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chest wall rigidity

Donald Nuss, Robert J Obermeyer, Robert E Kelly
Repair of pectus excavatum began at the beginning of the 20(th) century before endotracheal intubation was standard practice. Surgeons therefore developed techniques that corrected the deformity using an open procedure via the anterior chest wall. Initial techniques were unsatisfactory, but by the 1930s the partial rib resection and sternal osteotomy technique had been developed and was used in combination with external traction post-operatively to prevent the sternum from sinking back into the chest. In 1949, Ravitch recommended complete resection of the costal cartilages and complete mobilization of the sternum without external traction, and in 1961 Adkins and Blades introduced the concept of a substernal strut for sternal support...
September 2016: Annals of Cardiothoracic Surgery
Edward J Caruana, Pierogiorgio Solli, Aman S Coonar
Chest wall invasion is seen in 5% to 8% of patients presenting with lung cancer. We report a case of complete resection of a 14 cm × 9 cm pT3N0M0 squamous cell carcinoma arising from the right lower lobe and invading the lower chest wall posteriorly, in a 75 years old male, via a hybrid thoracoscopic [video-assisted thoracoscopic surgery (VATS)] approach. Following conventional VATS lobectomy, a targeted 10 cm incision was performed to allow wide resection of the 7(th) to 10(th) ribs and 6(th) to 9(th) transverse processes, with the defect being subsequently reconstructed with a composite rigid prosthesis...
September 2016: Journal of Thoracic Disease
Masahiro Yanagiya, Masaaki Sato, Shun Kawashima, Hideki Kuwano, Kazuhiro Nagayama, Jun-Ichi Nitadori, Masaki Anraku, Jun Nakajima
A patient with pleuroparenchymal fibroelastosis (PPFE) was successfully treated with living-donor lobar lung transplantation. A 27-year-old woman with a 3-month history of dyspnea received a diagnosis of PPFE. Her chest wall was extremely flattened over time, and her respiratory condition progressively deteriorated. She underwent semielective bilateral living-donor lobar lung transplantation. Her chest wall rigidity, which was secondary to PPFE, required intensive pulmonary rehabilitation postoperatively. By 6 months after transplantation, the flattening of her chest wall was reversed...
October 2016: Annals of Thoracic Surgery
Dawn E Jaroszewski, M'hamed Temkit, MennatAllah M Ewais, Todd C Luckritz, Joshua D Stearns, Ryan C Craner, Brantley D Gaitan, Harish Ramakrishna, Christopher A Thunberg, Ricardo A Weis, Kelly M Myers, Marianne V Merritt, David M Rosenfeld
BACKGROUND: Minimally invasive repair of pectus excavatum (MIRPE) is now performed in adults. Managing adult patients' pain postoperatively has been challenging due to increased chest wall rigidity and the pressure required for supporting the elevated sternum. The optimal pain management regimen has not been determined. We designed this prospective, randomized trial to compare postoperative pain management and outcomes between thoracic epidural analgesia (TEA) and bilateral subcutaneous infusion pump catheters (On-Q)...
August 2016: Journal of Thoracic Disease
Roger Mark Engel, Peter Gonski, Ken Beath, Subramanyam Vemulpad
STUDY DESIGN: Randomized clinical trial. OBJECTIVE: To investigate the effect of including manual therapy (MT) in a pulmonary rehabilitation program for patients with chronic obstructive pulmonary disease (COPD). BACKGROUND: The primary source of exercise limitation in people with COPD is dyspnea. The dyspnea is partly caused by changes in chest wall mechanics, with an increase in chest wall rigidity (CWR) contributing to a decrease in lung function...
May 2016: Journal of Manual & Manipulative Therapy
Haitham H Khalil, Marco N Malahias, Balapathiran Balasubramanian, Madava G Djearaman, Babu Naidu, Melvin F Grainger, Maninder Kalkat
BACKGROUND: Management of complex thoracic defects post tumor extipiration is challenging because of the nature of pathology, the radical approach, and the insertion of prosthetic material required for biomechanical stability. Wound complications pose a significant problem that can have detrimental effect on patient outcome. The authors outline an institutional experience of a multidisciplinary thoracic oncoplastic approach to improve outcomes. METHODS: Prospectively collected data from 71 consecutive patients treated with chest wall resection and reconstruction were analyzed (2009-2015)...
