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Journal articles on the topic 'Diaphragm fluoroscopy'
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1
Singh, Bhajan, Janine A. Panizza, and Kevin E. Finucane. "Breath-by-breath measurement of the volume displaced by diaphragm motion." Journal of Applied Physiology 94, no. 3 (March 1, 2003): 1084–91. http://dx.doi.org/10.1152/japplphysiol.00256.2002.
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To develop an accurate method to measure the volume displaced by diaphragm motion (ΔVdi) breath by breath, we compared ΔVdi measured by a previously evaluated biplanar radiographic method (Singh B, Eastwood PR, and Finucane KE. J Appl Physiol 91: 1913–1923, 2001) at several lung volumes during vital capacity inspirations in 10 healthy and nine hyperinflated subjects with 1) ΔVdi measured from the same chest X-rays by two previously described uniplanar methods (Petroll WM, Knight H, and Rochester DF. J Appl Physiol 69: 2175–2182, 1990; Verschakelen JA, Deschepper K, and Demendts M. J Appl Physiol 72: 1536–1540, 1992) and a proposed method that considered actual cross-sectional shape of the rib cage and spinal volume (ΔVdiS); and 2) ΔVdiS measured by lateral fluoroscopy in the same 10 healthy subjects. Relative to biplanar ΔVdi, ΔVdiS values from lateral chest X-rays and fluoroscopy were not different, whereas ΔVdi values of Petroll et al. and Verschakelen et al. were increased by (means ± SD) 1.98 ± 1.59 and 1.16 ± 0.82 liters, respectively (both P< 0.001). During quiet breathing, ΔVdiS by lateral fluoroscopy was 66 ± 16% of tidal volume and similar to that between functional residual capacity and one-half inspiratory capacity by the biplanar radiographic method. We conclude that accurate breath-by-breath measurements of ΔVdi can be made by using lateral fluoroscopy.
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Verschakelen, J. A., K. Deschepper, T. X. Jiang, and M. Demedts. "Diaphragmatic displacement measured by fluoroscopy and derived by Respitrace." Journal of Applied Physiology 67, no. 2 (August 1, 1989): 694–98. http://dx.doi.org/10.1152/jappl.1989.67.2.694.
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In eight healthy volunteers we simultaneously measured the axial diaphragmatic motion by fluoroscopy and the cross-sectional area changes of the rib cage (RC) and abdomen (ABD) by Respitrace (RIP) during semistatic vital capacities (VC). We found that, if the fluoroscopic axial displacement of the posterior part of the diaphragm between residual volume (RV) and total lung capacity (TLC) is considered equal to 100%, the movement of the middle part is 90%, whereas that of the anterior part is only approximately 60%; the ratio of the axial displacements to mouth volume, furthermore, decreases at high lung volumes, especially for the anterior part. The RIP signal is nearly linearly related to mouth volume, but the contribution of the RC (delta RC) progressively increases (and is approximately 80% RIP at TLC), whereas the volume contribution of the ABD (delta ABD) levels off (to 20% RIP at TLC). The diaphragmatic volume displacement calculated from the theoretical analysis described by Mead and Loring also levels off at high volumes similarly as the ABD but is approximately 50% RIP at TLC. Finally, the axial movements of the three parts of the diaphragm are linearly related to the RC and ABD cross-sectional-area changes (r 0.91–0.97) and are even significantly better correlated with the “calculated” diaphragmatic volume displacement.
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Greybeck, Brad J., Matthew Wettergreen, Rolf D. Hubmayr, and Aladin M. Boriek. "Diaphragm curvature modulates the relationship between muscle shortening and volume displacement." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 301, no. 1 (July 2011): R76—R82. http://dx.doi.org/10.1152/ajpregu.00673.2010.
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During physiological spontaneous breathing maneuvers, the diaphragm displaces volume while maintaining curvature. However, with maximal diaphragm activation, curvature decreases sharply. We tested the hypotheses that the relationship between diaphragm muscle shortening and volume displacement (VD) is nonlinear and that curvature is a determinant of such a relationship. Radiopaque markers were surgically placed on three neighboring muscle fibers in the midcostal region of the diaphragm in six dogs. The three-dimensional locations were determined using biplanar fluoroscopy and diaphragm VD, curvature, and muscle shortening were computed in the prone and supine postures during spontaneous breathing (SB), spontaneous inspiration efforts after airway occlusion at lung volumes ranging from functional residual capacity (FRC) to total lung capacity, and during bilateral maximal phrenic nerve stimulation at those same lung volumes. In supine dogs, diaphragm VD was approximately two- to three-fold greater during maximal phrenic nerve stimulation than during SB. The contribution of muscle shortening to VD nonlinearly increases with level of diaphragm activation independent of posture. During submaximal diaphragm activation, the contribution is essentially linear due to constancy of diaphragm curvature in both the prone and supine posture. However, the sudden loss of curvature during maximal bilateral phrenic nerve stimulation at muscle shortening values greater than 40% (ΔL/LFRC) causes a nonlinear increase in the contribution of muscle shortening to diaphragm VD, which is concomitant with a nonlinear change in diaphragm curvature. We conclude that the nonlinear relationship between diaphragm muscle shortening and its VD is, in part, due to a loss of its curvature at extreme muscle shortening.
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Greybeck, Brooke, Raymond Lu, Arvind Ramanujam, Mary Adeyeye, Matthew Wettergreen, Shari Wynd, and Aladin M. Boriek. "Regional diaphragm volume displacement is heterogeneous in dogs." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 312, no. 3 (March 1, 2017): R443—R450. http://dx.doi.org/10.1152/ajpregu.00270.2016.
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Muscle shortening and volume displacement (VD) are critical determinants of the pressure-generating capacity of the diaphragm. The present study was designed to test the hypothesis that diaphragm VD is heterogeneous and that distribution of VD is dependent on regional muscle shortening, posture, and the level of muscle activation. Radioopaque markers were sutured along muscle bundles of the peritoneal surface of the crural, dorsal costal, midcostal, and ventral costal regions of the left hemidiaphragm in four dogs. The markers were followed by biplanar video fluoroscopy during quiet spontaneous breathing, passive inflation to total lung capacity (TLC), and inspiratory efforts against an occluded airway at three lung volumes spanning the vital capacity [functional residual capacity, functional residual capacity + ½ inspiratory capacity, and TLC in both the prone and supine postures]. Our data show the ventral costal diaphragm had the largest VD and contributed nearly two times to the total diaphragm VD compared with the dorsal costal portion. In addition, the ventral costal diaphragm contributed nearly half of the total VD in the prone position, whereas it only contributed a quarter of the total VD in the supine postition. During efforts against an occluded airway and during passive inflation to TLC in the supine position, the crural diaphragm displaced volume equivalent to that of the midcostal portion. Regional muscle shortening closely matched regional VD. We conclude that the primary force generator of the diaphragm is primarily dominated by the contribution of the ventral costal region to its VD.
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Boriek, A. M., T. A. Wilson, and J. R. Rodarte. "Displacements and strains in the costal diaphragm of the dog." Journal of Applied Physiology 76, no. 1 (January 1, 1994): 223–29. http://dx.doi.org/10.1152/jappl.1994.76.1.223.
