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

In a prospective, randomized study of 18 infants treated with bovine surfactant (surfactant TA, Tokyo Tanabe Co, Tokyo) for severe respiratory distress syndrome, a lasting response was found in 12 infants (66%), a transient response was found in two (11%), and no response was found in four (22%) when arterial to alveolar PO2 ratios were used to define responses during the first 48 hours after treatment. In contrast, three of 23 control infants (13%) had a transient or lasting "response" to sham treatment (Pediatrics 1987;79:31-37). To determine whether maldistribution of surfactant could explain lack of response or a transient response, surfactant TA was mixed with technetium-99m sulfur colloid (approximately 300 mu Ci per infant), and eight infants with severe respiratory distress syndrome were treated six to 58 hours after birth. Scintigraphy of the lungs was performed three to 15 hours after treatment. Although a lasting response was observed in three infants, a transient one in three, and no response in two, no gross maldistribution of the radioactive label was found. Either lung received from 37% to 62% of the total radioactivity. During the past 3 years, in all infants with severe respiratory distress syndrome who were treated with surfactant (n = 29), poor or transient responses were associated with early patent ductus arteriosus and air leaks (pulmonary interstitial emphysema and pneumothoraces). Pathophysiologic conditions associated with respiratory distress syndrome are more likely to explain suboptimal responses after surfactant treatment than gross maldistribution of surfactant in the lungs.
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PMID:Factors associated with surfactant treatment response in infants with severe respiratory distress syndrome. 291 39

The low incidence of blunt trauma to the cervical portion of the trachea limits management experience in most centers. Hence, we combined our patients with those in published reports containing essential information on injury, treatment, and results. Among 51 patients (93% male), ages ranged from 3 to 65 years. There were 32 complete transections, 15 partial transections, and four tears. There were associated injuries of the recurrent laryngeal nerve (49%), esophagus (21%), larynx (14%), and cervical spine (9%). Presenting signs and symptoms included subcutaneous emphysema in 84%, respiratory distress in 76%, hoarseness/dysphonia in 46%, and hemoptysis in 21%. Tracheostomy was the best means of airway control; 13 of 17 (76%) attempted oral/nasotracheal intubations failed, necessitating emergency tracheostomy. Five patients with no respiratory distress and minimal tissue injury were successfully managed without tracheal repair. Ten patients had tracheal repair without tracheostomy. The only poor result occurred in a patient with a treatment delay of several days. Tracheal repair with tracheostomy was used in 27 patients, with good results in 19. Two patients died of other injuries, and six patients (four with delayed repair) required subsequent tracheal reconstruction. Repair over a stent was used in seven patients, four of whom had satisfactory results. From this review we conclude that (1) the diagnosis of blunt trauma to the cervical trachea requires a high index of suspicion, since this injury can easily be overlooked; (2) tracheostomy (vs intubation or cricothyroidotomy) is the preferred means of airway control; (3) preoperative laryngoscopy/bronchoscopy should be done to assess vocal cord function, possible laryngeal damage, and level of tracheal injury; (4) good long-term results, measured by voice and airway quality, are best obtained by immediate repair of significant injuries.
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PMID:Blunt injuries of the cervical trachea: review of 51 patients. 305 18

Five very low birthweight infants manifested unilateral tension pulmonary interstitial emphysema (PIE). All infants required intermittent positive pressure ventilation for respiratory distress syndrome. PIE was managed by positioning the infant on his (or her) side with PIE and by shortening the inspiratory time, in four patients also by shortening exspiratory time resulting in a higher frequency ventilation. PIE resolved within 3-6 days after institution of this treatment. This was paralleled by a reduction of FiO2 as well as peak inspiratory pressures. All infants could successfully be extubated 2-6 weeks after birth.
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PMID:[Treatment of unilateral space-occupying pulmonary interstitial emphysema with positioning measures and high-frequency ventilation]. 322 92

Pulmonary interstitial emphysema (PIE) is a common complication in premature infants with respiratory distress syndrome. The development of pulmonary interstitial emphysema leads to marked respiratory embarrassment in an already compromised infant. Although usually bilateral, PIE may be unilateral. Various forms of treatment for unilateral PIE in the premature infant have been described, including selective bronchial intubation, unilateral pneumonectomy, visceral pleurotomy, pure oxygen administration, and high-frequency low-pressure ventilation. A recently reported conservative regimen consisting of downward lateral positioning of the affected lung for several days may not be successful. We describe a premature infant with progressive worsening of unilateral PIE, which was successfully treated by selective bronchial balloon catheterization after failure of conservative management. In this manner, we avoided selective bronchial intubation or other aggressive forms of treatment.
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PMID:Successful resolution of unilateral pulmonary interstitial emphysema in a premature infant by selective bronchial balloon catheterization. 324 71

