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Sample records for iatrogenic tension pneumothorax

  1. Iatrogenic tension pneumothorax in children: two case reports

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    Mayordomo-Colunga Juan

    2009-06-01

    Full Text Available Abstract Introduction Two cases of iatrogenic tension pneumothorax in children are reported. Case presentations Case 1: A 2-year-old boy with suspected brain death after suffering multiple trauma suddenly developed intense cyanosis, extreme bradycardia and generalized subcutaneous emphysema during apnea testing. He received advanced cardiopulmonary resuscitation and urgent bilateral needle thoracostomy. Case 2: A diagnostic-therapeutic flexible bronchoscopy was conducted on a 17-month-old girl, under sedation-analgesia with midazolam and ketamine. She very suddenly developed bradycardia, generalized cyanosis and cervical, thoracic and abdominal subcutaneous emphysema. Urgent needle decompression of both hemithoraces was performed. Conclusion In techniques where gas is introduced into a child's airway, it is vital to ensure its way out to avoid iatrogenic tension pneumothorax. Moreover, the equipment to perform an urgent needle thoracostomy should be readily available.

  2. The risk of iatrogenic pneumothorax after electromyography.

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    Kassardjian, Charles D; O'gorman, Cullen M; Sorenson, Eric J

    2016-04-01

    Pneumothorax is a potentially serious complication of electromyography (EMG). Data on the frequency of pneumothorax after EMG are lacking. The purpose of this study was to determine the frequency, timing, and risk factors for iatrogenic pneumothorax after EMG. Cases of pneumothorax after EMG were reviewed for clinical, electrophysiological, and radiological data. Of 64,490 EMG studies, 7 patients had an association between the EMG and pneumothorax. All patients were symptomatic and presented within 24 hours of EMG. Sampling of serratus anterior and diaphragm was causative in 1 patient each. In 5 patients, multiple high-risk muscles were sampled. The highest frequency of pneumothorax was observed with examination of serratus anterior (0.445%) and diaphragm (0.149%). The frequency of symptomatic iatrogenic pneumothorax after EMG appears to be low, and examinations of serratus anterior and diaphragm carry the highest risk. Electromyographers should be aware of the risk of pneumothorax and should counsel patients accordingly. © 2015 Wiley Periodicals, Inc.

  3. Iatrogenic pneumothorax related to mechanical ventilation

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    Hsu, Chien-Wei; Sun, Shu-Fen

    2014-01-01

    Pneumothorax is a potentially lethal complication associated with mechanical ventilation. Most of the patients with pneumothorax from mechanical ventilation have underlying lung diseases; pneumothorax is rare in intubated patients with normal lungs. Tension pneumothorax is more common in ventilated patients with prompt recognition and treatment of pneumothorax being important to minimize morbidity and mortality. Underlying lung diseases are associated with ventilator-related pneumothorax with pneumothoraces occurring most commonly during the early phase of mechanical ventilation. The diagnosis of pneumothorax in critical illness is established from the patients’ history, physical examination and radiological investigation, although the appearances of a pneumothorax on a supine radiograph may be different from the classic appearance on an erect radiograph. For this reason, ultrasonography is beneficial for excluding the diagnosis of pneumothorax. Respiration-dependent movement of the visceral pleura and lung surface with respect to the parietal pleura and chest wall can be easily visualized with transthoracic sonography given that the presence of air in the pleural space prevents sonographic visualization of visceral pleura movements. Mechanically ventilated patients with a pneumothorax require tube thoracostomy placement because of the high risk of tension pneumothorax. Small-bore catheters are now preferred in the majority of ventilated patients. Furthermore, if there are clinical signs of a tension pneumothorax, emergency needle decompression followed by tube thoracostomy is widely advocated. Patients with pneumothorax related to mechanical ventilation who have tension pneumothorax, a higher acute physiology and chronic health evaluation II score or PaO2/FiO2 < 200 mmHg were found to have higher mortality. PMID:24834397

  4. Sonography of iatrogenic pneumothorax in pediatric patients

    Science.gov (United States)

    2013-01-01

    Pneumothorax is defined as the presence of air in the pleural cavity. The incidence of iatrogenic pneumothorax in the pediatric population is 0.3–0.48 in 1000 patients. A conventional chest X-ray, in some cases supplemented with chest computed tomography, is a typical imaging examination used to confirm the diagnosis of pneumothorax. Within the last years, the relevance of transthoracic lung ultrasound in the diagnostic process of this disease entity has greatly increased. This is confirmed by the opinion of a group of experts in ultrasound lung imaging in patients in a life-threatening condition, who strongly recommend a transthoracic ultrasound examination for the diagnosis of pneumothorax in such patients. These data constituted the basis for initiating the prospective studies on the application of this method in pneumothorax diagnosis in patients of pediatric hematology and oncology wards. Aim The aim of the study was to present the possibility of using the transthoracic lung ultrasound in the diagnostic process of pneumothorax in pediatric patients, with particular attention paid to its iatrogenic form. The article discusses sonographic criteria for pneumothorax diagnosis in pediatric patients, including the sensitivity and specificity of the method, in relation to conventional chest X-ray. Material and methods The prospective studies included a group of patients treated in the Clinic of Pediatrics, Pediatric Hematology, Oncology and Endocrinology of the Academic Clinical Centre (Medical University of Gdańsk, Poland) in whom a central venous catheter was placed in the subclavian veins. The studies lasted for one year – from 1 July 2011 to 30 June 2012. The examined group comprised 63 patients – 25 girls (39.7%) and 38 boys (60.3%) aged from 1 to 17. The analysis included the results of 115 ultrasound examinations conducted in this group. Results In t he examined group with suspected or diagnosed neoplasm, iatrogenic pneumothorax was identified in 4 out

  5. Delayed Tension Pneumothorax During Surgery

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    Ying-Lun Chen

    2005-10-01

    Full Text Available Tension pneumothorax is a life-threatening emergency that rapidly results in cardiopulmonary arrest. It requires prompt diagnosis and treatment. We present 2 cases from our practice, 1 caused by blunt chest trauma and the other resulting from laparoscopic surgery. Both were successfully treated by insertion of a chest tube. The diagnosis and treatment of intraoperative pneumothorax is discussed together with a review of the literature.

  6. Tension Pneumothorax following an Accidental Kerosene Poisoning ...

    African Journals Online (AJOL)

    Tension pneumothorax is a rare complication following an accidental kerosene poisoning. In such situation, a bed-side needle thoracocentesis is performed because of its potential of becoming fatal; hence its clinical importance. A case of 15 month old boy with tension pneumothorax following accidental kerosene ...

  7. Bilateral tension pneumothorax after acupuncture.

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    Mohammad, Nurashikin

    2018-04-19

    Acupuncture is an ancient complementary medicine which is currently used worldwide. Many serious adverse events have been reported which include a spectrum of mild-to-fatal complications. However, the level of awareness with regard to complications is still low both to physicians and patients. We report a 63-year-old who presented with acute shortness of breath 2 hours after having had acupuncture. On examination, there was absent breath sound heard on the left lung and slightly reduced breath sound on the right lung. She had type 1 respiratory failure. Urgent chest radiograph confirmed bilateral pneumothorax which was more severe on the left with tension pneumothorax and mediastinal shift. Chest tubes were inserted bilaterally after failed needle aspiration attempts. Subsequently, the pneumothoraces resolved, and she was discharged well. The bilateral pneumothoraces caused by acupuncture were curable but could have been potentially fatal if diagnosis was delayed. This case report adds to the limited current literature on the complications of acupuncture leading to bilateral pneumothoraces. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  8. Gastrothorax or tension pneumothorax: A diagnostic dilemma

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    Singh Sarvesh

    2011-01-01

    Full Text Available Gastrothorax, a rare complication following thoracoabdominal aortic aneurysm repair, is reported. The clinical features of a gastrothorax and tension pneumothorax are similar and thus, a gastrothorax can masquerade as a tension pneumothorax. The diagnosis is made by a high level of clinical suspicion, chest X-ray shows a distended stomach with air fluid levels and a computerised tomography is useful in assessing the diaphragm and establishing the positions of the various intra-abdominal organs. Also, the risk of an intercostal drainage tube placement and the role of nasogastric tube in avoiding the development of a tension gastrothorax is highlighted.

  9. Bilateral tension pneumothorax related to acupuncture.

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    Tagami, Rumi; Moriya, Takashi; Kinoshita, Kosaku; Tanjoh, Katsuhisa

    2013-06-01

    We report on a patient with a rare case of bilateral tension pneumothorax that occurred after acupuncture. A 69-year-old large-bodied man, who otherwise had no risk factors for spontaneous pneumothorax, presented with chest pressure, cold sweats and shortness of breath. Immediately after bilateral pneumothorax had been identified on a chest radiograph in the emergency room, his blood pressure and percutaneous oxygen saturation suddenly decreased to 78 mm Hg and 86%, respectively. We confirmed deterioration in his cardiopulmonary status and diagnosed bilateral tension pneumothorax. We punctured his chest bilaterally and inserted chest tubes for drainage. His vital signs promptly recovered. After the bilateral puncture and drainage, we learnt that he had been treated with acupuncture on his upper back. We finally diagnosed a bilateral tension pneumothorax based on the symptoms that appeared 8 h after the acupuncture. Because the patient had no risk factors for spontaneous pneumothorax, no alternative diagnosis was proposed. We recommend that patients receiving acupuncture around the chest wall must be adequately informed of the possibility of complications and expected symptoms, as a definitive diagnosis can be difficult without complete information.

  10. Iatrogenic pneumothorax: Experience of a Moroccan Emergency Center

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    M.M. El Hammoumi

    2013-03-01

    Full Text Available The incidence of iatrogenic pneumothorax (IPx will increase with invasive procedures particularly at training hospitals, that is why we have made a retrospective study of the common diagnostic or therapeutic causes of IPx and its impact on morbidity. From January 2011 to December 2011, 36 patients developed IPx as emergencies, after an invasive procedure. Their mean age was 38 years (range: 19–69 years. Of the patients, 21 (58% were male and 15 (42% were female. The purpose was diagnostic in 6 cases and therapeutic in 30 cases. In 8 patients (22% the procedure was performed due to underlying lung diseases and in 28 patients (78% for other diseases. The procedure most frequently causing IPnx was central venous catheterization, with 20 patients (55%, other frequent causes were mechanical ventilation in 8 cases (22% (of whom we reported 3 cases of bilateral pneumothorax, 6 cases of thoracentesis (16% and 2 patients had life-saving percutaneous tracheotomy. The majority of our patients were managed by a small chest tube placement (unilateral n = 30, bilateral n = 3. The average duration of drainage was 3 days (range: 1–15 days, sadly one of our patients died of ischemic brain damage 15 days after tracheotomy.At training hospitals the incidence of IPnx will increase with the increase in invasive procedures, which should only be performed by experienced personnel or under their supervision. Resumo: A incidência de pneumotórax iatrogénico (IPx vai aumentar com procedimentos invasivos particularmente em hospitais de formação, sendo esse o motivo pelo qual fizemos um estudo retrospetivo do diagnóstico ou das causas terapêuticas comuns de IPx e do seu impacto na morbilidade. Desde janeiro de 2011 até dezembro de 2011, 36 pacientes desenvolveram IPx como emergências, depois de um procedimento invasivo. A sua média de idades foi de 38 anos (intervalo: 19-69 anos. Dos pacientes, 21 (58% eram do sexo

  11. Iatrogenic pneumothorax: experience of a Moroccan Emergency Center

    Directory of Open Access Journals (Sweden)

    M.M. El Hammoumi

    2013-03-01

    Full Text Available The incidence of iatrogenic pneumothorax (IPx will increase with invasive procedures particularly at training hospitals, which is why we have made a retrospective study of the common diagnostic or therapeutic causes of IPx and its impact on morbidity. From January 2011 to December 2012, 36 patients developed IPx as emergencies, after an invasive procedure .Their mean age was 38 years (range: 19-69 years. Of the patients, 21 (58% were male and 15 (42% were female. The purpose was diagnostic in 6 cases and therapeutic in 30 cases. In 8 patients (22% the procedure was performed due to underlying lung diseases and in 28 patients (78% for other diseases. The procedure most frequently causing IPnx was central venous catheterization, with 20 patients (55%, other frequent causes were mechanical ventilation, 8 cases (22% of whom we reported 3 cases of bilateral pneumothorax, 6 cases of thoracentesis (16% and 2 patients had life-saving percutaneous tracheotomy. The majority of our patients were managed by a small chest tube placement (unilateral n = 30, bilateral n = 3.The average duration of drainage was 3 days (range: 1-15 days, sadly one of our patients died of ischemic brain damage 15 days after tracheotomy.At training hospitals the incidence of IPnx will increase with the increase in invasive procedures, which should only be performed by experienced personnel or under their supervision. Resumo: A incidência de pneumotórax iatrogénico (IPx vai aumentar com procedimentos invasivos particularmente em hospitais de formação, sendo esse o motivo pelo qual fizemos um estudo retrospetivo do diagnóstico ou das causas terapêuticas comuns de IPx e do seu impacto na morbidade. Desde janeiro de 2011 até dezembro de 2012, 36 pacientes desenvolveram IPx como emergências, depois de um procedimento invasivo. A sua média de idades foi de 38 anos (intervalo: 19-69 anos. Dos pacientes, 21 (58% eram do sexo masculino e 15 (42% do sexo feminino. O objetivo

  12. Tension pneumothorax, is it a really life-threatening condition?

    Science.gov (United States)

    2013-01-01

    Background Tension pneumothorax is a life-threatening occurrence that is infrequently the consequence of spontaneous pneumothorax. The aim of this study was to identify the risk factors for the development of tension pneumothorax and its effect on clinical outcomes. Methods We reviewed patients who were admitted with spontaneous pneumothorax between August 1, 2003 and December 31, 2011. Electronic medical records and the radiological findings were reviewed with chest x-ray and high-resolution computed tomography scans that were retrieved from the Picture Archiving Communication System. Results Out of the 370 patients included in this study, tension pneumothorax developed in 60 (16.2%). The bullae were larger in patients with tension pneumothorax than in those without (23.8 ± 16.2 mm vs 16.1 ± 19.1 mm; P = 0.007). In addition, the incidence of tension pneumothorax increased with the lung bulla size. Fibrotic adhesion was more prevalent in the tension pneumothorax group than in that without (P = 0.000). The bullae were large in patients with fibrotic adhesion than in those without adhesion (35.0 ± 22.3 mm vs 10.4 ± 11.5 mm; P = 0.000). On multivariate analysis, the size of bullae (odds ratio (OR) = 1.03, P = 0.001) and fibrotic adhesion (OR = 10.76, P = 0.000) were risk factors of tension pneumothorax. Hospital mortality was 3.3% in the tension pneumothorax group and it was not significantly different from those patients without tension pneunothorax (P = 0.252). Conclusions Tension pneumothorax is not uncommon, but clinically fatal tension pneumothorax is extremely rare. The size of the lung bullae and fibrotic adhesion contributes to the development of tension pneumothorax. PMID:24128176

  13. Ultrasound Findings in Tension Pneumothorax: A Case Report.

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    Inocencio, Maxine; Childs, Jeannine; Chilstrom, Mikaela L; Berona, Kristin

    2017-06-01

    Delayed recognition of tension pneumothorax can lead to a mortality of 31% to 91%. However, the classic physical examination findings of tracheal deviation and distended neck veins are poorly sensitive in the diagnosis of tension pneumothorax. Point-of-care ultrasound is accurate in identifying the presence of pneumothorax, but sonographic findings of tension pneumothorax are less well described. We report the case of a 21-year-old man with sudden-onset left-sided chest pain. He was clinically stable without hypoxia or hypotension, and the initial chest x-ray study showed a large pneumothorax without mediastinal shift. While the patient was awaiting tube thoracostomy, a point-of-care ultrasound demonstrated findings of mediastinal shift and a dilated inferior vena cava (IVC) concerning for tension physiology, even though the patient remained hemodynamically stable. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case demonstrates a unique clinical scenario of ultrasound evidence of tension physiology in a clinically stable patient. Although this patient was well appearing without hypotension, respiratory distress, tracheal deviation, or distended neck veins, point-of-care ultrasound revealed mediastinal shift and a plethoric IVC. Given that the classic clinical signs of tension pneumothorax are not uniformly present, this case shows how point-of-care ultrasound may diagnose tension pneumothorax before clinical decompensation. Published by Elsevier Inc.

  14. [Delayed (tension) pneumothorax after placement of a central venous catheter].

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    Tan, E C; van der Vliet, J A

    1999-09-11

    Laborious attempts at introducing a central venous catheter for parenteral nutrition in two women, aged 36 and 62 years, were followed by shortness of breath after 32 and 10 hours, respectively. This symptom was due to a (tension) pneumothorax not visible on earlier roentgenograms. Thoracic drainage led to recovery. In all patients with a central venous catheter an undetected delayed pneumothorax can be present. Urgent chest X-ray examination should be performed in all patients with acute respiratory symptoms. Patients undergoing elective intubation with positive pressure breathing should be examined carefully, since they are at risk of developing a late (tension) pneumothorax.

  15. Incidence of iatrogenic pneumothorax in the United States in teaching vs. non-teaching hospitals from 2000 to 2012.

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    John, Jason; Seifi, Ali

    2016-08-01

    Iatrogenic pneumothorax is a patient safety indicator (PSI) representing a complication of procedures such as transthoracic needle aspiration, subclavicular needle stick, thoracentesis, transbronchial biopsy, pleural biopsy, and positive pressure ventilation. This study examined whether there was a significant difference in rate of iatrogenic pneumothorax in teaching hospitals compared to non-teaching hospitals from 2000 to 2012. We performed a retrospective cohort study on iatrogenic pneumothorax incidence from 2000 to 2012 using the Healthcare Cost and Utilization Project (HCUP) database. Pairwise t tests were performed. Odds ratios and P values were calculated, using a Bonferroni-adjusted α threshold, to examine differences in iatrogenic pneumothorax incidence in teaching vs. non-teaching hospitals. Our study revealed that after the year 2000, teaching hospitals had significantly greater iatrogenic pneumothorax incidence compared to non-teaching hospitals in every year of the study period (Ppneumothorax occurred with significantly greater incidence in teaching hospitals compared to non-teaching hospitals from 2000 to 2012. This trend may have been enhanced by the residency duty-hour regulations implemented in 2003 in teaching institutions, or due to higher rates of procedures in teaching institutions due to the nature of a tertiary center. Iatrogenic pneumothorax was more prevalent in teaching hospitals compared to non-teaching hospitals after the year 2000. Further randomized control studies are warranted to evaluate the etiology of this finding. Published by Elsevier Inc.

  16. Iatrogenic Pneumothorax as a Complication to Delayed Breast Reconstruction With Tissue Expander—A Case Report

    DEFF Research Database (Denmark)

    Willert, Cecilie Balslev; Bredgaard, Rikke

    2017-01-01

    Breast reconstruction with expander implant is the most common breast reconstructive procedure. Irradiated patients are seldom reconstructed this way because the tissue expansion is difficult and the complication rates are higher. Pneumothorax is a serious condition and can be seen as a complicat......Breast reconstruction with expander implant is the most common breast reconstructive procedure. Irradiated patients are seldom reconstructed this way because the tissue expansion is difficult and the complication rates are higher. Pneumothorax is a serious condition and can be seen...... as a complication to the operation. Literature is sparse; hence, the only study is by Schneider et al who found an incidence of 0.55%. The study focused on immediate reconstruction only and did not report the percentage of irradiated patients. We present a unique case of iatrogenic pneumothorax in a previously...

  17. Vented chest seals for prevention of tension pneumothorax in a communicating pneumothorax.

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    Kotora, Joseph G; Henao, Jose; Littlejohn, Lanny F; Kircher, Sara

    2013-11-01

    Tension pneumothorax accounts for 3%-4% of combat casualties and 10% of civilian chest trauma. Air entering a wound via a communicating pneumothorax rather than by the trachea can result in respiratory arrest and death. In such cases, the Committee on Tactical Combat Casualty Care advocates the use of unvented chest seals to prevent respiratory compromise. A comparison of three commercially available vented chest seals was undertaken to evaluate the efficacy of tension pneumothorax prevention after seal application. A surgical thoracostomy was created and sealed by placing a shortened 10-mL syringe barrel (with plunger in place) into the wound. Tension pneumothorax was achieved via air introduction through a Cordis to a maximum volume of 50 mL/kg. A 20% drop in mean arterial pressure or a 20% increase in heart rate confirmed hemodynamic compromise. After evacuation, one of three vented chest seals (HyFin(®), n = 8; Sentinel(®), n = 8, SAM(®), n = 8) was applied. Air was injected to a maximum of 50 mL/kg twice, followed by a 10% autologous blood infusion, and finally, a third 50 mL/kg air bolus. Survivors completed all three interventions, and a 15-min recovery period. The introduction of 29.0 (±11.5) mL/kg of air resulted in tension physiology. All three seals effectively evacuated air and blood. Hemodynamic compromise failed to develop with a chest seal in place. HyFin(®), SAM(®), and Sentinel(®) vented chest seals are equally effective in evacuating blood and air in a communicating pneumothorax model. All three prevented tension pneumothorax formation after penetrating thoracic trauma. Published by Elsevier Inc.

  18. Tension Pneumothorax During Surgery for Thoracic Spine Stabilization in Prone Position

    OpenAIRE

    Rankin, Demicha; Mathew, Paul S.; Kurnutala, Lakshmi N.; Soghomonyan, Suren; Bergese, Sergio D.

    2014-01-01

    The intraoperative progression of a simple or occult pneumothorax into a tension pneumothorax can be a devastating clinical scenario. Routine use of prophylactic thoracostomy prior to anesthesia and initiation of controlled ventilation in patients with simple or occult pneumothorax remains controversial. We report the case of a 75-year-old trauma patient with an insignificant pneumothorax on the right who developed an intraoperative tension pneumothorax on the left side while undergoing thora...

  19. Bilateral tension pneumothorax following equipment improvisation.

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    Zambricki, Christine; Schmidt, Carol; Vos, Karen

    2014-02-01

    This case report describes an unexpected event that took place as a result of using improvised equipment. The patient, a 16-year-old female undergoing complex oral surgery, suffered bilateral pneumothorax following the improper use of an airway support device. During the immediate postoperative period with the patient still intubated, oxygen tubing was attached to a right angle elbow connector with the port closed and 10 L/minute oxygen flow was administered to the patient in a manner that did not allow the patient to exhale. Within seconds, pneumothorax was apparent as the patient's vital signs deteriorated, visible swelling was noted in the shoulders and neck, and there was an absence of breath sounds on auscultation. This case study has application beyond the immediate discussion of bilateral pneumothorax, serving as a caution about the unintended consequences of equipment improvisation. In addition to highlighting the hazards of providing patient care with a non-standard device, this study also provides a powerful example of the human factors that can contribute to medical errors in the healthcare setting.

  20. Needle Decompression of Tension Pneumothorax with Colorimetric Capnography.

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    Naik, Nimesh D; Hernandez, Matthew C; Anderson, Jeff R; Ross, Erika K; Zielinski, Martin D; Aho, Johnathon M

    2017-11-01

    The success of needle decompression for tension pneumothorax is variable, and there are no objective measures assessing effective decompression. Colorimetric capnography, which detects carbon dioxide present within the pleural space, may serve as a simple test to assess effective needle decompression. Three swine underwent traumatically induced tension pneumothorax (standard of care, n = 15; standard of care with needle capnography, n = 15). Needle thoracostomy was performed with an 8-cm angiocatheter. Similarly, decompression was performed with the addition of colorimetric capnography. Subjective operator assessment of decompression was recorded and compared with true decompression, using thoracoscopic visualization for both techniques. Areas under receiver operating curves were calculated and pairwise comparison was performed to assess statistical significance (P pneumothorax, that is, the absence of any pathologic/space-occupying lesion, in 100% of cases (10 of 10 attempts). Standard of care needle decompression was detected by operators in 9 of 15 attempts (60%) and was detected in 3 of 10 attempts when tension pneumothorax was not present (30%). True decompression, under direct visualization with thoracoscopy, occurred 15 of 15 times (100%) with capnography, and 12 of 15 times (80%) without capnography. Areas under receiver operating curves were 0.65 for standard of care and 1.0 for needle capnography (P = .002). Needle decompression with colorimetric capnography provides a rapid, effective, and highly accurate method for eliminating operator bias for tension pneumothorax decompression. This may be useful for the treatment of this life-threatening condition. Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

  1. An adult case of giant bronchogenic cyst mimicking tension pneumothorax.

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    Yalcinkaya, Serhat; Vural, A Hakan; Ozal, Hasan

    2010-10-01

    Bronchogenic cysts are usually discovered only incidentally in the adult. A giant bronchogenic cyst in a 19-year-old woman presenting with pain and shortness of breath was mistaken for tension pneumothorax and initially treated with tube thoracostomy. Giant bullae were diagnosed by computed tomography. Bullae resection was undertaken, but the remaining lung tissue required pneumonectomy. Pathologic examination of the specimen confirmed bronchogenic cyst.

  2. Tension pneumothorax secondary to automatic mechanical compression decompression device.

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    Hutchings, A C; Darcy, K J; Cumberbatch, G L A

    2009-02-01

    The details are presented of the first published case of a tension pneumothorax induced by an automatic compression-decompression (ACD) device during cardiac arrest. An elderly patient collapsed with back pain and, on arrival of the crew, was in pulseless electrical activity (PEA) arrest. He was promptly intubated and correct placement of the endotracheal tube was confirmed by noting equal air entry bilaterally and the ACD device applied. On the way to the hospital he was noted to have absent breath sounds on the left without any change in the position of the endotracheal tube. Needle decompression of the left chest caused a hiss of air but the patient remained in PEA. Intercostal drain insertion in the emergency department released a large quantity of air from his left chest but without any change in his condition. Post-mortem examination revealed a ruptured abdominal aortic aneurysm as the cause of death. Multiple left rib fractures and a left lung laceration secondary to the use of the ACD device were also noted, although the pathologist felt that the tension pneumothorax had not contributed to the patient's death. It is recommended that a simple or tension pneumothorax should be considered when there is unilateral absence of breath sounds in addition to endobronchial intubation if an ACD device is being used.

  3. Takotsubo Cardiomyopathy in the Setting of Tension Pneumothorax.

    Science.gov (United States)

    Gale, Michael; Loarte, Pablo; Mirrer, Brooks; Mallet, Thierry; Salciccioli, Louis; Petrie, Alison; Cohen, Ronny

    2015-01-01

    Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usually accompanied by electrocardiographic changes. The literature documents only two other cases of Takotsubo cardiomyopathy in the latter setting. Methods. A 78-year-old female presented to the ED with severe shortness of breath, hypertension, and tachycardia. On physical exam, heart sounds (S1 and S2) were regular and wheezing was noticed bilaterally. We found laboratory results with a WBC of 20.0 (103/μL), troponin of 16.52 ng/mL, CK-mb of 70.6%, and BNP of 177 pg/mL. The patient was intubated for acute hypoxemic respiratory failure. A chest X-ray revealed a large left-sided tension pneumothorax. Initial echocardiogram showed apical ballooning with a LVEF of 10-15%. A cardiac angiography revealed normal coronary arteries with no coronary disease. After supportive treatment, the patient's condition improved with a subsequent echocardiogram showing a LVEF of 60%. Conclusion. The patient was found to have Takotsubo cardiomyopathy in the setting of a tension pneumothorax. The exact mechanisms of ventricular dysfunction have not been clarified. However, multivessel coronary spasm or catecholamine cardiotoxicity has been suggested to have a causative role. We suggest that, in our patient, left ventricular dysfunction was induced by the latter mechanism related to the stress associated with acute pneumothorax.

  4. Takotsubo Cardiomyopathy in the Setting of Tension Pneumothorax

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    Michael Gale

    2015-01-01

    Full Text Available Background. Takotsubo cardiomyopathy is defined as a transient left ventricular dysfunction, usually accompanied by electrocardiographic changes. The literature documents only two other cases of Takotsubo cardiomyopathy in the latter setting. Methods. A 78-year-old female presented to the ED with severe shortness of breath, hypertension, and tachycardia. On physical exam, heart sounds (S1 and S2 were regular and wheezing was noticed bilaterally. We found laboratory results with a WBC of 20.0 (103/μL, troponin of 16.52 ng/mL, CK-mb of 70.6%, and BNP of 177 pg/mL. The patient was intubated for acute hypoxemic respiratory failure. A chest X-ray revealed a large left-sided tension pneumothorax. Initial echocardiogram showed apical ballooning with a LVEF of 10–15%. A cardiac angiography revealed normal coronary arteries with no coronary disease. After supportive treatment, the patient’s condition improved with a subsequent echocardiogram showing a LVEF of 60%. Conclusion. The patient was found to have Takotsubo cardiomyopathy in the setting of a tension pneumothorax. The exact mechanisms of ventricular dysfunction have not been clarified. However, multivessel coronary spasm or catecholamine cardiotoxicity has been suggested to have a causative role. We suggest that, in our patient, left ventricular dysfunction was induced by the latter mechanism related to the stress associated with acute pneumothorax.

  5. Tension pneumothorax due to perforated colon.

    Science.gov (United States)

    Abdullah, Muhammad; Stonelake, Paul

    2016-05-31

    A very rare case of traumatic diaphragmatic hernia is reported in a 65-year-old woman who presented 46 years after her initial thoracoabdominal injury with tension faecopneumothorax caused by a perforated colon in the chest cavity. She presented in a critical condition with severe respiratory distress, sepsis and acute kidney injury. She had a long-standing history of bronchial asthma with respiratory complications and had experienced progressive shortness of breath for the past year. A recent CT scan had excluded the presence of a diaphragmatic hernia but showed a significantly raised left hemidiaphragm. On admission, chest X-rays showed a significantly raised left hemidiaphragm and mediastinal shift, but the possibility of a diaphragmatic hernia with strangulated bowel in the chest was not suspected until the patient was reviewed by the surgical and intensive care unit consultants the next morning and a repeat CT performed. She had a successful outcome after her emergency operation. 2016 BMJ Publishing Group Ltd.

