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Belletti A, Pallanch O, Bonizzoni MA, Guidi L, De Cobelli F, Landoni G, Zangrillo A, De Bonis M, Palumbo D. Clinical use of Macklin-like radiological sign (Macklin effect): A systematic review. Respir Med 2023; 210:107178. [PMID: 36863617 DOI: 10.1016/j.rmed.2023.107178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Abstract
INTRODUCTION Recent studies suggested that Macklin sign is a predictor of barotrauma in patients with acute respiratory distress syndrome (ARDS). We performed a systematic review to further characterize the clinical role of Macklin. METHODS PubMed, Scopus, Cochrane Central Register and Embase were searched for studies reporting data on Macklin. Studies without data on chest CT, pediatric studies, non-human and cadaver studies, case reports and series including <5 patients were excluded. The primary objective was to assess the number of patients with Macklin sign and barotrauma. Secondary objectives were: occurrence of Macklin in different populations, clinical use of Macklin, prognostic impact of Macklin. RESULTS Seven studies enrolling 979 patients were included. Macklin was present in 4-22% of COVID-19 patients. It was associated with barotrauma in 124/138 (89.8%) of cases. Macklin sign preceded barotrauma in 65/69 cases (94.2%) 3-8 days in advance. Four studies used Macklin as pathophysiological explanation for barotrauma, two studies as a predictor of barotrauma and one as a decision-making tool. Two studies suggested that Macklin is a strong predictor of barotrauma in ARDS patients and one study used Macklin sign to candidate high-risk ARDS patients to awake extracorporeal membrane oxygenation (ECMO). A possible correlation between Macklin and worse prognosis was suggested in two studies on COVID-19 and blunt chest trauma. CONCLUSIONS Increasing evidence suggests that Macklin sign anticipate barotrauma in patients with ARDS and there are initial reports on use of Macklin as a decision-making tool. Further studies investigating the role of Macklin sign in ARDS are justified.
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Affiliation(s)
- Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ottavia Pallanch
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Aldo Bonizzoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Guidi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Alberto Zangrillo
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Michele De Bonis
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Gibson D, Watters A, Pieracci F, Reiss R, Mehler PS. Pneumatosis Intestinalis and Anorexia Nervosa. Surg Infect (Larchmt) 2022; 23:661-666. [PMID: 35969259 DOI: 10.1089/sur.2022.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Pneumatosis intestinalis (PI), the presence of gas within the intestinal wall, is a condition historically associated with many diagnoses and can be life-threatening. The purpose of this article is to understand PI better in the setting of malnutrition secondary to anorexia nervosa (AN), a condition not historically affiliated with PI. Patients and Methods: In this retrospective study, the clinical findings of seven patients with AN are reported. Results: The patients were all found to have PI involving the right colon, with only a single patient also found to have PI involving additional colonic areas. No patients had small intestine involvement, and most of the patients were also diagnosed with the binge-purge subtype of AN, were receiving tube feeds, and had tenderness on abdominal examination. All seven patients were managed non-operatively. Conclusions: The authors propose that there may be an association between AN and PI. Given the surgical risks associated with malnutrition, the decision to pursue surgery, in the absence of the discussed pathologic risk factors, should be made in a very thoughtful manner. Future studies are warranted to better understand this potential association between PI and AN.
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Affiliation(s)
- Dennis Gibson
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Fredric Pieracci
- Department of Surgery, Denver Health Hospital Authority, Denver, Colorado, USA.,Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rebecca Reiss
- Department of Pharmacy, Denver Health Hospital Authority, Denver, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
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3
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Alampoondi Venkataramanan SV, George L, Sahu KK. Spontaneous Pneumorachis - A Case-Based Review. J Asthma Allergy 2021; 14:1539-1554. [PMID: 34955642 PMCID: PMC8694274 DOI: 10.2147/jaa.s325293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 11/17/2021] [Indexed: 12/26/2022] Open
Abstract
Pneumorachis is characterized by the presence of free air in the spinal canal. It is referred by different names in literature such as epidural emphysema, intraspinal air, intraspinal pneumoc(o)ele, spinal epidural and subarachnoid pneumatosis, spinal and epidural emphysema, aerorachia, pneumosaccus, air myelogram, etc. Pneumorachis can be broadly classified as traumatic, iatrogenic, or spontaneous. In this case-based review, we present a case of spontaneous pneumorachis secondary to asthma exacerbation. This is followed by a systematic review of all cases of spontaneous pneumorachis identified in PubMed. The aim of this review is to understand the pathophysiology, common causes and the management of spontaneous pneumorachis.
