Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of severe asthmatic attack treated by isoflurane inhalational anesthesia and bronchial lavage is reported. A 24-year-old woman was admitted to our hospital with severe asthmatic attack. Although she was treated by intravenous administration of aminophylline and corticosteroids, pulmonary function and consciousness deteriorated. Therefore, she was intubated nasally and mechanically ventilated by IPPV with administration of aminophylline, corticosteroids and epinephrine. Despite this treatment, she remained in status asthmaticus with high airway pressure and barotrauma causing pneumomediastinum and subcutaneous emphysema. On the 3rd hospital day, a system was arranged so that isoflurane could be given in an air and oxygen mixture, and administration was started with a concentration of isoflurane of 1.5%. In addition, bronchial lavage via bronchoscopy was performed in order to clear any mucous plugs. After 24 hours, there was marked improvement of wheezing, airway pressure and arterial blood gas level. Eventually, she was weaned from the ventilator on the 6th hospital day without significant side effects. The use of halothane inhalational anesthetic treatment for status asthmaticus is widely known, but it has serious side effects such as arrhythmia and liver injury. Isoflurane may be the inhalational anesthetic agent of choice in the treatment of status asthmaticus.
 ...
PMID:[A case of intractable status asthmaticus treated by isoflurane inhalational anesthesia and bronchial lavage]. 146 92

We report six observations of pneumomediastinum, due to dental extraction and use of high speed air turbine drill, aspiration of a nut with air trapping, labor in delivery, status asthmaticus, mechanical ventilation, and rectal perforation. Some patients showed widespread extension of dissecting air presenting as subcutaneous emphysema, pneumopericardium or pneumoretroperitoneum. The mediastinum is thought to be a central pump, the diaphragm and the lung acting like bellows, which distribute interstitial air from and into communicating layers on both sides of the diaphragm. Pneumomediastinum does not prove an air leak in the thoracic cage nor does pneumoretroperitoneum absolutely indicate bowel rupture. Review of the literature.
 ...
PMID:[Dissecting emphysema]. 194 55

Pneumomediastinum cases admitted to our Respiratory Intensive Care Unit during the past 15 years are reviewed. After excluding secondary and iatrogenic pneumomediastinum, spontaneous pneumomediastinum was diagnosed in seven patients being all of them males. The causative conditions were status asthmaticus in four patients, intense cough in two and Valsalva manoeuver in one patient. The most frequent symptoms were dyspnea, chest pain and odynophagia. Subcutaneous emphysema appeared in six patients and there was associated pneumothorax in two cases. ECG was normal in six patients. All cases of spontaneous pneumomediastinum had a satisfactory evolution with conservative treatment resolving in four to eight days.
 ...
PMID:[Spontaneous pneumomediastinum in adults]. 227 Mar 26

Corticosteroids have been recognized as useful in the management of asthma for the past 35 years. Controversy remains as to their precise indications, dosage, and optimal methods of administration. Only recently has objective evidence been presented confirming their usefulness in acute severe attacks and status asthmaticus. In the treatment of the latter, high doses of methylprednisolone (125 mg every 6 hours) has been shown to be more effective than lower doses. The corticosteroids are also useful diagnostically to determine reversibility of airway obstruction in the bronchitis-emphysema syndrome. To prevent adrenal insufficiency, they are mandatory for patients previously receiving long-term systemic corticosteroid therapy who are undergoing stress (e.g., surgery). Indications for chronic severe asthma are the least well established. Patients with severe incapacitating asthma uncontrolled by bronchodilators or cromolyn should be considered candidates for corticosteroid therapy. When long-term therapy is necessary, aerosolized corticosteroids or alternate-day therapy are preferable to daily dosing. Regardless of the route used, it is advisable to limit the use of these agents to patients who clearly require them and to take all precautions to minimize side effects. Neither method, especially when higher doses are used, obviates possible development of serious complications.
 ...
PMID:Overview of corticosteroid therapy. 401 59

Spontaneous subcutaneous accumulations of air in the soft parts of the thorax during an asthmatic crisis (status asthmaticus) are rarely seen. The pathomechanism of the phenomenon, which may lead to the formation of an emphysema of the soft parts via the pneumomediastinum, is discussed, and the possible complications which must be taken into account are pointed out. The value of radiological examination of the thorax in children suffering from asthma bronchiale, is explained briefly.
 ...
PMID:[Subcutaneous emphysema in status asthmaticus]. 405 15