  6. Tension Pneumothorax and Subcutaneous Emphysema Complicating Insertion of Nasogastric Tube

    Directory of Open Access Journals (Sweden)

    Narjis AL Saif

    2015-01-01

    Full Text Available Nasogastric tube has a key role in the management of substantial number of hospitalized patients particularly the critically ill. In spite of the apparent simple insertion technique, nasogastric tube placement has its serious perhaps fatal complications which need to be carefully assessed. Pulmonary misplacement and associated complications are commonplace during nasogastric tube procedure. We present a case of tension pneumothorax and massive surgical emphysema in critically ill ventilated patient due to inadvertent nasogastric tube insertion and also discussed the risk factors, complication list, and arrays of techniques for safer tube placement.

  7. Tension Pneumothorax During Surgery for Thoracic Spine Stabilization in Prone Position

    Directory of Open Access Journals (Sweden)

    Demicha Rankin MD

    2014-06-01

    Full Text Available The intraoperative progression of a simple or occult pneumothorax into a tension pneumothorax can be a devastating clinical scenario. Routine use of prophylactic thoracostomy prior to anesthesia and initiation of controlled ventilation in patients with simple or occult pneumothorax remains controversial. We report the case of a 75-year-old trauma patient with an insignificant pneumothorax on the right who developed an intraoperative tension pneumothorax on the left side while undergoing thoracic spine stabilization surgery in the prone position. Management of an intraoperative tension pneumothorax requires prompt recognition and treatment; however, the prone position presents an additional challenge of readily accessing the standard anatomic sites for pleural puncture and air drainage.

  8. Prognostic Factors Influencing the Development of an Iatrogenic Pneumothorax for Computed Tomography-Guided Radiofrequency Ablation of Upper Renal Tumor

    International Nuclear Information System (INIS)

    Park, B.K.; Kim, C.K.

    2008-01-01

    Background: Percutaneous radiofrequency (RF) ablation of upper renal tumors is considered a minimally invasive treatment, but this technique may cause pneumothorax. Purpose: To assess retrospectively the prognostic factors influencing the development of iatrogenic pneumothorax for RF ablation of upper renal tumors. Material and Methods: Computed tomography (CT)-guided RF ablation was performed in 24 patients (21 men, three women; age range 31-77 years, mean age 53.3 years) with 28 upper renal tumors. Various factors for pneumothorax-complicated (PC) upper renal tumors and non-pneumothoracic (NP) upper renal tumors were compared during RF ablation to determine which of the factors were involved in the development of pneumothorax. Results: Among 28 upper renal tumors in 24 patients, a pneumothorax occurred accidentally in six patients with eight tumors and intentionally in two patients with two tumors. This complication was treated with conservative management, instead of tube drainage. PC upper renal tumors had shorter distance from the lung or from the costophrenic line to the tumor, a larger angle between the costophrenic line and the tumor, and a higher incidence of intervening lung tissue than NP upper renal tumors (P<0.01). Intervening lung tissue was more frequently detected on CT images obtained with the patient in the prone position than on CT images obtained with the patient in the supine position. Conclusion: The presence of intervening lung tissue and the close proximity between an upper renal tumor and the lung are high risk factors for developing an iatrogenic pneumothorax. Pre-ablation CT scan should be performed in the prone position to exactly evaluate intervening lung tissue

  9. Tension pneumothorax accompanied by type A aortic dissection.

    Science.gov (United States)

    Hifumi, Toru; Kiriu, Nobuaki; Inoue, Junichi; Koido, Yuichi

    2012-11-09

    A 51-year-old man was brought to the emergency room because of a sudden onset of severe dysponea. On presentation, his blood pressure was 94/55 mm Hg. Oxygen saturation was 86% while he was receiving 10 l/min oxygen through a non-rebreather mask. On physical examination, no jugular venous distention was noted, but breath sounds over the left lung were diminished. A bedside chest radiograph showed left tension pneumothorax, for which urgent needle decompression followed by chest thoracostomy was performed. Ventricular tachycardia developed, but a biphasic shock at 120 J immediately restored normal sinus rhythm. His vital signs, however, did not improve. A CT scan of the chest showed type A aortic dissection with bullae in the upper lobe of the left lung. He had an emergency operation for distal aortic arch displacement and was discharged on the 37th day of hospitalisation.

  10. [Case of tension pneumothorax associated with asthma attack during general anesthesia].

    Science.gov (United States)

    Komasawa, Nobuyasu; Ueki, Ryusuke; Kusuyama, Kazuki; Okano, Yukari; Tatara, Tsuneo; Tashiro, Chikara

    2010-05-01

    We report a case of tension pneumothorax associated with asthma attack during general anesthesia. An 86-year-old woman with dementia underwent cataract surgery under general anesthesia. At 70 min after the start of operation, airway pressure suddenly increased from 19 to 28 cm HO2O. In spite of bag ventilation with 100% oxygen, Sp(O2) decreased to 81%. Chest-Xp showed typical image of tension pneumothorax. Chest drainage was immediately performed, after which Pa(O2) recovered soon. She was extubated on postoperative day 1 without any neurological disorder. Hyperinflation of fragile alveoli by mechanical ventilation was likely a cause of tension pneumothorax.

  11. Boerhaave's syndrome and tension pneumothorax secondary to Norovirus induced forceful emesis

    DEFF Research Database (Denmark)

    Venø, Søren; Eckardt, Jens

    2013-01-01

    Boerhaave's syndrome or spontaneous esophageal perforation is a rare condition, with high mortality. We describe a case of Boerhaave's syndrome presenting with tension pneumothorax. The patient was infected with Norovirus and developed Boerhaave's syndrome, initially thought to be gastroenteritis...

  12. An unusual case of primary spontaneous tension pneumothorax in a jamaican female.

    Science.gov (United States)

    Johnson, M; French, S; Cornwall, D

    2014-06-01

    Spontaneous pneumothorax is a well-recognized entity with a classical presentation of acute onset chest pain and shortness of breath. It may be complicated by the development of a tension pneumothorax or a haemopneumothorax. We report an interesting case of a spontaneous tension haemopneumothorax which presented atypically and was diagnosed on computed tomography (CT) scan of the chest. The clinical and pathophysiological characteristics and treatment of this unusual entity is discussed.

  13. An Unusual Case of Primary Spontaneous Tension Pneumothorax in a Jamaican Female

    OpenAIRE

    Johnson, M; French, S; Cornwall, D

    2014-01-01

    Spontaneous pneumothorax is a well-recognized entity with a classical presentation of acute onset chest pain and shortness of breath. It may be complicated by the development of a tension pneumothorax or a haemopneumothorax. We report an interesting case of a spontaneous tension haemopneumothorax which presented atypically and was diagnosed on computed tomography (CT) scan of the chest. The clinical and pathophysiological characteristics and treatment of this unusual entity is discussed.

  14. Needle Decompression of Tension Pneumothorax Tactical Combat Casualty Care Guideline Recommendations

    Science.gov (United States)

    2012-07-06

    suspected torso trauma , consider a tension pneumothorax and decompress the chest on the side of the injury with a 14-gauge, 3.25 inch (8cm) needle...and known or suspected torso trauma , consider a tension pneumothorax and decompress the chest on the side of the injury with a 14-gauge, 3.25 inch...these studies used civilian volunteers, retrospective trauma database analysis and cadavers to measure the mean chest wall thickness. This population

  15. Pneumothorax

    Science.gov (United States)

    Pneumothorax Overview A pneumothorax (noo-moe-THOR-aks) is a collapsed lung. A pneumothorax occurs when air leaks into the space between your ... only a portion of the lung collapses. A pneumothorax can be caused by a blunt or penetrating ...

  16. Needle thoracostomy for tension pneumothorax: the Israeli Defense Forces experience.

    Science.gov (United States)

    Chen, Jacob; Nadler, Roy; Schwartz, Dagan; Tien, Homer; Cap, Andrew P; Glassberg, Elon

    2015-06-01

    Point of injury needle thoracostomy (NT) for tension pneumothorax is potentially lifesaving. Recent data raised concerns regarding the efficacy of conventional NT devices. Owing to these considerations, the Israeli Defense Forces Medical Corps (IDF-MC) recently introduced a longer, wider, more durable catheter for the performance of rapid chest decompression. The present series represents the IDF-MC experience with chest decompression by NT. We reviewed the IDF trauma registry from January 1997 to October 2012 to identify all cases in which NT was attempted. During the study period a total of 111 patients underwent chest decompression by NT. Most casualties (54%) were wounded as a result of gunshot wounds (GSW); motor vehicle accidents (MVAs) were the second leading cause (16%). Most (79%) NTs were performed at the point of injury, while the rest were performed during evacuation by ambulance or helicopter (13% and 4%, respectively). Decreased breath sounds on the affected side were one of the most frequent clinical indications for NT, recorded in 28% of cases. Decreased breath sounds were more common in surviving than in nonsurviving patients. (37% v. 19%, p chest tube was installed on the field in 35 patients (32%), all after NT. Standard NT has a high failure rate on the battlefield. Alternative measures for chest decompression, such as the Vygon catheter, appear to be a feasible alternative to conventional NT.

  17. Malfunction of a Heimlich flutter valve causing tension pneumothorax: case report of a rare complication

    Directory of Open Access Journals (Sweden)

    Braunstein Volker A

    2010-06-01

    Full Text Available Abstract Background Thoracic injuries play an important role in major trauma patients due to their high incidence and critical relevance. A serious consequence of thoracic trauma is pneumothorax, a condition that quickly can become life-threatening and requires immediate treatment. Decompression is the state of the art for treating tension pneumothorax. There are many different methods of decompression using different techniques, devices, valves and drainage systems. Referring to our case report we would like to discuss the utilization of these devices. Case presentation We report of a patient suffering from tension pneumothorax despite insertion of a chest drain at the accident scene. The decompression was by tube thoracostomy which was connected to a Heimlich flutter valve. During air transportation the patient suffered from cardiorespiratory arrest with asystole and was admitted to the trauma room undergoing manual chest compressions. The initial chest film showed a persisting tension pneumothorax, despite the chest tube that had been correctly placed and connected properly to the Heimlich valve. We assume that the Heimlich valve leaves did not open up and thus tension pneumothorax was not released. Conclusion We would like to raise awareness to the fact that if a Heimlich flutter valve is applied in the pre-hospital setting it should be used with caution. Failure in this type of valve may lead to recurrent tension pneumothorax.

  18. Pneumothorax

    International Nuclear Information System (INIS)

    Kramek, B.A.; Caywood, D.D.

    1987-01-01

    This article reviews the classification, etiopathogenesis, and treatment for the various forms of pneumothorax. Traumatic and nontraumatic pneumothoraces are discussed. New theories on the etiology and treatment of primary spontaneous and secondary pneumothorax are mentioned

  19. Clinical manifestations of tension pneumothorax: protocol for a systematic review and meta-analysis

    Science.gov (United States)

    2014-01-01

    Background Although health care providers utilize classically described signs and symptoms to diagnose tension pneumothorax, available literature sources differ in their descriptions of its clinical manifestations. Moreover, while the clinical manifestations of tension pneumothorax have been suggested to differ among subjects of varying respiratory status, it remains unknown if these differences are supported by clinical evidence. Thus, the primary objective of this study is to systematically describe and contrast the clinical manifestations of tension pneumothorax among patients receiving positive pressure ventilation versus those who are breathing unassisted. Methods/Design We will search electronic bibliographic databases (MEDLINE, PubMed, EMBASE, and the Cochrane Database of Systematic Reviews) and clinical trial registries from their first available date as well as personal files, identified review articles, and included article bibliographies. Two investigators will independently screen identified article titles and abstracts and select observational (cohort, case–control, and cross-sectional) studies and case reports and series that report original data on clinical manifestations of tension pneumothorax. These investigators will also independently assess risk of bias and extract data. Identified data on the clinical manifestations of tension pneumothorax will be stratified according to whether adult or pediatric study patients were receiving positive pressure ventilation or were breathing unassisted, as well as whether the two investigators independently agreed that the clinical condition of the study patient(s) aligned with a previously published tension pneumothorax working definition. These data will then be summarized using a formal narrative synthesis alongside a meta-analysis of observational studies and then case reports and series where possible. Pooled or combined estimates of the occurrence rate of clinical manifestations will be calculated using

  20. PNEUMOTHORAX- DIAGNOSIS AND TREATMENT

    OpenAIRE

    Milisavljević Slobodan; Spasić Marko; Milošević Bojan

    2015-01-01

    Introduction: Pneumothorax is defined as the presence of air in the pleural cavity, ie, the space between the chest wall and the lung itself. Pneumothorax is classified ethiologically into spontaneous pneumothorax and traumatic pneumothorax. Spontaneous pneumothorax is further classified into primary and secondary. Traumatic pneumothorax may result from either blunt trauma or penetrating injury to the chest wall. It can also be caused by iatrogenic injuries. Spontaneous pneumothorax is a sign...

  1. Bilateral tension pneumothorax resulting from a bicycle-to-bicycle collision.

    Science.gov (United States)

    Edwin, Frank; Sereboe, Lawrence; Tettey, Mark Mawutor; Aniteye, Ernest; Bankah, Patrick; Frimpong-Boateng, Kwabena

    2009-01-01

    Bilateral tension pneumothorax occurring as a result of recreational activity is exceedingly rare. A 10-year-old boy with no previous respiratory symptoms was involved in a bicycle-to-bicycle collision during play. He was the only one hurt. A few hours later, he was rushed to the general casualty unit of the emergency department of our institution with respiratory distress, diminished bilateral chest excursions and diminished breath sounds. The correct diagnosis was made after a chest radiograph was obtained in the course of resuscitation at the casualty unit. Pleural space needle decompression was suggestive of tension only on the right. Bilateral tube thoracostomies provided effective relief. He was discharged from hospital after a week in excellent health. This case illustrates the need for children to have safety instruction to reduce the risks of recreational bicycling. Chest radiography may be needed to establish the diagnosis of bilateral tension pneumothorax. Needle thoracostomy decompression is not always effective.

  2. Incarcerated Diaphragmatic Hernia with Bowel Perforation Presenting as a Tension Pneumothorax

    Directory of Open Access Journals (Sweden)

    Ryan P. Offman

    2014-03-01

    Full Text Available We present an interesting case of a patient with a previously known diaphragmatic hernia in which the colon became incarcerated, ischemic and finally perforated. She had no prior history of abdominal pain or vomiting, yet she present with cardiovascular collapse. To our knowledge, this is the only case report of a tension pneumothorax associated with perforated bowel that was not in the setting of trauma or colonoscopy. [West J Emerg Med. 2014;15(2:142-144.

  3. Vented versus unvented chest seals for treatment of pneumothorax and prevention of tension pneumothorax in a swine model.

    Science.gov (United States)

    Kheirabadi, Bijan S; Terrazas, Irasema B; Koller, Alexandra; Allen, Paul B; Klemcke, Harold G; Convertino, Victor A; Dubick, Michael A; Gerhardt, Robert T; Blackbourne, Lorne H

    2013-07-01

    Unvented chest seals (CSs) are currently recommended for the management of penetrating thoracic injuries in the battlefield. Since no supporting data exist, we compared the efficacy of a preferred unvented with that of a vented CS in a novel swine model of pneumothorax (PTx). An open chest wound was created in the left thorax of spontaneously air-breathing anesthetized pigs (n = 8). A CS was applied over the injury, then tension PTx was induced by incremental air injections (0.2 L) into the pleural cavity via a cannula that was also used to measure intrapleural pressure (IP). Both CS were tested on each pig in series. Tidal volume (V(T)), respiratory rate, IP, heart rate, mean arterial pressure, cardiac output, central venous pressure, pulmonary arterial pressure, venous and peripheral oxygen saturations (SvO2, SpO2) were recorded. Tension PTx was defined as a mean IP equal to or greater than +1 mm Hg plus significant (20-30%) deviation in baseline levels of the previously mentioned parameters and confirmed by chest x-ray study. PaO2 and PaCo2 were also measured. PTx produced immediate breathing difficulty and significant rises in IP and pulmonary arterial pressure and falls in V(T), SpO2, and SvO2. Both CSs returned these parameters to near baseline within 5 minutes of application. After vented CS was applied, serial air injections up to 2 L resulted in no significant change in the previously mentioned parameters. After unvented CS application, progressive deterioration of all respiratory parameters and onset of tension PTx were observed in all subjects after approximately 1.4-L air injection. Both vented and unvented CSs provided immediate improvements in breathing and blood oxygenation in our model of penetrating thoracic trauma. However, in the presence of ongoing intrapleural air accumulation, the unvented CS led to tension PTx, hypoxemia, and possible respiratory arrest, while the vented CS prevented these outcomes.

  4. Intraoperative Tension Pneumothorax in a Patient With Remote Trauma and Previous Tracheostomy

    Directory of Open Access Journals (Sweden)

    Ana Mavarez-Martinez MD

    2016-02-01

    Full Text Available Many trauma patients present with a combination of cranial and thoracic injury. Anesthesia for these patients carries the risk of intraoperative hemodynamic instability and respiratory complications during mechanical ventilation. Massive air leakage through a lacerated lung will result in inadequate ventilation and hypoxemia and, if left undiagnosed, may significantly compromise the hemodynamic function and create a life-threatening situation. Even though these complications are more characteristic for the early phase of trauma management, in some cases, such a scenario may develop even months after the initial trauma. We report a case of a 25-year-old patient with remote thoracic trauma, who developed an intraoperative tension pneumothorax and hemodynamic instability while undergoing an elective cranioplasty. The intraoperative patient assessment was made even more challenging by unexpected massive blood loss from the surgical site. Timely recognition and management of intraoperative pneumothorax along with adequate blood replacement stabilized the patient and helped avoid an unfavorable outcome. This case highlights the risks of intraoperative pneumothorax in trauma patients, which may develop even months after injury. A high index of suspicion and timely decompression can be life saving in this type of situation.

  5. Needle thoracostomy in the treatment of a tension pneumothorax in trauma patients: what size needle?

    Science.gov (United States)

    Zengerink, Imme; Brink, Peter R; Laupland, Kevin B; Raber, Earl L; Zygun, Dave; Kortbeek, John B

    2008-01-01

    A tension pneumothorax requires immediate decompression using a needle thoracostomy. According to advanced trauma life support guidelines this procedure is performed in the second intercostal space (ICS) in the midclavicular line (MCL), using a 4.5-cm (2-inch) catheter (5-cm needle). Previous studies have shown a failure rate of up to 40% using this technique. Case reports have suggested that this high failure rate could be because of insufficient length of the needle. To analyze the average chest wall thickness (CWT) at the second ICS in the MCL in a trauma population and to evaluate the length of the needle used in needle thoracostomy for emergency decompression of tension pneumothoraces. Retrospective review of major trauma admissions (Injury Severity Score >12) at the Foothills Medical Centre in Calgary, Canada, who underwent a computed tomography chest scan admitted in the period from October 2001 until March 2004. Subgroup analysis on men and women, /=40 years of age was defined a priori. CWT was measured to the nearest 0.01 cm at the second ICS in the MCL. The mean CWT in the 604 male patients and 170 female patients studied averaged 3.50 cm at the left second ICS MCL and 3.51 cm on the right. The mean CWT was significantly higher for women than men (p 4.5 cm and 24.1% to 35.4% of the women studied. A catheter length of 4.5 cm may not penetrate the chest wall of a substantial amount (9.9%-35.4%) of the population, depending on age and gender. This study demonstrates the need for a variable needle length for relief of a tension pneumothorax in certain population groups to improve effectiveness of needle thoracostomy.

  6. Tension pneumothorax during peroral endoscopic myotomy for treatment of esophageal achalasia under general anesthesia

    Directory of Open Access Journals (Sweden)

    Tsung-Shih Li

    Full Text Available Abstract More and more endoscopically gastrointestinal procedures require anesthesiologists to perform general anesthesia, such as "peroral endoscopic myotomy". Peroral endoscopic myotomy is a novel invasive treatment for the primary motility disorder of esophagus, called esophageal achalasia. Despite of its minimally invasive feature, there are still complications during the procedure which develop to critical conditions and threat patients’ lives. Herein we describe a case about tension pneumothorax subsequent to esophageal rupture during peroral endoscopic myotomy. The emergent management of the complication is stated in detail. The pivotal points of general anesthesia for patients undergoing peroral endoscopic myotomy are emphasized and discussed. Also, intraoperative and post-operative complications mentioned by literature are integrated.

  7. Delayed Tension Pneumothorax - Identification and Treatment in Traumatic Bronchial Injury: An Interesting Presentation.

    Science.gov (United States)

    Gupta, Amit; Rattan, Amulya; Kumar, Sunil; Rathi, Vinita

    2017-09-01

    A 13-year-old girl, who did not receive any treatment for few hours following Road Traffic Injury (RTI), reported to the Casualty Department and found to have patent airway with clinically normal C spine, air-hunger (RR 42/minute), trachea deviated to left, distended neck veins and absent breath sounds on the right side. The chest X-ray she carried, done immediately after the injury, showed right sided tension pneumothorax. She was put on oxygen at 11 L/minute and an Intercostal chest tube drainage (ICD) was inserted on right side. Her oxygen saturation (40%) failed to improve. ICD bag showed continuous bubbling and air entry remained absent on the right side. An urgent right thoracotomy was done which revealed right main bronchus tear; the tear was repaired using interrupted Prolene ® sutures. Patient recovered well and was discharged 10 days later in a stable condition.

  8. A case of radiation-related pneumonia and bilateral tension pneumothorax after extended thymectomy and adjuvant radiation for thymoma with myasthenia gravis

    International Nuclear Information System (INIS)

    Nakasone, Etsuko; Nakayama, Masayuki; Bando, Masashi; Endo, Shunsuke; Hironaka, Mitsugu; Sugiyama, Yukihiko

    2010-01-01

    A 62-year-old man was admitted to our hospital with a 2-month history of progressive cough and dyspnea. He had undergone thymectomy for thymoma with myasthenia gravis. Adjuvant radiation of 50 Gy had been performed until 6 months before the symptoms developed. Chest computed tomography showed infiltrative findings even outside the irradiated area. We diagnosed radiation-related pneumonia, and 30 mg per day prednisolone was initiated. On the final day, he developed bilateral tension pneumothorax. After chest tube drainage, the right S 5 bulla was resected with video-assisted thoracoscopic surgery (VATS). The right pneumothorax caused the bilateral tension pneumothorax, because the right and left thoracic cavity communicated in the anterior mediastinum after thymectomy. We should be aware of the risk of bilateral tension pneumothorax following radiation-related pneumonia after extended thymectomy and adjuvant radiation in patients with myasthenia gravis. (author)

  9. Open Pneumothorax

    Directory of Open Access Journals (Sweden)

    Bart Paull

    2017-07-01

    Full Text Available History of present illness: A 27-year-old male was transported to the emergency department by emergency medical services after crashing his motorcycle into a guardrail. Upon presentation he was alert, normotensive, and tachypneic. Significant findings: A large chest wound was clinically obvious. A chest radiograph performed after intubation showed subcutaneous emphysema, an anterior rib fracture, and a right-sided pneumothorax. He was then taken to the operating room for further management. Discussion: Thoracic injuries are responsible for one-quarter of all trauma-related deaths. Following rib fracture, pneumothorax is the second most common thoracic injury, occurring in 30% of patients with thoracic trauma. An open pneumothorax occurs when a chest wall injury results in direct communication between the atmosphere and pleura.1-2 It is estimated that open pneumothorax occurs in 80% of all penetrating chest wounds, with stab wounds being more common than gunshot wounds or impalement. Open pneumothoraces can lead to ventilatory insufficiency and rapid respiratory decompensation.2 Advanced Trauma Life Support recommends that the initial management of an open pneumothorax is placement of an occlusive dressing taped on three sides to create a ‘flutter-valve’ mechanism. This should then be followed by tube thoracostomy and repair of the chest wall defect.3 The placement of an occlusive dressing or initial wound closure without subsequent tube thoracostomy may result in the development of a tension pneumothorax.2 The patient was intubated and mechanical ventilation was initiated without complication. Due to the large size of the wound, an occlusive dressing was not placed in the emergency department and the patient was rapidly transported to the operating room for further management. In the operating room two chest tubes were placed. Operative findings included a right hemopneumothorax, multiple rib fractures, and a manubrial fracture. After

  10. Iatrogenic stomach perforation complicating unrecognized ...

    African Journals Online (AJOL)

    We report a case of 21-year-old male patient with traumatic diaphragmatic herniation of the stomach that is misdiagnosed as a hemo-pneumothorax with the resulting insertion of a chest tube causing iatrogenic perforation of the stomach and draining of gastric content into the pleural cavity. An emergency thoracotomy was ...

  11. Emergency percutaneous needle decompression for tension pneumoperitoneum

    Directory of Open Access Journals (Sweden)

    Körner Markus

    2011-05-01

    Full Text Available Abstract Background Tension pneumoperitoneum as a complication of iatrogenic bowel perforation during endoscopy is a dramatic condition in which intraperitoneal air under pressure causes hemodynamic and ventilatory compromise. Like tension pneumothorax, urgent intervention is required. Immediate surgical decompression though is not always possible due to the limitations of the preclinical management and sometimes to capacity constraints of medical staff and equipment in the clinic. Methods This is a retrospective analysis of cases of pneumoperitoneum and tension pneumoperitoneum due to iatrogenic bowel perforation. All patients admitted to our surgical department between January 2005 and October 2010 were included. Tension pneumoperitoneum was diagnosed in those patients presenting signs of hemodynamic and ventilatory compromise in addition to abdominal distension. Results Between January 2005 and October 2010 eleven patients with iatrogenic bowel perforation were admitted to our surgical department. The mean time between perforation and admission was 36 ± 14 hrs (range 30 min - 130 hrs, between ER admission and begin of the operation 3 hrs and 15 min ± 47 min (range 60 min - 9 hrs. Three out of eleven patients had clinical signs of tension pneumoperitoneum. In those patients emergency percutaneous needle decompression was performed with a 16G venous catheter. This improved significantly the patients' condition (stabilization of vital signs, reducing jugular vein congestion, bridging the time to the start of the operation. Conclusions Hemodynamical and respiratory compromise in addition to abdominal distension shortly after endoscopy are strongly suggestive of tension pneumoperitoneum due to iatrogenic bowel perforation. This is a rare but life threatening condition and it can be managed in a preclinical and clinical setting with emergency percutaneous needle decompression like tension pneumothorax. Emergency percutaneous decompression is no

  12. Pneumothorax: from definition to diagnosis and treatment

    OpenAIRE

    Zarogoulidis, Paul; Kioumis, Ioannis; Pitsiou, Georgia; Porpodis, Konstantinos; Lampaki, Sofia; Papaiwannou, Antonis; Katsikogiannis, Nikolaos; Zaric, Bojan; Branislav, Perin; Secen, Nevena; Dryllis, Georgios; Machairiotis, Nikolaos; Rapti, Aggeliki; Zarogoulidis, Konstantinos

    2014-01-01

    Pneumothorax is an urgent situation that has to be treated immediately upon diagnosis. Pneumothorax is divided to primary and secondary. A primary pneumothorax is considered the one that occurs without an apparent cause and in the absence of significant lung disease. On the other hand secondary pneumothorax occurs in the presence of existing lung pathology. There is the case where an amount of air in the chest increases markedly and a one-way valve is formed leading to a tension pneumothorax....

  13. Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    John Costumbrado

    2017-09-01

    patients is 4 per 100,000 males and 1.1 per 100,000 females per year.4 Risk factors for primary SP include male gender, tall and thin body habitus, and smoking.5 Considering this patient, asthma is a risk factor and morbidity and mortality can be increased when associated with SP; however, this is based primarily on case reports and further investigation is warranted.6 The diagnosis can be made clinically and confirmed with upright chest radiograph (sensitivity 50%, specificity 99%; however, studies suggest that ultrasound (sensitivity 91%, specificity 98% may be superior in its ability to rule out SP.7 Patients with SP of any size and significant symptoms should undergo needle aspiration or chest drain placement, especially since tension pneumothorax is a potential complication of SP; however, some guidelines suggest that observation for small, primary SP without significant symptoms is acceptable.1,4 While there are recommendations to treat large pneumothoraces (>15% of the hemithorax with a pigtail catheter (less than or equal to 14 French or chest tube, there is some evidence that pigtail catheters perform just as well as large-bore chest tubes (20-28 French in SP and may be associated with less pain.1,8 Even with proper management, patients should be counseled regarding the relatively high recurrence rate (16-52%.3

  14. Pneumothorax (image)

    Science.gov (United States)

    ... pleura and the lungs is usually very thin. Pneumothorax is the collection of air or gas in ... a lung collapse. The most common cause of pneumothorax is a breathing machine (mechanical ventilator).

  15. [Emergency Surgery and Treatments for Pneumothorax].

    Science.gov (United States)

    Kurihara, Masatoshi

    2015-07-01

    The primary care in terms of emergency for pneumothorax is chest drainage in almost cases. The following cases of pneumothorax and the complications need something of surgery and treatments. Pneumothorax with subcutaneous emphysema often needs small skin incisions around the drainage tube. Tension pneumothorax often needs urgent chest drainage. Pneumothorax with intractable air leakage often needs interventional treatments like endobroncheal occlusion (EBO) or thoracographic fibrin glue sealing method (TGF) as well as urgent thoracoscopic surgery. Pneumothorax with acute empyema also often needs urgent thoracoscopic surgery within 2 weeks if chest drainage or drug therapy are unsuccessful. It will probably become chronic empyema of thorax after then. Pneumothorax with bleeding needs urgent thoracoscopic surgery in case of continuous bleeding over 200 ml/2 hours. In any cases of emergency for pneumothorax, respiratory physicians should collaborate with respiratory surgeons at the 1st stage because it is important to timely judge conversion of surgical treatments from medical treatments.

