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

Perforation of the piriform fossa is a rare complication of attempted tracheal intubation. The consequences vary from cervical emphysema to respiratory distress, mediastinitis, septic shock, empyema pyopneumothorax and death. The mortality rate due to mediastinitis is over 50%, so early diagnosis and management can improve survival. This case report describes one case and discusses the diagnosis and management of this complication.
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PMID:Piriform fossa perforation during attempted tracheal intubation. 359 78

When clinical examination and routine chest x-ray do not adequately explain neonatal respiratory distress, lung scintigraphy using a submicronic aerosol particle may be most helpful. Three cases illustrating this point are presented. Discussion centers around the diagnosis of an atypical case of congenital lobar emphysema (CLE), and differentiating between CLE, foreign body aspiration and compensatory hyperinflation in neonates with respiratory distress. Conservative and surgical treatment options for CLE are also illustrated.
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PMID:Ventilation scintigraphy with submicronic radioaerosol as an adjunct in the diagnosis of congenital lobar emphysema. 359 6

A patient with acute respiratory distress secondary to emphysema and reactive airway disease had inadequate tidal volumes with and without endotracheal intubation. Because of the patient's failure to respond to maximal standard bronchodilator therapy and the physical inability to ventilate the patient by manual positive pressure, he received IV glycopyrrolate (0.2 mg) approximately 50 minutes after admission to the ED. The patient's condition immediately improved, as evidenced by the ability to manually ventilate the patient; he developed increased tidal volumes; and he began responding to inhalation therapy. This is the first reported case of IV glycopyrrolate administration for chronic obstructive pulmonary disease or asthma in the literature and demonstrates an instance in which inhalation therapy was ineffective due to low tidal volumes.
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PMID:Intravenous use of glycopyrrolate in acute respiratory distress due to bronchospastic pulmonary disease. 361 69

Chronic obstructive pulmonary disease was diagnosed in a 3-year-old Basset Hound that was referred to the hospital because of respiratory distress. Results of radiography, bronchoscopy, and pulmonary function tests indicated lung hyperinflation, airflow restriction, and loss of elastic recoil of the lungs. Because of the poor response to treatment, the dog was euthanatized. Postmortem findings revealed emphysema, bronchiectasis, and bronchitis, which comprise chronic obstructive pulmonary disease.
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PMID:Chronic obstructive pulmonary disease in a dog. 369 85

Significant changes in the radiographic features of bronchopulmonary dysplasia (BPD) have accompanied recent advances in treatment of neonatal respiratory distress syndrome. Retrospective study of 709 newborns showed atypical radiographic findings in many patients with clinical BPD. While 12/20 infants with clinical BPD showed changes identical to Northway's stage 4 disease, the remaining 8 (40% of patients with significant respiratory dysfunction) had diffuse, fine infiltrates without emphysema. Radiographic progression from RDS through all Northway stages was observed in only 4 patients. Diagnosis of stage 2 BPD was complicated by the presence of PDA in 9/17 cases. Stage 3 BPD was identified with certainty in only 5 infants, but may have coexisted with PIE in as many as 22 cases. Nevertheless, there was close agreement between the radiographic findings and clinical severity of chronic lung disease. Mild (type 1) infiltrates following RDS may be distinguished from chronic pulmonary insufficiency of prematurity (CPIP) or "immature lung." In patients who require only short-term supplemental O2, type 1 changes may reflect delayed resolution of RDS in an underdeveloped lung. These same findings in infants with prolonged O2 dependence usually indicate a mild form of BPD. Coarse infiltrates and emphysema (type 2) are almost always associated with severe respiratory impairment.
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PMID:Persistent pulmonary abnormalities in newborns: the changing picture of bronchopulmonary dysplasia. 370 91

Oesophageal barotraumatism is a rare lesion and only 19 cases have been reported in the literature. Four new cases are described, the mechanism involved being either a jet of gas into the oesophagus or an explosion close to the face producing rupture of the oesophagus by increased endoluminal pressure. Four characteristic clinical signs are noted: wounds or burns to the face or mouth, chest or epigastric pain, subcutaneous emphysema and respiratory distress. A pneumomediastinum or pleural effusion is a constant finding, and a perforation is identified regularly by an oesophageal water soluble opacification. Of the 19 cases reported in the literature, 4 were detected at autopsy, one patient died after surgery and 14 recovered after operation. The mediastinal infection was either subacute requiring external thoracic drainage after oesophageal exclusion, or acute, necessitating emergency direct oesophageal repair. Only one of the 4 patients reported in this paper survived the accident.
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PMID:[Barotraumatic rupture of the esophagus. 4 cases. Review of the literature]. 372 84

