1/12. Bilateral diaphragmatic paralysis after open heart surgery.The purpose of the present case report is to present a case of bilateral diaphragmatic paralysis as a complication of open-heart surgery. A 47-year-old male was operated for aortic and mitral valve replacement. After discontinuation of sedation, bilateral diaphragmatic paralysis as well as motor and sensitive dysfunction in the four extremities was observed. The patient remained with mechanical ventilation support for twenty months. Two years after the operation a complete normalisation of the diaphragmatic motion was observed. Although uncommon, bilateral diaphragmatic paralysis after open-heart surgery could take place, being necessary long term mechanical ventilation support until recovery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/12. Functional electrical stimulation (FES) for spinal cord injury.Restoration of respiratory motion by stimulation of the phrenic nerve was investigated. Respiratory motion was restored successfully by introducing a breathing pacemaker to a patient with respiratory disturbance due to upper cervical spinal cord injury. Breathing pacemakers are considered to be more similar to physiological conditions compared to mechanical ventilators. Although the system is very expensive, its cost effectiveness may be excellent, provided that it can be used for long hours each day over an extended period. The system is effective in improving patient QOL because it dramatically increases patient mobility. From these findings, it is concluded that breathing pacemakers should be used more frequently in japan, and that various forms of support are necessary to cope with economic and other concerns.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/12. Selective paralysis of voluntary but not limbically influenced automatic respiration.We describe a patient in whom a discrete infarction of the ventral basis pontis caused a complete loss of voluntary respiration, while automatic respiration remained intact. Respiratory excursions, quantified title volumes, and ventilatory response to carbon dioxide were normal, but the patient could not volitionally modify any respiratory parameters. Emotional stimuli producing laughter, crying, or anxiety appropriately modulated automatic respiration. This case established that pathways subserving limbic modulation of automatic respiration descend in the pontine tegmentum and/or lateral portion of the basis pontis spared by this lesion. Furthermore, descending limbic influences on automatic respiration are anatomically and functionally independent of the voluntary respiratory system.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/12. time course of recovery from frostbitten phrenics after coronary artery bypass graft surgery.Bilateral diaphragmatic paralysis developed in a patient after coronary artery bypass graft surgery during which cold cardioplegia was used. The patient's progress and eventual recovery over an 18-month period is described, with particular reference to chest wall motion and respiratory pressure measurements.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/12. Unilateral chest wall paradoxical motion mimicking a flail chest in a patient with hemilateral C7 spinal injury.After a lower hemi-cervical spinal cord injury, a patient presented with a left hemiplegia and on the same side a unilateral chest wall paradoxical motion mimicking a flail chest. x-rays demonstrated a left hemilateral C6 injury but no rib fractures. We demonstrated that the paradoxical motion was due to the action of the diaphragm acting on the rib cage with intercostal respiratory paralysis on the side of hemiplegia.- - - - - - - - - - ranking = 6keywords = motion (Clic here for more details about this article) |
6/12. Brachial neuritis involving the bilateral phrenic nerves.Brachial neuritis with bilateral hemidiaphragmatic paralysis has been reported in two previous cases in the literature. We report a patient who experienced severe right shoulder discomfort three weeks prior to hospital admission which evolved to include both shoulders. Two weeks prior to admission he noticed the onset of discomfort in breathing in the supine position and shortness of breath with minor exertion. The admitting diagnoses were myocardial infarction due to significant ECG changes and idiopathic elevated bilateral hemidiaphragms. The patient had findings significant for tachypnea, dyspnea, decreased breath sounds at the bases bilaterally, impaired motion of the bilateral lung bases on inspiration and paradoxical respirations. Comprehensive medical testing and evaluation revealed bilateral elevated hemidiaphragms and vital capacity 40% of normal. Weakness of the proximal shoulder girdle and bicep musculature bilaterally was noted. electromyography was significant for reduced recruitment pattern in the bilateral shoulder girdle musculature. Nerve conduction studies suggested bilateral phrenic neuropathy. This case is an unusual presentation of brachial neuritis affecting the bilateral shoulder girdle with phrenic nerve involvement. The differential diagnosis of acute shoulder pain associated with respiratory symptomatology should therefore include brachial neuritis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/12. Diaphragmatic paralysis evaluated by phrenic nerve stimulation during fluoroscopy or real-time ultrasound.Stimulation of the phrenic nerve by applying an electrical impulse to the neck during fluoroscopy or real-time ultrasound (sonoscopy) of the diaphragm allows more precise functional evaluation than fluoroscopy and/or sonoscopy alone. This is especially true of patients who are unable to cooperate because they are on a ventilator, unconscious, or very young. The authors cite cases in which diaphragmatic paralysis was diagnosed by conventional methods but stimulation of the phrenic nerve demonstrated good diaphragmatic motion, leading to a change in prognosis in some cases and a change in therapy in others.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/12. Bilateral diaphragmatic paralysis.Ventilatory failure developed insidiously in a patient due to bilateral diaphragmatic paralysis from bilateral phrenic neuropathy. The ventilatory failure progressed to respiratory arrest. We assessed the patient's diaphragmatic function by fluoroscopy, transdiaphragmatic pressure measurements during maximal inspiration, measurement of abdominal paradoxic motion, and electrical conduction measurements of the phrenic nerves. He improved and was discharged. A rocking bed was recommended for sleep after appropriate measurements of various respiratory support apparatuses. A history of supine breathlessness and a clinical observation of paradoxic abdominal wall motion during breathing in the supine position should suggest this possible cause.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
9/12. Utilization of temporary muscle paralysis to eliminate CT motion artifact in the critically ill patient.The intubated, critically ill patient often cannot suspend respiration long enough to eliminate severe computed tomographic (CT) motion artifact, even with current generation CT scanners. High quality, motion-free CT images were safely and easily obtained in two such patients using pancuronium bromide (Pavulon) to achieve muscle paralysis.- - - - - - - - - - ranking = 6keywords = motion (Clic here for more details about this article) |
10/12. Diaphragmatic paralysis managed by diaphragmatic replacement.A neonate had paralysis of the right hemidiaphragm secondary to brachial plexus birth trauma. Conventional diaphragmatic plication, performed on two separate occasions, failed to correct the ventilatory impairment, and mechanical ventilatory dependence persisted. Ventilatory insufficiency was subsequently corrected by total replacement of the right hemidiaphragm with Marlex mesh. This procedure ablated paradoxical motion of the right hemidiaphragm and arrested detrimental shifts of the mobile infantile mediastinum. The good result was immediate and long-lasting; there was no major prosthesis-related growth deformity 31/2 years later. Prosthetic fixation of the paralyzed diaphragm is not indicated as a primary procedure, but should be reserved for the occasional patient in whom conventional plication has failed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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