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A newborn with severe skeletal dysplasia.
Maalouf FI, Coggins SA, Phillips JA, Stefanescu BM, Weitkamp JH
(2016) Arch Dis Child Educ Pract Ed 101: 147
MeSH Terms: Bone Diseases, Developmental, Calcification, Physiologic, Extremities, Humans, Infant, Newborn, Male, Skull, Thorax, Treatment Outcome
Added October 16, 2015
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9 MeSH Terms
Impact of pleural manometry on the development of chest discomfort during thoracentesis: a symptom-based study.
Pannu J, DePew ZS, Mullon JJ, Daniels CE, Hagen CE, Maldonado F
(2014) J Bronchology Interv Pulmonol 21: 306-13
MeSH Terms: Aged, Aged, 80 and over, Chest Pain, Cohort Studies, Drainage, Dyspnea, Female, Humans, Linear Models, Male, Manometry, Middle Aged, Paracentesis, Pleural Effusion, Pneumothorax, Pressure, Pulmonary Edema, Retrospective Studies, Thoracic Surgical Procedures, Ultrasonography
Show Abstract · Added July 28, 2015
BACKGROUND - Routine manometry is recommended to prevent complications during therapeutic thoracentesis, but has not definitively been shown to prevent pneumothorax or reexpansion pulmonary edema. As chest discomfort correlates with negative pleural pressures, we aimed to determine whether the use of manometry could anticipate the development of chest discomfort during therapeutic thoracentesis.
METHODS - A retrospective chart review of 214 consecutive adults who underwent outpatient therapeutic thoracentesis at our institution between January 1, 2011 and June 30, 2013 was performed. We compared preprocedural to postprocedural discomfort (using a linear analog scale from 0 to 10) in patients undergoing thoracentesis with or without manometry. We used a multivariate model to adjust for possible confounders. Changes of dyspnea scores were also analyzed.
RESULTS - Manometry was performed in 82/214 patients (38%). On univariate and multivariate analyses, neither the change in chest discomfort nor dyspnea scores was significantly different in the manometry versus the control group (P=0.12 and 0.24, respectively). Similar results were also found in the subgroup of large-volume thoracentesis (P=0.32 for discomfort, P=1.0 for dyspnea).
CONCLUSIONS - In our retrospective study, the use of manometry did not appear to anticipate the development of chest discomfort during therapeutic thoracentesis. Prospective studies are needed to confirm these findings.
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20 MeSH Terms
Full of hot air? Do patients with large spontaneous pneumothoraces require hospitalization?: September 2014 Annals of Emergency Medicine Journal Club.
Barrett TW, Schriger DL
(2014) Ann Emerg Med 64: 328-9
MeSH Terms: Ambulatory Care, Chest Tubes, Female, Humans, Male, Pneumothorax
Added January 20, 2015
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6 MeSH Terms
The role for tunneled indwelling pleural catheters in patients with persistent benign chylothorax.
DePew ZS, Iqbal S, Mullon JJ, Nichols FC, Maldonado F
(2013) Am J Med Sci 346: 349-52
MeSH Terms: Adult, Aged, Aged, 80 and over, Catheters, Indwelling, Chylothorax, Cohort Studies, Disease Management, Female, Humans, Male, Pleural Cavity, Radiography, Thoracic, Retrospective Studies, Treatment Outcome
Show Abstract · Added February 1, 2016
BACKGROUND - Utilization of tunneled indwelling pleural catheters (TIPCs) for persistent pleural effusions is increasingly more common; however, the presence of chylothorax is generally considered a contraindication for utilization of a TIPC due to concerns regarding potential nutritional, immunologic and hemodynamic complications. Therefore, in this study, a cohort of patients with persistent benign chylothorax managed with TIPCs is described.
METHODS - A retrospective analysis of patients with persistent benign chylothorax managed with a TIPC at the study center between January 1, 2008, and March 1, 2012, was completed. Extracted data included patient characteristics, chylothorax etiologies, prior interventions, outcomes and complications.
