. Friedman, Kevin G; Kane, David A; Rathod, Rahul H; Renaud, Ashley; Farias, Michael; Geggel, Robert; Fulton, David R; Lock, James E; Saleeb, Susan F 2011-08-01 Chest pain is a common reason for referral to pediatric cardiologists and often leads to an extensive cardiac evaluation. The objective of this study is to describe current management practices in the assessment of pediatric chest pain and to determine whether a standardized care approach could reduce unnecessary testing. We reviewed all patients, aged 7 to 21 years, presenting to our outpatient pediatric cardiology division in 2009 for evaluation of chest pain.

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Demographics, clinical characteristics, patient outcomes, and resource use were analyzed. Testing included electrocardiography (ECG) in all 406 patients, echocardiography in 175 (43%), exercise stress testing in 114 (28%), event monitoring in 40 (10%), and Holter monitoring in 30 (7%). A total of 44 (11%) patients had a clinically significant medical or family history, an abnormal cardiac examination, and/or an abnormal ECG. Exertional chest pain was present in 150 (37%) patients.

In the entire cohort, a cardiac etiology for chest pain was found in only 5 of 406 (1.2%) patients. Two patients had pericarditits, and 3 had arrhythmias.

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We developed an algorithm using pertinent history, physical examination, and ECG findings to suggest when additional testing is indicated. Applying the algorithm to this cohort could lead to an ∼20% reduction in echocardiogram and outpatient rhythm monitor use and elimination of exercise stress testing while still capturing all cardiac diagnoses. Evaluation of pediatric chest pain is often extensive and rarely yields a cardiac etiology. Practice variation and unnecessary resource use remain concerns. Targeted testing can reduce resource use and lead to more cost-effective care.

Huhta, J.C. 1986-01-01 In this book the author spells out new diagnostic applications in pediatrics for high resolution cross-sectional ultrasonography, and demonstrates the ways in which Doppler techniques complement the cross-sectional method. This reference presents practical, step-by-step methods for non-invasive ultrasound examination of extra-cardiac anatomy and assessment of vascular blood flow. Ma, Yi-Chun; Peng, Ching-Tien; Huang, Yu-Chuen; Lin, Hung-Yi; Lin, Jaung-Geng 2015-01-01 Background. Acupuncture is applied to treat numerous diseases in pediatric patients.

Few reports have been published on the depth to which it is safe to insert needle acupoints in pediatric patients. We evaluated the depths to which acupuncture needles can be inserted safely in chest acupoints in pediatric patients and the variations in safe depth according to sex, age, body weight, and body mass index (BMI). We retrospectively studied computed tomography (CT) images of pediatric patients aged 4 to 18 years who had undergone chest CT at China Medical University Hospital from December 2004 to May 2013. The safe depth of chest acupoints was directly measured from the CT images. The relationships between the safe depth of these acupoints and sex, age, body weight, and BMI were analyzed. The results demonstrated significant differences in depth among boys and girls at KI25 (kidney meridian), ST16 (stomach meridian), ST18, SP17 (spleen meridian), SP19, SP20, PC1 (pericardium meridian), LU2 (lung meridian), and GB22 (gallbladder meridian).

Safe depth significantly differed among the age groups (P 0.08-p 1.0). However, one important difference in the two cohorts was that upper lobe infiltrates occurred exclusively in the pediatric group (p = 0.06).

There was a statistically significant (p 4 weeks) cough (KQ 1) are the common etiologies different from those in adults? (KQ 2) Are the common etiologies age or setting dependent, or both? (KQ 3) Is OSA a cause of chronic cough in children? Spf se 8 0 download diya.

We used the CHEST Expert Cough Panel's protocol and the American College of Chest Physicians ( CHEST) methodological guidelines and Grading of Recommendations Assessment, Development, and Evaluation framework. Data from the systematic reviews in conjunction with patients' values and preferences and the clinical context were used to form recommendations. Delphi methodology was used to obtain consensus. Combining KQs 1 and 2, we found moderate-level evidence from 10 prospective studies that the etiologies of cough in children are different from those in adults and are setting dependent.

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Data from three studies found that common etiologies of cough in young children were different from those in older children. However, data relating sleep abnormalities to chronic cough in children were found only in case studies. There is moderate-quality evidence that common etiologies of chronic cough in children are different from those in adults and are dependent on age and setting. As there are few data relating OSA and chronic cough in children, the panel suggested that these children should be managed in accordance with pediatric sleep guidelines.

