cardiac arrest. In light of the potential detrimental effects and challenges of large-volume fluid resuscitations, other methods have increasing importance. During cardiac arrest, active decompression of the chest and impedance of inspiratory airflow during the recoil of the chest work by increasing negative intrathoracic pressure and, hence, increase refilling of the ventricles and increase cardiac preload, with improvement in survival. Conversely, increased frequency of ventilation has detrimental effects on coronary perfusion pressure and survival rates in cardiac arrest and severe shock. Prolonged interruption of chest compressions for delivering single-rescuer ventilation or analyzing rhythm before shock delivery is associated with decreased survival rate. Cardiorespiratory interactions are of profound importance in states of cardiovascular collapse in which increased negative intrathoracic pressure during decompression of the chest has a favorable effect and increased intrathoracic pressure with ventilation has a detrimental effect on survival rate.

Benefits of a Low Severity Frontal Crash Test

PubMed Central

Digges, Kennerly; Dalmotas, Dainius

2007-01-01

The US Federal Motor Vehicle Safety Standard for frontal protection requires vehicle crash tests into a rigid barrier with two belted dummies in the front seats. The standard was recently modified to require two separate 56 Kph frontal tests. In one test the dummies are 50% males. In the other test, the dummies are 5% females. Analysis of crash test data indicates that the 56 Kph test does not encourage technology to reduce chest injuries in lower severity crashes. Tests conducted by Transport Canada provide data from belted 5% female dummies in the front seats of vehicles that were subjected crashes into a rigid barrier at 40 Kph. An analysis of the results showed that for many vehicles, the risks of serious chest injuries were higher in the 40 Kph test than in a 56 Kph test. This paper examines the benefits that would result from a requirement for a low severity (40 Kph) frontal barrier crash test with two belted 5% female dummies and more stringent chest injury requirements. A preliminary benefits analysis for chest deflection allowable in the range of 28 mm. to 36 mm. was conducted. A standard that limits the chest deflection to 34 mm. would reduce serious chest injury by 16% to 24% for the belted population in frontal crashes. PMID:18184499

Benefits of a low severity frontal crash test.

PubMed

Digges, Kennerly; Dalmotas, Dainius

2007-01-01

The US Federal Motor Vehicle Safety Standard for frontal protection requires vehicle crash tests into a rigid barrier with two belted dummies in the front seats. The standard was recently modified to require two separate 56 Kph frontal tests. In one test the dummies are 50% males. In the other test, the dummies are 5% females. Analysis of crash test data indicates that the 56 Kph test does not encourage technology to reduce chest injuries in lower severity crashes. Tests conducted by Transport Canada provide data from belted 5% female dummies in the front seats of vehicles that were subjected crashes into a rigid barrier at 40 Kph. An analysis of the results showed that for many vehicles, the risks of serious chest injuries were higher in the 40 Kph test than in a 56 Kph test. This paper examines the benefits that would result from a requirement for a low severity (40 Kph) frontal barrier crash test with two belted 5% female dummies and more stringent chest injury requirements. A preliminary benefits analysis for chest deflection allowable in the range of 28 mm. to 36 mm. was conducted. A standard that limits the chest deflection to 34 mm. would reduce serious chest injury by 16% to 24% for the belted population in frontal crashes.

Establishing Pulmonary and Critical Care Medicine in China: 2016 Report on Implementation and Government Recognition: Joint Statement of the Chinese Association of Chest Physicians and the American College of Chest Physicians.

PubMed

Qiao, Renli; Marciniuk, Darcy; Augustyn, Nicki; Rosen, Mark J; Dai, Huaping; Chen, Rongchang; Wu, Sinan; Wang, Chen

2016-08-01

This article provides an update on progress toward establishing pulmonary and critical care medicine (PCCM) fellowship training as one of the first four subspecialties to be recognized and supported by the Chinese government. Designed and implemented throughout 2013 and 2014 by a collaborative effort of the Chinese Thoracic Society (CTS) and the American College of Chest Physicians (CHEST), 12 leading Chinese hospitals enrolled a total of 64 fellows into standardized PCCM training programs with common curricula, educational activities, and assessment measures. Supplemental educational materials, online assessment tools, and institutional site visits designed to evaluate and provide feedback on the programs' progress are being provided by CHEST. As a result of this initial progress, the Chinese government, through the Chinese Medical Doctor's Association, endorsed the concept of subspecialty fellowship training in China, with PCCM as one of the four pilot subspecialties to be operationalized nationwide in 2016, followed by implementation across other subspecialties by 2020. This article also reflects on the achievements of the training sites and the challenges they face and outlines plans to enhance and expand PCCM training and practice in China. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Symptomatic Treatment of Cough Among Adult Patients With Lung Cancer: CHEST Guideline and Expert Panel Report.

PubMed

Molassiotis, Alex; Smith, Jaclyn A; Mazzone, Peter; Blackhall, Fiona; Irwin, Richard S

2017-04-01

Cough among patients with lung cancer is a common but often undertreated symptom. We used a 2015 Cochrane systematic review, among other sources of evidence, to update the recommendations and suggestions of the American College of Chest Physicians (CHEST) 2006 guideline on this topic. The CHEST methodologic guidelines and the Grading of Recommendations, Assessment, Development, and Evaluation framework were used. The Expert Cough Panel based their recommendations on data from the Cochrane systematic review on the topic, uncontrolled studies, case studies, and the clinical context. Final grading was reached by consensus according to the Delphi method. The Cochrane systematic review identified 17 trials of primarily low-quality evidence. Such evidence was related to both nonpharmacologic (cough suppression) and pharmacologic (demulcents, opioids, peripherally acting antitussives, or local anesthetics) treatments, as well as endobronchial brachytherapy. Compared with the 2006 CHEST Cough Guideline, the current recommendations and suggestions are more specific and follow a step-up approach to the management of cough among patients with lung cancer, acknowledging the low-quality evidence in the field and the urgent need to develop more effective, evidence-based interventions through high-quality research. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Low Yield of Chest Radiography in General Inpatients and Outpatients with "Positive PPD" Results in a Country with Low Prevalence of TB.

PubMed

Eisenberg, Ronald L; Heidinger, Benedikt H

2017-07-01

The purpose of this study was to assess the frequency and spectrum of abnormalities on routine screening chest radiographs among inpatients and outpatients with "positive purified protein derivative (PPD)" in a large tertiary care academic medical center in a country with low prevalence of tuberculosis (TB). The reports of all chest radiographs of general inpatients and outpatients referred for positive PPD (2010-2014) were evaluated for the frequency of evidence of active or latent TB and the spectrum of imaging findings. The results of additional chest radiographs and computed tomography scans were recorded, as were additional relevant clinical histories and symptoms. Of the 2518 patients who underwent chest radiography for positive PPD, the radiographs were normal in 91.3%. The vast majority of the abnormal radiographs demonstrated findings consistent with old tuberculous disease. There were three cases (0.1%) of active TB, all of which were either recent immigrants from an endemic area or had other relevant histories or clinical symptoms suggestive of the disease. Universal chest radiography in general inpatient and outpatient populations referred for positive PPD is of low yield for detecting active disease in a country with low prevalence of TB. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Segmentation of lung fields using Chan-Vese active contour model in chest radiographs

NASA Astrophysics Data System (ADS)

Sohn, Kiwon

2011-03-01

A CAD tool for chest radiographs consists of several procedures and the very first step is segmentation of lung fields. We develop a novel methodology for segmentation of lung fields in chest radiographs that can satisfy the following two requirements. First, we aim to develop a segmentation method that does not need a training stage with manual estimation of anatomical features in a large training dataset of images. Secondly, for the ease of implementation, it is desirable to apply a well established model that is widely used for various image-partitioning practices. The Chan-Vese active contour model, which is based on Mumford-Shah functional in the level set framework, is applied for segmentation of lung fields. With the use of this model, segmentation of lung fields can be carried out without detailed prior knowledge on the radiographic anatomy of the chest, yet in some chest radiographs, the trachea regions are unfavorably segmented out in addition to the lung field contours. To eliminate artifacts from the trachea, we locate the upper end of the trachea, find a vertical center line of the trachea and delineate it, and then brighten the trachea region to make it less distinctive. The segmentation process is finalized by subsequent morphological operations. We randomly select 30 images from the Japanese Society of Radiological Technology image database to test the proposed methodology and the results are shown. We hope our segmentation technique can help to promote of CAD tools, especially for emerging chest radiographic imaging techniques such as dual energy radiography and chest tomosynthesis.