RESULTS - Eleven patients (14 hemithoraces) had persistent benign chylothorax treated with placement of a TIPC during the inclusion time frame. Etiology of the chylothorax was nontraumatic in 8 of the 11 patients, with the remaining 3 secondary to thoracic surgery. Pleurodesis was achieved in 9 of the 14 hemithoraces, with a median time to pleurodesis of 176 days. All procedures were well tolerated, and no immediate periprocedural complications were reported. One serious complication was encountered in the form of a postoperative pulmonary embolism after replacement of an occluded TIPC, resulting in the patient's death. Two patients had transient occlusions of their TIPCs successfully treated with intracatheter thrombolytic therapy. No significant adverse nutritional, hemodynamic or immunologic outcomes were reported during follow-up for any included patient.
CONCLUSIONS - Utilization of a TIPC for the management of persistent benign chylothorax should be considered early because pleurodesis may be frequently and safely achieved in this patient population.
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14 MeSH Terms
Tension pneumoperitoneum after traumatic gastric rupture.
Patel MB, High K, Eckert M
(2012) Am Surg 78: E435-6
MeSH Terms: Accidents, Traffic, Humans, Male, Middle Aged, Multiple Trauma, Pneumothorax, Stomach Rupture, Tomography, X-Ray Computed
Added June 14, 2016
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8 MeSH Terms
A randomized clinical trial comparing advanced pneumatic truncal, chest, and arm treatment to arm treatment only in self-care of arm lymphedema.
Ridner SH, Murphy B, Deng J, Kidd N, Galford E, Bonner C, Bond SM, Dietrich MS
(2012) Breast Cancer Res Treat 131: 147-58
MeSH Terms: Adult, Aged, Arm, Breast Neoplasms, Electric Impedance, Female, Humans, Intermittent Pneumatic Compression Devices, Lymphedema, Middle Aged, Self Care, Thorax, Treatment Outcome
Show Abstract · Added March 13, 2014
Treatment of the truncal lymphatics prior to treatment of the lymphedematous arm is an accepted, although not empirically tested, therapeutic intervention delivered during decongestive lymphatic therapy (DLT). Breast cancer survivors with arm lymphedema are encouraged to use these techniques when performing simple lymphatic drainage as part of their life-long lymphedema self-care. Self-massage is at times difficult and pneumatic compression devices are used by many patients to assist with self-care. One such device, the Flexitouch(®) System, replicates the techniques used during DLT; however, the need for application of pneumatic compression in unaffected truncal areas to improve self-care outcomes in arm only lymphedema is not established. The objective of this study was to compare the therapeutic benefit of truncal/chest/arm advanced pneumatic compression therapy (experimental group) verses arm only pneumatic compression (control group) in self-care for arm lymphedema without truncal involvement using the Flexitouch(®) System. Outcomes of interest were self-reported symptoms, function, arm impedance ratios, circumference, volume, and trunk circumference. Forty-two breast cancer survivors, (21 per group), with Stage II lymphedema completed 30 days of home self-care using the Flexitouch(®) System. Findings revealed a statistically significant reduction in both the number of symptoms and overall symptom burden within each group; however, there were no statistically significant differences in these outcomes between the groups. There was no statistically significant overall change or differential pattern of change between the groups in function. A statistically significant reduction in bioelectrical impedance and arm circumference within both of the groups was achieved; however, there was no statistically significant difference in reduction between groups. These findings indicate that both configurations are effective, but that there may be no added benefit to advanced pneumatic treatment of the truncal lymphatics prior to arm massage when the trunk is not also affected. Further research is indicated in a larger sample.
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13 MeSH Terms
Relationship between chest lateral width, tube current, image noise, and radiation exposure associated with coronary artery calcium scanning on 320-detector row CT.
