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

The incidence of parturition difficulties from 239 sheep and 21 does from the last seven lambing periods was recorded at a clinic for obstetrics. Without exception the does were housed under extensive conditions by hobby-breeders. The sheep also originated predominantly from hobby-breeders and in a smaller amount from professional breeders, both practising extensive housing. The incidence of manual deliveries (m.d.) in both species was lower (39.3% in sheep; 42.8% in does) than that of caesarean sections (c.s; 57.3% in sheep; 47.7% in does). In a small amount the obstetrics were solved via fetotomy. The practical proceedings concerning the different methods of therapies including analgesia, surgical approaches and postoperative treatments are described. In sheep ringwomb was the dominating reason for dystocia for m.d. (43.5%) as well as for c.s. (73.7%), followed by obstetrics due to fetal abnormal presentation and/or position or posture (25.2% m.d.; 1.1% c.s.), secondary oversized fetuses due to postmortal emphysema and edema (19.1% m.d.; 10.7% c.s.), followed by primary relative or absolute oversized fetuses (1.0% m.d.; 4.8% c.s.) and simultaneously presentation of multiple fetuses (4.2% m.d.). Other causes of dystocia remained scarce (i.e. uterine torsion, hydrallantois, abdominal or perineal hernia). There rested an amount of sheep (7.1%) with preterm s.c. because of continuous pressure and pain symptoms followed by infections or injuries of the prolapsed vagina and/or rectum, pregnancy toxemia and other reasons. The main indication for fetotomy in sheep were fetuses with postmortal edema and emphysema (80.0%), deformity of the kids (20.0%) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Birth difficulties in sheep and goats--evaluation of patient outcome from seven lambing periods in an obstetrical clinic]. 772 May 47

A 60-year-old man was admitted to hospital because of severely impaired swallowing, retrosternal pain and marked weight loss. History and physical examination of the patient, whose general condition was obviously much reduced, pointed to carcinoma of the oesophagus. Contrast-medium swallow demonstrated subtotal stenosis in the oesophagus. Computed tomography and magnetic resonance imaging showed a space-occupying mass originating from the oesophagus, in close relationship to the trachea, main bronchi and descending aorta. Biopsy confirmed the diagnosis of oesophagus carcinoma and exploratory thoracotomy excluded curative surgical treatment. An attempt was made to introduce a feeding tube endoscopically to provide nutritional palliation. But the oesophagus was perforated during this manoeuvre and resulted in an oesophagobronchial fistula with subsequent mediastinitis and mediastinal emphysema. Using a self-expandable plastic-covered metal stent it was possible to cover the perforation and overcome the patient's dysphagia. The mediastinitis healed under intravenous administration of cefotaxim (2 g three times daily), netilmicin (400 mg daily) and metronidazole (500 mg three times daily), for 5 days.
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PMID:[Iatrogenic esophageal perforation in inoperable esophageal carcinoma. Its therapy with a plastic-coated metal stent]. 773 46

Laparoscopic cholecystectomy is a relatively new surgical procedure which is enjoying ever-increasing popularity and presenting new anesthetic challenges. The advantages of shorter hospital stay and more rapid return to normal activities are combined with less pain associated with the small limited incisions and less postoperative ileus compared with the traditional open cholecystectomy. The efficacy of laparoscopic appendectomy and hemicolectomy has been recently evaluated. However, there have been no prospective randomized studies to date comparing laparoscopic with traditional laparotomy techniques. The physiological effects of prolonged pneumoperitoneum and the longer duration of surgery with the laparoscopic techniques are of concern. The application of laparoscopic inguinal hernia repair may be limited because, unlike traditional surgical hepair, general anesthesia is required and concerns have been expressed about the duration of surgery and the possibility of hernia recurrence. Notwithstanding case reports and series describing successful diaphragmatic and hiatus hernia repair using a laparoscopic surgical technique, the frequently encountered complications of cervical surgical emphysema, pneumothorax, and pneumomediastinum, attributed to passage of insufflating gas through weak points or defects in the diaphragm, must be of major concern. Anesthesiologists must maintain a high index of suspicion for these potential complication and must undertake appropriate monitoring. If there is clinical evidence of a tension pneumothorax, immediate chest tube decompression is indicated. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiological changes associated with patient positioning and pneumoperitoneum creation. The choice of anesthetic technique for upper abdominal laparoscopic procedures is most frequently limited to general anesthesia. Controlled ventilation avoids hypercarbia, and an anesthetic technique incorporating antiemetics and nonsteroidal anti-inflammatory agents has reduced postoperative nausea and vomiting following laparoscopic cholecystectomy. The use of nitrous oxide during laparoscopic procedures remains controversial. Laparoscopic cholecystectomy is a major advance in the management of patients with symptomatic gall-bladder disease. However, in the present era of cost containment, older and sicker patients may present for this procedure on the day of surgery without adequate preoperative evaluation. Anesthesiologists should thus be prepared to recommend deflation of the pneumoperitoneum and possibly conversion to an open procedure if hemodynamic, oxygenation, or ventilation difficulties arise during the procedure.
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PMID:Laparoscopic surgery--anesthetic implications. 783 96

