Chest Roentgenogram Research Articles

PREVALENCE OF SICK EUTHYROID SYNDROME IN NON-THYROIDAL ILLNESS

INTRODUCTION: Sick euthyroid syndrome is also known as low triiodothyronine (T3) syndrome or non-thyroidal illness syndrome which is characterized by alterations in the levels of thyroid hormones in the absence of any disorder related to thyroid gland or hypothalamic-hypophysial axis. Abnormal findings on thyroid functions tests which occur in the setting of a non thyroidal illness (NTI) without preexisting hypothalamic-pituitary and thyroid gland dysfunction. In the 1970s initially described low T3 (triiodothyronine) syndrome, known as the euthyroid sick syndrome or the nonthyroidal illness syndrome (NTIS). This can be representing especially in in critically ill patients, particularly those admitted to intensive care units. Although by definition these abnormalities are not related to intrinsic diseases of hypothalamus-pituitary-thyroid axis though rather represent imbalances in thyroid hormone production, metabolism, and action. As there is progress in illness gradual development of a more complex syndrome associated with low levels of T3 and thyroxine (T4). AIM: The main objective of this study is to study clinical profile sick euthyroid syndrome in Non-thyroidal Illness. MATERIAL AND METHODS: Total 60 patients were included in this study with the diagnosis of euthyroid syndrome with suggestive of Non-thyroidal Illness. From all the patients detail history were recorded as data as well as all the necessary lab investigations were recorded as hemogram, renal function test, liver function test, ECG, Chest roentgenogram, and thyroid function status and serum cholrine esterase. RESULT: Total 60 patients were including in this study within the period of study with different age group. Patients with age group 20-30 years age group shows majority followed by age group 30-40 years age group as 33.3% and 30% respectively. Among the 60 patients only 15 patients were observed as sick Euthyroid. Out of 15 patients with sick Euthyroid 60% showed Low T3 alone and 40% shows changes in T3, T4 & TSH Levels. CONCLUSION: Non-thyroidal illness syndrome is common among male in comparisons to female with the middle ages. Since the mechanism of sick euthyroid syndrome is similar to sick euthyroid syndrome in other critical care illnesses. Therefore more and more studies should be done for the better evaluation of the prognostic value of NTIS in critically ill. Thyroid functions should be assessed routinely in patients for prevent of Non-thyroidal illness syndrome. 
 KEYWORDS: sick euthyroid syndrome, Non-thyroidal Illness, Thyroid

Round atelectasis in sarcoidosis


 
 
 Round atelectasis is a benign inflammatory condition most frequently observed in patients with asbestos exposure but it can also result from a variety of chronic pleural diseases like infection. It has not previously been described in sarcoidosis. We report the occurrence of round atelectasis in four previ- ously diagnosed sarcoidosis patients who were under follow up at our outpatient clinic. Three patients had symptoms con- sisting of thoracic pain, dry cough and sensation of fullness at the posterior thorax, respectively. Chest roentgenogram showed subpleural or pleural based opacity with diameters ranging from 2 to 3 cm in each of the patients. Chest comput- erized tomography (CT) revealed features of round atelecta- sis. Fiberoptic bronchoscopy with transbronchial lung biopsy was performed. Diagnosis was confirmed by the histopatho- logic examination of the biopsy samples. The mechanical influence of a prior pleural effusion due to sarcoidosis may be the predominant mechanism underlying the onset of round atelectasis in these patients. Clinicians should bear in mind the possibility of sarcoidosis as an etiologic factor for round atelectasis.
 
