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Komatsu H, Furukawa N, Kinoshita H, Okabe K. Double polytetrafluoroethylene patch repair for diaphragmatic defect caused by diaphragmatic rupture following diaphragmatic resection with endostapler. J Surg Case Rep 2024; 2024:rjae005. [PMID: 38283412 PMCID: PMC10810731 DOI: 10.1093/jscr/rjae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024] Open
Abstract
A 41-year-old man developed phrenic nerve palsy after the resection of anterior mediastinal tumor, who underwent diaphragmatic resection with an endostapler. After the surgery, the surgical stump ruptured, resulting in a large diaphragmatic defect with the liver prolapsing into the thoracic cavity. Then, the diaphragmatic defect was closed with a polytetrafluoroethylene (PTFE) patch. The diaphragm was reconstructed using a second PTFE patch overlaying the diaphragmatic defect that had been closed by the first PTFE patch, because solely patching the diaphragmatic defect had a risk of recurrence of diaphragmatic elevation due to remaining original diaphragm and the presence of phrenic nerve palsy. The second PTFE patch was fixed to the lower ribs by non-absorbable suture. The postoperative course was favorable. After 3 months, his symptoms and pulmonary function improved. We underwent double PTFE patch repair in a patient with both huge diaphragmatic defect and phrenic nerve palsy.
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Affiliation(s)
- Hiroaki Komatsu
- Department of Thoracic Surgery, Bell-Land General Hospital, 500-3, Higashiyama, Naka-ku, Sakai-shi, Osaka 599-8247, Japan
| | - Nao Furukawa
- Department of Thoracic Surgery, Bell-Land General Hospital, 500-3, Higashiyama, Naka-ku, Sakai-shi, Osaka 599-8247, Japan
| | - Hirotaka Kinoshita
- Department of Thoracic Surgery, Bell-Land General Hospital, 500-3, Higashiyama, Naka-ku, Sakai-shi, Osaka 599-8247, Japan
| | - Kazunori Okabe
- Department of Thoracic Surgery, Bell-Land General Hospital, 500-3, Higashiyama, Naka-ku, Sakai-shi, Osaka 599-8247, Japan
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Said SM, Mashadi AH, Salem MI, Narasimhan SL. Towards Zero Phrenic Nerve Injury in Reoperative Pediatric Cardiac Surgery: The Value of Intraoperative Phrenic Nerve Stimulation. J Cardiovasc Dev Dis 2023; 11:8. [PMID: 38248878 PMCID: PMC10816597 DOI: 10.3390/jcdd11010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Phrenic nerve injury is a devastating complication that results in significant morbidity and mortality. We developed a novel technique to localize the phrenic nerve and evaluate its success. METHODS Two groups of children underwent repeat sternotomy for a variety of indications. Group I (69 patients, nerve stimulator) and Group II (78 patients, no nerve stimulator). RESULTS There was no significant difference in the mean age and weight between the two groups: (6.4 ± 6.5 years vs. 5.6 ± 6.4 years; p = 0.65) and (25.2 ± 24.1 vs. 22.6 ± 22.1; p = 0.69), respectively. The two groups were comparable in the following procedures: pulmonary conduit replacement, bidirectional cavopulmonary anastomosis, aortic arch repair, and Fontan, while Group I had more pulmonary arterial branch reconstruction (p = 0.009) and Group II had more heart transplant patients (p = 0.001). There was no phrenic nerve injury in Group I, while there were 13 patients who suffered phrenic nerve injury in Group II (p < 0.001). No early mortality in Group I, while five patients died prior to discharge in Group II. Eleven patients underwent diaphragm plication in Group II (p = 0.001). The mean number of hours on the ventilator was significantly higher in Group II (137.3 ± 324.9) compared to Group I (17 ± 66.9), p < 0.001. Group II had a significantly longer length of ICU and hospital stays compared to Group I (p = 0.007 and p = 0.006 respectively). CONCLUSION Phrenic nerve injury in children continues to be associated with significant morbidities and increased length of stay. The use of intraoperative phrenic nerve stimulator can be an effective way to localize the phrenic nerve and avoid its injury.