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Radiopaque markers were attached at 1- to 2-cm intervals along three nearby muscle bundles to cover rectangular regions of the mid-costal diaphragms of seven dogs. The markers were tracked by biplane video fluoroscopy during spontaneous breathing (SB), mechanical ventilation with the same tidal volume (MV), and at inflation to total lung capacity (TLC) in the prone and supine positions. The three-dimensional positions of the markers at functional residual capacity (FRC), at end inspiration during SB and MV, and at TLC were determined, and the strains in the plane of the diaphragm relative to FRC were calculated. The principal strains were found to lie nearly along the muscle bundle direction and perpendicular to it. The principal strains along the muscle bundles, which describe muscle shortening, were uniform among the three bundles and uniform along the bundle for MV. For SB, in the prone and supine positions, shortening was approximately 30% greater in the middle of the bundle than near the central tendon and chest wall. Although the tidal volumes were the same for SB and MV, the shortening was larger for SB. The strains perpendicular to the bundle direction were not significantly different from zero. It appears that, for the loads that occur during tidal breathing, the diaphragm is inextensible in the direction perpendicular to the muscle direction. There is a very small displacement of the costal diaphragm at its insertion on the chest wall. The displacement at the central tendon is primarily a result of muscle shortening and rotation of the arc of the muscle around its insertion on the chest wall.
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Chu, Iris, Cristina Fernandez, Kathleen Allen Rodowicz, Michael A. Lopez, Raymond Lu, Rolf D. Hubmayr, and Aladin M. Boriek. "Diaphragm muscle shortening modulates kinematics of lower rib cage in dogs." American Journal of Physiology-Regulatory, Integrative and Comparative Physiology 299, no. 6 (December 2010): R1456—R1462. http://dx.doi.org/10.1152/ajpregu.00016.2010.
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We tested the hypothesis that diaphragm muscle shortening modulates volume displacement and kinematics of the lower rib cage in dogs and that posture and mode of ventilation affect such modulation. Radiopaque markers were surgically attached to the lower three ribs of the rib cage and to the midcostal region of the diaphragm in six dogs of ∼8 kg body masses, and the locations of these markers were determined by a biplane fluoroscopy system. Three-dimensional software modeling techniques were used to compute volume displacement and surface area of the midcostal diaphragm and the lower three ribs during quiet spontaneous breathing, mechanical ventilation, and bilateral phrenic nerve stimulation at different lung volumes spanning the vital capacity. Volume displaced by the diaphragm relative to that displaced by the lower ribs is disproportionately greater under mechanical ventilation than during spontaneous breathing in the supine position ( P < 0.05). At maximal stimulation, diaphragm volume displacement grows disproportionately larger than rib volume displacement as lung volume increases ( P < 0.05). Surface area of both the diaphragm and the lower ribs during maximal stimulation of the diaphragm is reduced compared with that at spontaneous breathing ( P < 0.05). In the prone posture, mechanical ventilation results in a smaller change in diaphragm surface area than spontaneous breathing ( P < 0.05). Our data demonstrate that during inspiration the lower rib cage moves not only through the pump- and bucket-handle motion, but also rotates around the spine. Taken together, these data support the observation that the kinematics of the lower rib cage and its mechanical interaction with the diaphragm are more complex than previously known.
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Hubmayr, R. D., J. Sprung, and S. Nelson. "Determinants of transdiaphragmatic pressure in dogs." Journal of Applied Physiology 69, no. 6 (December 1, 1990): 2050–56. http://dx.doi.org/10.1152/jappl.1990.69.6.2050.
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We measured the transdiaphragmatic pressure (Pdi) during bilateral phrenic nerve stimulation and evaluated the determinants of its change with lung volume, chest wall geometry, and respiratory system impedance in supine dogs. Four rows of radiopaque markers were sewn onto muscle bundles of the costal and crural diaphragm between their origin on the central tendon and their insertion on the rib cage and spine. The length of the diaphragm (L) was determined from the projection images of marker rows using biplane fluoroscopy. Measurements were made at lung volumes between total lung capacity and functional residual capacity before and after the infusion of Ringer lactate solution into the abdominal cavity. In contrast to relaxation, during tetanic stimulation the active lengths of the muscle bundles were similar at all volumes, but the diaphragm assumed different shapes. Although the small differences in active muscle length with volume and liquid loads are consistent with only small changes in muscle force output, Pdi varied by a factor of greater than or equal to 5. There was no single L/Pdi curve that fitted all data during 50-Hz stimulations. We conclude that under these experimental conditions Pdi is not a unique measure of the force produced by the diaphragm and that lung volume, chest wall geometry, and respiratory system impedance are important determinants of the mechanical efficiency of the diaphragm as a pressure generator.
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Bödeker, Hans, Steffen Leinung, Henning Wittenburg, Julia Fischer, Ingolf Schiefke, and Niels Teich. "The Hole in the Stomach." Diagnostic and Therapeutic Endoscopy 2008 (November 15, 2008): 1–2. http://dx.doi.org/10.1155/2008/257185.
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A 57 year old woman was presented to the emergency department with upper abdominal pain and left sided chest discomfort. No cardiac or pulmonary cause could be determined and the patient underwent upper gastrointestinal endoscopy. Inversion of the scope to the fundus and subsequent fluoroscopy revealed a diaphragmatic hernia with a large herniation of the gastric fundus. Immediate laparotomy showed a 3 cm orifice of the diaphragm. The orifice was widened and a partial necrosis of the incarcerated fundus was resected. The patient recovered fully and was discharged 12 days after laparotomy.
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Verschakelen, J. A., K. Deschepper, and M. Demedts. "Relationship between axial motion and volume displacement of the diaphragm during VC maneuvers." Journal of Applied Physiology 72, no. 4 (April 1, 1992): 1536–40. http://dx.doi.org/10.1152/jappl.1992.72.4.1536.
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During semistatic inspiratory and expiratory vital capacity (VC) maneuvers, axial motion of the diaphragm was measured by lateral fluoroscopy and was compared with diaphragmatic volume displacement. Axial motion was measured at the anterior, middle, and posterior parts of the diaphragm, and the mean of these measurements was used. The volume displacement was calculated in two ways: first, from respiratory inductive plethysmograph-(Respitrace) derived cross-sectional area changes of rib cage and abdomen (Vdi,RIP) by means of a theoretical analysis described by Mead and Loring (J. Appl. Physiol. 53: 750–755, 1982) and, second, from fluoroscopically measured changes in position and anteroposterior surface of the diaphragm (Vdi,F). A very good linear relationship was found between Vdi,RIP and Vdi,F during inspiration as well as expiration (r greater than 0.95), indicating that the analysis of Mead and Loring was valid in the conditions of the present study. The diaphragmatic volume displacement (active or passive) accounted for 50–60% of VC. A very good linear relationship was also found between mean axial motion and volume displacement of the diaphragm measured with both methods during inspiration and expiration (r greater than 0.98). Our data suggest that, over the VC range, diaphragmatic displacement functionally can be represented by a pistonlike model, although topographically and anatomically it does not behave as a piston.