[Chest trauma].

PubMed

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

2011-01-01

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

The prevalence of chest compression leaning during in-hospital cardiopulmonary resuscitation

PubMed Central

Fried, David A.; Leary, Marion; Smith, Douglas A.; Sutton, Robert M.; Niles, Dana; Herzberg, Daniel L.; Becker, Lance B.; Abella, Benjamin S.

2011-01-01

Objective Successful resuscitation from cardiac arrest requires the delivery of high-quality chest compressions, encompassing parameters such as adequate rate, depth, and full recoil between compressions. The lack of compression recoil (“leaning” or “incomplete recoil”) has been shown to adversely affect hemodynamics in experimental arrest models, but the prevalence of leaning during actual resuscitation is poorly understood. We hypothesized that leaning varies across resuscitation events, possibly due to rescuer and/or patient characteristics and may worsen over time from rescuer fatigue during continuous chest compressions. Methods This was an observational clinical cohort study at one academic medical center. Data were collected from adult in-hospital and Emergency Department arrest events using monitor/defibrillators that record chest compression characteristics and provide real-time feedback. Results We analyzed 112,569 chest compressions from 108 arrest episodes from 5/2007 to 2/2009. Leaning was present in 98/108 (91%) cases; 12% of all compressions exhibited leaning. Leaning varied widely across cases: 41/108 (38%) of arrest episodes exhibited <5% leaning yet 20/108 (19%) demonstrated >20% compression leaning. When evaluating blocks of continuous compressions (>120 sec), only 4/33 (12%) had an increase in leaning over time and 29/33 (88%) showed a decrease (p<0.001). Conclusions Chest compression leaning was common during resuscitation care and exhibited a wide distribution, with most leaning within a subset of resuscitations. Leaning decreased over time during continuous chest compression blocks, suggesting that either leaning may not be a function of rescuer fatiguing, or that it may have been mitigated by automated feedback provided during resuscitation episodes. PMID:21482010

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

PubMed

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

2018-01-01

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

The exploration of the exhibition informatization

NASA Astrophysics Data System (ADS)

Zhang, Jiankang

2017-06-01

The construction and management of exhibition informatization is the main task and choke point during the process of Chinese exhibition industry’s transformation and promotion. There are three key points expected to realize a breakthrough during the construction of Chinese exhibition informatization, and the three aspects respectively are adopting service outsourcing to construct and maintain the database, adopting advanced chest card technology to collect various kinds of information, developing statistics analysis to maintain good cutomer relations. The success of Chinese exhibition informatization mainly calls for mature suppliers who can provide construction and maintenance of database, the proven technology, a sense of data security, advanced chest card technology, the ability of data mining and analysis and the ability to improve the exhibition service basing on the commercial information got from the data analysis. Several data security measures are expected to apply during the process of system developing, including the measures of the terminal data security, the internet data security, the media data security, the storage data security and the application data security. The informatization of this process is based on the chest card designing. At present, there are several types of chest card technology: bar code chest card; two-dimension code card; magnetic stripe chest card; smart-chip chest card. The information got from the exhibition data will help the organizers to make relevant service strategies, quantify the accumulated indexes of the customers, and improve the level of the customer’s satisfaction and loyalty, what’s more, the information can also provide more additional services like the commercial trips, VIP ceremonial reception.

Radioactive implant migration in patients treated for localized prostate cancer with interstitial brachytherapy.

PubMed

Older, R A; Synder, B; Krupski, T L; Glembocki, D J; Gillenwater, J Y

2001-05-01

In several of the initial patients undergoing brachytherapy at our institution radioactive implants were visible in the thorax on chest radiography. The clinical ramifications of this unanticipated finding were unclear. Thus, we investigated the incidence of brachytherapy seed migration to the chest and whether these seeds were associated with any clinical significance. We retrospectively reviewed the records of all patients who underwent ultrasound or computerized tomography guided brachytherapy of 103palladium seeds from March 1997 to March 1999. This list of patients on brachytherapy was then matched against the radiology computer system to determine those who had undergone chest X-ray after brachytherapy. When the radiology report was unclear regarding brachytherapy seeds, chest x-rays were reviewed by one of us (R. O.) to determine the presence and position of the seeds. Post-brachytherapy chest x-rays were available in 110 of the 183 patients. In 78 cases no brachytherapy seeds were identified. Radioactive implants were identified on chest radiography in 32 patients (29%), including 1 to 5 seeds in 20, 8, 1, 2 and 1, respectively. No patients complained of any change in pulmonary symptoms after brachytherapy. Radioactive implants migrated after brachytherapy for localized prostate cancer in 29% of the patients who underwent post-procedure radiography. There did not appear to be a pattern to the seed distribution. However, while the incidence was not negligible, no patient appeared to have any acute pulmonary symptoms. Therefore, while the migration of radioactive implants to the chest is a real phenomenon, it appears to have no adverse clinical consequences in the early post-procedure period.

Point-of-care lung ultrasound in children with community acquired pneumonia.

PubMed

Yilmaz, Hayri Levent; Özkaya, Ahmet Kağan; Sarı Gökay, Sinem; Tolu Kendir, Özlem; Şenol, Hande

2017-07-01

To present lung ultrasound findings in children assessed with suspected pneumonia in the emergency department and to show the benefit of lung ultrasound in diagnosing pneumonia in comparison with chest X-rays. This observational prospective study was performed in the pediatric emergency department of a single center. Point of care lung ultrasound was performed on each child by an independent sonographer blinded to the patient's clinical and chest X-ray findings. Community acquired pneumonia was established as a final diagnosis by two clinicians based on the recommendations in the British Thoracic Society guideline. One hundred sixty children with a mean age of 3.3±4years and a median age of 1.4years (min-max 0.08-17.5years) were investigated. Final diagnosis in 149 children was community-acquired pneumonia. Lung ultrasound findings were compatible with pneumonia in 142 (95.3%) of these 149 children, while chest X-ray findings were compatible with pneumonia in 132 (88.5%). Pneumonia was confirmed with lung ultrasound in 15 of the 17 patients (11.4%) not evaluated as compatible with pneumonia at chest X-ray. While pneumonia could not be confirmed with lung ultrasound in seven (4.6%) patients, findings compatible with pneumonia were not determined at chest X-ray in two of these patients. When lung ultrasound and chest X-ray were compared as diagnostic tools, a significant difference was observed between them (p=0.041). This study shows that lung ultrasound is at least as useful as chest X-ray in diagnosing children with community-acquired pneumonia. Copyright © 2017 Elsevier Inc. All rights reserved.

The usefulness of Wi-Fi based digital chest drainage system in the post-operative care of pneumothorax

PubMed Central

Cho, Hyun Min; Hong, Yoon Joo; Byun, Chun Sung

2016-01-01

Background Chest drainage systems are usually composed of chest tube and underwater-seal bottle. But this conventional system may restrict patients doing exercise and give clinicians obscure data about when to remove tubes because there is no objective indicator. Recently developed digital chest drainage systems may facilitate interpretation of the grade of air leak and make it easy for clinicians to decide when to remove chest tubes. In addition, with combination of wireless internet devices, monitoring and managing of drainage system distant from the patient is possible. Methods Sixty patients of primary pneumothorax were included in a prospective randomized study and divided into two groups. Group I (study) consisted of digital chest drainage system while in group II (control), conventional underwater-seal chest bottle system was used. Data was collected from January, 2012 to September, 2013 in Eulji University Hospital, Daejeon, Korea. Results There was no difference in age, sex, smoking history and postoperative pain between two groups. But the average length of drainage was 2.2 days in group I and 3.1 days in group II (P<0.006). And more, about 90% of the patients in group I was satisfied with using new device for convenience. Conclusions Digital system was beneficial on reducing the length of tube drainage by real time monitoring. It also had advantage in portability, loudness and gave more satisfaction than conventional system. Moreover, internet based digital drainage system will be a good method in thoracic telemedicine area in the near future. PMID:27076934

Chest radiography in supporting the diagnosis of asthma in children with persistent cough.