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Affiliation(s)
- Sameh M. Said
- Division of Pediatric and Adult Congenital Cardiac Surgery, Maria Fareri Children’s Hospital, Westchester Medical Center, Valhalla, NY 10595, USA
- Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria 21544, Egypt
| | - Ali H. Mashadi
- Department of Integrative Biology and Physiology, Undergraduate Studies, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Mahmoud I. Salem
- Department of Cardiothoracic Surgery, University of Port Said, Port Said 42526, Egypt
| | - Shanti L. Narasimhan
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN 55455, USA
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CreveCoeur TS, Visco CJ, Ginsburg ME, Winfree CJ. Diagnosis and treatment of phrenic nerve hourglass constriction in patients with Parsonage-Turner syndrome. Neurosurg Focus Video 2023; 8:V7. [PMID: 36628100 PMCID: PMC9815208 DOI: 10.3171/2022.10.focvid22105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/03/2022] [Indexed: 01/02/2023]
Abstract
Phrenic nerve injury can occur anywhere along its course and clinically results in diaphragm paralysis. Although most patients with Parsonage-Turner syndrome and phrenic nerve dysfunction improve without treatment, some patients do not recover spontaneously. In these cases, an initial autoimmune response produces scarring along the affected nerve(s). This scar, known as an hourglass constriction, causes focal compression of the nerve at the site of the scar, which prevents the nerve from spontaneously recovering. Thus, the authors present a unique case of phrenic nerve injury secondary to Parsonage-Turner syndrome that improved with internal neurolysis. The video can be found here: https://stream.cadmore.media/r10.3171/2022.10.FOCVID22105.
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Affiliation(s)
- Travis S. CreveCoeur
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York;
| | - Christopher J. Visco
- Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, New York;
| | - Mark E. Ginsburg
- Department of Thoracic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Christopher J. Winfree
- Department of Neurological Surgery, Columbia University Irving Medical Center, New York;
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Chen Y, Yi J. [Advances of Diaphragm Ultrasound in Anesthesia Management]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2022; 44:891-898. [PMID: 36325788 DOI: 10.3881/j.issn.1000.503x.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Diaphragm excursion,diaphragm thickness,and diaphragmatic thickening fraction are three indicators for evaluating the two hemidiaphragms by ultrasound.Diaphragm ultrasound has been widely applied in clinical practice including anesthesia management.It can help to diagnose postoperative residual curarisation and identify patients at a high risk of suffering from postoperative pulmonary complications.It can serve to recognize patients with diaphragm paralysis due to surgical or anesthetic factors as early as possible.Moreover,diaphragm ultrasound plays a role in preoperative pulmonary function assessment for special sufferers with chronic obstructive pulmonary disease,adolescent idiopathic scoliosis,or neuromuscular disease.Apart from these,diaphragm ultrasound can give anesthesiologists and colleagues in intensive care unit an important clue for extubation and weaning from mechanical ventilation of patients.
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Affiliation(s)
- Ying Chen
- Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
| | - Jie Yi
- Department of Anesthesiology,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
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5
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Gritsiuta AI, Gordon M, Bakhos CT, Abbas AE, Petrov RV. Minimally Invasive Diaphragm Plication for Acquired Unilateral Diaphragm Paralysis: A Systematic Review. Innovations (Phila) 2022; 17:180-190. [PMID: 35549933 DOI: 10.1177/15569845221097761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Diaphragm paralysis is a relatively uncommon entity that can be both congenital and acquired in nature. While commonly asymptomatic, it can also cause a significant decrease in pulmonary function and reserve, particularly in patients with underlying pulmonary diseases. Our aim was to summarize the current literature regarding the minimally invasive techniques used in the surgical correction of acquired diaphragm paralysis via traditional and robotic minimally invasive approaches. Methods: We conducted a systematic review of available literature using the Cochrane methodology and reported findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Results: A total of 6,561 citations were identified through initial database and reference searches, of which 90 articles met the inclusion criteria for review. After further assessment, 33 appropriate full-text studies were selected for the review. Of the selected publications, the majority represented case reports and single-center retrospective studies with level of evidence 4. Only 1 level 2b study (individual cohort study) was identified, comparing minimally invasive and open approaches. Conclusions: Each of the minimally invasive approaches has its unique benefits and disadvantages, which are summarized and delineated in this article. Ultimately, no preferred method of diaphragm plication for diaphragm paralysis can be recommended at this time based on clinical data. The choice of procedure and surgical approach continues to be selected based on the surgeon's experience and preference.
