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

A 25-year-old primiparous woman in her third trimester (36. week) of pregnancy presented with spontaneous pneumomediastinum and cervical subcutaneous emphysema. The patient's symptoms were completely resolved after 2 weeks of supportive management. A Caesarean section was performed in 40. week under general anaesthesia resulting in the birth of a healthy infant. Spontaneous pneumomediastinum is very rare and generally dangerous for a pregnant woman and infant.
Ann Thorac Cardiovasc Surg 2006 Oct
PMID:Spontaneous pneumomediastinum in 3rd trimester of pregnancy. 1709 81

The objective of this study was to evaluate the feasibility and safety of lung volume reduction by transbronchial alcohol and lipiodol suspension infusion with the aid of balloon-tipped catheter occlusion. Twenty-six healthy adult rabbits were divided into four treatment groups: alcohol and lipiodol suspension infusion (n = 8), lipiodol infusion (n = 8), alcohol infusion (n = 5), or bronchial lumen occlusion (n = 5). After selective lobar or segmental bronchial catheterization using a balloon-tipped occlusion catheter, the corresponding drug infusion was performed. Bone cement was used to occlude the bronchial lumen in the occlusion group. The animals were followed up for 10 weeks by chest X-ray and computed tomography (CT), and then the whole lungs were harvested for histological examination. Alcohol and lipiodol suspension or lipiodol could be stably retained in alveoli in the first two groups based on chest X-ray and CT, but obvious collapse only occurred in the group receiving alcohol and lipiodol suspension or the bronchial lumen occlusion group. Histological examination revealed damage and disruption of the alveolar epithelium and fibrosis in related lung tissue in the group receiving alcohol and lipiodol suspension. Similar changes were seen in the bronchial lumen occlusion group, apart from obvious marginal emphysema of the target areas in two animals. Interstitial pneumonia and dilated alveoli existed in some tissue in target areas in the lipiodol group, in which pulmonary fibrosis obliterating alveoli also occurred. Chronic alveolitis and pleural adhesion in target areas occurred in the group infused with alcohol alone, whereas visceral pleura of the other three groups was regular and no pleural effusion or adhesion was found. Alcohol and lipiodol suspension that is stably retained in alveoli can result in significant lung volume reduction. Through alcohol and lipiodol suspension infusion, obstructive emphysema or pneumonia arising from bronchial lumen occlusion could be avoided.
Cardiovasc Intervent Radiol
PMID:A pilot study on the feasibility of interventional lung volume reduction. 1759 27

Boerhaave's perforation is a serious condition describing spontaneous transmural perforation of the oesophagus. The classical presentation of this condition is vomiting, lower thoracic pain and subcutaneous emphysema. However, the condition often presents atypically and it is important to reach the correct diagnosis quickly. We present the case of a 54-year-old woman with a Boerhaave's perforation that presented as Enterococcal bacterial pericardial effusion.
Interact Cardiovasc Thorac Surg 2007 Feb
PMID:Atypical presentation of Boerhaave's syndrome as Enterococcal bacterial pericardial effusion. 1766 91

A 67-year-old woman underwent a thoracoscopic resection of a large anterior mediastinal cyst. Before surgery, artificial pneumomediastinum was performed with a retrosternal technique. Injection of 400 ml of air from the sternal notch caused emphysema throughout the mediastinum. In those areas, dissection of loose connective tissue was mostly accomplished by the injected air, which formed an air layer around the cyst. On the other hand, emphysema was not apparent in the areas around the left innominate and thymic veins. Artificial pneumomediastinum may be useful as a supplementary technique in a thoracoscopic surgery setting.
Interact Cardiovasc Thorac Surg 2007 Jun
PMID:Artificial pneumomediastinum facilitates thoracoscopic surgery in anterior mediastinum. 1766 82

The surgical approach to the treatment of distal aortic arch aneurysms is still a matter of controversy. Median sternotomy is usually selected when the patient has the pulmonary emphysema, and the atherosclerotic change involves the ascending aorta or the aortic arch as well as the distal aortic arch. However, when the end of the aneurysm is deep and distant, distal anastomosis becomes more difficult. Left thoracotomy is another approach, but in the patients with impaired respiratory function or when dense lung adhesions to the chest wall are anticipated because of a history of inflammation, the risk of intraoperative bleeding and postoperative respiratory complications becomes a major concern. Total arch replacement by an open stent graft insertion method through a median sternotomy has been devised as a procedure that overcomes these problems. However, since no ideal device for delivering long stent grafts beyond the aneurysm is available, we developed a new delivery system, and we successfully applied it clinically in a patient with an enlarged distal aortic arch.
Interact Cardiovasc Thorac Surg 2006 Aug
PMID:New open stent-graft delivery system: the CLATE flexible metal graft holder. 1767 May 84