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Kleinman, Bruce S., Kerry Frey, Mark VanDrunen, Taqdees Sheikh, Donald DiPinto, Robert Mason, and Theodore Smith. "Motion of the Diaphragm in Patients with Chronic Obstructive Pulmonary Disease while Spontaneously Breathing versus during Positive Pressure Breathing after Anesthesia and Meeting Abstracts." Anesthesiology 97, no. 2 (August 1, 2002): 298–305. http://dx.doi.org/10.1097/00000542-200208000-00003.
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Background Diaphragmatic excursion during spontaneous ventilation (SV) in normal supine volunteers is greatest in the dependent regions (bottom). During positive pressure ventilation (PPV) after anesthesia and neuromuscular blockade and depending on tidal volume, the nondependent region (top) undergoes the greatest excursion, or the diaphragm moves uniformly. The purpose of this study was to compare diaphragmatic excursion (during SV and PPV) in patients with chronic obstructive pulmonary disease (COPD) with patients having normal pulmonary function. Methods Twelve COPD patients and 12 normal control subjects were compared. Cross-table diaphragmatic fluoroscopy was performed while patients breathed spontaneously. After anesthetic induction and pharmacologic paralysis and during PPV, diaphragmatic fluoroscopy was repeated. For analytic purposes, the diaphragm was divided into three segments: top, middle, and bottom. Percentage of excursion of each segment during SV and PPV in normal subjects was compared with the percentage of excursion of each segment in patients with COPD. Results There was no significant difference in the pattern of regional diaphragmatic excursion (as a percentage of total excursion)-top, middle, bottom-when comparing COPD patients with control subjects during SV and PPV. In the control subjects, regional diaphragmatic excursion was 16 +/- (5), 33 +/- (5), 51 +/- (4) during SV and 49 +/- (13), 32 +/- (6), 19 +/- (9) during PPV. In COPD patients, regional diaphragmatic excursion was 18 +/- (7), 34 +/- (5), 49 +/- (7) during SV and 47 +/- (10), 32 +/- (6), 21 +/- (9) during PPV. Conclusion Regional diaphragmatic excursion in patients with COPD during SV and PPV is similar to that in persons with normal pulmonary function.
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Boriek, Aladin M., Joseph R. Rodarte, and Theodore A. Wilson. "Kinematics and mechanics of midcostal diaphragm of dog." Journal of Applied Physiology 83, no. 4 (October 1, 1997): 1068–75. http://dx.doi.org/10.1152/jappl.1997.83.4.1068.
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Boriek, Aladin M., Joseph R. Rodarte, and Theodore A. Wilson. Kinematics and mechanics of midcostal diaphragm of dog. J. Appl. Physiol. 83(4): 1068–1075, 1997.—Radiopaque markers were attached to the peritoneal surface of three neighboring muscle bundles in the midcostal diaphragm of four dogs, and the locations of the markers were tracked by biplanar video fluoroscopy during quiet spontaneous breathing and during inspiratory efforts against an occluded airway at three lung volumes from functional residual capacity to total lung capacity in both the prone and supine postures. Length and curvature of the muscle bundles were determined from the data on marker location. Muscle lengths for the inspiratory states, as a fraction of length at functional residual capacity, ranged from 0.89 ± 0.04 at end inspiration during spontaneous breathing down to 0.68 ± 0.07 during inspiratory efforts at total lung capacity. The muscle bundles were found to have the shape of circular arcs, with the three bundles forming a section of a right circular cylinder. With increasing lung volume and diaphragm displacement, the circular arcs rotate around the line of insertion on the chest wall, the arcs shorten, but the radius of curvature remains nearly constant. Maximal transdiaphragmatic pressure was calculated from muscle curvature and maximal tension-length data from the literature. The calculated maximal transdiaphragmatic pressure-length curve agrees well with the data of Road et al. ( J. Appl. Physiol. 60: 63–67, 1986).
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Sanchez de Toledo, Joan, Ricardo Munoz, Douglas Landsittel, Dana Shiderly, Masahiro Yoshida, Rukmini Komarlu, Peter Wearden, Victor O. Morell, and Constantinos Chrysostomou. "Diagnosis of Abnormal Diaphragm Motion after Cardiothoracic Surgery: Ultrasound Performed by a Cardiac Intensivist vs. Fluoroscopy." Congenital Heart Disease 5, no. 6 (November 2010): 565–72. http://dx.doi.org/10.1111/j.1747-0803.2010.00431.x.
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Yoon, Seo Yeon, Hyun Im Moon, Joo‐Sup Kim, Tae Im Yi, and Yoon Ghil Park. "Comparison Between M‐Mode Ultrasonography and Fluoroscopy for Diaphragm Excursion Measurement in Patients With Acquired Brain Injury." Journal of Ultrasound in Medicine 39, no. 3 (September 12, 2019): 535–42. http://dx.doi.org/10.1002/jum.15130.
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Lin, Zhiyue, Hala Imam, Frèdèric Nicodème, Dustin A. Carlson, Chen-Yuan Lin, Brandon Yim, Peter J. Kahrilas, and John E. Pandolfino. "Flow time through esophagogastric junction derived during high-resolution impedance-manometry studies: a novel parameter for assessing esophageal bolus transit." American Journal of Physiology-Gastrointestinal and Liver Physiology 307, no. 2 (July 15, 2014): G158—G163. http://dx.doi.org/10.1152/ajpgi.00119.2014.
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This study aimed to develop and validate a method to measure bolus flow time (BFT) through the esophagogastric junction (EGJ) using a high-resolution impedance-manometry (HRIM) sleeve. Ten healthy subjects were studied with concurrent HRIM and videofluoroscopy; another 15 controls were studied with HRIM alone. HRIM studies were performed using a 4.2-mm-outer diameter assembly with 36 pressure sensors at 1-cm intervals and 18 impedance segments at 2-cm intervals (Given Imaging, Los Angeles, CA). HRIM and fluoroscopic data from four barium swallows, two in the supine and two in the upright position, were analyzed to create a customized MATLAB program to calculate BFT using a HRIM sleeve comprising three sensors positioned at the crural diaphragm. Bolus transit through the EGJ measured during blinded review of fluoroscopy was almost identical to BFT calculated with the HRIM sleeve, with the nadir impedance deflection point used as the signature of bolus presence. Good correlation existed between videofluoroscopy for measurement of upper sphincter relaxation to beginning of flow [ R = 0.97, P < 0.001 (supine) and R = 0.77, P < 0.01 (upright)] and time to end of flow [ R = 0.95, P < 0.001 (supine) and R = 0.82, P < 0.01 (upright)]. The medians and interquartile ranges (IQR) of flow time though the EGJ in 15 healthy subjects calculated using the virtual sleeve were 3.5 s (IQR 2.3–3.9 s) in the supine position and 3.2 s (IQR 2.3–3.6 s) in the upright position. BFT is a new metric that provides important information about bolus transit through the EGJ. An assessment of BFT will determine when the EGJ is open and will also provide a useful method to accurately assess trans-EGJ pressure gradients during flow.
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Choi, Jang-Hwan, and Sooyeul Lee. "Real-Time Tumor Motion Tracking in 3D Using Planning 4D CT Images during Image-Guided Radiation Therapy." Algorithms 11, no. 10 (October 11, 2018): 155. http://dx.doi.org/10.3390/a11100155.