Currently two genetic pulmonary disorders can be diagnosed before birth: alpha-1-antitrypsin deficiency and mucoviscidosis. For the latter there are two possible diagnostic techniques: first a study of the intestinal enzymes of the amniotic fluid, a reliable method only at the 18th week, and also a study of DNA markers (ADN) of the trophoblastic cells using molecular biological techniques: this can be performed from the 10th to 11th week of pregnancy but presupposes a family study in which there is already a subject suffering from the disorder. Foetal echocardiography enables various pulmonary abnormalities to be detected: pleural effusion, cyst, pulmonary hypoplasia and other disorders. This technique however has some limits, at least at present. Most often these severe malformations are revealed at birth such as respiratory distress or stillbirth. Adenomatous cystic malformations or congenital lobar emphysema, a posterior diaphragmatic hernia, and oesophageal atresia with oesophagotracheal fistula are the most frequent and are curable surgically.
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PMID:[Prenatal diagnosis and genetic diseases of the lung]. 326 Oct 24

A 14-year-old male pedestrian was hit by a truck and admitted with respiratory distress and subcutaneous emphysema. Aortography revealed disruption of the ascending aorta. Bronchoscopy revealed rupture of the left main bronchus at the carina. Both lesions were repaired using a median sternotomy, cardiopulmonary bypass, and a transpericardial approach for the bronchial repair. To our knowledge, this is the first report of successful repair of a combined rupture of a major bronchus and the ascending aorta.
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PMID:Traumatic rupture of ascending aorta and left main bronchus. 337 83

A 6-month-old female with a lifelong history of respiratory distress became increasingly difficult to manage and required right upper and middle pulmonary lobectomies for worsening emphysema and mediastinal shift. The postoperative course was stormy and confusing and the patient died despite emergency tracheostomy. The autopsy disclosed an anomalous bronchus to the right lower lobe, originating from the left mainstem bronchus. In addition, the left main pulmonary artery was positioned posterior to the left mainstem bronchus. Two other cases of bridging bronchus have been reported, but the association with posterior left pulmonary artery has not been described.
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PMID:Bridging bronchus and posterior left pulmonary artery: a unique association. 344 19

We undertook a randomized, controlled trial to determine whether human surfactant administered endotracheally at birth to very premature infants (gestational age, 24 to 29 weeks) would prevent the respiratory distress syndrome or reduce its severity. Thirty-one treated infants (birth weight, 938 +/- 286 g) were compared in a blinded fashion with 29 control infants (birth weight, 964 +/- 174 g). The lecithin/sphingomyelin ratio was less than 2 in all infants, and phosphatidylglycerol was not present in amniotic fluid or tracheal fluids at birth, indicating a deficiency of surfactant in the lungs. The principal dependent variables were neonatal death, the incidence of bronchopulmonary dysplasia, and the infant's requirement for respiratory support (and its complications). The surfactant-treated group had significantly fewer deaths than the control group (16 percent vs. 52 percent, P less than 0.001), fewer cases of bronchopulmonary dysplasia (16 percent vs. 31 percent), and significantly fewer cases of pulmonary interstitial emphysema (P less than 0.001) and pneumothorax (P less than 0.02). Prophylactic treatment with human surfactant also substantially reduced the period of neonatal intensive care. We conclude that treatment with human surfactant offers promise for improving the survival of very premature infants with a surfactant deficiency and for reducing the pulmonary sequelae of the respiratory distress syndrome.
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PMID:Prophylactic treatment of very premature infants with human surfactant. 352 53

The authors report a case of respiratory distress secondary to inhalation of meconial amniotic fluid treated by mechanical ventilation, which was complicated by severe interstitial emphysema. Treatment by pleurotomy allowed a favorable evolution. The various therapies of interstitial emphysema of the neonate, in particular surgical technics are described.
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PMID:[Neonatal bilateral interstitial emphysema. Surgical treatment. Apropos of 1 case]. 357 75

Pulmonary interstitial emphysema is one of the most serious complications of the respiratory distress syndrome. Its presence significantly increases morbidity and mortality. Preliminary reports have demonstrated the success of high-frequency ventilation in the treatment of pulmonary interstitial emphysema. In a previous investigation, we were able to develop a formula for predicting death in infants weighing less than 1,500 g with pulmonary interstitial emphysema. Using this subgroup of severely affected infants, we studied the efficacy of high-frequency ventilation in nine infants. Using the Volumetric Diffusive Respirator, we observed improvement in all respiratory values measured (pH, PCO2, and PO2), a significantly decreased mean airway pressure (MAP), and improvement in neonatal mortality. Complications of severe bleeding diatheses, hypotension, bronchopulmonary dysplasia, and necrotizing tracheobronchitis were observed. Our investigation was the first to systematically choose infants who might benefit from high-frequency ventilation and to compare them with similar infants with known outcomes. We realize that the study was rescue in nature using historical controls, but we felt compelled to assure the safety of the device before randomizing less sick infants. High-frequency ventilation appears to be effective in the acute management of low birth weight infants with pulmonary interstitial emphysema.
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PMID:High-frequency ventilation in the treatment of infants weighing less than 1,500 grams with pulmonary interstitial emphysema: a pilot study. 358 46


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