 

Transcatheter occlusion of giant congenital coronary cameral fistulae: a case series

BackgroundA coronary cameral fistula is a rare connection between a coronary artery and a cardiac chamber or vein bypassing the cardiac capillary bed system. Most of these fistulae are congenital and solitary, although they can be acquired and multiple.Cases presentationCase 1: A 10-year-old black South African boy presented with a long-standing history of fatigue; he had a heart murmur, and a bounding pulse and wide pulse pressure. An echocardiogram demonstrated a large coronary cameral fistula involving his left coronary artery and his left ventricle. This was also confirmed on ascending aortogram. Surgical ligation was done and his symptoms improved afterward, but a small residual fistula remained. Case 2: A 7-year-old black South African boy had decreased effort tolerance and a heart murmur on the mid-sternal border. He had cardiomegaly on chest roentgenogram and a dilated left coronary artery origin on echocardiogram. An ascending aortogram confirmed a large left coronary cameral fistula draining to the left ventricle. Case 3: A 28-year-old black South African woman with decreased effort tolerance and chest pain on exertion had a continuous murmur over the lower sternal border. Echocardiography demonstrated a dilated right coronary artery with a fistulous connection to her right ventricle. An ascending aortogram demonstrated a tortuous coronary cameral fistula arising from her right coronary artery to her right ventricle. All three patients were successfully treated percutaneously using the Amplatzer vascular plug type II device.ConclusionThe availability of numerous vascular closure devices has made transcatheter occlusion the treatment of choice for the majority of coronary cameral fistulae, rather than the traditional surgical ligation.

P4696Short- and long-term follow-up of 1024 Children with transcatheter closure of ventricular septal defects: A Single center Study

Abstract Objective To investigate the safety, efficacy and long-term prognosis of pediatric patients after percutaneous ventricular septal defect (VSD) closure. Method A total of 1024 children with VSD in were enrolled. All children underwent transthoracic echocardiography (TTE), electrocardiogram (ECG) and chest roentgenogram before and after the treatment. Follow-up evaluation was done at 1, 3, 6, 12 months. Results 1. 40 of 1024 patients gave up TC after angiography. Successful closure of VSD was achieved in 94.9% (934/984). 2. The defect were successfully occluded in 934 children. 939 VSD devices were implanted, 5 patients received 2 occluders. The average diameter of occluder was 6.40±2.13mm (3.00–18.00mm), and the mean operation time was 86.81±41.85min (30.00–360.00min). 3. Short postoperative complications were as follows: diffuse subarachnoid hemorrhage (1/934, 0.11%), high or complete atrioventricular block (1/934, 0.32%), mechanical hemolysis occurred (18/934, 1.93%). Moreover, the conduction disturbances included complete left bundle branch block (15/934, 1.61%), incomplete right bundle branch block (144/934, 15.42%), borderline rhythm (48/93, 45.14%), and complete right bundle branch block (44/934, 4.71%), left anterior branch block (27/934, 2.89%), premature contraction (21/934, 2.36%), ST-T segment changes (12/934, 1.28%). 4. The follow-up time ranged from1 to 192 months with the median time 36 months (12, 60) and the follow-up rate was 84.1% (795/934). There was no difference of mean left ventricular size between normal outpatients and patients accepted TC for more than 10 years (4.50±0.30cm V.S. 4.57±0.35cm, t=1.171, P=0.251). 5. New complications included III°AVB (1 case), CLBBB (1 case), ARs (27 cases) and residual shunt (12 cases). The operation age, the distance from defect to valve, the occluder diameter, the asymmetrical occluder and follow-up duration were associated risk factors of AR (OR= 4.107, 5.30, 3.824, 6.750, 9.625, P=0.033, 0.015, 0.045, 0.020, 0.000, respectively). The difference of occluder diameter, defect size and follow-up time were related risk factors of residual shunt (OR=7.000, 5.417, 11.333, 29.250, P=0.012, 0.037, 0.031, 0.000, respectively). 6. The patients were divided into 4 groups (∼3 years group, 3 ∼ 4 years group, 4∼ 6 years group, and 6∼ 18 years group. No significant differences of the success rate, defect size, operation time, incidence rate of short- and long-term complications rate. There was significantly difference of short complications incidence rate in 4 groups (c2=23.431 P=0.000). Conclusions The TC has a high successful rate in the pediatric patients with VSD. Patients with CLBBB or III°AVB can return to normal in the early stage after operation, but may recur during follow-up period. There is no significant difference in the successful rate and the incidence rate of long-term complications between patients <3 years and children ≥3 years old. Acknowledgement/Funding Taishan scholars (no. ts201511099)

Omitting Chest Tube Drainage after Subxiphoid Thoracoscopic Thymectomy.