Laparoscopic pelvic lymphadenectomy has been proposed for staging of prostate cancer and it might be used, in selected cases, also in bladder cancer. On a total of 31 laparoscopic lymphadenectomies (LPND), 18 for prostate cancer and 13 for bladder cancer, we found positive nodes in 8 cases (26.1%), 4 in prostate and 4 in bladder cancer group. We had no intraoperative complications and negligible postoperative complications (in 10% of cases shoulder-tip pain and in 24% subcutaneous emphysema); all these spontaneously disappeared after 24-36 hours. Patients with negative nodes underwent radical surgery except two prostate cancer patients who underwent radiotherapy, and patients with positive nodes underwent hormonal therapy (for prostate cancer) or chemoradiotherapy protocol (for bladder cancer). In conclusion, laparoscopic lymphadenectomy proved to be a feasible and safe method for staging urological malignancies, being less invasive, with shorter hospitalization and postoperative convalescence than open lymphadenectomy. It should be mainly indicated in high risk prostate cancer patients (elevated PSA and/or Gleason score). In bladder cancer patients, it could be proposed in bladder sparing investigational protocols, as the percentage of pelvic nodes metastases in T2/T3 bladder cancer is sufficiently high to justify an additional staging procedure.
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PMID:Laparoscopic pelvic lymphnodes dissection for prostate and bladder cancer: indication, techniques and results. 792 Jul 41

In recent times minimally invasive surgery has secured a firm place among the therapeutic options in thoracic surgery. The experience and results gained from video-assisted surgery on 109 patients between January 1, 1992 and July 31, 1993 are critically discussed. The procedure could be completed thoracoscopically on 94 of them. A change of method was necessary nine times for technical reasons and six times for oncological reasons (two times due to metastasis, four times due to bronchial carcinoma). A total of 154 individual operations were conducted. Sixty-three patients with recurrent spontaneous pneumothorax were successfully treated. The relapse rate was 1.5%. With the exception of three rethoracotomies (one due to postoperative hemorrhaging and two to persistent fistula) no significant complications occurred. Further indications included capsulated pleural empyema (n = 1), persistent hematothorax (n = 2), pleurectomy for malignant pleural effusion (n = 2), pleural tumors (n = 3), pulmonary parenchyma (n = 2), interstitial lung diseases (n = 3), bullous emphysema (n = 2), peripheral lung nodules (n = 18), mediastinal tumors (n = 8), and sympathectomy (n = 2). The advantages of video-assisted thoracoscopic surgery for patients include cosmetic considerations, low pain, earlier postoperative mobilization, and for some indications, a shorter operation period. The significant disadvantages for the surgeon are the loss of binocular vision as well as the impossibility of intraoperative palpation.
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PMID:Video-assisted thoracoscopic surgery--indications, results, complications, and contraindications. 812 59

A technique is described for laparoscopic abdominoperineal resection (APR). Three of four such cases could be successfully completed laparoscopically. One major complication was directly related to the laparoscopic approach, an enterotomy caused by the Babcock clamp, which was discovered at the time of conversion to laparotomy for bleeding. A minor complication related to the laparoscopic procedure, subcutaneous emphysema, required no treatment. There was one postoperative death unrelated to the laparoscopic technique. The intraoperative advantage was enhanced visualization; the intraoperative disadvantages were increased operative time and cost. Postoperative advantages were earlier mobilization, oral intake, and discharge; decreased pain; and improved cosmesis. Laparoscopic APR is both feasible and safe and with more experience should prove to be cost effective.
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PMID:Laparoscopic assisted abdominoperineal resection. 826 30

