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https://www.readbyqxmd.com/read/30553944/standard-and-viscoelastic-mechanical-properties-of-respiratory-system-compartments-in-dogs-effect-of-volume-posture-and-shape
#1
Edgardo D'Angelo, Edoardo Calderini, Mario Tavola, Matteo Pecchiari
In 9 anesthetized, paralyzed dogs lung and chest-wall standard (viscous resistance, Rint, and quasi-static elastance, Est) and viscoelastic parameters (resistance, Rvel, and time constant, τvel) were measured in the supine posture before and after rib-cage block, after application of an expiratory threshold load, and after 75° head-up tilting before and after wide chest opening. Lung and chest-wall τvel were the same under all conditions. Rvel was independent of volume and posture, and greater for the lung...
December 13, 2018: Respiratory Physiology & Neurobiology
https://www.readbyqxmd.com/read/30553561/amyloid-cardiomyopathy-in-the-emergency-department
#2
Mauricio Baca, Mark Newberry
BACKGROUND: Cardiac amyloidosis is an underdiagnosed cause of restrictive cardiomyopathy resulting from the infiltration of the myocardium by amyloid proteins. CASE REPORT: We report the case of an 83-year-old woman who presented with increasing dyspnea and lower-extremity swelling. She reported a medical history of unspecified heart failure. Evaluation in the Emergency Department (ED) revealed evidence of heart failure on physical examination, low-voltage electrocardiogram, chest x-ray study with mild pulmonary edema, and laboratory evaluation with elevated brain natriuretic peptide and troponin...
December 12, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30532584/erector-spinae-block-for-postoperative-analgesia-following-axillary-hidradenitis-suppurativa-resection-a-case-report
#3
Johanna Blair de Haan, Nadia Hernandez, Sudipta Sen
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the terminal hair follicle of the apocrine gland-bearing skin, presenting with inflamed nodules, abscesses, and sinus tracts. Autoimmune, genetic, and infectious factors have been implicated in its pathogenesis. HS can be managed medically using topical and systemic antibiotics and with tumor necrosis factor antibody therapy in severe cases. Surgical treatment can range from local excision, deroofing or excision of sinus tracts, or wide radical excision of severe lesions...
2018: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/30508532/customized-cutting-template-to-assist-sternotomy-in-pectus-arcuatum
#4
Stella Leng, Kejd Bici, Flavio Facchini, Yary Volpe, Francesca Uccheddu, Rocco Furferi, Lapo Governi, Monica Carfagni, Marco Ghionzoli, Antonio Messineo
PURPOSE: Pectus arcuatum is an anterior chest wall deformity that requires transverse wedge sternotomy. Determining and delivering the correct cutting angle is crucial for successful correction. We present the early clinical experience with a novel cutting template technology able to deliver the optimal cutting angle. DESCRIPTION: From patients' computer tomography scans, the optimal cutting angle is obtained through computer aided design (CAD). A template comprising of slots tilted at the right cutting angle and safety block to avoid damaging the posterior periosteum is printed through additive manufacturing...
November 30, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/30468319/lobular-breast-carcinoma-metastasis-to-skeletal-muscle-two-case-reports-diagnosed-by-ultrasound-guided-fna-with-evaluation-of-the-roles-of-interventional-cytopathology
#5
Sigei Asha, Elshenawy Yasmin, Janet F Stastny
Skeletal muscle metastasis from breast carcinoma is a relatively rare clinical entity. We report two cases of breast cancer metastatic to the skeletal muscle, diagnosed by ultrasound guided fine needle aspiration (US-FNA) biopsy done by interventional cytopathologists at an outpatient cytopathology center. Our two patients presented with lower anterior neck firmness and chest wall mass, respectively. Ultrasound evaluation of our first case demonstrated hypo-echoic thickened anterior strap muscles while in the second case there was significant distortion of the anatomy from previous surgeries...
