Development of a model to mimic pleural space mechanics

2013 ◽  
Vol 21 (4) ◽  
pp. 369-378
Author(s):  
K.-U. Schmitt ◽  
M. Walti ◽  
O. Schälli ◽  
E. Styger ◽  
T. Prud'homme
Keyword(s):  
Pleural Space ◽  
Space Mechanics

Comparison of Heffner Criteria and Light Criteria in Differentiating Exudative and Transudative Pleural Effusion

2020 ◽  
Vol 22 (3) ◽  
pp. 141-145
Author(s):  
Krishna Chandra Devkota ◽  
S Hamal ◽  
PP Panta
Keyword(s):  
Pleural Effusion ◽  
Cross Sectional Study ◽  
Pleural Space ◽  
Sectional Study ◽  
Inclusion Criteria ◽  
Cross Sectional ◽  
Medical College ◽  
The Common ◽  
The Mean ◽  
Exudative Pleural Effusion

Pleural effusion is present when there is >15ml of fluid is accumulated in the pleural space. It can be divided into two types; exudative and transudative pleural effusion. Tuberculosis and parapneumonic effusion are the common cause of exudative pleural effusion whereas heart failure accounts for most of the cases of transudative pleural effusion. This study was a hospital based cross sectional study performed at Nepal Medical College during the period of January 2016-December 2016. A total of 50 patients who fulfilled the inclusion criteria were enrolled. Pleural effusion was confirmed by clinical examination and radiology. After confirmation of pleural effusion, pleural fluid was aspirated and was analysed for protein, LDH, cholesterol. The Heffner criteria was compared with Light criteria to classify exudative or transudative pleural effusion. Among 50 patients, 30 were male and 20 were female. The mean age of patient was 45.4±21.85 years. The sensitivity and specificity of using Light criteria to detect the two type of pleural effusion was 100% and 90.9%, whereas using Heffner criteria was 94.87%, 100% respectively(P<0.01). There are variety of causes for development of pleural effusion and no one criteria is definite to differentiate between exudative or transudative effusion. In this study Light criteria was more sensitive whereas Heffner criteria was more specific to classify exudative pleural effusion. Hence a combination of criteria might be useful in case where there is difficulty to identify the cause of pleural effusion.

scholarly journals Optimal Initial Positioning of Chest Tubes to Prevent Retained Hemothorax Using a Novel Steerable Chest Tube With Extendable Infusion Cannula

2021 ◽  
Vol 186 (Supplement_1) ◽  
pp. 324-330
Author(s):  
John B Fortune ◽  
Serena Murphy ◽  
Kimberley Tiller
Keyword(s):  
Chest Tube ◽  
Animal Studies ◽  
Training Session ◽  
Penetrating Trauma ◽  
Pleural Space ◽  
Tube Placement ◽  
Clot Lysis ◽  
Retained Hemothorax ◽  
Tip Position

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.

scholarly journals A safe and simple procedure for laparoscopic hepatectomy with combined diaphragmatic resection

2021 ◽  
Author(s):  
Keisuke Oyama ◽  
Shin Nakahira ◽  
Sakae Maeda ◽  
Akihiro Kitagawa ◽  
Yuki Ushimaru ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Liver Resection ◽  
Liver Metastasis ◽  
Laparoscopic Liver Resection ◽  
Liver Tumors ◽  
Simple Procedure ◽  
Laparoscopic Hepatectomy ◽  
Pleural Space ◽  
Absorbable Suture ◽  
Surgical Field

AbstractDiaphragmatic resection may be required beneath the diaphragm in some patients with liver tumors. Laparoscopic diaphragmatic resection is technically difficult to secure in the surgical field and in suturing. We report a case of successful laparoscopic hepatectomy with diaphragmatic resection. A 48-year-old man who underwent laparoscopic partial hepatectomy for liver metastasis of rectal cancer 20 months ago underwent surgery because of a new hepatic lesion that invaded the diaphragm. The patient was placed in the left hemilateral decubitus position. The liver and diaphragm attachment areas were encircled using hanging tape. Liver resection preceded diaphragmatic resection with the hanging tape in place. Two snake retractors were used to secure the surgical field for the inflow of CO2 into the pleural space after diaphragmatic resection. The defective part of the diaphragm was repaired using continuous or interrupted sutures. Both ends of the suture were tied with an absorbable suture clip without ligation. In laparoscopic liver resection with diaphragmatic resection, the range of diaphragmatic resection can be minimized by performing liver resection using the hanging method before diaphragmatic resection. The surgical field can be secured using snake retractors. Suturing with an absorbable suture clip is conveniently feasible.

