Login to your account

Username *
Password *
Remember Me

Blog With Right Sidebar

    Vous êtes ici :  
  1. Accueil
  2. Blog With Right Sidebar

Are Chest Radiographs Routinely Indicated After Chest Tube Removal Following Cardiac Surgery?

OBJECTIVE. The purpose of this prospective study was to determine the incidence and clinical significance of pneumothoraces detected on routine radiography after chest tube removal following cardiac surgery and correlate those findings with an immediate postprocedure assessment of the likelihood of new pneumothorax.

SUBJECTS AND METHODS. Routine portable chest radiographs obtained after chest tube removal in 400 consecutive cardiac surgery patients were assessed by a radiologist to determine the incidence and grade of pneumothoraces and were correlated with the clinical estimation of the likelihood of this complication, and whether the radiographic finding changed medical management or led to surgical intervention.

RESULTS. Of 9.3% of cases (37/400) of new pneumothoraces after chest tube removal, 70.3% were tiny (barely perceptible), 27.0% were small (< 1 cm from the pleural line to the apex of the hemithorax), and 2.7% were medium (6–10 cm from the pleural line to the apex of the hemithorax). The incidences of small and medium pneumothoraces were substantially greater in patients with higher levels of clinical suspicion. All tiny pneumothoraces had no clinical importance. Not obtaining routine chest radiographs after chest tube removal in the 345 patients (86.3%) with the lowest level of clinical suspicion would have resulted in missing six small pneumothoraces (1.7%), none of which led to medical or surgical intervention or a delay in discharge.

CONCLUSION. Chest radiography performed after chest tube removal following cardiac surgery is necessary only if the patient has respiratory or hemodynamic changes or if there are problems with the technical aspect of chest tube removal. Following this guideline in our patient population could have eliminated 86.3% of radiographs without missing any clinically significant pneumothoraces.

The Reversed Halo Sign on High-Resolution CT in Infectious and Noninfectious Pulmonary Diseases

OBJECTIVE. The purpose of this article is to describe diseases that may present with the reversed halo sign on high-resolution CT. We emphasize the tomographic features most frequently associated with this sign and correlate them with histologic findings.

CONCLUSION. A wide spectrum of infectious and noninfectious diseases may present with the reversed halo sign on chest CT. The nonspecific nature of this sign should not cloud an otherwise fairly straightforward diagnosis, especially when associated background findings are typical. Although a rigorous analysis of associated CT findings may help with the differential diagnosis, histologic assessment is often needed for a definitive determination of the cause.

The NETT: Part I- Lessons Learned about Emphysema.

Authors: Criner GJ, Cordova F, Sternberg AL, Martinez FJ NETT was a multicenter prospective randomized controlled trial that compared optimal medical treatment, including pulmonary rehabilitation, to optimal medical treatment plus Lung volume Reduction Surgery (LVRS). It was the largest and most complete collection of patient demographic, clinical, physiologic and radiographic data ever compiled in severe emphysema. NETT investigated the effects of optimal medical management and LVRS on short and long-term survival, as well as lung function, exercise performance and quality of life. NETT also provided much information regarding the evaluation and prognosis of severe emphysema; specifically the important negative influences that hyperinflation and small airways disease have on survival....

Chemotherapy in elderly patients with resected stage II-IIIA lung cancer

As a result of increasing life expectancy, the number of lung cancers in elderly people is rising—most cancers occur in patients over 65 years, with a median age at diagnosis of about 70 years. In... (Source: BMJ Online First)

MedWorm Sponsor Message: Find out how you can get your message posted here and on over 100,000 other medical web pages in just a couple of days, plus support MedWorm at the same time.

Asthma control with extrafine‐particle hydrofluoroalkane–beclometasone vs. large‐particle chlorofluorocarbon–beclometasone: a real‐world observational study

Conclusion and Clinical Relevance During 1 year after initiating or stepping up ICS therapy by pMDI, patients who received EF HFA–BDP were more likely to achieve asthma control than those receiving CFC–BDP. These findings suggest that ICS formulation, particle size, and deposition characteristics play important roles in real‐life effectiveness of asthma therapy. This study shows that an EF‐particle formulation of beclometasone can be used at half the dose of the large‐particle formulation with at least as good clinical outcomes. (Source: Clinical and Experimental Allergy)

Search

Search