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At least 1,063 records · Page 59Linked to original sources
PubMed1983

[Respiratory center function in the course of the cough reflex in normoxia and hypoxia].

Impulse activity of the medulla respiratory neurons and electrical activity of the diaphragm and intercostal muscles were studied prior to, during and after coughing fit in anesthetized cats under conditions of normoxia and hypoxia. Simultaneously the intrapleural pressure was recorded and O2, paCO2, SaO2 were determined in arterial blood. Massive excitation of inspiratory and expiratory neurons as well as considerable augmentation of respiratory muscles electrical activity occurred during coughing fit. Soon after the fit the activity of neurons and muscles restored to initial level. During acute hypoxia the coughing fit shortened, the coughing seizures weakened as compared with the normoxic conditions. After the coughing fit, in result of hyperventilation during the fit, the paCO2 sharply dropped in arterial blood, the neuronal volley activity and the muscles rhythmic activity became disorganized, and apnea occurred. Within 20-40 sec rhythmic volley activity of the medulla inspiratory neurons disrupted the apnea.

Animals↗
PubMed1982

The radiology of pulmonary complications associated with acute spinal cord injury.

Pulmonary complications after acute cervical spinal cord injury are common. Paralysis of the intercostal muscles leads to decreased respiratory function. In addition, injuries of the thoracic cage, pleura and lungs are commonly associated with spinal injuries. A survey of radiologically demonstrable pulmonary complications in 50 patients with acute tetraplegia has been made. Changes were present in 28% of the patients surveyed. The changes in pulmonary and haemodynamic function consequent upon cervical spinal cord injury are briefly described. Radiological manifestations of pulmonary complications due to decreased pulmonary function, direct pulmonary trauma and rare pulmonary complications of skeletal injury are reviewed. The value of routine and intensive radiographic monitoring of the chest in the patient with acute tetraplegia is emphasized, as clinical diagnosis is hampered in the absence of motor and sensory function.

Acute Disease↗
PubMed1980

Intractable hiccups. (singultus).

Intractable hiccups (singultus) is an uncommon disorder with various etiologies. The majority of reported studies of intractable hiccups has claimed ipsilateral spasm of the hemidiaphragm based solely on clinical or radiographic evidence. A case of intractable hiccups is presented. Documentation of normal phrenic nerve latencies with bilateral synchronous firing of anterior scalene, intercostal muscles and bilateral hemidiaphragm involvement is presented. This combination of muscle group involvement supports the concept of a "supraspinal hiccup center." A systematic trial of chemotherapeutic agents described as effective against hiccups was employed. Relief lasting for three to four week periods has been obtained by the intravenous administration of a specially prepared sterile solution of methylphenidate. The nerve pathways pertinent to hiccup are discussed. The etiology of intractable hiccups and the various treatment modalities are presented.

Brain Stem↗
PubMed1995

[A recurrence of benign fibrous mesothelioma of the pleura: a case report].

A 64-year-old man who complained of the right chest pain was admitted in our hospital. A mass shadow which revealed the extrapleural sign was shown in the chest X-ray. This patient was performed thoracotomy and a tumor invading to the intercostal muscles was resected. Pathological diagnosis was benign fibrous mesothelioma. About 10 months after this operation, we suspected the local recurrence of the tumor on the chest X-ray. The re-operation was performed, and we resected the recurrent tumor and the 2nd and 3rd ribs. Pathologically the resected tumor was benign fibrous mesothelioma.

Humans↗
PubMed1995

[Solitary plasmacytoma of the rib--a case report and review of Japanese literatures].

A 72-year-old woman with solitary plasmacytoma of the right fifth rib was surgically treated. She underwent radical resection of the bony chest wall including the right fifth rib, the ribs above and below the involved rib, the intercostal muscle, and the parietal pleura. Histological finding of the tumor was plasmacytoma of the rib. The type of monoclonal protein was IgG and lamda. She is doing well one year and eleven months after surgery without any signs of recurrence. Solitary plasmacytoma is rare as compared with multiple myeloma. Patients with solitary plasmacytoma originating in the rib have a feasibility of operative indication, and radical treatment is expected to be by adequate surgical resection. Seventeen cases of solitary chest wall plasmacytoma described in the Japanese literature are reviewed.

Adult↗
PubMed1995

The route of administration is a major determinant of the transduction efficiency of rat tissues by adenoviral recombinants.

