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

Criteria for the prescription of long-term oxygen therapy (LTOT) have been published by academic societies and regulatory bodies, but many prescriptions for LTOT do not fulfil these criteria. Demographic, functional data and survival were compared in chronic obstructive pulmonary disease (COPD) patients with different levels of oxygenation, i.e. arterial oxygen tension (Pa,O2) < 8 kPa or > or = 8 kPa (60 mmHg), at the time of initial registration in the ANTADIR Observatory. Data were collected between 1984-1995. Selection criteria were a diagnosis of COPD or emphysema with forced expiratory volume in one second (FEV1) < 80% pred, FEV1/vital capacity (VC) < 70% and age between 18-75 yrs. Of 7,700 patients prescribed LTOT 18.5% had stable Pa,O2 > or = 8 kPa. While the FEV1 was the same they differed from the patients with more severe hypoxaemia in having a higher rate of diagnosis of primary emphysema and a lower arterial carbon dioxide tension (Pa,CO2). In this group of patients LTOT was more frequently administered as liquid oxygen than in other patients on LTOT. The survival of these patients was reduced compared to the general population of the same age and sex but comparable to that of patients with a Pa,O2 between 6.7-8 kPa (50-60 mmHg). Patients prescribed long-term oxygen therapy with an arterial oxygen tension > or = 8 kPa (60 mmHg) in the ANTADIR network were shown to have severe chronic obstructive pulmonary disease on the basis of spirometry and their survival was similar to that of more hypoxaemic patients. Randomized controlled trials of the effect of long-term oxygen therapy in patients with arterial oxygen tension > or = 8 kPa are needed.
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PMID:Characteristics and survival of patients prescribed long-term oxygen therapy outside prescription guidelines. 981 40

Many patients with emphysema are able to meet ventilatory demands during resting conditions, but they show severe limitations during exercise. To examine the effect of lung volume reduction (LVR) surgery on exercise performance and the mechanism of possible improvement, we measured ventilatory mechanics (pulmonary resistance [RL], work of breathing [WOB], dynamic intrinsic positive end-expiratory pressure [PEEPi,dyn], peak expiratory flow rate [PEFR]), breathing pattern, oxygen uptake (V O2), and carbon dioxide removal (V CO2) at rest and during cycle ergometry in eight patients before and 3 mo after LVR surgery. Ventilatory mechanics were evaluated assessing esophageal pressure and air flow. Three months after LVR surgery, the tolerated workload was doubled when compared with the preoperative value (p < 0.0005), associated with a reduction of RL (p < 0.05), PEEPi,dyn (p < 0.005), and WOB (p < 0. 005) at comparable workloads. Maximal ventilatory capacity and maximal tidal volume (VT) increased significantly (p < 0.01). Maximal V O2 increased from 474 +/- 23 to 601 +/- 16 ml/min (p < 0. 005) and maximal V CO2 from 401 +/- 13 to 558 +/- 21 ml/min (p < 0. 005), though no significant difference at comparable workloads could be observed. In conclusion, emphysema surgery leads to an improvement of ventilatory mechanics at rest and during exercise. Higher maximal VT and minute ventilation were observed, resulting in improvement of maximal V O2 and V CO2 and exercise capacity.
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PMID:Ventilatory mechanics and gas exchange during exercise before and after lung volume reduction surgery. 981 89

Traditional practice has dictated that intra-abdominal pressure during laparoscopy be kept at or below 15 mm Hg to minimize the risk of cardiovascular and pulmonary complications. This study was undertaken to determine if maintaining an intra-abdominal pressure of 20 mm Hg could be utilized safely during genitourinary laparoscopy. We reviewed the intraoperative records of 76 consecutive patients undergoing various endoscopic urologic procedures at an intra-abdominal pressure of 20 mm Hg to assess physiologic changes and complications. The records were examined for operating time, minute ventilation (MV), end-tidal CO2 (ETCO2), and peak inspiratory pressure (PIP), which were compared with the preinsufflation values. Also, in the first 39 patients, initial insufflation volumes were recorded at 15 mm Hg and then again when pressure was raised to 20 mm Hg. The mean operating time was 186 +/- 90 min. There was an average 22% increase in the sufflated volume when the pressure was elevated from 15 to 20 mm Hg. To maintain a suitable ETCO2, the anesthesiologist needed to increase the MV an average of 2.9 +/- 2.0 L/min. Increases in ETCO2 (average 4.5 +/- 4.6 mm Hg) and PIP (6.9 +/- 3.6 mm Hg) were noted. In two cases, the intra-abdominal pressure had to be decreased from 20 to 15 mm Hg because of inability to maintain an acceptable ETCO2. Subcutaneous emphysema was noted in three patients, which resolved spontaneously within 24 hr. In one patient, asymptomatic pneumomediastinum was noted after a 6-hr procedure. Intra-abdominal insufflation can be safely maintained at 20 mm Hg in most patients. This higher pressure improves maintenance of the pneumoperitoneum.
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PMID:Laparoscopic genitourinary surgery utilizing 20 mm Hg intra-abdominal pressure. 1023 49

