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

Esophageal perforation is a serious complication of pneumatic dilatation. We studied the cases of 4 patients (2 men and 2 women, mean age 58 years, range 56-62) who had surgical treatment for achalasia, two of which had had previous dilatation. The main symptoms were pain and dyspnea. Pneumomediastinum was present in all patients, pleural effusion in 2 and cervical emphysema in 1. Esophagographic results showed evidence of perforation in all four cases and gastric patches were surgically placed on the esophageal tear within 12 hours. Three patients received enteral nutrition for an average of 13 days. Mean hospital stay was 14 days. No post-operative complications were exhibited although one patient did develop gastroesophageal reflux 3 months later and underwent surgery to repair a hernia in the thorax 5 years later. Early and aggressive treatment is considered the best therapy and the gastric patch, in our opinion, is an effective and reliable technique for esophageal perforation repair in achalasia patients.
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PMID:[Perforation of the esophagus during pneumatic dilatation in achalasia]. 1051 19

After difficult endotracheal intubation in oral and maxillofacial surgery, esophageal or tracheal injuries can cause mediastinal, pericardial or cervicofacial soft tissue emphysema. If a patient has of thoracic pain after general anesthesia, mediastinal emphysema should be taken into consideration because of the possibility of subsequent life-threatening complications. Diagnosis can be established with computed tomography and fiber-endoscopy. We present the diagnostic and therapeutic management of two patients.
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PMID:[Tracheobronchial perforations--a complication after mouth, maxillary and facial surgery]. 1054 Aug 30

Minimally invasive therapy aims to minimize the trauma of any interventional process but still achieve a satisfactory therapeutic result. The development of "critical pathways," rapid mobilization and early feeding have contributed towards the goal of shorter hospital stay. This concept has been extended to include laparoscopic cholecystectomy and hernia repair. Reports have been published confirming the safety of same day discharge for the majority of patients. However, we would caution against overenthusiastic ambulatory laparoscopic cholecystectomy on the rational but unproven assumption that early discharge will lead to occasional delays in diagnosis and management of postoperative complications. Intraoperative complications of laparoscopic surgery are mostly due to traumatic injuries sustained during blind trocar insertion and physiologic changes associated with patient positioning and pneumoperitoneum creation. General anesthesia and controlled ventilation comprise the accepted anesthetic technique to reduce the increase in PaCO2. Investigators have recently documented the cardiorespiratory compromise associated with upper abdominal laparoscopic surgery, and particular emphasis is placed on careful perioperative monitoring of ASA III-IV patients during insufflation. Setting limits on the inflationary pressure is advised in these patients. Anesthesiologists must maintain a high index of suspicion for complications such as gas embolism, extraperitoneal insufflation and surgical emphysema, pneumothorax and pneumomediastinum. Postoperative nausea and vomiting are among the most common and distressing symptoms after laparoscopic surgery. A highly potent and selective 5-HT3 receptor antagonist, ondansetron, has proven to be an effective oral and IV prophylaxis against postoperative emesis in preliminary studies. Opioids remain an important component of the anesthesia technique, although the introduction of newer potent NSAIDs may diminish their use. A preoperative multimodal analgesic regimen involving skin infiltration with local anesthesia. NSAIDs to attenuate peripheral pain and opioids for central pain may reduce postoperative discomfort and expedite patient recovery/discharge. There is no conclusive evidence to demonstrate clinically significant effects of nitrous oxide on surgical conditions during laparoscopic cholecystectomy or on the incidence of postoperative emesis. Laparoscopic cholecystectomy has proven to be a major advance in the treatment of patients with symptomatic gallbladder disease.
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PMID:Anesthetic implications of laparoscopic surgery. 1060 86

Spontaneous subcutaneous emphysema is a rare and usually benign entity that may occasionally be symptomatic. We report a case of a patient with advanced cancer who developed extensive but asymptomatic subcutaneous emphysema shortly before death. Perforation of the lower gastrointestinal tract, perhaps as a result of straining due to severe unrelieved constipation or due to fistula formation, is suspected to have been the mechanism. The causes, treatment, and implications for management of this condition are discussed.
J Pain Symptom Manage 2000 Jan
PMID:Subcutaneous emphysema in advanced cancer. 1118 32