One of the key factors that determines the efficacy of adenovirus-mediated gene therapy in genetic diseases, is the degree and extent of transduction of the target cells by adenovirus (AV)-recombinants carrying the therapeutic gene or cDNA. In this paper we provide experimental evidence which indicates that the route of administration of the AV-recombinants has a major influence on the transduction of various tissues in young rats. The heart, diaphragm, intercostal muscles and thymus show high transduction after intra-arterial (left cardiac ventricle) injection. By contrast, the liver shows a high transduction after intravenous injection. A substantial viremia develops within 2 h of gastric-rectal, intraperitoneal and intracardiac administration of AV recombinants. The number of adenoviral DNA copies per nucleus of transduced cells ranged from one to three in most tissues. These numbers correlated well with the overall transduction efficiency of the tissue determined by reporter gene expression. The various factors that determine which route of administration favors a high transduction rate in a particular tissue can be analyzed and this can lead to an improved efficiency of gene therapy in targeting a particular tissue in a disease.

Adenoviridae↗
PubMed1976

Function of external respiration after experimental lung autotransplantation.

The function of external respiration was studied by way of a dynamic observation of 15 animals whose course was uneventful following autotransplantation of the left lung. The longest follow-up period was 4 years. The following studies were conducted: spirography, bronchospirography, functional tests with the right (intact) lung excluded from respiration, bronchopneumotachygraphy, electromyography of the intercostal muscles, and analyses of blood gases and acid-base balance. During the early hours and days after left lung autotransplantation, hyperventilation and gas exchange decrease were observed in the operated lung, along with arterial and venous hypoxemia and signs of metabolic acidosis. With the right (intact) lung excluded and only the autograft breathing, a considerable reduction of oxygen saturation of the peripheral arterial blood was observed, which indicated the low compensatory capacity of the autotransplanted lung. Restoration and normalization of ventilation and gas exchange, blood gases, and acid-base balance were noted within 8 days after left lung autotransplantation. The compensatory capacity of the lung autograft, as shown by the test with the right (intact) lung excluded, was restored within the first 2 months after surgery. Following lung autotransplantation, in the absence of the Hering-Breuer reflex, the adaptative reactions of the external respiration apparatus are provided by the reflexes from the proprioreceptors of the breathing muscles of the thoracic wall and by humoral factors that acquire a leading role in the regulation of respiratory mechanisms. After removal of the right (intact) lung in the late postoperative period, the left lung autograft supports normal vital functions of the body (with the longest follow-up being 3 1/4 years). This convincingly proves that the organ's function and structure have been restored.

Acid-Base Equilibrium↗
PubMed1994

Respiratory dysfunction associated with traumatic injury to the central nervous system.

Pulmonary dysfunction is a common complication of head trauma and spinal cord injury. Abnormal breathing patterns reflect the influence of altered neural integration. Early arterial hypoxemia can result from ventilation-perfusion mismatching, microatelectasis, aspiration, fat embolism, or the development of the adult respiratory distress syndrome. Significant changes in lung volumes, ventilation, and gas exchange can occur in spinal cord injury as a result of the loss of diaphramatic or intercostal muscle function. Recruitment of accessory respiratory muscles plays an important role in stabilizing the rib cage and improving expiratory function. Strength training improves expiratory muscle function in quadriplegics and should be continued indefinitely. Most importantly, survival of patients with CNS injuries improves with meticulous and vigorous pulmonary hygiene. The pulmonary hygiene program should include regular changes in the patient's position, assisted coughing and deep breathing exercises, incentive spirometer, bronchodilators, fiberoptic bronchoscopy when indicated, and frequent monitoring of pulmonary mechanics. Long-term survival of the patient with head trauma or spinal cord injury is correlated to successful weaning from mechanical ventilation. Various forms of mechanical ventilator support can be adopted for the patient's ventilatory needs, and many patients will achieve some degree of freedom from mechanical ventilation. Newer ventilatory assist devices that do not require tracheostomy should be considered.

Brain Injuries↗
PubMed1994

[A successful case of omentopexy for bronchopleural fistula and empyema after right pneumonectomy].

A 59-year-old male was performed right pneumonectomy with R 2 b lymph node dissection and intercostal muscle flap to the bronchial stump for squamous cell carcinoma of right upper lobe of the lung (cT 2 N 2 M 0-stage III A). But four weeks later bronchial stump was suddenly reopened and he developed empyema. Omentopexy for bronchopleural fistula (15 x 11 mm in size) and thoracoplasty for empyema was performed. Bronchoscopically the fistula is 2 mm in diameter and reepithelization is started around the fistula at 14 POD and the fistula is completely closed and covered with reepithelized mucosa without inflammation at 100 POD. We think omentopexy for bronchopleural fistula after pneumonectomy is very effective procedure, so we should be considered this method at first. But if the fistula is accompanying empyema as our case thoracoplasty should be added.

Bronchial Fistula↗
PubMed1994

Anastomotic pitfalls in lung transplantation.