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Affiliation(s)
- Andrei I Gritsiuta
- Department of Surgical Services, 6595University of Pittsburgh Medical Center, PA, USA
| | - Matthew Gordon
- Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Charles T Bakhos
- Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Abbas E Abbas
- Department of Thoracic Oncology, 12321Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Roman V Petrov
- Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, 12314Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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Lazzarini LM, Werner JM, Perez IA, Seruya M, Ramos-Platt L, Tiongson E, Keens TG. Does acute flaccid myelitis cause respiratory failure in children? Pediatr Pulmonol 2022; 57:682-685. [PMID: 34910378 DOI: 10.1002/ppul.25789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 10/15/2021] [Accepted: 11/23/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Acute flaccid myelitis (AFM) is a rare disease that affects spinal cord gray matter, results in acute flaccid weakness of one or more limbs and predominantly involves the cervical spinal cord, which places patients at higher risk for respiratory failure. Our study aims to describe respiratory failure in pediatric AFM patients with emphasis on the need for assisted ventilation and respiratory nerve involvement from an acute and long-term perspective. MATERIALS AND METHODS We reviewed the medical records of patients diagnosed with AFM seen in a multidisciplinary clinic for persistent limb weakness between 2016 and 2020. RESULTS We studied 54 patients, 35% were female. The median age of patients at illness onset was 5 years (range 7 months-19 years). The median age of patients at the time of study was 8.5 years (range 2-20 years). Eleven patients (20%) required assisted ventilation for acute respiratory failure. Of those that experienced acute respiratory failure, 81% developed chronic respiratory failure. Fifty-six percent of patients with chronic respiratory failure were able to wean off assisted ventilation by 1 year. All patients that experienced unilateral diaphragm impairment with AFM onset experienced acute and chronic respiratory failure. DISCUSSION Many patients with AFM may experience respiratory compromise and develop chronic respiratory failure. However, most of these patients can be weaned off ventilatory support by 1 year from illness onset. Most children with unilateral diaphragm impairment can sustain adequate ventilation without the need for long-term ventilatory support.
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Affiliation(s)
- Laura M Lazzarini
- Division of Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Julie M Werner
- Division of Rehabilitation Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.,Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Iris A Perez
- Division of Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Mitchel Seruya
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA.,Plastic and Reconstructive Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Leigh Ramos-Platt
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.,Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Emmanuelle Tiongson
- Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.,Division of Neurology, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Thomas G Keens
- Division of Pulmonology and Sleep Medicine, Children's Hospital Los Angeles, Los Angeles, California, USA.,Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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Carlson CS, Brown SR, Wilson MW, Choi PJ. Noninvasive ventilation: An important option in the management of hemi diaphragm paralysis. J Card Surg 2021; 36:3921-3923. [PMID: 34260766 DOI: 10.1111/jocs.15824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/30/2021] [Indexed: 11/27/2022]
Abstract
Hemidiaphragm paralysis (HP) is a potential complication of cardiac surgery. While most patients are either asymptomatic or have mild symptoms, some are at risk of developing life-threatening hypercapnia. We present a case of a patient who developed HP after tricuspid valve replacement. Diaphragm plication was deferred due to underlying comorbidities, but over time she developed severe hypercapnic respiratory failure requiring intensive care unit admission. Chronic noninvasive ventilation therapy (NIV) was initiated, which improved her symptoms and hypercapnia and prevented further hospitalizations. For patients with iatrogenic HP unable to undergo diaphragm plication, Pulmonology referral for initiation of NIV should be strongly considered.
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Affiliation(s)
- Christie S Carlson
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Sarah R Brown
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew W Wilson
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Philip J Choi
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan, USA
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8
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Nardini M, Jayakumar S, Migliore M, Nosotti M, Paul I, Dunning J. Minimally Invasive Plication of the Diaphragm: A Single-Center Prospective Study. Innovations (Phila) 2021; 16:343-349. [PMID: 34130535 DOI: 10.1177/15569845211011583] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Plication of the diaphragm is a life-changing procedure for patients affected by diaphragm paralysis. Traditionally, this procedure is performed through a thoracotomy. Access to the diaphragm via this incision is poor and the indications for surgery are limited to patients who can actually sustain such an invasive approach and associated morbidities. A minimally invasive approach was developed to improve the surgical management of diaphragm paralysis. METHODS Patients underwent minimally invasive diaphragm plication either by video-assisted or robotic surgery through a 3-port technique with CO2 insufflation. Patients were followed at the routine 6-week clinic and also by telephone consultation 6 to 12 months postoperatively. Data were collected on postoperative complications, postoperative pain or numbness, symptomatic improvement, and change to quality of life following surgery. RESULTS Forty-eight patients underwent 49 minimally invasive diaphragm plication. Median postoperative length of hospital stay was 4 days (range: 2 to 34 days) and there were no cases of mortality. Mean reduction in Medical Research Council dyspnea score per patient was 2.2 points (mode: 3 points). Twenty-eight patients (77.8%) reported a significant symptomatic improvement enabling improvements in quality of life, and 97.2% (n = 35) were satisfied with the surgical outcome. CONCLUSIONS Minimally invasive diaphragm plication is a safe procedure associated with prompt postoperative recovery. It is effective at reducing debilitating dyspnea and improving quality of life.
