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

The author questions the conventional assumption that the pneumoperitoneum must be established before insertion of the laparoscope and its trocar. Complications commonly associated with establishment of a needle-induced pneumoperitoneum include subcutaneous emphysema, blood vessel penetration, retroperitoneal emphysema, bowel distention, overdistention, gas embolism, and omental emphysema. This paper summarizes the author's experience with 301 outpatient laparoscopies performed in 1976-77 using the method of direct trocar insertion without prior pneumoperitoneum. The process of pneumoperitoneum was visualized directly through the Needlescope. 54 cases were performed under general anesthesia and 247 under local anesthesia. Complications were encountered in only 3 cases (1 uterine perforation and 2 cases requiring postoperative hospitalization for nausea and vomiting). There were no cases of technical failure. Comparison of recovery times for 250 consecutive patients treated without preliminary pneumoperitoneum and 117 patients treated with the conventional technique indicated that the recovery time was 19 minutes shorter on average in the former group because of a lessened degree of postoperative discomfort, nausea, and vomiting. Although further research is necessary to confirm the findings in this series, it seems plausible to suggest that a reduction of complications associated with needle-induced pneumoperitoneum may be possible with this technique.
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PMID:Direct laparoscope trocar insertion without prior pneumoperitoneum. 15 Nov 44

Dyspnea is the medical term for the patient's or subject's complaint of shortness of breath. It encompasses the respiratory discomfort experienced in many different diease states as well as the shortness of breath felt by a normal subject during or after strenuous exercise. Several parameters which have been shown to correlate with the onset or severity of dyspnea are described, including reduced vital capacity, the ratio of minute ventilation to vital capacity, reduced breathing reserve, the work of breathing, and the oxygen cost of breathing. Attempts at quantitation of dyspnea have usually consisted of measuring physiological parameters associated with the sensation, such as the "dyspneic index". The direct measurement of respiratory sensations using modern psycho-physical methods is at an early stage of development. Since the observation that the existence of dyspnea is often unrelated to any disturbance of arterial blood gas composition, it has been generally held that the mechanism of dyspnea is primarily neurophysiological. The neural pathways may conceptually be divided into those which transmit the "dyspnea message" from the respiratory apparatus to integrating centers in the brain, and those concerned with subsequently bringing the sensation to the level of consciousness. It seems likely that there is no single sensing mechanism and neural pathway which will be able to explain dyspnea in the diverse populations of patients and subjects who experience unpleasant respiratory sensations. Three theories concerning mechanisms of dyspnea are briefly described: "length-tension inappropriateness", vagal afferent activity especially from the J-receptors, and the recent concept of diaphragmatic fatigue. Some specific characteristics of the shortness of breath experienced in certain disease states are described, including chronic bronchitis and emphysema, bronchial asthma, pulmonary fibrosis and congestive heart disease.
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PMID:Dyspnea. 50 81

The functional residual capacity (FRC) has been measured by gas dilution technique (GA) and body plethysmographic technique (BP) using the panting maneuver (PA). However, this maneuver is difficult to perform for patients who experience discomfort in breathing, and in cases of chronic obstructive pulmonary diseases, the FRC value measured by panting maneuver overestimates the true FRC value. Thus, in order to minimize these factors, we measured FRC during non-panting breathing (NP) using a BP device (BX-82, Minato Co., Osaka) and compared the results with the usual two methods. One hundred healthy subjects (Group I), 72 patients with restrictive ventilatory disorder (Group II, %VC = 62.7%) and 66 patients with pulmonary emphysema (Group III, FEV1.0% = 44.9%) were studied. All measurements were performed under 0.5 Hz respiratory frequency. The non-panting FRC measurement was performed by closing the mouth shutter of the BP for about 500 msec at the end of both the expiratory and inspiratory phase. From the box volume change and mouth pressure change, lisajous curves were formed and fitted by linear regression method. From this regression line, the volume of FRC was calculated. The obtained data had no significant differences among them, and there was a significant relationship between each technique. The correlation coefficient of non-panting breathing technique in Group III was slightly poor compared with the other techniques, and we therefore tried to re-classify Group III into small groups according to the severity of obstruction. It was subsequently found that this technique did not have the tendency to give a higher FRC value with increase in obstructive disorder.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical use of the measurement of functional residual capacity during non-panting breathing--study on healthy subjects and respiratory patients]. 140 96