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Affiliation(s)
| | - Lovin George
- Department of Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Kamal Kant Sahu
- Department of Hematology and Medical Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
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4
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Puckett L, Grayeb D, Khatri V, Cass K, Mehler P. A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa. J Clin Med 2021; 10:jcm10122555. [PMID: 34207744 PMCID: PMC8226688 DOI: 10.3390/jcm10122555] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 02/08/2023] Open
Abstract
Anorexia nervosa is a complex and deadly psychiatric disorder. It is characterized by a significant degree of both co-occurring psychiatric diseases and widespread physiological changes which affect nearly every organ system. It is important for clinicians to be aware of the varied consequences of this disorder. Given the high rate of mortality due to AN, there is a need for early recognition so that patients can be referred for appropriate medical and psychiatric care early in the course of the disorder. In this study, we present a comprehensive review of the recent literature describing medical findings commonly encountered in patients with AN. The varied and overlapping complications of AN affect pregnancy, psychological well-being, as well as bone, endocrine, gastrointestinal, cardiovascular, and pulmonary systems.
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Affiliation(s)
- Leah Puckett
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Daniela Grayeb
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Vishnupriya Khatri
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Kamila Cass
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Philip Mehler
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
- Eating Recovery Center, Denver, CO 80230, USA
- Correspondence: ; Tel.: +1-(303)-602-4972
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5
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Cheong L, Koh EST, Teo DBS. Pay Air-Tension: Anorexia and Tension Pneumomediastinum. Am J Med 2019; 132:1292-1294. [PMID: 31152713 DOI: 10.1016/j.amjmed.2019.05.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Louisa Cheong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Desmond Boon-Seng Teo
- Division of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, National University Healthcare System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Abstract
Eating disorders affect a significant number of individuals across the life span and are found among all demographic groups (including all genders, socioeconomic statuses, and ethnicities). They can cause malnutrition, which can have significant effects on every organ system in the body. Cardiovascular complications are particularly dangerous and cause eating disorders to have the highest mortality rate of all mental illnesses. This article outlines the medical assessment and treatment of malnutrition due to disordered eating.
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Affiliation(s)
- Rebecka Peebles
- Eating Disorder Assessment and Treatment Program, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Roberts Center for Pediatric Research, 2716 South Street, Room 14360, Philadelphia, PA 19146, USA.
| | - Erin Hayley Sieke
- The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard 9NW55, Philadelphia, PA 19104, USA
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Abstract
Anorexia nervosa and bulimia nervosa are mental illnesses with associated complications affecting all body systems with arguably the highest mortality of all mental health disorders. A comprehensive medical evaluation is an essential first step in the treatment of anorexia nervosa and bulimia nervosa. Weight restoration and cessation of purging behaviors are often essential components in the management of medical complications of these illnesses.
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Affiliation(s)
- Dennis Gibson
- ACUTE @ Denver Health, 777 Bannock Street, Denver, CO 80204, USA; Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Cassandra Workman
- Eating Recovery Center, 7351 East Lowry Boulevard, Suite 200, Denver, CO 80230, USA
| | - Philip S Mehler
- ACUTE @ Denver Health, 777 Bannock Street, Denver, CO 80204, USA; Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA; Eating Recovery Center, 7351 East Lowry Boulevard, Suite 200, Denver, CO 80230, USA.
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8
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Tan TSE, Tan JSH. Anorexia nervosa presenting as diffuse spontaneous air leaks. BMJ Case Rep 2019; 12:12/2/bcr-2018-227838. [PMID: 30755429 DOI: 10.1136/bcr-2018-227838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Timothy Shao Ern Tan
- Manchester Medical School, The University of Manchester, Manchester, UK.,Department of Diagnostic Radiology, Singapore General Hospital, Singapore
| | - Janice Ser Huey Tan
- Manchester Medical School, The University of Manchester, Manchester, UK.,Department of Diagnostic Radiology, Singapore General Hospital, Singapore
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