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Affiliation(s)
- Marco Nardini
- 9304 Department of Thoracic Surgery and Lung Transplantation, University of Milan, Italy.,4964 Department of Cardiothoracic Surgery, Royal Brompton and Harefield Hospitals, London, UK
| | - Shruti Jayakumar
- 156705 Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Marcello Migliore
- 8903 Department of Thoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Mario Nosotti
- 9304 Department of Thoracic Surgery and Lung Transplantation, University of Milan, Italy
| | - Ian Paul
- 156705 Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
| | - Joel Dunning
- 156705 Department of Thoracic Surgery, James Cook University Hospital, Middlesbrough, UK
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Ghani MOA, Foster J, Shannon CN, Bichell DP. Association of chest tube position with phrenic nerve palsy after neonatal and infant cardiac surgery. J Thorac Cardiovasc Surg 2020; 161:1618-1622.e1. [PMID: 32807556 DOI: 10.1016/j.jtcvs.2020.05.121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Diaphragm paralysis (DP) complicates the postoperative course of neonates and infants undergoing cardiac surgery. Events causing DP remain poorly understood, and preventive strategies remain elusive. This retrospective cohort analysis aims to test the hypothesis that chest tubes in contact with the phrenic nerve in the pleural apex may cause pressure palsy. METHODS In late 2018, the chest tube positioning strategy was changed so as to avoid a putative "danger zone" configuration, defined as (1) the chest tube looping apicomedially at the level of the second right intercostal space, and (2) wedging of chest tube tip against pericardium. A preintervention and postintervention analysis of 531 patients from 2012 to 2019 was performed to evaluate any association of chest tube position or duration in place with DP. Univariable and multivariable analyses were carried out, with significance set a priori at P < .05. RESULTS The preintervention group comprised 488 patients, of whom 32 (6.6%) had RDP. The postintervention group comprised 43 patients, none of whom had DP. Multivariable analysis of the entire cohort revealed chest tube positioning in the danger zone as the only significant association with RDP (odds ratio, 4.22; 95% confidence interval, 1.57-11.33; P < .05). CONCLUSIONS Chest tubes that occupy the right superior pleural space are associated with increased risk of DP.
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Affiliation(s)
- Muhammad Owais Abdul Ghani
- Division of Pediatric Cardiac Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn; Surgical Outcomes Center for Kids (SOCKs), Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Jarrett Foster
- Surgical Outcomes Center for Kids (SOCKs), Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn
| | - Chevis N Shannon
- Surgical Outcomes Center for Kids (SOCKs), Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn
| | - David P Bichell
- Division of Pediatric Cardiac Surgery, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn; Surgical Outcomes Center for Kids (SOCKs), Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tenn.
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Doyle MP, McCarty JP, Lazzara AA. Case Study of Phrenic Nerve Paralysis: "I Can't Breathe!". J Emerg Med 2020; 58:e237-e241. [PMID: 32354588 DOI: 10.1016/j.jemermed.2020.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 01/16/2020] [Accepted: 03/18/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The anatomic course of the phrenic nerve runs in the fascia covering the anterior scalene muscle. Interscalene blocks are commonly performed by an anesthesiologist for shoulder surgery, such as a rotator cuff repair, total shoulder replacement, humeral fracture, or other arm surgery. Phrenic nerve palsy or paralysis is a known complication from interscalene block and is covered in multiple case reports and series in both Anesthesia and Neurosurgical literature, but only one case report in the Emergency Medicine literature. CASE REPORT This case involves a 57-year-old man who had an uncomplicated arthroscopic rotator cuff repair with placement of interscalene block under care of anesthesia. He was discharged with a pain pump in place and then subsequently presented to the Emergency Department (ED) later that same day for evaluation of dyspnea. Using point-of-care ultrasound, his right diaphragm did not appear to be moving. Chest x-ray study revealed an elevated right hemidiaphragm. He was diagnosed with iatrogenic right phrenic nerve paralysis from interscalene block. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergent diagnosis of phrenic nerve paralysis in the ED is complicated by a distressed patient and need for quick intervention. Most formal tests for this diagnosis are not immediately available to emergency physicians. Ultrasound is a rapid and reproducible, noninvasive resource with high sensitivity and specificity, making it an ideal imaging modality for the emergent evaluation of possible phrenic nerve palsy or paralysis.