AIMS: Spontaneous rupture of the oesophagus (SRO) is a rare and often fatal event. The aim of this study was to evaluate the presentation, management and outcome of SRO in a single unit. METHODS: Data were collected on all patients presenting with SRO over a 5-year period with respect to presenting features, diagnostic investigations and subsequent management. Statistical analysis was by Student's t test, chi2 and Fisher's exact tests. RESULTS: Fourteen patients were identified, 12 men and two women with a median age of 64 (range 18-78) years; eight were tertiary referrals. Thirteen of 14 patients presented with chest or upper abdominal pain following vomiting or retching and 13 had an abnormal initial chest radiograph; only one presented with Mackler's triad of pain, vomiting and surgical emphysema. The median delay to diagnosis was 21 (range 1-84) h; this delay did not significantly affect outcome (P = 0.16). An endoscopic assessment and contrast swallow were performed in all patients. Nine of ten patients with a demonstrable leak and full-thickness tear were managed surgically and the four patients with no leak were managed conservatively (P = 0.005); surgical management consisted of thoracotomy, lavage, repair of the perforation and a feeding jejunostomy. Seven patients had a repair over a T tube and two had a primary repair. All conservatively managed patients had contained, controlled or intramural perforations and two also required a feeding jejunostomy. Patients requiring surgery had a longer hospital stay (mean(s.d.) 57.9(34.8) versus 22.2(30.7) days; P = 0.081) and a significantly longer intensive care unit stay (P = 0.044). The overall mortality rate from SRO was 14 per cent (two patients); no deaths occurred in the conservatively managed group. CONCLUSIONS: SRO continues to be diagnosed late despite a classical history and/or abnormal chest radiograph. Endoscopic assessment of perforations is safe and in combination with a contrast swallow can confidently predict patients with contained or controlled rupture in whom non-operative management is successful.
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PMID:Management of spontaneous rupture of the oesophagus 1071 69

Inguinal hernioplasty using extraperitoneal laparoscopy is a new surgical option but still controversial because of the great technical difficulty involved. To analyze the clinical factors that could be related to intraoperative and postoperative morbidity, a prospective study was performed of 131 patients (153 repairs) undergoing totally extraperitoneal endoscopic surgery for inguinal hernia in an Outpatient Surgery Unit. Clinical parameters (age, sex, associated diseases, prior abdominal surgery, site and type), intraoperative complications (detachment of epigastric vessels, preperitoneal bleeding, rupture of the peritoneal sac, subcutaneous emphysema, problems with extending the mesh, visceral or deferential lesions, and rate of reconversion), postoperative complications (haematomas, urinary retention, transitory pain, neuralgias, and infections), and rate of recurrence were evaluated. Follow-up averaged 18 months (range, 1-3 years) and was complete in 100% of the patients. Intraoperative morbidity was 47%; postoperative, 16%; and the rate of reconversion, 4%. The rate of readmissions was 0%. One patient underwent reoperation for suspected early recurrence. The following statistically significant relations were shown: bleeding to recurrent hernias; presence of pain to hematomas; peritoneal rupture to female sex, diabetes, prior infraumbilical surgery and bilateral site; detachment of epigastric vessels to absence of prior surgery and hernia type 3a; and hematomas to age older than 50 years (P < 0.05). The preperitoneal laparoscopic technique is a difficult surgical operation, which often requires added interventions to resolve unexpected problems. The complications are acceptable, and the rate of recurrence is low (0.65%). We establish a standard for selecting patients during a program of apprenticeship.
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PMID:Intraoperative and postoperative complications of totally extraperitoneal laparoscopic inguinal hernioplasty. 1087 23