This study investigated the feasibility and safety of omitting chest tube drainage after subxiphoid thoracoscopic thymectomy. From July 2018 through October 2018, 20 patients underwent subxiphoid thoracoscopic thymectomy without chest tube drainage. The clinical characteristics and perioperative outcomes of these patients are presented. All patients (10 males, 10 females; average age: 53.25 ± 12.50 years old) completed the operation. Chest tube drainage was omitted in a total of 20 patients. The operative time was 89.45 ± 49.80 minutes. No adverse events were observed. The bed-side ultrasound examination of the pleural cavity on the day of surgery showed a thimbleful of effusion and did not require thoracentesis. A postoperative chest roentgenogram on the next morning showed full expansion without pneumothorax in all patients. None of the patients required reintervention with chest drainage through the time of discharge. The omission of chest tube drainage may be an alternative procedure for selected patients undergoing thoracoscopic thymectomy. The omission of chest tubes in thymectomy is safe, but further investigation is required.

Novel Formula to Calculate Three-Dimensional Angle Between Inflow Cannula and Device Body of HeartMate II LVAD

The acute angle between inflow cannula and device body of HeartMate II left ventricular assist device (LVAD) (Abbott, Pleasanton, California) is associated with device thrombosis. However, most studies utilized two-dimensional (2D) angle obtained from chest roentgenogram (CXR), which is unlikely accurate. We aimed to create and validate a formula to estimate actual three-dimensional (3D) angle. We retrospectively reviewed the cohort undergoing HeartMate II LVAD implantation between 2008 and 2016. A formula for calculating 3D angles of the LVAD inflow cannula relative to the device body was mathematically derived, using simple 2D measurements from CXR. The cohort included consecutive 275 patients with HeartMate II (median age: 60 [25% quartile: 51, 75% quartile: 68] years). There was no significant difference between the calculated 3D angles (from formula) and actual 3D angles (from computed tomography) from the subset group with 3D computed tomography (n= 28) (71.7° ± 13.4° vs 71.1° ± 11.5°, P= .858). Among all participants, the calculated 3D angle (from formula) was 74.4° ± 14.2°, which was significantly larger than the 2D projected angle (from CXR) (65.2° ± 11.3°, P < .001). There was no statistical difference in the calculated 3D angles (from formula) between patients with/without device thrombosis, hemorrhagic stroke, ischemic stroke, or mortality (P > .05 for all). We established a novel formula to mathematically calculate actual 3D angles between inflow cannula and device body of HeartMate II. The formula would help investigators to validate their findings of the relationship between 2D projected angle (from CXR) and device thrombosis.

Three-Dimensional Optical Imaging for Pectus Excavatum Assessment

Corrective surgery for pectus excavatum often relies on the Haller index (HI), derived from chest roentgenograms or computed tomography; however, this exposes children to potentially unnecessary radiation. Our aim was to develop a novel three-dimensional (3D) optical imaging technique to accurately measure chest wall dimensions in a clinically relevant manner. Patients with pectus excavatum were imaged using a 3D structured light scanner. Patient characteristics, including height, weight, body mass index, and radiographic HIs (rHI) were recorded. We defined the optical index (OI) as the ratio of the lateral to anterior-posterior measurements obtained from the 3D optical images and compared those to patients' rHIs. Two-thirds of the patients' images were used to develop a predictive model of the rHI, using their OI and biometric data in multilinear regression modeling. The predictive model was applied to the remaining images, and the predicted HIs (pHI) were compared to the rHIs. Optical imaging was performed in 42 patients (ages, 5-35 years) with pectus excavatum; of these, 31 had recent chest roentgenograms, with rHIs ranging from 2.00 to 7.20. The OIs derived from the images correlated closely with rHIs (r= 0.850). Our predictive model, using patients' OI, height, and weight, was able to accurately estimate their rHIs with a median error of 8.11% (interquartile range, 3.5%-17.4%). 3D optical imaging of patients with pectus excavatum is emerging as an alternative method to assess HIs without the use of ionizing radiation. Additional studies will focus on volumetric quantification of chest wall deformities, using the 3D capabilities of this technology.