  16. Pneumothorax in human immunodeficiency virus infection

    Directory of Open Access Journals (Sweden)

    Sibes Kumar Das

    2015-01-01

    Full Text Available Pneumothorax occurs more frequently in people with Human immunodeficiency virus infection in comparison with the general population. In most cases it is secondary the underlying pulmonary disorder, especially pulmonary infections. Though Pneumocystis jiroveci pneumonia is most common pulmonary infection associated with pneumothorax, other infections, non-infective etiology and iatrogenic causes are also encountered. Pneumothorax in these patients are associated with persistent bronchopleural fistula, prolonged hospital stay, poor success with intercostal tube drain, frequent requirement of surgical intervention and increased mortality. Optimal therapeutic approach in these patients is still not well-defined.

  17. Relative device stability of anterior versus axillary needle decompression for tension pneumothorax during casualty movement: Preliminary analysis of a human cadaver model.

    Science.gov (United States)

    Leatherman, Matthew L; Held, Jenny M; Fluke, Laura M; McEvoy, Christian S; Inaba, Kenji; Grabo, Daniel; Martin, Matthew J; Earley, Angela S; Ricca, Robert L; Polk, Travis M

    2017-07-01

    Tension pneumothorax (tPTX) remains a significant cause of potentially preventable death in military and civilian settings. The current prehospital standard of care for tPTX is immediate decompression with a 14-gauge 8-cm angiocatheter; however, failure rates may be as high as 17% to 60%. Alternative devices, such as 10-gauge angiocatheter, modified Veress needle, and laparoscopic trocar, have shown to be potentially more effective in animal models; however, little is known about the relative insertional safety or mechanical stability during casualty movement. Seven soft-embalmed cadavers were intubated and mechanically ventilated. Chest wall thickness was measured at the second intercostal space at the midclavicular line (2MCL) and the fifth intercostal space along the anterior axillary line (5AAL). CO2 insufflation created a PTX, and needle decompression was then performed with a randomized device. Insertional depth was measured between hub and skin before and after simulated casualty transport. Thoracoscopy was used to evaluate for intrapleural placement and/or injury during insertion and after movement. Cadaver demographics, device displacement, device dislodgment, and injuries were recorded. Three decompressions were performed at each site (2MCL/5AAL), totaling 12 events per cadaver. Eighty-four decompressions were performed. Average cadaver age was 59 years, and body mass index was 24 kg/m. The CWT varied between cadavers because of subcutaneous emphysema, but the average was 39 mm at the 2MCL and 31 mm at the 5AAL. Following movement, the 2MCL site was more likely to become dislodged than the 5AAL (67% vs. 17%, p = 0.001). Median displacement also differed between 2MCL and 5AAL (23 vs. 2 mm, p = 0.001). No significant differences were noted in dislodgement or displacement between devices. Five minor lung injuries were noted at the 5AAL position. Preliminary results from this human cadaver study suggest the 5AAL position is a more stable and reliable location

  18. Management of Pneumothorax in Emergency Medicine Departments: Multicenter Trial

    Science.gov (United States)

    Ince, Abdulkadir; Ozucelik, Dogac Niyazi; Avci, Akkan; Nizam, Ozgur; Dogan, Halil; Topal, Mehmet Ali

    2013-01-01

    Background: Pneumothorax is common and life-threatening clinical condition which may require emergency treatment in Emergency Medicine Departments. Objectives: We aimed to reveal the epidemiological analysis of the patients admitted to the Emergency Department with pneumothorax. Material and Methods: This case-control and multi-center study was conducted in the patients treated with the diagnosis of pneumothorax between 01.01.2010-31.12.2010. Patient data were collected from hospital automation system. According to the etiology of the pneumothorax, study groups were arranged like spontaneous pneumothorax and traumatic pneumothorax. Results: 82.2% (n = 106) of patients were male and 17.8% (n = 23) of patients were female and mean age were 31.3 ± 20,2 (Minimum: 1, Maximum: 87). 68.2% (n = 88) of patients were spontaneous pneumothorax (61.36%, n=79 were primary spontaneous pneumothorax) and 31.8% (n = 41) of patients were traumatic pneumothorax (21.95% were iatrogenic pneumothorax). Main complaint is shortness of breath (52.3%, n=67) and 38% (n=49) of patients were smokers. Posteroanterior (PA) Chest X-Ray has been enough for 64.3% (n = 83) of the patients' diagnosis. Tube thoracostomy is applied to 84.5% (n = 109) of patients and surgery is applied to 9.3% (n = 12) of patients and 6.2% (n = 8) of patients were discharged with conservative treatment. Spontaneous pneumothorax showed statistically significant high recurrence compared with traumatic pneumothorax (P = 0.007). 4.65% of (n = 6) patients died. The average age of those who died (9.3 ± 19.9), statistically were significantly lower the mean age of living patients (32.4 ± 19.7) (t test, P = 0,006). 83.33% of the patients who died were neonatals and in the 0-1 years age group, and five of these patients were secondary spontaneous pneumothorax, and one of these patients were iatrogenic pneumothorax due to mechanical ventilation. Conclusions: Pneumothorax in adults can be treated by tube thoracostomy or

  19. Pneumothorax in intensive-care patients: Ranking of tangential views

    International Nuclear Information System (INIS)

    Jantsch, H.; Winkler, M.; Pichler, W.; Mauritz, W.; Lechner, G.; Vienna Univ.

    1990-01-01

    In 55 intensive-care patients an additional tangential view of the chest was taken to demonstrate or exclude a pneumothorax in patients with sudden deterioration of gas exchange and negative ap-chest x-ray, if there was a suspicion of pneumothorax or a confirmed small pneumothorax in the ap-view. In 14 of 42 cases (33.3%) with negative or suspected ap-chest x-ray the tangential view revealed a pneumothorax. 6 of these 14 pneumothoraces were under tension. In 7 out of 11 patients (63.6%) with small pneumothorax, the tangential view showed additionally a tensionpneumothorax. (orig.) [de

  20. Protective pneumothorax in CT monitored mediastinal puncture

    International Nuclear Information System (INIS)

    Wein, B.B.; Dickgreber, N.J.; Guenther, R.W.

    1997-01-01

    Purpose: To achieve an extrapulmonary pathway for biopsy of mediastinal masses. Methods: In 6 patients a protective, temporary pneumothorax was established before performing large-bore needle biopsies of mediastinal masses using a Verres-needle. Results: Transpleural, extrapulmonary access was easy to achieve. One patient developed a tension pneumothorax after biopsy which was drained by percutaneous small chest tube. Another patient showed mediastinal tumour bleeding through the biopsy needle. As a prophylactic measure the bleeding was stopped by injection of tissue glue through the biopsy needle. Conclusion: The use of protective pneumothorax allows cutting needle biopsies of mediastinal masses where aspiration cytology yields no secure specific diagnosis. (orig.) [de

  1. Pneumothorax: from definition to diagnosis and treatment.

    Science.gov (United States)

    Zarogoulidis, Paul; Kioumis, Ioannis; Pitsiou, Georgia; Porpodis, Konstantinos; Lampaki, Sofia; Papaiwannou, Antonis; Katsikogiannis, Nikolaos; Zaric, Bojan; Branislav, Perin; Secen, Nevena; Dryllis, Georgios; Machairiotis, Nikolaos; Rapti, Aggeliki; Zarogoulidis, Konstantinos

    2014-10-01

    Pneumothorax is an urgent situation that has to be treated immediately upon diagnosis. Pneumothorax is divided to primary and secondary. A primary pneumothorax is considered the one that occurs without an apparent cause and in the absence of significant lung disease. On the other hand secondary pneumothorax occurs in the presence of existing lung pathology. There is the case where an amount of air in the chest increases markedly and a one-way valve is formed leading to a tension pneumothorax. Unless reversed by effective treatment, this situation can progress and cause death. Pneumothorax can be caused by physical trauma to the chest or as a complication of medical or surgical intervention (biopsy). Symptoms typically include chest pain and shortness of breath. Diagnosis of a pneumothorax requires a chest X-ray or computed tomography (CT) scan. Small spontaneous pneumothoraces typically resolve without treatment and require only monitoring. In our current special issue we will present the definition, diagnosis and treatment of pneumothorax from different experts in the field, different countries and present different methods of treatment.

  2. Spontaneous tension haemopneumothorax

    OpenAIRE

    Patterson, Benjamin Oliver; Itam, Sarah; Probst, Fey

    2008-01-01

    Abstract We present a patient with sudden onset progressive shortness of breath and no history of trauma, who rapidly became haemodynamically compromised with a pneumothorax and pleural effusion seen on chest radiograph. He was treated for spontaneous tension pneumothorax but this was soon revealed to be a tension haemopneumothorax. He underwent urgent thoracotomy after persistent bleeding to explore an apical vascular abnormality seen on CT scanning. To our knowledge this is the first such c...

  3. High negative pressure subcutaneous suction drain for managing debilitating subcutaneous emphysema secondary to tube thoracostomy for an iatrogenic post computed tomography guided transthoracic needle biopsy pneumothorax: Case report and review of literature.

    Science.gov (United States)

    Ahmed, Zeeshan; Patel, Pinakin; Singh, Suresh; Sharma, Raj Govind; Somani, Pankaj; Gouri, Abdul Rauf; Singh, Shiv

    2016-01-01

    Subcutaneous emphysema is a common complication of tube thoracostomy. Though self-limiting, it should be treated when it causes palpebral closure, dyspnea, dysphagia or undue disfigurement resulting in anxiety and distress to the patient. A 72year old man who was a known case of COPD on bronchodilators developed a large pneumothorax and respiratory distress after a CT guided transthoracic lung biopsy done for a lung opacity (approx. 3×3cm) at the right hilar region on Chest X-ray. Within 24h of an urgent tube thoracostomy, patient developed intractable subcutaneous emphysema with closure of palpebral fissure and dyspnea unresponsive to increasing suction on chest tube. A subcutaneous fenestrated drain was placed mid-way between the nipple and clavicle in the mid-clavicular line bilaterally. Continuous negative suction (-150mmHg) resulted in immediate, sustained relief and complete resolution within 5days. Extensive and debilitating SE (subcutaneous emphysema) has to be treated promptly to relieve patient discomfort, dysphagia or imminent respiratory compromise. A variety of treatment have been tried including infraclavicular blow-hole incisions, subcutaneous drains +/- negative pressure suction, fenestrated angiocatheters, Vacuum assisted dressings and increasing suction on a pre-existing chest tube. We describe a high negative pressure subcutaneous suction drain which provides immediate and sustained relief in debilitating SE. Debilitating subcutaneous emphysema which causes distress, anxiety, palpebral closure, dyspnoea or dysphagia requires intervention. High negative pressure subcutaneous suction drain provides immediate and sustained relief in extensive and debilitating SE. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Catamenial pneumothorax

    Science.gov (United States)

    Visouli, Aikaterini N.; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Huang, Haidong; Li, Qiang; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Papaiwannou, Antonis; Lampaki, Sofia; Zaric, Bojan; Branislav, Perin; Porpodis, Konstantinos

    2014-01-01

    Catamenial pneumothorax (CP) is the most common form of thoracic endometriosis syndrome, which also includes catamenial hemothorax, catamenial hemoptysis, catamenial hemopneumothorax and endometriosis lung nodules, as well as some exceptional presentations. Usually onset of lung collapse is less than 72 hours after menstruation. Most commonly occurs in women aged 30-40 years, but has been diagnosed in young girls as early as 10 years of age and post menopausal women (exclusively in women of menstrual age) most with a history of pelvic endometriosis. Diagnosis can be hinted by high recurrence rates of lung collapse in a woman of reproductive age with endometriosis. Moreover; CA-125 is elevated. Video-assisted thoracoscopy or medical thoracoscopy is used for confirmation. In our current work we will present all aspects of CP from diagnosis to treatment. PMID:25337402

  5. Radiation-induced pneumothorax

    International Nuclear Information System (INIS)

    Epstein, D.M.; Littman, P.; Gefter, W.B.; Miller, W.T.; Raney, R.B. Jr.

    1983-01-01

    Pneumothorax is an uncommon complication of radiation therapy to the chest. The proposed pathogenesis is radiation-induced fibrosis promoting subpleural bleb formation that ruptures resulting in pneumothorax. We report on two young patients with primary sarcomas without pulmonary metastases who developed spontaneous pneumothorax after irradiation. Neither patient had antecedent radiographic evidence of pulmonary fibrosis

  6. Fluoroscopy guided percutaneous catheter drainage of pneumothorax in good mid-term patency with tube drainage

    International Nuclear Information System (INIS)

    Park, Ga Young; Oh, Joo Hyung; Yoon, Yup; Sung, Dong Wook

    1995-01-01

    To evaluate efficacy and the safety of percutaneous catheter drainage in patients with pneumothorax that is difficult to treat with closed thoracotomy. We retrospectively reviewed effectiveness of percutaneous catheter drainage (PCD) in 10 patients with pneumothorax. The catheter was inserted under fluoroscopic guidance. Seven patients had spontaneous pneumothorax caused by tuberculosis (n =4), reptured bullae (n = 2), and histiocytosis-X (n = 1). Three patients had iatrogenic pneumothorax caused by trauma (n = 1) and surgery (n = 2). All procedures were performed by modified Seldinger's method by using 8F-20F catheter. All catheter were inserted successfully. In 9 of 10 patients, the procedure was curative without further therapy. Duration of catheter insertion ranged from 1 day to 26 days. In the remaining 1 patient in whom multiple pneumothorax occurred after operation, catheter insertion was performed twice. Percutaneous catheter drainage under fluoroscopic guidance is effective and safe procedure for treatment of pneumothorax in patients with failed closed thoracotomy

  7. Fluoroscopy guided percutaneous catheter drainage of pneumothorax in good mid-term patency with tube drainage

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ga Young; Oh, Joo Hyung; Yoon, Yup; Sung, Dong Wook [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1995-10-15

    To evaluate efficacy and the safety of percutaneous catheter drainage in patients with pneumothorax that is difficult to treat with closed thoracotomy. We retrospectively reviewed effectiveness of percutaneous catheter drainage (PCD) in 10 patients with pneumothorax. The catheter was inserted under fluoroscopic guidance. Seven patients had spontaneous pneumothorax caused by tuberculosis (n =4), reptured bullae (n = 2), and histiocytosis-X (n = 1). Three patients had iatrogenic pneumothorax caused by trauma (n = 1) and surgery (n = 2). All procedures were performed by modified Seldinger's method by using 8F-20F catheter. All catheter were inserted successfully. In 9 of 10 patients, the procedure was curative without further therapy. Duration of catheter insertion ranged from 1 day to 26 days. In the remaining 1 patient in whom multiple pneumothorax occurred after operation, catheter insertion was performed twice. Percutaneous catheter drainage under fluoroscopic guidance is effective and safe procedure for treatment of pneumothorax in patients with failed closed thoracotomy.

  8. Subinterlobular Pleural Location Is a Risk Factor for Pneumothorax After Bronchoscopy.

    Science.gov (United States)

    Chino, Haruka; Iikura, Motoyasu; Saito, Nayuta; Sato, Nahoko; Suzuki, Manabu; Ishii, Satoru; Morino, Eriko; Naka, Go; Takasaki, Jin; Izumi, Shinyu; Hojo, Masayuki; Takeda, Yuichiro; Sugiyama, Haruhito

    2016-12-01

    Pneumothorax is one of the most important complications after bronchoscopy. This study was conducted to determine the risk factors for post-bronchoscopy pneumothorax. We retrospectively reviewed the medical records of 23 consecutive subjects who were diagnosed with iatrogenic pneumothorax after bronchoscopy between August 2010 and February 2014. Forty-six control subjects who did not develop pneumothorax after bronchoscopy were randomly selected. The factors affecting the occurrence of pneumothorax were determined by univariate and multivariate analyses. Among 991 patients who underwent bronchoscopy during the study period, 23 (2.3%) developed pneumothorax after bronchoscopy. Among these 23 subjects, 13 (57%) required chest tube drainage. Compared with the control group (46 randomly selected from 968 subjects who did not develop pneumothorax), the group that developed pneumothorax had a preponderance of women and had more target lesions located in the subpleural area (odds ratio [OR] 7.8, 95% CI 0.9-64), especially those that were close to the interlobular pleura (OR 5.1, 95% CI 1.6-16.1) and the left lung (OR 3.2, 95% CI 1.1-9.5). Multivariate analysis revealed that a subinterlobular pleural location of a lesion was a risk factor for pneumothorax (OR 4.8, 95% CI 1.1-20.4). Pneumothorax occurred significantly more frequently when bronchoscopy was performed for subinterlobular pleural lesions. Close attention and care should be taken during bronchoscopy, especially when target lesions are abutting the interlobular pleura. Copyright © 2016 by Daedalus Enterprises.

  9. Unusual causes of pneumothorax

    Science.gov (United States)

    Ouellette, Daniel R.; Parrish, Scott; Browning, Robert F.; Turner, J. Francis; Zarogoulidis, Konstantinos; Kougioumtzi, Ioanna; Dryllis, Georgios; Kioumis, Ioannis; Pitsiou, Georgia; Machairiotis, Nikolaos; Katsikogiannis, Nikolaos; Tsiouda, Theodora; Madesis, Athanasios; Karaiskos, Theodoros

    2014-01-01

    Pneumothorax is divided to primary and secondary. It is a situation that requires immediate treatment, otherwise it could have severe health consequences. Pneumothorax can be treated either by thoracic surgeons, or pulmonary physicians. In our current work, we will focus on unusual cases of pneumothorax. We will provide the etiology and treatment for each case, also a discussion will be made for each situation. PMID:25337394

  10. Catamenial pneumothorax - case report

    International Nuclear Information System (INIS)

    Hasara, R.; Kudelkova, J.; Pestal, A.; Jedlicka, V.; Capov, I.; Reismullerova, L.

    2014-01-01

    Catamenial pneumothorax is a rare type of spontaneous pneumothorax, developed in women in reproductive age due to the presence of thoracic endometriosis. Medical history is the key to the correct diagnosis. Treatment combines methods of thoracic surgery, together with hormonal substitution therapy and, in rare cases, also gynecological operation. We present the case report of young woman with spontaneous pneumothorax due to thoracic endometriosis. (author)

  11. Occult pneumothorax, revisited

    OpenAIRE

    Mangar Devanand; Abdelmalak Hany; Omar Hesham R; Rashad Rania; Helal Engy; Camporesi Enrico M

    2010-01-01

    Abstract Pneumothorax is a recognized cause of preventable death following chest wall trauma where a simple intervention can be life saving. In cases of trauma patients where cervical spine immobilization is mandatory, supine AP chest radiograph is the most practical initial study. It is however not as sensitive as CT chest for early detection of a pneumothorax. "Occult" pneumothorax is an accepted definition of an existing but usually a clinically and radiologically silent disturbance that i...

  12. Spontaneous tension haemopneumothorax.

    Science.gov (United States)

    Patterson, Benjamin Oliver; Itam, Sarah; Probst, Fey

    2008-10-31

    We present a patient with sudden onset progressive shortness of breath and no history of trauma, who rapidly became haemodynamically compromised with a pneumothorax and pleural effusion seen on chest radiograph. He was treated for spontaneous tension pneumothorax but this was soon revealed to be a tension haemopneumothorax. He underwent urgent thoracotomy after persistent bleeding to explore an apical vascular abnormality seen on CT scanning. To our knowledge this is the first such case reported.Aetiology and current approach to spontaneous haemothorax are discussed briefly.

  13. Spontaneous tension haemopneumothorax

    Directory of Open Access Journals (Sweden)

    Itam Sarah

    2008-10-01

    Full Text Available Abstract We present a patient with sudden onset progressive shortness of breath and no history of trauma, who rapidly became haemodynamically compromised with a pneumothorax and pleural effusion seen on chest radiograph. He was treated for spontaneous tension pneumothorax but this was soon revealed to be a tension haemopneumothorax. He underwent urgent thoracotomy after persistent bleeding to explore an apical vascular abnormality seen on CT scanning. To our knowledge this is the first such case reported. Aetiology and current approach to spontaneous haemothorax are discussed briefly.

  14. Deadly pressure pneumothorax after withdrawal of misplaced feeding tube

    DEFF Research Database (Denmark)

    Andresen, Erik Nygaard; Frydland, Martin; Usinger, Lotte

    2016-01-01

    BACKGROUND: Many patients have a nasogastric feeding tube inserted during admission; however, misplacement is not uncommon. In this case report we present, to the best of our knowledge, the first documented fatality from pressure pneumothorax following nasogastric tube withdrawal. CASE PRESENTATION......, but our patient died less than an hour after withdrawal. The autopsy report stated that cause of death was tension pneumothorax, which developed following withdrawal of the misplaced feeding tube. CONCLUSIONS: The indications for insertion of nasogastric feeding tubes are many and the procedure...... is considered harmless; however, if the tube is misplaced there is good reason to be cautious on removal as this can unmask puncture of the pleura eliciting pneumothorax and, as this case report shows, result in an ultimately deadly tension pneumothorax....

  15. Delayed Development of Pneumothorax After Pulmonary Radiofrequency Ablation

    International Nuclear Information System (INIS)

    Clasen, Stephan; Kettenbach, Joachim; Kosan, Bora; Aebert, Hermann; Schernthaner, Melanie; Kroeber, Stefan-Martin; Boemches, Andrea; Claussen, Claus D.; Pereira, Philippe L.

    2009-01-01

    Acute pneumothorax is a frequent complication after percutaneous pulmonary radiofrequency (RF) ablation. In this study we present three cases showing delayed development of pneumothorax after pulmonary RF ablation in 34 patients. Our purpose is to draw attention to this delayed complication and to propose a possible approach to avoid this major complication. These three cases occurred subsequent to 44 CT-guided pulmonary RF ablation procedures (6.8%) using either internally cooled or multitined expandable RF electrodes. In two patients, the pneumothorax, being initially absent at the end of the intervention, developed without symptoms. One of these patients required chest drain placement 32 h after RF ablation, and in the second patient therapy remained conservative. In the third patient, a slight pneumothorax at the end of the intervention gradually increased and led into tension pneumothorax 5 days after ablation procedure. Underlying bronchopleural fistula along the coagulated former electrode track was diagnosed in two patients. In conclusion, delayed development of pneumothorax after pulmonary RF ablation can occur and is probably due to underlying bronchopleural fistula, potentially leading to tension pneumothorax. Patients and interventionalists should be prepared for delayed onset of this complication, and extensive track ablation following pulmonary RF ablation should be avoided.

  16. CT detection of occult pneumothorax in head trauma

    International Nuclear Information System (INIS)

    Tocino, I.M.; Miller, M.H.; Frederick, P.R.; Bahr, A.L.; Thomas, F.

    1984-01-01

    A prospective evaluation for occult pneumothorax was performed in 25 consecutive patients with serious head trauma by combining a limited chest CT examination with the emergency head CT examination. Of 21 pneuomothoraces present in 15 patients, 11 (52%) were found only by chest CT and were not identified clinically or by supine chest radiograph. Because of pending therapeutic measures, chest tubes were placed in nine of the 11 occult pneumothoraces, regardless of the volume. Chest CT proved itself as the most sensitive method for detection of occult pneumothorax, permitting early chest tube placement to prevent transition to a tension pneumothorax during subsequent mechanical ventilation or emergency surgery under general anesthesia

  17. CT detection of occult pneumothorax in head trauma

    Energy Technology Data Exchange (ETDEWEB)

    Tocino, I.M.; Miller, M.H.; Frederick, P.R.; Bahr, A.L.; Thomas, F.

    1984-11-01

    A prospective evaluation for occult pneumothorax was performed in 25 consecutive patients with serious head trauma by combining a limited chest CT examination with the emergency head CT examination. Of 21 pneuomothoraces present in 15 patients, 11 (52%) were found only by chest CT and were not identified clinically or by supine chest radiograph. Because of pending therapeutic measures, chest tubes were placed in nine of the 11 occult pneumothoraces, regardless of the volume. Chest CT proved itself as the most sensitive method for detection of occult pneumothorax, permitting early chest tube placement to prevent transition to a tension pneumothorax during subsequent mechanical ventilation or emergency surgery under general anesthesia.

  18. Pneumoretroperitoneum and Perirenal Air Associated With Pneumothorax in an Extremely Low-Birth-Weight Infant

    Directory of Open Access Journals (Sweden)

    Belma Saygili Karagol

    2011-02-01

    Full Text Available Pneumothorax-associated pneumoretroperitoneum and perirenal air have rarely been reported in infants. We report a case of an extremely low-birth-weight infant who developed pneumoretroperitoneum and perirenal air associated with tension pneumothorax and deteriorated acutely despite prompt pleural water-seal vacuum drainage system insertion. Our aim in presenting this case report is to emphasize keeping in mind that there could be extrapleural air leaks, such as pneumoretroperitoneum in patients with pneumothorax.

  19. Silicosis with bilateral spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Fotedar Sanjay

    2010-01-01

    Full Text Available Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax.The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature.

  20. Acoustic detection of pneumothorax

    Science.gov (United States)

    Mansy, Hansen A.; Royston, Thomas J.; Balk, Robert A.; Sandler, Richard H.

    2003-04-01

    This study aims at investigating the feasibility of using low-frequency (pneumothorax detection were tested in dogs. In the first approach, broadband acoustic signals were introduced into the trachea during end-expiration and transmitted waves were measured at the chest surface. Pneumothorax was found to consistently decrease pulmonary acoustic transmission in the 200-1200-Hz frequency band, while less change was observed at lower frequencies (ppneumothorax states (pPneumothorax was found to be associated with a preferential reduction of sound amplitude in the 200- to 700-Hz range, and a decrease of sound amplitude variation (in the 300 to 600-Hz band) during the respiration cycle (pPneumothorax changed the frequency and decay rate of percussive sounds. These results imply that certain medical conditions may be reliably detected using appropriate acoustic measurements and analysis. [Work supported by NIH/NHLBI #R44HL61108.

  1. Sonographic diagnosis of pneumothorax

    Directory of Open Access Journals (Sweden)

    Lubna F Husain

    2012-01-01

    Full Text Available Lung sonography has rapidly emerged as a reliable technique in the evaluation of various thoracic diseases. One important, well-established application is the diagnosis of a pneumothorax. Prompt and accurate diagnosis of a pneumothorax in the management of a critical patient can prevent the progression into a life-threatening situation. Sonographic signs, including ′lung sliding′, ′B-lines′ or ′comet tail artifacts′, ′A-lines′, and ′the lung point sign′ can help in the diagnosis of a pneumothorax. Ultrasound has a higher sensitivity than the traditional upright anteroposterior chest radiography (CXR for the detection of a pneumothorax. Small occult pneumothoraces may be missed on CXR during a busy trauma scenario, and CXR may not always be feasible in critically ill patients. Computed tomography, the gold standard for the detection of pneumothorax, requires patients to be transported out of the clinical area, compromising their hemodynamic stability and delaying the diagnosis. As ultrasound machines have become more portable and easier to use, lung sonography now allows a rapid evaluation of an unstable patient, at the bedside. These advantages combined with the low cost and ease of use, have allowed thoracic sonography to become a useful modality in many clinical settings.

  2. Management of Open Pneumothorax in Tactical Combat Casualty Care: TCCC Guidelines Change 13-02.

    Science.gov (United States)

    Butler, Frank K; Dubose, Joseph J; Otten, Edward J; Bennett, Donald R; Gerhardt, Robert T; Kheirabadi, Bijan S; Gross, Kriby R; Cap, Andrew P; Littlejohn, Lanny F; Edgar, Erin P; Shackelford, Stacy A; Blackbourne, Lorne H; Kotwal, Russ S; Holcomb, John B; Bailey, Jeffrey A

    2013-01-01

    During the recent United States Central Command (USCENTCOM) and Joint Trauma System (JTS) assessment of prehospital trauma care in Afghanistan, the deployed director of the Joint Theater Trauma System (JTTS), CAPT Donald R. Bennett, questioned why TCCC recommends treating a nonlethal injury (open pneumothorax) with an intervention (a nonvented chest seal) that could produce a lethal condition (tension pneumothorax). New research from the U.S. Army Institute of Surgical Research (USAISR) has found that, in a model of open pneumothorax treated with a chest seal in which increments of air were added to the pleural space to simulate an air leak from an injured lung, use of a vented chest seal prevented the subsequent development of a tension pneumothorax, whereas use of a nonvented chest seal did not. The updated TCCC Guideline for the battlefield management of open pneumothorax is: ?All open and/ or sucking chest wounds should be treated by immediately applying a vented chest seal to cover the defect. If a vente chest seal is not available, use a non-vented chest seal. Monitor the casualty for the potential development of a subsequent tension pneumothorax. If the casualty develops increasing hypoxia, respiratory distress, or hypotension and a tension pneumothorax is suspected, treat by burping or removing the dressing or by needle decompression.? This recommendation was approved by the required two-thirds majority of the Committee on TCCC in June 2013. 2013.

  3. Iatrogenic psoas abscess. Case report

    DEFF Research Database (Denmark)

    Bernstein, Inge Thomsen; Hansen, B J

    1991-01-01

    A case of iatrogenic pneumococcus psoas abscess is reported. The etiology was probably repeated local anaesthetic blockades in the lumbogluteal structures because of lumbago.......A case of iatrogenic pneumococcus psoas abscess is reported. The etiology was probably repeated local anaesthetic blockades in the lumbogluteal structures because of lumbago....