Emphysema is a disabling disease, for which there is no curative therapy available today. Lung transplantation offers a valuable option for a very selected number of patients, however, due to the enormous organ shortage, only few patients can be offered such a therapy. Recently there has been important resurgence of interest in lung volume reduction surgery and as a consequence, we have embarked in such a program since may 1997. We have now performed unilateral lung volume reduction surgery in 29 emphysema patients (25 on the right and 4 on the left side). Twenty-four patients were already discharged home. There has been no perioperative mortality. The mean hospital stay was 19.8 +/- 11.4 days (range, 8-47 d). Twenty patients of whom we already have follow-up data during 6 months (m) form the further basis of this report. Six weeks after the procedure the FEV1 increased from 0.82 +/- 0.28 L (28 +/- 8%) to 1.05 +/- 0.39 L, a mean increase of 28%. There was a further increase of the FEV1 to a maximum of 1.06 +/- 0.42 L at 6 m, a mean maximum increase of 29% (p = 0.0046, ANOVA). Similarly, the FVC increased from 2.80 +/- 1.10 L to 3.15 +/- 1.00 L, a mean increase of 12.5%. A further increase was also obtained at 6 m and was 19.6% (3.35 +/- 1.05 L, p = 0.014, ANOVA). The maximum decrease in RV was obtained at 3 m (from 5.91 +/- 1.37 L to 4.37 +/- 0.85 L (p = 0.0001, ANOVA), a mean decrease of 26%. The maximum TLC decrease was demonstrated at 3 m (from 8.71 +/- 1.71 L to 7.60 +/- 1.56 L (p = 0.002, ANOVA), a mean decrease of 12.8%. Afterwards there was again a gradual raise of the TLC. The six minute walking distance increased from 231 +/- 31 m to 272 +/- 34 m (p = NS) after pulmonary rehabilitation and to 416 +/- 77 m at 3 m and 415 +/- 18 m at 6 m (p = 0.0002, ANOVA) after the operation. The quality of life (measured with a standardized questionnaire, the Nottingham Health Profile) improved significantly in several domains (e.g. mobility, pain, energy, emotions and social) at 3 m postoperatively. There was one late death (at 6 m) due to an unknown cause. The actuarial survival rate was therefore 100% at 3 m and 95% at 12 m. In conclusion, unilateral thoracoscopic lung volume reduction surgery is a new and safe treatment modality for patients suffering from severe end-stage emphysema. The objective and subjective improvement is marked and the mortality is very low. Rigid selection criteria are, however, necessary to be able to guarantee an optimal result.
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PMID:Lung volume reduction surgery (LVRS) for emphysema: initial experience at the University Hospital Gasthuisberg. Leuven LVRS Group. 1098 23

We report anesthetic experience of two patients for endoscopic removal of thyroid tumor by new surgical approach. A subplatysmal air pocket, which had been created by using a subcutaneous dissector, was maintained by insufflating carbon dioxide (CO2) at an insufflation pressure of 6 mmHg. In one patient, the arterial CO2 pressure increased from 29 mmHg to 44 mmHg, and in another patient from 31 mmHg to 36 mmHg. We did not experience any symptoms of sustained CO2 absorption such as severe hypercarbia, acidosis, and massive subcutaneous emphysema. The patients were discharged on the fifth and the fourth postoperative day with no complications. The advantages of this endoscopic surgery include little postoperative pain, quick recovery, and short hospital stay after operation. However, possible occurrence of intraoperative hypercarbia during endoscopic surgery must be considered, and continuous monitoring of ventilation by end-tidal CO2 or arterial CO2 pressure is mandatory.
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PMID:[Anesthetic management for endoscopic surgery in two patients with goiter]. 1099 86

A retrospective study of 35 patients with acute external laryngeal injury who were treated at Maharaj Nakorn Chiang Mai Hospital from January 1989 to 1998 was done. Eighty-six per cent of the patients with blunt trauma had been injured from a motor vehicle accident and the rest had a penetrating injury from a stab wound. The frequent signs and symptoms were hoarseness, skin contusion, pain and subcutaneous emphysema. The severity of the injury was classified into minor and major groups. There were 2 patients in the minor group and 33 in the major group. Both patients in the minor injury group had good result from conservative treatment. All patients in the major injury group, except one with left vocal cord paralysis, required surgical management. No airway problem was found in any patient and only one patient had unintelligible voice after treatment. Twenty-three per cent had minor complications and responded well to conventional treatment. Early diagnosis and proper management gave the best outcome of the patient's airway and voice.
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PMID:Acute external laryngeal injury. 1121 74

Two men, aged 52 and 57 years, had vomited and then developed chest pain, dyspnoea and tachypnoea. After a myocardial infarction had been excluded in the cardiac emergency room, further examination revealed a rupture of the oesophagus. This was treated surgically with the ultimate creation of a tubular stomach. Both patients then recovered well. The Boerhaave's syndrome, a 'spontaneous' perforation of the oesophagus, is a rare and potentially lethal condition which should be diagnosed at an early stage. Pain in the chest, dyspnoea and vomiting are frequent symptoms. A cardiac cause is sometimes erroneously suspected. Subcutaneous emphysema is a major indication for a perforation of the oesophagus. The chest X-ray shows also mediastinal emphysema and infiltrative abnormalities; in case of doubt a second X-ray should be made some hours later.
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PMID:[Boerhaave's syndrome: also in the emergency room]. 1126 4


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