Qian Z, Joshi PH, Shaukat AF, Laury T, Kirkland B, Meyers L, Drew A, Angel E, Krivitsky E, Bajpai A, Vazquez G, O'Rourke C, Carr JJ, Rinehart S, Voros S
(2011) J Cardiovasc Comput Tomogr 5: 231-9
MeSH Terms: Aged, Algorithms, Analysis of Variance, Anthropometry, Artifacts, Calcinosis, Chi-Square Distribution, Coronary Angiography, Coronary Artery Disease, Equipment Design, Female, Georgia, Humans, Male, Middle Aged, Phantoms, Imaging, Predictive Value of Tests, Radiation Dosage, Radiographic Image Interpretation, Computer-Assisted, Retrospective Studies, Severity of Illness Index, Thorax, Tomography, X-Ray Computed
Show Abstract · Added February 15, 2014
BACKGROUND - The relationship between chest lateral width, tube current, image noise, and radiation exposure on 320-detector row CT has not been reported.
OBJECTIVE - We investigated the relationships between chest lateral width, estimated radiation exposure (DLPe), and image noise in 300 patients undergoing clinical coronary calcium scanning.
METHODS - Patients undergoing coronary calcium scanning with 320-detector row CT (prospective, volumetric mode, 120 kV of tube voltage, 100-550 mA of tube current, 0.5-mm detector width) were grouped by chest lateral width (small, medium, and large) from anteroposterior topograms and 100 consecutive patients were selected from each group (n = 300). Tube current, DLPe, and noise were compared among groups with Kruskal-Wallis or one-way ANOVA. Phantom experiments were performed to evaluate the accuracy of calcium quantification as a function of size and tube current.
RESULTS - Median tube current in small, medium, and large patients was 130, 200, and 250 mA, respectively (P < 0.0001). Despite the use of higher tube current settings, noise levels also increased with size (20.2 ± 4.5 HU, 22.0 ± 3.9 HU, and 25.1 ± 4.9 HU, respectively; global P < 0.001). DLPe was significantly higher with increasing size (54, 83, and 104 mGy · cm, respectively; P < 0.0001). Phantom experiments showed that 50-100 mA, 150-200 mA, and approximately 300 mA in small, medium, and large phantoms were associated with stable estimate of calcium.
CONCLUSIONS - Increasing chest lateral width is associated with increasing radiation exposure and image noise. The use of 50-100 mA in small and 150-200 mA in medium patients is associated with acceptable noise and stable estimate of coronary artery calcium. In large patients, precise identification of individual calcified lesions remains difficult despite increasing tube current and radiation exposure.
Copyright © 2011 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
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23 MeSH Terms
Update on uncommon pleural effusions.
Ryu JH, Tomassetti S, Maldonado F
(2011) Respirology 16: 238-43
MeSH Terms: Chylothorax, Female, Humans, Male, Pleural Effusion, Treatment Outcome, Yellow Nail Syndrome
Show Abstract · Added February 1, 2016
Although infections, malignancies and heart failure are responsible for the majority of pleural effusions, there are many other causes and several uncommon but distinctive types of pleural fluid. For this update we have chosen several uncommon forms of pleural effusions or disorders in which there have been recent advances in our understanding over the past several years. Chylothorax, pseudochylothorax and urinothorax are associated with characteristic clinical contexts and pleural fluid parameters but are likely underdiagnosed. Yellow nail syndrome is a rare disorder that can be associated with chylothorax and manifests multisystem features. Recognition of these entities is important because each of these disorders is associated with distinctive aetiology and management modalities. Correct diagnosis depends on the clinician's awareness of the clinical contexts and manifestations along with diagnostic pleural fluid findings in these disorders.
© 2011 The Authors. Respirology © 2011 Asian Pacific Society of Respirology.
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7 MeSH Terms
Medical and surgical management of chylothorax and associated outcomes.
