The Role of the Orthopaedic Oncologist in Chest Wall Resections and Reconstructions

Purpose: patients with neuromuscular diseases presents an high incidence of respiratory infections favoured by stagnation of deep bronchial secretions and deficit of cough. The aim of the study is to evaluate the correct treatment of this condition and the role of High Frequency Chest Wall Oscillation (HFCWO) in helping the removal of bronchial secretions and reduce the incidence of infections in patients with neuromuscular disease. Methods: analysis of the current bibliography related to respiratory infections and neuromuscular disease. PCEF (Peak Cough Expiratory Flow) is used as a standardized indicator of efficiency of cough. Results: the High Frequency Chest Wall Oscillation (HFCWO) is useful, in cases of increased production of mucus and impairment of muco-ciliary clearance, to remove the tracheobronchial secretions and reduce the incidence of infections. Conclusions: the correct approach to patients with neuromuscular disease and frequent respiratory infections is focused on treatment of cough ineffective and management of bronchial secretions. High Frequency Chest Wall Oscillation (HFCWO) (VEST) has a central role in treatment of cough ineffective and management of bronchial secretions reducing respiratory infections.

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Anterior Mediastinal Extension of Primary Chest Wall Infections: Role of Spiral CT in Detection and Management

Critical Reviews in Diagnostic Imaging ◽

10.3109/10408370390808496 ◽

2003 ◽

Vol 44 (2) ◽

pp. 79-93 ◽

Cited By ~ 4

Author(s):

Steven L. Novick ◽

Elliot K. Fishman

Keyword(s):

Chest Wall ◽

Spiral Ct ◽

Mediastinal Extension

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Role of Plastic Surgery in Chest Wall Corrections

Chest Wall Deformities and Corrective Procedures ◽

10.1007/978-3-319-23968-2_16 ◽

2015 ◽

pp. 129-135

Author(s):

Simon Withey ◽

Robert A. Pearl

Keyword(s):

Plastic Surgery ◽

Chest Wall

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Steady-state response of quadriplegic subjects to inspiratory resistive load

Journal of Applied Physiology ◽

10.1152/jappl.1986.60.5.1482 ◽

1986 ◽

Vol 60 (5) ◽

pp. 1482-1492 ◽

Cited By ~ 7

Author(s):

V. Im Hof ◽

H. Dubo ◽

V. Daniels ◽

M. Younes

Keyword(s):

Steady State ◽

Chest Wall ◽

Muscle Spindles ◽

Normal Subjects ◽

Afferent Feedback ◽

Resistive Load ◽

State Response ◽

The Face ◽

Inspiratory Resistance

Normal subjects preserve tidal volume (VT) in the face of added inspiratory resistance by increasing maximal amplitude and duration of the rising phase of respiratory driving pressure (DP) and by changing the shape of this phase to one that is more concave to the time axis. To explore the possible role of chest wall afferents in mediating these responses, we determined averaged DP in eight quadriplegic subjects during steady-state unloaded breathing and while breathing through an inspiratory resistance (8.5 cmH2O X 1(-1) X s). As with normal subjects, quadriplegics preserved VT (loaded VT = 106% control) by utilizing all three mechanisms. However, prolongation of the inspiratory duration derived from the DP waveform (+22% vs. +42%) and shape response were significantly less in the quadriplegic subjects. Shape response was completely absent in subjects with C4 lesions. The results provide strong evidence that respiratory muscle spindles are responsible for shape response and that changes in afferent feedback from the chest wall play an important role in mediating inspiratory prolongation.

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Stiffness of the pleural surface of the chest wall is similar to that of the lung

Journal of Applied Physiology ◽

10.1152/japplphysiol.00588.2003 ◽

2003 ◽

Vol 95 (6) ◽

pp. 2345-2349 ◽

Cited By ~ 8

Author(s):

Andrew Gouldstone ◽

Richard E. Brown ◽

James P. Butler ◽

Stephen H. Loring

Keyword(s):

Chest Wall ◽

Elastohydrodynamic Lubrication ◽

Geometric Standard Deviation ◽

Parietal Pleura ◽

Shear Stresses ◽

Membrane Tension ◽

Similar Extent ◽

Spatial Uniformity ◽

Pleural Surface

To address the role of the parietal pleura in reduction of mesothelial shear stresses during breathing, we measured the stiffness of the parietal pleural surface of mammalian chest walls using microindentation. The pleural surface was indented over ribs and intercostal spaces with rigid flat punches (tip radii of 0.01, 0.02, and 0.1 cm) to probe stiffness at length scales comparable with those of surface asperities. We found a tissue shear modulus of 6,700 dyn/cm2 and pleural membrane tension of 4,900 dyn/cm, with a geometric standard deviation of 0.42. These values are similar to those measured for the lung by Hajji et al., using indentation (Hajji MA, Wilson TA, and Lai-Fook SJ. J Appl Physiol Respirat Environ Exerc Physiol 47: 175–181, 1979). Surprisingly, the pleural surface over ribs and intercostal spaces exhibited similar stiffness. In addition, caudal regions exhibited lower stiffness than cranial regions. In the context of elastohydrodynamic lubrication, these results suggest that shear-induced pressures during breathing deform the chest wall and lung surfaces to a similar extent, promoting spatial uniformity of pleural fluid thickness and reducing shear stresses.

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