الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 136 |  |  |
| | | from | 136 | | |
Abstract
Chest wall deformities, or abnormal development and
appearance of the chest, can vary from mild to severe. These
deformities are considered to be congenital and may be
apparent at birth or later in childhood. Regardless, the severity
of the deformity usually progresses rapidly during puberty. A
variety of anomalies are described however the most common
are pectus excavatum (sunken chest or funnel chest) or pectus
carinatum (pigeon chest). Less common types of chest wall
abnormalities including Poland’s syndrome, Jeune’s syndrome,
and defects of the ribs and sternum. (Nuss et al., 1998).
Since diaphragmatic motion plays a prominent role in
spontaneous respiration, observation of the diaphragm kinetics
seems essential. The use of tools previously available for this
purpose is limited due to the associated risks of ionizing
radiation (fluoroscopy, computed tomography) or due to their
complex and/or highly specialized nature, requiring a skilled
operator (trans-diaphragmatic pressure measurement,
diaphragmatic electromyography, phrenic nerve stimulation,
magnetic resonance imaging) (Ayoub et al., 2002).
Cobb’s Angle” is used worldwide to measure and
quantify the magnitude of spinal deformities, especially in the
Summary
87
case of scoliosis. The Cobb angle measurement is the “gold
standard” of scoliosis evaluation endorsed by Scoliosis
Research Society.
The aim of study was to Assess the diaphragmatic
mobility by chest ultrasound in patients with chest deformities
(developmental or acquired) with correlation of the results with
the severity of the disease by measuring cobb’s angle,and
spirometric variables.
Chest 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).
This study was carried out on 40 patients with acquired
and developmental chest wall deformities. sex distribution
among study population where 19 were females & 21 male, the
mean±SD age was (34.93± 17.71),and Mean±SD of BMI Was
(25.35± 8.57)kg/m2.
And also on 20 of controlled healthy volunteers with no
past medical history of cardiopulmonary disorders.
Summary
88
there was no significant differences between patients and
control group as regard age, sex and BMI(body mass index)the
P value was less than 0.01.
In the current study that carried out on 40 cases(10
kyphosis,13 kyphoscoliosis and 17 scoliosis) ,21 males and 19
females.mean age 34 ,SD34.93 ± 17.71years old and mean
BMI(body mass index) 25, SD25.35 ± 8.57 Kg/m2 showing 9
cases mild, 18 moderate and 13 severe according to cobb’s
angle.
According to restriction severity by (FVC) mean
,SD54.80 ± 16.55 of spirometry (19 are severe,14 moderate,5
mild and 2 cases are within normal).
In the current study there was no significant correlation
between severity of restriction by spirometry by (forced vital
capacity) and age,sex nor BMI (body mass index). This was’t
matching with the results of the study carried out by Lynell C.
Collins, MD 1995 who studied the Effect of Body Fat
Distribution on Pulmonary Function Tests and found that FVC,
FEV1, and TLC were significantly lower in the patients with
upper body fat distribution (Lynell C. Collins, MD et al
1995)this difference may be due to the small number of patients
with high body mass index included in this study.
Summary
89
There was a significant correlation (P value was less
than (0.011)) between the severity of the disease (by
measureing cobb’s angle) and the age of the patients ,and a
highly significant correlation between the severity of the
disease and the BMI (body mass index) P value was(0.001) .
These findings were close to the study carried out by Guo JM ,
Zhang GQ , Alimujiang who studied the Effect of BMI on
lumbar lordosis and sacrum slant angle in middle and elderly
women and they found that BMI exceeding 24 kg/m2 may
increase the measurements of Cobb angle. (Guo JM et al2008)
.
There was a high significant correlation between the
severity of the disease(according to cobb’s angle) and the
values of pulmonary function (highly significant between
severity of the disease and reduction of FVC),P value was
0.001. These findings were close to the study carried out by
Amir szeinberg MD 1988 that studied the correlation between
Forced vital capacity and maximal respiratory pressures in
patients with mild and moderate scoliosis and he found that
Lung function and maximal respiratory pressures of 24
adolescent females with mild-to-moderate idiopathic scoliosis
(spinal curvature 10-60°) were determined and compared with
38 age- and sex-matched controls. Twelve patients with
Summary
90
moderate scoliosis had significantly reduced mean values for
FVC (% predicted) and maximal inspiratory pressure (MIP), as
compared to the controls (Amir szeinberg MD 1988).
In current study there was no significant correlation
between the range of movement of diaphragm and age nor the
body mass index of the patients ,unfortunately there wasno
studies discussing this point.
there was a significant correlation between the
ROM(range of movement) and the side of deformity :left
kyphoscoliosis (the mean of right ROM 8.3mm and mean of
left ROM 9.9mm), right kyphoscoliosis( the mean of right
ROM 9.9mm and mean of left ROM 7.5mm),left scoliosis (the
mean of right ROM 8.6mm and mean of left ROM 9.9mm) and
right scoliosis (the mean of right ROM 9.5mm and the mean of
left ROM 8.6mm).
There was a significant impairement in the range of
movement in patient group in comparison to the control
group(the mean right ROM in control group 35 mm and the
mean of left ROM in control group 18.5mm).and in patient
group ( the mean of right ROM 10.1mm and the mean of left
ROM 9.2mm).
Summary
91
Sonography receives increasing recognition as a fast,
easy and accurate method of noninvasively evaluating
diaphragmatic function at the bedside. (Lerolle et al., 2009).
In recent years, ultrasound has also become used to
evaluate diaphragmatic mobility it offers some advantages over
fluoroscopy including the lack of ionizing radiation and the
possibility of use at the bedside of the patient, and direct
quantification of the movement of the diaphragm. So
ultrasongraphy has been shown to be a promising tool in the
evaluation of the diaphragm function (Sahebjami h and
Gartside, 1996).