Long-term oxygen therapy prolongs life in adults with chronic hypoxia caused by chronic bronchitis and emphysema who have cor pulmonale, pulmonary hypertension, and secondary polycythemia ('blue bloaters'). Good results require oxygen therapy for more than 15 hours and preferably 20-24 hours per day. The oxygen concentrator, delivering 1 to 3 l/min of oxygen by nasal prongs, is probably the most cost-effective method of providing this therapy. Dangers of the therapy include fires and burning of patients who smoke, and this is a contraindication to treatment. Excessive CO2 retention during sleep should not result from controlled low-dose oxygen therapy unless the patient also has an obstructive sleep apnea syndrome. Oxygen therapy during sleep may prevent hypoxemic episodes in blue bloaters, and it may thus reverse their pulmonary hypertension, which probably potentiates the risk of right-heart failure and cor pulmonale.
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PMID:Long-term oxygen therapy--state of the art. 1031 96

Endoscopic laser resection of hypopharyngeal diverticula has been used in the ENT Department, Odense, Denmark, since 1989. The outcome of treatment is reported in this presentation. Of the 61 patients, 32 (52%) were males. Age at operation was 72 years (median), range 37-94 years. The diagnosis in all patients was confirmed by barium radiography of the hypopharynx and the oesophagus. A Benjamin-Hollinger diverticuloscope was used for viewing the tissue bridge separating the diverticulum and the oesophagus. The tissue bridge was cut from the apex to the base using a CO2 laser. Perioperative complications were seen in 6 patients: Bleeding (1), subcutaneous emphysema without (3) or with (1) inflammation, inflammation without emphysema (1). The duration of postoperative nasogastric feeding was 2 days (median) (range 1-11 days). Fifty-four patients received prophylactic antibiotic treatment for a median of 3 days (range 0.5-13 days). The duration of postoperative hospitalization was 3 days (median) (range 2-14 days). The patients were routinely examined 2-3 months postoperatively. There were recurrences in 6 patients (10%), all successfully re-operated. A follow-up questionnaire was sent to patients who had finished their postoperative examination in March 1999. All 37 patients still alive responded. Median follow-up time was 37 months (range 3-96 months). Two patients reported recurrence at the time of follow-up and have been successfully re-operated. Eight patients reported minor and intermittent symptoms that did not indicate further evaluation. We conclude that laser resection of hypopharyngeal diverticula is an efficient therapy, which is applicable to and well tolerated in the great majority of patients. The rate of recurrence is low and re-operation can be performed without difficulty.
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PMID:Endoscopic CO2 laser therapy of Zenker's diverticulum--experience from 61 patients. 1090 28

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

In patients with lung emphysema, changes in lung volumes as well as changes in airway resistance are well known. The change in airway resistance is caused by obstruction of central airways, which is supposed to reduce the respiratory dead space. Until now, it was not possible to measure the respiratory dead space in patients with lung emphysema using the method of Fowler [2], because in this method distinction of the three phases of an inert gas expirogram is essential. While this distinction is easy in healthy subjects (fig. 1; expirogram 3), the separation of the three phases in patients with lung emphysema is not possible due to gradual transition of phase II into phase III in these patients (fig. 1; expirogram 2). The use of C18O2 as tracer gas allows to separate phase II and phase III even if the patients have severe emphysema (fig. 1; expirogram 1). CO2 labeled with the stable oxygen isotope 18O (C18O2) is completely taken up in the gas exchanging region of the lung, but not from the conducting airways. Therefore C18O2 is only expired from the dead space of the lung, but not from the alveolar region. Hence, C18O2 allows exact measurement of the respiratory dead space in patients with lung emphysema. 21 healthy nonsmoking subjects and 29 patients with clinical signs of lung emphysema participated in this study. There was a good correlation between respiratory dead space, measured by the use of Ar-gas and C18O2-gas in healthy subjects (fig. 2). This indicates, that the use of C18O2 is a valid method to measure the functional dead space. As expected, there was also a correlation between the airway resistance and respiratory dead space in patients with lung emphysema (fig. 3), but not in healty subjects. There was no significant difference of the mean values of the respiratory dead space between these two groups (223 +/- 43 ml in healthy subjects vs. 227 +/- 52 ml in patients), even though there were large differences in airway resistance (0.20 +/- 0.10 kPa/l/s vs. 0.49 +/- 0.27 kPa/l/s). This may be due to a loss of alveolar function in the area of the terminal bronchioli, which is typical for emphysematous patients. This entails a shift of functional dead space towards lung periphery and therefore causes an increase of the volume of functional dead space. But this enlargement may be compensated by the volume reduction, caused by the airway obstruction. Hence, these two oppositional mechanisms may result in only minimal change of dead space volume.
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PMID:[Measurement of the Fowler dead space in patients with pulmonary emphysema using C18O2]. 1129 46