During the last two years video-assisted operative thoracoscopy has introduced new impetus into thoracic surgery. Today it is viewed as a sparing and safe alternative to thoracotomy for a wide spectrum of indications. The prerequisites, instruments, and operative techniques are discussed. In oncological thoracic surgery it still remains to be verified whether the criteria of radicality are fulfilled by this new technique. Using video-assisted operative thoracoscopy, we have successfully operated on 209 patients with the following indications: recurrent pneumothorax (n = 94), interstitial lung disease (n = 25), coin lesion (n = 20), pleural effusion (n = 17), hyperhidrosis (n = 14), mediastinal tumor or lymphoma (n = 10), thoracic empyema (n = 9), bullous emphysema (n = 8), pleural tumor (n = 5), hematothorax (n = 3), malignant pericardial effusion (n = 3), and chylothorax (n = 1). The advantages of this minimally traumatizing operating technique lie in a better view of the operative site, the objectively measurable reduction in postoperative restriction, less pain, earlier postoperative mobilization, and shorter hospital stay. This operating technique, in addition to being sparing, requires markedly less time than a thoracotomy. The disadvantages are the two-dimensional monitor picture and, especially, the loss of palpation.
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PMID:Prerequisites, indications, and techniques of video-assisted thoracoscopic surgery. 836 65

The authors describe their technique of videoscopic (VS) lumbar sympathectomy (LSE), compared to the open LSE. From 1992 to 1994, 21 open and 19 VS LSE were performed. The indication was reflex sympathetic dystrophy in 17 and arterial insufficiency in 23 patients. In the open LSE the mean duration of anaesthesia was 80 min (55-115) and of surgery 37 min (25-65). The length of the chain removed varied from 1 to 3 ganglia (6-7 cm). Complications were noted in 5 patients: 1 pneumonia, 2 superficial wound problems and 2 cases of postsympathectomy neuralgia. Hospital stay of patients with RSD varied from 2 to 5 days. Of the 19 attempts to perform a VS LSE 4 had to be converted to the open technique. The duration of anesthesia was 150 min (90-280) and of surgery 92 min (45-240). Lengths of chain removed varied from 1 to several ganglia (6-7 cm). A pneumoperitoneum was present in 10 procedures, but a Veress needle was placed in only 4 of these. Complications were present in 9 patients: 1 important subcutaneous emphysema, 1 severe costal pain, 2 neuralgia, 1 temporary psoas dysfunction, 1 haemorrhage from a lumbar vein with conversion to the open technique and 3 minor superficial wound problems. The hospital stay ranged from 2 to 5 days. This study suggests that the VS LSE has no benefit over the open technique as far as the operative and early results are concerned. Whether this technique avoids some of the late disadvantages of a lumbotomy remains to be seen.
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PMID:Technique and early results of videoscopic lumbar sympathectomy. 862 81

Alveolar air leakage after pulmonary resection usually heals with adequate pleural drainage, but must be more actively treated if leakage may be severe. If left untreated, the postresection space can lead to empyema. We used a muscle flap to prevent alveolar air leakage from a large sectional plane of the lung resected because of metastases in the lung and chest wall. A 48-year-old man complained of pain and a mass on the right side of his back. He had undergone resection and chemotherapy for clear cell sarcoma that originated on the back of the left hand when 43 years of age, wedge resection of the right lower lobe of the lung for a metastatic pulmonary tumor at 46 years, and lobectomy of the same lobe for a recurrence of the metastatic pulmonary tumor at 47 years. The diagnosis was of a metastatic tumor to the right chest wall with peripheral pulmonary tumors of the right upper and middle lobes. Resection of the chest wall and the lung including the tumors was done. Much air leakage from the extensive sectional plane of the right upper and middle lobes was seen intraoperatively, and this plane was therefore covered with a flap of the musculus latissimus dorsi. Chest tubes were removed on day 7 postoperatively when air leakage was no longer seen. Subcutaneous emphysema, which appeared on day 14 postoperatively, required redrainage of the pleural air space, but pleurodesis was effective. Use of a muscle flap was simple and effective for covering of a sectional plane of the lung, and should be considered when alveolar air leakage may be extensive.
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PMID:[Flap of the musculus latissimus dorsi to prevent alveolar air leakage from sectional plane of the lung after resection of metastatic pulmonary and chest wall tumor]. 895 27

This article summarizes the care of patients undergoing bilateral lung volume reduction surgery as a treatment for end-stage emphysema. Surgical removal of emphysematous tissue allows for a reconfiguration of the chest wall and diaphragm, improving pulmonary mechanics. This results in reduced air trapping and improved gas exchange. It is important for nurses caring for these patients to be knowledgeable in the postoperative care of thoracic surgical patients and to have an understanding of the pathophysiology of emphysema, the medical management, and, in particular, the relationship between dyspnea and anxiety. Strategies to assist with airway clearance, control pain, prevent and alleviate dyspnea, reduce and treat anxiety, and ensure nutrition need to be incorporated into the postoperative plan of nursing care.
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PMID:Lung volume reduction surgery for emphysema. 909 5


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