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 12,197 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1968 and 1973 forty nine patients suffering from poliomyelitic scoliosis were treated surgically at the Rizzoli Institute. They were due to asymmetrical paralysis and contracture in the muscles of the trunk and limbs. Associated pathological conditions were found, such as pelvic obliquity, and vascular and trophic changes due to ganglionic lesions. The differing incidence and combination of these factors gave rise to various clinical types of spinal deformity. The average severity of curve was 39 degrees, the localisation was predominantly central, the average extent was ten vertebrae, and there was a marked predominance of right convexity (twenty nine out of thirty six). The rate of progression was maximum during puberty and almost negligible after bony maturity. It was greater in males and was unfavourably affected by the severity and asymmetrical distribution of the paralysis, by the early appearance of the disease, by high localisation of the deformity, and by the erect posture in patients who were ambulant. The most frequent visceral complications were in the respiratory system (ten patients with a deficit over 50%), followed by cardiac changes. Surgical treatment was adopted in patients with progressive curves over 60 degrees, because of the inevitable deterioration in their general condition and the tendency of the deformity to become fixed. Pre-operative correction by Halo-traction results (52% correction) than Risser plasters (38%). Posterior arthrodesis by Harrington's method was carried out in all the more recent cases (forty four). Post-operative plaster was maintained for eight months and then replaced by an orthopaedic corset. At bony maturity there was an averaged improvement of 35% in the angle of curvature, and an average improvement of 6% in vital capacity. The best corrections were obtained in patients under fourteen (42%), in dorso-lumbar scoliosis (40%) and in patients with curves above 100 degrees (38%). There was an average increase in height of 9.1 cms and a reduction in the gibbus of 3.4 cms. The complications included one traumatic pneumothorax, eight pseudarthroses, and breakage of the distraction rod in two cases resulting in complete relapse of the deformity. In six cases the upper hooks became loos and there were two cases of postoperative staphylococcal infection. In the distally sited curves our present policy is towards combining posterior arthrodesis with Dwyer's anterior interbody fusion.
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PMID:Surgical treatment of poliomyelitic scoliosis. 102 7

Pectus excavatum was repaired by the sternal eversion (turnover) technique in 26 patients over a 7-year period. Vascular supply to the sternal graft was maintained by preservation of one internal mammary vascular pedicle. Good results were obtained in 21 (81%) patients followed for periods ranging from 2 to 76 months (mean, 32 months) postoperatively. Four patients (15%) had fair results; 2 patients with Marfan's syndrome had partial recurrence, as did 1 patient with skin necrosis and 1 with hypertrophic scar. One patient (4%) had a poor early result due to wound infection and distal sternal necrosis requiring reoperation. Other complications were minor: superficial wound seroma in 2 patients and pneumothorax in 1. The sternal eversion technique for repair of pectus excavatum utilizes the concave shape of the sternum when turned over to create a cosmetically acceptable convex anterior chest wall contour. Judicious tailoring of the costal cartilages and shaping of the anterior sternum corrects asymmetrical deformities. The chest wall is very stable after repair. Since no prosthetic struts or pins are used, a second operation for removal is avoided. Preservation of the vascular supply to the sternum should allow normal growth of the anterior chest wall. The results have been sufficiently encouraging for us to recommend sternal eversion as the primary method for repair of pectus excavatum.
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PMID:Repair of pectus excavatum by sternal eversion. 648 51

Nuss described a minimally invasive technique for correcting pectus excavatum in children. A curved stainless-steel bar is inserted behind the sternum through the chest cavity with the convex surface face down, then rotated 180 degrees to elevate the sternum and correct the deformity. The procedure gained wide acceptance in children. The purpose of this study was to determine if the procedure is effective in adults. Only patients with symptoms limiting lifestyle, chest wall indices higher than 3.25, and demonstrable cardiac compression on echocardiography were accepted. Between April 1998 and January 2001, 14 adults aged 19 to 46 underwent assessment for the Nuss minimally invasive technique for correction of pectus excavatum. Eight patients, 19 to 32 years of age, met the stated criteria for acceptance. The comorbidities were 2 asymmetrical deformities, 2 scolioses, 1 previous pectus repair, and 1 previous breast augmentation. The patients were informed of the benefits and disadvantages of both the Ravitch and the Nuss procedures. All patients except the first had talked to one or more adults who previously had the procedure. Follow-up was 7 to 37 months (mean 22.1 months). Four patients have had their bars removed and maintained correction. Success of the operation was based on relief of cardiac compression, alleviation of symptoms, and adequate pain control. Operating time was 1 to 2:05 hours (mean 1:32 hours). Complications were pneumothorax in one patient, urinary retention in 2, and left lower lobe atelectasis in 5. Complications did not prolong hospitalization. Postoperative epidural analgesia was discontinued after 2 to 4 days (mean 2.8 days). Average daily pain scores were between 1.6 and 3.7 on a scale of 0 to 10. Hospital stay was 3 to 5 days (mean 4 days). Relief of symptoms and increase in activity were obtained in all patients. Relief of cardiac compression was demonstrated in the 6 patients who have had postoperative echocardiograms. Patients returned to normal activity 2 to 4 weeks postoperatively (mean 2.3 weeks). Duration of pain medicine was 2 to 4 weeks in 6 patients and 2 and 4 months for the other 2 (mean 5.5 weeks). There were 2 late complications related to the bar, but without loss of correction. The early experience with the Nuss minimally invasive pectus excavatum repair in adults is encouraging. The procedure is effective for correcting pectus excavatum in selected patients. Early results are dependent upon adequate bar stabilization and pain control. The long-term results in adults are unknown.
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PMID:Early experience with the Nuss minimally invasive correction of pectus excavatum in adults. 1220 30