Thirty consecutive patients undergoing lung resections were randomized into two groups: Group A (n = 15) received minitracheotomy postoperatively and group B (n = 15) were control patients. Postoperative respiratory course was monitored by serial clinical assessments, chest x-ray examination, arterial blood gases, sputa bacterial cultures, and the patient's requirement and response to chest physiotherpy. The two groups were similarly matched in age (mean 58.5 years), smoking habits, pulmonary functions, and surgical procedures. Postoperative pulmonary complications of collapse/consolidation developed in 11 patients (two in group A and nine in group B) (p less than 0.03). Four patients (all in group B) required nimitracheotomy in addition to antibiotics and chest physiotherapy to treat their pneumonia. Chest physiotherapy requirement was less in group A than in group B, with a mean number of sessions of seven in group A and eight in group B and a mean total time of 92 minutes in group A and 112 minutes in group B. The mean duration of minitracheotomy was 4.13 days. Minor temporary symptoms resulted from the minitracheotomy in eight patients (42%) and included discomfort, voice changes, subcutaneous emphysema, and stridor. There was one case of long-term morbidity (5%)-skin scarring from wound infection at the site of the minitracheotomy. No postoperative deaths resulted. We conclude that the prophylactic use of minitracheotomy is safe and effective in decreasing postoperative respiratory complications in patients undergoing lung resections.
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PMID:Prophylactic minitracheotomy in lung resections. A randomized controlled study. 202 47

Various types of partial mandibulectomy and maxillectomy techniques can be performed to control local tumor growth, but various intraoperative and postoperative problems and complications are associated with these techniques. Intraoperative complications relate mainly to technical problems. Postoperative complications include incisional dehiscence, infection, injury to salivary ducts, subcutaneous emphysema, mandibular instability, abnormal salivation with secondary cheilitis or dermatitis, anemia, pain and discomfort, lingual dysfunction and prehension difficulties, anorexia, ocular problems, cosmetic defects, local tumor recurrence, and distant metastatic disease. The surgeon should be aware of these potential complications and have a clear understanding of their prevention and treatment.
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PMID:Results and complications associated with partial mandibulectomy and maxillectomy techniques. 213 89

The ACTA-Scanner has virtually unlimited potential in the evalution of any part of the body. The usefulness of the technique has already been shown in the appraisal of pathologies of the brain and cerebrospinal fluid cavities. The orbits and the eyeballs, the facial sinuses, and skull base lesions have also been elucidated. Tumors of the larynx, pharynx, thyroid, and parathyroid; lymphomas; and pathology of the spine and spinal cord are well within the reach of this new diagnostic methodology. Lung pathologies, such as emphysema, pneumonias, neoplasms, infarctions, pleural effusions and granulomatous diseases, and mediastinal pathology represent a challenging complex of lesions to be appraised by ACTA-scanning. For the heart, there is great potential for observing cardiac chamber size, hypertrophy of ventricular or atrial walls, and ventricular or aortic aneurysms, and possibly for recognizing the damaged myocardial tissue immediately after or some time after an infarction. The abdominal pathologies that can be studied are almost uncountable: gastric neoplasms, pancreatic cysts and stones, gallstones, neoplasms of the liver and pancreas, bowel tumors, abdominal aortic aneurysms, renal neoplasms and cysts, atrophy of the kidneys, bladder tumors, uterine tumors, ovarian cysts, and many more. Although bones and joints are adequately demonstrated by conventional x-ray techniques, there is no doubt that as the new technique is developed ACTA-grams will contribute significant information in the transverse plane, as well as in densitometric analyses. The impact of ACTA-scanning will not be limited to the diagnostic area, but will extend, at least indirectly, to general patient management and to some aspects of medical economics as well. Risk-laden, technically complex, and costly diagnostic procedures, sometimes requiring lengthy hospitalization, will in some cases be eliminated. The simple, innocuous, and noninvasive ACTA-scanning can be performed on an outpatient basis. Repeated follow-up examinations should be easily accepted by the patients, considering that this diagnostic test is carried out without discomfort. The entire field of diagnostic radiology is on the verge of revolutionary changes.
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PMID:Computerized transaxial x-ray tomography of the human body. 460 76