Although airway, arterial, and venous connections required for lung transplantation appear simple, in practice we have encountered morbid early stenosis and obstructions, which are now avoided by technical modifications gradually made since 1985 in 134 cases (60 single lung and 74 double lung). Our initial eight double lung transplant procedures were done with tracheal anastomoses and omental wraps, but ischemic disruption, with a 75% (6 of 8) rate of complications, resulted in the subsequent use of bi-bronchial connections. A total of 192 bronchial anastomoses were reviewed (60 single lung, 66 double lung). Although all anastomoses were constructed between the donor trimmed to one to two rings above the upper lobe origin and the host divided at its emergence from the mediastinum, the suture technique has evolved. Nine (32%) of 28 cases with early bronchial anastomoses with end-to-end suture and intercostal muscle wrap had ischemic or stenotic complications, but the telescoping technique without wrap in 164 bronchial anastomoses reduced the problem to 12% (19 of 164). Twelve anastomoses required temporary intraluminal stenting. Vascular anastomotic obstructions occurred in five arterial (excessive length 2, short allograft artery 1, restrictive suture or clot 2) and two venous (excessive length 1, restrictive suture or clot 1) connections. Suspicion of arterial obstruction was prompted by persisting pulmonary hypertension and reduced flow to the allograft measured by postoperative nuclear scan and hypoxia. Venous obstructions were suggested by persisting radiographic and clinical pulmonary edema. Modifications of earlier techniques have improved our early success in lung transplantation and might be considered by others entering this demanding field.

Anastomosis, Surgical↗
PubMedDate not supplied

Rigid spine syndrome presenting with respiratory failure--report of one case.

A case of rigid spine syndrome presenting with respiratory failure was reported. A seven-year-old girl had had dyspnea and orthopnea for one month. Symptoms had aggravated gradually and she was in a state of respiratory failure on arrival at our hospital. There was no evidence of active lung lesions and response to mechanical ventilation was good. Physical examination revealed an extremely thin girl with marked flexion limitation of neck and severe wasting of sternocleidomastoid and intercostal muscles. Serum creatine phosphokinase was moderately elevated (801 IU/L). Muscle biopsy specimen obtained from the right quadriceps femoris revealed increased perimyseal connective tissue and marked Type II fiber atrophy. Electromyography of left paraspinal muscles demonstrated small amplitude, short duration motor unit potentials. She received tracheostomy and a home-care ventilator use during sleep. Ventilatory insufficiency, though rare, should be anticipated in patients with rigid spine syndrome, and timely ventilatory support should be given.

Child↗
PubMed1993

[A case of von Recklinghausen's disease associated with large cell carcinoma of the lung].

A 75-year-old man, a heavy smoker with a history of exposure to dust, was admitted to our hospital because of right back pain. Since café au lait spots, diffuse pigmentation and multiple neurofibromatosis were observed on the skin, he was considered to have von Recklinghausen's disease. Chest X-ray film showed a tumor shadow in the right S2, and chest CT demonstrated that the tumor involved the chest wall. Histopathological examination of the percutaneous lung biopsy specimen demonstrated large cell carcinoma. Following radiotherapy to the tumor, he underwent right upper lobectomy with chest wall resection. Macroscopic examination of the resected specimen revealed invasion of tumor into the external intercostal muscles, although microscopically all cancerous tissue was replaced by necrotic tissue and no viable tumor cells remained. The patient survived for three years after treatment, and subsequently died of respiratory failure caused by pneumonia.

Adult↗
PubMed1993

[An hourglass type intrathoracic lipoma--a case report of surgical treatment].

We report a rare case of hourglass type intrathoracic lipoma. Until now, there are 114 reported cases on intrathoracic lipoma in Japanese literature, among which 22 are hourglass type. The patient was a 43-year-old woman, who was found to have a pleural tumor on her chest X-ray examination for healthy check-up. Computed tomography showed that it had intra- and extrathoracic portion with almost the same density as the subcutaneous fat tissue. The tumor was excised along with pleura, periostia and intercostal muscle approximately 1 cm apart from it. It was dumbbell-shaped and weighed 30 grams. Microscopically it was found to be intramuscular lipoma. According to Fletcher, intramuscular lipoma was classified into two groups of infiltrative and non-infiltrative type. In their cases, infiltrative intramuscular lipomas recurred up to 19%, mainly secondary to incorrect resection. Our case corresponds to infiltrative type. We consider that intrathoracic lipoma, though benign, have to be resected radically with utmost care.

Adolescent↗
PubMed1993

[A case of solitary plasmacytoma that originated in a rib].