PubMed

Halaby, Claudia; Feuerman, Martin; Barlev, Dan; Pirzada, Melodi

2014-03-01

To establish whether chest radiographic findings suggestive of lower airway obstruction (LAO) disease support the diagnosis of asthma in pediatric patients with persistent cough in an outpatient setting. 180 patient charts were reviewed. The patients were children aged 1 to 18 years referred over a 3-year period to a pediatric pulmonary subspecialty clinic for evaluation of cough lasting ≥ 4 weeks. Chest radiographic images obtained after the initial evaluation of 90 patients diagnosed with cough-variant asthma and 90 patients diagnosed with persistent cough from nonasthma origins were compared with radiologic findings of a control group consisting of patients with a positive tuberculin skin test and no respiratory symptoms. Increased peribronchial markings/peribronchial cuffing and hyperinflation were considered radiographically suggestive findings of LAO disease. Children diagnosed with cough-variant asthma at the initial evaluation had higher rates of chest radiographic findings suggestive of LAO disease (30.00%) than children with persistent cough from other causes (17.80%) or those with a positive tuberculin skin test and no respiratory symptoms (8.16%) (overall P value = 0.0063). They also had higher rates of spirometry abnormalities suggestive of an LAO defect. Children with chest radiographic findings suggestive of LAO disease were found to be younger than those with normal chest radiographic findings (5.0 ± 2.7 years vs 8.6 ± 4.7 years; P < 0.0001). This study suggests that chest radiographic findings indicative of an LAO in correlation with the clinical presentation can support the diagnostic suspicion of asthma, especially in younger children unable to perform spirometry.

Epidemiology of angina pectoris: role of natural language processing of the medical record

PubMed Central

Pakhomov, Serguei; Hemingway, Harry; Weston, Susan A.; Jacobsen, Steven J.; Rodeheffer, Richard; Roger, Véronique L.

2007-01-01

Background The diagnosis of angina is challenging as it relies on symptom descriptions. Natural language processing (NLP) of the electronic medical record (EMR) can provide access to such information contained in free text that may not be fully captured by conventional diagnostic coding. Objective To test the hypothesis that NLP of the EMR improves angina pectoris (AP) ascertainment over diagnostic codes. Methods Billing records of in- and out-patients were searched for ICD-9 codes for AP, chronic ischemic heart disease and chest pain. EMR clinical reports were searched electronically for 50 specific non-negated natural language synonyms to these ICD-9 codes. The two methods were compared to a standardized assessment of angina by Rose questionnaire for three diagnostic levels: unspecified chest pain, exertional chest pain, and Rose angina. Results Compared to the Rose questionnaire, the true positive rate of EMR-NLP for unspecified chest pain was 62% (95%CI:55–67) vs. 51% (95%CI:44–58) for diagnostic codes (p<0.001). For exertional chest pain, the EMR-NLP true positive rate was 71% (95%CI:61–80) vs. 62% (95%CI:52–73) for diagnostic codes (p=0.10). Both approaches had 88% (95%CI:65–100) true positive rate for Rose angina. The EMR-NLP method consistently identified more patients with exertional chest pain over 28-month follow-up. Conclusion EMR-NLP method improves the detection of unspecified and exertional chest pain cases compared to diagnostic codes. These findings have implications for epidemiological and clinical studies of angina pectoris. PMID:17383310

Evaluation of Pulmonary Nodules: Clinical Practice Consensus Guidelines for Asia.

PubMed

Bai, Chunxue; Choi, Chang-Min; Chu, Chung Ming; Anantham, Devanand; Chung-Man Ho, James; Khan, Ali Zamir; Lee, Jang-Ming; Li, Shi Yue; Saenghirunvattana, Sawang; Yim, Anthony

2016-10-01

American College of Chest Physicians (CHEST) clinical practice guidelines on the evaluation of pulmonary nodules may have low adoption among clinicians in Asian countries. Unique patient characteristics of Asian patients affect the diagnostic evaluation of pulmonary nodules. The objective of these clinical practice guidelines was to adapt those of CHEST to provide consensus-based recommendations relevant to practitioners in Asia. A modified ADAPTE process was used by a multidisciplinary group of pulmonologists and thoracic surgeons in Asia. An initial panel meeting analyzed all CHEST recommendations to achieve consensus on recommendations and identify areas that required further investigation before consensus could be achieved. Revised recommendations were circulated to panel members for iterative review and redrafting to develop the final guidelines. Evaluation of pulmonary nodules in Asia broadly follows those of the CHEST guidelines with important caveats. Practitioners should be aware of the risk of lung cancer caused by high levels of indoor and outdoor air pollution, as well as the high incidence of adenocarcinoma in female nonsmokers. Furthermore, the high prevalence of granulomatous disease and other infectious causes of pulmonary nodules need to be considered. Therefore, diagnostic risk calculators developed in non-Asian patients may not be applicable. Overall, longer surveillance of nodules than those recommended by CHEST should be considered. TB in Asia favors lesser reliance on PET scanning and greater use of nonsurgical biopsy over surgical diagnosis or surveillance. Practitioners in Asia are encouraged to use these adapted consensus guidelines to facilitate consistent evaluation of pulmonary nodules. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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

PubMed

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

2017-09-01

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

Impact of a feedback device on chest compression quality during extended manikin CPR: a randomized crossover study.

PubMed

Buléon, Clément; Delaunay, Julie; Parienti, Jean-Jacques; Halbout, Laurent; Arrot, Xavier; Gérard, Jean-Louis; Hanouz, Jean-Luc

2016-09-01

Chest compressions require physical effort leading to increased fatigue and rapid degradation in the quality of cardiopulmonary resuscitation overtime. Despite harmful effect of interrupting chest compressions, current guidelines recommend that rescuers switch every 2 minutes. The impact on the quality of chest compressions during extended cardiopulmonary resuscitation has yet to be assessed. We conducted randomized crossover study on manikin (ResusciAnne; Laerdal). After randomization, 60 professional emergency rescuers performed 2 × 10 minutes of continuous chest compressions with and without a feedback device (CPRmeter). Efficient compression rate (primary outcome) was defined as the frequency target reached along with depth and leaning at the same time (recorded continuously). The 10-minute mean efficient compression rate was significantly better in the feedback group: 42% vs 21% (P< .001). There was no significant difference between the first (43%) and the tenth minute (36%; P= .068) with feedback. Conversely, a significant difference was evident from the second minute without feedback (35% initially vs 27%; P< .001). The efficient compression rate difference with and without feedback was significant every minute, from the second minute onwards. CPRmeter feedback significantly improved chest compression depth from the first minute, leaning from the second minute and rate from the third minute. A real-time feedback device delivers longer effective, steadier chest compressions over time. An extrapolation of these results from simulation may allow rescuer switches to be carried out beyond the currently recommended 2 minutes when a feedback device is used. Copyright © 2016 Elsevier Inc. All rights reserved.

Duplex Ultrasonography Has Limited Utility in Detection of Postoperative DVT After Primary Total Joint Arthroplasty.

PubMed

Vira, Shaleen; Ramme, Austin J; Alaia, Michael J; Steiger, David; Vigdorchik, Jonathan M; Jaffe, Frederick

2016-07-01

Duplex ultrasound is routinely used to evaluate suspected deep venous thrombosis after total joint arthroplasty. When there is a clinical suspicion for a pulmonary embolism, a chest angiogram (chest CTA) is concomitantly obtained. Two questions were addressed: First, for the population of patients who receive duplex ultrasound after total joint arthroplasty, what is the rate of positive results? Second, for these patients, how many of these also undergo chest CTA for clinical suspicion of pulmonary embolus and how many of these tests are positive? Furthermore, what is the correlation between duplex ultrasound results and chest CTA results? A retrospective chart review was conducted of total joint replacement patients in 2011 at a single institution. Inclusion criteria were adult patients who underwent a postoperative duplex ultrasonography for clinical suspicion of deep venous thrombosis (DVT). Demographic data, result of duplex scan, clinical indications for obtaining the duplex scan, and DVT prophylaxis used were recorded. Additionally, if a chest CTA was obtained for clinical suspicion for pulmonary embolus, results and clinical indication for obtaining the test were recorded. The rate of positive results for duplex ultrasonography and chest CTA was computed and correlated based on clinical indications. Two hundred ninety-five patients underwent duplex ultrasonography of which only 0.7% were positive for a DVT. One hundred three patients underwent a chest CTA for clinical suspicion of a pulmonary embolism (PE) of which 26 revealed a pulmonary embolus, none of which had a positive duplex ultrasound. Postoperative duplex scans have a low rate of positive results. A substantial number of patients with negative duplex results subsequently underwent chest CTA for clinical suspicion for which a pulmonary embolus was found, presumably resulting from a DVT despite negative duplex ultrasound result. A negative duplex ultrasonography should not rule out the presence of a DVT which can embolize to the lungs and thus should not preclude further workup when clinical suspicion exists for a pulmonary embolus.

