SEARCH · Search PubMed
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Forty-five patients with restrictive respiratory diseases, including thoracic wall diseases (TWD, n = 27) and neuromuscular diseases (NMD, n = 18), underwent 18 months of home mechanical ventilation (HMV) treatment. Treatment consisted of a two-level pressure system for 7h at night, with oxygen available if needed. Questionnaire-based assessments of health-related quality-of-life (HRQL) were evaluated before treatment and at 3, 6, 9, 12 and 18 months of follow-up. Hospitalization rates pre- and post-treatment were recorded, and the numbers need to treat (NNT) to avoid hospitalization and absolute risk reduction (ARR) rates were calculated. Several categories of HRQL, including physical function and vitality, improved significantly with treatment in both groups of patients; these improvements persisted over the entire 18 months. In contrast, other categories such as social function and mental health improved initially and declined subsequently. Hospitalizations decreased significantly with treatment. NNT calculations indicated that treatment would be needed for two TWD patients (ARR 63%) and one NMD patient (ARR 78%) to prevent one hospitalization per year per disease group. We conclude that improved quality-of-life and decreased hospitalizations make home non-invasive mechanical ventilation an useful treatment for patients with restrictive respiratory disorders.
PURPOSE: To retrospectively assess the indication for thoracic real-time MRI, demonstrate typical findings, analyze the diagnostic potential in subgroups with suspected pulmonary embolism (PE) and aortic dissection (AD), and describe the influence of real-time MRI on the role of MRI in acute thoracic diseases. MATERIALS AND METHODS: From July 2001 to February 2005, real-time MRI was applied in 2,256 examinations in 1,714 patients. MRI was the primary diagnostic modality for these thoracic diseases as computed tomography has been available only since 2003. Characteristics of the TrueFISP sequence applied were: TR/TE/flip angle 3.1 ms/1.6 ms/59 degrees , respectively. FOV 340 - 360 mm, matrix size 156 to 192 x 256 pixels, slice thickness 3 to 4 mm, slices overlapped by 50 %. Acquisition time was 0.4 to 0.5 s per image. Three hundred and twenty transverse, coronal and sagittal images were acquired in three minutes. No breath holding, and only minimal patient cooperation, was required. Turbo-spin-echo sequences as well as ECG-gated and contrast-enhanced sequences were added depending on the indication. RESULTS: Most common indications were: acute thoracic nonspecified disease (n = 276, 12.24 %), PE (n = 573, 25.4 %), bleeding (n = 154, 6.8 %), AD (n = 222, 9.8 %), topographic information in complex findings (n = 654, 29.0 %). Real-time MRI was the sole MRI technique applied in 180 examinations (8.0 %), ECG-gated real-time MRI was applied in 87 examinations and breath hold was used in 107 examinations. PE was diagnosed in 181 examinations; reference techniques (MRI, computed tomography, single photon emission computed tomography) confirmed 170 of these and detected 19 more cases (sensitivity 90.0 %, specificity 97.1 %). Real-time MRI detected 141 suspected AD and 53 more nonsuspected AD. Of these, 191 were confirmed by other MRI techniques, surgery or clinical course (98.5 %). Real-time MRI coincidentally detected 56 pulmonary tumors, all were confirmed with computed tomography. Thus, especially vascular diseases could be easily assessed with real-time MRI, while computed tomography had advantages in the evaluation of the lung parenchyma. CONCLUSION: Real-time MRI both enables emergency MRI examinations for thoracic diseases in clinical patients in unstable condition and allows an explorative style of working in patients with nondefined acute thoracic diseases.
Explore the source record for details and available documents.
A simple, single-stage, quasi-tomographic technique which is employable with ordinary C-arm fluoroscopes is presented as an alternative to small field chest tomography. Fluoroscopic axialography utilizes image intensifier filming during axial rotation to obtain sharp tomogram-like images of areas of interest. The technique incorporates preliminary fluoroscopic localization and has many applications in the chest. The use of axial rather than planar blurring and intensifier camera filming rather than radiography does not reduce the clinical usefulness of the method.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
In patients with purulent disease of thoracic cavity the discrete plasmapheresis and infusion-transfusional therapy, using perftoran emulsion, were applied in complex of treatment. The efficacy of application of oxygentransporting blood substitutes, based on perfluorohydrocarbons, for the plasmexfusion and in the treatment of respiratory hypoxia in patients was established.
Explore the source record for details and available documents.
The technical details of producing an NMR image are briefly explained, followed by a discussion of what relaxation times mean and how tissue properties affect the NMR image. The rest of the article is devoted to the NMR imaging of the thorax.
Most patients who have end stage thoracic disease have moderate to severe dyspnea. The dyspnea may be the result of the underlying lung disease, localized disease progression, or the accumulation of fluid within the chest. The most effectively treated clinical problem at the end of life is secondary fluid accumulation in the pleural space or pericardial sac. Focused surgical intervention can play an important role in treating effusive disease of the pleura and pericardium. Minimally invasive surgical interventions, such as the use of video thoracoscopy, can relieve dyspnea effectively and improve the quality of life for patients who have end stage thoracic disease.
Explore the source record for details and available documents.