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Affiliation(s)
- Michael P Doyle
- Emergency Department, Henry Ford Allegiance Health, Jackson, Michigan
| | - James P McCarty
- Emergency Department, Henry Ford Allegiance Health, Jackson, Michigan
| | - Alan A Lazzara
- Emergency Department, Henry Ford Allegiance Health, Jackson, Michigan
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Talebian P, Kermansaravi M, Pazouki A, Kabir A. A case of stapled resection of redundant diaphragm and early evisceration of gastrointestinal content. Wideochir Inne Tech Maloinwazyjne 2019; 14:141-4. [PMID: 30766642 DOI: 10.5114/wiitm.2018.77543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/06/2018] [Indexed: 11/17/2022] Open
Abstract
Diaphragm paralysis has been observed following cervical spinal cord and diaphragm injuries. Patients with diaphragm paralysis require plication of the diaphragm if significant pulmonary dysfunction occurs. We aimed to report the unsuccessful stapling technique in the correction of diaphragm paralysis. We report a 49-year-old man with unilateral diaphragmatic paralysis, who underwent laparoscopic resection of the diaphragm using staplers. He then underwent thoracotomy with mesh reinforcement due to the unsuccessful initial procedure. Based on our report, using a stapler can result in failure of surgical resection of the diaphragm. Further studies need to be performed to investigate the efficacy and safety of stapling in diaphragm resection.
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12
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Meneses JDA, Ishigami AC, de Mello LM, de Albuquerque LL, de Brito CAA, Cordeiro MT, Pena LJ. Lessons Learned at the Epicenter of Brazil's Congenital Zika Epidemic: Evidence From 87 Confirmed Cases. Clin Infect Dis 2018; 64:1302-1308. [PMID: 28329257 DOI: 10.1093/cid/cix166] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/21/2017] [Indexed: 02/01/2023] Open
Abstract
Congenital Zika virus infection has stimulated great international concern. A prospective case series of 87 infants with laboratory-confirmed congenital Zika syndrome (CZS) at the epicenter of the Brazilian Zika epidemic in Pernambuco state is presented. Mothers were interviewed for symptoms of possible Zika virus (ZIKV) infection during pregnancy, and fetal ultrasounds were obtained. Infant cerebrospinal fluid (CSF) samples were tested for ZIKV-specific antibodies, and sera were screened for other congenital infections. Neuroimaging and ophthalmologic evaluations were also performed. Sixty-six mothers (76%) reported symptoms of ZIKV infection during gestation. Fetal ultrasounds were available from 90% of the mothers, and all demonstrated brain structural abnormalities. All of the CSF samples tested positive for ZIKV immunoglobulin M. The majority of infants (89%) were term; the mean birth weight was 2577 ± 260 g, and the mean head circumference was 28.1 ± 1.8 cm. Severe microcephaly, defined as head circumference 3 SD below the mean for sex and gestational age, was found in 72 (82%) infants. All infants had an abnormal neurological exam, and 18 (20.7%) had arthrogryposis. The main abnormalities detected in computed tomography scans were calcifications (99%), followed by ventricular enlargement (94%), cortical hypogyration (81%), and less commonly, cerebellar hypoplasia (52%). Unilateral diaphragm paralysis was identified in 3 infants. Maternal young age, term infant, small for gestational age, and the presence of ophthalmologic abnormalities were significantly associated with a smaller head circumference Z score. Our findings, based on laboratory-confirmed ZIKV infection, add valuable evidence for the understanding of CZS.