July 2016: Plastic and Reconstructive Surgery. Global Open
Jonathan D Spicer, Jitesh B Shewale, Mara B Antonoff, Arlene M Correa, Wayne B Hofstetter, David C Rice, Ara A Vaporciyan, Reza J Mehran, Garrett L Walsh, Jack A Roth, Stephen G Swisher, Boris Sepesi
BACKGROUND: Emerging technologies for prosthetic reconstruction after chest wall resection have yielded a wide variety of reconstructive options for thoracic surgeons. The ideal chest wall reconstruction and its impact on perioperative outcomes has not been well defined. Our goal was to determine whether mesh characteristics such as rigidity or absorbability altered perioperative pulmonary and infectious outcomes. METHODS: Our institutional database was queried for patients who underwent chest wall resection and reconstruction for primary or secondary chest wall tumors between the years 1998 and 2013...
August 12, 2016: Annals of Thoracic Surgery
Makoto Endoh, Hiroyuki Oizumi, Hirohisa Kato, Jun Suzuki, Hikaru Watarai, Akira Hamada, Katsuyuki Suzuki, Ai Takahashi, Kenta Nakahashi, Masato Sugawara, Takashi Tsuchiya, Mitsuaki Sadahiro
Extensive chest wall resection carries the risk of difficult reconstruction and surgical complications. We report our experience on chest wall reconstruction using titanium plates for a wide thoracic defect after tumor resection. A 74-year-old man was diagnosed with chondrosarcoma of the 6th rib on the right. He needed extensive chest wall resection because of skip lesions on 4th rib noted on operative inspection, leaving a defect measuring 33 × 20 cm. Reconstruction using 5 transverse titanium plates sandwiched between an expanded polytetrafluoroethylene patch and a polypropylene mesh sheet stabilized the chest wall...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Eduardo Barbin Zuccolotto, Guilherme Coelho Machado Nunes, Rafael Soares Lopes Nogueira, Eugenio Pagnussatt Neto, José Roberto Nociti
BACKGROUND AND OBJECTIVES: Multiple sclerosis is a demyelinating disease of the brain and spinal cord, characterized by muscle weakness, cognitive dysfunction, memory loss, and personality disorders. Factors that promote disease exacerbation are stress, physical trauma, infection, surgery, and hyperthermia. The objective is to describe the anesthetic management of a case referred to urological surgery. CASE REPORT: A female patient, 44 years of age, with multiple sclerosis, diagnosed with nephrolithiasis, referred for endoscopic ureterolythotripsy...
July 2016: Brazilian Journal of Anesthesiology
Javier Aragón, Itzell Pérez Méndez
Due to high rates of complications, chest wall resection and reconstruction is a high risk procedure when large size of resection is required. Many different prosthetic materials have been used with similar results. Recently, thanks to the new advances in technology, personalized reconstruction have been possible with specific custom-made prosthesis. Nevertheless, they all generate certain amount of stiffness in thoracic motion because of his rigidity. In this report, we present a forward step in prosthesis design based on tridimensional titanium-printed technology...
June 2016: Journal of Thoracic Disease
Guillaume Cazoulat, Dawn Owen, Martha M Matuszak, James M Balter, Kristy K Brock
Spatial correlation of lung tissue across longitudinal images, as the patient responds to treatment, is a critical step in adaptive radiotherapy. The goal of this work is to expand a biomechanical model-based deformable registration algorithm (Morfeus) to achieve accurate registration in the presence of significant anatomical changes. Six lung cancer patients previously treated with conventionally fractionated radiotherapy were retrospectively evaluated. Exhale CT scans were obtained at treatment planning and following three weeks of treatment...
July 7, 2016: Physics in Medicine and Biology
Jee-Won Suh, Seok Joo, Geun Dong Lee, Seok Jin Haam, Sungsoo Lee
BACKGROUND: We used an Abramson technique for minimally invasive repair of pectus carinatum in patients who preferred surgery to brace therapy, had been unsuccessfully treated via brace therapy, or were unsuitable for brace therapy because of a rigid chest wall. METHODS: Between July 2011 and May 2015, 16 patients with pectus carinatum underwent minimally invasive surgery. RESULTS: The mean age of the patients was 24.35±13.20 years (range, 14-57 years), and all patients were male...
April 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Yuko Matsuoka, Satoshi Tanaka, Takanobu Hirabayashi, Mikito Kawamata
We here report a case in which tracheal stent insertion was performed using veno-venous extracorporeal membrane oxygenation (V-V ECMO). A 78-year-old man with severe tracheal stenosis due to thyroid cancer was suffering from dyspnea at rest. Computed tomography showed that the narrowest caliber of the trachea was 1.5 mm in diameter at 5 cm below the level of the vocal cords. Femoro-femoral V-V ECMO was established without hemodynamic instability. General anesthesia was induced with propofol 70 mg and fentanyl 50 μg and was maintained with propofol 150-200 mg x hr(-1) and remifentanil 0...
