Ehlers-Danlos Syndrome: It’s Not Your Normal Hoofbeats

The purpose of this article is to acquaint the reader with the presentation, diagnosis, and management of Ehlers-Danlos syndrome (EDS), a group of genetic connective tissue disorders. Progressive weakness of connective tissue is the underlying cause of all types of EDS. The symptoms of EDS are numerous, with variability in presentation. However, decreased quality of life caused by chronic pain and fatigue is a commonality of all types of EDS. This article will assist the nurse practitioner in recognizing EDS and offer guidance for treatment.     

基于肺体表投影的腧穴分类及针刺后气胸的预防

[目的] 对易造成气胸的腧穴进行分类和归纳，以期针灸工作者，尤其是针灸初学者更科学地掌握腧穴的针刺操作，预防气胸发生。[方法] 为了更好地预防针刺后气胸的发生，以腧穴定位和针刺操作为主要着眼点，根据肺体表投影及经穴的分布特点，将可能造成气胸的腧穴分成4大类，基于此从针刺操作角度、方向、深度三要素总结4类穴位的操作要点，并结合文献分析可能引起针刺后气胸或增加发生概率的其他危险因素。 [结果] 第一类位于肺体表投影内的腧穴，包括8条经、39个腧穴及1个经外奇穴，针刺操作要点在于不能直刺深刺。第二类位于肺体表投影边缘的腧穴，包括4条经、5个腧穴及11个经外奇穴，针刺操作要点在于不能朝肺深刺。第三类位于肺体表投影附近，包括6条经和10个腧穴，针刺操作要点在于不能朝肺深刺。第四类位于肩胛骨之上的腧穴，包括2条经和4个腧穴，针刺操作要点在于以直刺为主。文献分析发现，肺部基础疾病可增加针刺后气胸风险。 [结论] 在准确掌握肺脏解剖和经穴定位的基础上，严格规范针刺操作，了解患者肺部基础疾病，可最大程度地避免针刺后气胸的发生。     

A case of recurrent pneumothorax related to oral methylphenidate

Primary spontaneous pneumothorax (PSP) commonly occurs in young, tall, and thin males, without any identifiable cause except for emphysema-like changes (ELCs). However, other risk factors may be overlooked. Herein, we report the case of a 19-year-old male who presented with recurrent spontaneous pneumothorax while taking oral methylphenidate.     

胸腔镜治疗老年自发性气胸的临床研究与感染预防

目的探讨胸腔镜和传统开胸手术治疗老年自发性气胸的临床疗效,降低手术感染率。方法 2010年6月-2012年6月共收治老年自发性气胸患者80例,随机分为观察组和对照组各40例,观察组患者给予胸腔镜治疗,对照组患者给予传统的开胸手术进行治疗;分析比较两组患者的术中出血量、术后引流时间及引流量、平均手术时间、平均住院时间、术后镇痛剂使用时间等主要指标、手术前后的肺功能改善及感染率,总结围术期感染预防方法。结果两组的术中出血量、平均手术时间、平均住院天数和术后胸腔引流时间及引流量相比,差异有统计学意义(P<0.05);术后2周观察组患者肺功能改善明显优于对照组(P<0.05),术后4周两组比较差异无统计学意义;观察组患者共发生2例感染,感染率为5.0%,对照组共发生5例感染,感染率为12.5%,两组比较差异有统计学意义(P<0.05)。结论胸腔镜治疗在辨证施治的同时满足了微创的要求,是老年自发性气胸患者、特别是心肺功能较差者的首选治疗方法,该方法较之于传统开胸手术治疗,其术后感染率明显降低,但仍应重视围术期感染的预防工作。     

A chest drainage system with a real-time pressure monitoring device

Background

Tube thoracostomy is a common procedure. A chest bottle may be used to both collect fluids and monitor the recovery of the chest condition. The presence of the “tidaling phenomenon” in the bottle can be reflective of the extent of patient’s recovery.

Objectives

However, current practice essentially depends on gross observation of the bottle. The device used here is designed for a real-time monitoring of change in pleural pressure to allow clinicians to objectively determine when the lung has recovered, which is crucially important in order to judge when to remove the chest tube.