November 23, 2018: Diagnostic Cytopathology
https://www.readbyqxmd.com/read/30337220/quality-of-life-after-postmastectomy-radiotherapy-in-patients-with-intermediate-risk-breast-cancer-supremo-2-year-follow-up-results-of-a-randomised-controlled-trial
#6
Galina Velikova, Linda Jane Williams, Sarah Willis, J Michael Dixon, Juliette Loncaster, Matthew Hatton, Jacqueline Clarke, Ian H Kunkler, Nicola S Russell
BACKGROUND: Postmastectomy radiotherapy in patients with four or more positive axillary nodes reduces breast cancer mortality, but its role in patients with one to three involved nodes is controversial. We assessed the effects of postmastectomy radiotherapy on quality of life (QOL) in women with intermediate-risk breast cancer. METHODS: SUPREMO is an open-label, international, parallel-group, randomised, controlled trial. Women aged 18 years or older with intermediate-risk breast cancer (defined as pT1-2N1; pT3N0; or pT2N0 if also grade III or with lymphovascular invasion) who had undergone mastectomy and, if node positive, axillary surgery, were randomly assigned (1:1) to receive chest wall radiotherapy (50 Gy in 25 fractions or a radiobiologically equivalent dose of 45 Gy in 20 fractions or 40 Gy in 15 fractions) or no radiotherapy...
October 15, 2018: Lancet Oncology
https://www.readbyqxmd.com/read/30275796/trauma-induced-conduction-disturbances
#7
Mohamad Soud, Abdulah Alrifai, Amjad Kabach, Zaher Fanari, M Chadi Alraies
Background: Electrical disturbances following blunt cardiac injuries are rare but can be caused by electrical or structural damage to the heart. We present the case of a patient who had conduction abnormalities following blunt traumatic injury that were incidentally detected on telemetry. Case Report: A 64-year-old female with no history of cardiac disease was brought to the emergency department after a motor vehicle collision that resulted in chest wall bruising...
2018: Ochsner Journal
https://www.readbyqxmd.com/read/30244489/effect-of-ultrasound-guided-intercostal-nerve-block-versus-fluoroscopy-guided-epidural-nerve-block-in-patients-with-thoracic-herpes-zoster-a-comparative-study
#8
Hyo Jeong Lee, Hong Souk Park, Hyun Im Moon, Seo Yeon Yoon
OBJECTIVES: To compare the efficacy of a conventional fluoroscopy-guided epidural nerve block and an ultrasound (US)-guided intercostal nerve block in patients with thoracic herpes zoster (HZ). METHODS: This work was a comparative study of 38 patients with thoracic HZ pain and a chest wall herpetic eruption, aged 18 years or older, with pain intensity of 5 or greater on a numeric rating scale (NRS) for less than a 1-month duration. Patients were consecutively enrolled and assigned to 2 groups in which the intervention was either the US-guided intercostal nerve block or the fluoroscopy-guided epidural nerve block approach with the addition of a 5-mL mix of 2...
September 23, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/30233862/management-of-residual-pleural-space-after-lung-resection-fully-controllable-paralysis-of-the-diaphragm-through-continuous-phrenic-nerve-block
#9
Miriam Patella, Andrea Saporito, Francesco Mongelli, Ramon Pini, Rolf Inderbitzi, Stefano Cafarotti
Background: Residual pleural space after lung resection associated with air leak is a challenging issue, potentially causing serious complications. We report a new, postoperative technique to reduce the pleural space, inducing a controlled and reversible paralysis of the diaphragm. Methods: Ten patients were enrolled (7 lobectomies, 2 bilobectomy, 1 wedge resection). Inclusion criteria were: digitally detected air flow >200 mL/min at post-op day 3, presence of empty pleural space at chest x-ray, absence of restrictive lung disease, absence of known arrhythmias...
August 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/30225148/coronary-artery-ectasia-presenting-as-a-non-st-elevation-myocardial-infarction-in-a-young-adult-case-presentation-and-literature-review
#10
Kareem Genena, Mir Ali, Donald Christmas, Henry Siu
While acute coronary syndromes most commonly occur secondary to unstable atherosclerotic plaque, coronary aneurysms, also known as coronary artery ectasia (CAE), represent a less common etiology. Whereas coronary atherosclerosis accounts for about 50% of CAE, the remaining 50% are either congenital or secondary to a host of inflammatory and connective tissue disorders, with Kawasaki disease being a well-known association. Patients with CAE have worse outcomes than the general population regardless of the presence of associated atherosclerotic coronary artery disease...
