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Chest wall block

Joseph M Besho, Akiko Tanaka, Hazim J Safi, Anthony L Estrera
Pseudoaneurysms of the descending aorta after open graft replacement usually occur in patients with connective tissue disorders and form at anastomotic or cannulation sites. We present a case of an iatrogenic pseudoaneurysm in the descending thoracic aortic graft body caused by intercostal nerve block. The patient had undergone repair for thoracoabdominal aortic aneurysm four years prior and underwent a series of intercostal nerve blocks after experiencing persistent post-thoracotomy pain. A pseudoaneurysm in the descending thoracic graft, contiguous with the chest wall was encountered...
March 11, 2019: Annals of Thoracic Surgery
Naveen Raj
Systemic opioids have been the main stay for the management of perioperative pain in children undergoing cardiac surgery with sternotomy. The location, distribution and duration of pain in these children has not been studied as extensively as in adults. Currently there is no consensus to the dose of opioids required to provide optimum analgesia and attenuate the stress response whilst minimising their unwanted side effects. At present there is a tendency to use lower dose aiming for early extubation and minimise opioid related side effects, but this may not obtund the stress response in all children...
March 12, 2019: Paediatric Anaesthesia
Zicheng Wang, Yanwei Wang, Haiyan Lin, Shengjie Wang, Xianlei Cai, Da Gao
BACKGROUND: Fulminant myocarditis (FM) is a sub-category myocarditis. Its primary characteristic is a rapidly progressive clinical course that necessitates hemodynamic support. FM can be difficult to predict at the onset of myocarditis. The aim of this meta-analysis was to identify the early characteristics in FM compared to those of non-fulminant myocarditis (NFM). METHODS: We searched the databases of MEDLINE, EMBASE, CENTRAL, for studies comparing FM with acute NFM from January 1, 2000 to June 1, 2018...
February 2019: Medicine (Baltimore)
Jeff L Xu, Jorge Con, Jian Hou, Shalvi B Parikh, Joshua M Junge, Bernd Dotzauer
No abstract text is available yet for this article.
January 1, 2019: American Surgeon
Jeff L Xu, Jorge Con, Jian Hou, Shalvi B Parikh, Joshua M Junge, Bernd Dotzauer
No abstract text is available yet for this article.
January 1, 2019: American Surgeon
Ender Sir, Sami Eksert, M Emin Ince, Fatih Simsek, Gokhan Ozkan, M Burak Eskin
Serratus anterior plane block has been used for pain management during the acute period of conditions affecting the thorax, such as post-thoracotomy recovery, rib fracture, and breast surgery recovery. Here, we report the use of serratus anterior plane block in post-traumatic chronic pain treatment. We describe a case of post-traumatic chronic intercostal neuralgia, in which successful pain relief was achieved via repeated injections of local anesthetic and steroid combinations in the serratus anterior plane under ultrasonographic guidance...
December 28, 2018: American Journal of Physical Medicine & Rehabilitation
Edgardo D'Angelo, Edoardo Calderini, Mario Tavola, Matteo Pecchiari
In 9 anesthetized, paralyzed dogs lung and chest-wall standard (viscous resistance, Rint, and quasi-static elastance, Est) and viscoelastic parameters (resistance, Rvel, and time constant, τvel) were measured in the supine posture before and after rib-cage block, after application of an expiratory threshold load, and after 75° head-up tilting before and after wide chest opening. Lung and chest-wall τvel were the same under all conditions. Rvel was independent of volume and posture, and greater for the lung...
December 13, 2018: Respiratory Physiology & Neurobiology
Mauricio Baca, Mark Newberry
BACKGROUND: Cardiac amyloidosis is an underdiagnosed cause of restrictive cardiomyopathy resulting from the infiltration of the myocardium by amyloid proteins. CASE REPORT: We report the case of an 83-year-old woman who presented with increasing dyspnea and lower-extremity swelling. She reported a medical history of unspecified heart failure. Evaluation in the Emergency Department (ED) revealed evidence of heart failure on physical examination, low-voltage electrocardiogram, chest x-ray study with mild pulmonary edema, and laboratory evaluation with elevated brain natriuretic peptide and troponin...