  4. [Diagnostic ultrasound in pneumothorax].

    Science.gov (United States)

    Maury, É; Pichereau, C; Bourcier, S; Galbois, A; Lejour, G; Baudel, J-L; Ait-Oufella, H; Guidet, B

    2016-10-01

    For a long time the lung has been regarded as inaccessible to ultrasound. However, recent clinical studies have shown that this organ can be examined by this technique, which appears, in some situations, to be superior to thoracic radiography. The examination does not require special equipment and is possible using a combination of simple qualitative signs: lung sliding, the presence of B lines and the demonstration of the lung point. The lung sliding corresponds to the artefact produced by the movement of the two pleural layers, one against the other. The B lines indicate the presence of an interstitial syndrome. The presence of lung sliding and/or B lines has a negative predictive value of 100% and formally excludes a pneumothorax in the area where the probe has been applied. The presence of the lung point is pathognomonic of pneumothorax but the sensitivity is no more than 60%. Ultrasound is therefore a rapid and simple means of excluding a pneumothorax (lung sliding or B lines) and of confirming a pneumothorax when the lung point is visible. The question that remains is whether ultrasound can totally replace radiography in the management of this disorder. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  5. Pneumothorax and idiopathic pulmonary fibrosis

    International Nuclear Information System (INIS)

    Iwasawa, Tae; Ogura, Takashi; Takahashi, Hiroshi; Asakura, Akira; Gotoh, Toshiyuki; Yazawa, Takuya; Inoue, Tomio

    2010-01-01

    We evaluated the relation between the severity of idiopathic pulmonary fibrosis (IPF) and the incidence of pneumothorax on computed tomography (CT) images. In this retrospective study, we evaluated the presence of pneumothorax in 56 consecutive patients who died of IPF from the initial CT to death. We quantitatively analyzed a total of 207 CT images and measured the volume of the normal pattern (N-pattern) and each lesion pattern on the initial CT and their serial changes. The effects of pneumothorax and clinical and CT features on survival were evaluated using Cox regression analysis. Pneumothorax occurred in 17 of 56 patients. Comparison of the pneumothorax (+) and (-) groups showed the initial vital capacity (VC) was lower (P=0.005) and the follow-up period was shorter (P=0.03) in the former group. The decrease in the N-pattern volume in the pneumothorax (+) group was significantly faster than in the pneumothorax (-) group (P=0.013). Cox regression analyses identified a rapid decrease in N-pattern volume (P=0.008) and a rapid decrease in VC (P=0.002), but not pneumothorax, as significant predictors of poor survival. Pneumothorax in IPF patients is associated with lower VC and rapid deterioration of CT findings. The findings suggest that pneumothorax is a complication of advanced IPF. (author)

  6. Genetics Home Reference: primary spontaneous pneumothorax

    Science.gov (United States)

    ... Home Health Conditions Primary spontaneous pneumothorax Primary spontaneous pneumothorax Printable PDF Open All Close All Enable Javascript ... view the expand/collapse boxes. Description Primary spontaneous pneumothorax is an abnormal accumulation of air in the ...

  7. Pneumothorax in cardiac pacing

    DEFF Research Database (Denmark)

    Kirkfeldt, Rikke Esberg; Johansen, Jens Brock; Nohr, Ellen Aagaard

    2012-01-01

    AIM: To identify risk factors for pneumothorax treated with a chest tube after cardiac pacing device implantation in a population-based cohort.METHODS AND RESULTS: A nationwide cohort study was performed based on data on 28 860 patients from the Danish Pacemaker Register, which included all Danish...... age was 77 years (25th and 75th percentile: 69-84) and 55% were male (n = 15 785). A total of 190 patients (0.66%) were treated for pneumothorax, which was more often in women [aOR 1.9 (1.4-2.6)], and in patients with age >80 years [aOR 1.4 (1.0-1.9)], a prior history of chronic obstructive pulmonary...

  8. Pneumothorax in severe thoracic traumas

    International Nuclear Information System (INIS)

    Camassa, N.W.; Boccuzzi, F.; Diettorre, E.; Troilo, A.

    1988-01-01

    The authors reviewed CT scans and supine chest X-ray of 47 patients affected by severe thoracic trauma, examined in 1985-86. The sensibility of the two methodologies in the assessment of pneumothorax was compared. CT detected 25 pneumothorax, whereas supine chest X-ray allowed a diagnosis in 18 cases only. In 8 of the latter (44.4%) the diagnosis was made possible by the presence of indirect signs of pneumothorax only - the most frequent being the deep sulcus sign. The characterization of pneumothorax is important especially in the patients who need to be treated with mechanical ventilation therapy, or who are to undergo surgery in total anaesthesia

  9. [Results of conservative treatment in patients with occult pneumothorax].

    Science.gov (United States)

    Llaquet Bayo, Heura; Montmany Vioque, Sandra; Rebasa, Pere; Navarro Soto, Salvador

    2016-04-01

    An occult pneumothorax is found in 2-15% trauma patients. Observation (without tube thoracostomy) in these patients presents still some controversies in the clinical practice. The objective of the study is to evaluate the efficacy and the adverse effects when observation is performed. A retrospective observational study was undertaken in our center (university hospital level II). Data was obtained from a database with prospective registration. A total of 1087 trauma patients admitted in the intensive care unit from 2006 to 2013 were included. In this period, 126 patients with occult pneumothorax were identified, 73 patients (58%) underwent immediate tube thoracostomy and 53 patients (42%) were observed. Nine patients (12%) failed observation and required tube thoracostomy for pneumothorax progression or hemothorax. No patient developed a tension pneumothorax or experienced another adverse event related to the absence of tube thoracostomy. Of the observed patients 16 were under positive pressure ventilation, in this group 3 patients (19%) failed observation. There were no differences in mortality, hospital length of stay or intensive care length of stay between the observed and non-observed group. Observation is a safe treatment in occult pneumothorax, even in pressure positive ventilated patients. Copyright © 2014 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Pneumothorax associated with nontuberculous mycobacteria

    Science.gov (United States)

    Ueyama, M; Asakura, Takanori; Morimoto, Kozo; Namkoong, Ho; Matsuda, Shuichi; Osawa, Takeshi; Ishii, Makoto; Hasegawa, Naoki; Kurashima, Atsuyuki; Goto, Hajime

    2016-01-01

    Abstract The incidence of nontuberculous mycobacterial pulmonary disease (NTMPD) is increasing worldwide. Secondary spontaneous pneumothorax occurs as a complication of underlying lung disease and is associated with higher morbidity, mortality, and recurrence than primary spontaneous pneumothorax. We here investigated the clinical features and long-term outcomes of pneumothorax associated with NTMPD. We conducted a retrospective study on consecutive adult patients with pneumothorax associated with NTMPD at Fukujuji Hospital and Keio University Hospital from January 1992 to December 2013. We reviewed the medical records of 69 such patients to obtain clinical characteristics, radiological findings, and long-term outcomes, including pneumothorax recurrence and mortality. The median age of the patients was 68 years; 34 patients were women. The median body mass index was 16.8 kg/m2. Underlying pulmonary diseases mainly included chronic obstructive pulmonary disease and pulmonary tuberculosis. On computed tomography, nodules and bronchiectasis were observed in 46 (98%) and 45 (96%) patients, respectively. Consolidation, pleural thickening, interlobular septal thickening, and cavities were most common, and observed in 40 (85%), 40 (85%), 37 (79%), and 36 (77%) patients, respectively. Regarding pneumothorax treatment outcomes, complete and incomplete lung expansion were observed in 49 patients (71%) and 15 patients (22%), respectively. The survival rate after pneumothorax was 48% at 5 years. By the end of the follow-up, 33 patients had died, and the median survival was 4.4 years with a median follow-up period of 1.7 years. The rate of absence of recurrence after the first pneumothorax was 59% at 3 years. By the end of the follow-up, 18 patients had experienced pneumothorax recurrence. Furthermore, 12/18 patients (66%) with recurrent pneumothorax died during the study period. Twenty-three patients (70%) died because of NTMPD progression. Low body mass index (BMI) was a

  11. The influence of chest tube size and position in primary spontaneous pneumothorax

    DEFF Research Database (Denmark)

    Riber, Sara S.; Riber, Lars P S; Olesen, Winnie H.

    2017-01-01

    Background: Optimal chest tube position in the pleural cavity is largely unexplored for the treatment of primary spontaneous pneumothorax (PSP). We investigated whether type, size and position of chest tubes influenced duration of treatment for PSP. Methods: A retrospective follow-up study of all...... patients admitted with PSP over a 5-year period. Traumatic, iatrogenic and secondary pneumothoraxes were excluded. Gender, age, smoking habits, type and size of chest tube used (pigtail catheter or surgical chest tube) were recorded from the patients' charts. All chest X-rays upon admittance...... and immediately following chest tube placement were retrieved and re-evaluated for size of pneumothorax (categorized into five groups) and location of the chest tube tip (categorized as upper, middle or lower third of the pleural cavity). All data were analysed in a Cox proportional hazards regression model...

  12. A late presenting congenital diaphragmatic hernia misdiagnosed as spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Chitra Sanjeev Juwarkar

    2010-01-01

    Full Text Available Congenital diaphragmatic hernia (CDH is described as (1 failure of diaphragmatic closure at development, (2 presence of herniated abdominal contents into chest and (3 pulmonary hypoplasia. Usually, pleural space is drained urgently when there is respiratory distress and radiological appearance of mediastinal shift. We present a case of a 5-month-old baby, diagnosed as tension pneumothorax and treated with chest drain insertion. CDH was the intraoperative diagnosis.

  13. Recurrence of primary spontaneous pneumothorax in young adults and children.

    Science.gov (United States)

    Noh, Dongsub; Lee, Sungsoo; Haam, Seok Jin; Paik, Hyo Chae; Lee, Doo Yun

    2015-08-01

    Although better nutritional support has improved the growth rates in children, the occurrence of primary spontaneous pneumothorax has also been increasing in children. The current study attempts to investigate the occurrence and recurrence of primary spontaneous pneumothorax and the efficacy of surgery for primary spontaneous pneumothorax in young adults and children. A total of 840 patients were treated for pneumothorax at our hospital from January 2006 to December 2010. Exclusion criteria for this study were age >25 or secondary, traumatic or iatrogenic pneumothorax, and a total of 517 patients were included. Patients were classified into three groups according to age at the first episode of primary spontaneous pneumothorax: Group A: ≤16 years; Group B: 17-18 years and Group C: ≥19 years. The study group was composed of 470 male and 47 female patients. There were 234 right-sided, 279 left-sided and 4 bilateral primary spontaneous pneumothoraces. Wedge resection by video-assisted thoracic surgery was performed in 285 patients, while 232 were managed by observation or closed thoracostomy. In the wedge resection group, 51 patients experienced recurrence. The recurrence rates after wedge resection were 27.9% in Group A, 16.5% in Group B and 13.2% in Group C (P = 0.038). The recurrence rates after observation or closed thoracostomy were 45.7% in Group A, 51.9% in Group B and 47.7% in Group C (P = 0.764). In the present study, postoperative recurrence rates were higher than those in the literature. Intense and long-term follow-up was probably one reason for the relatively high recurrence rate. The recurrence rate after wedge resection in patients aged ≤16 years was higher than that in older patients. There was no difference between the recurrence rates after observation or closed thoracostomy, regardless of age. These results suggest that wedge resection might be delayed in children. © The Author 2015. Published by Oxford University Press on behalf of the

  14. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report.

    Science.gov (United States)

    Idris, Baig M; Hefny, Ashraf F

    2016-01-01

    Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. A 63- year- old man presented to the Emergency Department complaining of left lateral chest pain due to a fall on his chest at home. On examination, he was hemodynamically stable. An urgent chest X-ray showed evidence of left sided pneumothorax. CT scan of the chest showed pneumothorax of more than 30% of the left hemithorax (around 600ml of air) with multiple left ribs fracture. Patient refused tube thoracostomy and was admitted to surgical department for close observation. The patient was managed conservatively without chest tube insertion. A repeat CT scan of the chest has shown complete resolution of the pneumothorax. The clinical spectrum of pneumothorax varies from asymptomatic to life threatening tension pneumothorax. In stable patients, conservative management can be safe and effective for small pneumothorax. To the best of our knowledge, this is the second reported case in the English literature with large pneumothorax which resolved spontaneously without chest drain. Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Pneumotórax hipertensivo na sala de recuperação pós-anestésica: relato de caso Pneumotórax hipertensivo en la sala de recuperación pos-anestésica: relato de caso Tension pneumothorax in post-anesthetic care unit: case report

    Directory of Open Access Journals (Sweden)

    Ana Claudia Chiaratti Mega

    2004-10-01

    Recuperación Pós-Anestésica (SRPA. RELATO DEL CASO: Paciente del sexo masculino, 34 años, estado físico ASA I E, víctima de lesiones por arma de fuego. Fue sometido a laparotomía exploradora y exploración de arteria y vena femoral a derecha, sobre anestesia general balanceada con inducción en secuencia rápida, con estabilidad hemodinámica durante todo el procedimiento quirúrgico. En la SRPA, presentó instabilidad hemodinámica, con insuficiencia respiratoria, sudoresis, taquicardia e hipertensión arterial. La tomografía computadorizada de tórax evidenció hemoneumotórax a la derecha, siendo inmediatamente drenado. Fue transferido para el Centro de Terapia Intensiva, presentó mejora progresiva del cuadro, con alta hospitalar, sin secuelas, después de 22 días. CONCLUSIONES: El pneumotórax hipertensivo es una enfermedad letal que puede ser fácilmente reconocida a través del examen clínico y radiológico; debiendo ser siempre sospechado en la presencia de traumatismo torácico, y en este caso, se debe realizar inmediatamente el drenaje de tórax antes de la ventilación mecánica y de procedimientos quirúrgicos.BACKGROUND AND OBJECTIVES: The incidence of pneumothorax after penetrating chest trauma is 100%. Tension pneumothorax, a high mortality rate condition, may be triggered, among other causes, by pulmonary injury not previously identified, and may also be associated to mechanical ventilation. This report presents a case of tension pneumothorax diagnosed in the Post-Anesthetic Care Unit (PACU. CASE REPORT: A 34-year-old black male patient, physical status ASA I E, victim of gunshot wound was submitted to explorative laparotomy and right femoral artery and vein exploration under general balanced anesthesia with rapid sequence induction. The patient kept hemodynamically stable throughout the procedure. However, in the PACU patient presented hemodynamic instability with respiratory failure, sweating, tachycardia and hypertension. Chest CT-scan revealed

  16. Exclusion of pneumothorax by radionuclide lung scan

    International Nuclear Information System (INIS)

    Weiss, P.E.

    1986-01-01

    A case is reported in which ventilation lung imaging was useful in excluding a large pneumothorax. This technique may be helpful in patients with emphysema in whom exclusion of pneumothorax by radiographic criteria might be difficult

  17. Should Euthanasia Be Considered Iatrogenic?

    Science.gov (United States)

    Barone, Silvana; Unguru, Yoram

    2017-08-01

    As more countries adopt laws and regulations concerning euthanasia, pediatric euthanasia has become an important topic of discussion. Conceptions of what constitutes harm to patients are fluid and highly dependent on a myriad of factors including, but not limited to, health care ethics, family values, and cultural context. Euthanasia could be viewed as iatrogenic insofar as it results in an outcome (death) that some might consider inherently negative. However, this perspective fails to acknowledge that death, the outcome of euthanasia, is not an inadvertent or preventable complication but rather the goal of the medical intervention. Conversely, the refusal to engage in the practice of euthanasia might be conceived as iatrogenic insofar as it might inadvertently prolong patient suffering. This article will explore cultural and social factors informing families', health care professionals', and society's views on pediatric euthanasia in selected countries. © 2017 American Medical Association. All Rights Reserved.

  18. Tension bulla: a cause of reversible pulmonary hypertension.

    Science.gov (United States)

    Waxman, Michael J; Waxman, Jacob D; Forman, John M

    2015-01-01

    A tension pneumothorax represents a medical emergency warranting urgent diagnosis and treatment. A rapidly expanding bulla may resemble the same clinical presentation but requires an entirely different treatment. A 53-year-old woman presented with increasing shortness of breath and her physical examination and chest x-ray were interpreted as showing a tension pneumothorax. A chest tube was placed which did not resolve the process. Placement of a second chest tube was likewise unsuccessful. A chest CT was then performed and was interpreted as showing an unresolved tension pneumothorax, despite seemingly adequate placement of the 2 chest tubes. Further review of the CT showed the border of a giant bulla and a tentative diagnosis was made of a rapidly expanding bulla with tension physiology. Echocardiogram revealed significant pulmonary hypertension. The bulla was surgically excised, the patient had marked improvement in her clinical symptoms and signs, and echocardiographic follow-up showed complete resolution of the pulmonary hypertension.

  19. Case report: an electrocardiogram of spontaneous pneumothorax mimicking arm lead reversal.

    Science.gov (United States)

    Wieters, J Scott; Carlin, Joseph P; Morris, Andrew

    2014-05-01

    There are several previously documented findings for electrocardiograms (ECGs) of spontaneous pneumothorax. These findings include axis deviation, T-wave inversion, and right bundle branch block. When an ECG has the arm leads incorrectly placed, the ECG will display right axis deviation and inversion of the P waves in lead I. There have been no previously published ECGs of spontaneous pneumothorax that have shown the same findings as reversal of the limb leads of an ECG. A possible finding of spontaneous pneumothorax is an identical finding to that of an ECG that has been flagged for limb lead reversal. A patient presented in the emergency setting with acute chest pain and shortness of breath caused by a tension pneumothorax. An ECG was administered; findings indicated reversal of the arm leads (right axis deviation and inverted P waves in lead I), but there was no actual limb lead reversal present. ECG findings resolved upon resolution of the pneumothorax. If a patient presents with chest pain and shortness of breath, and the patient's ECG is flagged for limb lead reversal despite being set up correctly, the physician should raise clinical suspicion for a possible spontaneous pneumothorax. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Pneumothorax and Pneumomediastinum in Pregnancy: A Case Report

    Directory of Open Access Journals (Sweden)

    S. Sathiyathasan

    2009-01-01

    Full Text Available Case Report. A 37 years old patient at 40 weeks gestation presented with acute severe hypoxia with a seizure followed by fetal bradycardia. Caesarean section was performed under GA and she was intubated and ventilated. History revealed longstanding right pleural endometriosis with multiple pneumothoraces and hydrothoraces. A CT chest showed extensive bilateral pnenumothoraces. Her clinical condition improved with a left-sided chest drain. Discussion. Severe hypoxia and seizures in a patient with previous history of pnenumothorax are highly suggestive of tension pneumothorax. Radiological investigations are vital for diagnosis. The traditional treatment approach to recurrent pneumothorax has been thorocotomy with bleb or bulla resection and pleurodeisis. The advantages of thorocoscopic surgical treatment over thorocotomy are decreased time of exposure to anaesthetic drugs, rapid lung expansion, decreased post operative pain, and a potentially shorter post operative recovery. In any future pregnancy due to the high risk of recurrence of pneumothorax Contemporary obstetric management should determine the method of delivery and continuous lumbar/epidural anesthesia should be used if at all feasible. Preconceptual counseling about this risk is vital, and women must be advised about potential serious adverse outcomes.

  1. Spontaneous pneumothorax in silicotuberculosis of lung

    International Nuclear Information System (INIS)

    Kolenic, J.; Jurgova, T.; Zimacek, J.; Vajo, J.; Krchnavy, M.

    1995-01-01

    The authors describe the case of 62 years old man with the appearance of spontaneous pneumothorax, in whom the basic pulmonary disease was silicotuberculosis of the lung. At clinic of occupational diseases in Kosice have been evidence 965 cases of silicosis and silicotuberculosis. From 1971 they have now the first case of spontaneous pneumothorax. The authors make discussion about possible mechanical and biochemical factors, which cause relatively low incidence of spontaneous pneumothorax in silicosis of the lung. (authors)

  2. Post biopsy pneumothorax: Risk factors and course

    International Nuclear Information System (INIS)

    Sanchez, J.A.; Retamar, J.A.; Blazquez, J.; Castano, J.C.

    1996-01-01

    The was to study the natural course of pneumothorax produced after aspiration biopsy in the attempt to differentiate those cases that will resolve spontaneously from those that will require drainage, and to assess the possible risk factors associated with the development of this entity. Eighty-nine CT-guided aspiration biopsies were performed in 80 patients. Control CT was done immediately after the procedure and 24 hours later. When pneumothorax persisted, CT was repeated at 48 h, 72 h, day 5 and day 7 or until a drainage tube was introduced. The cases of pneumothorax were classified as minimal, anterior or anterolateral. Seven variables were assessed as possible risk factors for its occurrence. Pneumothorax developed on 29 occasions (32.5%), requiring drainage in 12 cases (13.5%). In 20 patients (22%), pneumothorax occurred immediately, while in the remaining 9 (10%) it was detected in the 24 h CT scan. When studied according to type, drainage was required in 3 of the 19 cases of minimal or anterior pneumothorax (15%) and in 9 or the 10 cases of anterolateral location (90%) (p<0.0005). The mean thickness of the parenchyma punctured was 3.4 cm +- 2.2. cm when pneumothorax developed and 1.3 cm+- 2 cm when it did not (p<0.0001). There is a statistically significant association between the development of anterolateral pneumothorax and the need for chest drainage. The thickness of the punctured parenchyma is associated with the production of pneumothorax. 16 refs

  3. Chest Tube Management after Surgery for Pneumothorax.

    Science.gov (United States)

    Pompili, Cecilia; Salati, Michele; Brunelli, Alessandro

    2017-02-01

    There is scant evidence on the management of chest tubes after surgery for pneumothorax. Most of the current knowledge is extrapolated from studies performed on subjects with lung cancer. This article reviews the existing literature with particular focus on the effect of suction and no suction on the duration of air leak after lung resection and surgery for pneumothorax. Moreover, the role of regulated suction, which seems to provide some benefit in reducing pneumothorax recurrence after bullectomy and pleurodesis, is discussed. Finally, a personal view on the management of chest tubes after surgery for pneumothorax is provided. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma.

    Science.gov (United States)

    Wilkerson, R Gentry; Stone, Michael B

    2010-01-01

    Supine anteroposterior (AP) chest radiographs in patients with blunt trauma have poor sensitivity for the identification of pneumothorax. Ultrasound (US) has been proposed as an alternative screening test for pneumothorax in this population. The authors conducted an evidence-based review of the medical literature to compare sensitivity of bedside US and AP chest radiographs in identifying pneumothorax after blunt trauma. MEDLINE and EMBASE databases were searched for trials from 1965 through June 2009 using a search strategy derived from the following PICO formulation of our clinical question: patients included adult (18 + years) emergency department (ED) patients in whom pneumothorax was suspected after blunt trauma. The intervention was thoracic ultrasonography for the detection of pneumothorax. The comparator was the supine AP chest radiograph during the initial evaluation of the patient. The outcome was the diagnostic performance of US in identifying the presence of pneumothorax in the study population. The criterion standard for the presence or absence of pneumothorax was computed tomography (CT) of the chest or a rush of air during thoracostomy tube placement (in unstable patients). Prospective, observational trials of emergency physician (EP)-performed thoracic US were included. Trials in which the exams were performed by radiologists or surgeons, or trials that investigated patients suffering penetrating trauma or with spontaneous or iatrogenic pneumothoraces, were excluded. The methodologic quality of the studies was assessed. Qualitative methods were used to summarize the study results. Data analysis consisted of test performance (sensitivity and specificity, with 95% confidence intervals [CIs]) of thoracic US and supine AP chest radiography. Four prospective observational studies were identified, with a total of 606 subjects who met the inclusion and exclusion criteria. The sensitivity and specificity of US for the detection of pneumothorax ranged from

  5. Unrecognized blunt tracheal trauma with massive pneumomediastinum and tension pneumothorax

    Directory of Open Access Journals (Sweden)

    Nanda Shetty

    2011-01-01

    Full Text Available Blunt neck trauma with an associated laryngotracheal injury is rare. We report a patient with blunt neck trauma who came to the emergency room and was sent to ward without realizing the seriousness of the situation. He presented later with respiratory distress and an anesthesiologist was called in for emergency airway management. Airway management in such a situation is described in this report.

  6. Iatrogenics in Orthodontics and its challenges.

    Science.gov (United States)

    Barreto, Gustavo Mattos; Feitosa, Henrique Oliveira

    2016-01-01

    Orthodontics has gone through remarkable advances for those who practice it with dignity and clinical quality, such as the unprecedented number of patients treated of some type of iatrogenic problems (post-treatment root resorptions; occlusal plane changes; midline discrepancies, asymmetries, etc). Several questions may raise useful reflections about the constant increase of iatrogenics. What is causing it? Does it occur when dentists are properly trained? In legal terms, how can dentists accept these patients? How should they be orthodontically treated? What are the most common problems? This study analyzed and discussed relevant aspects to understand patients with iatrogenic problems and describe a simple and efficient approach to treat complex cases associated with orthodontic iatrogenics.

  7. Diagnosis and management of iatrogenic endoscopic perforations

    DEFF Research Database (Denmark)

    Paspatis, Gregorios A; Dumonceau, Jean-Marc; Barthet, Marc

    2014-01-01

    This Position Paper is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the diagnosis and management of iatrogenic perforation occurring during diagnostic or therapeutic digestive endoscopic procedures. Main recommendations 1 ESGE recommends that ea...

  8. MESOTHELIOMA PRESENTING WITH PNEUMOTHORAX AND INTERLOBAR TUMOR

    NARCIS (Netherlands)

    MANNES, GPM; GOUW, ASH; BERENDSEN, HH; VERHOEFF, AJ; POSTMUS, PE

    A patient presented with a pneumothorax, a parahilar mass and a pleural effusion on the left side. Histology proved that this was caused by a malignant mesothelioma, epithelial type. The pneumothorax persisted, even after chest drainage and pleurodesis with talc powder and tetracycline.

  9. Inhalational Steroids and Iatrogenic Cushing's Syndrome.

    Science.gov (United States)

    A V, Raveendran

    2014-01-01

    Bronchial asthma (BA) and Allergic rhinitis (AR) are common clinical problems encountered in day to day practice, where inhalational corticosteroids (ICS) or intranasal steroids (INS) are the mainstay of treatment. Iatrogenic Cushing syndrome (CS) is a well known complication of systemic steroid administration. ICS /INS were earlier thought to be safe, but now more and more number of case reports of Iatrogenic Cushing syndrome have been reported, especially in those who are taking cytochrome P450 (CYP 450) inhibitors. Comparing to the classical clinical features of spontaneous Cushing syndrome, iatrogenic Cushing syndrome is more commonly associated with osteoporosis, increase in intra-ocular pressure, benign intracranial hypertension, aseptic necrosis of femoral head and pancreatitis, where as hypertension, hirsuitisum and menstrual irregularities are less common. Endocrine work up shows low serum cortisol level with evidence of HPA (hypothalamo-pituitary-adrenal) axis suppression. In all patients with features of Cushing syndrome with evidence of adrenal suppression always suspect iatrogenic CS. Since concomitant administration of cytochrome P450 inhibitors in patients on ICS/INS can precipitate iatrogenic CS, avoidance of CYP450 inhibitors, its dose reduction or substitution of ICS are the available options. Along with those, measures to prevent the precipitation of adrenal crisis has to be taken. An update on ICS-/INS- associated iatrogenic CS and its management is presented here.

  10. Effectiveness of Ambulatory Tru-Close Thoracic Vent for the Outpatient Management of Pneumothorax: A Prospective Pilot Study.

    Science.gov (United States)

    Kim, Yong Pyo; Haam, Seok Jin; Lee, Sungsoo; Lee, Geun Dong; Joo, Seung-Moon; Yum, Tae Jun; Lee, Kwang-Hun

    2017-01-01

    This study aimed to assess the technical feasibility, procedural safety, and long-term therapeutic efficacy of a small-sized ambulatory thoracic vent (TV) device for the treatment of pneumothorax. From November 2012 to July 2013, 18 consecutive patients (3 females, 15 males) aged 16-64 years (mean: 34.7 ± 14.9 years, median: 29 years) were enrolled prospectively. Of these, 15 patients had spontaneous pneumothorax and 3 had iatrogenic pneumothorax. A Tru-Close TV with a small-bore (11- or 13-Fr) catheter was inserted under bi-plane fluoroscopic assistance. Technical success was achieved in all patients. Complete lung re-expansion was achieved at 24 hours in 88.9% of patients (16/18 patients). All patients tolerated the procedure and no major complications occurred. The patients' mean numeric pain intensity score was 2.4 (range: 0-5) in daily life activity during the TV treatment. All patients with spontaneous pneumothorax underwent outpatient follow-up. The mean time to TV removal was 4.7 (3-13) days. Early surgical conversion rate of 16.7% (3/18 patients) occurred in 2 patients with incomplete lung expansion and 1 patient with immediate pneumothorax recurrence post-TV removal; and late surgical conversion occurred in 2 of 18 patients (11.1%). The recurrence-free long-term success rate was 72.2% (13/18 patients) during a 3-year follow-up period from November 2012 to June 2016. TV application was a simple, safe, and technically feasible procedure in an outpatient clinic, with an acceptable long-term recurrence-free rate. Thus, TV could be useful for the immediate treatment of pneumothorax.