In their review of female sterilization procedures, Dr. Mumford and colleagues indicate a high complication rate for laparoscopy. In my extensive experience of laparoscopy, I occasionally create emphysema of the abdominal wall and even of the omentum. Abdominal wall emphysema is totally innocuous, and the same can be said for omental emphysema. To call these situations "complications" significantly distorts the true meaning of the word and skews the figures in a biased fashion. Eliminating the 20% of laparoscopic complications attributed to abdominal wall emphysema would reduce the rate to a level more comparable with that of other procedures reviewed. Many occurrences during surgery cause the patient little harm or discomfort. To list these events as complications compromises the meaning of the term and provides further grist for the legal mill. Care is needed with terminology, particularly as it pertains to surgical complications. The problem is that those who write the papers do not get sued, but those who read them do.
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PMID:Complications of laparoscopic sterilisation. 610 78

Spontaneous intramural rupture or intramural haematoma of the oesophagus is a rare cause of acute pain in the chest and upper abdomen. Much less ominous than spontaneous complete rupture from which it must be distinguished, it seldom if ever necessitates operation. Five new cases are described and reviewed together with 15 collected from published reports. The dominant symptom of every case was severe and constant retrosternal or epigastric pain; concomitant dysphagia was mentioned in 11 cases. In seven the pain was preceded by or coincided with vomiting. The condition was related to other stresses in three and appeared to be truly spontaneous in 10. In approximately one-third of cases it started suddenly but more often it began as discomfort worsening rapidly. Fourteen patients vomited blood after experiencing pain but only four were given transfusions. In contradistinction to complete rupture, none had surgical emphysema and plain chest radiographs were unremarkable. All had abnormal gastrografin or barium swallows. Intramural haematomas with or without mucosal tears were seen in the 11 cases in which oesophagoscopy was performed. Fifteen patients made rapid and complete recoveries on conservative management. Of the four who did not respond satisfactorily, one had the oesophagus repaired, two had drainage of the mediastinum after failure to find the false lumen at thoracotomy, and one had only an abdominal exploration. The only death in the whole series occurred after a disastrous emergency exploration and subsequent total oesophagectomy.
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PMID:Spontaneous intramural rupture and intramural haematoma of the oesophagus. 697 33

A prospective study of the complications and consequences of translaryngeal endotracheal intubation and tracheotomy was conducted on 150 critically ill adult patients. Adverse consequences occurred in 62 percent of all endotracheal intubations and in 66 percent of all tracheotomies during placement and use of the artificial airways. The most frequent problems during endotracheal intubation were excessive cuff pressure requirements (19 percent), self-extubation (13 percent) and inability to seal the airway (11 percent). Patient discomfort and difficulty in suctioning tracheobronchial secretions were very uncommon. Problems with tracheotomy included stomal infection (36 percent), stomal hemorrhage (36 percent), excessive cuff pressure requirements (23 percent) and subcutaneous emphysema or pneumomediastinum (13 percent). Complications of tracheotomy were judged to be more severe than those of endotracheal intubation. Follow-up studies of survivors revealed a high prevalence of tracheal stenosis after tracheotomy (65 percent) and significantly less after endotracheal intubation (19 percent)(p < 0.01). Thirty-nine of 41 (95 percent) patients with endotracheal intubation and 20 of 22 (91 percent) patients with tracheotomy had laryngotracheal injury at autopsy. Ulcers on the posterior aspect of the true vocal cords were found at autopsy in 51 percent of the patients who died after endotracheal intubation. There was no significant relationship between the duration of endotracheal intubation or tracheotomy and the over-all amount of laryngotracheal injury at autopsy, although patients with prolonged endotracheal intubation followed by tracheotomy had more laryngeal injury at autopsy (P = 0.06) and more frequent tracheal stenosis (P = 0.05) than patients with short-term endotracheal intubation followed by tracheotomy. Adverse effects of both endotracheal intubation and tracheotomy are common. The value of tracheotomy when an artificial airway is required for periods as long as three weeks is not supported by data obtained in this study.
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PMID:Complications and consequences of endotracheal intubation and tracheotomy. A prospective study of 150 critically ill adult patients. 745 92

Although pulmonary barotrauma (PBT) is a well-known clinical entity, its recognition in divers is sometimes delayed and its implications for future diving often are unappreciated. The pulmonary complications of diving activities range from mere discomfort from mediastinal emphysema or pneumothorax, or both, to life-threatening gas embolization. In nine cases described here, only minor manifestations were associated with PBT which occurred at or close to the surface, but three of these four divers were found to have abnormal pulmonary function. More serious manifestations resulted from PBT which took place at depths of 16 to 120 ft. Even minor forms of PBT should be considered a contraindication to further diving, since they are prone to recur. Such recurrences--even at shallow depths--may cause serious complications.
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PMID:Pulmonary barotrauma and related events in divers. 778 61


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