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Query: UMLS:C0034067 (emphysema)
 11,506 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two patients with primary spontaneous pneumothorax died despite intensive treatment. In the first the pneumothorax had been present for 10 days, and, after insertion of a chest drain, pulmonary oedema developed unilaterally, followed by cardiac arrest. She was resuscitated, but later died of a tension pneumothorax on the other side, probably due to cardiac massage and artificial ventilation. In the second patient, after insertion of a chest drain, mediastinal emphysema spread to the head and neck, causing fatal obstruction of the hypopharynx.
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PMID:Two unexpected deaths from pneumothorax. 8 5

Clinical symptoms such as mediastinal and tissue emphysema, impaired inflow with cyanosis and extreme dyspnoea, signs of tension pneumothorax suggest rupture of a bronchus; nonstop loss of air via intercostal drainage is an almost certain sign and bronchoscopy provides the final proof. Injury to smaller bronchi may remain asymptomatic. 1,600 persons were treated for chest injury during the past 17 years, 7 of them on account of a ruptured bronchus. The right and left main bronchus were involved in 4 cases and one case respectively. The bronchus of the right upper lobe and the trachea were ruptured in one case each. Once the injury has been diagnosed surgical repair should follow quickly, although the results of anastomoses performed at a later stage were also satisfactory. Closure was by chromcut knotted sutures. Partial pneumonectomy is indicated only if damage to the lungs is extensive. The postoperative respiratory function of the injured lung was satisfactory in all cases.
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PMID:[Diagnosis and treatment of injuries to the tracheo-bronchial system (author's transl)]. 37 50

263 persons with chest injuries were treated over a period of 16 years. 47 had performating chest injuries, in the remaining cases it was a blunt trauma. Prompt recognition of a life-endangering situation (cardiac tamponade, tension pneumothorax, mediastinal emphysema, massive haemothorax) is essential; radiological and laboratory diagnostic methods play a secondary role. The most effective emergency treatment is intercostal continuous suction; in many cases it is the only one needed. A haemothorax must be evacuated completely because of the risk of complications and fibrin formation. Thoracotomy is rarely, and surgical removal of lung tissue hardly ever, indicated. 30 persons needed emergency thoracotomy. Accompanying intraabdominal injuries, mostly rupture of the diaphragm and spleen, were observed in 45 patients. Late sequels were lung abscesses, posttraumatic cysts, pleural empyema and adhesions, atelectases. Decortication, if indicated, should be performed at an early stage.
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PMID:[Surgical aspects of open and closed chest injuries (author's transl)]. 46 18

Postmortem chest roentgenograms in approximately 3,500 cases of a random autopsy population were reviewed. Pneumothorax was found in 77 cases (2.2%). Simple pneumothorax was present in 38 cases, and tension pneumothorax or combined simple and tension pneumothorax was present in 39 cases. Only 40 of the 77 patients had been clinically diagnosed as having pneumothorax. Pulmonary conditions most often present in cadavers with pneumothorax were bacterial pneumonia, pulmonary emphysema, and pulmonary embolism, with or without infarcts and infarct abscesses. Procedures most frequently associated with pneumothorax were mechanical ventilation and attempts at cardiorespiratory resuscitation. Rib fractures (iatrogenic and noniatrogenic) were found in 23 of the 77 cases.
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PMID:Pneumothorax in a large autopsy population. A study of 77 cases. 69 69

The modern continuous flow anaesthetic machine supplies gases under high pressure directly to the patient's trachea. Accidental obstruction to the outflow of expired gases is not uncommon, and may lead to the application of excessive pressure to the patient's airways with potentially disastrous results. The ways in which obstruction to outflow may occur, and the factors which affect the subsequent rise in intrapulmonary pressure are enumerated. The effects of a substained elevation of airway pressure on cardiac output are discussed and an outline is given of the sequence of events which lead from alveolar rupture to the development of mediastinal emphysema and tension pneumothorax. Finally, suggestions are made for ways in which the patient can be protected from excessive airway pressure, by routine use of a pressure-limiting reservoir bag in conjunction with a suitable pressure-limiting valve on all anaesthetic breathing attachments.
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PMID:Excessive airway pressure during anaesthesia. Hazards, effects and prevention. 71 13

In order to be able to carry out effective emergency medicine outside the hospital, knowledge of some of the important puncture techniques is essential. Sometimes injection and infusion is required under difficult conditions, and sometimes decompression punctures are the vitally decisive interventions. Among these are central venous access via the subclavian vein, intracardial injection, decompression puncture in cardiac tamponade, relief of tension pneumothorax, cannulation of the trachea and relief of mediastinal emphysema. These interventions are outlined according to indication, technique and complications.
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PMID:[Puncture techniques in emergency medicine (author's transl)]. 81 32

