The Experts below are selected from a list of 309 Experts worldwide ranked by ideXlab platform
Alfredo Garcia - One of the best experts on this subject based on the ideXlab platform.
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severe Restrictive Lung Disease and vertebral surgery in a pediatric population
European Spine Journal, 2009Co-Authors: Jorge Payo, Francisco Sanchez Perezgrueso, N Fernandezbaillo, Alfredo GarciaAbstract:The aim of this study is to describe the outcome of surgical treatment for pediatric patients with forced vital capacity (FVC) <40% and severe vertebral deformity. Few studies have examined surgical treatment in these patients, who are considered to be at a high risk because of their pulmonary Disease, and in whom preoperative tracheostomy is sometimes recommended. Inclusion criteria include FVC <40%, age <19 years and diagnosis of scoliosis. The retrospective study of 24 patients with severe Restrictive Lung Disease, who underwent spinal surgery. Variables studied were age and gender, pre- and postoperative spirometry (FVC, FEV1, FEV1/FVC), preoperative, postoperative and late use of non-invasive ventilation (BiPAP) or mechanical ventilation, associated multidisciplinary treatment, type and location of the curve, pre- and postoperative curve values, type of vertebral fusion, intra- and postoperative complications, duration of intensive care unit (ICU) stay and length of postoperative hospitalization. Mean age was 13 years (9–19) of which 13 were males and 11 females. Mean follow-up was 32 months (24–45). The etiology was neuromuscular in 17 patients and other etiologies in 7 patients. Mean preoperative FVC was 26% (13–39%). Eight patients had preoperative home BiPAP, 15 preoperative in-hospital BiPAP, and 2 preoperative mechanical ventilation. Nine patients had preoperative nutritional support. Preoperative curve value of the deformity was 88° (40°–129°). Nineteen patients with posterior fusion alone and 5 with anterior and posterior fusion were found. Mean duration of ICU stay was 5 days (1–21). Total postoperative hospital stay was 17 days (7–33). Ventilatory support in the immediate postoperative includes 16 patients requiring BiPAP and 2 volumetric ventilation. None of the patients required a tracheostomy. The intraoperative complications include one death due to acute heart failure; immediate postoperative, four respiratory failures (2 required ICU readmission) and one respiratory infection; and other minor complications occurred in six patients. Overall, 58% of patients had complications. Percentage of angle correction was 56%. After a follow-up of 30 months, FVC was 29% (13–50%). In conclusion, corrective scoliosis surgery in pediatric patients with severe Restrictive Lung Disease is well tolerated, but the management of this population requires extensive experience with the vertebral surgery involved, and a multidisciplinary approach that includes pulmonologists, nutritionists and anesthesiologists. Currently, there is no indication for routine preoperative tracheostomy.
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Severe Restrictive Lung Disease and vertebral surgery in a pediatric population
European Spine Journal, 2009Co-Authors: Jorge Payo, Francisco Sanchez Perez-grueso, Nicomedes Fernandez-baillo, Alfredo GarciaAbstract:The aim of this study is to describe the outcome of surgical treatment for pediatric patients with forced vital capacity (FVC)
Matthew G. Hartwig - One of the best experts on this subject based on the ideXlab platform.
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transplant size mismatch in Restrictive Lung Disease
Transplant International, 2017Co-Authors: Asvin M. Ganapathi, Michael S. Mulvihill, Brian R. Englum, Paul J. Speicher, Brian C. Gulack, Asishana A. Osho, Babatunde A. Yerokun, Laurie R. Snyder, D. Davis, Matthew G. HartwigAbstract:To maximize the benefit of Lung transplantation, the effect of size mismatch on survival in Lung transplant recipients with Restrictive Lung Disease (RLD) was examined. All single and bilateral RLD Lung transplants from 1987 to 2011 in the United Network for Organ Sharing (UNOS) Database were identified. Donor predicted total Lung capacity (pTLC):Recipient pTLC ratio (pTLCr) quantified mismatch. pTLCr was segregated into five strata. A Cox proportional hazards model evaluated the association of pTLCr with mortality hazard. To identify a critical pTLCr, a Cox model using a restricted cubic spline for pTLCr was used. A total of 6656 transplants for RLD were identified. Median pTLCr for single orthotopic Lung transplant (SOLT) and bilateral orthotopic Lung transplant (BOLT) was 1.0 (0.69-1.47) and 0.98 (0.66-1.45). Examination of pTLCr as a categorical variable revealed that undersizing (pTLCr <0.8) for SOLT and moderate oversizing (pTLCr = 1.1-1.2) for SOLT and BOLT had a harmful survival effect [for SOLT pTLC <0.8: HR 1.711 (95% CI 1.146-2.557), P = 0.01 and for BOLT pTLC 1.1-1.2: HR 1.717 (95% CI 1.112-2.651), P = 0.02]. Spline analysis revealed significant changes in SOLT mortality by variation of pTLCr between 0.8-0.9 and 1.1-1.2. RLD patients undergoing SOLT are susceptible to detriments of an undersized Lung. RLD patients undergoing BOLT have higher risk of mortality when pTLCr falls between 1.1 and 1.2.