The lungs of 6 elderly nonsmoking persons with severe long-standing "allergic" asthma (mean duration, 45 yr), not dying in status asthmaticus, were examined quantitatively to characterize the structural alterations that would produce clinical chronic air-flow obstruction. The percent of bronchial smooth muscle was not significantly elevated in these asthmatics, compared with that in 7 control subjects. Two asthmatics had reduced small airway diameters, with histologic evidence of inflammation or fibrosis. Mean linear intercept (interalveolar distance) in asthmatics was not significantly elevated over that in control subjects, but one asthmatic had a clearly increased mean linear intercept and histologic evidence of very mild emphysema. Bronchial basement membrane thickness was 8.3 +/- 2.0 mu in asthmatics and 5.1 +/- 0.9 mu in control subjects (p less than 0.01), a measurement that discriminated best between asthmatics and nonasthmatics. Small airway narrowing may develop in long-standing asthma to explain the component of nonreversible air-flow obstruction that characterizes such patients.
 ...
PMID:Quantitative structural alterations in long-standing allergic asthma. 646 83

The management of a case of status asthmaticus complicated by surgical emphysema is described. In view of voice changes, intubation was necessary but intermittent positive pressure ventilation was considered unwise, because of the surgical emphysema. A means of maintaining adequate sedation in an intubated patient whilst allowing spontaneous respiration is outlined.
 ...
PMID:Status asthmaticus. Management of status asthmaticus complicated by surgical emphysema--avoidance of intermittent positive pressure ventilation. 704 90

A 19-year-old endotracheally intubated women was admitted to our hospital in severe status asthmaticus that was not relieved by inhalation of beta 2-agonists or by epinephrine, aminophylline, or corticosteroids. A chest radiography revealed pneumomediastinum and subcutaneous emphysema. Pressure-limited mechanical ventilation at a peak airway pressure of 20--30 cmH2O failed to ventilate the lungs, and caused a left pneumothorax and atelectasis. Extracorporeal lung assist (ECLA) was begun and enabled repeated suctioning through a fiberoptic bronchoscope for more than a minute with no serious complications. During ECLA aerosol therapy with a large dose of a beta 2-agonist (procatherol 0.15 mg) increased the tidal volume with no adverse effects. Atelectatic areas of the lungs re-expanded, pulmonary function improved, and ECLA was stopped 86 hours after it had been started. We suggest that, although it is highly invasive, ECLA can be useful in patients with status asthmaticus refractory to mechanical ventilation, and can allow endobronchial suctioning to be done safely.
 ...
PMID:[Endobronchial treatments made possible by extracorporeal lung assist in a patient in status asthmaticus refractory to mechanical ventilation]. 862 85

A 23-year-old man was transferred to our hospital in an unconscious state due to hypercapnea with massive subcutaneous emphysema secondary to status asthmaticus. Mechanical ventilation was ineffective for removal of carbon dioxide and oxygenation. After the initiation of extracorporeal lung assist the patient was able to effectively clear his secretions. This resulted in marked improvement in his pulmonary compliance. There were no hemorrhagic pulmonary or hematologic complications. This is the first patient in whom we have used venovenous bypass in the treatment of status asthmaticus.
 ...
PMID:Clinical use of extracorporeal lung assist for a patient in status asthmaticus. 878 29

Bronchial asthma remains a significant cause of mortality at all ages, despite the increased understanding of its pathogenesis and the range of drugs available for its treatment. Changes in therapeutic management can influence death rates and constant surveillance, combined with high-quality post mortem investigations, is essential. Disease severity, poor disease management and adverse psychosocial circumstances are all risk factors for asthma mortality. Bronchial asthma causes characteristic histological changes in the mucosa of the airways which are present even before the clinical diagnosis of asthma can be made. These include fibrous thickening of the lamina reticularis of the epithelial basement membrane, smooth muscle hypertrophy and hyperplasia, increased mucosal vascularity and an eosinophil-rich inflammatory cell infiltrate. In addition, mucoid plugging of the airway lumen is frequently associated with fatal asthma. The recognition of these changes can allow the diagnosis of asthma to be made for the first time at autopsy, in those cases where asthma goes undiagnosed in life. Acute severe asthma may be accompanied by pneumothorax and surgical emphysema of the mediastinum. Disorders which may mimic asthma include pulmonary embolism, chronic obstructive pulmonary disease and anaphylaxis, but careful post mortem examination and appropriate investigations should reveal the true cause of death.
 ...
PMID:Asthma deaths; persistent and preventable mortality. 1287 25


1 2 Next >>