The Early Diagnostic Value of Procalcitonin in Pneumonia After Off-Pump Coronary Artery Bypass Grafting Surgery

BackgroundThe incidence of early postoperative pneumonia (EPOP) after off-pump coronary artery bypass grafting surgery (CABG) is relatively high, but its diagnosis by traditional methods remains difficult, which could be deleterious to the prognosis. Moreover, few data exist regarding procalcitonin (PCT) in early diagnosis of pneumonia after off-pump CABG. Thus, this study was performed to evaluate the value of PCT in diagnosing EPOP after off-pump CABG.Material/MethodsA total of 402 consecutive patients undergoing off-pump CABG were retrospectively enrolled. Forty-four patients were diagnosed with EPOP and 112 patients were diagnosed with systemic inflammatory response syndrome (SIRS). Chest roentgenogram, serum PCT, white blood cells, neutral granulocyte ratio, and daily maximum body temperature were recorded. The ability of PCT to diagnose EPOP was evaluated by receiver operating characteristic (ROC) analyses in comparison with traditional methods. Clinical net benefits were estimated via decision curve analysis (DCA).ResultsPCT presented satisfying accuracy in diagnosing EPOP with a cutoff value of 1.585 ng/mL (area under the curve [AUC] 0.808, 95% confidence interval [CI] 0.724–0.891, sensitivity 73%, specificity 86%). PCT performed better in diagnosing EPOP among SIRS patients (AUC 0.868, 95% CI 0.748–0.988, sensitivity 85%, specificity 89%). DCA showed valuable clinical net benefits of PCT in diagnosing EPOP after off-pump CABG regardless of threshold selected.ConclusionsPCT could be a diagnostic marker for EPOP after off-pump CABG. The optimal cutoff value for diagnosing EPOP was 1.585 ng/mL. The application of PCT in diagnosing EPOP in SIRS patients was also satisfying with a cutoff value of 1.775 ng/mL.

Imaging of Pulmonary Hypertension: Pictorial Essay

Pulmonary hypertension (PH) is an end result of a diverse array of complex clinical conditions that invoke hemodynamic and pathophysiological changes in the pulmonary vasculature. Many patients' symptoms begin with dyspnea on exertion for which screening tests such as chest roentgenograms and more definitive noninvasive tests such as CT scans are ordered initially. It is imperative that clinicians are cognizant of subtle clues on these imaging modalities that alert them to the possibility of PH. These clues may serve as a stepping stone towards more advanced noninvasive (echocardiogram) and invasive (right heart catheterization) testing. On the CT scan, the signs are classified into mediastinal and lung parenchymal abnormalities. In addition to suspecting the diagnosis of PH, this paper provides a pictorial essay to guide health care professionals in identifying the etiology of PH. This paper also provides concrete definitions, wherever possible, of what constitutes abnormalities in PH, such as dilated pulmonary arteries, pruning of vessels, and increased thickness of free wall of the right ventricle. The sensitivities and specificities of each sign are enumerated. The common radiographic and clinical features of many different etiologies of PH are tabulated for the convenience of the readers. Some newer imaging modalities such as dual-energy CT of the chest that hold promise for the future are also described.