  11. Effectiveness of ambulatory tru-close thoracic vent for the outpatient management of pneumothorax: A prospective pilot study

    International Nuclear Information System (INIS)

    Kim, Yong Pyo; Lee, Sung Soo; Lee, Geun Dong; Joo, Seung Moon; Yum, Tae Jun; Lee, Kwang Hun; Haam, Seok Jin

    2017-01-01

    This study aimed to assess the technical feasibility, procedural safety, and long-term therapeutic efficacy of a small-sized ambulatory thoracic vent (TV) device for the treatment of pneumothorax. From November 2012 to July 2013, 18 consecutive patients (3 females, 15 males) aged 16–64 years (mean: 34.7 ± 14.9 years, median: 29 years) were enrolled prospectively. Of these, 15 patients had spontaneous pneumothorax and 3 had iatrogenic pneumothorax. A Tru-Close TV with a small-bore (11- or 13-Fr) catheter was inserted under bi-plane fluoroscopic assistance. Technical success was achieved in all patients. Complete lung re-expansion was achieved at 24 hours in 88.9% of patients (16/18 patients). All patients tolerated the procedure and no major complications occurred. The patients' mean numeric pain intensity score was 2.4 (range: 0–5) in daily life activity during the TV treatment. All patients with spontaneous pneumothorax underwent outpatient follow-up. The mean time to TV removal was 4.7 (3–13) days. Early surgical conversion rate of 16.7% (3/18 patients) occurred in 2 patients with incomplete lung expansion and 1 patient with immediate pneumothorax recurrence post-TV removal; and late surgical conversion occurred in 2 of 18 patients (11.1%). The recurrence-free long-term success rate was 72.2% (13/18 patients) during a 3-year follow-up period from November 2012 to June 2016. TV application was a simple, safe, and technically feasible procedure in an outpatient clinic, with an acceptable long-term recurrence-free rate. Thus, TV could be useful for the immediate treatment of pneumothorax

  12. Effectiveness of ambulatory tru-close thoracic vent for the outpatient management of pneumothorax: A prospective pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yong Pyo; Lee, Sung Soo; Lee, Geun Dong; Joo, Seung Moon; Yum, Tae Jun; Lee, Kwang Hun [Gangnam Severance Hospital, Yonsei University Health System, Seoul (Korea, Republic of); Haam, Seok Jin [Dept. of Cardiothoracic Surgery, Ajou University Hospital, Suwon (Korea, Republic of)

    2017-06-15

    This study aimed to assess the technical feasibility, procedural safety, and long-term therapeutic efficacy of a small-sized ambulatory thoracic vent (TV) device for the treatment of pneumothorax. From November 2012 to July 2013, 18 consecutive patients (3 females, 15 males) aged 16–64 years (mean: 34.7 ± 14.9 years, median: 29 years) were enrolled prospectively. Of these, 15 patients had spontaneous pneumothorax and 3 had iatrogenic pneumothorax. A Tru-Close TV with a small-bore (11- or 13-Fr) catheter was inserted under bi-plane fluoroscopic assistance. Technical success was achieved in all patients. Complete lung re-expansion was achieved at 24 hours in 88.9% of patients (16/18 patients). All patients tolerated the procedure and no major complications occurred. The patients' mean numeric pain intensity score was 2.4 (range: 0–5) in daily life activity during the TV treatment. All patients with spontaneous pneumothorax underwent outpatient follow-up. The mean time to TV removal was 4.7 (3–13) days. Early surgical conversion rate of 16.7% (3/18 patients) occurred in 2 patients with incomplete lung expansion and 1 patient with immediate pneumothorax recurrence post-TV removal; and late surgical conversion occurred in 2 of 18 patients (11.1%). The recurrence-free long-term success rate was 72.2% (13/18 patients) during a 3-year follow-up period from November 2012 to June 2016. TV application was a simple, safe, and technically feasible procedure in an outpatient clinic, with an acceptable long-term recurrence-free rate. Thus, TV could be useful for the immediate treatment of pneumothorax.

  13. Contemporary pharmacotherapy and iatrogenic pathology

    Directory of Open Access Journals (Sweden)

    Trailović D.R.

    2005-01-01

    Full Text Available During the past few decades, the pharmaceutical industry has developed into a powerful human activity highly influencing modern medicine. Thousands of synthetic therapeuticals have been developed, and these formulations enabled the successful treatment of many diseases, some of which were considered incurable. An increase in drug consumption followed the development of the pharmaceutical industry and the introduction of synthetic drugs. The widespread use of new medicals enabled the collection of data confirming their effectiveness, but also more and more data concerning side and unwanted effects were reported. Frequent side/unwanted effect reports gave rise to development of iatrogenic pathology, a new branch of clinical pathology. The knowledge of the possible unwanted effects of drugs on macro organisms did not enable the effective withdrawal of such formulations from the market. At the beginning, the reports concerning unwanted effects were not verealed. Consequently some potentially harmful formulations were used for years without methodical analyses of their side/unwanted effects. Some potentially dangerous formulations are still on the market such as drugs containing ulcerogenic, hepatotoxic, nephrotoxic substances as well as those inducing bone marrow aplasia. The administration of these potentially dangerous formulations is understandable in the case of clear therapeutic indications allowing no alternatives. In these cases the risk of harmful side effects is greatly overwhelmed by the risk from the primary disease. Otherwise the administration of the potentially harmful drug is unjustified, especially if the indication is not a disease. Many potentially harmful drugs are formulated for use in healthy animals, recommended as growth, laying and milk stimulators, those allowing higher speed and strength in sport and racing horses, estrus inducers and suppressors. The misuse or maluse medication is highly present in sport horses daily

  14. Iatrogenic Lower Extremity Subcutaneous Emphysema after Prolonged Robotic-Assisted Hysterectomy

    Directory of Open Access Journals (Sweden)

    Monica Hagan Vetter

    2015-01-01

    Full Text Available Subcutaneous emphysema is a known complication of carbon dioxide insufflation, an essential component of laparoscopy. The literature contains reports of hypercarbia, pneumothorax, or pneumomediastinum. However, isolated lower extremity subcutaneous emphysema remains a seldom-reported complication. We report a case of unilateral lower extremity subcutaneous emphysema following robotic-assisted hysterectomy, bilateral salpingooophorectomy, staging, and anterior/posterior colporrhaphy for carcinosarcoma and vaginal prolapse. On postoperative day 1, the patient developed tender crepitus and bruising of her right ankle. Radiography confirmed presence of subcutaneous air. Vital signs and laboratory findings were unremarkable. Her symptoms spontaneously improved over time, and she was discharged in good condition on day 2. In stable patients with postoperative extremity swelling or pain with crepitus on exam, the diagnosis of iatrogenic subcutaneous emphysema must be considered.

  15. Primary Spontaneous Pneumothorax in Menstruating Women Has High Recurrence.

    Science.gov (United States)

    Mehta, Christopher K; Stanifer, Bryan P; Fore-Kosterski, Susan; Gillespie, Colin; Yeldandi, Anjana; Meyerson, Shari; Odell, David D; DeCamp, Malcolm M; Bharat, Ankit

    2016-10-01

    Primary spontaneous pneumothorax (PSP) is treated on the basis of studies that have predominantly consisted of tall male subjects. Here, we determined recurrence of PSP in average-statured menstruating women and studied prevalence of catamenial pneumothorax (CP) in this population. Men and menstruating women, aged 18 to 55 years, without underlying lung disease or substance abuse were retrospectively studied between 2009 and 2015. A chest pathologist reviewed all specimens for thoracic endometriosis. Kaplan-Meier curves were constructed to determine recurrence. The median age of women (n = 33) and men (n = 183) was 33.4 and 31.6 years, respectively. In women, 9 (27%) had left-sided and 24 (73%) had right-sided PSP, treated with tube thoracostomy. Recurrence occurred in 21 women (64%) with median follow-up of 14 months, and they were treated with thoracoscopic pleurodesis. Right PSP had higher recurrence (70%) than left PSP (56%, p = 0.02). Four women (12%) presented with recurrent tension pneumothorax within 6 months. Eight patients (24%) had PSP within 72 hours of menses, meeting clinical criteria of CP. All these were placed on hormonal suppression after initial episode but went on to experience recurrence that was treated with pleurodesis. Classical endometrial glands were not found in any biopsy specimens obtained during the thoracoscopy. In contrast to female subjects, only 8 average-statured men (4.4%) had recurrence (p < 0.001) with a median follow-up of 16 months. PSP in healthy average-statured menstruating women has high recurrence compared with male counterparts. CP is a clinical diagnosis and often recurs despite hormonal suppression therapy. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  16. Primary spontaneous pneumothorax in menstruating females has high recurrence

    Science.gov (United States)

    Mehta, Christopher K.; Stanifer, Bryan P.; Fore-Kosterski, Susan; Gillespie, Colin; Yeldandi, Anjana; Meyerson, Shari; Odell, David D.; DeCamp, Malcolm M.; Bharat, Ankit

    2016-01-01

    Background Primary spontaneous pneumothorax (PSP) is treated based on studies that have predominantly consisted of tall male subjects. Here we determined recurrence of PSP in average-statured menstruating women and studied prevalence of catamenial pneumothorax (CP) in this population. Methods Males and menstruating females, aged 18-55 years, without underlying lung disease or substance abuse were retrospectively studied between 2009-2015. A chest pathologist reviewed all specimens for thoracic endometriosis. Kaplan-Meier curves were constructed to determine recurrence. Results The median age of females (n=33) and males (n=183) was 33.4 and 31.6 years, respectively. In females, nine (27%) had left-sided and 24 (73%) had right-sided PSP, treated with tube thoracostomy. Recurrence occurred in 21 (64%) females with median follow up of 14 months and was treated with thoracoscopic pleurodesis. Right PSP had higher recurrence (70%) compared to left (56%, p=0.02). Four females (12%) presented with recurrent tension pneumothorax within six months. Eight (24%) patients had PSP within 72 hours of menses, meeting clinical criteria of CP. All these were placed on hormonal suppression after initial episode but went on to develop recurrence that was treated with pleurodesis. However, classic endometrial glands were not found in any biopsy specimens obtained during the thoracoscopy. In contrast to female subjects, only 8 (4.4%) average-statured males had recurrence (p<0.001) with a median follow up of 16 months. Conclusions PSP in healthy average-statured menstruating women has high recurrence compared to male counterparts. CP is a clinical diagnosis and often recurs despite hormonal suppression therapy. PMID:27345097

  17. Pneumothorax, pneumomediastinum and pneumopericardium: a pictorial review

    International Nuclear Information System (INIS)

    Jeon, Kyung Nyeo; Bae, Kyung Soo; Yoo, Jin Jong; Jung, Sung Hoon; Kang, Duk Sik

    2004-01-01

    Pneumothorax, pneumomediastinum and pneumopericardium usually develop during emergency situations and these conditions may result in cardiopulmonary compromise, so an early and accurate diagnosis is seen as crucial for proper treatment. For diagnosis of pneumothorax, pneumomediastinum and pneumopericardium, chest radiography is a primary modality and CT can help for diagnosing them earlier and detecting associated abnormalities. The purpose of this pictorial essay is to describe the pathophysiology, various radiographic signs and diagnostic pitfalls of pneumothorax, pneumomediastinum and peumopericardium on chest radiographs that are correlated with CTs, and to aid the physician in the radiographic diagnosis

  18. Tension Headache

    Science.gov (United States)

    ... tight band around your head. A tension headache (tension-type headache) is the most common type of headache, and ... Headache after a head injury, especially if the headache gets worse ... tension or stress. But research suggests muscle contraction isn't the ...

  19. Iatrogenic orthodontic dental trauma: a case report.

    Science.gov (United States)

    Gencay, Koray; Tuna, Elif Bahar; Yaman, Duygu; Ozgen, Mehmet; Demirel, Korkud

    2013-01-01

    Iatrogenic trauma can be defined as any adverse condition in a patient resulting from treatment by a physician or dentist. Orthodontic treatment carries with it the risks of tissue damage and treatment failure. The aim of this article is to present traumatic oral tissue lesions resulting from iatrogenic orthodontic origin with a 2-year follow-up period based on orthodontic intervention followed by periodontal surgery. The management of traumatic injuries is dependent on the severity of the involvement of the periodontal tissues. While, in most cases, the elimination of the offending agent and symptomatic therapy is sufficient, in severe cases, or when the injury resulted in permanent defects, periodontal/regenerative therapy may be necessary. The dentist must be aware of these risks in order to help the patient make a fully informed choice whether to proceed with orthodontic treatment. The skill, experience, and up-to-date knowledge of dentists are the main factors to prevent possible iatrogenic traumas.

  20. Spontaneous pneumothorax associated with lung cancer

    International Nuclear Information System (INIS)

    Sung, Dong Wook; Jung, Seung Hyae; Yoon, Yup; Lim, Jae Hoon; Cho, Kyu Soek; Yang, Moon Ho

    1991-01-01

    Spontaneous pneumothorax is a rare manifestation of lung cancer. Eight cases of pneumothorax found in 1648 patients with lung cancer from 1979-1990 are reported. Histopathologic types of cancer were adenocarcinoma in three cases, squamous cell carcinoma in two cases, bronchioloalveolar carcinoma in two cases, and metastatic renal cell carcinoma in one case. The primary tumor mass was not found even after thoracotomy in two cases. Spontaneous pneumothorax occurred on the ipsilateral side of the cancer. All the patients were more than 40 years old with a history of smoking 1-2 packs a day for 20 to 50 years, and had chronic lung diseases. The authors emphasize that bronchogenic carcinoma may be one of the causes of spontaneous pneumothorax in appropriate clinical settings

  1. [Tuberculous pneumothorax: Diagnosis and treatment].

    Science.gov (United States)

    Ben Saad, S; Melki, B; Douik El Gharbi, L; Soraya, F; Chaouch, N; Aouina, H; Cherif, J; Hamzaoui, A; Merghli, A; Daghfous, H; Tritar, F

    2018-04-01

    Pneumothorax is a serious complication of cavitary pulmonary tuberculosis. The aim of this study was to describe clinical futures, to highlight challenges of its management. A retrospective multicentric and descriptive study including 65 patients treated for PT (1999-2015) was conducted to figure out clinical futures and its work-up. The mean age was 37.8 years. The sex ratio was 3.6. Smoking history and incarceration were noted respectively in 67.6 and 15.3% of cases. Acute respiratory failure and cachexia were reported in 26.1 and 10.7% of cases. The PT was inaugural in 41.5% of cases. Pyo-pneumothorax was noted in 69.2% of cases. The duration of antituberculous treatment ranged from 6 to 15 months for susceptible TB and was at least 12 months for resistant TB (4 cases). Thoracic drainage was performed in 90.7% patients. Its average length was 47 days. The drain drop was noted in 20% of cases. Bronchopleural fistula was diagnosed in 6 cases and pleural infection in 5 of cases. Surgery treatment was necessary in 6 cases. Mean time to surgery was 171 days. Six patients had pleural decortication associated with pulmonary resection in 4 cases. Persistent chronic PT was noted in 12.6% and chronic respiratory failure in 3% of cases and death in 15.3% of cases. The diagnosis of the PT is often easy. Its treatment encounters multiples difficulties. Duration of thoracic drainage and anti-TB treatment are usually long. Surgery is proposed lately. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  2. Iatrogenic injury to the inferior alveolar nerve

    DEFF Research Database (Denmark)

    Hillerup, Søren

    2008-01-01

    The purpose of this prospective, non-randomised, descriptive study is to characterise the neurosensory deficit and associated neurogenic discomfort in 52 patients with iatrogenic injury to the inferior alveolar nerve (IAN). All patients were examined and followed up according to a protocol...

  3. Balloon dilatation of iatrogenic urethral strictures

    International Nuclear Information System (INIS)

    Acunas, B.; Acunas, G.; Gokmen, E.; Celik, L.

    1988-01-01

    Balloon dilatation of the urethra was performed in five patients with iatrogenic urethral strictures. The urethral strictures were successfully negotiated and dilated in all patients. Redilatation became necessary in a period ranging from 3 to 10 months. The authors believe that balloon dilatation of the urethra can be safely and successfully performed; the procedure produces minimal trauma and immediate relief of symptoms. (orig.)

  4. Risk factors in iatrogenic spinal cord injury.

    Science.gov (United States)

    Montalva-Iborra, A; Alcanyis-Alberola, M; Grao-Castellote, C; Torralba-Collados, F; Giner-Pascual, M

    2017-09-01

    In the last years, there has been a change in the aetiology of spinal cord injury. There has been an increase in the number of elderly patients with spinal cord injuries caused by diseases or medical procedures. The aim of this study is to investigate the frequency of the occurrence of iatrogenic spinal cord injury in our unit. The secondary aim is to study what variables can be associated with a higher risk of iatrogenesis. A retrospective, descriptive, observational study of patients with acute spinal cord injury admitted from June 2009 to May 2014 was conducted. The information collected included the patient age, aetiology, neurological level and grade of injury when admitted and when discharged, cardiovascular risk factors, a previous history of depression and any prior treatment with anticoagulant or antiplatelet drugs. We applied a logistic regression. The grade of statistical significance was established as Pinjury was the thoracic level (48%). The main aetiology of spinal cord injury caused by iatrogenesis was surgery for degenerative spine disease, in patients under the age of 30 were treated with intrathecal chemotherapy. Iatrogenic spinal cord injury is a frequent complication. A statistically significant association between a patient history of depression and iatrogenic spinal cord injury was found as well as with anticoagulant and antiplatelet drug use prior to iatrogenic spinal cord injury.

  5. Iatrogenic burns injury complicating neonatal resuscitation ...

    African Journals Online (AJOL)

    A case of iatrogenic thermal injury in a newborn infant during resuscitation for perinatal asphyxia at a secondary health facility is described. The injury, with surface area coverage of about 4%, involved the lower limbs. This report highlights the poor newborn resuscitation skills of traditional medical practice. Un cas d'une ...

  6. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma.

    Science.gov (United States)

    Mierlo, Camille Van; Pinto, Luis Abegão; Stalmans, Ingeborg

    2015-01-01

    Iatrogenic pigment dispersion syndrome generally originates from a repetitive, mechanical trauma to the pigmented posterior epithelium of the iris. This trauma can arise after intraocular surgery, most commonly due to an abnormal contact between the intraocular lens (IOL) and the iris. Whether surgical removal of this primary insult can lead to a successful intraocular pressure (IOP) control remains unclear. Case-series. Patients with IOP elevation and clinical signs of pigment dispersion were screened for a diagnosis of iatrogenic IOL-related pigment dispersion. Three patients in which the IOL or the IOL-bag complex caused a pigment dispersion through a repetitive iris chafing were selected. In two cases, replacement of a sulcus-based single-piece IOL (patient 1) or a sub-luxated in-the-bag IOL (patient 2) by an anterior-chamber (AC) iris-fixed IOL led to a sustained decrease in IOP. In the third case, extensive iris atrophy and poor anatomical AC parameters for IOL implantation precluded further surgical intervention. IOL-exchange appears to be a useful tool in the management of iatrogenic pigment dispersion glaucoma due to inappropriate IOL implantation. This cause-oriented approach seems to be effective in controlling IOP, but should be offered only if safety criteria are met. How to cite this article: Van Mierlo C, Abegao Pinto L, Stalmans I. Surgical Management of Iatrogenic Pigment Dispersion Glaucoma. J Curr Glaucoma Pract 2015;9(1):28-32.

  7. Endovascular Treatment of an Iatrogenic Right Internal Jugular Vein- Right Subclavian Artery Fistula and Pseudoaneurysm During the Attempt of a Hemodialysis Catheter Insertion: A Case Report

    International Nuclear Information System (INIS)

    Cho, Eui Min; Kim, Hyun Lee; Kim, Dong Hyun

    2009-01-01

    Complications during the placement of a central venous catheter, via the right internal jugular vein puncture include local hematoma, hemothorax, pneumothorax, central vein thrombosis, and hemopericardium. Iatrogenic right internal jugular vein-right subclavian artery fistula with the formation of right subclavian artery pseudoaneurysms is an extremely rare complication in patients undergoing a central vein puncture. We report the case of a patient who developed a local hematoma at the vein puncture site and dyspnea due to a right internal jugular vein-subclavian artery fistula and a right subclavian artery pseudoaneurysm at the mediastinum after puncture of right internal jugular vein. The patient was successfully treated by embolization using microcoils

  8. Bilateral spontaneous pneumothorax with pulmonary metastases of synovial sarcoma

    International Nuclear Information System (INIS)

    Matushita, J.P.K.; Azevedo, C.M. de

    1989-01-01

    The association of bilateral spontaneous pneumothorax with pulmonary tumor is uncommon and with pulmonary metastases is rare. The clinical and radiological features of bilateral spontaneous pneumothorax from a synovial sarcoma in a 14 years old boy are described. (author) [pt

  9. Iatrogenic disease in the elderly: risk factors, consequences, and prevention

    Directory of Open Access Journals (Sweden)

    Sompol Permpongkosol

    2011-03-01

    Full Text Available Sompol PermpongkosolDivision of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandAbstract: The epidemiology of iatrogenic disease in the elderly has not been extensively reported. Risk factors of iatrogenic disease in the elderly are drug-induced iatrogenic disease, multiple chronic diseases, multiple physicians, hospitalization, and medical or surgical procedures. Iatrogenic disease can have a great psychomotor impact and important social consequences. To identify patients at high risk is the first step in prevention as most of the iatrogenic diseases are preventable. Interventions that can prevent iatrogenic complications include specific interventions, the use of a geriatric interdisciplinary team, pharmacist consultation and acute care for the elderly units.Keywords: iatrogenic disease, elderly, risk factors, prevention

  10. Pneumothorax in pediatric patients: management strategies to improve patient outcomes [digest].

    Science.gov (United States)

    Harris, Matthew; Rocker, Joshua; Pade, Kathryn H

    2017-03-22

    The clinical presentation of pneumothorax is highly variable. Spontaneous pneumothoraces may present with subtle symptoms when a small air leak is present, but can progress to hemodynamic instability in the setting of tension physiology. The etiologies are broad and the severity can vary greatly. A trauma patient with a pneumothorax may also have the added complexity of other potentially life-threatening injuries. While there is a wealth of evidence-based guidelines for the management of pneumothoraces in the adult literature, the approach to pediatric patients is largely extrapolated from that literature without a significant evidence base. In this issue, aspects of the history and physical examination, the use of various diagnostic imaging modalities, and the range of interventions available to the emergency clinician are discussed. [Points & Pearls is a digest of Pediatric Emergency Medicine Practice].

  11. TRAVEL TO COUNTRY IATROGENIC (Message 2

    Directory of Open Access Journals (Sweden)

    L. I. Dvoretsky

    2017-01-01

    Full Text Available The problem of iatrogenesis inevitably dictates the need for not only an exhaustive definition (which in principle is impossible, but also classification with a division into different species. The article deals with the main types of iatrogenia, the classification of iatrogenic proposed by I.A. Kassirsky, E.M. Tareev, S.Ya. Doletsky, A.V. Smolyannikov, V.V. Nekatchalov, and others, which are based on various principles and approaches. Given the expanded interpretation of iatrogenic and the need for a multidisciplinary approach to this problem among iatrogenic events, it is suggested to distinguish the following types of iatrogenic: psychogenic, hospital, therapeutic and preventive, iatrogenic diagnostic studies. Particular attention is paid in the article to psychogenic iatrogenia, which often arises in the process of communication between a doctor and patients. They consider not only iatrogenia, «having a starting point for the behavior of a doctor», but also iatrogenia, caused by certain traits of the patient’s character (insecurity, propensity to anxiety fears, increased attention to the slightest changes in health, emotional vulnerability, etc., predetermining inadequate reactions to any Medical information. Of no small importance in the development of psychogenic iatrogenia is the quality of the medical documentation issued by the doctor to the patient (extracts from the case histories, advisory opinions, descriptions of research results, recommendations, etc.. In this case, it is necessary to avoid formulations that, without proper explanation, may be inadequately perceived by the patient and alert him or her. To the sources of psychogenic iatrogenic, some authors also refer to improperly conducted medical education, the publication of contentious, nonscientific results that do not meet the requirements of evidence-based medicine, although the doctor may not directly participate in this. The author of the article encourages

  12. Lung ultrasonography to diagnose pneumothorax of the newborn.

    Science.gov (United States)

    Liu, Jing; Chi, Jing-Han; Ren, Xiao-Ling; Li, Jie; Chen, Ya-Juan; Lu, Zu-Lin; Liu, Ying; Fu, Wei; Xia, Rong-Ming

    2017-09-01

    To explore the reliability and accuracy of lung ultrasound for diagnosing neonatal pneumothorax. This study was divided into two phases. (1) In the first phase, from January 2013 to June 2015, 40 patients with confirmed pneumothorax had lung ultrasound examinations performed to identify the sonographic characteristics of neonatal pneumothorax. (2) In the second phase, from July 2015 to August 2016, lung ultrasound was undertaken on 50 newborn infants with severe lung disease who were suspected of having pneumothorax, to evaluate the sonographic accuracy and reliability to diagnose pneumothorax. (1) The main ultrasonic manifestations of pneumothorax are as follows: ① lung sliding disappearance, which was observed in all patients (100%); ② the existence of the pleural line and the A-line, which was also observed in all patients (100%); ③ the lung point, which was found in 75% of the infants with mild-moderate pneumothorax but not found to exist in 25% of the severe pneumothorax patients; ④ the absence of B-lines in the area of the pneumothorax (100% of the pneumothorax patients); and ⑤ no lung consolidation existed in the area of the pneumothorax (100% of the pneumothorax patients). (2) The accuracy and reliability of the lung sonographic signs of lung sliding disappearance as well as the existence of the pleural line and the A-line in diagnosing pneumothorax were as follows: 100% sensitivity, 100% specificity, 100% positive predictive value, and 100% negative predictive value. When the lung point exists, the diagnosis is mild-moderate pneumothorax, whereas if no lung point exists, the diagnosis is severe pneumothorax. Lung ultrasound is accurate and reliable in diagnosing and ruling out neonatal pneumothorax and, in our study, was found to be as accurate as chest X-ray. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Spontaneous pneumothorax in diffuse cystic lung diseases.

    Science.gov (United States)

    Cooley, Joseph; Lee, Yun Chor Gary; Gupta, Nishant

    2017-07-01

    Diffuse cystic lung diseases (DCLDs) are a heterogeneous group of disorders with varying pathophysiologic mechanisms that are characterized by the presence of air-filled lung cysts. These cysts are prone to rupture, leading to the development of recurrent spontaneous pneumothoraces. In this article, we review the epidemiology, clinical features, and management DCLD-associated spontaneous pneumothorax, with a focus on lymphangioleiomyomatosis, Birt-Hogg-Dubé syndrome, and pulmonary Langerhans cell histiocytosis. DCLDs are responsible for approximately 10% of apparent primary spontaneous pneumothoraces. Computed tomography screening for DCLDs (Birt-Hogg-Dubé syndrome, lymphangioleiomyomatosis, and pulmonary Langerhans cell histiocytosis) following the first spontaneous pneumothorax has recently been shown to be cost-effective and can help facilitate early diagnosis of the underlying disorders. Patients with DCLD-associated spontaneous pneumothorax have a very high rate of recurrence, and thus pleurodesis should be considered following the first episode of spontaneous pneumothorax in these patients, rather than waiting for a recurrent episode. Prior pleurodesis is not a contraindication to future lung transplant. Although DCLDs are uncommon, spontaneous pneumothorax is often the sentinel event that provides an opportunity for diagnosis. By understanding the burden and implications of pneumothoraces in DCLDs, clinicians can facilitate early diagnosis and appropriate management of the underlying disorders.

  14. Iatrogenic Urethral Defect Repairment: A Case Report

    Directory of Open Access Journals (Sweden)

    Ulas Fidan

    2013-10-01

    Full Text Available    Iatrogenic urethral defect is a complication that occurs after vaginal surgical procedures. Many surgical methods according to place of defect are described in case of injury of urethra. In this article, we reported the repairment of distal urethral defect with the help of greft taken from labia minor. This defect is made by the excision of the granulation tissue that occurred after chronic paraurethral  gland infection.

  15. [Management of spontaneous pneumothorax: about 138 cases].

    Science.gov (United States)

    Habibi, Bouchra; Achachi, Leila; Hayoun, Sohaib; Raoufi, Mohammed; Herrak, Laila; Ftouh, Mustapha El

    2017-01-01

    Pneumothorax is a collection of air in the pleural cavity. We conducted a retrospective study of patients with spontaneous pneumothorax in the Department of Pneumology at the Ibn Sina Hospital in Rabat (2009-2011) with the aim to determine the epidemiological, clinical, radiological, therapeutic and evolutionary manifestation of spontaneous pneumothorax. The study involved 138 patients: 128 men and 10 women (17-83 years), with an average age of 44.5 +/- 17.4 years and sex ratio of 12/8. 81.2% of patients were smokers. Clinical symptomatology was chest pain (92%), dyspnea (60%). Chest radiograph showed total unilateral (110 cases); partial (10 cases); localized (6 cases); bilateral (4 cases); right (51.4%) or left (45.7%) PNO (pneumothorax). During our study period we found that 70% of patients had spontaneous primitive pneumothorax and 30% had PNO secondary to Chronic obstructive pulmonary disease (COPD) (44%) and pulmonary tuberculosis (TB) (39%). Initial management included patients hospitalization, chest drainage (95%), needle exsufflation (1%), rest and O 2 (4%). It enables the lung to stick to the chest wall within 10 days in 63% of patients. Evolution was favorable in 89% of patients. Immediate complications included: subcutaneous emphysema (5 cases); infection (6 cases) and 3 deaths (cardiorespiratory arrest). Late complications included: recurrences in 11.6%; the first recurrence occurred in 13 cases (chest drainage in 11 cases and oxygen therapy in 2 cases) while the second recurrence occurred in 3 cases (surgery). This study shows the role of chest drainage and monitoring in the management of pneumothorax to avoid complications and especially to prevent recurrences, with a possible need to resort to surgery.