Correlation between the signal-to-noise ratio improvement factor (KSNR) and clinical image quality for chest imaging with a computed radiography system

NASA Astrophysics Data System (ADS)

Moore, C. S.; Wood, T. J.; Saunderson, J. R.; Beavis, A. W.

2015-12-01

This work assessed the appropriateness of the signal-to-noise ratio improvement factor (KSNR) as a metric for the optimisation of computed radiography (CR) of the chest. The results of a previous study in which four experienced image evaluators graded computer simulated chest images using a visual grading analysis scoring (VGAS) scheme to quantify the benefit of using an anti-scatter grid were used for the clinical image quality measurement (number of simulated patients  =  80). The KSNR was used to calculate the improvement in physical image quality measured in a physical chest phantom. KSNR correlation with VGAS was assessed as a function of chest region (lung, spine and diaphragm/retrodiaphragm), and as a function of x-ray tube voltage in a given chest region. The correlation of the latter was determined by the Pearson correlation coefficient. VGAS and KSNR image quality metrics demonstrated no correlation in the lung region but did show correlation in the spine and diaphragm/retrodiaphragmatic regions. However, there was no correlation as a function of tube voltage in any region; a Pearson correlation coefficient (R) of  -0.93 (p  =  0.015) was found for lung, a coefficient (R) of  -0.95 (p  =  0.46) was found for spine, and a coefficient (R) of  -0.85 (p  =  0.015) was found for diaphragm. All demonstrate strong negative correlations indicating conflicting results, i.e. KSNR increases with tube voltage but VGAS decreases. Medical physicists should use the KSNR metric with caution when assessing any potential improvement in clinical chest image quality when introducing an anti-scatter grid for CR imaging, especially in the lung region. This metric may also be a limited descriptor of clinical chest image quality as a function of tube voltage when a grid is used routinely.

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

PubMed

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

2013-08-01

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

Chest compression rates and survival following out-of-hospital cardiac arrest.

PubMed

Idris, Ahamed H; Guffey, Danielle; Pepe, Paul E; Brown, Siobhan P; Brooks, Steven C; Callaway, Clifton W; Christenson, Jim; Davis, Daniel P; Daya, Mohamud R; Gray, Randal; Kudenchuk, Peter J; Larsen, Jonathan; Lin, Steve; Menegazzi, James J; Sheehan, Kellie; Sopko, George; Stiell, Ian; Nichol, Graham; Aufderheide, Tom P

2015-04-01

Guidelines for cardiopulmonary resuscitation recommend a chest compression rate of at least 100 compressions/min. A recent clinical study reported optimal return of spontaneous circulation with rates between 100 and 120/min during cardiopulmonary resuscitation for out-of-hospital cardiac arrest. However, the relationship between compression rate and survival is still undetermined. Prospective, observational study. Data is from the Resuscitation Outcomes Consortium Prehospital Resuscitation IMpedance threshold device and Early versus Delayed analysis clinical trial. Adults with out-of-hospital cardiac arrest treated by emergency medical service providers. None. Data were abstracted from monitor-defibrillator recordings for the first five minutes of emergency medical service cardiopulmonary resuscitation. Multiple logistic regression assessed odds ratio for survival by compression rate categories (<80, 80-99, 100-119, 120-139, ≥140), both unadjusted and adjusted for sex, age, witnessed status, attempted bystander cardiopulmonary resuscitation, location of arrest, chest compression fraction and depth, first rhythm, and study site. Compression rate data were available for 10,371 patients; 6,399 also had chest compression fraction and depth data. Age (mean±SD) was 67±16 years. Chest compression rate was 111±19 per minute, compression fraction was 0.70±0.17, and compression depth was 42±12 mm. Circulation was restored in 34%; 9% survived to hospital discharge. After adjustment for covariates without chest compression depth and fraction (n=10,371), a global test found no significant relationship between compression rate and survival (p=0.19). However, after adjustment for covariates including chest compression depth and fraction (n=6,399), the global test found a significant relationship between compression rate and survival (p=0.02), with the reference group (100-119 compressions/min) having the greatest likelihood for survival. After adjustment for chest compression fraction and depth, compression rates between 100 and 120 per minute were associated with greatest survival to hospital discharge.

Efficacy and safety of a single 2 mg dose or 4 mg double dose of alteplase for 50 occluded chest ports using a unique instillation technique.

PubMed

Sharma, Rajinder P; Ree, Chung Ja; Ree, Alexander

2008-01-01

To evaluate the effectiveness and safety of a single 2 mg dose or a 4 mg double dose of alteplase for restoring function in occluded chest ports. A prospective, open-label, nonblinded study was performed on 40 enrolled patients with a total of 50 chest ports at the Henry Ford Hospital Interventional Radiology Department (Detroid, Michigan, USA). Alteplase (Cathflo Activase; Genentech, USA), a recombinant tissue plasminogen activator produced by recombinant DNA technology, was used to restore the function of 50 occluded chest ports. Occlusion was defined as the inability to withdraw blood freely from the port, or the inability to flush the port easily. A 2 mg (2 mL) dose of alteplase was injected into the port through a Huber needle, using a gentle push and pull technique, and was left to dwell for 30 min. If the port remained occluded after the initial 2 mg alteplase treatment, an additional 2 mg alteplase treatment was administered with the same dwell time of 30 min. If a port had remained occluded despite the above regimen, this outcome would have been considered a failure and the chest port would have required surgical intervention. However, all ports were successfully treated, and no surgical intervention was required. The safety end points included minor or major hemorrhages, such as intracranial hemorrhages, or sepsis. Safety end points were determined by a 24 h follow-up telephone call. Of the 50 chest ports (30 single ports and 10 double ports) treated with alteplase, 36 required 2 mg (72%) and 14 required 4 mg (28%). The efficacy end point was 100% for all chest ports treated, without any adverse events. High efficacy and safety rates of restoring function in occluded chest ports were obtained with 2 mg or 4 mg doses of alteplase. Part of this high efficacy rate may be due to the gentle push and pull technique used in the present study.

Outcomes and radiation exposure of emergency department patients with chest pain and shortness of breath and ultralow pretest probability: a multicenter study.

PubMed

Kline, Jeffrey A; Shapiro, Nathan I; Jones, Alan E; Hernandez, Jackeline; Hogg, Melanie M; Troyer, Jennifer; Nelson, R Darrell

2014-03-01

Excessive radiation exposure remains a concern for patients with symptoms suggesting acute coronary syndrome and pulmonary embolism but must be judged in the perspective of pretest probability and outcomes. We quantify and qualify the pretest probability, outcomes, and radiation exposure of adults with both chest pain and dyspnea. This was a prospective, 4-center, outcomes study. Patients were adults with dyspnea and chest pain, nondiagnostic ECGs, and no obvious diagnosis. Pretest probability for both acute coronary syndrome and pulmonary embolism was assessed with a validated method; ultralow risk was defined as pretest probability less than 2.5% for both acute coronary syndrome and pulmonary embolism. Patients were followed for diagnosis and total medical radiation exposure for 90 days. Eight hundred forty patients had complete data; 23 (3%) had acute coronary syndrome and 15 (2%) had pulmonary embolism. The cohort received an average of 4.9 mSv radiation to the chest, 48% from computed tomography pulmonary angiography. The pretest probability estimates for acute coronary syndrome and pulmonary embolism were less than 2.5% in 227 patients (27%), of whom 0 of 277 (0%; 95% confidence interval 0% to 1.7%) had acute coronary syndrome or pulmonary embolism and 7 of 227 (3%) had any significant cardiopulmonary diagnosis. The estimated chest radiation exposure per patient in this ultralow-risk group was 3.5 mSv, including 26 (3%) with greater than 5 mSv radiation to the chest and no significant cardiopulmonary diagnosis. One quarter of patients with chest pain and dyspnea had ultralow risk and no acute coronary syndrome or pulmonary embolism but were exposed to an average of 3.5 mSv radiation to the chest. These data can be used in a clinical guideline to reduce radiation exposure. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

SU-E-P-57: Radiation Doses Assessment to Paediatric Patients for Some Digital Diagnostic Radiology Examination in Emergency Department in Qatar

DOE Office of Scientific and Technical Information (OSTI.GOV)