OBJECTIVE: Mediastinoscopy is a common procedure used for the diagnosis of thoracic disease and the staging of lung cancer. We sought to determine the current role of mediastinoscopy in the evaluation of thoracic disease. METHODS: We conducted a retrospective review of all mediastinoscopies performed by members of our service between January 1988 and September 1998. RESULTS: We performed mediastinoscopies on 2137 patients. A total of 1745 patients underwent mediastinoscopy for known or suspected lung cancer. In 422 of these procedures, N2 or N3 disease was identified; only 28 of these patients underwent resection. The remaining 1323 had no evidence of metastatic disease. In these patients 947 had lung cancer. Only 76 of the patients with lung cancer were found to have N2 disease at exploration. Among the 1323 patients with a negative mediastinoscopy result, 52 underwent resection of a nonbronchogenic malignancy, and 217 had resection of a benign lesion. A total of 392 patients underwent mediastinoscopy for the evaluation of mediastinal adenopathy in the absence of any identifiable pulmonary lesion. Of these, 161 had a nonbronchogenic malignancy, 209 had benign disease, and 25 had no diagnosis established; mediastinoscopy established a definitive diagnosis in 93.6% of patients. In the entire group of 2137 patients, there were 4 perioperative deaths and 12 complications. Only one death was directly attributed to mediastinoscopy. No deaths or complications occurred in patients undergoing mediastinoscopy for benign disease. CONCLUSIONS: Mediastinoscopy is a highly effective and safe procedure. We believe that mediastinoscopy should currently be used routinely in the diagnosis and staging of thoracic diseases.
Most all the thoracic structures are visible with magnetic resonance imaging: the mediastin, the myocardium including the endocardium and the pericardium, the pulmonary parenchyma and hile and the pleural walls. In cases of mediastrinal masses, T1 images clearly delimit their relations with neighbouring organs and vessels. The intensity of the signal is compared with that of the muscles on T1 weighted images of the preceding sections and T2 weighted images of fat. Images of aneurysms and chronic dissections can be synchronized with the ECG allowing three-dimensional measurement of the size and thickness of the vessel walls. Thrombi or extension to other vessels can also be recognized. Small hilar tumours can be differentiated from vessels but the scanner is better for analyzing systematization and bronchial lesions. For lung tissue itself, magnetic resonance imaging can detect nodules greater than one centimeter in diameter, but the low proton density and respiratory movements hinder spatial resolution. MRI is indicated for localizing tumours situated anteriorly or posteriorly or at the apex and to identify parietal extension of peripheral cancers. Spinal, vascular, pericardial, diaphragmatic and lymph node metastases can be recognized. MRI is the noninvasive method of choice for evaluating left ventricular masse, intra and paracardiac mass studies and for investigating congenital and acquired cardiomyopathies. Technical advances have made it possible to evaluate myocardial perfusion and heart function.
Thoracic disease in the HIV negative immunocompromised host is most frequently caused by infection. Patterns of involvement produced on the chest radiograph include (1) lobar or segmental consolidation, (2) nodules with rapid growth and/or cavitation, and (3) diffuse lung disease. The lung also may be directly involved by lymphoma, metastases, drug reactions, radiation pneumonitis, or nonspecific interstitial pneumonitis. The lung is a frequent target organ for opportunistic infections in AIDS patients, particularly of Pneumocystis carinii pneumonia and tuberculosis. Computed tomography may be particularly helpful in these patients in the detection of early disease and in the characterization of patterns and extent of involvement as well as complications.
BACKGROUND: The use of nasal intermittent positive pressure ventilation (NIPPV) would be expected to ameliorate dyspnea, ventilatory capacity and exercise tolerance durability in individuals with hypercapnic respiratory failure secondary to restrictive thoracic disease. OBJECTIVES: The purpose of this study was to determine the short-term effect of NIPPV on respiratory muscle endurance, exercise capacity and respiratory functions in patients with chronic respiratory failure due to restrictive thoracic disease. METHODS: Twelve patients with chronic ventilatory failure due to restrictive thoracic disease underwent nasal bilevel positive airway pressure (BiPAP) ventilation for 2 h a day during 15 consecutive days. The effects were assessed by spirometry, arterial blood gas analysis, 6-min walking test, sensation of dyspnea according to the American Thoracic Society dyspnea scoring scales (ATS) and surface electromyogram of the diaphragm (EMGdi) before and after the study (on day 15). RESULTS: Nasal BiPAP reduced the ATS dyspnea score from 2.5 +/- 0.9 to 1.6 +/- 0.4 (p < 0.01). Distances walked in 6 min increased from 320.66 +/- 93.56 to 382.41 +/- 121.20 m (p < 0.05). Comparison of baseline with levels after nasal BiPAP ventilation showed a statistically significant improvement in PaCO(2) (p < 0.05). Forced vital capacity increased from 35 to 50% of the predicted value (p < 0.01). There were no statistically significant reductions in the amplitude of EMGdi after the therapy. CONCLUSION: These results indicate that NIPPV delivered via nasal BiPAP improves respiratory functions, exercise capacity, and reduces dyspnea in the short term in patients with chronic respiratory failure due to restrictive thoracic disease. Whether such short-term improvements can be sustained merits further study.
We developed a coding system for respiratory diseases and related conditions for computer-aided analyses of these diseases. It is a one-axis alphanumeric system with a list of three-character categories and additional digits separated by a decimal point for subcategories. Respiratory and related diseases are categorized into eight groups; diseases of (1) the lung and airway, (2) the pleura, (3) the mediastinum, (4) the diaphragm, (5) the chest wall, (6) the heart and cardiovascular system, (7) the esophagus, and (8) clinical conditions predisposing to pulmonary disease. The first character, a letter from the A to G, represents a major disease category of (1) to (7) and X that of (8); and subdivisions are shown in the second position using the numbers from 0 to 9. Further subdivisions are provided in the third position also using numbers. Actual coding was done on case reports which appeared in the Japanese Journal of Thoracic Diseases from 1973 to 1993, and all cases were coded properly. The system is expected to prove useful in computer aided analyses of respiratory diseases.