  16. Is pneumothorax after acupuncture so uncommon?

    DEFF Research Database (Denmark)

    Stenger, Michael; Bauer, Nicki Eithz; Licht, Peter B

    2013-01-01

    Acupuncture is one of the most widely used forms of traditional Chinese medicine often referred to as alternative therapy in the Western World and over the past decades it has become increasingly popular in Denmark. Pneumothorax is known as the most common serious complication following acupuncture......, but it is quite rarely reported. During a three-month period two patients with pneumothorax caused by acupuncture were admitted to our department. The purpose of this case report is to increase awareness of this complication, which may not be so uncommon....

  17. Bradycardia after Tube Thoracostomy for Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Yomi Fashola

    2018-01-01

    Full Text Available We present the case of an elderly patient who became bradycardic after chest tube insertion for spontaneous pneumothorax. Arrhythmia is a rare complication of tube thoracostomy. Unlike other reported cases of chest tube induced arrhythmias, the bradycardia in our patient responded to resuscitative measures without removal or repositioning of the tube. Our patient, who had COPD, presented with shortness of breath due to spontaneous pneumothorax. Moments after tube insertion, patient developed severe bradycardia that responded to Atropine. In patients requiring chest tube insertion, it is important to be prepared to provide cardiopulmonary resuscitative therapy in case the patient develops a life-threatening arrhythmia.

  18. Chemotherapy-induced Spontaneous Pneumothorax: Case Series

    Directory of Open Access Journals (Sweden)

    Een Hendarsih

    2016-09-01

    The mechanism of pneumothorax following chemotherapy is not clearly understood yet, however, several hypotheses have been considered: 1 the rupture of a subpleural bulla after chemotherapy; 2 the rupture of an emphysematous bulla in an over expanded portion of the lung which is partially obstructed by a neoplasm; 3 tumor lyses or necrosis due to cytotoxic chemotherapy directly induces the formation of fistula. Dyspnea and chest pain suddenly appear during successful chemotherapy for metastatic chemosensitive tumors should alert the physician to the possibility of SP. The treatment is directed toward lung re-expansion. Chemotherapy induced pneumothorax should be considered as oncologic emergency.

  19. Hypoxemia after pneumothorax exsufflation: a case report ...

    African Journals Online (AJOL)

    We describe a 36-year-old patient who was admitted to the emergency ward for acute dyspnea due to a spontaneous pneumothorax. He was successfully drained but shortly after presented a severe hypoxemia due to pulmonary oedema secondary to pulmonary re-expansion. The physiopathology behind this complication ...

  20. De spontane pneumothorax; een klinische studie

    NARCIS (Netherlands)

    Vervaat, Theodorus Johannes

    1963-01-01

    De pneumothorax, een ziektebeeld dat reeds 150 jaar bekend is, heeft voortdurend de aandacht en belangstelling van clinici gehad, vooral nadat de herkenning van dit ziektebeeld door de ontwikkeling van de roentgenologie eenvoudiger wqs geworden.De ontstaanswijze van een bepaalde vorm van

  1. Continuous pneumothorax monitoring by remittance measurement

    NARCIS (Netherlands)

    Beek, J. F.; Sterenborg, H. J.; van Gemert, M. J.

    1993-01-01

    The feasibility of a noninvasive method, based on a remittance measurement, to monitor continuously for the occurrence of pneumothorax in neonates under ventilation, was investigated through animal experiments. Light from a He-Ne laser (632.8 nm) or a semiconductor laser (790 nm) was incident on the

  2. Four Cases of Postoperative Pneumothorax Among 2814 Consecutive Laparoscopic Gynecologic Surgeries: A Possible Correlation Between Postoperative Pneumothorax and Endometriosis.

    Science.gov (United States)

    Hirata, Tetsuya; Nakazawa, Akari; Fukuda, Shinya; Hirota, Yasushi; Izumi, Gentaro; Takamura, Masashi; Harada, Miyuki; Koga, Kaori; Wada-Hiraike, Osamu; Fujii, Tomoyuki; Osuga, Yutaka

    2015-01-01

    To evaluate the frequency of pneumothorax after laparoscopic surgery and to identify possible correlations to endometriosis. Retrospective review. Tokyo University Hospital between 2006 and 2013. Four patients among a total of 2814 patients with a postoperative pneumothorax. Laparoscopic surgery for gynecologic benign disease. The main outcome was the clinical frequency and characteristics of the patients with postoperative pneumothorax. We observed 4 (0.14%) cases of postoperative pneumothorax after laparoscopic surgery, all of whom were diagnosed with endometriomas and developed a right-sided pneumothorax. The incidence of postoperative pneumothorax in 1097 patients with endometriomas was 0.36%, which was significantly higher than those without endometriomas. The presence of endometrioma should be considered a risk factor for postoperative pneumothorax in gynecologic laparoscopic surgery. Copyright © 2015 AAGL. Published by Elsevier Inc. All rights reserved.

  3. Thoracoscopic modified pleural tent for spontaneous pneumothorax.

    Science.gov (United States)

    Kawachi, Riken; Matsuwaki, Rie; Tachibana, Keisei; Karita, Shin; Nakazato, Yoko; Tanaka, Ryota; Nagashima, Yasushi; Takei, Hidefumi; Kondo, Haruhiko

    2016-08-01

    We developed a modified pleural tent (m-tent) procedure and used it in our hospital in almost 30 consecutive patients with spontaneous pneumothorax. The objective of this study was to clarify the feasibility and effectiveness of a thoracoscopic m-tent for the treatment of spontaneous pneumothorax. From July 2013 to November 2014, 107 patients with spontaneous pneumothorax were treated in our institution. Eighty-nine of these patients were analysed retrospectively. The inclusion criteria for thoracoscopic m-tent for spontaneous pneumothorax were multiple and widespread bullae, postoperative relapse and secondary spontaneous pneumothorax. The surgical procedures were usually performed through three ports. After bullectomy, an m-tent is made to strip the parietal pleura off the chest wall from about the level of the fourth or fifth rib to the apex, and two or three ligations are then applied to fix the pleural tent and lung parenchyma. Patients in whom an m-tent was not indicated underwent bullectomy plus coverage using absorbable materials. Twenty-seven patients underwent bullectomy plus m-tent (m-tent group) and 62 underwent bullectomy plus coverage over a staple line using an absorbable material such as a polyglycolic acid sheet or nitrocellulose sheet (coverage group). No severe postoperative complications were observed in either group. The m-tent and coverage groups showed significant differences in operation time (129 vs 86 min, mean), haemorrhage (12.8 vs 7.2 ml), postoperative hospital stay (3.7 vs 2.9 days) and postoperative painkiller intake (8.6 vs 6.8 days). Recurrence was observed in 1 (3.7%) and 2 patients (3.2%), respectively. The thoracoscopic m-tent procedure requires a longer operation, a longer hospital stay and greater painkiller intake. However, these differences are acceptable, and an m-tent should be considered as an option for pleural reinforcement in spontaneous pneumothorax, especially in patients who are complicated with severe pulmonary

  4. Iatrogenic nerve injuries during shoulder surgery.

    Science.gov (United States)

    Carofino, Bradley C; Brogan, David M; Kircher, Michelle F; Elhassan, Bassem T; Spinner, Robert J; Bishop, Allen T; Shin, Alexander Y

    2013-09-18

    The current literature indicates that neurologic injuries during shoulder surgery occur infrequently and result in little if any morbidity. The purpose of this study was to review one institution's experience treating patients with iatrogenic nerve injuries after shoulder surgery. A retrospective review of the records of patients evaluated in a brachial plexus specialty clinic from 2000 to 2010 identified twenty-six patients with iatrogenic nerve injury secondary to shoulder surgery. The records were reviewed to determine the operative procedure, time to presentation, findings on physical examination, treatment, and outcome. The average age was forty-three years (range, seventeen to seventy-two years), and the average delay prior to referral was 5.4 months (range, one to fifteen months). Seven nerve injuries resulted from open procedures done to treat instability; nine, from arthroscopic surgery; four, from total shoulder arthroplasty; and six, from a combined open and arthroscopic operation. The injury occurred at the level of the brachial plexus in thirteen patients and at a terminal nerve branch in thirteen. Fifteen patients (58%) did not recover nerve function after observation and required surgical management. A structural nerve injury (laceration or suture entrapment) occurred in nine patients (35%), including eight of the thirteen who presented with a terminal nerve branch injury and one of the thirteen who presented with an injury at the level of the brachial plexus. Nerve injuries occurring during shoulder surgery can produce severe morbidity and may require surgical management. Injuries at the level of a peripheral nerve are more likely to be surgically treatable than injuries of the brachial plexus. A high index of suspicion and early referral and evaluation should be considered when evaluating patients with iatrogenic neurologic deficits after shoulder surgery.

  5. Medicolegal aspects of iatrogenic root perforations

    DEFF Research Database (Denmark)

    Tsesis, I; Rosen, E; Bjørndal, L

    2014-01-01

    AIM: To retrospectively analyze the medico-legal aspects of iatrogenic root perforations (IRP) that occurred during endodontic treatments. METHODOLOGY: A comprehensive search in a professional liability insurance database was conducted to retrospectively identify cases of IRP following root canal...... treatment (p root perforation is a complication of root canal treatment and may result in tooth extraction...... and in legal actions against the treating practitioner. Mandibular molars are more prone to medico-legal claims related to root perforations. The patient should be informed of the risks during RCT and should get information on alternative treatments and their risks and prognosis...

  6. Tension headache.

    Science.gov (United States)

    Ziegler, D K

    1978-05-01

    Headache is an extremely common symptom, and many headaches undoubtedly have a relationship to stressful situations. The clear definition, however, of a "tension headache" complex and its differentiation from migraine in some patients is difficult. The problems are in the identification of a specific headache pattern induced by stress or "tension" and the relationship of the symptom to involuntary contraction of neck and scalp muscles. Treatment consists of analgesics and occasionally mild tranquilizers. Psychotherapy consists of reassurance and often other supportive measures, including modification of life styles. Various feedback techniques have been reported of value, but their superiority to suggestion and hypnosis is still problematic.

  7. Lung Parenchymal Assessment in Primary and Secondary Pneumothorax.

    Science.gov (United States)

    Bintcliffe, Oliver J; Edey, Anthony J; Armstrong, Lynne; Negus, Ian S; Maskell, Nick A

    2016-03-01

    The definition of primary spontaneous pneumothorax excludes patients with known lung disease; however, the assumption that the underlying lung is normal in these patients is increasingly contentious. The purpose of this study was to assess lung structure and compare the extent of emphysema in patients with primary versus secondary spontaneous pneumothorax and to patients with no pneumothorax in an otherwise comparable control group. We identified patients treated for pneumothorax by screening inpatient and outpatient medical records at one medical center in the United Kingdom. From this group, 20 patients had no clinically apparent underlying lung disease and were classified as having a primary spontaneous pneumothorax, and 20 patients were classified as having a secondary spontaneous pneumothorax. We assembled a control group composed of 40 subjects matched for age and smoking history who had a unilateral pleural effusion or were suspected to have a thoracic malignancy and had a chest computed tomography scan suitable for quantitative analysis. Demographics and smoking histories were collected. Quantitative evaluation of low-attenuation areas of the lung on computed tomography imaging was performed using semiautomated software, and the extent of emphysema-like destruction was assessed visually. The extent of emphysema and percentage of low-attenuation areas was greater for patients with primary spontaneous pneumothorax than for control subjects matched for age and smoking history (median, 0.25 vs. 0.00%; P = 0.019) and was also higher for patients with secondary pneumothorax than those with primary spontaneous pneumothorax (16.15 vs. 0.25%, P pneumothorax who smoked had significantly greater low-attenuation area than patients with primary pneumothorax who were nonsmokers (0.7 vs. 0.1%, P = 0.034). The majority of patients with primary spontaneous pneumothorax had quantifiable evidence of parenchymal destruction and emphysema. The exclusion of patients

  8. 20-year experience with iatrogenic penile injury.

    Science.gov (United States)

    Amukele, Samuel A; Lee, Gene W; Stock, Jeffrey A; Hanna, Moneer K

    2003-10-01

    We review our experience with the management of iatrogenic penile injuries. Apart from circumcision, serious damage to the penis can occur following hypospadias repair, surgery for priapism or total loss of the penis following surgical repair of bladder exstrophy. A retrospective analysis of patients with iatrogenic penile amputation referred to us between 1980 and 2000 was undertaken. Causes of injury and choice of management were reviewed. Of the 13 cases treated during the 20-year period mechanism of primary injury was circumcision in 4, hypospadias repair in 6, priapism in 1, bladder exstrophy repair in 1 and penile carcinoma in 1. A variety of techniques were used for phallic reconstruction. Penile degloving, division of suspensory ligament and rotational skin flaps achieved penile augmentation and enhancement. Reasonable cosmesis and penile length were achieved in all cases. In indicated cases microsurgical phalloplasty was technically feasible. However long-term followup showed various complications including erosions from the use of a penile stiffener. The ultimate goal of reconstructive surgery is to have a penis with normal function and appearance. The management of penile injury requires a wide variety of surgical techniques that are tailored to the individual patient. Expedient penile reconstruction is successful and therapeutic delay is associated with complications.

  9. [Occult pneumothorax: Does it take drain before elective surgery?].

    Science.gov (United States)

    Bensghir, M; Moutaoukil, M; Meziane, M; Jaafari, A; Hemmaoui, B; Haimeur, C

    2016-08-01

    Pneumothorax occult is defined by the presence of a non-visible to standard asymptomatic pneumothorax and pulmonary diagnosed only by X-ray computed tomography. The presence of this type of pneumothorax before planned surgery is a rare situation. What to do remains non-consensual. Through two clinic cases and a literature review, the authors discuss the modalities of management of this entity. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  10. Pneumothorax simulated by detachment of parietal pleura associated with pneumomediastinum

    International Nuclear Information System (INIS)

    Rozeik, C.; Kotterer, O.; Deininger, H.K.

    1994-01-01

    We report a case of blunt chest trauma, where findings on repeated conventional chest radiographs were compatible with pneumothorax developing after 2 days of mechanical high-pressure ventilation. CT showed that the appearance was due to a detachment of the parietal pleura along the lateral, mediastinal and diaphragmatic boundaries of the lungs, imitating a pneumothorax. The case report illustrates the key role of CT in the differential diagnosis of epipleural interstitial air collection versus pneumothorax. (orig./MG)

  11. Pneumothorax simulated by detachment of parietal pleura associated with pneumomediastinum

    Energy Technology Data Exchange (ETDEWEB)

    Rozeik, C. [Radiologie 1, Staedtische Kliniken Darmstadt (Germany); Kotterer, O. [Radiologie 1, Staedtische Kliniken Darmstadt (Germany); Deininger, H.K. [Radiologie 1, Staedtische Kliniken Darmstadt (Germany)

    1994-10-01

    We report a case of blunt chest trauma, where findings on repeated conventional chest radiographs were compatible with pneumothorax developing after 2 days of mechanical high-pressure ventilation. CT showed that the appearance was due to a detachment of the parietal pleura along the lateral, mediastinal and diaphragmatic boundaries of the lungs, imitating a pneumothorax. The case report illustrates the key role of CT in the differential diagnosis of epipleural interstitial air collection versus pneumothorax. (orig./MG)

  12. Postoperative recurrence after VATS for spontaneous pneumothorax

    International Nuclear Information System (INIS)

    Katsuno, Gotaro; Tsumura, Makoto; Kokudo, Yasutaka; Muraoka, Atsushi; Tsuruno, Masaki

    2003-01-01

    A total of 88 cases of 81 patients with spontaneous pneumothorax treated at the hospital from March 1992 to August 2001 were subjected to a study of examining preoperative chest CT and thoracographic findings from the standpoint of postoperative recurrence. Preoperative chest CT and thoracography were conducted in 82 cases and 41 cases (including 25 cases with continuous air leakage), respectively. Eight (9.1%) patients developed recurrence of pneumothorax, and three patients of them underwent reoperation. Considering the intraoperative findings, newly formed bullae appeared to be a cause of recurrence. Resulting from these examinations, we conclude that it is difficult to predict the risk factor for postoperative recurrence at this time, in addition, it is important that the area of air leakage can be confirmed by thoracoscopic findings. (author)

  13. Spontaneous pneumothorax and pneumomediastinum in IPF

    International Nuclear Information System (INIS)

    Franquet, T.; Gimenez, A.; Torrubia, S.; Sabate, J.M.; Rodriguez-Arias, J.M.

    2000-01-01

    Patients with idiopathic pulmonary fibrosis (IPF) are at risk for a variety of acute pulmonary complications, including pneumothorax and pneumomediastinum. Our aim was to describe the radiographic and CT findings and to determine the frequency of complicating spontaneous pneumothorax and pneumomediastinum in patients with IPF. A retrospective study was performed including 78 consecutive patients who underwent CT scanning of the chest and who had confirmed IPF. The chest radiographs and CT scans were reviewed by two chest radiologists and classified as showing features of extra-alveolar air collections. The CT scans showed extra-alveolar air in 9 (11.2 %) of 78 patients (six females and three males; age range 26-90 years, mean age 65 years). Pneumothorax was demonstrated in 5 patients and mediastinal air collections in 4 patients. All patients had dyspnea for 1-48 months (mean 14 months). Of the five cases with pneumothorax, four developed acute onset of dyspnea and pleuritic chest pain, whereas 1 patient had a relatively stable functional status. Of the 4 patients with pneumomediastinum, three presented with nonpleuritic chest pain and acute dyspnea. Chest radiographs showed extra-alveolar air in 6 patients. Three cases were predicted to be negative by chest radiographs. Follow-up CT showed that air collections had resolved completely in 5 patients. Two patients died of respiratory failure within 4 months after CT. Extra-alveolar air should be recognized as a relatively common IPF-related complication. Chest CT is a useful imaging method in determining air collections in patients with IPF that become acutely breathless and their chest radiograph fails to reveal the presence of extra-alveolar air. (orig.)

  14. Recurrent secondary spontaneous pneumothorax in silicosis: a case report.

    Science.gov (United States)

    Amanda, Gina; Taufik, Feni Fitriani

    2016-01-01

    Silicosis is an occupational lung disease which is caused by inhalation and accumulation of crystalline silica particles in the lung. It commonly occurs in workers involved in quarrying, mining, sandblasting, tunneling, foundry work, and ceramics. Pneumothorax is one of the complications of silicosis with pleural involvement. The occurrence of pneumothorax in a patient with silicosis is a rare event, but it may be fatal. The rate of pneumothorax recurrence in silicosis is usually low. We report a case of recurrent secondary spontaneous pneumothorax in silicosis.

  15. Analysis on the occurrence rate of pneumothorax after percutaneous pneumocentesis

    International Nuclear Information System (INIS)

    Zhu Qi; Wang Kun; Ren Ran

    2001-01-01

    Objective: To analyze the influence of multiple variable factors on the occurrence rate of pneumothorax associated with transthoracic needle aspiration biopsy of the lung. Methods: Fluoroscopical guided lung biopsies were performed in 46 patients. Variable factors were analyzed including lesion size, location, number of puncture, presence of emphysema and patients position after needle biopsy of the lung. Results: Pneumothorax occurred at 9 (19.6%) of 46 patients and that occurred at 4(44.4%) of 9 emphysematous patients. Among them 2 necessitated chest drainage tube placement. The pneumothorax occurrence rate was 30% (3/10) for lesions of diameter 3 cm or less in size. In the dependent group, pneumothorax occurred in 4 of 20 patients (20%). In the non-dependent group, pneumothorax occurred in 5 of 26 patients (19.2%). Conclusion: The correlation showed that increasing frequency of pneumothorax with decreasing size of lesions. An increased rate of pneumothorax was correlated with presence of emphysema. Patients with emphysema are more likely to have a symptomatic pneumothorax. No significant differences were found in the incidence of pneumothorax between patients placed with the puncture site dependent after biopsy and those placed with the puncture site non-dependent

  16. Video-assisted thoracoscopy treatment of spontaneous pneumothorax

    International Nuclear Information System (INIS)

    Chen Haitao; Ren Jian; Che Jiaming; Hang Junbiao; Qiu Weicheng; Chen Zhongyuan

    2002-01-01

    Objective: To propose a treatment protocol by video thoracoscopy in spontaneous pneumothorax. Methods: One hundred and three patients underwent Video-assisted thoracoscopy (VATS) treatment of spontaneous pneumothorax and hemothorax. Indications included recurrent pneumothorax, persistent air leakage following conservative therapy, complicated hemothorax and CT scan identified bullae formation. Results: No operative deaths occurred, conversion rate was 2.91%, recurrence rate was 0.97%, complication rate was 3.81% and mean postoperative hospital stay was 5.6 days. Conclusions: VATS treatment of spontaneous pneumothorax is better than open chest surgery and also superior than conservative therapy

  17. CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma

    Energy Technology Data Exchange (ETDEWEB)

    Wall, S.D. (Univ. of California, San Francisco); Federle, M.P.; Jeffrey, R.B.; Brett, C.M.

    1983-11-01

    Review of abdominal CT scans for evaluation of blunt abdominal trauma yielded 35 cases of pneumothorax, 10 of which had not been diagnosed before CT by clinical examination of plain radiographs. Of the 10 cases initially diagnosed on CT, seven required tube thoracostomy for treatment of the pneumothorax. CT detection of pneumothorax is especially important if mechanical assisted ventilation or general anesthesia is used. Demonstration of pneumothorax requires viewing CT scans of the upper abdomen (lower thorax) at lung windows in addition to the usual soft-tissue windows.

  18. CT diagnosis of unsuspected pneumothorax after blunt abdominal trauma

    International Nuclear Information System (INIS)

    Wall, S.D.; Federle, M.P.; Jeffrey, R.B.; Brett, C.M.

    1983-01-01

    Review of abdominal CT scans for evaluation of blunt abdominal trauma yielded 35 cases of pneumothorax, 10 of which had not been diagnosed before CT by clinical examination of plain radiographs. Of the 10 cases initially diagnosed on CT, seven required tube thoracostomy for treatment of the pneumothorax. CT detection of pneumothorax is especially important if mechanical assisted ventilation or general anesthesia is used. Demonstration of pneumothorax requires viewing CT scans of the upper abdomen (lower thorax) at lung windows in addition to the usual soft-tissue windows

  19. Iatrogenic Digital Compromise with Tubular Dressings

    Directory of Open Access Journals (Sweden)

    Corre, Kenneth A

    2009-08-01

    Full Text Available Objective: This case report describes a digit amputation resulting from an improperly applied tubular dressing. The safe application of digital tubular dressings, and the rationale behind it, is detailed to raise emergency physician (EP awareness.Methods: We present a case report of a recent iatrogenic-induced digit ischemia caused by improperly applied tube gauze. We review the literature on the subject and the likely sources of poor outcomes presented. The proper application of tubular gauze dressings is then outlined.Conclusion: EPs and emergency department personnel must be educated on the safe application of tubular gauze dressings to avoid dire outcomes associated with improper applications.[WestJEM. 2009;10:190-192.

  20. Size of pneumothorax can be a new indication for surgical treatment in primary spontaneous pneumothorax: a prospective study.

    Science.gov (United States)

    Sayar, Adnan; Kök, Abdulaziz; Citak, Necati; Metin, Muzaffer; Büyükkale, Songül; Gürses, Atilla

    2014-01-01

    Surgical treatment of primary spontaneous pneumothorax (PSP) is usually performed in cases of prolonged air leak (PAL) or recurrence. We investigated the effect of the size of pneumothorax in surgically treated PSP cases. Between 2007 and 2008, 181 patients hospitalized with the diagnosis of PSP were prospectively recorded. The size of pneumothorax was calculated in percentages by the method defined by Kircher and Swartzel. Patients were divided into two groups, according to pneumothorax size: Group A (large pneumothorax, ≥50%), and Group B (small or moderate pneumothorax, <50%). The mean size of pneumothorax was 80.5 ± 10.4% in Group A (n = 54, 29%) and 39.5 ± 6.5% in Group B (n = 127, 71%). History of smoking and smoking index were significantly higher in Group A patients (p = 0.02, p <0.001, respectively). Fifty-five patients (29.3%) required surgery because of PAL or ipsilateral recurrence. The rate of patients requiring surgical operation was significantly higher in Group A (51.9%) than in Group B (n = 25; p <0.001). Rates of PAL and recurrence were higher in Group A than in Group B (p = 0.007, p = 0.004, respectively). The size of pneumothorax is larger in those with a smoking history and a higher smoking index. Surgical therapy can be considered in cases with a pneumothorax size ≥50% after the first episode immediately.

  1. Subcutaneous emphysema in cavitary pulmonary tuberculosis without pneumothorax or pneumomediastinum

    Directory of Open Access Journals (Sweden)

    Ramakant Dixit

    2012-01-01

    Full Text Available Extra-alveolar air in the form of subcutaneous tissue emphysema is observed in a variety of clinical settings. Spontaneous subcutaneous emphysema in the absence of pneumothorax or pneumomediastinum is very rare. We report a case of spontaneous subcutaneous emphysema secondary to cavitary pulmonary tuberculosis in the absence of pneumothorax or pneumomediastinum.

  2. Pneumothorax Following Feeding Tube Placement: Precaution and Treatment

    Directory of Open Access Journals (Sweden)

    Morteza Zahmatkesh

    2012-05-01

    Full Text Available Nasojejunal feeding tubes are being used at an increased frequency, but it is not without complications that could be life-threatening. We report two cases of pneumothorax following small-bore feeding tube insertion into the pleural cavity, resulting in pneumothorax. We further discuss the potential measures that can be taken to prevent and treat this serious complication.

  3. Browse Title Index

    African Journals Online (AJOL)

    Vol 28, No 1 (2017), Spontaneous resolution of post-traumatic chronic ... with pseudo-dextrocardia, complicated by iatrogenic tension pneumothorax, Abstract ... ST-segment elevation after blunt chest trauma: myocardial contusion with normal ...

  4. Computed tomography in the assessment of idiopathic spontaneous pneumothorax

    International Nuclear Information System (INIS)

    Kim, Sang Jin; Lee, Doo Yun; Kim, Hyung Jung

    1991-01-01

    It is well known that idiopathic spontaneous pneumothorax is caused by rupture of the subpleural bleb and presents difficulty in exact detection and localization of the bleb with plain chest X - ray alone. The authors performed chest CT scans for accurate diagnosis of bleb that would act as a guide for optimal management of idiopathic spontaneous pneumothorax patients in order to prevent recurrent pneumothorax. We could detect blebs in 93 % (26/28) of the patients with idiopathic spontaneous pneumothorax, and 68 % (19/ 28) of the patient had bilateral blebs. Sensitivity was 0.63, and false negative was 37% (37/100) of the blebs, and 51% (19/37) of these 37 false negative cases were ruptured blebs. Only 7 % (2/28) of the patients had a single bleb. The authors concluded that CT is a useful method of study for optimal management of idiopathic spontaneous pneumothorax patients

  5. Acute kidney injury secondary to iatrogenic bilateral ureteric ligation ...

    African Journals Online (AJOL)

    Acute kidney injury secondary to iatrogenic bilateral ureteric ligation following emergency abdominal hysterectomy. Oluseyi A. Adejumo, Olurotimi S. Ogundiniyi, Ayodeji A. Akinbodewa, Lawrence A. Adesunloro, Oladimeji J. Olafisoye ...

  6. Automated Quantification of Pneumothorax in CT

    Science.gov (United States)

    Do, Synho; Salvaggio, Kristen; Gupta, Supriya; Kalra, Mannudeep; Ali, Nabeel U.; Pien, Homer

    2012-01-01

    An automated, computer-aided diagnosis (CAD) algorithm for the quantification of pneumothoraces from Multidetector Computed Tomography (MDCT) images has been developed. Algorithm performance was evaluated through comparison to manual segmentation by expert radiologists. A combination of two-dimensional and three-dimensional processing techniques was incorporated to reduce required processing time by two-thirds (as compared to similar techniques). Volumetric measurements on relative pneumothorax size were obtained and the overall performance of the automated method shows an average error of just below 1%. PMID:23082091

  7. Delayed Diagnosis of Iatrogenic Bladder Perforation in a Neonate

    Directory of Open Access Journals (Sweden)

    Antoinette S. Birs

    2016-01-01

    Full Text Available Iatrogenic bladder injuries have been reported in the neonate during umbilical artery/vein catheterization, voiding cystourethrogram, urinary catheterizations, and overwhelming hypoxic conditions. Patients with iatrogenic bladder perforations can present with acute abdomen indicating urinary peritonitis, septic-uremic shock, or subtle symptoms like abdominal distension, pain, hematuria, uremia, electrolyte imbalances, and/or difficulty urinating. The following neonatal case report of perforated bladder includes a review of the signs, symptoms, diagnostic tools, and management of bladder injury in neonates.

  8. Conjunctival Mass as an Initial Presentation of Iatrogenic Orbital Encephalocele.

    Science.gov (United States)

    Rautenbach, Pierre; Thyagaraja, Dhanurjaya Vignesh; Irvine, Fiona

    2015-01-01

    A 46-year-old woman presented with a symptomatic conjunctival mass of the right eye, appearing 2 months after undergoing right frontal craniotomy to excise a meningioma. MRI of the brain revealed a new iatrogenic encephalocele extending into the right temporal orbit. Our opinion is that the conjunctival mass resulted directly from this encephalocele. To date this has been conservatively managed, and we believe this to be the first report of an iatrogenic encephalocele presenting in this manner.

  9. [Tension gastrothorax as a cause of death by obstructive shock - case report].