February 2016: Masui. the Japanese Journal of Anesthesiology
Glenn Burns, Rebecca T DeRienz, Daniel D Baker, Marcel Casavant, Henry A Spiller
BACKGROUND: There has been a significant spike in fentanyl-related deaths from illicit fentanyl supplied via the heroin trade. Past fentanyl access was primarily oral or dermal via prescription fentanyl patch diversion. One factor potentially driving this increase in fatalities is the change in route of administration. Rapid intravenous (IV) fentanyl can produce chest wall rigidity. We evaluated post-mortem fentanyl and norfentanyl concentrations in a recent surge of lethal fentanyl intoxications...
June 2016: Clinical Toxicology
Vaidehi Agrawal, Kirby Wilson, Roxana Reyna, Mohammad Ali Emran
BACKGROUND: Opioid analgesics such as morphine are frequently used for pain management in pediatric patients undergoing dressing changes for negative pressure wound therapy (NPWT). While these medications reduce associated pain, they are also associated with adverse side effects ranging from constipation, headache, and dizziness to respiratory depression, chest wall rigidity, and death. Alternative analgesic approaches are needed for pediatric patients undergoing NPWT. METHODS: Four percent topical lidocaine was used for pain management during dressing changes for NPWT in a 15-year-old Hispanic male with necrotizing adenopathy...
November 2015: Journal of Wound, Ostomy, and Continence Nursing
Damien Subit, Felix Möhler, Bengt Pipkorn
OBJECTIVE: Field data show that side impact car crashes have become responsible for a greater proportion of the fatal crashes compared to frontal crashes, which suggests that the protection gained in frontal impact has not been matched in side impact. One of the reasons is the lack of understanding of the torso injury mechanisms in side impact. In particular, the deformation of the rib cage and how it affects the mechanical loading of the individual ribs have yet to be established. Therefore, the objective of this study was to characterize the ribcage deformation in side impacts by describing the kinematics of the sternum relative to the spine...
2015: Traffic Injury Prevention
H Böhm, H El Ghait, M Shousha
BACKGROUND: In spite of modern pedicle-based systems, the correction of a rigid rib hump or hypokyphosis remains a problem in posterior-only scoliosis surgery. As there has so far been no reliable method of predicting the intraoperative extent of kyphosis restoration or rib hump correction by posterior-only surgery, it has been difficult to determine the indication for an additional anterior release. METHODS: The method described here circumvents this dilemma. Like an optional module, horacoscopically assisted release in prone position (TARP) can be added when it is obvious during posterior surgery that the correction is insufficient...
November 2015: Der Orthopäde
Giovanni Leuzzi, Dania Nachira, Alfredo Cesario, Pierluigi Novellis, Leonardo Petracca Ciavarella, Filippo Lococo, Francesco Facciolo, Pierluigi Granone, Stefano Margaritora
BACKGROUND: To address the question of how much chest-wall (CW) resections and prosthetic reconstructions influence functional outcome. METHODS: We retrospectively reviewed 175 patients who underwent surgery for CW tumors. The clinical, histological, surgical, oncological, and functional factors were analyzed. RESULTS: We performed: 75 rib resections; 20 sternal resections; 15 combined resections; and 27 lung resections. In 39 cases (22.2%) CW was stabilized with non-rigid prosthesis (Vicryl-mesh: 8 patients; Goretex-mesh: 31 patients)...
May 2015: Thoracic Cancer
Javier Alonso Baena-Del Valle, Victoria Eugenia Murillo-Echeverri, Alejandro Gaviria-Velásquez, Diego Miguel Celis-Mejía, Gustavo Matute-Turizo
BACKGROUND: Glomus tumours are neoplasms arising from cells of the neuromyoarterial glomus bodies, which almost always occur in a subungual location. A lung location is extremely rare, with few cases reported in the literature. CLINICAL CASE: The case is presented of a 33 year-old male, with non-productive cough, dyspnoea at rest, intermittent fever, and mild pain in rib cage. A chest radiograph showed a consolidation in the left lung, and computed tomography revealed a lesion in the hilum that extended to the bronchus of the lingula obstructing, and causing post-obstructive pneumonia...
July 2015: Cirugia y Cirujanos
C P Kamerling, M F Fast, P Ziegenhein, M J Menten, S Nill, U Oelfke
PURPOSE: This work provides a proof-of-concept study for real-time 4D dose reconstruction on 4DCT lung data treated with MLC tracking and its impact on the size of target margins. METHODS: We have implemented online dose reconstruction by connecting our research platform for dynamic dose delivery to an Agility MLC at an Elekta Synergy linac with our in-house treatment planning software (TPS). Actual MLC apertures and (simulated) target positions are reported to the TPS every 40ms and 33ms respectively...
June 2015: Medical Physics
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