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In this paper we propose a novel method for tracking the respiratory phase and 3D tumor position in real time during treatment. The method uses planning four-dimensional (4D) computed tomography (CT) obtained through the respiratory phase, and a kV projection taken during treatment. First, digitally rendered radiographs (DRRs) are generated from the 4DCT, and the structural similarity (SSIM) between the DRRs and the kV projection is computed to determine the current respiratory phase and magnitude. The 3D position of the tumor corresponding to the phase and magnitude is estimated using non-rigid registration by utilizing the tumor path segmented in the 4DCT. This method is evaluated using data from six patients with lung cancer and dynamic diaphragm phantom data. The method performs well irrespective of the gantry angle used, i.e., a respiration phase tracking accuracy of 97.2 ± 2.5%, and tumor tracking error in 3D of 0.9 ± 0.4 mm. The phantom study reveals that the DRRs match the actual projections well. The time taken to track the tumor is 400 ± 53 ms. This study demonstrated the feasibility of a technique used to track the respiratory phase and 3D tumor position in real time using kV fluoroscopy acquired from arbitrary angles around the freely breathing patient.
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Te, Tue, Hina Emanuel, Kanta Velamuri, and Supriya Singh. "838 Not All Hypercapnia is COPD." Sleep 44, Supplement_2 (May 1, 2021): A326—A327. http://dx.doi.org/10.1093/sleep/zsab072.835.
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Abstract Introduction Sleep breathing disorder related to isolated unilateral or bilateral diaphragmatic dysfunction (DD), in the absence of a generalized neuromuscular disorder, is not well understood and often under-recognized. There have been only a few cases reported of apneas and hypoponeas during REM sleep due to diaphragmatic dysfunction. We present here, a case of an 62 year-old man who developed acute hypercapnic respiratory failure with presumed COPD exacerbation requiring invasive ventilation. Report of case(s) A 62-year-old man was found on the sidewalk extremely short of breath and was intubated in the emergency department. Initial post-intubation arterial blood gas showed pH 7.1, pCO2 82, pO2 263, CO3 25.5. CXR showed no infiltrates. Echocardiography showed EFof 55%-65%. Long-term tobacco use supported the picture of COPD exacerbation. However, PFT was within normal limits. HSAT one year prior which showed severe OSA with AHI 52.6 event per hour. Patient had not pursued positive airway pressure (PAP) titration study afterward. In ICU, he was treated for presumed COPD exacerbation and successfully weaned off invasive ventilation. Inpatient PAP titration study recommended IPAP 12 and EPAP 8 cm H20. A fluoroscopy of the diaphragm was performed and showed that the right diaphragm had limited mobility. Electromyogram did not show generalized myopathy. Conclusion In conclusion, this case report describes the presentation of sleep disordered breathing seen in patients with unilateral diaphragmatic palsy. In these patients, the respiratory events seen are mainly hypopneas and desaturations, worse in REM sleep and supine position. This was an unusual presentation of a patient with untreated OSA and unilateral diaphragmatic palsy. A characteristic finding in these patients is worsening of the OSA in supine position. This has been reported in several studies and was seen in our case as well. This case underscores the need for critical thinking and diagnostic reasoning in the evaluation of a patient with hypercapnic respiratory failure and consider a wide differential and not only COPD exacerbation as the cause. Unilaterally diaphragmatic palsy is a rare cause of hypercapnic respiratory failure but must be considered when seen with obstructive sleep apnea with predominantly hypopneas and hypoxemia out of proportion of the respiratory events. Support (if any):
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Pan, Xiao-jie, De-bin Ou, Xing Lin, and Ming-Fang Ye. "Management of Pleural Space After Lung Resection by Cryoneuroablation of Phrenic Nerve: A Randomized Study." Surgical Innovation 24, no. 3 (January 3, 2017): 240–44. http://dx.doi.org/10.1177/1553350616685201.
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Objectives. Residual air space problems after pulmonary lobectomy are an important concern in thoracic surgical practice, and various procedures have been applied to manage them. This study describes a novel technique using controllable paralysis of the diaphragm by localized freezing of the phrenic nerve, and assesses the effectiveness of this procedure to reduce air space after pulmonary lobectomy. Methods. In this prospective randomized study, 207 patients who underwent lobectomy or bilobectomy and systematic mediastinal node dissection in our department between January 2009 and November 2013 were randomly allocated to a cryoneuroablation group or a conventional group. Patients in the cryoneuroablation group (n = 104) received phrenic nerve cryoneuroablation after lung procedures, and patients in the conventional group (n = 103) did not receive cryoneuroablation after the procedure. Data regarding preoperative clinical and surgical characteristics in both groups were collected. Both groups were compared with regard to postoperative parameters such as total amount of pleural drainage, duration of chest tube placement, length of hospital stay, requirement for repeat chest drain insertion, prolonged air leak, and residual space. Perioperative lung function was also compared in both groups. Recovery of diaphragmatic movement in the cryoneuroablation group was checked by fluoroscopy on the 15th, 30th, and 60th day after surgery. Results. There was no statistically significant difference in patient characteristics between the 2 groups; nor was there a difference in terms of hospital stay, new drain requirement, and incidence of empyema. In comparison with the conventional group, the cryoneuroablation group had less total drainage (1024 ± 562 vs 1520 ± 631 mL, P < .05), fewer cases of residual space (9 vs 2, P < .05), fewer cases of prolonged air leak (9 vs 1, P < .01), and shorter duration of drainage (3.2 ± 0.2 vs 4.3 + 0.3 days, P < .01). Diaphragmatic paralyses caused by cryoneuroablation reversed within 30 to 60 days. Conclusions. Cryoneuroablation of the phrenic nerve offers a reasonable option for prevention of residual air space following major pulmonary resection.
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Knight, H., W. M. Petroll, J. M. Adams, H. A. Shaffer, and D. F. Rochester. "Videofluoroscopic assessment of muscle fiber shortening in the in situ canine diaphragm." Journal of Applied Physiology 68, no. 5 (May 1, 1990): 2200–2207. http://dx.doi.org/10.1152/jappl.1990.68.5.2200.
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We tested the hypothesis that dynamic shortening of the costal diaphragm can be accurately estimated from measurements of the radiographic width of the zone of apposition (WZapp) by studying seven supine anesthetized dogs. Both muscle fiber length, represented by the distance between implanted radiopaque markers, and WZapp were measured from digitized recordings of fluoroscopic images utilizing interactive computer software. The WZapp was highly correlated with the length of costal fibers during active respiration in all animals (mean R2 = 0.94). The accuracy in the prediction of fiber length and shortening during breathing is enhanced by inclusion of additional variables describing the displacement of the abdominal wall and the resting geometric orientation of the fibers. We conclude that dynamic fluoroscopic measurement of WZapp is a valuable technique for estimating dynamic diaphragm fiber length and shortening. Depending on the experimental circumstances, WZapp may be a more easily acquired indicator of diaphragm shortening than other variables that have been previously utilized. As such, it may provide a suitable approach to assess active shortening of the diaphragm in humans.
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Petroll, W. M., H. Knight, and D. F. Rochester. "A model approach to assess diaphragmatic volume displacement." Journal of Applied Physiology 69, no. 6 (December 1, 1990): 2175–82. http://dx.doi.org/10.1152/jappl.1990.69.6.2175.