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Transplant size mismatch in Restrictive Lung Disease.
Transplant international : official journal of the European Society for Organ Transplantation, 2017Co-Authors: Asvin M. Ganapathi, Michael S. Mulvihill, Brian R. Englum, Paul J. Speicher, Brian C. Gulack, Asishana A. Osho, Babatunde A. Yerokun, Laurie R. Snyder, D. Davis, Matthew G. HartwigAbstract:To maximize the benefit of Lung transplantation, the effect of size mismatch on survival in Lung transplant recipients with Restrictive Lung Disease (RLD) was examined. All single and bilateral RLD Lung transplants from 1987 to 2011 in the United Network for Organ Sharing (UNOS) Database were identified. Donor predicted total Lung capacity (pTLC):Recipient pTLC ratio (pTLCr) quantified mismatch. pTLCr was segregated into five strata. A Cox proportional hazards model evaluated the association of pTLCr with mortality hazard. To identify a critical pTLCr, a Cox model using a restricted cubic spline for pTLCr was used. A total of 6656 transplants for RLD were identified. Median pTLCr for single orthotopic Lung transplant (SOLT) and bilateral orthotopic Lung transplant (BOLT) was 1.0 (0.69-1.47) and 0.98 (0.66-1.45). Examination of pTLCr as a categorical variable revealed that undersizing (pTLCr
Charles G. Irvin - One of the best experts on this subject based on the ideXlab platform.
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Anatomic Correlates of Reversible Restrictive Lung Disease
Chest, 1993Co-Authors: David A. Kaminsky, Charles G. IrvinAbstract:A 19-year-old woman presented with lifelong asthma. Pulmonary function studies revealed a mixed Restrictive-obstructive pattern, with significantly decreased elastic recoil as demonstrated by a pressure-volume study. Upon administration of inhaled bronchodilator, however, the patient's Lung volume and compliance returned to normal, illustrating the rare phenomenon of reversible Restrictive Lung Disease. Open Lung biopsy revealed respiratory bronchiolitis, confirming the suspected involvement of small airways. Mechanisms of reversible restriction, specifically alveolar duct constriction, are discussed. The authors speculate on the observed relation between anatomic and physiologic abnormalities.
David A. Kaminsky - One of the best experts on this subject based on the ideXlab platform.
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Grading the Severity of Obstruction in Mixed Obstructive-Restrictive Lung Disease
Chest, 2011Co-Authors: Zechariah S. Gardner, Gregg L Ruppel, David A. KaminskyAbstract:Background The severity of obstructive pulmonary Disease is determined by the FEV1 % predicted based on the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. In patients with coexisting Restrictive Lung Disease, the decrease in FEV1 can overestimate the degree of obstruction. We hypothesize that adjusting the FEV1 for the decrease in total Lung capacity (TLC) results in a more appropriate grading of the severity of obstruction. Methods We examined a large pulmonary function test database and identified patients with both Restrictive (TLC Results We identified 199 patients with coexisting Restrictive and obstructive Lung Disease. By ATS/ERS grading, the unadjusted data categorized 76% of patients as having severe or very severe obstruction and 11% as having mild or moderate obstruction. The adjusted data classified 33% with severe or very severe obstruction and 44% with mild or moderate obstruction. Of the corrected values, 83% resulted in a change to less severe obstruction by ATS/ERS guidelines, and 44% and 70% of patients, respectively, would be reclassified as having less severe obstruction by current asthma and COPD guidelines. Conclusions This method results in a more appropriate distribution of severity of obstruction, which should lead to more accurate treatment of obstruction in these patients.