Value of the Chest X-Rays in Diagnosis of Children with Heart Disease in the Age Group 1-4 Years

AbstractBackground: Chest X-ray continues to have an important role in diagnosis of heart diseases.Aim of Study: We aim by this the study to evaluate the use of chest X-ray in the Pediatric Cardiology Unit in Assiut University Children Hospital for children (1-4 years old) with suspected heart disease.Patients and Methods: This was a six-month, case series clinical study undertaken in the inpatient Pediatric Cardiology Unit, Assiut University Hospital, Assiut City, Egypt; between 1 of April 2016 to 30 of September 2016.Results: Chest X-ray is an important tool in evaluating heart disease in children. Noninvasive imaging such as echocar-diography and cardiac MRI provide valuable and detailed assessment of the cardiovascular system; however, the cost incurred from these diagnostic procedures is significant making their routine use difficult.Conclusion: Auditing the guidelines of interpretation of the chest radiograph for children aged one year to four years at the Pediatric Cardiology Unit of Assiut University Hospital for Children, it could be concluded: Chest roentgenogram is accurate in detecting cardiac site and situs.

Right Heart Failure in Young People in Emerging Countries Is Most Commonly Secondary to Tuberculous Constrictive Pericarditis

Constrictive pericarditis is a rare disease with a challenging diagnosis and treatment. Tuberculous pericarditis accounts to 1-2% of the cases in the United States, but is the most common cause in other countries. We report a 17-year-old male presenting with right heart failure. His initial work up that included an Electrocardiogram, chest roentgenogram and echocardiogram suspected constrictive pericarditis. Right heart catheterization and cardiac MRI confirmed the diagnosis. Total Pericardiectomy was performed. Tissue PCR showed tuberculous pericarditis and the patient was treated with anti-tuberculous drugs for 9 months. Tuberculosis is a common cause of constrictive pericarditis especially in developing countries, whereas in developed countries most cases are idiopathic. To note that the diagnosis of tuberculous pericarditis can be difficult especially in negative PPD patients However It remains a common cause of constrictive pericarditis in some parts of the world where a high index of suspicion is requested. The treatment is curative and thus an aggressive approach in diagnosis and treatment is indicated.

Bedside Lung Ultrasound for Postoperative Lung Conditions in Cardiothoracic Intensive Care Unit: Diagnostic Value and Comparison with Bedside Chest Roentgenogram.

Background:The postoperative settings in cardiothoracic intensive care unit (ICU) patients pose a certain risk with pulmonary dysfunction causing morbidity and mortality. Lung ultrasound (LUS) has a potential to supplant or replace Chest X-rays (CXR) in these subset of patients, who will require bed side pulmonary pathology diagnosis and interventions.Aims and Objectives:Aim of the study is to compare the diagnosis predicted from LUS to the diagnosis made from routine bedside CXR and to find the degree of agreement in diagnosis made by both modalities in different cardiopulmonary pathologies in ICUs.Materials and Methods:Prospective observational study involving 250 postoperative patients, admitted in cardio-thoracic and vascular ICU of a tertiary referral centre. LUS was done in the study patients after the scheduled CXR in the immediate postoperative period and postoperative day one. Findings of pulmonary pathologies by each imaging modality were independently interpreted by two different team of specialist investigators. The findings were evaluated for the degree of agreement between the two imaging modalities using Cohen's kappa statistical test.Results:CXR and LUS imaging showed substantial agreement in the diagnosing cardiopulmonary pathologies (κ = 0.652) in the immediate postoperative period as well as on the postoperative day one (κ = 0.740). For specific cardiopulmonary pathologies, the degree of agreement was moderate for pleural effusion (κ = 0.561), substantial for atelectasis (κ = 0.673) and interstitial edema (κ = 0.707) and perfect for pneumothorax (κ = 0.931).Conclusions:LUS can effectively replace CXR with reduction in radiation exposure in the immediate postoperative period and also in the follow up period. It can be used as a bedside diagnostic and monitoring tool in postoperative cardiothoracic and ICUs for diagnosing pneumothorax, pleural effusion, atelectasis and interstitial edema.