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Diaphragmatic volume displacement (Vdi) is calculated from two models using measurements obtained from anteroposterior fluoroscopic images of supine anesthetized dogs. In model 1, diaphragmatic descent was treated as if it were a "piston in a cylinder." In contrast, model 2 incorporated thoracic configuration as well as inspiratory changes in rib cage diameter and diaphragm shape. In one dog, a computerized tomography reconstruction of Vdi was compared with Vdi calculated using the models. Vdi calculated from model 2 lay within 11% of the computerized tomographic value, whereas Vdi based on model 1 was 30% larger. In seven animals, radiopaque markers were sewn to the right costal diaphragm. Digitized fluoroscopic images were used to measure intermarker distance, an index of muscle shortening. For four tidal breaths per dog, in model 2 Vdi averaged 49 +/- 18% of tidal volume and was weakly correlated with costal diaphragm muscle shortening (R = 0.74). It is concluded that Vdi can be estimated from linear dimensions in the coronal plane, provided that inspiratory changes in rib cage diameter and diaphragmatic shape change are taken into account.
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Liu, Jianmin, James L. Puckett, Torahiko Takeda, Hwoon-Yong Jung, and Ravinder K. Mittal. "Crural diaphragm inhibition during esophageal distension correlates with contraction of the esophageal longitudinal muscle in cats." American Journal of Physiology-Gastrointestinal and Liver Physiology 288, no. 5 (May 2005): G927—G932. http://dx.doi.org/10.1152/ajpgi.00353.2004.
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Esophageal distension causes simultaneous relaxation of the lower esophageal sphincter (LES) and crural diaphragm. The mechanism of crural diaphragm relaxation during esophageal distension is not well understood. We studied the motion of crural and costal diaphragm along with the motion of the distal esophagus during esophageal distension-induced relaxation of the LES and crural diaphragm. Wire electrodes were surgically implanted into the crural and costal diaphragm in five cats. In two additional cats, radiopaque markers were also sutured into the outer wall of the distal esophagus to monitor esophageal shortening. Under light anesthesia, animals were placed on an X-ray fluoroscope to monitor the motion of the diaphragm and the distal esophagus by tracking the radiopaque markers. Crural and costal diaphragm electromyograms (EMGs) were recorded along with the esophageal, LES, and gastric pressures. A 2-cm balloon placed 5 cm above the LES was used for esophageal distension. Effects of baclofen, a GABAB agonist, were also studied. Esophageal distension induced LES relaxation and selective inhibition of the crural diaphragm EMG. The crural diaphragm moved in a craniocaudal direction with expiration and inspiration, respectively. Esophageal distension-induced inhibition of the crural EMG was associated with sustained cranial motion of the crural diaphragm and esophagus. Baclofen blocked distension-induced LES relaxation and crural diaphragm EMG inhibition along with the cranial motion of the crural diaphragm and the distal esophagus. There is a close temporal correlation between esophageal distension-mediated LES relaxation and crural diaphragm inhibition with the sustained cranial motion of the crural diaphragm. Stretch caused by the longitudinal muscle contraction of the esophagus during distension of the esophagus may be important in causing LES relaxation and crural diaphragm inhibition.
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Hoshino, Yusuke, and Junichi Arai. "Diaphragm ultrasound examination for congenital diaphragmatic eventration in two premature neonates." BMJ Case Reports 13, no. 2 (February 2020): e232813. http://dx.doi.org/10.1136/bcr-2019-232813.
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Congenital diaphragmatic eventration (CDE) is always diagnosed by fluoroscopic examination. However, this technique is inappropriate for premature neonates because of risks of transport, hypothermia and ionising radiation. Herein, we describe two cases of premature neonates suspected to have CDE on radiography. We could not perform fluoroscopic examination due to their prematurity status. Therefore, we performed ultrasound examination and succeeded in diagnosing CDE without any risks. Using ultrasound examination, we could evaluate movement and thickness of the diaphragm. We consider this additional information useful for CDE diagnosis. This is the first report on CDE diagnosis using ultrasound examination.
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Ballas, Samir K., Marcia Kucler, and Kutaiba Tabbaa. "Management of Severe Intractable Sickle Cell Pain with Intrathecal Opioid Analgesia." Blood 104, no. 11 (November 16, 2004): 3742. http://dx.doi.org/10.1182/blood.v104.11.3742.3742.
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Abstract Management of severe Sickle Cell Pain (SCP) often entails the utilization of opioids via the intravenous route. In this abstract, we describe the utilization of Intrathecal Morphine Analgesia (IMA) infusion in the management of severe SCP. Two African American women were the subjects of this study: a 50-year-old patient with sickle cell anemia and a 51-year-old patient with sickle-b+-thalassemia. Complications of their disease included frequent acute painful episodes, S/P cholecystectomy, iron overload, and severe avascular necrosis (AVN) of the left hip in the first patient and frequent acute painful episodes, S/P cholecystectomy, retinopathy, and severe AVN of the right hip in the second patient. Both patients were admitted frequently to the hospital due to severe acute painful episodes involving mostly the hips and lower extremities. In both patients, a Medtronic Indura Catheter was inserted intrathecally under fluoroscopy guidance. The entry level was at the L3–L4 lumbar space and the tip of the catheter reached the T8 level. The catheter was attached to an Isomed pump that was filled with a mixture of preservative free morphine and clonidine and placed in a subcutaneous pouch in the abdominal wall. The first patient required 0.5mg of morphine and 25mg of clonidine daily, and the second patient required 1.5mg of morphine and 150mg of clonidine daily. The pumps were refilled every 2–3 months. No side effects were noted and the vital signs of both patients remained stable. Both patients continue to use IMA for 2–3 years to date with no complications. The utilization of IMA resulted in significant decrease in the frequency of acute painful episodes treated in the emergency room or hospital, as well as the number of hospital days and the amount of oral opioid consumption expressed in morphine sulfate (MOSO4) equivalent as shown in the table. Moreover, the quality of life of both patients improved: the first patient resumed social and family activities and the second patient could be gainfully employed. The data show that utilization of IMA in selected patients with severe intractable pain below the diaphragm has a significant salutary effect on the frequency and duration of hospital admissions and the total amount of opioids consumed. Effect of IMA on Annual Utilization of Medical Facilities and Opioid Consumption Hospital Amissions Hospital Days ER Visits PO MOSO4 Equivalent Patient #1 Before IMA 15 222 14 17585 mg After IMA 7 88 7 6885 mg Patient #2 Before IMA 9 19 21 8415 mg After IMA 5 18 9 3310 mg
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Knight, H., W. M. Petroll, and D. F. Rochester. "Relationships between abdominal and diaphragmatic volume displacements." Journal of Applied Physiology 71, no. 2 (August 1, 1991): 565–72. http://dx.doi.org/10.1152/jappl.1991.71.2.565.