Abdallah, I; Aly, A; Al Naemi, H

Purpose: The aim of this study was to evaluate radiation doses to pediatric patients undergoing standard radiographic examinations using Direct Digital Radiography (DDR) in Paediatric emergency center of Hamad General Hospital (HGH) in state of Qatar and compared with regional and international Dose Reference Levels (DRLs). Methods: Entrance Skin Dose (ESD) was measured for 2739 patients for two common X-ray examinations namely: Chest AP/PA, Abdomen. Exposure factors such as kV, mAs and Focal to Skin Distance (FSD) were recorded for each patient. Tube Output was measured for a range of selected kV values. ESD for each individual patient was calculatedmore » using the tube output and the technical exposure factors for each examination. The ESD values were compared with the some international Dose Reference Levels (DRL) for all types of examinations. Results: The most performed procedure during the time of this study was chest PA/PA (85%). The mean ESD values obtained from AP chest, PA chest and AP abdomen ranged 91–120, 80–84 and 209 – 659 µGy per radiograph for different age’s groups respectively. Two protocols have been used for chest AP and PA using different radiological parameters, and the different of ESD values for chest PA and were 41% for 1 years old child, 57% for 5 years old for chest AP. Conclusion: The mean ESD were compared with those found in literature and were found to be comparable. The radiation dose can be reduced more for Chest AP and PA examination by optimization of each investigation and hence more studies are required for this task. The results presented will serve as a baseline data needed for deriving local reference doses for pediatric X-ray examinations in this local department and hence it can be applied in the whole Qatar.« less

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cheung, Y; Rahimi, A; Sawant, A

Purpose: Active breathing control (ABC) has been used to reduce treatment margin due to respiratory organ motion by enforcing temporary breath-holds. However, in practice, even if the ABC device indicates constant lung volume during breath-hold, the patient may still exhibit minor chest motion. Consequently, therapists are given a false sense of security that the patient is immobilized. This study aims at quantifying such motion during ABC breath-holds by monitoring the patient chest motion using a surface photogrammetry system, VisionRT. Methods: A female patient with breast cancer was selected to evaluate chest motion during ABC breath-holds. During the entire course ofmore » treatment, the patient’s chest surface was monitored by a surface photogrammetry system, VisionRT. Specifically, a user-defined region-of-interest (ROI) on the chest surface was selected for the system to track at a rate of ∼3Hz. The surface motion was estimated by rigid image registration between the current ROI image captured and a reference image. The translational and rotational displacements computed were saved in a log file. Results: A total of 20 fractions of radiation treatment were monitored by VisionRT. After removing noisy data, we obtained chest motion of 79 breath-hold sessions. Mean chest motion in AP direction during breath-holds is 1.31mm with 0.62mm standard deviation. Of the 79 sessions, the patient exhibited motion ranging from 0–1 mm (30 sessions), 1–2 mm (37 sessions), 2–3 mm (11 sessions) and >3 mm (1 session). Conclusion: Contrary to popular assumptions, the patient is not completely still during ABC breath-hold sessions. In this particular case studied, the patient exhibited chest motion over 2mm in 14 out of 79 breath-holds. Underestimating treatment margin for radiation therapy with ABC could reduce treatment effectiveness due to geometric miss or overdose of critical organs. The senior author receives research funding from NIH, VisionRT, Varian Medical Systems and Elekta.« less

Long-term retention of cardiopulmonary resuscitation skills after shortened chest compression-only training and conventional training: a randomized controlled trial.

PubMed

Nishiyama, Chika; Iwami, Taku; Kitamura, Tetsuhisa; Ando, Masahiko; Sakamoto, Tetsuya; Marukawa, Seishiro; Kawamura, Takashi

2014-01-01

It is unclear how much the length of a cardiopulmonary resuscitation (CPR) training program can be reduced without ruining its effectiveness. The authors aimed to compare CPR skills 6 months and 1 year after training between shortened chest compression-only CPR training and conventional CPR training. Participants were randomly assigned to either the compression-only CPR group, which underwent a 45-minute training program consisting of chest compressions and automated external defibrillator (AED) use with personal training manikins, or the conventional CPR group, which underwent a 180-minute training program with chest compressions, rescue breathing, and AED use. Participants' resuscitation skills were evaluated 6 months and 1 year after the training. The primary outcome measure was the proportion of appropriate chest compressions 1 year after the training. A total of 146 persons were enrolled, and 63 (87.5%) in the compression-only CPR group and 56 (75.7%) in the conventional CPR group completed the 1-year evaluation. The compression-only CPR group was superior to the conventional CPR group regarding the proportion of appropriate chest compression (mean ± SD = 59.8% ± 40.0% vs. 46.3% ± 28.6%; p = 0.036) and the number of appropriate chest compressions (mean ± SD = 119.5 ± 80.0 vs. 77.2 ± 47.8; p = 0.001). Time without chest compression in the compression-only CPR group was significantly shorter than that in the conventional CPR group (mean ± SD = 11.8 ± 21.1 seconds vs. 52.9 ± 14.9 seconds; p < 0.001). The shortened compression-only CPR training program appears to help the general public retain CPR skills better than the conventional CPR training program. UMIN-CTR UMIN000001675. © 2013 by the Society for Academic Emergency Medicine.

Analysis of bone healing in flail chest injury: do we need to fix both fractures per rib?

PubMed

Marasco, Silvana; Liew, Susan; Edwards, Elton; Varma, Dinesh; Summerhayes, Robyn

2014-09-01

Surgical rib fixation (SRF) for severe rib fracture injuries is generating increasing interest in the medical literature. It is well documented that poorly healed fractured ribs can lead to chronic pain, disability, and deformity. An unanswered question in SRF for flail chest injury is whether it is sufficient to fix one fracture per rib, on successive ribs, thus converting a flail chest injury into simple fractured ribs, or whether both ends of the floating segment of the chest wall should be fixed. This study aimed to analyze SRF in flail chest injury, assessing 3-month outcomes for nonfixed fractured rib ends in the flail segment. This is a retrospective review (2005-2013) of 60 consecutive patients who underwent SRF for flail chest injury admitted to the Alfred Hospital, Melbourne, Australia. Imaging by three-dimensional computed tomography (3D CT) of the chest at admission was compared with follow-up 3D CT at 3 months after injury. The 3-month CT scans were assessed for degree of healing and presence of residual deformity at the fracture fixation site. Follow-up CT was performed in 52 of the 60 patients. At 3 months after surgery, 86.5% of the patients had at least partial healing with good alignment and adequate fracture stabilization. Hardware failure was noted in five patients (9.6%) and occurred with the absorbable prostheses only. Six patients who had preoperative overlapping or displacement showed no improvement in deformity despite fixing the lateral fractures. Callus formation and bony bridging between adjacent ribs was often noted in the rib fractures not fixed (28 of 52 patients, 54%) This retrospective review of 3D CT chest at 3 months after rib fixation indicates that a philosophy of fixing only one fracture per rib in a flail segment does not avoid deformity and displacement, particularly in posterior rib fractures. Therapeutic study, level V; epidemiologic study, level V.

Clinical outcomes and cost effectiveness of accelerated diagnostic protocol in a chest pain center compared with routine care of patients with chest pain.

PubMed

Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

2015-01-01

The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14-0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources.