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Anatomic Correlates of Reversible Restrictive Lung Disease
Chest, 1993Co-Authors: David A. Kaminsky, Charles G. IrvinAbstract:A 19-year-old woman presented with lifelong asthma. Pulmonary function studies revealed a mixed Restrictive-obstructive pattern, with significantly decreased elastic recoil as demonstrated by a pressure-volume study. Upon administration of inhaled bronchodilator, however, the patient's Lung volume and compliance returned to normal, illustrating the rare phenomenon of reversible Restrictive Lung Disease. Open Lung biopsy revealed respiratory bronchiolitis, confirming the suspected involvement of small airways. Mechanisms of reversible restriction, specifically alveolar duct constriction, are discussed. The authors speculate on the observed relation between anatomic and physiologic abnormalities.
Ahmed Mohamed Elbadawy - One of the best experts on this subject based on the ideXlab platform.
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Comparative study of mid-thoracic spinal versus epidural anesthesia for open nephrectomy in patients with obstructive/Restrictive Lung Disease: A randomized controlled study
Wolters Kluwer Medknow Publications, 2019Co-Authors: Nazmy Edward Seif, Ahmed Mohamed ElbadawyAbstract:Background: The aim of this randomized controlled study is to compare the safety and efficacy of thoracic spinal versus thoracic epidural anesthesia for open nephrectomy in patients with obstructive/Restrictive Lung Disease. Methods: Sixty patients with mild to moderate chronic obstructive/Restrictive Lung Disease undergoing open nephrectomy were randomized into two groups, 30 patients each. The thoracic spinal group (TSA) group received ultrasound guided mid-thoracic spinal anesthesia, and the thoracic epidural group (TEA) group received thoracic epidural anesthesia. All blocks were performed at the T7-T8. Hemodynamics, visual analogue scale score, sensory and motor block profile as well as any adverse events, and patient satisfaction were all reported. Results: Both blocks were successfully performed and were effective for surgery in all patients, with the exception of only one patient in TSA group who needed to receive general anesthesia even after IV midazolam because of extreme anxiety and was excluded from the study analysis. The sensory block ranges were quiet close, with T2-T5 for the TSA group and T3-T6 for the TEA group as the upper level and L3-L5 as the same lower level. The values for the onset time and the duration of sensory and motor blocks were lower in TSA group. There were no statistically significant differences existed in intraoperative VAS, and hemodynamics between the two groups. Postoperative adverse effects were negligible and insignificant, with no case reporting any neurological sequel. Conclusion: Ultrasound guided thoracic spinal anesthesia can be performed safely and effectively for open nephrectomy in patients with obstructive/Restrictive Lung Disease with the potential for an early ambulation and great patient satisfaction
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comparative study of mid thoracic spinal versus epidural anesthesia for open nephrectomy in patients with obstructive Restrictive Lung Disease a randomized controlled study
Saudi Journal of Anaesthesia, 2019Co-Authors: Nazmy Edward Seif, Ahmed Mohamed ElbadawyAbstract:Background: The aim of this randomized controlled study is to compare the safety and efficacy of thoracic spinal versus thoracic epidural anesthesia for open nephrectomy in patients with obstructive/Restrictive Lung Disease. Methods: Sixty patients with mild to moderate chronic obstructive/Restrictive Lung Disease undergoing open nephrectomy were randomized into two groups, 30 patients each. The thoracic spinal group (TSA) group received ultrasound guided mid-thoracic spinal anesthesia, and the thoracic epidural group (TEA) group received thoracic epidural anesthesia. All blocks were performed at the T7-T8. Hemodynamics, visual analogue scale score, sensory and motor block profile as well as any adverse events, and patient satisfaction were all reported. Results: Both blocks were successfully performed and were effective for surgery in all patients, with the exception of only one patient in TSA group who needed to receive general anesthesia even after IV midazolam because of extreme anxiety and was excluded from the study analysis. The sensory block ranges were quiet close, with T2-T5 for the TSA group and T3-T6 for the TEA group as the upper level and L3-L5 as the same lower level. The values for the onset time and the duration of sensory and motor blocks were lower in TSA group. There were no statistically significant differences existed in intraoperative VAS, and hemodynamics between the two groups. Postoperative adverse effects were negligible and insignificant, with no case reporting any neurological sequel. Conclusion: Ultrasound guided thoracic spinal anesthesia can be performed safely and effectively for open nephrectomy in patients with obstructive/Restrictive Lung Disease with the potential for an early ambulation and great patient satisfaction.