Suppurative diseases of the lung and pleural space part I: Empyema thoracis and lung abscess

1986 ◽  
Vol 23 (1) ◽  
pp. 5-89 ◽  
Author(s):  
B.T. le Roux ◽  
M.L. Mohlala ◽  
J.A. Odell ◽  
I.D. Whitton
Keyword(s):  
Lung Abscess ◽  
Pleural Space ◽  
Empyema Thoracis

scholarly journals Management of pleural space infections: A population-based analysis

2007 ◽  
Vol 133 (2) ◽  
pp. 346-351.e1 ◽  
Author(s):  
Farhood Farjah ◽  
Rebecca Gaston Symons ◽  
Bahirathan Krishnadasan ◽  
Douglas E. Wood ◽  
David R. Flum
Keyword(s):  
Population Based ◽  
Pleural Space

Video-Assisted Implantation of a Left Ventricular Lead and Intrathoracic Tunneling to a Right-Sided CRT-D Device

2011 ◽  
Vol 6 (5) ◽  
pp. 341-343
Author(s):  
Thijs Stoker ◽  
Theo J. Klinkenberg ◽  
Alexander H. Maass ◽  
Massimo A. Mariani
Keyword(s):  
Left Ventricular ◽  
Pleural Space ◽  
Left Ventricular Lead ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Video Assisted ◽  
Ventricular Lead ◽  
Pacing Lead ◽  
Left Ventricular Pacing ◽  
The Right

We describe two cases in which a biventricular implantable cardioverter defibrillator for cardiac resynchronization therapy had to be placed on the right side due to unsuitability of the left subclavian vein. Endocardial implantation of a left ventricular lead through the coronary sinus was previously attempted but was unsuccessful. Implantation of the epicardial left ventricular pacing lead was performed through video-assisted thoracic surgery on the left side. The connector end of the left ventricular pacing lead was tunnelized through the anterior mediastinum into the right pleural space. The right-sided pocket was then opened. A tunnel was created from the pocket to the thoracic wall, and the pleural space was entered over the second rib. The lead was retrieved from the right pleural space and connected with the Cardiac resynchronization therapy-device (CRT-D). Both procedures and postoperative periods were uneventful. Intrathoracic left-to-right tunneling of an epicardial left ventricular lead by video-assisted thoracic surgery is feasible and safe. It provides an alternative to subcutaneous tunneling.

Pleural Space Management after Lung Transplant: Early and Late Outcomes of Pleural Decortication

2021 ◽  
Author(s):  
Jesse M. Rappaport ◽  
Hafiz U. Siddiqui ◽  
Andrew Tang ◽  
Lucy W. Thuita ◽  
Siva Raja ◽  
...  
Keyword(s):  
Lung Transplant ◽  
Pleural Space ◽  
Space Management

Pleural Effusions: Diagnostic Considerations

1995 ◽  
Vol 16 (2) ◽  
pp. 79-79
Author(s):  
Jeffrey M. Ewig
Keyword(s):  
Chest Pain ◽  
Pleural Space ◽  
Pleural Effusions ◽  
Pleuritic Chest Pain ◽  
Radiographic Appearance ◽  
Air Bubble ◽  
Presenting Symptoms ◽  
Breath Sounds ◽  
Costophrenic Angle ◽  
Pleural Involvement

The presence of fluid in the pleural space can be seen in a variety of disorders. Presenting symptoms include dyspnea, pleuritic chest pain, and ipsilateral shoulder pain if pleural involvement occurs at the central portion of the diaphragm. Physical examination findings include chest asymmetry, diminished breath sounds, dullness to percussion, and decreased tactile fremitus. In an upright patient, the radiographic appearance of pleural fluid includes blunting of the costophrenic angle, straightening or a more lateral peak of the hemidiaphragm contour, simulation of an elevated hemidiaphragm, or a distance of greater than 2 cm between the gastric air bubble and the lung.

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