When will pulmonary function recover after rib fracture?

Rib fracture is almost recovered with conservative management including oral medication. Pain is easily controlled with medication, but physiologic function is not readily evaluated. This study is aimed to investigate the factors influencing to recovery of pulmonary function test (PFT) and changes according to times after rib fracture. From August 2015 to January 2018, medical records of patients with rib fracture were reviewed retrospectively. Factors may influencing to recovery of PFT (age, chronic obstructive pulmonary disease, numbers of fractures, intercostal nerve block) were evaluated, and serial (initial, 1 month, 2 months) changes of parameters PFT (forced vital capacity [FVC], forced expiratory volume in 1 sec [FEV1], total lung capacity [TLC], vital capacity [VC]) for 2 months were observed. Total patients were 60, and PFT was completed 38 and 27 patients after 1 month and 2 months respectively. Mean age was 55.1 years (20-84 years) and mean numbers of fracture were 3.98 (1-11). Intercostal nerve block and rib fixation were performed in 32 cases and 2 cases respectively. Age, numbers of fracture and intercostal nerve block were not significant factors to changes of PFT. But chronic obstructive pulmonary disease was significant factor to recovery of FEV1 in 1 month. PFT was improved in FVC, FEV1 through 2 months, and improved in TLC, VC in 1 month. This study showed the evidence and prognosis of physiologic recovery after rib fracture. And we could tell about physiologic recovery to rib fracture patients with this study.

Simple X-ray versus ultrasonography examination in blunt chest trauma: effective tools of accurate diagnosis and considerations for rib fractures.

Simple radiography is the best diagnostic tool for rib fractures caused by chest trauma, but it has some limitations. Thus, other tools are also being used. The aims of this study were to investigate the effectiveness of ultrasonography (US) for identifying rib fractures and to identify influencing factors of its effectiveness. Between October 2003 and August 2007, 201 patients with blunt chest trauma were available to undergo chest radiographic and US examinations for diagnosis of rib fractures. The two modalities were compared in terms of effectiveness based on simple radiographic readings and US examination results. We also investigated the factors that influenced the effectiveness of US examination. Rib fractures were detected on radiography in 69 patients (34.3%) but not in 132 patients. Rib fractures were diagnosed by using US examination in 160 patients (84.6%). Of the 132 patients who showed no rib fractures on radiography, 92 showed rib fractures on US. Among the 69 patients of rib fracture detected on radiography, 33 had additional rib fractures detected on US. Of the patients, 76 (37.8%) had identical radiographic and US results, and 125 (62.2%) had fractures detected on US that were previously undetected on radiography or additional fractures detected on US. Age, duration until US examination, and fracture location were not significant influencing factors. However, in the group without detected fractures on radiography, US showed a more significant effectiveness than in the group with detected fractures on radiography (P=0.003). US examination could detect unnoticed rib fractures on simple radiography. US examination is especially more effective in the group without detected fractures on radiography. More attention should be paid to patients with chest trauma who have no detected fractures on radiography.

Effectiveness of intercostal nerve block for management of pain in rib fracture patients.

Controlling pain in patients with fractured ribs is essential for preventing secondary complications. Conventional medications that are administered orally or by using injections are sufficient for the treatment of most patients. However, additional aggressive pain control measures are needed for patients whose pain cannot be controlled effectively as well as for those in whom complications or a transition to chronic pain needs to be prevented. In this study, we retrospectively analyzed the medical records of patients in our hospital to identify the efficacy and characteristics of intercostal nerve block (ICNB), as a pain control method for rib fractures. Although ICNB, compared to conventional methods, showed dramatic pain reduction immediately after the procedure, the pain control effects decreased over time. These findings suggest that the use of additional pain control methods (e.g. intravenous patient-controlled analgesia and/or a fentanyl patch) is recommended for patients in who the pain level increases as the ICNB efficacy decreases.

Multimodal treatment of primary extraskeletal Ewing's sarcoma of the chest wall: report of 2 cases.

Extraskeletal Ewing's sarcoma (EES) is a type of Ewing's sarcoma that arises in soft tissue and is now regarded as a member of a family of small round cell neoplasms of bone and soft tissue, including primitive neuroectodermal tumors (PNETs). EES occurs predominantly in adolescents and young adults between the ages of 10 and 30 years. The disease follows an aggressive course with a high recurrence rate. The presence of a distant metastasis is also common. EES arises in the soft tissue of either the trunk or extremities. We recently experienced two cases of EES that occurred in the chest wall. The two patients underwent wide resection and combined radiochemotherapy. There was no evidence of disease 30 and 22 months, respectively, after surgery. Although extremely rare, EES should be considered in the differential diagnosis of chest wall tumors. We report two cases of EES with a brief review of the literature.

1,2-bis(2-aminophenoxy)ethane-N,N,N'N'-tetraacetic acid (BAPTA-AM) inhibits caffeine-induced apoptosis in human neuroblastoma cells.

In the present study, it was investigated whether 1,2-bis(2-aminophenoxy)ethane-N,N,N'N'-tetraacetic acid (BAPTA-AM), an intracellular Ca(2+) chelator, possesses protective effect against caffeine-induced apoptosis in the central nervous system. Through morphological and biochemical analyses, cells treated with caffeine exhibited several apoptotic features. On the other hand, cells treated with caffeine and BAPTA-AM, showed decreased occurrence of apoptotic features. In addition, it was shown that BAPTA-AM treatment inhibits caffeine-induced increase of caspase-3 enzyme activity. These results show that caffeine induces apoptotic death in human SK-N-MC neuroblastoma cells and BAPTA-AM prevents apoptosis by attenuating caffeine-induced caspase-3 activation.

Decision of Shunt Insertion Based on Electroencephalography and Stump Pressure During Carotid Endarterectomy

BACKGROUND: Carotid endarterectomy (CEA) is an effective treatment for the prevention of stroke in patients with high grade carotid stenosis. Electroencephalographic (EEG) monitoring and measurement of stump pressure are the most widely used methods for assessing the risk of cerebral ischemia during CEA. We designed this study to assess the usefulness of EEG and stump pressure for shunt insertion during CEA. METHODS: Nineteen patients were enrolled from January, 1996 to April, 1999. We calculated the percent of carotid stenosis in the patients by the NASCET (North American Symptomatic Carotid Endarterectomy Trial) criteria. The inclusion criteria of the CEA were high grade stenosis (>70%), or moderate stenosis (>50%) with ulcerated plaque. Intra-operative monitoring by using stump pres-sure, and an EEG was performed in 19 operations. RESULTS: The number of patients with asymptomatic and sympto-matic carotid stenosis were 6 and 13 respectively. Shunt during the operations was used in 12 patients; nine had both significant EEG changes and low stump pressures, two had only low stump pressure, one patient had only a significant EEG change. The peri-operative complications of mortality and stroke were found in one case. In the other patients, there no stroke recurrences during the mean follow-up period of 24 months. CONCLUSIONS: EEG and stump pressure may be useful in deciding shunt insertion during CEA for detecting ischemic changes.