Methods

The device is made of a pressure sensor with an operating range between −100 to +100 cmH₂O and an amplifying using the “Wheatstone bridge” concept. Recording and analysis was performed with LABview software. The data can be shown in real-time on screen and also be checked retrospectively. The device was connected to the second part of a three-bottle drain system by a three-way connector.

Results

The test animals were two 40-kg pigs. We used a thoracoscopic procedure to create an artificial lung laceration with endoscopic scissors. Active air leaks could result in vigorous tidaling phenomenon up to 20 cmH₂O. In the absence of gross tidaling phenomenon, the pressure changes were around 0.25 cmH₂O.

Conclusions

This real-time pleural pressure monitoring device can help clinicians objectively judge the extent of recovery of the chest condition. It can be used as an effective adjunct with the current chest drain system.     

电视胸腔镜与传统开胸手术治疗外伤性血气胸的效果比较

目的 比较电视胸腔镜(VATS)和传统开胸手术治疗外伤性血气胸的临床效果.方法 血气胸患者41例随机分为实验组和对照组,对照组26例,采用传统开胸手术方法;实验组15例,采用VATS治疗,对两组患者一般临床资料、术中出血量、手术时间、术后胸管放置时间、术后引流量等进行比较.结果 41例患者均无手术死亡、二次开胸止血,术后均未呼吸机辅助呼吸.实验组术中出血量[(176.5 ±78.5) ml]明显少于对照组[(401.3±90.7)ml],手术时间[实验组(64.7-±21.3) min,对照组(129.4±30.3) min]、术后胸管放置时间[实验组(2.3±0.9)d,对照组(4.5±1.0)d]、住院时间[实验组(9.1±2.1)d,对照组(12.7±2.2)d]及术后并发症发生率等方面均少于对照组,两组比较差异有统计学意义(P＜0.05).结论 VATS治疗外伤性血气胸与传统开胸手术比较,诊断快速准确,安全可靠,并发症少.     

胸腔镜术后复发性气胸的再次胸腔镜手术治疗

目的 探讨再次胸腔镜手术治疗胸腔镜术后复发性气胸的可行性.方法 2009年1月～2012年11月对77例胸腔镜手术后复发性气胸再次胸腔镜手术治疗,行粘连松解、肺大疱切除、胸膜固定、闭式引流等.结果 77例均在胸腔镜下顺利完成手术,术中见胸腔均有较重粘连,无术中大出血及围术期死亡等严重并发症.手术时间35 ～87 min,(59±12)min;术中出血量30 ～160 ml,(92±33)ml.77例随访1～46个月,(22±13)月,无气胸复发.结论 术后复发性气胸再次胸腔镜手术可行、安全、有效,术中应选择性地松解胸腔粘连.     

Bronchoscopic Lung Volume Reduction: A New Hope for Patients With Severe Emphysema and Air Trapping

Chronic obstructive pulmonary disease (COPD) is common and has significant morbidity and mortality as the fourth leading cause of death in the United States. In many patients, particularly those with emphysema, COPD is characterized by markedly increased residual volume contributing to exertional dyspnea. Current therapies have limited efficacy. Surgical resection of diseased areas of the lung to reduce residual volume was effective in identified subgroups but also had significant mortality in and suboptimal cost effectiveness. Lung-volume reduction, using bronchoscopic techniques, has shown substantial benefits in a broader patient population with less morbidity and mortality. This review is meant to spread the awareness about bronchoscopic lung-volume reduction and to promote its consideration and early referral for patients with advanced COPD and emphysema frequently encountered by both primary care physicians and specialists. A search was conducted on PubMed (MEDLINE), EMbase, and Cochrane library for original studies, using the following keywords: “lung-volume reduction.” “endobronchial valves,” “intrabronchial valves,” “bronchoscopic lung-volume reduction,” and “endoscopic lung-volume reduction.” We included reports from systematic reviews, narrative reviews, clinical trials, and observational studies. Two reviewers evaluated potential references. A total of 27 references were included in our review. Included studies report experience in the diagnosis and bronchoscopic treatment for emphysema; case reports and non-English or non-Spanish studies were excluded.