Although right main bronchus intubation is associated with adverse consequences, the optimal endotracheal tube (ETT) tip position above the carina in neonates is not known. The aim of this study was to determine the association between ETT tip position and adverse pulmonary effects as assessed by chest radiographs (CXRs). Lung aeration was examined after masking ETT positions in the first two CXRs taken after birth in 74 consecutive ventilated premature infants <or= 28 weeks. All the CXRs of the infants during the first week were examined for predefined combined adverse pulmonary outcomes by two examiners (right upper lobe collapse, localized pulmonary interstitial emphysema [PIE], and pneumothorax). Infants who had ETT tips below T4 or in the right main bronchus were excluded. The ETT tip was above T1 in 4 (5.4%), at T1 in 11 (14.8%), at T2 in 19 (25.6%), at T3 in 27 (36.5%), and at T4 in 13 (17.6%) infants. The patients were categorized into group A (ETT tips at T1/2) or group B (ETT above T1 or below T2). The combined adverse pulmonary outcome of pneumothorax, localized PIE, and right upper lobe collapse was significantly higher in group B compared with group A ( P=0.03). On logistic regression analysis, the only independent association for adverse pulmonary outcome and asymmetrical lung aeration was the ETT position. The odds ratio for developing nonuniform lung aeration was 6 (95% confidence interval [CI] 1.8, 20) and for adverse pulmonary outcome was 8 (95% CI 1.1, 73) when the ETT tip was at T3/T4 compared with T1/2. We concluded that the ETT tip should be kept at the level of the first or second thoracic vertebrae in extremely premature babies to reduce the incidence of nonuniform lung aeration and adverse pulmonary outcomes.
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PMID:Optimal endotracheal tube tip position in extremely premature infants. 1802 11

Ankylosing spondylitis, a chronic multisystem inflammatory disorder, can present with articular and extra-articular features. It can affect the tracheobronchial tree and the lung parenchyma, and respiratory complications include chest wall restriction, apical fibrobullous disease with or without secondary pulmonary superinfection, spontaneous pneumothorax, and obstructive sleep apnea. Ankylosing spondylitis is a common cause of pulmonary apical fibrocystic disease; early involvement may be unilateral or asymmetrical, but most cases eventually consist of bilateral apical fibrobullous lesions, many of which are progressive with coalescence of the nodules, formation of cysts and cavities, fibrosis, and bronchiectasis. Mycobacterial or fungal superinfection of the upper lobe cysts and cavities occurs commonly. Aspergillus fumigatus is the most common pathogen isolated, followed by various species of mycobacteria. Prognosis of patients with fibrobullous apical lesions is mainly determined by the presence, extent, and severity of superinfection. Pulmonary function test results are nonspecific and generally parallel the severity of parenchymal involvement. A restrictive ventilatory impairment can develop in patients with ankylosing spondylitis because of either fusion of the costovertebral joints and ankylosis of the thoracic spine or anterior chest wall involvement. Chest radiographic findings may mirror the severity of clinical involvement. Pulmonary parenchymal disease is typically progressive, and cyst formation, cavitation, and fibrosis are seen in advanced cases. No treatment has been shown to alter the clinical course of apical fibrobullous disease. Although several antiinflammatory agents, such as infliximab, etanercept, and adalimumab, are being used to treat ankylosing spondylitis, their effects on pulmonary manifestations are unclear.
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PMID:Pulmonary manifestations of ankylosing spondylitis. 2069 46