Maldonado F, Cartin-Ceba R, Hawkins FJ, Ryu JH
(2010) Am J Med Sci 339: 314-8
MeSH Terms: Adult, Aged, Aged, 80 and over, Chylothorax, Disease Management, Female, Humans, Lymphography, Male, Middle Aged, Retrospective Studies, Treatment Outcome, Young Adult
Show Abstract · Added February 1, 2016
Chylothorax is an uncommon form of pleural effusion that can be associated with traumatic and nontraumatic causes. Optimal management and outcome for patients with chylothorax remain unclear. This retrospective single-center study assessed the modes of management for chylothorax in 74 adult patients (> or =18 years old) and associated outcomes. The role of lymphangiographic imaging was also evaluated. Initial treatment approach was nonsurgical in 57 patients (77%) but a surgical procedure (pleurodesis, thoracic duct ligation, and/or surgical repair) was eventually performed in 44 patients (59%). The rate of resolution with initial treatment measures was significantly worse for patients with nontraumatic chylothorax compared with those with traumatic causes (27% versus 50%, P = 0.048). Even after additional therapeutic maneuvers including surgery, chylous effusion recurred more commonly in nontraumatic chylothorax when compared with the traumatic group (50% versus 13%, respectively, P < 0.001). Lymphatic imaging did not seem to materially influence management. Nonsurgical approaches may lead to resolution of the chylothorax in nearly one half of patients with traumatic chylothorax but in only a minority of those with nontraumatic chylothorax. The majority of patients with nontraumatic chylothorax will eventually require surgical maneuvers, but one third of such patients still fail to resolve their chylothorax.
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13 MeSH Terms
Hemorrhagic complications of percutaneous radiofrequency ablation for liver tumors.
Goto E, Tateishi R, Shiina S, Masuzaki R, Enooku K, Sato T, Ohki T, Kondo Y, Goto T, Yoshida H, Omata M
(2010) J Clin Gastroenterol 44: 374-80
MeSH Terms: Adult, Aged, Aged, 80 and over, Blood Transfusion, Catheter Ablation, Databases, Factual, Drainage, Female, Hemobilia, Hemoperitoneum, Hemorrhage, Hemothorax, Humans, Liver Neoplasms, Logistic Models, Male, Middle Aged, Platelet Count, Risk Factors
Show Abstract · Added May 2, 2014
BACKGROUND - Although radiofrequency ablation (RFA) is widely accepted as a percutaneous treatment for liver tumors; serious complications may occur resulting in 0.1% to 0.5% mortality. This study analyzed the risk factors and management of hemorrhagic complications, such as hemoperitoneum, hemothorax, and hemobilia.
METHODS - We performed 4133 RFA treatments in 2154 patients with primary and metastatic liver tumors from February 1999 to December 2007. Of these, we enrolled patients with hemorrhagic complications and reviewed their medical records thoroughly. The risk factors for each hemorrhagic complication were analyzed using unconditional logistic regression.
RESULTS - Hemorrhagic complications occurred in 63 out of 4133 treatments (1.5%), including hemoperitoneum in 29 (0.7%), hemothorax in 14 (0.3%), and hemobilia in 20 (0.5%). Eleven, 8, and 4 of these patients, respectively, were categorized as major complications requiring blood transfusion or drainage. Two patients died after hemoperitoneum. Logistic regression analysis revealed large tumor size [odds ratio (OR) 1.06 per 1 mm increase in diameter] and low platelet count (OR 0.88 per 10,000/microL increase) were significant risk factors for hemoperitoneum. The location of tumor nodules was a significant risk factor for hemothorax (segment 7, OR 2.31) and hemobilia (segment 1, OR 3.30). Other factors, including the number of needle insertions or the duration of ablation, were not significant.
CONCLUSIONS - Although hemorrhagic complications were relatively rare with percutaneous RFA, specific treatments, such as blood transfusion and drainage, were required in some cases. Care must be taken, especially in high-risk patients.
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19 MeSH Terms