2018: Case Reports in Cardiology
https://www.readbyqxmd.com/read/30174899/video-assisted-thoracoscopic-left-upper-lobectomy-and-broncho-and-angioplasty-for-a-giant-central-lung-cancer-complicated-with-intratumoral-abscess-one-case-report
#11
Guang-Jie Hou, Yi He, Pu Zhao
A 70-year-old male patient with chest pain and high fever was diagnosed as lung squamous carcinoma T4N0M0 in the left upper lobe complicated with intratumoral lung abscess. With no improvement resulted from antibiotic treatment for 4 days, to control his infection and resect his large tumor, he received video-assisted thoracoscopic surgery (VATS) left upper lung lobe resection and broncho-and angioplasty. Two-port technique was employed and the utility port was 10 cm long because the tumor's diameter (max) was 12 cm...
July 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/30169476/rhomboid-intercostal-and-subserratus-plane-block-a-cadaveric-and-clinical-evaluation
#12
Hesham Elsharkawy, Robert Maniker, Robert Bolash, Prathima Kalasbail, Richard L Drake, Nabil Elkassabany
BACKGROUND AND OBJECTIVES: Fascial plane blocks are rapidly emerging to provide safe, feasible alternatives to epidural analgesia for thoracic and abdominal pain. We define a new option for chest wall and upper abdominal analgesia, termed the rhomboid intercostal and subserratus plane (RISS) block. The RISS tissue plane extends deep to the erector spinae muscle medially and deep to the serratus anterior muscle laterally. We describe a 2-part proof-of-concept study to validate the RISS block, including a cadaveric study to evaluate injectate spread and a retrospective case series to assess dermatomal coverage and analgesic efficacy...
October 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/30142600/surgical-treatment-for-a-case-of-coronary-steal-from-a-traumatic-coronary-artery-cameral-fistula-after-blunt-cardiac-injury
#13
Kevin L Chow, Philip J Alexander, James P Sur, Ellen C Omi
INTRODUCTION: Blunt cardiac trauma covers a spectrum of injuries from clinically insignificant myocardial contusions to lethal ruptures of cardiac valves and chambers. Traumatic coronary artery-cameral fistulas (TCAF) are a rare sequelae of blunt chest trauma. CASE PRESENTATION: A 53-year-old male developed a TCAF after a motor vehicle collision. He was found on admission to be in cardiogenic shock with an elevated troponin and intermittent bifascicular block. An echocardiogram revealed hypokinesis of the mid-anteroseptal myocardium with an ejection fraction of 50%...
2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/30095696/pectoral-block-failure-may-be-due-to-incomplete-coverage-of-anatomical-targets-a-dissection-study
#14
Lena F Carstensen, Morten Jenstrup, Jørgen Lund, Jørgen Tranum-Jensen
BACKGROUND AND OBJECTIVES: The popularization of ultrasound-guided nerve blocks in cosmetic and reconstructive breast surgery calls for better anatomical understanding of chest wall innervation. When inserting subpectoral implants, pain from pocket dissection, stretching of muscle, and release of costal attachments may be relieved by blocking the pectoral nerves in the interpectoral (IP) space.We describe the variable anatomy of the pectoral nerves in the IP space in order to define the area to be covered for sufficient blockade, based on cadaver dissections...
November 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/30094117/syncopal-episodes-of-arrhythmogenic-right-ventricular-cardiomyopathy-in-a-patient-with-pre-existing-seizure-disorder
#15
James R Kimber, Syed Rafay Ali Sabzwari, Hiwot Ayele
Arrhythmogenic right ventricular cardiomyopathy (ARVC), is a heritable condition that is an important, and under-recognized cause of sudden cardiac death. Microscopically, it is represented by fibrofatty replacement of myocardium involving the right ventricular inflow area, apex, and infundibulum. Common clinical manifestations of ARVC include palpitations, syncope, chest pain, dyspnea, and sudden cardiac death. This is a case of a 25-year-old male with a history of thalassemia, and tonic-clonic seizure status post head trauma with cystic encephalomalacia in left parietal lobe who described recurrent syncope...