Copyright © 2017. Published by Elsevier Inc. Main, E; Prasad, A; Schans, C 2005-01-25 Cystic fibrosis is an inherited life-limiting disorder, characterised by pulmonary infections and thick airway secretions. Chest physiotherapy has been integral to clinical management in facilitating removal of airway secretions. Conventional chest physiotherapy techniques (CCPT) have depended upon assistance during treatments, while more contemporary airway clearance techniques are self-administered, facilitating independence and flexibility. To compare CCPT with other airway clearance techniques in terms of their effects on respiratory function, individual preference, adherence, quality of life and other outcomes.

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group trials register which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched CINAHL from 1982 to 2002 and AMED from 1985 to 2002.

Date of most recent search: January 2004. Randomised or quasi-randomised clinical trials including those with a cross-over design where CCPT was compared with other airway clearance techniques. Studies of less than seven days duration were excluded. Two reviewers allocated quality scores to relevant studies and independently extracted data. If we were unable to extract data, we invited authors to submit their data. We excluded studies from meta-analysis when data were lost or study design precluded comparison.

For some continuous outcomes, we used the generic inverse variance method for meta-analysis of data from cross-over trials and data from parallel-designed trials were incorporated for comparison. We also examined efficacy of specific techniques and effects of treatment duration.

Seventy-eight publications were identified by the searches. Twenty-nine of these were included, representing 15 data sets with 475 participants. There was no difference between CCPT and other airway clearance techniques in terms of respiratory function. Hayashi, Tamaki; Sakurai, Yoshihiko; Fukuda, Kazuyoshi; Yada, Koji; Ogiwara, Kenichi; Matsumoto, Tomoko; Yoshizawa, Hiroyuki; Takahashi, Yukihiro; Yoshikawa, Yoshiro; Hayata, Yoshihiro; Taniguchi, Shigeki; Shima, Midori 2011-08-01 Systemic coagulation disorders after cardiac surgery represent serious postoperative complications.

There have been few reports, however, identifying preoperative coagulation tests that predict postoperative bleeding. The aim of the present study was to investigate the relationship between postoperative hemorrhage and coagulation parameters determined by global coagulation assays, to define potential predictive markers. Twenty-one pediatric patients were enrolled.

Blood samples were collected before and 24 h after cardiac surgery. Laboratory investigations included platelet count, hematocrit, classical coagulation tests prothrombin time, activated partial thromboplastin time, thrombin-antithrombin complex (TAT), rotation thromboelastometry (ROTEM), and the thrombin generation test (TGT). The duration of the surgical procedure was recorded. Chest tube drainage was monitored for 24 h after operation as an index of postoperative hemorrhage. Comparisons between preoperative and postoperative results indicated that TAT increased significantly after operation, whereas ROTEM parameters did not show a hypercoagulable pattern.

Preoperative endogenous thrombin potential (ETP) measured in the TGT and clot formation time (CFT) in the ROTEM correlated with chest tube drainage. The classical coagulation tests were not informative. Postoperatively, peak height and ETP in TGT, all ROTEM parameters, and duration of surgery were correlated with chest tube drainage. Duration of surgery was correlated with postoperative ROTEM parameters but not with TGT. Postoperative maximum clot firmness and AUC were correlated with platelet count decrease ratio.

The preoperative CFT and ETP provide useful indices for predicting postoperative chest tube drainage volume. In addition, the duration of surgery also correlated with chest tube drainage and affected ROTEM parameters. © 2011 Blackwell Publishing Ltd. Clinkscale, Darnetta; Spihlman, Kathleen; Watts, Peggy; Rosenbluth, Daniel; Kollef, Marin H 2012-02-01 Conventional chest physical therapy (CCPT), applied by therapists using cupped hands to perform percussion, is commonly used in hospitalized adults. However, increased work load demands and occupational health concerns (eg, carpal tunnel syndrome) limit the overall utilization of this therapy. Therefore, we conducted a study to compare the overall effectiveness of CCPT to high-frequency chest wall compressions (HFCWC) applied via a vibratory vest.