Customized Cutting Template to Assist Sternotomy in Pectus Arcuatum

Pectus arcuatum is an anterior chest wall deformity that requires transverse wedge sternotomy. Determining and delivering the correct cutting angle are crucial for successful correction. This report describes the early clinical experience with a novel cutting template technology able to deliver the optimal cutting angle. From patients' computed tomographic scans, the optimal cutting angle is obtained using computer-aided design. A template comprising slots tilted at the right cutting angle and a safety block to avoid damaging the posterior periosteum is printed through additive manufacturing. The template allows surgeons to perform a precise wedge sternotomy, safely sparing the posterior periosteum in all patients, without complications. Postoperative chest roentgenograms and clinical photographs demonstrate optimal sternal realignment and cosmetic outcome. In this report, the mean operative time was 110 minutes. All patients were successfully discharged, with a mean length of stay of 4 days. Transverse wedge sternotomy aided by a computer-aided design-devised cutting template may reduce the technical challenge of this procedure, thereby increasing its safety and reducing operative times and hospital stay. Further research on long-term patient outcomes is necessary.

792. Number and Volume of Cavitary Lesions on Chest Computed Tomography Associated With Prolonged Time to Culture Conversion in Drug-Susceptible Pulmonary Tuberculosis

BackgroundCavitary lesions (CLs) may be a marker of poor treatment response in pulmonary tuberculosis (PTB). Identification of CLs by chest roentgenogram (CXR) has important limitations. Chest computed tomography (CT) is more sensitive than CXR to detect CLs but the clinical relevance of CLs identified by CT remains understudied. We compared detection of CLs between CT and CXR and assessed their association with time to sputum culture conversion (tSCC). We hypothesized that increasing number and volume of CLs on CT would be associated with prolonged tSCC.MethodsRetrospective cohort study of 141 culture confirmed PTB patients who underwent chest CT. We used multivariate Cox proportional hazards models to evaluate the association between chest radiological features and tSCC.ResultsSeventy-five (53%) patients had one or more CLs on CT. CT identified cavities in 31% of patients without a CL on CXR. Detection of cavity on CT was associated with an increased median [IQR] time to culture conversion (15 [7–35] days among noncavitary CT vs. 39 [25–55] days among cavitary CT; P < 0.0001). Among patients without CL on CXR, detection of CL on CT was associated with prolonged tSCC (median difference (CI): 16 (7–25) days, P = 0.0008). Similar results were observed among patients with 3–4+ sputum smear (median difference: 19.5 (8–31) days, P = 0.001). Adjusted Kaplan–Meier curves of number and volume of CLs and tSCC are shown in Figure 1. After confounder adjustment patients with single and multiple CL had a prolonged tSCC relative to patients without CLs on CT (adjusted Hazard Ratio [aHR] 0.56 (0.32–0.97) and 0.31 (0.16–0.60), respectively). Similarly, patients with CL volume 25 mL or more had a prolonged tSCC (aHR 0.39 (0.21–0.72)). CXR CL was not associated with prolonged tSCC.ConclusionWe observed a dose–response relationship between increasing number and volume of CLs on CT and delayed tSCC independent of sputum bacillary load. Our findings highlight a role for CT in a clinical research setting to predict shorter time to culture conversion. Disclosures All authors: No reported disclosures.

Clinical Profile, Radiological Resolution and Risk Factors Associated with Community Acquired Pneumonia