February 2019: Journal of Emergency Medicine
Johanna Blair de Haan, Nadia Hernandez, Sudipta Sen
Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the terminal hair follicle of the apocrine gland-bearing skin, presenting with inflamed nodules, abscesses, and sinus tracts. Autoimmune, genetic, and infectious factors have been implicated in its pathogenesis. HS can be managed medically using topical and systemic antibiotics and with tumor necrosis factor antibody therapy in severe cases. Surgical treatment can range from local excision, deroofing or excision of sinus tracts, or wide radical excision of severe lesions...
2018: Local and Regional Anesthesia
Stella Leng, Kejd Bici, Flavio Facchini, Yary Volpe, Francesca Uccheddu, Rocco Furferi, Lapo Governi, Monica Carfagni, Marco Ghionzoli, Antonio Messineo
PURPOSE: Pectus arcuatum is an anterior chest wall deformity that requires transverse wedge sternotomy. Determining and delivering the correct cutting angle is crucial for successful correction. We present the early clinical experience with a novel cutting template technology able to deliver the optimal cutting angle. DESCRIPTION: From patients' computer tomography scans, the optimal cutting angle is obtained through computer aided design (CAD). A template comprising of slots tilted at the right cutting angle and safety block to avoid damaging the posterior periosteum is printed through additive manufacturing...
November 30, 2018: Annals of Thoracic Surgery
Sigei Asha, Elshenawy Yasmin, Janet F Stastny
Skeletal muscle metastasis from breast carcinoma is a relatively rare clinical entity. We report two cases of breast cancer metastatic to the skeletal muscle, diagnosed by ultrasound guided fine needle aspiration (US-FNA) biopsy done by interventional cytopathologists at an outpatient cytopathology center. Our two patients presented with lower anterior neck firmness and chest wall mass, respectively. Ultrasound evaluation of our first case demonstrated hypo-echoic thickened anterior strap muscles while in the second case there was significant distortion of the anatomy from previous surgeries...
November 23, 2018: Diagnostic Cytopathology
Galina Velikova, Linda Jane Williams, Sarah Willis, J Michael Dixon, Juliette Loncaster, Matthew Hatton, Jacqueline Clarke, Ian H Kunkler, Nicola S Russell
BACKGROUND: Postmastectomy radiotherapy in patients with four or more positive axillary nodes reduces breast cancer mortality, but its role in patients with one to three involved nodes is controversial. We assessed the effects of postmastectomy radiotherapy on quality of life (QOL) in women with intermediate-risk breast cancer. METHODS: SUPREMO is an open-label, international, parallel-group, randomised, controlled trial. Women aged 18 years or older with intermediate-risk breast cancer (defined as pT1-2N1; pT3N0; or pT2N0 if also grade III or with lymphovascular invasion) who had undergone mastectomy and, if node positive, axillary surgery, were randomly assigned (1:1) to receive chest wall radiotherapy (50 Gy in 25 fractions or a radiobiologically equivalent dose of 45 Gy in 20 fractions or 40 Gy in 15 fractions) or no radiotherapy...
October 15, 2018: Lancet Oncology
Mohamad Soud, Abdulah Alrifai, Amjad Kabach, Zaher Fanari, M Chadi Alraies
Background: Electrical disturbances following blunt cardiac injuries are rare but can be caused by electrical or structural damage to the heart. We present the case of a patient who had conduction abnormalities following blunt traumatic injury that were incidentally detected on telemetry. Case Report: A 64-year-old female with no history of cardiac disease was brought to the emergency department after a motor vehicle collision that resulted in chest wall bruising...
2018: Ochsner Journal
Hyo Jeong Lee, Hong Souk Park, Hyun Im Moon, Seo Yeon Yoon
OBJECTIVES: To compare the efficacy of a conventional fluoroscopy-guided epidural nerve block and an ultrasound (US)-guided intercostal nerve block in patients with thoracic herpes zoster (HZ). METHODS: This work was a comparative study of 38 patients with thoracic HZ pain and a chest wall herpetic eruption, aged 18 years or older, with pain intensity of 5 or greater on a numeric rating scale (NRS) for less than a 1-month duration. Patients were consecutively enrolled and assigned to 2 groups in which the intervention was either the US-guided intercostal nerve block or the fluoroscopy-guided epidural nerve block approach with the addition of a 5-mL mix of 2...