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We investigated the relationship between the volumes displaced by the diaphragm and the abdominal wall during spontaneous breathing in supine anesthetized dogs. Diaphragmatic volume displacement (Vdi) was calculated from measurements taken from anteroposterior fluoroscopic images employing a previously described geometric model. The volume displacement of the abdominal wall (Vabd) was measured with a calibrated Respitrace. Shortening of single diaphragm muscle bundles in costal and crural regions was measured as the distance between radiopaque beads sutured to the peritoneal surface of the muscle. We found that Vdi always exceeded Vabd, but Vabd/Vdi was larger in animals in which the abdominal wall was more compliant. In this preparation, Vdi is better correlated with costal than with crural shortening. Vabd did not correlate with either costal or crural shortening. We infer that the difference between Vdi and Vabd reflects the volume displacement of the lower rib cage caused by diaphragm contraction. This volume difference was tightly correlated with costal shortening. We conclude from these data that coupling between Vdi and Vabd is influenced by the relative compliances of the chest wall and abdomen. Shortening of regions of the diaphragm may have variable relationships to the measured volume displacement, but costal shortening is intimately related to expansion of the lower rib cage.
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Chantawong, P., K. Komin, W. Banlunara, and M. Kalpravidh. "Diaphragmatic hernia repair using a rectus abdominis muscle pedicle flap in three dogs." Veterinary and Comparative Orthopaedics and Traumatology 26, no. 02 (2013): 135–39. http://dx.doi.org/10.3415/vcot-12-02-0023.
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SummaryObjective: To report the clinical use of a pedicle flap from the rectus abdominis muscle to repair extensive diaphragmatic tears in dogs with diaphragmatic hernia.Materials and methods: Three dogs with a combination of radial and circumferential diaphragmatic tears were studied. The circumferential tear was repaired by suturing the wound edge with the edge at the abdominal wall. A pedicle flap of the rectus abdominis muscle was used for repairing the radial tear. The dogs were examined radiographically for lung and diaphragm appearance and evidence of reherniation at 10 days, and at one, two, and four months after surgery, and fluoroscopically for paradoxical motion of the diaphragm at one and four months.Results: The rectus abdominis muscle pedicle flap was successfully used in all three dogs. The animals recovered uneventfully without evidence of reherniation during the four follow-up months. Fluoroscopic examination revealed no paradoxical motion of the diaphragm.Clinical significance: A rectus abdominis muscle pedicle flap can be used for repairing large diaphragmatic defects in dogs.
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Wilson, Theodore A., Aladin M. Boriek, and Joseph R. Rodarte. "Mechanical advantage of the canine diaphragm." Journal of Applied Physiology 85, no. 6 (December 1, 1998): 2284–90. http://dx.doi.org/10.1152/jappl.1998.85.6.2284.
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The mechanical advantage (μ) of a respiratory muscle is defined as the respiratory pressure generated per unit muscle mass and per unit active stress. The value of μ can be obtained by measuring the change in the length of the muscle during inflation of the passive lung and chest wall. We report values of μ for the muscles of the canine diaphragm that were obtained by measuring the lengths of the muscles during a passive quasistatic vital capacity maneuver. Radiopaque markers were attached along six muscle bundles of the costal and two muscle bundles of the crural left hemidiaphragms of four bred-for-research beagle dogs. The three-dimensional locations of the markers were obtained from biplane video-fluoroscopic images taken at four volumes during a passive relaxation maneuver from total lung capacity to functional residual capacity in the prone and supine postures. Muscle lengths were determined as a function of lung volume, and from these data, values of μ were obtained. Values of μ are fairly uniform around the ventral midcostal and crural diaphragm but significantly lower at the dorsal end of the costal diaphragm. The average values of μ are −0.35 ± 0.18 and −0.27 ± 0.16 cmH2O ⋅ g−1 ⋅ kg−1 ⋅ cm−2in the prone and supine dog, respectively. These values are 1.5–2 times larger than the largest values of μ of the intercostal muscles in the supine dog. From these data we estimate that during spontaneous breathing the diaphragm contributes ∼40% of inspiratory pressure in the prone posture and ∼30% in the supine posture. Passive shortening, and hence μ, in the upper one-third of inspiratory capacity is less than one-half of that at lower lung volume. The lower μ is attributed primarily to a lower abdominal compliance at high lung volume.
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Hsiao, H. M., S. Prabhu, A. Nikanorov, and M. Razavi. "Renal Artery Stent Bending Fatigue Analysis." Journal of Medical Devices 1, no. 2 (September 13, 2006): 113–18. http://dx.doi.org/10.1115/1.2736396.
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During normal breathing, the kidneys move up and down due to the diaphragm motion and the renal artery subsequently experiences bending. Whether bending of the renal artery during respiration impacts stent bending fatigue was not previously known. This study presents the first evaluation of the effect of the kidney movement on renal stent bending fatigue performance. Measurements of fluoroscopic images demonstrated a minor (1.7deg) change in bending angle between inspiration and expiration for an 18mm long renal stent after removing rigid-body motion. Finite element analysis revealed excellent fatigue resistance of the studied renal stent under simulated respiratory motion.
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Schwarz, M., H. Teske, M. Stoll, and Rolf Bendl. "Improving accuracy of markerless tracking of lung tumours in fluoroscopic video by incorporating diaphragm motion." Journal of Physics: Conference Series 489 (March 24, 2014): 012082. http://dx.doi.org/10.1088/1742-6596/489/1/012082.
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YORGUN, Hikmet, Yusuf Ziya ŞENER, Metin OKŞUL, Uğur CANPOLAT, Banu EVRANOS, Ahmet Hakan ATEŞ, and Kudret AYTEMİR. "Phrenic Nerve Damage After Atrial Fibrillation Ablation Using Second Generation Cryoballoon." Acta Medica 50, no. 1 (March 30, 2019): 14–19. http://dx.doi.org/10.32552/2019.actamedica.335.
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Abstract
Objective:
Cryoballoon (CB) ablation is a safe alternative to radiofrequency ablation in the treatment of atrial fibrillation (AF). However, phrenic nerve damage (PND) is a bothersome complication of the procedure. In this study, we aimed to establish the incidence of PND during CB and define the characteristics of affected patients.
Material & Methods:
In this retrospective analysis, all patients with AF that underwent CB ablation between 2013 and 2018 were included into the study. Characteristics and outcomes of patients complicated with PND were evaluated. PNP was detected by palpation of diaphragma contractions or observation of reduced diaphragma motility by fluoroscopy during the procedure.
Results:
Totally 653 patients were included in the study. PND was detected in 3.5% (23/653) of the patients. Median age of the patients with PNP was 56 (25-78) years and 10 patients (43.4 %) were male. The most common ablation site related with PND was RSPV (18 patients, 78%). Transient PND was observed in 16 patients (69%) of the patients which resolved within 24 hours after the procedure. In the remaining 5 patients (21%) diaphragmatic contraction was recovered at the 6th month control visit. In 2 patients (10%), phrenic nerve paralysis was still present >1 year visit
Conclusion:
PND is not a rare complication of CB ablation despite all the preventive maneuvers during the procedure and technological developments. However, most of the PND recovered during the follow-up.
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Schwarz, M., T. Teske, and R. Bendl. "PO-0885 IMPROVING ACCURACY OF MARKERLESS TRACKING OF LUNG TUMORS IN FLUOROSCOPIC VIDEO BY INCORPORATING DIAPHRAGM MOTION." Radiotherapy and Oncology 103 (May 2012): S347—S348. http://dx.doi.org/10.1016/s0167-8140(12)71218-5.