A single-center, randomized trial among hospitalized intubated and non-intubated adult patients requiring chest physical therapy comparing CCPT and HFCWC. The primary outcome measure was hospital stay. A total of 280 per-protocol patients (out of an a priori estimated 320 patients required to demonstrate a 20% relative reduction in hospital stay) were randomly assigned to receive CCPT (no. = 146, 52.1%) or HFCWC (no. = 134, 47.9%). The hospital stay was 12.5 ± 8.8 days for patients randomized to CCPT and 13.0 ± 8.9 days for patients randomized to HFCWC (P =.62). Patient comfort was assessed using a visual analog scale (increasing score reflects greater discomfort) and was statistically greater for patients randomized to CCPT compared to HFCWC (2.2 ± 0.8 vs 1.9 ± 0.8, P =.009).

The duration of time until radiographic resolution of lobar atelectasis trended less for CCPT compared to HFCWC (5.2 ± 4.3 d vs 6.5 ± 5.2 d, P =.051). All other secondary outcomes, including hospital mortality and nosocomial pneumonia, were similar for both treatment groups. This study was inadequately powered for the primary outcome of interest and hence we cannot make recommendations on the preferential use of HFCWC or CCPT for intubated and non-intubated adult patients.

HFCWC was associated with statistically better comfort scores. (ClinicalTrials.gov registration NCT00717873.). Seidenbusch, M C; Schneider, K 2015-07-01 Radiation safety in conventional X-ray diagnostics is based on the concepts of justification, optimization of an X-ray examination and limitation of the radiation exposure achieved during the examination. Optimization of an X-ray examination has to be considered as a multimodal process in which all technical components of the X-ray equipment have to be adapted to each other and also have to be adapted to the anthropometric characteristics of patients and the clinical indications.

In this article the technical components of a conventional pediatric chest X-radiograph are presented, and recommendations for optimizing chest X-rays in children are provided. The following measures are of prime importance: correct x-ray beam limitation, using the posteroanterior projection when possible and not using anti-scatter grids in children under approximately 8 years old. In pediatric radiology chest x-rays that are taken not at the peak of inspiration can also be of some diagnostic significance. Optimization of an X-ray examination inevitably results in the limitation of radiation exposure. Causes Chest pain can also be caused by: Panic attack. If you have periods of intense fear accompanied. Fear of dying, you may be experiencing a panic attack.

Caused by a reactivation of the chickenpox. News Physician Resources Professions Site Index A-Z X-ray (Radiography) - Chest Chest x-ray uses a very. Limitations of Chest Radiography? What is a Chest X-ray ( Chest Radiography)? The chest x-ray is the. Silva, Michael Da; Lew, Cheryl D; Lundy, Laura; Lang, Kellie R; Melamed, Irene; Shaul, Randi Zlotnik 2016-01-01 This article provides support for the use of a particular international human rights law document, the U.N. Convention on the Rights of the Child (CRC), in contemporary pediatric bioethics practice without relying on the legally binding force of the document.

It first demonstrates that the CRC's core commitments and values substantially overlap with the core commitments and values of mainstream bioethics and with the laws of many domestic jurisdictions where mainstream bioethics are currently practiced. It then explores some implications of this overlap. For instance, the substantial international human rights law scholarship on how to understand these commitments and values can be helpful in suggesting ways to operationalize them in domestic bioethics practice and can offer insightful, internationally generated ethical perspectives that may not have been considered. The article also argues that the CRC can help health-care organizations develop policies consistent with the best interests of children and that the CRC can serve as a common language of values for transnational health-care collaborations. However, as a final case discussion demonstrates, whatever the merits of the CRC, one may face practical difficulties in trying to use it. Balmes, John R. 1992-01-01 The Council on Scientific Affairs of the California Medical Association presents the following inventory of items of progress in chest diseases.

Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome, and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, researchers, or scholars to stay abreast of these items of progress in chest diseases that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another. The items of progress listed below were selected by the Advisory Panel to the Section on Chest Diseases of the California Medical Association, and the summaries were prepared under its direction. PMID:1441468.

Budassi, S A 1978-09-01 For any patient with obvious or suspected chest trauma, one must first assure an adequate airway and adequate ventilation. One should never hesitate to administer oxygen to a victim with a chest injury. The nurse should be concerned with adequate circulation-this may mean the administration of intravenous fluids, specifically volume expanders, via large-bore cannulae. Any obvious open chest wound should be sealed, and any fractures should be splinted. These patients should be rapidly transported to the nearest Emergency Department capable of handling this type of injury.

