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Query: UMLS:C0020505 (hyperphagia)
 6,116 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A young man with severe multiple injuries following a motorcycle accident was admitted with head and mandible fractures, coma, fracture dislocation at C5-C6 resulting in total leg paralysis, partial paralysis of the right arm and intercostal muscles, and closed chest injury with possible pulmonary contusion. On the fourth day he developed fulminating mediastinitis and massive empyema, and was found to have a ruptured esophagus. Recovery became possible with surgical drainage of the pleural cavity and mediastinum, proximal and distal decompression of the esophagus, antimicrobial therapy, irrigation of the pleural cavity, complete intravenous hyperalimentation, and infusions of salt-poor albumin. The patient was discharged after 95 days, and 7 months after injury is neurologically intact except for a partial right wrist drop. This rare esophageal rupture should be suspected in any chest injury patients, especially those characterized by extreme cyanosis, dyspnea, shock, and prostration incompatible with thoracic cage injury.
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PMID:Rupture of the thoracic esophagus from blunt trauma. 59 47

The development of esophagopleural fistula following pulmonary resection is an uncommon but serious complication. The fistula may appear either soon after operation, due to direct trauma to the esophagus or to its blood supply during extensive dissection, or later, in association with the development of a bronchopleural fistula and empyema following the pulmonary resection. Treatment of these fistulas is usually complicated, and the recovery period is prolonged. Control of infection, hyperalimentation, obliteration of the empyema space, and closure of the fistula with a muscle or pleural flap are recommended methods of management. The pathogenesis, treatment, results, and prevention of this complication are discussed.
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PMID:Esophagopleural fistula following pulmonary resection. 61 16

The patient was a 43-year-old woman, who had undergone a right middle and lower lobectomy for adenocarcinoma of the lung. An esophagobronchopleural fistula developed two months after the operation. It was treated by a combined procedure consisting of pedicle flap closure of the fistula and thoracoplasty. The esophagobronchopleural fistula recurred two days later, however, and another pedicle flap closure with fenestration of the chest wall were performed in a third operation. A bronchopleural fistula then recurred, after which it was treated by conservative therapy including intravenous hyperalimentation, frequent dressing changes and systemic administration of appropriate antibiotics. It closed spontaneously 23 days after surgery, in spite of this being a very rare but serious complication very difficult to treat and cure. From our experience with this particular case, we recommend, for treating esophagobronchopleural fistulas, proper drainage, antibiotic therapy, intravenous hyperalimentation and packing of the empyema space, together with closure of the fistula using a muscle or pleural flap.
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PMID:An esophagobronchopleural fistula successfully treated by a surgical procedure combined with conservative therapy after resection for lung cancer. 260 42

Eleven patients were examined by ultrasound before undergoing cholecystectomy (n = 9) or cholecystostomy (n = 2) for acalculous cholecystitis after abdominal surgery. The ultrasound images were analyzed retrospectively and compared with the surgical and histologic findings. The results indicate several established ultrasound criteria of cholecystitis to be less reliable than usual. Although 10 of 11 patients were on parenteral hyperalimentation, gross distention of the gallbladder was observed in only 3. In 4 of 7 patients, in whom pericholecystic fluid was observed, no gallbladder perforation was found at surgery. However, thickening of the gallbladder wall was displayed in 10 of 11 cases, combined with a sonolucent intramural layer in 6. Furthermore, intraluminal nonshadowing echogenic densities correlated with empyema or hemorrhage in 5 of 8 cases. In conclusion, despite several limitations, ultrasound can be of considerable help when one is deciding to perform repeat laparotomy when acalculous cholecystitis is suspected.
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PMID:Ultrasound in postoperative acalculous cholecystitis. 351 Sep 33

Nutritional supplements administered through flexible small caliber feeding tubes are an increasingly popular substitute for parenteral hyperalimentation. Small and large caliber nasogastric tubes can inadvertently pass into the tracheobronchial tree, even in the presence of an endotracheal tube with an inflated cuff. We report three patients who had small caliber feeding tubes passed through the tracheobronchial tree perforating into the pleural space. Potential complications include immediate or delayed pneumothorax, tension pneumothorax, hydropneumothorax, and empyema. Prompt post-insertion chest radiography is required to verify correct placement of small caliber feeding tubes.
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PMID:Iatrogenic bronchopleural fistula caused by feeding tube insertion. 392 Feb 21

The patient was a 75-year-old male who had a right empyema with bronchopleural fistula, which had developed after right upper lobectomy for pulmonary tuberculosis performed 18 years previously. He also had diabetes and renal dysfunction. The fistula failed to close 5 months after open drainage thoracotomy. Accordingly, closure was performed by the intrathoracic transposition of an omental and muscle flaps obtained from the right latissimus dorsi, pectoralis major, and pectoralis minor. At 70 days after the closure, the fistula reopened due to his poor nutritional state, but it closed again spontaneously following intravenous hyperalimentation. In those patients who have empyema with bronchopleural fistula associated with diabetes or renal dysfunction, long-term postoperative care, especially nutritional management, is necessary because of their poor general health condition.
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PMID:[A case of empyema with bronchopleural fistula associated with diabetes and renal failure treated utilizing omental and muscle flap]. 840 20

Pleural space disease is often complex, difficult to diagnose, and problematic to manage. At computed tomography (CT), empyema appears as an oblong fluid collection with smooth inner margins that compresses and displaces the surrounding lung and airways away from the pleural collection. CT findings in hemothorax include heterogeneous attenuation of pleural fluid, hyperattenuating areas of debris within pleural fluid, and a "fluid-hematocrit" level. Nodular pleural thickening at chest radiography or CT indicates a malignant pleural effusion; the cross-sectional capability of CT allows scrutiny of all pleural surfaces to detect enhancing tumor implants in addition to pleural effusions. Pleural plaque, rounded atelectasis, and pleural pseudotumor can mimic neoplastic disease on chest radiographs but can often be diagnosed with CT. Bronchopleural fistula may also be difficult to diagnose with radiography alone, necessitating further analysis with CT. Pleurocentesis fluid containing chyle, cerebrospinal fluid, amylase, or hyperalimentation fluid indicates pleural space disease with an unusual or iatrogenic cause. Recent advances in image-guided procedures have significantly improved treatment options for many complex pleural space processes.
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PMID:Complex disease of the pleural space: radiographic and CT evaluation. 901

We experience a case of esophagopleural fistula successfully cured by conservative therapy after the lung cancer operation. A 46-year-old man was received middle and lower lobectomy for adenoid cystic carcinoma of the right lung. Complication of empyema associated with an esophagopleural fistula occurred on postoperative 4th day. Conservative therapy of nothing by mouth, intravenous hyperalimentation and antibiotics was started. Three thoracic drains were inserted and the thoracic irrigation of total 3,000 ml warm saline per day twice on one day was continued. The esophagopleural fistula was closed on 6th week and the patient was discharged on 11th week after the therapy start. This complication is much rare, but recent advance in the diagnostic methods seemed to increase the indication of conservative therapy in future.
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PMID:[A case of esophagopleural fistula successfully cured by conservative therapy after middle and lower lobectomy of right lung]. 940 15