The development of modern critical care lung ultrasound is based on the classical representation of anatomical structures and the need for the assessment of specific sonography artefacts and phenomena. The air and fluid content of the lungs is interpreted using few typical artefacts and phenomena, with which the most important differential diagnoses can be made. According to a recent international consensus conference these include lung sliding, lung pulse, B-lines, lung point, reverberation artefacts, subpleural consolidations and intrapleural fluid collections. An increased number of B-lines is an unspecific sign for an increased quantity of fluid in the lungs resembling interstitial syndromes, for example in the case of cardiogenic pulmonary edema or lung contusion. In the diagnosis of interstitial syndromes lung ultrasound provides higher diagnostic accuracy (95%) than auscultation (55%) and chest radiography (72%). Diagnosis of pneumonia and pulmonary embolism can be achieved at the bedside by evaluating subpleural lung consolidations. Detection of lung sliding can help to detect asymmetrical ventilation and allows the exclusion of a pneumothorax. Ultrasound-based diagnosis of pneumothorax is superior to supine anterior chest radiography: for ultrasound the sensitivity is 92-100% and the specificity 91-100%. For the diagnosis of pneumothorax a simple algorithm was therefore designed: in the presence of lung sliding, lung pulse or B-lines, pneumothorax can be ruled out, in contrast a positive lung point is a highly specific sign of the presence of pneumothorax. Furthermore, lung ultrasound allows not only diagnosis of pleural effusion with significantly higher sensitivity than chest x-ray but also visual control in ultrasound-guided thoracocentesis.
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PMID:[Lung ultrasound in acute and critical care medicine]. 2277 47

Giant bullous emphysema is an uncommon condition characterised by large asymmetric bullae with upper lobe predominance. This condition is most frequent in young male smokers. Patients usually present with progressive breathlessness which is secondary to enlargement of the bullae leading to compression of the lung parenchyma. Large asymmetrical bullae may appear as a unilateral hyperlucency on a plain chest radiograph, and may mimic the appearances of pneumothorax. A computed tomography scan is needed to delineate the lung pathology. We describe two cases with this condition that presented acutely and discuss the management of bullous emphysema.
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PMID:The vanishing lung: an important cause of hyperlucency on chest radiograph. 2409 75

An 11-year-old girl with no significant medical or ocular history presented to the emergency department with asymmetrical eyelid swelling for 2 days. She was noted to have eyelid crepitus on examination. The patient reported a prolonged episode of crying followed by chest pain and dyspnea that resolved prior to her presentation. Both face and chest CT showed extensive air tracking in the subcutaneous tissues of the neck and face and pneumomediastinum without pneumothorax. The patient was discharged home without further intervention. On follow-up 1 to 2 weeks later, she had complete resolution of her symptoms. While pneumomediastinum is extremely rare in the pediatric population, it can be considered in the differential diagnoses of eyelid swelling and crepitus in the appropriate context. To this author's knowledge, this is the first pediatric case of pneumomediastinum with an initial presentation of eyelid swelling.
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PMID:Eyelid swelling, an unusual presentation of pneumomediastinum. 2483 58

Vanishing lung syndrome, also known as idiopathic giant bullous emphysema, is a rare disease characterized by giant emphysematous bullae. The disease is diagnosed by radiological findings of giant bullae in one, or both, of the upper lobes of the lung, occupying at least one-third of the hemithorax. There have been several reports of vanishing lung syndrome, however it remains to be determined whether genetic inheritance is associated with the disease. In the present study, five patients within one family, with vanishing lung syndrome, were reported during a follow-up period of ~ 20 years. All of the patients were diagnosed by radiological findings, which showed diffuse bullae in the lungs, which were of varying size and asymmetrical distribution, and the occurrence of pneumothorax or emphysema. The Medical Ethics Committee of the People's Hospital of Zhangye Municipality (Zhangye, China) approved this study, and all subjects gave their informed consent During the follow-up period of 20 years, bullae in these patients were shown to progressively increase, and no other pulmonary diseases, including lung cancer, tuberculosis, pneumoconiosis and chronic bronchitis were observed. Autosomal dominant inheritance was observed in five cases, and autosomal recessive inheritance was observed in one case. The present study suggests that vanishing lung syndrome may be associated with autosomal dominant and recessive genetic inheritance.
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PMID:Vanishing lung syndrome in one family: five cases with a 20-year follow-up. 2532 95

A large part of the world is presently in the grip of the coronavirus disease (COVID-19) by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus), declared a pandemic in March 2020. This document is a brief commentary of the imaging modalities used in the screening, diagnosis and management of COVID-19 pneumonia. Chest x-rays, especially portable, still form a part of majority of official guidelines, with reports of the suggestive radiologic features. The potential of CT scan and ultrasound is also realised, with earlier detection rate. Typical radiologic findings of bilateral, asymmetrical, crazy-paved ground glass opacification, consolidation, reverse halo sign, opacities, progressing to fibrosis are well described for both the X-ray and CT scan. Atypical findings include airway changes, pleural effusion, pulmonary nodules and acute pulmonary embolism. Absence of lymphadenopathy, pleural effusion and pneumothorax is notable. The role of portable lung ultrasound, reported to be useful in emergency, is yet to be established in the guidelines. Disinfection of the equipment is a major concern. Governmental guidelines still advocate X-ray despite professional societies increasingly recommending CT scan.
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PMID:Radiology of COVID-19 - Imaging the pulmonary damage. 3251 87


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