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Affiliation(s)
| | | | | | | | | | | | - Lindomar José Pena
- Department of Virology, Oswaldo Cruz Foundation (Fiocruz), Recife, Pernambuco, and
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13
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Oruc O, Sarac S, Afsar GC, Topcuoglu OB, Kanbur S, Yalcinkaya I, Tepetam FM, Kirbas G. Is polysomnographic examination necessary for subjects with diaphragm pathologies? Clinics (Sao Paulo) 2016; 71:506-10. [PMID: 27652831 PMCID: PMC5004572 DOI: 10.6061/clinics/2016(09)04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 06/28/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES While respiratory distress is accepted as the only indication for diaphragmatic plication surgery, sleep disorders have been underestimated. In this study, we aimed to detect the sleep disorders that accompany diaphragm pathologies. Specifically, the association of obstructive sleep apnea syndrome with diaphragm eventration and diaphragm paralysis was evaluated. METHODS This study was performed in Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital between 2014-2016. All patients had symptoms of obstructive sleep apnea (snoring and/or cessation of breath during sleep and/or daytime sleepiness) and underwent diaphragmatic plication via video-assisted mini-thoracotomy. Additionally, all patients underwent pre- and postoperative full-night polysomnography. Pre- and postoperative clinical findings, polysomnography results, Epworth sleepiness scale scores and pulmonary function test results were compared. RESULTS Twelve patients (7 males) with a mean age of 48 (range, 27-60) years and a mean body mass index of 25 (range, 20-30) kg/m2 were included in the study. Preoperative polysomnography showed obstructive sleep apnea syndrome in 9 of the 12 patients (75%), while 3 of the patients (25%) were regarded as normal. Postoperatively, patient complaints, apnea hypopnea indices, Epworth sleepiness scale scores and pulmonary function test results all demonstrated remarkable improvement. CONCLUSION All patients suffering from diaphragm pathologies with symptoms should undergo polysomnography, and patients diagnosed with obstructive sleep apnea syndrome should be operated on. In this way, long-term comorbidities of sleep disorders may be prevented.
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Affiliation(s)
- Ozlem Oruc
- Sureyyapasa Chest & Thoracic Surgery Training and Research Hospital, Chest Diseases, Istanbul, Turkey
- E-mail:
| | - Sema Sarac
- Sureyyapasa Chest & Thoracic Surgery Training and Research Hospital, Chest Diseases, Istanbul, Turkey
| | - Gulgun Cetintas Afsar
- Sureyyapasa Chest & Thoracic Surgery Training and Research Hospital, Chest Diseases, Istanbul, Turkey
| | - Ozgur Bilgin Topcuoglu
- Sureyyapasa Chest & Thoracic Surgery Training and Research Hospital, Neurology, Istanbul, Turkey
| | - Serda Kanbur
- Sureyyapasa Chest & Thoracic Surgery Training and Research Hospital, Thoracic Surgery, Istanbul, Turkey
| | - Irfan Yalcinkaya
- Sureyyapasa Chest & Thoracic Surgery Training and Research Hospital, Thoracic Surgery, Istanbul, Turkey
| | - Fatma Merve Tepetam
- Sureyyapasa Chest & Thoracic Surgery Training and Research Hospital, Allergy and Immunology, Istanbul, Turkey
| | - Gokhan Kirbas
- Faculty of Medicine Dicle University, Chest Diseases, Diyarbakir, Turkey
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Simoncic M, Kopriva S, Zupancic Z, Jerse M, Babnik J, Srpcic M, Grosek S. Mediastinal teratoma with hydrops fetalis in a newborn and development of chronic respiratory insufficiency. Radiol Oncol 2014; 48:397-402. [PMID: 25435854 DOI: 10.2478/raon-2013-0080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 07/24/2013] [Indexed: 11/20/2022] Open
Abstract
Background Mediastinal fetal teratoma can be detected as a mass in the chest during a routine prenatal ultra-sound screening. Because of the pressure on mediastinal structures it can be the cause of non-immune hydrops fetalis and polyhydramnion. The development of hydrops fetalis leads to fetal death or premature delivery in most reported cases. Early surgical removal is important, but, the result of treatment depends on the stage of development of mediastinal organs and complications in the postoperative period. Case report. A 31-year-old gravida carrying twins, with spontaneous membrane rupture at 32 weeks gestation underwent urgent caesarean section after antenatal ultrasound revealed severe polyhydramnion and hydrops fetalis in geminus A. The child was intubated immediately after birth due to severe respiratory distress. Ultrasound and X-ray revealed a tumour mass in the right hemithorax. Tumour resection was performed at the age of 7 days. Histology examination revealed an encapsulated immature teratoma. The postoperative course was complicated with respiratory insufficiency which turned into chronic at the age of eight months. Conclusion This is the fifth reported child with fetal mediastinal teratoma and severe hydrops fetalis that survived the neonatal period. Additional diagnostic search revealed abnormal course of both pulmonary arteries, which was probably one of the main causes of respiratory insufficiency.
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