The majority of patients who arrive in the Emergency Department following blunt or penetrating trauma should be considered to be in critical condition until proven otherwise. On presentation, it is essential to recognize those signs, symptoms, and laboratory values that identify the patient's condition as life-threatening. Simple recognition of these signs and symptoms and early appropriate intervention may alter an otherwise fatal outcome.

Lee, Julia; Sanchez, Thomas Ray; Zhang, Yanhong; Jhawar, Sanjay 2015-01-01 Interstitial lung disease (ILD) is rare in infancy or early childhood. Differentiating between the different types of ILD is important for reasons of treatment, monitoring of clinical course and prognosis. We present a case of a 5-month old female with tachypnea and hypoxemia. The clinical suspicion of neuroendocrine cell hyperplasia of infancy (NEHI) was confirmed by high-resolution chest CT and subsequent lung biopsy. We conclude that high-resolution chest CT has characteristics findings that can be used as a non-invasive test to support the clinical diagnosis of neuroendocrine cell hyperplasia of infancy. Hayden, C.K. Jr.; Swischuk, L.E.

1987-01-01 Two leading experts explore the benefits and limitations of pediatric ultrasonography, explaining the latest techniques for optimal imaging of specific body regions: the head, chest, abdomen, pelvis, extremities, and soft tissues. Numerous illustrations emphasize significant points and combine with the text to show specifically what to look for when imaging children. By Image/Video Gallery Your radiologist explains chest x-ray. Transcript Welcome to Radiology Info dot org!

You about chest radiography also known as chest x-rays. Chest x-rays are the most commonly performed.

Johnsson, Ase Allansdotter; Vikgren, Jenny; Bath, Magnus 2014-02-01 The recent implementation of chest tomosynthesis is built on the availability of large, dose-efficient, high-resolution flat panel detectors, which enable the acquisition of the necessary number of projection radiographs to allow reconstruction of section images of the chest within one breath hold. A chest tomosynthesis examination obtains the increased diagnostic information provided by volumetric imaging at a radiation dose comparable to that of conventional chest radiography. There is evidence that the sensitivity of chest tomosynthesis may be at least three times higher than for conventional chest radiography for detection of pulmonary nodules.

The sensitivity increases with increasing nodule size and attenuation and decreases for nodules with subpleural location. Differentiation between pleural and subpleural lesions is a known pitfall due to the limited depth resolution in chest tomosynthesis. Studies on different types of pathology report increased detectability in favor of chest tomosynthesis in comparison to chest radiography. The technique provides improved diagnostic accuracy and confidence in the diagnosis of suspected pulmonary lesions on chest radiography and facilitates the exclusion of pulmonary lesions in a majority of patients, avoiding the need for computed tomography (CT).

However, motion artifacts can be a cumbersome limitation and breathing during the tomosynthesis image acquisition may result in severe artifacts significantly affecting the detectability of pathology. In summary, chest tomosynthesis has been shown to be superior to chest conventional radiography for many tasks and to be able to replace CT in selected cases. In our experience chest tomosynthesis is an efficient problem solver in daily clinical work. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Kundel, Harold L.; Seshadri, Sridhar B.; Langlotz, Curtis P.; Lanken, Paul N.; Horii, Steven C.; Polansky, Marcia; Kishore, Sheel; Finegold, Eric; Brikman, Inna; Bozzo, Mary T.; Redfern, Regina O. 1995-05-01 The purpose of this study was to compare the efficiency of image delivery, the effectiveness of image information transfer, and the timeliness of clinical actions in a medical intensive care unit (MICU) using either conventional screen-film imaging (SF-HC), computed radiography (CR-HC) or a CR based PACS. When the CR based PACS was in use, images could be viewed in the MICU on digital workstation (CR-WS) or in the radiology department as laser printed hard copy (CR-HC). Data were collected by daily interviews with the house-staff, by monitoring computer log-ons and other time stamped activities, and by observing film viewing times in the radiology department with surveillance cameras.