IntroductionPneumonia is a widespread and commonest infectious lung disease that causes inflammation which lead to reduced oxygenation. Indeed, it is the leading cause of child death in the world. The study was carried out to fine out the demographic, clinical characteristics and radiologic resolution of Pneumonia in children between 2 months to 16 years of age.Material and MethodsA prospective study done in 121 cases over 18 month period in patients admitted in pediatric department of Dhulikhel hospital. Demography, clinical profile, diagnosis, Down’s scoring at presentation, response of treatment and risk factor for fetal Community acquired pneumonia were analyzed using descriptive statics. Chest radiography was done on admission and every 2 weeks until its complete resolution occurred.ResultsA total of 121 patients with community acquired pneumonia were enrolled. The male and female ratio was 1.69:1. Among all age group it was most significantly common in children less than 1 year (p=.022).The common symptoms of Community acquired pneumonia observed in this study were cough (80%), fever (66%) and shortness of breath (38.8%). On chest roentgenogram right middle zone(47.9%) was most frequently involved. The total leukocyte count had low degree of association with pneumonia. More than half of patients (54.08%) with community acquired pneumonia had radiographic resolution at 2 weeks. The respiratory distress was significantly high (p&lt;0.0001) in children who delayed to seek medical treatment in a health facility by three days.Anemia, lymphopenia, thrombocytopenia, sepsis and hemorrhagic pleural effusion were the clinical characteristics associated withfatal Community acquired pneumoniaConclusionClinical presentations variesin Community acquired pneumonia with different age groups. Chest radiography is still best investigation for the diagnosis of pneumonia and most of the radiological clearance occurs in 2 weeks.

Burden of Human Metapneumovirus and Respiratory Syncytial Virus Infections in Asthmatic Children.

Human metapneumovirus (hMPV) and respiratory syncytial virus (RSV) are the leading causes of acute respiratory illness in children. Clinical burden of each infection on the respiratory distress in asthmatic patients remains unclear. The purpose of the study was to clarify the effect of these infections on the severity of asthmatic children in the seasonal outbreaks. A total of 1,217 pediatric inpatients with hMPV (n = 114) or RSV (n = 1,103) infection in Yamaguchi prefecture, Japan, between 2011 and 2014 were enrolled. Bronchial asthma was defined as having more than 3 episodes of wheezing illness over 1 year of age. Infection was determined by the positive antigen test for each virus in the nasal specimens. The number of patients peaked at age 12-15 months in hMPV infection and at age 0-3 months in RSV infection. The proportion of hypoxic patients (40-50%) did not differ at any age between hMPV-infected and RSV-infected children. In the analysis of date from > 1 year old patients with hypoxia, hMPV-infection group was older (P = 0.036), and more frequently had history of asthma (P = 0.015) or abnormal chest roentgenogram (P < 0.001) than RSV-infection group. Multivariate analysis indicated that the hypoxia-associated factors were history of asthma in both hMPV (odds ratio [OR]: 15.8; P < 0.001) and RSV infections (OR, 2.2; P = 0.005), higher body temperature in hMPV infection (OR, 2.2; P = 0.009), and younger age in RSV infection (OR, 1.4; P = 0.004). Outbreaks of hMPV, rather than, RSV infection may have a greater impact on the development of hypoxic respiratory illness in asthmatic children.

Surgical management of lung abscess: from open drainage to pulmonary resection

Lung abscess is a type of infectious pulmonary disease, which occurs because of infection and destruction of the pulmonary parenchyma with central necrosis, eventually leading to cavity formation. The characteristic finding of chest roentgenogram is an air-fluid level in the cavitary lesion. In the era without antibiotics, putrid lung abscess was a crushing condition. In the early decades of the 20 th century, Neuhof proposed open drainage procedure for infection control of lung abscess, which effectively decreased the mortality rate of lung abscess from 75% to 2.5%. Around 1946, due to the advent of antibiotic, treatment of acute lung abscess with systemic antibiotics showed satisfied outcome. Thereafter, patients received medical treatment with systemic antibiotics rather than surgical management. Medical therapy with systemic antibiotics had become the principal treatment of lung abscess since then. Currently primary management of lung abscess mainly involves proper systemic antibiotics, intensive care, and, if indicated, percutaneous tube thoracostomy drainage. Surgical management for lung abscess became a more challenging task, since indication, timing, and the proper procedure for lung abscess are not well established. Undoubtedly, surgical intervention, including pulmonary resection or decortication procedure, tends to be restricted to those refractories to intensive medical treatment, complicated by life-threatening hemoptysis, pyopneumothorax, or pleural empyema. The primary goal of surgical management is adequate control of the septic focus.