Clinical Outcomes and Cost Effectiveness of Accelerated Diagnostic Protocol in a Chest Pain Center Compared with Routine Care of Patients with Chest Pain

PubMed Central

Asher, Elad; Reuveni, Haim; Shlomo, Nir; Gerber, Yariv; Beigel, Roy; Narodetski, Michael; Eldar, Michael; Or, Jacob; Hod, Hanoch; Shamiss, Arie; Matetzky, Shlomi

2015-01-01

Aims The aim of this study was to compare in patients presenting with acute chest pain the clinical outcomes and cost-effectiveness of an accelerated diagnostic protocol utilizing contemporary technology in a chest pain unit versus routine care in an internal medicine department. Methods and Results Hospital and 90-day course were prospectively studied in 585 consecutive low-moderate risk acute chest pain patients, of whom 304 were investigated in a designated chest pain center using a pre-specified accelerated diagnostic protocol, while 281 underwent routine care in an internal medicine ward. Hospitalization was longer in the routine care compared with the accelerated diagnostic protocol group (p<0.001). During hospitalization, 298 accelerated diagnostic protocol patients (98%) vs. 57 (20%) routine care patients underwent non-invasive testing, (p<0.001). Throughout the 90-day follow-up, diagnostic imaging testing was performed in 125 (44%) and 26 (9%) patients in the routine care and accelerated diagnostic protocol patients, respectively (p<0.001). Ultimately, most patients in both groups had non-invasive imaging testing. Accelerated diagnostic protocol patients compared with those receiving routine care was associated with a lower incidence of readmissions for chest pain [8 (3%) vs. 24 (9%), p<0.01], and acute coronary syndromes [1 (0.3%) vs. 9 (3.2%), p<0.01], during the follow-up period. The accelerated diagnostic protocol remained a predictor of lower acute coronary syndromes and readmissions after propensity score analysis [OR = 0.28 (CI 95% 0.14–0.59)]. Cost per patient was similar in both groups [($2510 vs. $2703 for the accelerated diagnostic protocol and routine care group, respectively, (p = 0.9)]. Conclusion An accelerated diagnostic protocol is clinically superior and as cost effective as routine in acute chest pain patients, and may save time and resources. PMID:25622029

Chest Low-Dose Computed Tomography for Early Lung Cancer Diagnosis as an Opportunity to Diagnose Vertebral Fractures in HIV-Infected Smokers, an ANRS EP48 HIV CHEST Substudy.

PubMed

Thouvenin, Yann; Makinson, Alain; Cournil, Amandine; Eymard-Duvernay, Sabrina; Lentz, Pierre; Delemazure, Anne-Sophie; Corneloup, Olivier; Fabre, Sylvie; Quesnoy, Mylène; Poire, Sylvain; Brillet, Pierre-Yves; Cyteval, Catherine; Reynes, Jacques; Le Moing, Vincent

2015-07-01

To estimate the prevalence of vertebral fractures on chest low-dose computed tomography (LDCT) in HIV-infected smokers. Cross-sectional study of vertebral fractures visualized on chest LDCT from a multicenter prospective cohort evaluating feasibility of chest LDCT for early lung cancer diagnosis in HIV-infected subjects. Subjects were included if 40 years or older, had been active smokers within the last 3 years of at least 20 pack-years, and had a CD4 T-lymphocyte nadir cell count <350 per microliter and an actual CD4 T-cell count >100 cells per microliter. Spinal reconstructed sagittal planes obtained from chest axial native acquisitions were blindly read by a musculoskeletal imaging specialist. Assessment of the fractured vertebra used Genant semiquantitative method. The study end point was the prevalence of at least 1 vertebral fracture. Three hundred ninety-seven subjects were included. Median age was 49.5 years, median smoking history was 30 pack-years, median last CD4 count was 584 cells per microliter, and median CD4 nadir count was 168 cells per microliter; 90% of subjects had a viral load below 50 copies per milliliter. At least 1 fracture was visible in 46 (11.6%) subjects. In multivariate analysis, smoking ≥40 packs-years [OR = 2.5; 95% CI: (1.2 to 5.0)] was associated with an increased risk of vertebral fracture, while HIV viral load <200 copies per milliliter [OR = 0.3; 95% CI: (0.1 to 0.9)] was protective. Prevalence of vertebral fractures on chest LDCT was 11.6% in this high-risk population. Smoking cessation and early introduction of antiretroviral therapy for prevention of vertebral fractures could be beneficial. Chest LDCT is an opportunity to diagnose vertebral fractures.

Exertional dyspnea associated with chest wall strapping is reduced when external dead space substitutes for part of the exercise stimulus to ventilation.

PubMed

Garske, Luke A; Lal, Ravin; Stewart, Ian B; Morris, Norman R; Cross, Troy J; Adams, Lewis

2017-05-01

Chest wall strapping has been used to assess mechanisms of dyspnea with restrictive lung disease. This study examined the hypothesis that dyspnea with restriction depends principally on the degree of reflex ventilatory stimulation. We compared dyspnea at the same (iso)ventilation when added dead space provided a component of the ventilatory stimulus during exercise. Eleven healthy men undertook a randomized controlled crossover trial that compared four constant work exercise conditions: 1 ) control (CTRL): unrestricted breathing at 90% gas exchange threshold (GET); 2 ) CTRL+dead space (DS): unrestricted breathing with 0.6-l dead space, at isoventilation to CTRL due to reduced exercise intensity; 3 ) CWS: chest wall strapping at 90% GET; and 4 ) CWS+DS: chest strapping with 0.6-l dead space, at isoventilation to CWS with reduced exercise intensity. Chest strapping reduced forced vital capacity by 30.4 ± 2.2% (mean ± SE). Dyspnea at isoventilation was unchanged with CTRL+DS compared with CTRL (1.93 ± 0.49 and 2.17 ± 0.43, 0-10 numeric rating scale, respectively; P = 0.244). Dyspnea was lower with CWS+DS compared with CWS (3.40 ± 0.52 and 4.51 ± 0.53, respectively; P = 0.003). Perceived leg fatigue was reduced with CTRL+DS compared with CTRL (2.36 ± 0.48 and 2.86 ± 0.59, respectively; P = 0.049) and lower with CWS+DS compared with CWS (1.86 ± 0.30 and 4.00 ± 0.79, respectively; P = 0.006). With unrestricted breathing, dead space did not change dyspnea at isoventilation, suggesting that dyspnea does not depend on the mode of reflex ventilatory stimulation in healthy individuals. With chest strapping, dead space presented a less potent stimulus to dyspnea, raising the possibility that leg muscle work contributes to dyspnea perception independent of the ventilatory stimulus. NEW & NOTEWORTHY Chest wall strapping was applied to healthy humans to simulate restrictive lung disease. With chest wall strapping, dyspnea was reduced when dead space substituted for part of a constant exercise stimulus to ventilation. Dyspnea associated with chest wall strapping depended on the contribution of leg muscle work to ventilatory stimulation. Chest wall strapping might not be a clinically relevant model to determine whether an alternative reflex ventilatory stimulus mimics the intensity of exertional dyspnea. Copyright © 2017 the American Physiological Society.

Heart bypass surgery - discharge

MedlinePlus

... Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest . 2012;141(2 ... surgery Heart failure - overview High blood cholesterol levels Smoking - ...

Radiological Findings in a case of Advance staged Mesothelioma

PubMed Central

Aziz, Fahad

2009-01-01

Chest X Ray is the initial screening test for the mesothelioma like all other the chest diseases. But computed tomography (CT) is the imaging technique of choice for charactering pleural masses. CT also gives important information regarding invasion of the chest wall and surrounding structures. Certain CT features help differentiate benign from malignant processes. This short article highlights the salient CT appearance of mesothelioma; the most common pleural tumor. PMID:22263002

Traumatic Pancreatitis: A Rare Complication of Cardiopulmonary Resuscitation.

PubMed

Aziz, Muhammad

2017-08-17

An elderly gentleman was successfully revived after undergoing cardiopulmonary resuscitation (CPR) for cardiac arrest. Post CPR, the patient developed acute pancreatitis which was likely complication of inappropriately delivered chest compressions which caused further complications and resulted in the death of the patient. This case underlines the importance of quality chest compressions that includes correct placement of hands by the operator giving chest compressions to avoid lethal injuries to the receiver.

Tension gastrothorax in a child presenting with abdominal pain.

PubMed

Hooker, Ross; Claudius, Ilene; Truong, Anh

2012-02-01

A 4-year-old girl was brought to our hospital by her parents because of abdominal pain. She had suffered minor trauma after rolling from her standard-height bed 2 days prior. Vital signs were appropriate for age. Physical examination was remarkable for decreased breath sounds to the left side of the chest. A chest radiograph (Figure) demonstrated a large gas-filled structure in the left side of the chest with mediastinal shift.

Chest wall resection for local recurrence of breast cancer. Presented at the 99th Meeting of the Royal Belgium Society of Obstetrics and Gynecology, Brussels May 9th 1998, Belgium.