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Miura, Hiroshi, Takuji Yamagami, Koshi Terayama, Rika Yoshimatsu, Tomohiro Matsumoto, and Tsunehiko Nishimura. "Pneumothorax induced by radiofrequency ablation for hepatocellular carcinoma beneath the diaphragm under real-time computed tomography-fluoroscopic guidance." Acta Radiologica 51, no. 6 (July 2010): 613–18. http://dx.doi.org/10.3109/02841851003786001.
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Quesnel, Alexandre, Françoise Beuret Blanquart, Jean Paul Marie, and Eric Verin. "Explorations of Unilateral Diaphragmatic Paralysis." Journal of Respiratory Medicine 2014 (April 1, 2014): 1–6. http://dx.doi.org/10.1155/2014/683852.
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Objective. The aim of the present study was to evaluate sniff test, maximal inspiratory pressure, and presence of paradoxical inspiratory diaphragmatic movements and their diagnostic value in patients referred for suspicion of diaphragmatic dysfunction. Methods. Twenty-two patients (8 men and 14 women, 58±13 years) with suspected diaphragmatic dysfunction were included. Pulmonary function test was evaluated by spirometry. Diaphragm dysfunction was diagnosed with unilateral phrenic nerve stimulation. Esophageal pressure was recorded during sniff test and maximal static inspiratory movements. Detection of paradoxical diaphragmatic movement was performed with anteroposterior projection of chest X-ray fluoroscopic video. Results. Phrenic nerve stimulation enabled diagnosis of diaphragmatic paralysis in 15 of the 22 patients. The remaining 7 patients had normal explorations. Lung volumes were significantly lower in patients with diaphragmatic paralysis than in control subjects, as maximal inspiratory pressure. No patient with normal diaphragmatic exploration had paradoxical inspiratory movement. The combined diagnostic value of reduced esophageal pressure during sniff test, reduced esophageal pressure during maximal static inspiratory movements, and presence of paradoxical inspiratory movement had a sensitivity of 87% and a specificity of 71%. Conclusion. Our results suggest that, in most cases, a combination of sniff test, maximal inspiratory pressure, and paradoxical inspiratory movement could help to diagnose diaphragmatic dysfunction. Nevertheless, phrenic nerve stimulation remains the best test for assessing diaphragmatic dysfunction.
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Takemura, A., K. Ito, S. Shoji, and Y. Kikuchi. "Correlative Analysis between Diaphragm Positions in Fluoroscopic Sequence and Indicator Values of a Respiration Monitoring Device Which Represents the Level of Chest and Abdominal Wall." International Journal of Radiation Oncology*Biology*Physics 78, no. 3 (November 2010): S691—S692. http://dx.doi.org/10.1016/j.ijrobp.2010.07.1604.
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Fortune, John B., Serena Murphy, and Kimberley Tiller. "Optimal Initial Positioning of Chest Tubes to Prevent Retained Hemothorax Using a Novel Steerable Chest Tube With Extendable Infusion Cannula." Military Medicine 186, Supplement_1 (January 1, 2021): 324–30. http://dx.doi.org/10.1093/milmed/usaa295.
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ABSTRACT Introduction With blunt and penetrating trauma to the chest, warfighters and civilians frequently suffer from punctured lung (pneumothorax) and/or bleeding into the pleural space (hemothorax). Optimal management of this condition requires the rapid placement of a chest tube to evacuate as much of the blood and air as possible. Incomplete drainage of blood leading to retained hemothorax may be the result of the final tube tip position not being in contact with the blood collections. To address this problem, we sought to develop a “steerable” chest tube that could be accurately placed or repositioned into a specific desired position in the pleural space to assure optimal drainage. An integrated infusion cannula was added for the instillation of anticoagulants to maintain tube patency, thrombolytics for clot lysis, and analgesics for pain control if required. Materials and Methods A triple-lumen tube was designed to provide a channel for a pull-wire which was wound around an axle integrated into a small proximal handle and controlled by a ratcheted thumbwheel. Tension on the wire creates an arc on the tube that allows for positioning. In vitro testing focused on the relationship between the tension on the pull-wire and the resultant arc. Two adult cadavers and two anesthetized pigs were used to study the feasibility of accurate tube placement. After a brief training session, providers were asked to place tubes inferiorly along the diaphragm where blood was anticipated to accumulate or at the apex of the lung for pneumothorax. Success was determined with fluoroscopic images and was judged as a tube tip lying in the targeted position. Results The design was prototyped with an extruded polyvinyl chloride multilumen tube and a 3D printed tensioning handle. In vitro studies showed that one turn of the thumbwheel created 70° to 90° of arc of the tube. Cadaver and animal studies showed consistent success in the desired placement of the tube at or near the lateral diaphragm or in the apex. Attempts were also successful by surgical residents with minimal training. Conclusions Initial preliminary studies on a novel steerable chest tube have demonstrated the ability to appropriately position the tube in a desired location. The addition of an extendable cannula will allow for safe clot lysis or maintained tube patency. Additional studies are planned to confirm the benefit of this device in preventing retained hemothorax.
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Laghi, Franco A., Marina Saad, and Hameeda Shaikh. "Ultrasound and non-ultrasound imaging techniques in the assessment of diaphragmatic dysfunction." BMC Pulmonary Medicine 21, no. 1 (March 15, 2021). http://dx.doi.org/10.1186/s12890-021-01441-6.
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AbstractDiaphragm muscle dysfunction is increasingly recognized as an important element of several diseases including neuromuscular disease, chronic obstructive pulmonary disease and diaphragm dysfunction in critically ill patients. Functional evaluation of the diaphragm is challenging. Use of volitional maneuvers to test the diaphragm can be limited by patient effort. Non-volitional tests such as those using neuromuscular stimulation are technically complex, since the muscle itself is relatively inaccessible. As such, there is a growing interest in using imaging techniques to characterize diaphragm muscle dysfunction. Selecting the appropriate imaging technique for a given clinical scenario is a critical step in the evaluation of patients suspected of having diaphragm dysfunction. In this review, we aim to present a detailed analysis of evidence for the use of ultrasound and non-ultrasound imaging techniques in the assessment of diaphragm dysfunction. We highlight the utility of the qualitative information gathered by ultrasound imaging as a means to assess integrity, excursion, thickness, and thickening of the diaphragm. In contrast, quantitative ultrasound analysis of the diaphragm is marred by inherent limitations of this technique, and we provide a detailed examination of these limitations. We evaluate non-ultrasound imaging modalities that apply static techniques (chest radiograph, computerized tomography and magnetic resonance imaging), used to assess muscle position, shape and dimension. We also evaluate non-ultrasound imaging modalities that apply dynamic imaging (fluoroscopy and dynamic magnetic resonance imaging) to assess diaphragm motion. Finally, we critically review the application of each of these techniques in the clinical setting when diaphragm dysfunction is suspected.
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Farrugia, Briana, Richard Khor, Farshad Foroudi, Michael Chao, Kellie Knight, and Caroline Wright. "Protocol of a study investigating breath-hold techniques for upper-abdominal radiation therapy (BURDIE): addressing the challenge of a moving target." Radiation Oncology 15, no. 1 (October 30, 2020). http://dx.doi.org/10.1186/s13014-020-01688-z.