September 23, 2018: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Miriam Patella, Andrea Saporito, Francesco Mongelli, Ramon Pini, Rolf Inderbitzi, Stefano Cafarotti
Background: Residual pleural space after lung resection associated with air leak is a challenging issue, potentially causing serious complications. We report a new, postoperative technique to reduce the pleural space, inducing a controlled and reversible paralysis of the diaphragm. Methods: Ten patients were enrolled (7 lobectomies, 2 bilobectomy, 1 wedge resection). Inclusion criteria were: digitally detected air flow >200 mL/min at post-op day 3, presence of empty pleural space at chest x-ray, absence of restrictive lung disease, absence of known arrhythmias...
August 2018: Journal of Thoracic Disease
Kareem Genena, Mir Ali, Donald Christmas, Henry Siu
While acute coronary syndromes most commonly occur secondary to unstable atherosclerotic plaque, coronary aneurysms, also known as coronary artery ectasia (CAE), represent a less common etiology. Whereas coronary atherosclerosis accounts for about 50% of CAE, the remaining 50% are either congenital or secondary to a host of inflammatory and connective tissue disorders, with Kawasaki disease being a well-known association. Patients with CAE have worse outcomes than the general population regardless of the presence of associated atherosclerotic coronary artery disease...
2018: Case Reports in Cardiology
Guang-Jie Hou, Yi He, Pu Zhao
A 70-year-old male patient with chest pain and high fever was diagnosed as lung squamous carcinoma T4N0M0 in the left upper lobe complicated with intratumoral lung abscess. With no improvement resulted from antibiotic treatment for 4 days, to control his infection and resect his large tumor, he received video-assisted thoracoscopic surgery (VATS) left upper lung lobe resection and broncho-and angioplasty. Two-port technique was employed and the utility port was 10 cm long because the tumor's diameter (max) was 12 cm...
July 2018: Journal of Thoracic Disease
Hesham Elsharkawy, Robert Maniker, Robert Bolash, Prathima Kalasbail, Richard L Drake, Nabil Elkassabany
BACKGROUND AND OBJECTIVES: Fascial plane blocks are rapidly emerging to provide safe, feasible alternatives to epidural analgesia for thoracic and abdominal pain. We define a new option for chest wall and upper abdominal analgesia, termed the rhomboid intercostal and subserratus plane (RISS) block. The RISS tissue plane extends deep to the erector spinae muscle medially and deep to the serratus anterior muscle laterally. We describe a 2-part proof-of-concept study to validate the RISS block, including a cadaveric study to evaluate injectate spread and a retrospective case series to assess dermatomal coverage and analgesic efficacy...
October 2018: Regional Anesthesia and Pain Medicine
Kevin L Chow, Philip J Alexander, James P Sur, Ellen C Omi
INTRODUCTION: Blunt cardiac trauma covers a spectrum of injuries from clinically insignificant myocardial contusions to lethal ruptures of cardiac valves and chambers. Traumatic coronary artery-cameral fistulas (TCAF) are a rare sequelae of blunt chest trauma. CASE PRESENTATION: A 53-year-old male developed a TCAF after a motor vehicle collision. He was found on admission to be in cardiogenic shock with an elevated troponin and intermittent bifascicular block. An echocardiogram revealed hypokinesis of the mid-anteroseptal myocardium with an ejection fraction of 50%...
2018: International Journal of Surgery Case Reports
Lena F Carstensen, Morten Jenstrup, Jørgen Lund, Jørgen Tranum-Jensen
BACKGROUND AND OBJECTIVES: The popularization of ultrasound-guided nerve blocks in cosmetic and reconstructive breast surgery calls for better anatomical understanding of chest wall innervation. When inserting subpectoral implants, pain from pocket dissection, stretching of muscle, and release of costal attachments may be relieved by blocking the pectoral nerves in the interpectoral (IP) space.We describe the variable anatomy of the pectoral nerves in the IP space in order to define the area to be covered for sufficient blockade, based on cadaver dissections...
November 2018: Regional Anesthesia and Pain Medicine
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