Chest wall

As the external pressure on the chest wall becomes larger than its internal pressure during the passage of a blast wave, the chest wall moves inward, thus causing injury. Because the inward motion takes time, the duration of the blast wave is important. Results of animal tests indicate that overpressure is only important for long durations, and impulse is important for relatively short durations (White et al. 1971). 

Chest-wall injury (e.g., surgery, herpes zoster)... 

Prior radiation treatment to the breast or chest wall... 

Radiation is an important modality in the treatment of symptomatic metastatic disease. The most common indication for treatment with radiation therapy is painful bone metastases or other localized sites of disease refractory to systemic therapy. Radiation therapy gives significant pain relief to approximately 90% of patients who are treated for painful bone metastases. Radiation is also an important modality in the palliative treatment of metastatic brain lesions and spinal cord lesions, which respond poorly to systemic therapy, as well as eye or orbit lesions and other sites where significant accumulation of tumor cells occurs. Skin and/or lymph node metastases confined to the chest wall area also may be treated with radiation therapy for palliation (e.g., open wounds or painful lesions). 

Retching A process that follows nausea and consists of diaphragm, abdominal wall, and chest wall contractions and spasmodic breathing against a closed glottis. 

Mineral Oil Hydraulic Fluids. No specific methods were located for interfering with the mechanism of action for toxic effects produced by mineral oil hydraulic fluids. Unstable alveoli and distal airways have been proposed as major factors in the respiratory symptoms that occur after the ingestion of other petroleum-derived materials. Continuous positive airway pressure or continuous negative chest wall pressure, as well as the application of supplemental oxygen, have been recommended to counteract the resultant pneumonitis (Eade et al. 1974 Klein and Simon 1986). 

The entry of air into the pleural cavity is referred to as a pneumothorax. This may occur spontaneously when a "leak" develops on the surface of the lung, allowing air to escape from the airways into pleural space. It may also result from a physical trauma that causes penetration of the chest wall so that air enters pleural space from the atmosphere. In either case, the pleural cavity is no longer a closed space and the pressure within it equilibrates with the atmospheric pressure (0 cmH20). As a result, the transpulmonary pressure is also equal to 0 cmH20 and the lung collapses. 

FNA specimens consist of abdomen, adrenal glands, breast, bone, brain, chest wall, head and neck, kidney, lymph nodes, liver, lung, mediastinum, pancreas,... 

Hydrochloride is a colorless solid with no odor. This material is hazardous through inhalation, penetration through broken skin, and ingestion. May cause nausea and vomiting as well as muscle rigidity that includes the chest wall causing apnea. 

Vomiting diarrhea, noisy breathing and an increase in respiratory rate as symptoms progress Labored breathing with retractions of the chest wall, nasal flaring and grunting Physical examination... 

Increased tactile fremitus, whispered pectoriloquy, and egophony Chest wall retractions and grunting respirations Diminished breath sounds over the affected area Inspiratory crackles during lung expansion Chest radiograph... 

Stage III Usually a large tumor with extensive nodal involvement in which node or tumor is fixed to the chest wall also includes inflammatory breast cancer, which is rapidly progressive. 

Pulmonary i Respiratory muscle strength i Chest wall compliance i Total alveolar surface i Vital capacity i Maximal breathing capacity... 

Total resistance = Chest wall resistance + lung resistance... 

Cardiac arrhythmia and bradycardia were reported in a man that splashed an unspecified concentration of a phenol-water solution over his face, chest wall, hand, and both arms (Horch et al. 1994). The cardiac effects were noted during the first 6 hours after exposure. The serum levels of phenol in g/L were 11,400 after 1 hour, 17,400 after 4 hours, and 6,000 after 8 hours. 

Gastrointestinal Effects. During the first few days after a man splashed a phenol-water solution (concentration not stated) on his face, chest wall, hand, and both arms, he complained of nausea and vomited twice (Horch et al. 1994). A worker who was partially immersed for only a few seconds in a shallow vat containing a mixture of 40% phenol in dichloromethane, collapsed after showering and was taken to a hospital where he was found to have bums over 50% of his body. Initial observations were stable however, after drinking fluids, he developed nausea and vomiting (Foxall et al. 1989). 

Hepatic Effects. An increase in serum iron, which may reflect an adverse liver effect, was observed in workers exposed for 6 months to phenol in a wood treatment liquid (Baj et al. 1994). Elevated concentrations of hepatic enzymes in serum, and an enlarged and tender liver suggestive of liver injury, were reported in an individual who had been exposed repeatedly to phenol vapor for 13.5 years (Merliss 1972). Since phenol was also spilled on his clothes resulting in skin irritation, dermal and inhalation exposures were involved. A 2-fold increase in serum bilirubin was observed in a man who was accidentally splashed with a phenol solution over his face, chest wall, hand, and both arms (Horch et al. 1994). Changes in liver enzymes were not observed in persons exposed to phenol in drinking water for several weeks after an accidental spill (Baker et al. 1978). This study is not conclusive because the measurements were completed 7 months after the exposure. 

SD lymph nodes, liver, chest wall lesions ... 

The second factor is motion. The lung in the upper trunk (thoracic cavity) is encased by a lining membrane known as the visceral pleura. In fact, this is a dual membrane one membrane covers the lung and a second membrane lines the chest wall (the parietal pleura, see Fig. 3.1). Characteristics of the pleura are discussed later, but we mention this important tissue here because the movements of the lung are facilitated by the juxtaposition of the visceral and parietal pleura and the thin layer of fluid between them. 

Currently available devices are able to provide left ventricular support for a short duration only. Development of percutaneously or minimally invasive long-term support devices is also underway. At least three such devices are undergoing preclinical evaluation. The Synergy device (CircuLite, Inc., Hackensack, NJ) is being developed as a pocket circulatory assist (PAC) device that would sit in a subcuatenous pocket over the chest wall and use a micro-pump with cannulas in the subclavian artery and vein to withdraw blood from the left atrium through a transseptal approach and deliver it to the subclavian artery. The device is connected to a power... 

Cardiac patients need to be monitored closely when receiving these drugs because of their bradycardiac effects (which can lead to ectopic arrhythmias), and hypotensive effects resulting from prolonged vasodilation. In addition, the drugs stiffen the chest wall musculature, an effect reversed by naloxone. 

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