June 7, 2018: Curēus
https://www.readbyqxmd.com/read/30063656/serratus-plane-block-a-cadaveric-study-to-evaluate-optimal-injectate-spread
#16
Abhijit Biswas, Valera Castanov, Zhi Li, Anahi Perlas, Richelle Kruisselbrink, Anne Agur, Vincent Chan
BACKGROUND AND OBJECTIVES: Although serratus plane block reportedly provides satisfactory analgesia for breast and thoracic surgeries, the optimal technique for consistent success has not been studied. The goal of this anatomical study was to evaluate the impact of volume, level, and site of injection on the extent of injectate spread that can influence anesthetic coverage. METHODS: Ultrasound-guided dye injection and subsequent dissection were performed in 39 cadaveric hemithoraces...
November 2018: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/29961280/-application-of-chest-ct-scan-in-gestational-trophoblastic-neoplasia-with-lung-metastasis
#17
Y Cheng, F H Ma, X R Wang, X N Le, G F Zhang, X Lu
Objective: To explore the role of CT scan for the diagnosis of lung metastasis in stage Ⅲ gestational trophoblastic neoplasia (GTN) . Methods: To figure out the role of CT scan for lung metastasis in GTN initial diagnosis, treatment and follow-up, 93 GTN patients with lung metastasis from January, 2015 to December, 2016 were retrospectively analyzed in Obstetrics and Gynecology Hospital of Fudan University. Results: (1) Among 93 GTN patients with lung metastasis, 70 patients with the International Federation of Gynecology and Obstetrics (FIGO) score ≤6 were defined as low risk GTN and 23 patients score score ≥7 were defined as high risk GTN...
June 25, 2018: Zhonghua Fu Chan Ke za Zhi
https://www.readbyqxmd.com/read/29912448/nuclear-stress-testing-referrals-time-for-a-novel-radiation-sparing-approach
#18
Steven C Romero, Joshua P Dettmer
Background: A Science Advisory from the American Heart Association implores clinicians to always consider equivalent tests which do not use ionizing radiation. Intersocietal guidelines describe only two scenarios where a nuclear stress test is the only option for non-invasive evaluation: left bundle branch block (LBBB) and ventricular-paced rhythm; otherwise, treadmill EKG and stress echocardiography are feasible. This study sought to measure our compliance with appropriate use criteria,6 and then to apply our own Novel Radiation Sparing Approach (NRSA) to measure what percentage could have been evaluated without radiation...
November 1, 2018: Military Medicine
https://www.readbyqxmd.com/read/29904455/high-grade-atrioventricular-block-in-von-recklinghausen-disease-a-rare-phenomenon
#19
Glenmore Lasam, Marcelina Lasam
A case of a 73-year-old woman with a history of von Recklinghausen disease (neurofibromatosis type 1) who presented initially with a gradual onset of shortness of breath and lightheadedness with no associated fever, chills, angina, palpitations, cough, weight loss, night sweats, nausea, vomiting, or constipation. She was found to be severely bradycardic and in third degree atrioventricular block by her primary care physician. She was admitted in the hospital because of intermittent bouts of lightheadedness and progression of the shortness of breath...
June 2018: Cardiology Research
https://www.readbyqxmd.com/read/29738329/transthoracic-arteriovenous-graft-repair-with-the-pectoralis-pecs-ii-nerve-block-for-primary-intraoperative-anesthesia-and-postoperative-analgesia-a-case-report
#20
Gabriel Farkas, Garret Weber, Jonathon Miller, Jeff Xu
The PECS II nerve block is a relatively new regional anesthetic technique that targets the medial and lateral pectoral nerves, as well as the lateral cutaneous branches of the intercostal nerves. It has been described for surgical cases involving the breast, as an adjunct or alternative to neuraxial or paravertebral techniques. This case report describes the first successful use of the PECS II nerve block placed using ultrasound guidance as the primary anesthetic and postoperative analgesic in a non-breast-related chest wall surgery...
October 15, 2018: A&A practice
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