PubMed

Tjalma, W; Van Schil, P; Verbist, A M; Buytaert, P; van Dam, P

1999-05-01

We present three cases of chest wall resection for locally recurrent breast cancer and a Medline review of the current literature. In selected cases full thickness resection of the chest wall may be used as a salvage procedure to improve the quality of life and prolong the survival at low morbidity and mortality.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kunal, Bhagatwala, E-mail: kunalbhagatwala@gmail.com; Nidhi, Karia

A 91 years old female presented with chest pain and shortness of breath after a fall. Chest radiograph showed a very large left-sided fluid collection surrounded by calcified pleura and collapse of the left lung (Figure 1). CT scan of chest with contrast revealed a chronic appearing increased density left pleural effusion contained within thick calcified pleura (). Upon further questioning patient reported that when she was 20 years old she had repeated punctures to her left chest to collapse the lung for the treatment of suspected tuberculosis. The air-filled pleural space eventually got transformed into calcified pleura with containedmore » effusion. No further intervention was performed for this effusion as the patient’s symptoms improved. She did not have any symptoms before the fall.« less

Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 3: In a penetrating chest wound is a three-sided dressing or a one-way chest seal better at preventing respiratory complications?

PubMed

Walthall, Kirsten

2012-04-01

A short-cut review was carried out to establish whether the traditional three-sided dressing is better than a one-way chest seal at preventing the respiratory complications from penetrating chest trauma. Only one animal study, two guidelines and two case reports provided published evidence relevant to the question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. The clinical bottom line is that there is very little evidence, but that the one-way seals may have practical advantages, particularly in the out-of-hospital setting.

Chest radiographs for acute lower respiratory tract infections.

PubMed

Cao, Amy Millicent Y; Choy, Joleen P; Mohanakrishnan, Lakshmi Narayana; Bain, Roger F; van Driel, Mieke L

2013-12-26

Acute lower respiratory tract infections (LRTIs) (e.g. pneumonia) are a major cause of morbidity and mortality and management focuses on early treatment. Chest radiographs (X-rays) are one of the commonly used strategies. Although radiological facilities are easily accessible in high-income countries, access can be limited in low-income countries. The efficacy of chest radiographs as a tool in the management of acute LRTIs has not been determined. Although chest radiographs are used for both diagnosis and management, our review focuses only on management. To assess the effectiveness of chest radiographs in addition to clinical judgement, compared to clinical judgement alone, in the management of acute LRTIs in children and adults. We searched CENTRAL 2013, Issue 1; MEDLINE (1948 to January week 4, 2013); EMBASE (1974 to February 2013); CINAHL (1985 to February 2013) and LILACS (1985 to February 2013). We also searched NHS EED, DARE, ClinicalTrials.gov and WHO ICTRP (up to February 2013). Randomised controlled trials (RCTs) of chest radiographs versus no chest radiographs in acute LRTIs in children and adults. Two review authors independently applied the inclusion criteria, extracted data and assessed risk of bias. A third review author compiled the findings and any discrepancies were discussed among all review authors. We used the standard methodological procedures expected by The Cochrane Collaboration. Two RCTs involving 2024 patients (1502 adults and 522 children) were included in this review. Both RCTs excluded patients with suspected severe disease. It was not possible to pool the results due to incomplete data. Both included trials concluded that the use of chest radiographs did not result in a better clinical outcome (duration of illness and of symptoms) for patients with acute LRTIs. In the study involving children in South Africa, the median time to recovery was seven days (95% confidence interval (CI) six to eight days (radiograph group) and six to nine days (control group)), P value = 0.50, log-rank test) and the hazard ratio for recovery was 1.08 (95% CI 0.85 to 1.34). In the study with adult participants in the USA, the average duration of illness was 16.9 days versus 17.0 days (P value > 0.05) in the radiograph and no radiograph groups respectively. This result was not statistically significant and there were no significant differences in patient outcomes between the groups with or without chest radiograph.The study in adults also reports that chest radiographs did not affect the frequencies with which clinicians ordered return visits or antibiotics. However, there was a benefit of chest radiographs in a subgroup of the adult participants with an infiltrate on their radiograph, with a reduction in length of illness (16.2 days in the group allocated to chest radiographs and 22.6 in the non-chest radiograph group, P < 0.05), duration of cough (14.2 versus 21.3 days, P < 0.05) and duration of sputum production (8.5 versus 17.8 days, P < 0.05). The authors mention that this difference in outcome between the intervention and control group in this particular subgroup only was probably a result of "the higher proportion of patients treated with antibiotics when the radiograph was used in patient care".Hospitalisation rates were only reported in the study involving children and it was found that a higher proportion of patients in the radiograph group (4.7%) required hospitalisation compared to the control group (2.3%) with the result not being statistically significant (P = 0.14). None of the trials report the effect on mortality, complications of infection or adverse events from chest radiographs. Overall, the included studies had a low or unclear risk for blinding, attrition bias and reporting bias, but a high risk of selection bias. Both trials had strict exclusion criteria which is important but may limit the clinical practicability of the results as participants may not reflect those presenting in clinical practice. Data from two trials suggest that routine chest radiography does not affect the clinical outcomes in adults and children presenting to a hospital with signs and symptoms suggestive of a LRTI. This conclusion may be weakened by the risk of bias of the studies and the lack of complete data available.

Evaluation and Management of the Nursing Home Resident With Respiratory Symptoms and an Equivocal Chest X-Ray Report.

PubMed

McClester Brown, Mallory; Sloane, Philip D; Kistler, Christine E; Reed, David; Ward, Kimberly; Weber, David; Zimmerman, Sheryl

2016-12-01

Pneumonia is a leading cause of morbidity and mortality in nursing home (NH) residents. Chest x-ray evidence is considered a key diagnostic criterion for pneumonia by the Infectious Disease Society of America (IDSA) diagnostic guidelines, the modified McGeer diagnostic criteria, and the Loeb criteria for initiating antibiotics; however, x-ray interpretation is often equivocal. We conducted chart audits of patients in NHs who had chest x-rays for new respiratory symptoms to determine the degree of ambiguity in the radiology reports and their relationship to antibiotic prescription decisions. Cross-sectional study. Thirty-one NHs in North Carolina. Two hundred twenty-six NH residents who had a chest x-ray. Medical charts were abstracted to record (1) the patient's clinical presentation when a chest x-ray was ordered, (2) the verbatim report of the chest x-ray, and (3) the patient's course during the subsequent 7 days. To standardize the radiologist reports, a seven-category coding system was developed, which was further aggregated into three groups based on the radiologist's description of the likelihood of pneumonia. Of the 226 chest x-rays, 118 (52%) identified a very low likelihood of pneumonia, 67 (30%) indicated that pneumonia was present or highly likely, and the remaining 41 (18%) used a variety of terms to describe uncertainty regarding the presence of pneumonia. NH medical providers tended to treat ambiguous chest x-ray reports similarly to positive x-ray reports, prescribing antibiotic therapy to 71% of patients with ambiguous reports and 78% of positive reports. Also notable is that 40 (34%) of the 118 patients with a very low likelihood of pneumonia based on chest x-ray results were prescribed antibiotics, the majority of whom failed to meet criteria for a clinical diagnosis of pneumonia or chronic obstructive pulmonary disease exacerbation. The moderate rate of ambiguous x-ray interpretations in NH residents is likely a combination of the poor quality of portable x-rays, a high prevalence of chronic lung conditions, and conservative (ie, cautious) decision making by radiologists whose interpretation is based on little clinical information and a suboptimal quality film. As a result, data suggest that chest x-rays obtained in NHs may unnecessarily encourage antibiotic prescribing because a majority of readings are ambiguous or show a low likelihood of pneumonia, yet more than half of the patients are still treated. From an antibiotic stewardship standpoint, the apparent solution is to more closely rely on clinical signs and symptoms for diagnosis of pneumonia and to place less emphasis on the role of the chest x-ray given the high number of unclear readings. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Investigation of a relationship between external force to shoulder and chest injury of WorldSID and THUMS in 32 km/h oblique pole side impact.