    Science.gov (United States)

    García-Regalado, Juan F; Navarro-Rojas, Mariana M

    2014-07-01

    Tension gastrothorax is caused by the herniation of the stomach into the thorax due to a congenital defect of the diaphragm; the Bochdaleck diaphragmatic hernia (HDB) is the most frequent type. Tension gastrothorax should be considered as a differential diagnosis in patients with obstructive shock and tension pneumothorax. A previously healthy 10 month-old male infant, who presented increased respiratory distress, increased volume of the left hemithorax, absence of breath sounds, ipsilateral hyper-resonance, 76% saturation, cold skin and capillary filling > 5 seconds, followed by a cardio-respiratory arrest. Due to clinical suspicion of pneumothorax, needle decompression was performed reversing cardiac arrest, but with persistent hemodynamic and respiratory instability; chest radiograph suggested diaphragmatic hernia. He underwent surgery confirming the presence of a diaphragmatic hernia of 5 cm. The evolution of this case shows the difficulty differentiating a tension gastrothorax from tension pneumothorax in patients admitted to the emergency room who are in serious condition; therefore, a high index of suspicion is needed for its identification.

  10. Understanding placebo, nocebo, and iatrogenic treatment effects.

    Science.gov (United States)

    Bootzin, Richard R; Bailey, Elaine T

    2005-07-01

    Placebo and nonplacebo treatments have both positive and negative effects on patient outcomes. To better understand the patterning of treatment effects, three specific interventions will be discussed that are reported to produce more harm than benefit: critical incident stress debriefing, group therapy for adolescents with conduct disorders, and psychotherapy for dissociative identity disorder. In each case, there is an interaction between mechanisms thought to underlie both placebo and specific treatment effects. Mechanisms hypothesized to underlie placebo and nocebo effects include patient expectancy, self-focused attention to symptoms, motivation to change, and sociocultural role-enactment cues. In the three treatments discussed, specific mechanisms interact with nonspecific mechanisms to produce iatrogenic effects. To advance knowledge, it is important both to specify the theory of treatment and its expected outcomes and to put the theory to test. Only with attention to the empirical findings from programmatic research of specific and nonspecific effects and their interaction is it possible to improve the outcomes of treatment beyond the status quo.

  11. Iatrogenic causes of salivary gland dysfunction

    International Nuclear Information System (INIS)

    Schubert, M.M.; Izutsu, K.T.

    1987-01-01

    Saliva is important for maintaining oral health and function. There are instances when medical therapy is intended to decrease salivary flow, such as during general anesthesia, but most instances of iatrogenic salivary gland dysfunction represent untoward or unavoidable side-effects. The clinical expression of the salivary dysfunction can range from very minor transient alteration in saliva flow to a total loss of salivary function. The most common forms of therapy that interfere with salivation are drug therapies, cancer therapies (radiation or chemotherapy), and surgical therapy. These therapies can affect salivation by a number of different mechanisms that include: disruption of autonomic nerve function related to salivation, interference with acinar or ductal cell functions related to salivation, cytotoxicity, indirect effects (vasoconstriction/dilation, fluid and electrolyte balance, etc.), and physical trauma to salivary glands and nerves. A wide variety of drugs is capable of increasing or decreasing salivary flow by mimicking autonomic nervous system actions or by directly acting on cellular processes necessary for salivation: drugs can also indirectly affect salivation by altering fluid and electrolyte balance or by affecting blood flow to the glands. Ionizing radiation can cause permanent damage to salivary glands, damage that is manifest as acinar cell destruction with subsequent atrophy and fibrosis of the glands. Cancer chemotherapy can cause changes in salivation, but the changes are usually much less severe and only transient. Finally, surgical and traumatic injuries interfere with salivation because of either disruption of gland innervation or gross physical damage (or removal) of glandular tissue (including ducts)

  12. Foreign body gingivitis: An iatrogenic disease

    Energy Technology Data Exchange (ETDEWEB)

    Daley, T.D.; Wysocki, G.P. (Univ. of Western Ontario, London (Canada))

    1990-06-01

    Gingival biopsy specimens from eight patients exhibiting a localized, erythematous, or mixed erythematous/leukoplakic gingivitis that was refractory to conventional periodontal therapy were examined histologically and by energy-dispersive X-ray microanalysis. Histologic examination revealed variable numbers of small, usually subtle, sometimes equivocal, and occasionally obvious foci of granulomatous inflammation. Special stains for fungi and acid-fast bacilli were consistently negative. In all cases, the granulomatous foci contained particles of foreign material that were often inconspicuous and easily overlooked during routine histologic examination. Energy-dispersive X-ray microanalysis of these foreign particles disclosed Ca, Al, Si, Ti, and P in most lesions. However, other elements such as Zr, V, Ag, and Ni were found only in specific biopsy specimens. By comparing the elemental analyses, clinical features, and history of the lesions, strong evidence for an iatrogenic source of the foreign material was found in one case, and good evidence in five cases. In the remaining two patients, the source of the foreign particles remains unresolved.

  13. Identification and Management of Iatrogenic Aortocoronary Dissection

    Directory of Open Access Journals (Sweden)

    Shao-Ping Nie, MD, PhD, FESC, FSCAI

    2016-05-01

    Full Text Available Iatrogenic aortocoronary dissection (IACD is a rare but potentially life-threatening complication during coronary catheterizations. Although the incidence was relatively low, the dissection often leads to procedure failure with increased risk of myocardial infarction and death. IACD is mainly caused by disruption of intima at the ostia of left or right coronary artery during interventional procedures, and appears as luminal filling defects or persistence of contrast (“extraluminal cap” or intimal tear outside the coronary lumen. Dissection could disseminate antegradely and lead to subtotal or total occlusion of the coronary lumen. Similarly, it could extend retrogradely into the sinus of Valsalva and cusp, or even the ascending aorta, aortic arch, or descending aorta, leading to hemodynamic collapse. Early identification and prompt management is crucial to the prognosis of patients with IACD. Immediate bail-out stenting should be performed as rapidly as possible in most cases of severe dissection, even when significant propagation has already occurred. Surgery should only be considered when stenting failed to seal the dissection and the patients had hemodynamic compromise.

  14. Foreign body gingivitis: An iatrogenic disease

    International Nuclear Information System (INIS)

    Daley, T.D.; Wysocki, G.P.

    1990-01-01

    Gingival biopsy specimens from eight patients exhibiting a localized, erythematous, or mixed erythematous/leukoplakic gingivitis that was refractory to conventional periodontal therapy were examined histologically and by energy-dispersive X-ray microanalysis. Histologic examination revealed variable numbers of small, usually subtle, sometimes equivocal, and occasionally obvious foci of granulomatous inflammation. Special stains for fungi and acid-fast bacilli were consistently negative. In all cases, the granulomatous foci contained particles of foreign material that were often inconspicuous and easily overlooked during routine histologic examination. Energy-dispersive X-ray microanalysis of these foreign particles disclosed Ca, Al, Si, Ti, and P in most lesions. However, other elements such as Zr, V, Ag, and Ni were found only in specific biopsy specimens. By comparing the elemental analyses, clinical features, and history of the lesions, strong evidence for an iatrogenic source of the foreign material was found in one case, and good evidence in five cases. In the remaining two patients, the source of the foreign particles remains unresolved

  15. Iatrogenic osteomalacia: report of two cases.

    Science.gov (United States)

    Yamamoto, Sunao; Okada, Yosuke; Mori, Hiroko; Kurozumi, Akira; Torimoto, Keiichi; Arao, Tadashi; Tanaka, Yoshiya

    2013-03-01

    CASE 1: An 80-year-old man presented at our hospital with pain in both knees.He had received continuous intravenous administration of saccharated ferric oxide (SFO) over a period of five years following a diagnosis of iron-deficiency anemia.Blood tests revealed hypophosphatemia (1.4 mg/dl) and high circulating levels of fibroblast growth factor 23 (FGF23) at 248.8 mg/dl.These findings led to the diagnosis of FGF23-related osteomalacia due to SFO administration.Accordingly, the treatment plan was first to discontinue SFO, which led to a decrease in pain and normalization of phosphorus and FGF23 after 1 month.CASE 2: A 63-year-old woman presented at our hospital with leg pain.She had undergone total gastrectomy for gastric cancer at 36 years of age.Blood tests revealed hypocalcemia (8.3 mg/dl) and hypophosphatemia (2.2 mg/dl), and 25(OH)D at no more than 5 pg/ml.Bone X-rays showed significantly diminished bone shadowing.These findings led to a diagnosis of vitamin D-deficient osteomalacia due to impaired absorption following total gastrectomy.For therapy, she was treated with 1 μg/day oral alfacalcidol.Two months after initiating treatment, the pain improved. When a patient is diagnosed with unexplained pain, it is important to pay attention to the possibility of an iatrogenic etiology.

  16. The sharp edge: a frequent radiographic sign in neonatal pneumothorax

    International Nuclear Information System (INIS)

    Oestreich, A.E.

    1987-01-01

    The sharp edge sign, an unusually sharply defined silhouette of the heart and/or hemidiaphragm on frontal radiographs of the supine neonate, has been valuable in the initial recognition of pneumothorax. In a prospective study of 50 neonatal pneumothoraces, a sharp edge sign was present on the initial pneumothorax film 49 times. In seven of these, only the hemidiaphragm showed a sharp edge, while the heart margin was superimposed on the vertebral column. Greater awareness of the sharp edge sign would promote earlier recognition of neonatal pneumothorax. 6 refs.; 3 figs

  17. Diagnosis of pneumothorax using a microwave-based detector

    Science.gov (United States)

    Ling, Geoffrey S. F.; Riechers, Ronald G., Sr.; Pasala, Krishna M.; Blanchard, Jeremy; Nozaki, Masako; Ramage, Anthony; Jackson, William; Rosner, Michael; Garcia-Pinto, Patricia; Yun, Catherine; Butler, Nathan; Riechers, Ronald G., Jr.; Williams, Daniel; Zeidman, Seth M.; Rhee, Peter; Ecklund, James M.; Fitzpatrick, Thomas; Lockhart, Stephen

    2001-08-01

    A novel method for identifying pneumothorax is presented. This method is based on a novel device that uses electromagnetic waves in the microwave radio frequency (RF) region and a modified algorithm previously used for the estimation of the angle of arrival of radar signals. In this study, we employ this radio frequency triage tool (RAFT) to the clinical condition of pneumothorax, which is a collapsed lung. In anesthetized pigs, RAFT can detect changes in the RF signature from a lung that is 20 percent or greater collapsed. These results are compared to chest x-ray. Both studies are equivalent in their ability to detect pneumothorax in pigs.

  18. CT staging of lung cancer: the role of artificial pneumothorax

    International Nuclear Information System (INIS)

    Lee, Jin Seong; Im, Jung Gi; Han, Man Chung

    1991-01-01

    To determine the role of artificially induced pneumothorax in the evaluation of the chest wall and mediastinal invasion in patients with peripheral bronchogenic carcinoma. CT scans of 22 patients obtained after induced pneumothorax were evaluated. All patients had peripheral lung mass abutting the pleura on a routine CT scan. Room air of 200-400ml was introduced through intrathoracic negative pressure initially, followed by pressure injection through the 18 gauge long bevelled needle under fluoroscopic control. Conclusively, CT with artificial pneumothorax added more information than conventional CT in the evaluation of the chest wall or mediastinal invasion by lung cancer without notable risk

  19. X-ray diagnosis of pneumothorax in intensive care units

    International Nuclear Information System (INIS)

    Galanski, M.; Hartenauer, U.; Krumme, B.

    1981-01-01

    Pneumothorax is the most severe manifestation of pulmonary barotrauma which occurs in mechanical ventilation. Diagnosis of pneumothorax in intensive care radiology is of particular difficulty. Chest radiographs in supine position show a variety of signs which may be helpful but are not conclusive. There are different techniques for verification of ventrally located pneumothorax. 45 0 tangential radiographs of the hemithorax in question are most conclusive for demonstration of extrapulmonary air located inside the pleural cavity. This 45 0 technique is easy to carry out without changing the patients position. (orig.) [de

  20. Bleb Point: Mimicker of Pneumothorax in Bullous Lung Disease

    Directory of Open Access Journals (Sweden)

    Gelabert, Christopher

    2015-05-01

    Full Text Available In patients presenting with severe dyspnea, several diagnostic challenges arise in distinguishing the diagnosis of pneumothorax versus several other pulmonary etiologies like bullous lung disease, pneumonia, interstitial lung disease, and acute respiratory distress syndrome. Distinguishing between large pulmonary bullae and pneumothorax is of the utmost importance, as the acute management is very different. While multiple imaging modalities are available, plain radiographs may be inadequate to make the diagnosis and other advanced imaging may be difficult to obtain. Ultrasound has a very high specificity for pneumothorax. We present a case where a large pulmonary bleb mimics the lung point and therefore inaccurately suggests pneumothorax. [West J Emerg Med. 2015;16(3:447–449.

  1. Pneumothorax and subcutaneous emphysema secondary to blunt chest injury

    OpenAIRE

    Porhomayon, Jahan; Doerr, Ralph

    2011-01-01

    This is the case of a patient with a history of blunt chest trauma associated with subcutaneous emphysema and pneumothorax. The patient complained of inspiratory stridor on presentation. Anatomical relationships can explain the pathophysiological process.

  2. Novel folliculin (FLCN) mutation and familial spontaneous pneumothorax.

    Science.gov (United States)

    Zhu, J-F; Shen, X-Q; Zhu, F; Tian, L

    2017-01-01

    Familial spontaneous pneumothorax is one of the characteristics of Birt-Hogg-Dubé syndrome (BHDS), which is an autosomal dominant disease caused by the mutation of folliculin (FLCN). To investigate the mutation of FLCN gene in a familial spontaneous pneumothorax. Prospective case study. Clinical and genetic data of a Chinese family with four patients who presented spontaneous pneumothorax in the absence of skin lesions or renal tumors were collected. CT scan of patient's lung was applied for observation of pneumothorax. DNA sequencing of the coding exons (4-14 exons) of FLCN was performed for all 11 members of the family and 100 unrelated healthy controls. CT scan of patient's lung showed spontaneous pneumothorax. A mutation (c. 510C > G) that leads to a premature stop codon (p. Y170X) was found in the proband using DNA sequencing of coding exons (4-14 exons) of FLCN. This mutation was also observed in the other affected members of the family. A nonsense mutation of FLCN was found in a spontaneous pneumothorax family. Our results expand the mutational spectrum of FLCN in patients with BHDS. © The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Transthoracic needle biopsy: factors effecting risk of pneumothorax

    International Nuclear Information System (INIS)

    Topal, Ugur; Ediz, Buelent

    2003-01-01

    Objective: to evaluate the factors that could effect the risk of pneumothorax in patients undergoing transthoracic biopsy. Material and methods: variables that could increase the risk of pneumothorax were evaluated in 453 CT-guided transthoracic biopsies. Factors were evaluated in two groups: (1) lesion related (presence of emphysema around the lesion, lesion depth, cavitation, presence of fissure/atelectasis and pleural tag in the needle trajectory); and (2) procedure related (biopsy type, needle size, number of passages, level of experience of the operator). All variables were analysed by χ 2 test and multivariate logistic regression statistics. Results: pneumothorax was developed in 85 (18.8%) out of 453 procedures. A chest tube was inserted in ten (11.7%) of them. Variables that were significantly associated with an increased risk of pneumothorax were depth of the lesion (P<0.001) and severity of the emphysema (P<0.01). Conclusion: the length of the lung parenchyma traversed during the biopsy is the predominant risk factor for pneumothorax in patients undergoing CT-guided transthoracic biopsy. The risk of pneumothorax was also increased with the severity of the emphysema around the lesion

  4. Recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax.

    Science.gov (United States)

    Dagnegård, Hanna H; Rosén, Alice; Sartipy, Ulrik; Bergman, Per

    2017-08-01

    There is an on-going discussion regarding the recurrence rate after surgery for primary spontaneous pneumothorax by video assisted thoracic surgery (VATS) or by thoracotomy access. This study aimed to describe the recurrence rate, and to identify a possible learning curve, following surgery for primary spontaneous pneumothorax by VATS. All patients who underwent surgery for primary spontaneous pneumothorax by VATS at Karolinska University Hospital 2004-2013 were reviewed. Preoperative and operative characteristics were obtained from medical records. Patients were followed-up through telephone interviews or questionnaires and by review of medical records. The primary outcome of interest was time to recurrence of pneumothorax requiring intervention. Outcomes were compared between patients operated during 2004-June 2010 and July 2010-2013. 219 patients who underwent 234 consecutive procedures were included. The mean follow-up times were 6.3 and 2.9 years in the early and late period, respectively. The postoperative recurrence rate in the early period was 16% (11%-25%), 18% (12%-27%), and 18% (12%-27%), at 1, 3 and 5 years, compared to 1.7% (0.4%-6.8%), 7.6% (3.7%-15%), and 9.8% (4.8%-19%) at 1, 3 and 5 years, in the late period (p = 0.016). We found that the recurrence rate after thoracoscopic surgery for primary spontaneous pneumothorax decreased significantly during the study period. Our results strongly suggest that thoracoscopic surgery for pneumothorax involve a substantial learning curve.

  5. Spontaneous pneumothorax after upper mantle radiation therapy for Hodgkin disease

    International Nuclear Information System (INIS)

    Paszat, L.; Basrur, V.; Tadros, A.

    1986-01-01

    Between 1967 and 1981, 158 of 256 consecutive adult patients received upper mantle (UM) radiation therapy as part of initial treatment of Hodgkin disease at the Hamilton Regional Cancer Centre. Chemotherapy was also part of the initial treatment in 21 of 158 patients who received UM radiation therapy. Spontaneous pneumothorax was observed in six of 158 patients during remission after UM radiation therapy in this series. Three cases were incidental findings on follow-up radiographs, but three other patients were seen initially with symptoms of spontaneous pneumothorax. The entity occurred in three of 21 patients (14%) treated with UM radiation therapy and chemotherapy, and in three of 137 (2%) treated with UM radiation therapy (P < .05). Within the range of UM doses (3,500-4,000 cGy in 4 weeks), higher dose was not associated with higher risk of spontaneous pneumothorax. Although these cases of spontaneous pneumothorax are clustered in an age range classic for this entity, the incidence of spontaneous pneumothorax in this group of patients is higher than the anticipated lifetime incidence of 1:500 for the general population. This risk of spontaneous pneumothorax after UM radiation therapy may be even higher in patients who also receive chemotherapy

  6. The Role of Incentive Spirometry in Primary Spontaneous Pneumothorax.

    Science.gov (United States)

    Pribadi, Rabbinu R; Singh, Gurmeet; Rumende, Cleopas M

    2016-01-01

    Pneumothorax is the presence of air in the pleural space. Its management consists of noninvasive and invasive therapies and it is determined based on clinical manifestations, type and size of pneumothorax. We present a case of a patient with diagnosis of primary spontaneous pneumothorax treated with incentive spirometry (noninvasive therapy). A 20 year old man came to respirology clinic with chief complaint of shortness of breath. He was recently diagnosed with left pneumothorax based on previous chest X-ray in another health care facilities and was advised to undergo tube thoracostomy but he refused the procedure. On physical examination, vital signs were normal. Chest X-ray showed 33% of pneumothorax or 1.2 cm. He was asked to perform incentive spirometry therapy at home. During 12 days of therapy, shortness of breath slowly disappeared and on repeated chest X-ray, it showed minimal pneumothorax in the left upper hemithorax. Noninvasive treatment such as incentive spirometry can be considered in patient with minimal symptoms and no signs of life-threatening respiratory distress.

  7. Iatrogenic intraspinal epidermoid tumor: Myelo-CT and MRI diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Visciani, A.; Balestrini, M.R.; Solero, C.L.; Savoiardo, M.

    1989-07-01

    An 11-year-old boy, treated for acute lymphatic leukemia at the age of 2 with intrathecal injections of Methotrexate, presented with a two year history of pain and signs of lumbo-sacral lesion. MRI, myelography and myelo-CT demonstrated an intradural L4-L5 epidermoid tumor which was removed. Iatrogenic implantation of epithelial cells at the age of two with lumbar punctures is most likely. Decline in incidence of lumbar iatrogenic epidermoid cysts, now an exceedingly rare event, is probably related to improved needles for lumbar punctures. (orig.).

  8. Iatrogenic intraspinal epidermoid tumor: Myelo-CT and MRI diagnosis

    International Nuclear Information System (INIS)

    Visciani, A.; Balestrini, M.R.; Solero, C.L.; Savoiardo, M.

    1989-01-01

    An 11-year-old boy, treated for acute lymphatic leukemia at the age of 2 with intrathecal injections of Methotrexate, presented with a two year history of pain and signs of lumbo-sacral lesion. MRI, myelography and myelo-CT demonstrated an intradural L4-L5 epidermoid tumor which was removed. Iatrogenic implantation of epithelial cells at the age of two with lumbar punctures is most likely. Decline in incidence of lumbar iatrogenic epidermoid cysts, now an exceedingly rare event, is probably related to improved needles for lumbar punctures. (orig.)

  9. Comparison between plain chest film and CT in estimating the size of pneumothorax

    International Nuclear Information System (INIS)

    Seto, Yuichi

    1995-01-01

    Regarding the patients diagnosed as having traumatic and spontaneous pneumothorax at our emergency center within the past 6 years we examined the distribution of pneumothorax shown by plain chest film and CT, and compared the pneumothorax rate evaluated by Kircher's method with plain chest film and that by one slice method with CT, which was based on full slice integration method with CT. Occult pneumothorax was found in 47.6% of traumatic cases and 11.1% of spontaneous cases. The distribution of pneumothoraces showed no significant differences. However, as compared with classical pneumothorax, the ratio of pneumothoraces in the apicolateral recess in the occult pneumothoraces tended to be lower, whereas the ratio of the ones in the anteromedial recess and in the subpulmonic recess tended to be comparatively high. The plain chest film of occult pneumothorax had been taken on supine position in most cases of traumatic pneumothorax and in more than half the cases of spontaneous pneumothorax. This was considered to be the cause of the unique distribution of pneumothorax. The pneumothorax rate evaluated by Kircher's method tended to be underestimated in comparison with the basic rate, where the correlation coefficient was R=0.84 for traumatic pneumothorax and R=0.14 for spontaneous pneumothorax. Especially in the cases of low pneumothorax rate the correlation was poor. The pneumothorax rate calculated by one slice method produced better figures with the correlation coefficient of R=0.92 for traumatic pneumothorax and R=0.85 for spontaneous pneumothorax. The one slice method was considered to be effective in evaluation of the degree of serious cases, and also for the choice of treatment modality for pneumothorax. (author)

  10. Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery.

    Science.gov (United States)

    Daniels, Alan H; Hart, Robert A; Hilibrand, Alan S; Fish, David E; Wang, Jeffrey C; Lord, Elizabeth L; Buser, Zorica; Tortolani, P Justin; Stroh, D Alex; Nassr, Ahmad; Currier, Bradford L; Sebastian, Arjun S; Arnold, Paul M; Fehlings, Michael G; Mroz, Thomas E; Riew, K Daniel

    2017-04-01

    Retrospective cohort study of prospectively collected data. To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011, were reviewed to identify occurrence of iatrogenic spinal cord injury. In total, 3 cases of iatrogenic spinal cord injury following cervical spine surgery were identified. Institutional incidence rates ranged from 0.0% to 0.24%. Of the 3 patients with quadriplegia, one underwent anterior-only surgery with 2-level cervical corpectomy, one underwent anterior surgery with corpectomy in addition to posterior surgery, and one underwent posterior decompression and fusion surgery alone. One patient had complete neurologic recovery, one partially recovered, and one did not recover motor function. Iatrogenic spinal cord injury following cervical spine surgery is a rare and devastating adverse event. No standard protocol exists that can guarantee prevention of this complication, and there is a lack of consensus regarding evaluation and treatment when it does occur. Emergent imaging with magnetic resonance imaging or computed tomography myelography to evaluate for compressive etiology or malpositioned instrumentation and avoidance of hypotension should be performed in cases of intraoperative and postoperative spinal cord injury.

  11. Iatrogenic encephalocele : a rare complication of vacuum extraction delivery

    NARCIS (Netherlands)

    Jeltema, Hanne-Rinck; Hoving, Eelco

    2011-01-01

    Vacuum extraction is a frequently used form of assisted vaginal delivery. Here we describe a child who was born by vacuum extraction delivery. Days after the birth, a frontal swelling, which was thought to be a caput succedaneum, enlarged. Imaging revealed an iatrogenic encephalocele with a large

  12. Modified Ravitch procedure: a customized solution for iatrogenic ...

    African Journals Online (AJOL)

    the chest wall following a repair for congenital diaphragm- matic hernia (CDH) in early childhood [2]. Most of the acquired varieties need one or more corrective proce- dures [3]. Here we present a case of iatrogenic unilateral pectus excavatum in a 3-year-old child, which was secondary to a CDH repair done in childhood.

  13. Iatrogenic medication errors in a paediatric intensive care unit in ...

    African Journals Online (AJOL)

    This unit has guided the development of various types of adverse event reporting, ... iatrogenic medi cation errors in children at healthcare facilities in industrialised .... A pharmacist dispenses electronically submitted medication orders but ..... Hand-held devices such as smartphones with medication dosage applications.

  14. Diagnostic accuracy of oblique chest radiograph for occult pneumothorax: comparison with ultrasonography

    OpenAIRE

    Matsumoto, Shokei; Sekine, Kazuhiko; Funabiki, Tomohiro; Orita, Tomohiko; Shimizu, Masayuki; Hayashida, Kei; Kazamaki, Taku; Suzuki, Tatsuya; Kishikawa, Masanobu; Yamazaki, Motoyasu; Kitano, Mitsuhide

    2016-01-01

    Backgraound An occult pneumothorax is a pneumothorax that is not seen on a supine chest X-ray but is detected by computed tomography scanning. However, critical patients are difficult to transport to the computed tomography suite. We previously reported a method to detect occult pneumothorax using oblique chest radiography (OXR). Several authors have also reported that ultrasonography is an effective technique for detecting occult pneumothorax. The aim of this study was to evaluate the useful...

  15. Delayed pneumothorax complicating minor rib fracture after chest trauma.

    Science.gov (United States)

    Lu, Ming-Shian; Huang, Yao-Kuang; Liu, Yun-Hen; Liu, Hui-Ping; Kao, Chiung-Lun

    2008-06-01

    Pneumothorax (PTX) after trauma is a preventable cause of death. Drainage procedures such as chest tube insertion have been traditionally advocated to prevent fatal tension PTX. We evaluated the safety of close observation in patients with delayed PTX complicating rib fracture after minor chest trauma. Adult patients (>18 years) with a diagnosis of chest trauma and 3 or fewer fractured ribs were reviewed. Case patients were divided according to age, location and number of fractured ribs, mechanism of trauma, and initial pulmonary complication after thoracic trauma for comparative analysis. There were 207 male (70.2%) and 88 female (29.8%) patients whose ages ranged from 18 to 93 years (median, 55 years). The mechanisms of trauma were a motor vehicle accident in 207 patients, falls in 66, pedestrian injury in 10, and assaults in 14. Ninety-five patients sustained 1 rib fracture, 95 had 2 rib fractures, and 105 suffered 3 rib fractures. Right-sided injury occurred in 164 cases, left-sided injury did in 127, and bilateral injury did in 4. The most frequent location of rib fractures was from the fourth rib to the ninth rib. The initial pulmonary complications after trauma were PTX in 16 patients, hemothorax in 43, pneumohemothorax in 14, lung contusion in 75, and isolated subcutaneous emphysema (SubcEmph) in 33. Thirty percent of the patients (n = 5/16) who presented with traumatic PTX were observed safely without drainage. Delayed PTX was recorded in 16 patients, occurring mostly during the first 2 days of their admission. Associated extrathoracic injury was recorded in 189 patients. The mean hospital stay of the patients was 7.66 days. Longer hospital stay was related to increasing number of fractured ribs, need for thoracic drainage, and the presence of associated extrathoracic injury. The mortality rate for the entire group was 2%. The presence of SubcEmph was the only risk factor associated with the development of delayed PTX. Patients sustaining blunt chest

  16. Value of digital radiography in expiration in detection of pneumothorax

    International Nuclear Information System (INIS)

    Thomsen, L.; Natho, O.; Feigen, U.; Kivelitz, D.; Schulz, U.

    2014-01-01

    Purpose: The purpose of this study was to find out whether pneumothorax detection and exclusion is superior in expiratory digital chest radiography. Materials and Methods: 131 patients with pneumothorax with paired inspiratory and expiratory chest radiographs were analyzed regarding localization and size of pneumothorax. Sensitivity, specificity, negative (npv) and positive predictive value (ppv) as well as the positive (LR+) and negative likelihood ratio (LR-) were determined in a blinded randomized interobserver study with 116 patients. The evaluation was performed by three board-certified radiologists. Results: In 131 patients, there were 139 pneumothoraces, 135 (97.1 %) were located apical, 88 (63.3 %) lateral and 33 (23.7 %) basal. Sensitivity was 99 % for inspiratory and 97 % for expiratory radiographs. The interobserver study yielded a mean sensitivity of 86.1 %/86.1 %, specificity of 97.3 %/93.4 %, npv of 88.7 %/88.5 % and ppv of 96.7 %/92.1 % for inspiration/expiration. For inspiratory radiographs the LR+/LR- were 40.2/0.14 and for expiration 13.9 and 0.15. McNemar-Test showed no significant difference for the detection of pneumothoraces in in-/exspiration. Conclusion: Inspiratory and expiratory digital radiographs are equally suitable for pneumothorax detection. Inspiratory radiographs are recommended as the initial examination of choice for pneumothorax detection, an additional expiratory radiograph is only recommended in doubtful cases. (orig.)