The optimal selection of patients for lung volume reduction surgery (LVRS) is currently based on empiric clinical findings. Patients who benefit from LVRS have the common characteristics of impaired quality of life associated with apical predominant pulmonary hyperinflation and airflow obstruction. Within this category, patients who do not benefit from LVRS appear to have small airways disease that can be detected by inspiratory resistance studies. In addition to appropriate emphysema physiology, the selection of patients for LVRS must consider medical comorbidities and perioperative risk factors. Based on findings of the National Emphysema Treatment Trial, most of the perioperative morbidity and mortality of LVRS is associated with cardiopulmonary risk that needs to be considered preoperatively. Finally, a preoperative conditioning program can provide an additional screening process to identify patients physically and emotionally prepared for surgery.
Semin Thorac Cardiovasc Surg 2007
PMID:Optimizing the selection of surgical candidates for lung volume reduction surgery. 1787 11

Three surgical procedures are pertinent to the treatment of end-stage emphysema: giant bullectomy, lung volume reduction surgery (LVRS), and lung transplantation. Patients with localized disease manifesting as a giant bulla that compresses adjacent healthy lung tissues can be offered bullectomy. Patients with diffuse disease can be offered LVRS, lung transplantation, or staged LVRS/lung transplant, depending on multiple factors including age, lung function parameters, lobar predominance, and whether the disease is uni- or bilateral. Since end-stage emphysema is refractory to most medical treatment, surgery is often the only remaining option.
Semin Thorac Cardiovasc Surg 2007
PMID:Surgical interventions for emphysema. 1787 12

Medicare coverage for lung volume reduction surgery has been approved recently by the Centers for Medicare and Medicaid Services for the treatment of severe emphysema. The scientific basis for this approval stems largely from findings of the National Emphysema Treatment Trial (NETT). The purpose of this article is to review the contributions of the NETT to the management of chronic obstructive pulmonary disease.
Semin Thorac Cardiovasc Surg 2007
PMID:Lessons from the national emphysema treatment trial. 1787 13

Novel endobronchial methods for reducing lung volume in patients with advanced emphysema are currently being evaluated in clinical trials as potential alternatives to lung volume reduction surgery (LVRS). Three bronchoscopic lung volume reduction (BLVR) approaches have shown promise in initial testing: (1) placement of endobronchial one-way valves to promote atelectasis by blocking inspiratory flow; (2) airway bypass tract formation using a radiofrequency catheter to facilitate emptying of damaged lung regions with long expiratory times; and (3) instillation of biological adhesives designed to collapse and remodel hyperinflated lung. The limited clinical data currently available suggests all three techniques are reasonably safe. However, efficacy signals have been smaller and less durable than those observed after LVRS. Studies to optimize patient selection, refine treatment strategies, characterize procedural safety, elucidate mechanisms of action, and characterize short- and longer-term effectiveness of each approach are ongoing.
Semin Thorac Cardiovasc Surg 2007
PMID:Evolving endoscopic approaches for treatment of emphysema. 1787 14

The aim of this study was to evaluate the efficacy of outpatient management of postbiopsy pneumothoraces with small-caliber chest tubes and to assess the factors that influence the need for prolonged drainage or additional interventions. We evaluated the medical records of patients who were treated with small-caliber chest tubes attached to Heimlich valves for pneumothoraces resulting from image-guided transthoracic needle biopsy to determine the hospital admission rates, the number of days the catheters were left in place, and the need for further interventions. We also evaluated the patient, lesion, and biopsy technique characteristics to determine their influence on the need for prolonged catheter drainage or additional interventions. Of the 191 patients included in our study, 178 (93.2%) were treated as outpatients. Ten patients (5.2%) were admitted for chest tube-related problems, either for underwater suction (n = 8) or for pain control (n = 2). No further interventions were required in 146 patients (76.4%), with successful removal of the chest tubes the day after the biopsy procedure. Prolonged catheter drainage (mean, 4.3 days) was required in 44 patients (23%). Nineteen patients (9.9%) underwent additional interventions for management of pneumothorax. Presence of emphysema was noted more frequently in patients who required additional interventions or prolonged chest tube drainage than in those who did not (51.1% vs. 24.7%; p = 0.001). We conclude that use of the Heimlich valve allows safe and successful outpatient treatment of most patients requiring chest tube placement for postbiopsy pneumothorax. Additional interventions or prolonged chest tube drainage are needed more frequently in patients with emphysema in the needle path.
Cardiovasc Intervent Radiol
PMID:Outpatient management of postbiopsy pneumothorax with small-caliber chest tubes: factors affecting the need for prolonged drainage and additional interventions. 1807 73


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