A 52-year-old woman was admitted to our hospital with the chief complaint of left anterior chest pain. A chest X-ray showed a tumor shadow in the left 4th rib. No abnormalities were detected in peripheral blood and aspirated bone marrow samples. The tumor was surgically resected with the involved bone, the intercostal muscle and the parietal pleura. The resected specimen contained a 3 x 6 x 3 cm lesion, and histological investigation of the tumor revealed a plasmacytoma of the rib. It relapsed as a multiple myeloma within two months after surgery. Chemotherapy was administered and the bone lesions were observed to disappear. We believe that the best way to treat solitary plasmacytoma is to first resect the solitary tumor, and then to add cobalt irradiation and chemotherapy after surgery.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Electrical stimulation to restore respiration.

Electrical stimulation has been used for over 25 years to restore breathing to patients with high quadriplegia causing respiratory paralysis and patients with central alveolar hypoventilation. Three groups have developed electrical pacing systems for long-term support of respiration in humans. These systems consist of electrodes implanted on the phrenic nerves, connected by leads to a stimulator implanted under the skin, and powered and controlled from a battery-powered transmitter outside the body. The systems differ principally in the electrode design and stimulation waveform. Approximately 1,000 people worldwide have received one of the three phrenic pacing devices, most with strongly positive results: reduced risk of tracheal problems and chronic infection, the ability to speak and smell more normally, reduced risk of accidental interruption of respiration, greater independence, and reduced costs and time for ventilatory care. For patients with partial lesions of the phrenic nerves, intercostal muscle stimulation may supplement respiration.

Electric Stimulation Therapy↗
PubMed1996

Massive chylothorax after anterior fusion of the thoracic spine.

We report a case of massive chylothorax occurring postoperatively in a patient with Potts paraplegia who underwent transthoracic anterior debridement and fusion of the T7 and T8 vertebrae. This is an uncommon complication of anterior spinal surgery but has a significant morbidity and mortality. Diagnosis of the condition and the institution of the appropriate therapy will reduce this significantly. The treatment principles are continuous tube drainage, nutritional support and reduction of chyle production. In 50% of cases a surgical procedure will be required. There are a variety of techniques available. We describe a technique that uses a pedicled intercostal muscle flap, which to our knowledge, has not been described previously. Among the other techniques, video-assisted thoracoscopic surgery is the most promising because of its low morbidity.

Adult↗
PubMed1996

[Pulsating tumor of the sternum: enlarged exeresis and reconstruction with marlex-methylmethacrylate prosthesis].

The authors report on a rare case of pulsating tumor of the sternum. En bloc resection was carried out with removal of the sternal manubrium and body, tracts of the I-II-III rib with the intercostal muscles and part of the left pectoralis major. Reconstruction of the thoracic wall was performed with a marlex MMA sandwich prosthesis. From a histological viewpoint, the carcinoma was well differentiated and compatible with thyroid primitivity. Non complementary antiblastic therapies were provided as all the examinations carried out were negative and the intervention was radical. The patient had been followed-up with serial controls and three complete stagings at one, three and five years after intervention (CT, echography and function tests of the thyroid, bone scintigraphy). At follow-up of more than six years the patient is doing well and is event free. The authors believe, even with the help of reports from the literature that, in sternal metastases from thyroid carcinomas, especially when single and large, surgical therapy is required.

Carcinoma↗
PubMed1996

[Comparison of computerized tomography and magnetic resonance in the assessment of benign and malignant pleural diseases].

To compare the diagnostic capabilities of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) in differentiating benign from malignant pleural disease, we examined with MRI at 0.5 T forty-five patients with pleural lesions identified on CT scans. For 34 patients, a final diagnosis of malignant (n = 18) or benign (n = 16) disease was made. T1, proton density/T2 and enhanced T1-weighted spin-echo images were acquired. CT and MR images were independently studied by two observers, who were unaware of the final diagnosis. Various morphological features suggesting benign or malignant pleural disease were evaluated. On the basis of the morphological CT features, a final diagnosis of benignity of malignancy was expressed in terms of two different levels of confidence-probable or definitive. The MR signal intensity of pleural lesions was compared with that of intercostal muscles (isohypointense or hyperintense). No significant differences were observed between CT and MR morphological findings. High signal intensity on proton density/T2-weighted images was observed in all malignant lesions and in 2 benign lesions (100% sensitivity, 87% specificity). In the absence of this sign (i.e., isointense or hypointense signal), the lesions were always benign (100% negative predictive value). All the definitive CT diagnoses were correct, while 6 of 17 probable CT diagnoses were incorrect. In the subgroup of lesions misinterpreted with CT, MR signal intensity on long-TR images always allowed the correct differentiation of benign from malignant conditions. To conclude, MR signal intensity is a valuable additional feature to differentiate benign from malignant pleural disease. We suggest the use of MRI in the pleural lesions where the level of confidence of CT diagnosis is low.

Adult↗