PubMed

Tanaka, Shinobu; Hayashi, Shigeki; Fukushima, Satoshi; Yasuki, Tsuyoshi

2013-01-01

This article describes the chest injury risk reduction effect of shoulder restraints using finite element (FE) models of the worldwide harmonized side impact dummy (WorldSID) and Total Human Model for Safety (THUMS) in an FE model 32 km/h oblique pole side impact. This research used an FE model of a mid-sized vehicle equipped with various combinations of curtain shield air bags, torso air bags, and shoulder restraint air bags. As occupant models, AM50 WorldSID and THUMS AM50 Version 4 were used for comparison. The research investigated the effect of shoulder restraint air bag on chest injury by comparing cases with and without a shoulder side air bag. The maximum external force to the chest was reduced by shoulder restraint air bag in both WorldSID and THUMS, reducing chest injury risk as measured by the amount of rib deflection, number of the rib fractures, and rib deflection ratio. However, it was also determined that the external force to shoulder should be limited to the chest injury threshold because the external shoulder force transmits to the chest via the arm in the case of WorldSID and via the scapula in the case of THUMS. Because these results show the shoulder restraint air bag effect on chest injury risk, the vent hole size of the shoulder restraint air bag was changed for varying reaction forces to investigate the relationship between the external force to the shoulder and the risk of chest injury. In the case of THUMS, an external shoulder force of 1.8 kN and more force from the shoulder restraint air bag was necessary to help prevent rib fracture. Increasing external force applied to shoulder up to 6.2 kN (the maximum force used in this study) did not induce any rib or clavicle fractures in the THUMS. When the shoulder restraint air bag generated external force to the shoulder from 1.8 to 6.2 kN in THUMS, which were applied to the WorldSID, the shoulder deflection ranged from 35 to 68 mm, and the shoulder force ranged from 1.8 to 2.3 kN. In the test configuration used, a shoulder restraint using the air bag helps reduce chest injury risk by lowering the maximum magnitude of external force to the shoulder and chest. To help reduce rib fracture risk in the THUMS, the shoulder restraint air bag was expected to generate a force of 3.7 kN with a minimum rib deflection ratio. This corresponds to a shoulder rib deflection of 60 mm and a shoulder load of 2.2 kN in WorldSID. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

The application of MDCT in the diagnosis of chest trauma.

PubMed

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 recognition of chest trauma, characterized by high sensitivity and specificity in the assessment of life-threatening injures and for depicting tracheal and bronchial injuries. The diagnostic value of CXR was low. The compatibility of MCTD and intraoperative assessment was confirmed, with the exception of diaphragm injures and lung laceration. Change of treatment modality was certified after MDCT in 83% of patients.

Effectiveness of a simplified cardiopulmonary resuscitation training program for the non-medical staff of a university hospital

PubMed Central

2014-01-01

Background The 2010 Consensus on Science and Treatment Recommendations Statement recommended that short video/computer self-instruction courses, with minimal or no instructor coaching, combined with hands-on practice can be considered an effective alternative to instructor-led basic life support courses. The purpose of this study was to examine the effectiveness of a simplified cardiopulmonary resuscitation (CPR) training program for non-medical staff working at a university hospital. Methods Before and immediately after a 45-min CPR training program consisting of instruction on chest compression and automated external defibrillator (AED) use with a personal training manikin, CPR skills were automatically recorded and evaluated. Participants’ attitudes towards CPR were evaluated by a questionnaire survey. Results From September 2011 through March 2013, 161 participants attended the program. We evaluated chest compression technique in 109 of these participants. The number of chest compressions delivered after the program versus that before was significantly greater (110.8 ± 13.0/min vs 94.2 ± 27.4/min, p < 0.0001), interruption of chest compressions was significantly shorter (0.05 ± 0.34 sec/30 sec vs 0.89 ± 3.52 sec/30 sec, p < 0.05), mean depth of chest compressions was significantly greater (57.6 ± 6.8 mm vs 52.2 ± 9.4 mm, p < 0.0001), and the proportion of incomplete chest compressions of <5 cm among all chest compressions was significantly decreased (8.9 ± 23.2% vs 38.6 ± 42.9%, p < 0.0001). Of the 159 participants who responded to the questionnaire survey after the program, the proportion of participants who answered ‘I can check for a response,’ ‘I can perform chest compressions,’ and ‘I can absolutely or I think I can use an AED’ increased versus that before the program (81.8% vs 19.5%, 77.4% vs 10.1%, 84.3% vs 23.3%, respectively). Conclusions A 45-min simplified CPR training program on chest compression and AED use improved CPR quality and the attitude towards CPR and AED use of non-medical staff of a university hospital. PMID:24887037

A new multiple trauma model of the mouse.

PubMed

Fitschen-Oestern, Stefanie; Lippross, Sebastian; Klueter, Tim; Weuster, Matthias; Varoga, Deike; Tohidnezhad, Mersedeh; Pufe, Thomas; Rose-John, Stefan; Andruszkow, Hagen; Hildebrand, Frank; Steubesand, Nadine; Seekamp, Andreas; Neunaber, Claudia

2017-11-21

Blunt trauma is the most frequent mechanism of injury in multiple trauma, commonly resulting from road traffic collisions or falls. Two of the most frequent injuries in patients with multiple trauma are chest trauma and extremity fracture. Several trauma mouse models combine chest trauma and head injury, but no trauma mouse model to date includes the combination of long bone fractures and chest trauma. Outcome is essentially determined by the combination of these injuries. In this study, we attempted to establish a reproducible novel multiple trauma model in mice that combines blunt trauma, major injuries and simple practicability. Ninety-six male C57BL/6 N mice (n = 8/group) were subjected to trauma for isolated femur fracture and a combination of femur fracture and chest injury. Serum samples of mice were obtained by heart puncture at defined time points of 0 h (hour), 6 h, 12 h, 24 h, 3 d (days), and 7 d. A tendency toward reduced weight and temperature was observed at 24 h after chest trauma and femur fracture. Blood analyses revealed a decrease in hemoglobin during the first 24 h after trauma. Some animals were killed by heart puncture immediately after chest contusion; these animals showed the most severe lung contusion and hemorrhage. The extent of structural lung injury varied in different mice but was evident in all animals. Representative H&E-stained (Haematoxylin and Eosin-stained) paraffin lung sections of mice with multiple trauma revealed hemorrhage and an inflammatory immune response. Plasma samples of mice with chest trauma and femur fracture showed an up-regulation of IL-1β (Interleukin-1β), IL-6, IL-10, IL-12p70 and TNF-α (Tumor necrosis factor- α) compared with the control group. Mice with femur fracture and chest trauma showed a significant up-regulation of IL-6 compared to group with isolated femur fracture. The multiple trauma mouse model comprising chest trauma and femur fracture enables many analogies to clinical cases of multiple trauma in humans and demonstrates associated characteristic clinical and pathophysiological changes. This model is easy to perform, is economical and can be used for further research examining specific immunological questions.

Revision of orthovoltage chest wall treatment using Monte Carlo simulations.

PubMed

Zeinali-Rafsanjani, B; Faghihi, R; Mosleh-Shirazi, M A; Mosalaei, A; Hadad, K

2017-01-01

Given the high local control rates observed in breast cancer patients undergoing chest wall irradiation by kilovoltage x-rays, we aimed to revisit this treatment modality by accurate calculation of dose distributions using Monte Carlo simulation. The machine components were simulated using the MCNPX code. This model was used to assess the dose distribution of chest wall kilovoltage treatment in different chest wall thicknesses and larger contour or fat patients in standard and mid sternum treatment plans. Assessments were performed at 50 and 100 cm focus surface distance (FSD) and different irradiation angles. In order to evaluate different plans, indices like homogeneity index, conformity index, the average dose of heart, lung, left anterior descending artery (LAD) and percentage target coverage (PTC) were used. Finally, the results were compared with the indices provided by electron therapy which is a more routine treatment of chest wall. These indices in a medium chest wall thickness in standard treatment plan at 50 cm FSD and 15 degrees tube angle was as follows: homogeneity index 2.57, conformity index 7.31, average target dose 27.43 Gy, average dose of heart, lung and LAD, 1.03, 2.08 and 1.60 Gy respectively and PTC 11.19%. Assessments revealed that dose homogeneity in planning target volume (PTV) and conformity between the high dose region and PTV was poor. To improve the treatment indices, the reference point was transferred from the chest wall skin surface to the center of PTV. The indices changed as follows: conformity index 7.31, average target dose 60.19 Gy, the average dose of heart, lung and LAD, 3.57, 6.38 and 5.05 Gy respectively and PTC 55.24%. Coverage index of electron therapy was 89% while it was 22.74% in the old orthovoltage method and also the average dose of the target was about 50 Gy but in the given method it was almost 30 Gy. The results of the treatment study show that the optimized standard and mid sternum treatment for different chest wall thicknesses is with 50 cm FSD and zero (vertical) tube angle, while in large contour patients, it is with 100 cm FSD and zero tube angle. Finally, chest wall kilovoltage and electron therapies were compared, which revealed that electron therapy produces a better dose distribution than kilovoltage therapy.

Heart bypass surgery - minimally invasive - discharge

MedlinePlus

... thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest . 2012;141(2 ... bypass surgery - minimally invasive Heart failure - overview High blood cholesterol ...