By Gregory R. D. Evans
An overview of the results of radiation and chemotherapy at the reconstruction of the chest, stomach and pelvis. tactics of specific curiosity during this reference contain alloplastic reconstruction of chest wall deformities; direct closure, tissue enlargement and grafting of the stomach wall; in addition to rectus abdominus muscle involvement within the reconstruction of stomach and pelvic defects.
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14. 15. 16. 17. 18. 19. 20. 21. Copyrighted Material 4 Treatment of Sternal Clefts MICHAEL J. A. Clefts of the sternum with or without ectopia cordis represent a rare clinical entity. In a 1977 review of all the available cases from the literature, Ravitch (I) was able to identify only 44 patients who had surgical repair of a cleft sternum from 1888 to 1977 (2). In a 1998 review of the literature, Hazari et a1. (3) were able to identify 73 cases reported in the literature since 1800. Daum and Zachariou (4) argue that there are fewer than 100 reported cases of cleft sternum.
Secondary empyema occurs as a complication of thoracic surgical procedures, trauma, or extension of infectious processes fr0111 the neck or the abdomen. The progression of primary empyema occurs in essentially three stages: uncomplicated/exudative; complicated/ fibropurulent; and frank empyema. Initially, there is minimal neutrophilic effusion that is sterile (5). The exudate is clear and yellow with a white blood cell count <500 cell/ml. Left untreated, fibroblastic proliferation accelerates leading to the development of heavy fibrin deposits on the pleural surfaces.
However, it has not been proven that growth hormone improves pulmonary function more than hyperalimentation treatment alone (39,40). It has been shown in patients with end-stage chronic obstructive pulmonary disease that administration of recombinant human growth hormone improves expiratory tidal volume, increases peak expiratory flow rate, and increases respiratory muscular strength after 10 days of hormone therapy. In patients on long-term mechanical support, growth hormone treatment improves respiratory strength and protein metabolism (41), and reduces the duration of mechanical ventilation.