There were 34 episodes of pneumothorax out of 400 episodes of COPD (i.e. 8.5% of the total) among patients who were admitted to Chulalongkorn Hospital during the period 1982 to 1986; the episodes of pneumothorax occurred among 22 males and one female, with the average age on admission being 64.0 +/- 8.5 years. All patients had a long history of smoking (average 40 years) with a history of recurrent pneumothorax (47.8%) and two episodes of pneumothorax per patient. Since only about one third of our patients had chest pain or positive signs of pneumothorax on physical examination, the possibility of pneumothorax should be considered in every patient who develops sudden and increasing shortness of breath, especially during mechanical ventilation, or even in association with other obvious precipitating factors, e.g. URI. With regard to complications, there were eight, four, two, two and five episodes of severe respiratory failure requiring assisted ventilation, tension pneumothorax, bilateral simultaneous pneumothorax, pneumomediastinum with subcutaneous emphysema, and plural effusion, respectively. The death rate was 23.5 per cent. Patients who had a pneumothorax requiring assisted ventilation or who developed a pneumothorax during assisted ventilation had a grave prognosis because of multiple complications from mechanical ventilation. Two episodes with minimal pneumothoraxes achieved re-expansion after conservative treatment. The treatment required 3.3 days for the lung to fully expand, 9.6 days when the air-leak stopped and the duration of tube drainage was 10.8 days. Our study indicates that the longer the duration of lung collapse the longer the time required for re-expansion of the lung.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Spontaneous pneumothorax in chronic obstructive pulmonary disease. 140 43

Subcutaneous emphysema, pneumomediastinum, and tension pneumothorax are previously unreported complications of shoulder arthroscopy with subacromial decompression. Three patients developed extensive subcutaneous emphysema, pneumomediastinum, and bilateral tension pneumothorax during or immediately after shoulder arthroscopy with subacromial decompression. The procedure was terminated and appropriate treatment was given. All three patients recovered completely with no residual damage. The complications are thought to be associated with the extravasation of air that may be drawn in from the lateral portal when the arthroscopic infusion pump and power shaver with suction are turned on. Early diagnosis, followed by immediate termination of the infusion pump and suction shaver along with appropriate treatment can be life-saving.
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PMID:Subcutaneous emphysema, pneumomediastinum, and potentially life-threatening tension pneumothorax. Pulmonary complications from arthroscopic shoulder decompression. 158 82

Imaging of the respiratory system developed with exceptional rapidity in North America during the spring of 1896, after Roentgen's discovery of X-rays in November 1895, largely because of the efforts of a unique physicians, Francis H. Williams. With great zeal, this pioneer used fluoroscopy for early detection of tuberculosis and other life-threatening chest disorders. By the summer of 1896, he had accumulated more than 100 volumes containing tracings of clinical chest fluoroscopy. As a result of his extensive clinical experience, his dedication to patients' welfare, and his sense of scientific inquiry, several inventions and many landmark clinical observations were made in the first few years after the discovery of the X-ray. These included (1) the invention of a "densitometer" for standardized measurements of relative X-ray attenuation of the lung, (2) the invention of a "seehear" device to correlate auscultative findings and fluoroscopic observations, (3) the recognition that fluoroscopy was more accurate than percussion for estimating mediastinal displacement, (4) the discovery that clinically occult tuberculosis and congestive heart failure could be detected with fluoroscopy, (5) the documentation that unilateral chest disease caused decreased ipsilateral ventilatory compliance and increased contralateral ventilation, (6) the identification of the classical imaging characteristics of tuberculosis, pneumonia, pneumothorax, tension pneumothorax, pleural effusion, hydropneumothorax, emphysema, congestive heart failure, and air trapping. In April 1896, Dr. Williams described the "air bronchogram" in a radiograph of a patient with pneumonia.
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PMID:Fleischner Lecture. Imaging the respiratory system in the first few years after discovery of the X-ray: contributions of Francis H. Williams, M.D. 160 79

Pulmonary interstitial emphysema (PIE) may occur spontaneously, as a complication of endotracheal tube displacement, intrauterine viral pneumonia or massive aspiration of formula. Nevertheless PIE occurs more frequently in neonates requiring mechanical ventilation for RDS. Untoward effects of large air collections in the extra-alveolar spaces are based on decreased perfusion and ventilation of the affected lung tissues, compression of adjacent pulmonary parenchyma and mediastinum, possible air embolism. Sometimes PIE spontaneously regress, but in some instances the process is self perpetuating, leading to an "air block syndrome". Fourteen (19.4%) of 72 infants ventilated for RDS in a three-year period had radiological evidence of PIE during the first few days of life. All 5 bilateral, 7 diffuse and 2 localized cases were treated with "vigorous pulmonary therapy". In addition to these procedures, 4 neonates were submitted to a selective bronchial intubation (SBI) and 5 different infants improved after HFV. No one of our patients underwent a surgical procedure. Infants with fine linear hyperlucencies improved sooner. All pneumothoraces (7 of 14) were preceded by X-ray appearances of PIE. Three neonates died. Mortality was observed in newborns with bilateral PIE, because of an intraventricular hemorrhage in two and an intractable under tension pneumothorax in one patient. Plain chest roentgenograms, histological pictures and treatment modalities of PIE remain separated from these considered for congenital lobar emphysema, congenital cystic adenomatoid malformation, bronchogenic cyst or lung sequestration. Surgical treatment of PIE is not as universally accepted as in congenital cystic lesions of the lung, in which it's mandatory.
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PMID:[Interstitial pulmonary emphysema. Combined therapeutic approach in a retrospective multidisciplinary study]. 179 94


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