Spontaneous hyperinflation of a giant bulla of the non-ventilated lung during laparoscopic cholecystectomy under one-lung ventilation: a case report.

BACKGROUND: Anesthetic management of non-thoracic surgery in patients with giant bullae is challenging. We present a case of laparoscopic cholecystectomy in a patient with a giant bulla managed with one-lung ventilation (OLV). CASE PRESENTATION: A 75-year-old man with a giant bulla occupying the lower half of the right hemithorax underwent laparoscopic cholecystectomy. We managed anesthesia with OLV to avoid positive pressure ventilation of the giant bulla. Surgery was completed uneventfully; however, postoperative chest radiography indicated a large lucency occupying the entire right hemithorax. Although we suspected a pneumothorax due to a ruptured bulla, chest computed tomography (CT) led to a diagnosis of giant bulla hyperinflation. The giant bulla deflated gradually to its preoperative size within three postoperative days. CONCLUSIONS: Managing laparoscopic cholecystectomy in a patient with a giant bulla with OLV resulted in spontaneous hyperinflation of the giant bulla. Chest CT ruled out a pneumothorax.

Non-linear growth trends of toe flexor muscle strength among children, adolescents, and young adults: a cross-sectional study.

PURPOSE: There are only a few studies on the muscular strength of the foot in children and adolescents; thus, the developmental pattern and normative data of these populations during growth are unclear. We sought to elucidate the developmental pattern of the foot muscle strength among children, adolescents, and young adults compared with that of the hand. METHODS: A total of 747 children, adolescents, and young adults participated in this study, and their maximum isometric toe flexor strength (TFS), hand grip strength (HGS), and foot length were measured. RESULTS: TFS was correlated with HGS (r = 0.785), age (r = 0.659), height (r = 0.757), body mass (r = 0.737), and foot length (r = 0.594). Multiple regression analyses revealed that TFS was correlated with age (ß = 0.243 in boys; ß = 0.461 in girls), squared value of age (age2; ß = - 0.296 in boys; ß = - 0.260 in girls), and body mass (ß = 0.256 in boys; ß = 0.311 in girls) in both sexes, indicating a non-linear relationship between age and TFS development. In a regression model for HGS, age was a significant variable, but not age2. HGS increased linearly from childhood until young adulthood, whereas TFS increased from childhood until adolescence and then levelled off. CONCLUSION: Our results demonstrate that TFS has a different developmental pattern compared with HGS.

Toe flexor strength and foot arch height in children.

PURPOSE: The aim of this study was to investigate the muscle strength and arch height of the foot in the standing position and the relations between these indices and physical performances involving the lower limbs in children. METHODS: A total of 301 elementary school children (third grade: n = 158, age = 8.6 ± 0.5 yr; fifth grade: n = 143, age = 10.6 ± 0.5 yr; means ± SD) participated. The maximal isometric toe flexor strength (TFS) in the standing position was measured using a toe flexor dynamometer. Foot arch height was assessed as the distance between the navicular tuberosity of the foot and the floor in the standing position, and foot arch height relative to the foot length was represented by the foot arch index (FAI). For physical performance involving the lower limbs, 50-m sprint, standing broad jump, repeated side step, and rebound jump were measured. RESULTS: There were no significant correlations between TFS and FAI and between relative TFS (relative TFS = TFS/body mass) and FAI. Relative TFS was significantly correlated with all physical performance tests. No significant correlations among FAI and physical performances were found, except for rebound jump ability in fifth graders. After multiple regression analyses adjusting for gender and body mass, TFS was the only significant correlating factor for all physical performances involving the lower limbs. CONCLUSIONS: This study showed that TFS was associated with enhancement of some measures of lower limb physical performance in children. These results suggest that foot function should be evaluated with both the muscle strength and arch height of the foot in children.