Disruption of the posterior tracheal wall is an uncommon complication of tracheotomy, bronchoscopy, or even endotracheal intubation. With disruption of the posterior tracheal wall, air tracking may present as surgical emphysema, pneumomediastinum, or pneumothoraces, and may be associated with respiratory distress. Six children with posterior tracheal wall disruptions are presented: three associated with tracheotomy, one bronchoscopy, and another during endotracheal intubation. Early recognition and appropriate management of tracheal disruption will minimize air tracking and the associated morbidity. Tracheal disruption may be avoided by utilizing appropriate surgical, endoscopic, and intubation techniques.
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PMID:Posterior tracheal wall disruption: a rare complication of pediatric tracheotomy and bronchoscopy. 377 29

A prospective study was performed to ascertain the incidence of, and risk factors for, the development of a contralateral pneumothorax in 32 neonates with respiratory distress, without evidence of pulmonary hypoplasia, who had an initial unilateral air leak requiring pleural drainage. The mean postnatal age of occurrence of the first pneumothorax was 31.04 hours (range 0.1 to 92 hours); a subsequent contralateral pneumothorax developed in 14 infants (44%) at a mean postnatal age of 61.5 hours (range 8 to 106 hours). Thirteen of the 14 infants with a subsequent contralateral pneumothorax had pulmonary interstitial emphysema visible on the chest radiograph taken immediately after drainage of the first pneumothorax, compared with eight of the 18 infants without a contralateral pneumothorax (P less than .005). Other factors significantly associated with a contralateral pneumothorax were alveolar-arterial oxygen gradient (P less than .01) and FiO2 (P less than .005), both measured one hour after the pneumothorax, and gestational age (P less than .05). Multivariate discriminant function analysis did not usefully add to the predictive power of pulmonary interstitial emphysema alone. Infants with pulmonary interstitial emphysema at the time of an initial unilateral pneumothorax are at significant risk for the development of a contralateral pneumothorax.
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PMID:Contralateral pneumothoraces in the newborn: incidence and predisposing factors. 382 43

Chest radiographs of 18 newborns treated with endotracheal instillation of human surfactant for respiratory distress syndrome (RDS) were compared with those of 18 similar but untreated infants. In the treated infants, severity of RDS significantly improved after surfactant administration. Most treated infants (16/18) exhibited a left-to-right shunt, presumably through a patent ductus arteriosus; similar findings were noted in untreated infants (17/18). Complications of respiratory assistance in the treated infants included transient pulmonary interstitial emphysema (n = 1), pneumothorax (n = 1), and mild (n = 4) to moderate (n = 2) bronchopulmonary dysplasia; the incidences of these complications did not exceed those in untreated infants. In three treated infants, a transient interstitial lung disease developed 3-4 days after surfactant administration.
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PMID:Respiratory distress syndrome treated with human surfactant: radiographic findings. 384 Feb 68

We performed a randomized, prospective clinical trial comparing intratracheal administration of human surfactant with conventional treatment with intermittent mandatory mechanical ventilation alone for treatment of severe respiratory distress syndrome in preterm infants of less than 30 weeks gestation. Twenty-two infants (mean gestational age 27.0 weeks, mean birth weight 987 gm) were given surfactant, and 23 infants (mean gestational age 27.2 week, mean birth weight 1055 gm) received intermittent mandatory ventilation. Infants given surfactant required less FiO2 during the first week, had lower mean airway pressure during the first 48 hours, and had improved ventilatory index and a/A PO2 ratio. Death or the occurrence of bronchopulmonary dysplasia was significantly less among infants given surfactant (P = 0.019). Pneumothorax, pulmonary interstitial emphysema, and need for FiO2 greater than or equal to 0.3 for greater than 30 days was significantly less in the surfactant group. This trial confirms the efficacy of treatment with human surfactant in preterm infants with severe respiratory distress syndrome.
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PMID:Exogenous human surfactant for treatment of severe respiratory distress syndrome: a randomized prospective clinical trial. 388 59


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