PS01.034: GENDER AND BODY MASS INDEX HAVE AN INFLUENCE ON DELAYED GASTRIC EMPTYING FOLLOWING ESOPHAGECTOMY AND GASTRIC PULL-UP

Abstract Background Delayed gastric emptying is a common feature after gastric pull-up for reconstruction following esophagectomy. Symptoms range from mild discomfort to life-threatening recurrent aspiration. Apart from the well-known and technically inevitable truncal vagotomy neither causative factors nor effective preventive measures have been clearly identified. Methods We did a retrospective study in 381 patients (317 males, 64 females; age: 22 -88 years; mean: 62,4 years), who underwent esophagectomy and gastric pull-up with cervical esophagogastrostomy between 1/2008 and 12/2017. During this period the surgical technique had been the same except that in the first phase no intervention at the pylorus had been done (N = 207), whereas in the second pyloromytomy (N = 97) and in the third (N = 110) intrapyloric injection of Botulinum-toxin was performed. Delayed gastric emptying was diagnosed by distension of the conduit with an air-fluid level on chest roentgenogram, and by symptoms and signs of regurgitation or vomiting in absence of other bowel obstruction. 122 patients had retrosternal pull-up due to transmural tumour growth or lymph-nodes, in 259 the orthotopic route was chosen. All patients were followed-up for at least three months after the operation. Results 56 patients (14,7%) developed delayed gastric emptying. Neither pyloromytomy nor injection of Botox had any effect as compared with the patients in the no-intervention period. The route of gastric pull-up had no influence either. In women (N = 15; 23,4%), however, delayed gastric emptying was significantly more frequent than in men (N = 41; 12,9%; P = 0.03). Moreover, the Body Mass Index (BMI) of patients with delayed gastric emptying (BMI = 26.6) was significantly higher than in those who had not (BMI = 24,7; P = 0.03). By multivariate analysis the influence of gender and BMI on the development of delayed gastric emptying remained significant. Conclusion The results of our single center retrospective analysis may show that both, gender and BMI might significantly influence the development of postoperative delayed gastric emptying after esophagectomy and reconstruction by gastric pull-up. For a better understanding and management of delayed gastric emptying prospective trials with larger numbers of patients are definitely needed. Disclosure All authors have declared no conflicts of interest.

Digital Air Leak Monitoring for Lung Resection Patients: A Randomized Controlled Clinical Trial

Digital chest drainage devices objectively measure airflow to guide chest tube management. There are contradictory results regarding their utility in reducing length of stay and chest tube duration. The objective of this study was to compare digital and analog devices in patients undergoing anatomic lung resection. A single-institution randomized trial was conducted. Patients undergoing anatomic lung resection between November 2013 and July 2016 were randomized to digital or analog devices. Chest tubes were managed using a standardized protocol. Hospital length of stay and chest tube duration were primary outcomes. Chest tube clamping, number of chest roentgenograms, and chest tube reinsertion were secondary outcomes. The study randomized 215 patients, with 107in the digital group and 108 in the analog group. There was no significant difference in outcomes for length of stay (p= 1), chest tube duration (p= 0.71), number of chest roentgenograms performed (p= 0.78) or need for chest tube reinsertion (p= 0.21). The only significantfinding was a higher number of patients who had their chest tubes clamped before removal, with 47%in the analog group and 19% in the digital group (p<0.0001). Digital devices did not result in reduced chest tube duration or hospital length of stay. Approximately one half of the patients in the analog group had their chest tubes clamped before removal because of uncertainty in air leak assessment. Digital devices provided objective quantification of air leaks that decreased chest tube clamping.

The Person Behind the Inventor of the Heart-Lung Machine: John H. Gibbon Jr, MD (1903-1973).

The Person Behind the Inventor of the Heart-Lung Machine: John H. Gibbon Jr, MD (1903-1973).