The time at which image information was made available to the MICU physicians was decreased during the CR-PACS period as compared with either the SF-HC periods or the CR-HC periods but the image information was not accessed more quickly by the clinical staff. However, the time required to perform image related clinical actions for pulmonary and pleural problems was decreased when images were viewed on the workstation. Till, Holger; Basharkhah, Ali; Hock, Andras 2016-10-01 Conventional laparoscopy (CL) using 3-5 mm ports has become the goldstandard for pediatric nephrectomy (N), heminephrectomy (HN) and heminephrecto-ureterectomy (HNU) for many years now. Recently the spectrum of minimal invasive surgery (MIS) has been extended by variants like laparoendoscopic single-site surgery (LESS) or robot-assisted surgery (RAS). However such technical developments tend to drive surgical euphoria and feasibility studies, but may miss adequate academic research about function and proven patients' benefits. This article delivers a comprehensive analysis of present pediatric studies comparing at least two MIS approaches to N, HN and HNU.

A systematic literature-based search for studies published between 2011-2016 about CL versus LESS or RAS for pediatric N, HN, and HNU was performed using multiple electronic databases and sources. The level of evidence was determined using the Oxford Centre for Evidence-based Medicine (OCEBM) criteria. Single arm observational studies about N, HN or HNU using CL, LESS or RAS as well as publications including adult patients were excluded. A total of 11 studies met defined inclusion criteria, reporting on CL versus LESS or RAS. No studies of OCEBM Level 1 or 2 were identified. Performing CL for N and HN limited evidence indicated reduced analgesic requirements and shorter hospital stay over open surgery, but longer operating time.

Preservation of renal function of the remaining moiety after CL-HN was 95%. Importantly, of patients losing their remaining moiety, median age at surgery was 9 months (range, 4-42 months), and all except 1 (6/7) had an upper pole HN. Several authors compared TNP versus RPN access for CL and confirmed a longer operating time for RPN versus TPN-NU. Moreover one study reported a longer ureteric stump in RPN versus TPN-HNU (range, 2-5 cm vs. Disadvantages of LESS or RAS over CL were longer operative time and higher total costs (RAS). There were no differences regarding complications.

Dan, Posa Ioan; Florin, Georgescu Remus; Virgil, Ciobanu; Antonescu, Elisabeta 2011-09-01 The place of the study is a pediatrics clinic which realizes a great variety of emergency, ambulatory ad hospital examinations. The radiology compartment respects work procedures and a system to ensure the quality of X ray examinations.

The results show a constant for the programmator of the digital detector machine for the tension applied to the tube. For the screen-film detector machine the applied tension increases proportionally with the physical development of the child considering the trunk thickness. Dan, Posa Ioan; Florin, Georgescu Remus; Virgil, Ciobanu; Antonescu, Elisabeta 2011-09-14 The place of the study is a pediatrics clinic which realizes a great variety of emergency, ambulatory ad hospital examinations. The radiology compartment respects work procedures and a system to ensure the quality of X ray examinations. The results show a constant for the programmator of the digital detector machine for the tension applied to the tube. For the screen-film detector machine the applied tension increases proportionally with the physical development of the child considering the trunk thickness.

Chest drainage tube insertion; Insertion of tube into chest; Tube thoracostomy; Pericardial drain. When your chest tube is inserted, you will lie on your side or sit partly upright, with one arm over your head. This page from the NHLBI on Twitter. Chest X Ray A chest x ray is a fast and painless imaging test that. Tissue scarring, called fibrosis. Doctors may use chest x rays to see how well certain treatments are working. Inside of the chest cavity.

Chest injuries and disorders include Heart diseases Lung diseases and collapsed lung Pleural disorders Esophagus disorders Broken ribs Thoracic aortic aneurysms Disorders. Computed tomography angiography - thorax; CTA - lungs; Pulmonary embolism - CTA chest; Thoracic aortic aneurysm - CTA chest; Venous thromboembolism - CTA lung; Blood clot - CTA lung; Embolus - CTA lung; CT. McDonnell, Cassandra J.; White, Kamila S.; Grady, R. Mark 2012-01-01 Pediatric NCCP may be characterized by recurrent pain accompanied by emotional distress and functional impairment. This paper reviews and critiques literature on pediatric noncardiac chest pain (NCCP) and introduces a theoretical conceptualization to guide future study of NCCP in children and adolescents.

A developmentally informed biopsychosocial. McDonnell, Cassandra J.; White, Kamila S.; Grady, R.

Mark 2012-01-01 Pediatric NCCP may be characterized by recurrent pain accompanied by emotional distress and functional impairment. This paper reviews and critiques literature on pediatric noncardiac chest pain (NCCP) and introduces a theoretical conceptualization to guide future study of NCCP in children and adolescents. A developmentally informed biopsychosocial.