Carbon dioxide can extravasate from the abdominal cavity during insufflation and result in pneumomediastinum, pneumothorax, and subcutaneous emphysema. We report a case of unilateral pneumothorax with pneumomediastinum and subcutaneous emphysema after laparoscopic extraperitoneal bilateral inguinal hernia repair. Additionally, we discuss the pathophysiology, diagnostic work-up, and management of this malady. Because of the natural resolution of CO2 pneumothoraces, observation for asymptomatic patients is appropriate, whereas tube thoracostomy should be reserved for symptomatic patients. It is utmost importance to determine the etiology of gas extravastion and consider other complications such as airway or esophageal injury or pulmonary barotrauma.
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PMID:Gas extravasation complicating laparoscopic extraperitoneal inguinal hernia repair. 1134 43

A parathyroid tumor is not larger than other tumors, so minimally invasive surgery has long been a major focus of parathyroid surgeons. Improving endoscopic instruments has facilitated the recent changes in approaches to parathyroid surgery. Endoscopic parathyroidectomy is developed in a totally closed space with CO2 gas insufflation. This method has a risk of complications, such as extensive emphysema or hypercarbia. Minimally invasive video-assisted parathyroidectomy (MIVAP) has greater safety, low cost, easy procedure and flexibility in changing the working space including conversion to open method when compared with endoscopic parathyroidectomy. MIVAP can be performed with only a 1-1.5-cm small incision on the neck. MIVAP is indicated in the patient with parathyroid adenoma or renal hyperplasia that is defined preoperatively using ultrasonography and 99mTc-methoxyisobutylisonitrile (MIBI) scan. Furthermore, the radio-guided technique using nuclear navigation after preoperative administered MIBI is being developed. This method is so useful during MIVAP that we combined MIVAP and radio-guided surgery to develop minimally invasive radio-guided and video-assisted parathyroidectomy (MIRVAP). After injection of 600 MBq of MIBI, intraoperative nuclear mapping was performed using a hand-held gamma probe. Then we expected to find swollen parathyroid tumor at surgery when radioactivity at a level relatively higher than background was found. Following this mapping result, MIVAP was started and succeeded. The radio-guided technique is also indicated for open parathyroidectomy (radio-guided open parathyroidectomy, RGOP) in multiglandular disease (MGD) when it was not possible to identify those lesions completely, for instance in asymmetric hyperplasia, such as multiple endocrine neoplasia (MEN) 1. In conclusion, MIVAP is beneficial for minimal invasiveness and cosmesis. Furthermore, radio-guided parathyroidectomy (MIRVAP and RGOP) is more useful and feasible. Improvement of endoscopic instruments and modification of the dose of MIBI administered might facilitate treating more cases by MIRVAP instead of RGOP.
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PMID:Video-assisted parathyroidectomy. 1248 44

Neck surgery is one of the newest fields of endoscopic surgical application. One hundred patients underwent endoscopic thyroidectomy. We used 3 incisions: 1 on both upper circumareolar areas and 1 approximately 3 cm below the clavicle on the tumor side. Subplatysmal and subcutaneous operative space was created with CO2 insufflation at 6 mm Hg of pressure. The thyroidal vessels and the parenchyma of the gland were dissected and divided with ultrasonic scalpel and commonly used laparoscopic instruments. The mean (+/-SD) operation time was 136 +/- 10 minutes before the year 2000 and 67 +/- 9 in the year 2000 (P < 0.05). There were six cases of conversion to conventional thyroidectomy. Postoperative complications occurred in five cases. There was no subcutaneous emphysema. The patients were satisfied with the cosmetic result. On the basis of our experience with these 100 patients, we believe that endoscopic thyroidectomy is feasible and safe for resection of thyroid tumors. Thus, this procedure will provide another surgical technique for treatment of thyroid tumors, with maximized cosmetic effect.(2)
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PMID:100 cases of endoscopic thyroidectomy: breast approach. 1259 53


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