الفهرس 
U LTRASOUND AND THE D IAPHRAGMOnly 14 pages are availabe for public view
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Abstract
Context: Chest wall malformations (CWMs) are a wide spectrum of anomalies with high morbidity, that was classified by years ago by Acastello [1] into Kyphoscoliosis, ankylosing spondylitis, pectus excavatum. The Diaphragm being the major respiratory muscle is affected by these CWMs leading to respiratory insufficiency and failure. Ultrasound is the modality of choice used in assessment of diaphragmatic mobility and monitoring its affection in the four mentioned diseases.
Aims: Assessment of the Diaphragmatic Mobility by Chest Ultrasound in Patients with Chest Deformities Before and After Pulmonary Rehabilitation Program.
Settings and Design: An observational comparative study.
Methods and material: The study included 40 patients with acquired and developmental chest wall deformities, non-smoker and no cardiopulmonary disorders. Chest wall deformity was diagnosed by chest X-ray P-A & lateral views and the severity of the deformity was determined by measuring the cobb’s angle in comparison to severity of spirometry as regard FVC (forced vital capacity). Spirometry of these patients was done pre and post pulmonary rehabilitation program along with chest ultrasound to follow up their diaphragmatic excursion and comparing the results.
Statistical analysis used: SPSS program [Statistical Package for Social Sciences] software version 20.
Results: A highly significant decrease in right range of movement of diaphragmatic copula (P value 0.001) and a significant decrease in left range of movement of diaphragmatic copula were noted in the patient group (P value 0.029). Also a highly significant improvement was noted in right & left ROM, diaphragmatic thickness and MIP after rehabilitation (P value 0.001). Cobb’s angle more than 43ᵒ was statistically proposed as a cut off value to predict mortality. MIP less than 55% was statistically proposed as a cut off value to predict mortality after operation.
Conclusions: CWMs constrict the skeletal structure of the chest wall and the spine with its articulations hence interfering with diaphragmatic mobility. Ultrasound provides a good reliable real time tool for assessment of diaphragmatic mobility and monitoring its response to rehabilitation programs.
تتداخل الأمراض التي تقيد الهيكل العظمي لجدار الصدر والعمود الفقري بمفاصلها مع القدرة الوظيفية للمضخة الحجابية.
يتلقى التصوير بالموجات فوق الصوتية اعترافًا متزايدًا كطريقة سريعة وسهلة ودقيقة لتقييم وظيفة الحجاب الحاجز كفحص سريري.
برنامج إعادة التأهيل الرئوي للمرضى الذين يعانون من تشوهات في جدار الصدر يمكن أن يحسن حركة الحجاب الحاجز اثناء التنفس وسمك الحجاب الحاجز واقصى ضغط استنشاق ولكن لم يلاحظ أي تحسن في بيانات قياس التنفس.
تم التعامل مع أقصى ضغط استنشاق ك أكثر قيمة تنبؤية للوفيات مع (AUC) المنطقة الواقعة تحت منحنى ال (ROC) من 0.99.