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Abstract Background Radiation therapy to upper abdominal sites is technically challenging due to motion of tumors and surrounding organs resulting from normal respiration. Breath-hold, using an Active Breathing Coordinator is one strategy used to reduce motion in these tumor sites. Though widely used, no studies have prospectively compared the different breath-hold techniques (inspiration, deep-inspiration and expiration) using ABC in the same patient cohort. Methods Patients planned for radiation therapy to upper abdominal tumors are invited to participate in this prospective study. Participants attempt three breath hold techniques: inspiration, deep-inspiration and expiration breath-hold, in random order. kV fluoroscopy images of the dome of diaphragm are taken of five consecutive breath-holds in each technique. Reproducibility and stability of tumour position are measured, and used to select the technique with which to proceed to planning and treatment. Reproducibility at planning and each treatment fraction is measured, along with breath hold time, treatment efficiency and patient experience. Discussion The screening method was validated after the first three participants. This screening process may be able to select the best breath-hold technique for an individual, which may lead to improved reproducibility. The screening process is being piloted as a prospective clinical trial. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): 12618001691235. Registered 12th October 2018. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376109&isReview=true.
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Al-Saadi, Hatem, Stephanie Evans, Alistair Sharples, SCarl Bradbury, Vittal Rao, and Balaji Nagammapudur. "O34 A SLIGHTLY CRAZY BUT INFORMATIVE EXPERIMENT OF THE EFFECT OF THE HEAD DOWN (HD) POSTURE ON THE CHARACTERISTICS OF OESOPHAGEAL MOTILITY AND OESOPHAGOGASTRIC JUNCTION (OGJ) USING HIGH RESOLUTION OESOPHAGEAL MANOMETRY." Diseases of the Esophagus 32, Supplement_2 (November 2019). http://dx.doi.org/10.1093/dote/doz092.34.
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Abstract Background It is known that posture (Supine Vs Sitting) variations can affect the dynamics and manometric characteristics of the OG junction and Oesophageal motility. Aims To study the effect of the Head Down (HD) upside down posture on the esophageal motility characteristics and dynamics of the OG junction using High resolution manometry. This would partially replicate the effect of Obesity (High Intraabdominal pressure) on the OGJ. Methods A single crazy (but sane) volunteer who had no symptoms of GORD served as the model for this unique experiment. A high-resolution manometry was performed using a solid-state transducer catheter with 36 channels. The study was performed in the sitting, supine and head down posture. Basal characteristics recording followed by wet swallows of 5ml of water and completed by rapid water swallows was done in each posture. Analysis was performed in the standard fashion using Chicago classification metrics. Further correlation of findings with a multipostural barium video oesophagogram is awaited. Results The procedure was completed satisfactorily in all the three postures. Satisfactory progression of swallows in a peristaltic sequence was obtained in all the 3 postures. However it was noted that there was a sequential change in the following parameters from the sitting to the supine to head down postures. Increased residual and contraction pressures in the Cricopharyngeal high pressure zone more pronounced in the HD position. Decreased amplitude of contraction of peristaltic sequences Decrease in slope of the peristaltic wave in the HD posture Diminished resting pressure in the HD position Exaggerated separation of the crural diaphragm (CD) and LES on the HD position Increased intragastric pressures in the HD position. Conclusion The above experiment is the first reported of Oesophageal function and OGJ dynamics in a completely unaided head down position using high resolution manometry and video fluoroscopy. The findings may serve to imitate the effect of Obesity on the OJ junction
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Çoruh, Başak, and Joshua O. Benditt. "Chest Wall and Neuromuscular Disease." DeckerMed Medicine, August 1, 2014. http://dx.doi.org/10.2310/im.1380.
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Chest wall and neuromuscular diseases encompass a broad spectrum of illnesses that affect the mechanics of breathing. This chapter reviews the physiology of the respiratory system and the impact of these diseases. A brief discussion of various chest wall and neuromuscular diseases is included. The approach to the evaluation of a patient with suspected chest wall or neuromuscular disease, including key aspects of the history, physical examination, and diagnostic testing, is discussed. Respiratory care, including ventilation, cough, swallowing, and sleep, is described. Tables outline neuromuscular diseases affecting the respiratory system, causes of diaphragm weakness and paralysis, and a comprehensive approach to respiratory care in chest wall and neuromuscular disease. Figures include illustrations of the anatomy of the respiratory system and contraction of the diaphragm, pressure measures above and below the diaphragm, radiographic images of chest wall diseases and measurement of the Cobb angle, a computed tomographic scan of a patient with pectus excavatum, a graph showing patterns of pulmonary function testing in chest wall and neuromuscular disease, and photos of mouthpiece ventilation and a mechanical insufflator-exsufflator device. Videos show a fluoroscopic sniff test demonstrating unilateral diaphragm paralysis and the use of a mechanical insufflator-exsufflator device. This review contains 9 highly rendered figures, 2 videos, 3 tables, and 40 references.
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Yorgun, H., M. Oksul, Y. Z. Sener, U. Canpolat, B. Evranos, A. H. Ates, and K. Aytemir. "P1862Phrenic nerve damage after atrial fibrillation ablation using second generation cryoballoon." European Heart Journal 40, Supplement_1 (October 1, 2019). http://dx.doi.org/10.1093/eurheartj/ehz748.0612.
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Abstract Background Cryoballoon (CB) ablation is a safe alternative to radiofrequency ablation in the treatment of atrial fibrillation (AF). However, phrenic nerve damage (PND) is a bothersome complication of the procedure. Purpose In this study, we aimed to establish the incidence of PND during CB and define the characteristics of affected patients. Methods In this retrospective analysis, all patients with AF that underwent CB ablation between 2013 and 2018 were included into the study. Characteristics and outcomes of patients complicated with PND were evaluated. PND was detected by palpation of diaphragma contractions or observation of reduced diaphragma motility by fluoroscopy during the procedure. Results Totally 653 patients were included in the study. PND was detected in 3.5% (23/653) of the patients. Median age of the patients with PNP was 56 (25–78) years and 10 patients (43.4%) were male. The most common ablation site related with PND was right superior pulmonary vein (RSPV) (18 patients, 78%). Transient PND was observed in 16 patients (69%) of the patients which resolved within 24 hours after the procedure. In the remaining 5 patients (21%) diaphragmatic contraction was recovered at the 6th month control visit. In 2 patients (10%), phrenic nerve paralysis was still present >1 year visit. Table 1. Baseline characteristics of patients with PND Age (years), median (min–max) 56 (25–78) Gender, n (male %) 10 (43.4%) Hypertension, n (%) 9 (39.1%) LA (mm), (mean ± sd) 38.5±5.8 EF (%), (mean ± sd) 60.8±6.5 Structrual heart disease, n (%) 3 (0.13%) – HCMP 2 (0.087%) – DCMP 1 (0.043%) DCMP: Dilated cardiomyopathy; HCMP: Hypertrophic cardiomyopathy; EF: Ejection fraction; LA: Left atrium; PND: Phrenic nerve damage. Conclusion PND is not a rare complication of CB ablation despite all the preventive maneuvers during the procedure and technological developments. However, most of the PND recovered during the follow-up.