  17. Lung Ultrasound for Diagnosing Pneumothorax in the Critically Ill Neonate.

    Science.gov (United States)

    Raimondi, Francesco; Rodriguez Fanjul, Javier; Aversa, Salvatore; Chirico, Gaetano; Yousef, Nadya; De Luca, Daniele; Corsini, Iuri; Dani, Carlo; Grappone, Lidia; Orfeo, Luigi; Migliaro, Fiorella; Vallone, Gianfranco; Capasso, Letizia

    2016-08-01

    To evaluate the accuracy of lung ultrasound for the diagnosis of pneumothorax in the sudden decompensating patient. In an international, prospective study, sudden decompensation was defined as a prolonged significant desaturation (oxygen saturation pneumothorax was detected in 26 (62%). Lung ultrasound accuracy in diagnosing pneumothorax was as follows: sensitivity 100%, specificity 100%, positive predictive value 100%, and negative predictive value 100%. Clinical evaluation of pneumothorax showed sensitivity 84%, specificity 56%, positive predictive value 76%, and negative predictive value 69%. After sudden decompensation, a lung ultrasound scan was performed in an average time of 5.3 ± 5.6 minutes vs 19 ± 11.7 minutes required for a chest radiography. Emergency drainage was performed after an ultrasound scan but before radiography in 9 cases. Lung ultrasound shows high accuracy in detecting pneumothorax in the critical infant, outperforming clinical evaluation and reducing time to imaging diagnosis and drainage. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Identifying Primary Spontaneous Pneumothorax from Administrative Databases: A Validation Study

    Directory of Open Access Journals (Sweden)

    Eric Frechette

    2016-01-01

    Full Text Available Introduction. Primary spontaneous pneumothorax (PSP is a disorder commonly encountered in healthy young individuals. There is no differentiation between PSP and secondary pneumothorax (SP in the current version of the International Classification of Diseases (ICD-10. This complicates the conduct of epidemiological studies on the subject. Objective. To validate the accuracy of an algorithm that identifies cases of PSP from administrative databases. Methods. The charts of 150 patients who consulted the emergency room (ER with a recorded main diagnosis of pneumothorax were reviewed to define the type of pneumothorax that occurred. The corresponding hospital administrative data collected during previous hospitalizations and ER visits were processed through the proposed algorithm. The results were compared over two different age groups. Results. There were 144 cases of pneumothorax correctly coded (96%. The results obtained from the PSP algorithm demonstrated a significantly higher sensitivity (97% versus 81%, p=0.038 and positive predictive value (87% versus 46%, p<0.001 in patients under 40 years of age than in older patients. Conclusions. The proposed algorithm is adequate to identify cases of PSP from administrative databases in the age group classically associated with the disease. This makes possible its utilization in large population-based studies.

  19. Ultrasound Evaluation of the Magnitude of Pneumothorax: A New Concept

    Science.gov (United States)

    Sargsyan, Ashot E.; Nicolaou, S.; Kirkpatrick, A. W.; Hamilton, D. R.; Campbell, M. R,; Billica, R. D.; Dawson, D. L.; Williams, D. R.; Dulchavsky, S. A.

    2000-01-01

    Pneumothorax is commonly seen in trauma patients; the diagnosis is usually confirmed by radiography. Use of ultrasound for this purpose, in environments such as space flight and remote terrestrial areas where radiographic capabilities are absent, is being investigated by NASA. In this study, the ability of ultrasound to assess the magnitude of pneumothorax in a porcine model was evaluated. Sonography was performed on anesthetized pigs (avg. wt. 50 kg) in both ground-based laboratory (n = 5) and micro gravity conditions (0 g) aboard the KC-135 aircraft during parabolic flight (n = 4). Aliquots of air (50-1 OOcc) were introduced into the chest through a catheter to simulate pneumothorax. Results were video-recorded and digitized for later interpretation by radiologists. Several distinct sonographic patterns of partial lung sliding were noted, including the combination of a sliding zone with a still zone, and a "segmented" sliding zone. These "partial lung sliding" patterns exclude massive pneumothorax manifested by a complete separation of the lung from the parietal pleura. In 0 g, the sonographic picture was more diverse; 1 g differences between posterior and anterior aspects were diminished. CONCLUSIONS: Modest pneumothorax can be inferred by the ultrasound sign of "partial lung sliding". This finding, which increases the negative predictive value of thoracic ultrasound, may be attributed to intermittent pleural contact, small air spaces, or alterations in pleural lubricant. Further studies of these phenomena are warranted.

  20. Characteristics of Neonatal Pneumothorax in Saudi Arabia: Three Years’ Experience

    Directory of Open Access Journals (Sweden)

    Abdulrahman Al Matary

    2017-03-01

    Full Text Available Objectives: To identify the incidence, clinical characteristics, predisposing factors, morbidity, and mortality among hospitalized neonates with pneumothorax. Methods: The records of 2 204 infants admitted to the neonatal intensive care unit at King Fahad Medical City, Saudi Arabia, between 2011 and 2014 were reviewed. All newborns hospitalized in the neonatal intensive care unit with pneumothorax were included in the study. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax (NP, accompanying disorders, and mortality. Results: Pneumothorax was diagnosed in 86 patients, with an incidence of 3.9%. The most common predisposing factors of NP were bag mask ventilation, followed by hypoplastic lung disease, and mechanical ventilation. Twenty-five (29.1% newborns with pneumothorax died. The most common accompanying disorder was premature rupture of membrane. On multivariate analysis, pulmonary hemorrhage, a birth weight < 2 500 g, and low Apgar score (< 7 at one minute were independently associated with mortality. Conclusions: This study highlights the extent of NP problems among hospitalized neonates and the most common predisposing factors of NP.

  1. Frequency and Intensive Care Related Risk Factors of Pneumothorax in Ventilated Neonates

    Directory of Open Access Journals (Sweden)

    Ramesh Bhat Yellanthoor

    2014-01-01

    Full Text Available Objectives. Relationships of mechanical ventilation to pneumothorax in neonates and care procedures in particular are rarely studied. We aimed to evaluate the relationship of selected ventilator variables and risk events to pneumothorax. Methods. Pneumothorax was defined as accumulation of air in pleural cavity as confirmed by chest radiograph. Relationship of ventilator mode, selected settings, and risk procedures prior to detection of pneumothorax was studied using matched controls. Results. Of 540 neonates receiving mechanical ventilation, 10 (1.85% were found to have pneumothorax. Respiratory distress syndrome, meconium aspiration syndrome, and pneumonia were the underlying lung pathology. Pneumothorax mostly (80% occurred within 48 hours of life. Among ventilated neonates, significantly higher percentage with pneumothorax received mandatory ventilation than controls (70% versus 20%; P20 cm H2O and overventilation were not significantly associated with pneumothorax. More cases than controls underwent care procedures in the preceding 3 hours of pneumothorax event. Mean airway pressure change (P=0.052 and endotracheal suctioning (P=0.05 were not significantly associated with pneumothorax. Reintubation (P=0.003, and bagging (P=0.015 were significantly associated with pneumothorax. Conclusion. Pneumothorax among ventilated neonates occurred at low frequency. Mandatory ventilation and selected care procedures in the preceding 3 hours had significant association.

  2. Frequency and Intensive Care Related Risk Factors of Pneumothorax in Ventilated Neonates

    Science.gov (United States)

    Bhat Yellanthoor, Ramesh; Ramdas, Vidya

    2014-01-01

    Objectives. Relationships of mechanical ventilation to pneumothorax in neonates and care procedures in particular are rarely studied. We aimed to evaluate the relationship of selected ventilator variables and risk events to pneumothorax. Methods. Pneumothorax was defined as accumulation of air in pleural cavity as confirmed by chest radiograph. Relationship of ventilator mode, selected settings, and risk procedures prior to detection of pneumothorax was studied using matched controls. Results. Of 540 neonates receiving mechanical ventilation, 10 (1.85%) were found to have pneumothorax. Respiratory distress syndrome, meconium aspiration syndrome, and pneumonia were the underlying lung pathology. Pneumothorax mostly (80%) occurred within 48 hours of life. Among ventilated neonates, significantly higher percentage with pneumothorax received mandatory ventilation than controls (70% versus 20%; P 20 cm H2O and overventilation were not significantly associated with pneumothorax. More cases than controls underwent care procedures in the preceding 3 hours of pneumothorax event. Mean airway pressure change (P = 0.052) and endotracheal suctioning (P = 0.05) were not significantly associated with pneumothorax. Reintubation (P = 0.003), and bagging (P = 0.015) were significantly associated with pneumothorax. Conclusion. Pneumothorax among ventilated neonates occurred at low frequency. Mandatory ventilation and selected care procedures in the preceding 3 hours had significant association. PMID:24876958

  3. Clinical and radiological outcome following pneumothorax after endoscopic lung volume reduction with valves.

    Science.gov (United States)

    Gompelmann, D; Benjamin, N; Kontogianni, K; Herth, Fjf; Heussel, C P; Hoffmann, H; Eberhardt, R

    2016-01-01

    Valve implantation has evolved as a therapy for patients with advanced emphysema. Although it is a minimally invasive treatment, it is associated with complications, the most common being pneumothorax. Pneumothorax occurs due to the rapid target lobe volume reduction and may be a predictor of clinical benefit despite this complication. The objective of this study was to conduct an exploratory data analysis of patients who developed a pneumothorax following endoscopic valve therapy for emphysema. This study performed a retrospective evaluation of pneumothorax management and the impact of pneumothorax on clinical outcomes in 70 patients following valve therapy in 381 consecutive patients. Pneumothorax rate following valve therapy was 18%. Pneumothorax management consisted of chest tube insertion, valve removal, and surgical intervention in 87% (61/70), 44% (31/70), and 19% (13/70) of the patients, respectively. Despite pneumothorax, patients experienced modest but significant improvements in lung function parameters (forced expiratory volume in 1 second: 55±148 mL, residual volume: -390±964 mL, total lung capacity: -348±876; all P pneumothorax, which was associated with relevant clinical improvement, was observed in only 21% (15/70) of the patients. Pneumothorax is a frequent severe complication following valve therapy that requires further intervention. Nevertheless, the pneumothorax does not impair the clinical status in the majority of patients. Patients with lobar atelectasis benefit after recovering from pneumothorax in terms of lung function parameters.

  4. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

    Directory of Open Access Journals (Sweden)

    Omar Hesham R

    2011-09-01

    Full Text Available Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

  5. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients.

    Science.gov (United States)

    Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

    2011-09-27

    Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a true occult pneumothorax where an initial AP chest X-ray revealed no evidence of pneumothorax and a CT chest immediately performed revealed evidence of pneumothorax. The second case represents an example of a missed rather than a truly occult pneumothorax where the initial chest radiograph revealed clues suggesting the presence of pneumothorax which were missed by the reading radiologist. The third case emphasizes the fact that "occult pneumothorax is predictable". The presence of subcutaneous emphesema and pulmonary contusion should call for further imaging with CT chest to rule out pneumothorax. Thoracic CT scan is therefore the "gold standard" for early detection of a pneumothorax in trauma patients. This report aims to sensitize readers to the entity of occult pneumothorax and create awareness among intensivists and ER physicians regarding the proper diagnosis and management.

  6. Value of digital radiography in expiration in detection of pneumothorax; Wertigkeit der digitalen Roentgenaufnahme in Exspiration zum Nachweis eines Pneumothorax

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, L.; Natho, O.; Feigen, U.; Kivelitz, D. [Asklepios Klinik St. Georg, Hamburg (Germany). Dept. of Radiology; Schulz, U. [medistat GmbH, Kiel (Germany). Medical Statistics

    2014-03-15

    Purpose: The purpose of this study was to find out whether pneumothorax detection and exclusion is superior in expiratory digital chest radiography. Materials and Methods: 131 patients with pneumothorax with paired inspiratory and expiratory chest radiographs were analyzed regarding localization and size of pneumothorax. Sensitivity, specificity, negative (npv) and positive predictive value (ppv) as well as the positive (LR+) and negative likelihood ratio (LR-) were determined in a blinded randomized interobserver study with 116 patients. The evaluation was performed by three board-certified radiologists. Results: In 131 patients, there were 139 pneumothoraces, 135 (97.1 %) were located apical, 88 (63.3 %) lateral and 33 (23.7 %) basal. Sensitivity was 99 % for inspiratory and 97 % for expiratory radiographs. The interobserver study yielded a mean sensitivity of 86.1 %/86.1 %, specificity of 97.3 %/93.4 %, npv of 88.7 %/88.5 % and ppv of 96.7 %/92.1 % for inspiration/expiration. For inspiratory radiographs the LR+/LR- were 40.2/0.14 and for expiration 13.9 and 0.15. McNemar-Test showed no significant difference for the detection of pneumothoraces in in-/exspiration. Conclusion: Inspiratory and expiratory digital radiographs are equally suitable for pneumothorax detection. Inspiratory radiographs are recommended as the initial examination of choice for pneumothorax detection, an additional expiratory radiograph is only recommended in doubtful cases. (orig.)

  7. Computerized detection of pneumothorax on digital chest radiographs

    International Nuclear Information System (INIS)

    Sanada, S.; Doi, K.; MacMahon, H.; Montner, S.M.

    1990-01-01

    This paper reports on neumothoraces that are clinically important abnormalities that usually appear as a subtle, fine line pattern on chest radiographs. We are developing a computer vision system for automated detection of pneumothorax to aid radiologists diagnosis. Chest images were digitized with a 0.175-mm pixel size, yielding a 2,000 x 2,430 matrix size, and 10 bits of gray scale. After indentification of the lung regions, an edge detection filter was employed in the apical areas to enhance a pneumothorax pattern. Ribs were detected with a technique based on statistical analysis of edge gradients and their orientations. Points located on a curved line suggestive of a pneumothorax in this enhanced image were detected with a Hough transform

  8. Open pneumothorax resulting from blunt thoracic trauma: a case report.

    Science.gov (United States)

    McClintick, Colleen M

    2008-01-01

    Cases of open pneumothorax have been documented as early as 326 BC. Until the last 50 years, understanding of the epidemiology and treatment of penetrating chest trauma has arisen from military surgery. A better understanding of cardiopulmonary dynamics, advances in ventilatory support, and improvement in surgical technique have drastically improved treatment and increased the survival rate of patients with penetrating thoracic trauma. Open pneumothorax is rare in blunt chest trauma, but can occur when injury results in a substantial loss of the chest wall. This case study presents an adolescent who sustained a large open pneumothorax as a result of being run over by a car. Early and appropriate surgical intervention coupled with coordinated efforts by all members of the trauma team resulted in a positive outcome for this patient.

  9. A Case of Spontaneously Resolved Bilateral Primary Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Hasan Kahraman

    2014-03-01

    Full Text Available A condition of intrapleural air-space accumulation in individuals without any history of trauma or lung disease is called as primary spontaneous pneumothorax (PSP. Sixteen-years-old male patient admitted with complains of chest pain and dyspnea beginning 3 day ago. On physical examination, severity of breath sounds decreased on right side. Chest radiograph was taken and right-sided pneumothorax was detected and tube thoracostomy was inserted. Two months ago the patient referred to a doctor with similar complaints and physical examination and chest radiograph were reported as normal. The radiograph was retrospectively examined and bilateral PSP was detected. We presented the case duo to spontaneous recovery of bilateral PSP is seen very rarely and so contributes data to the literature. In patients admitted to the clinic with chest pain and shortness of breath, pneumothorax should be considered at differential diagnosis.

  10. Reactor vessel stud tensioner

    International Nuclear Information System (INIS)

    Malandra, L.J.; Beer, R.W.; Salton, R.B.; Spiegelman, S.R.; Cognevich, M.L.

    1982-01-01

    A quick-acting stud tensioner, for facilitating the loosening or tightening of a stud nut on a reactor vessel stud, has gripper jaws which when the tensioner is lowered into engagement with the upper end of the stud are moved inwards to grip the upper end and which when the tensioner is lifted move outward to release the upper end. (author)

  11. Hemoptysis following Talc Pleurodesis in a Pneumothorax Patient

    Directory of Open Access Journals (Sweden)

    Yusuke Kakiuchi

    2017-01-01

    Full Text Available The purpose of this article is to report a case of hemoptysis occurring in combination with secondary spontaneous pneumothorax following chemical pleurodesis by talc. A Japanese male with cancer of renal pelvis was found with the left pneumothorax and multiple lung metastases. A computed-tomography scan revealed severe emphysema throughout the lungs. Talc pleurodesis was employed to arrest air leakage. The patient developed hemoptysis 45 minutes after talc injection into the thorax. This is the first report of hemoptysis following talc pleurodesis. The agent could induce severe inflammation in capillary vessels of the lung following visceral pleura infiltration.

  12. Radiographic aspects of pleural disorders [pleura, hydrothorax, pneumothorax, diaphragmatic hernia

    International Nuclear Information System (INIS)

    Stambouli, F.

    1995-01-01

    Radiographic modifications of the pleural space and pleura are due to the presence of air (pneumothorax), liquid (hydrothorax), a mass of tissue or displaced abdominal organs (the latter two disorders are often masked by liquid). Effusions are characterised by the presence of intralobar fissures, retraction and collapse of the pulmonary lobes of the thoracic wall and a general diffuse opacification starring ventrally. Pneumothorax is associated with an accentuated radiotransparence of the thorax and a retraction of the lungs, they become separated from the thoracic wall by a space without a pulmonary tissue framework

  13. A rare case of lymphangioleiomyomatosis with recurrent pneumothorax

    Directory of Open Access Journals (Sweden)

    Vinay Mahishale

    2015-01-01

    Full Text Available Lymphangioleiomyomatosis (LAM is a rare disease of unknown etiology that traditionally affects young women of childbearing or premenopausal age. It is characterized by proliferation of atypical smooth muscle cells, preferentially along bronchovascular structures that cause progressive respiratory failure. Owing to its unusual and nonspecific presenting symptoms, patients often receive missed or delayed diagnosis. This disease occurs sporadically or in association with the genetic disease-tuberous sclerosis complex. Recurrent pneumothorax is the hallmark of LAM. We present a 16-year-old young female having recurrent pneumothorax with LAM.

  14. Primary Cystic Pleuropulmonary Synovial Sarcoma Presenting as Recurrent Pneumothorax

    Directory of Open Access Journals (Sweden)

    Eric D. Johnson

    2017-07-01

    Full Text Available Primary pleuropulmonary synovial sarcomas are quite rare, representing 0.1–0.5% of all pulmonary malignancies. We report an entirely cystic monophasic synovial sarcoma in a 25-year-old male who presented with recurrent pneumothorax and no evidence of a mass lesion on imaging. The purpose of this case report is to increase awareness of neoplasms clinically presenting as a pneumothorax with no imagining evidence of a mass-forming lesion and emphasize the significance of fluorescent in situ hybridization testing in nontypical synovial sarcoma cases.

  15. Pneumothorax, without chest wall fracture, following airbag deployment

    Directory of Open Access Journals (Sweden)

    Samuel Parsons

    2010-12-01

    Full Text Available Air bags are an automatic crash protection system. They have been shown to reduce mortality from motor vehicle accidents by 31% following direct head-on impacts, by 19% following any frontal impact and by 11% overall. Despite obvious benefits there has been a corresponding increase in the number of injuries resulting from their deployment. We describe a case of a pneumothorax in the absence of chest wall pathology associated with airbag deployment, in a belted driver. There has been one previous description of pneumothorax associated with airbag deployment, in an unbelted driver.

  16. Anterior versus lateral needle decompression of tension pneumothorax: comparison by computed tomography chest wall measurement.

    Science.gov (United States)

    Sanchez, Leon D; Straszewski, Shannon; Saghir, Amina; Khan, Atif; Horn, Erin; Fischer, Christopher; Khosa, Faisal; Camacho, Marc A

    2011-10-01

    Recent research describes failed needle decompression in the anterior position. It has been hypothesized that a lateral approach may be more successful. The aim of this study was to identify the optimal site for needle decompression. A retrospective study was conducted of emergency department (ED) patients who underwent computed tomography (CT) of the chest as part of their evaluation for blunt trauma. A convenience sample of 159 patients was formed by reviewing consecutive scans of eligible patients. Six measurements from the skin surface to the pleural surface were made for each patient: anterior second intercostal space, lateral fourth intercostal space, and lateral fifth intercostal space on the left and right sides. The distance from skin to pleura at the anterior second intercostal space averaged 46.3 mm on the right and 45.2 mm on the left. The distance at the midaxillary line in the fourth intercostal space was 63.7 mm on the right and 62.1 mm on the left. In the fifth intercostal space the distance was 53.8 mm on the right and 52.9 mm on the left. The distance of the anterior approach was statistically less when compared to both intercostal spaces (p < 0.01). With commonly available angiocatheters, the lateral approach is less likely to be successful than the anterior approach. The anterior approach may fail in many patients as well. Longer angiocatheters may increase the chances of decompression, but would also carry a higher risk of damage to surrounding vital structures. © 2011 by the Society for Academic Emergency Medicine.

  17. Two Young Women with Left-sided Pneumothorax Due to Thoracic Endometriosis.

    Science.gov (United States)

    Yukumi, Shungo; Suzuki, Hideaki; Morimoto, Masamitsu; Shigematsu, Hisayuki; Okazaki, Mikio; Abe, Masahiro; Kitazawa, Sohei; Nakamura, Kenji; Sano, Yoshifumi

    Pneumothorax associated with thoracic endometriosis (TE) generally occurs in women around 30 years old and it usually affects the right pleural cavity. We herein report two cases of TE associated with left-sided pneumothorax in young women. The prevalence of TE in younger patients may be underestimated if these cases are treated as spontaneous pneumothorax. Pneumothorax occurring in younger patients has not been reported to show laterality. TE-related or catamenial pneumothorax in young women must therefore represent a different clinical entity from the condition seen in older patients.

  18. [Successful surgical treatment for catamenial pneumothorax at the time of menstruation].

    Science.gov (United States)

    Kita, Hidefumi; Shiraishi, Yuji; Katsuragi, Naoya; Shimoda, Kiyomi; Saitou, Miyako

    2013-11-01

    A 39-year-old female was referred to our hospital due to repeated right pneumothorax. Each episode was related to the onset of menstruation, suggesting catamenial pneumothorax. Thoracoscopy showed multiple blue berry spots on the diaphragm. Partial resection of the diaphragm including these lesions were performed. But she had a recurrent right pneumothorax. Treatment with a gonadotropin-releasing hormone analogue was started, resulting in failure to introduce menopose and the pneumothorax repeatedly appeared again. Reoperation was intentionally done at the time of menstruation enable to find the lesion. Patient is free from pneumothorax more than 6 years after surgery.

  19. [Specific iatrogenic risks to patients with HIV infection].

    Science.gov (United States)

    De Tournemire, R; Yeni, P

    1994-01-01

    Human immunodeficiency virus-infected patients are exposed to more or less specific iatrogenic diseases. The main characteristics of the risks encountered in this field are described: drug intolerance, mostly to sulfamethoxazole-trimethoprim, is extremely frequent; nucleoside analogue antiviral toxicity is reminiscent of that of chemotherapy; nosocomial infections, in general, are more prominent than in HIV-non infected patients. Intravenous line infections are particularly frequent, but these devices are necessary for prolonged intravenous therapies such as anti-CMV treatment of parenteral nutrition. An improved understanding of different etiopathogenic mechanisms and a better approach of the toxicity/efficacy ratio for each treatment would allow to reduce the excessive morbidity due to iatrogenicity.

  20. COVERED STENTS IN IATROGENIC CORONARY ARTERY FISTULA; A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Masoud Poormoghaddas

    2010-11-01

    Full Text Available Abstract    BACKGROUND: Coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber or major cardiac vessels, mostly congenital but some of them are acquired as a consequence of coronary artery perforation.    CASE PRESENTATION: We report a case of cavity spilling coronary artery perforation during percutaneous coronary intervention 7 years ago. Because of continuing symptoms and risk of developing heart failure and pulmonary hypertension we were ought to treat this iatrogenically formed coronary artery fistula. We used stent graft implantation to treat it with acceptable results.    CONCLUSION: Beside their application as a rescue for acute coronary artery perforations, stent grafts can be used with acceptable results in iatrogenically acquired coronary artery coronary artery fistula      Keywords: Coronary artery perforation, Coronary artery fistula, Stent graft.

  1. Iatrogenic Spinal Cord Injury Resulting From Cervical Spine Surgery

    OpenAIRE

    Daniels, Alan H.; Hart, Robert A.; Hilibrand, Alan S.; Fish, David E.; Wang, Jeffrey C.; Lord, Elizabeth L.; Buser, Zorica; Tortolani, P. Justin; Stroh, D. Alex; Nassr, Ahmad; Currier, Bradford L.; Sebastian, Arjun S.; Arnold, Paul M.; Fehlings, Michael G.; Mroz, Thomas E.

    2017-01-01

    Study Design: Retrospective cohort study of prospectively collected data. Objective: To examine the incidence of iatrogenic spinal cord injury following elective cervical spine surgery. Methods: A retrospective multicenter case series study involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network was conducted. Medical records for 17?625 patients who received cervical spine surgery (levels from C2 to C7) between January 1, 2005, and December 31, 2011,...

  2. Iatrogenic nocturnal eneuresis- an overlooked side effect of anti histamines?

    Directory of Open Access Journals (Sweden)

    D Italiano

    2015-01-01

    Full Text Available Nocturnal enuresis is a common disorder in childhood, but its pathophysiological mechanisms have not been fully elucidated. Iatrogenic nocturnal enuresis has been described following treatment with several psychotropic medications. Herein, we describe a 6-year-old child who experienced nocturnal enuresis during treatment with the antihistamine cetirizine. Drug rechallenge was positive. Several neurotransmitters are implicated in the pathogenesis of nocturnal enuresis, including noradrenaline, serotonin and dopamine. Antihistamine treatment may provoke functional imbalance of these pathways resulting in incontinence.

  3. Embolis cutis medicamentosa, a rare preventable iatrogenic complication

    Directory of Open Access Journals (Sweden)

    Manjunath Kavya,

    2015-07-01

    Full Text Available Embolis cutis medicamentosa is an uncommon iatrogenic complication characterised by variable degree of skin and tissue necrosis, likely to follow intramuscular injection. Intense pain and purplish discoloration of overlying skin, with or without reticulate pattern subsequently followed by tissue necrosis and scarring is highly specific for this syndrome. It has also been reported following intravenous, intra-articular and subcutaneous injections. Herein we are reporting two cases of this rare preventable entity.

  4. 2017 WSES guidelines for the management of iatrogenic colonoscopy perforation

    OpenAIRE

    de’Angelis, Nicola; Di Saverio, Salomone; Chiara, Osvaldo; Sartelli, Massimo; Martínez-Pérez, Aleix; Patrizi, Franca; Weber, Dieter G.; Ansaloni, Luca; Biffl, Walter; Ben-Ishay, Offir; Bala, Miklosh; Brunetti, Francesco; Gaiani, Federica; Abdalla, Solafah; Amiot, Aurelien

    2018-01-01

    Iatrogenic colonoscopy perforation (ICP) is a severe complication that can occur during both diagnostic and therapeutic procedures. Although 45–60% of ICPs are diagnosed by the endoscopist while performing the colonoscopy, many ICPs are not immediately recognized but are instead suspected on the basis of clinical signs and symptoms that occur after the endoscopic procedure. There are three main therapeutic options for ICPs: endoscopic repair, conservative therapy, and surgery. The therapeutic...

  5. Human prion diseases: surgical lessons learned from iatrogenic prion transmission.

    Science.gov (United States)

    Bonda, David J; Manjila, Sunil; Mehndiratta, Prachi; Khan, Fahd; Miller, Benjamin R; Onwuzulike, Kaine; Puoti, Gianfranco; Cohen, Mark L; Schonberger, Lawrence B; Cali, Ignazio

    2016-07-01

    The human prion diseases, or transmissible spongiform encephalopathies, have captivated our imaginations since their discovery in the Fore linguistic group in Papua New Guinea in the 1950s. The mysterious and poorly understood "infectious protein" has become somewhat of a household name in many regions across the globe. From bovine spongiform encephalopathy (BSE), commonly identified as mad cow disease, to endocannibalism, media outlets have capitalized on these devastatingly fatal neurological conditions. Interestingly, since their discovery, there have been more than 492 incidents of iatrogenic transmission of prion diseases, largely resulting from prion-contaminated growth hormone and dura mater grafts. Although fewer than 9 cases of probable iatrogenic neurosurgical cases of Creutzfeldt-Jakob disease (CJD) have been reported worldwide, the likelihood of some missed cases and the potential for prion transmission by neurosurgery create considerable concern. Laboratory studies indicate that standard decontamination and sterilization procedures may be insufficient to completely remove infectivity from prion-contaminated instruments. In this unfortunate event, the instruments may transmit the prion disease to others. Much caution therefore should be taken in the absence of strong evidence against the presence of a prion disease in a neurosurgical patient. While the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) have devised risk assessment and decontamination protocols for the prevention of iatrogenic transmission of the prion diseases, incidents of possible exposure to prions have unfortunately occurred in the United States. In this article, the authors outline the historical discoveries that led from kuru to the identification and isolation of the pathological prion proteins in addition to providing a brief description of human prion diseases and iatrogenic forms of CJD, a brief history of prion disease nosocomial transmission

  6. Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

    International Nuclear Information System (INIS)

    Chiramel, George Koshy; Keshava, Shyamkumar Nidugala; Moses, Vinu; Kekre, Nitin; Tamilarasi, V; Devasia, Anthony

    2015-01-01

    To evaluate the effectiveness of endovascular management in iatrogenic renal injuries with regard to clinical status on follow-up and requirements for repeat angiography and embolization. This retrospective study included patients who were referred for endovascular management of significant hemorrhage following an iatrogenic injury. Data was recorded from the Picture Archiving and Communication system (PACS) and electronic medical records. The site and type of iatrogenic injury, imaging findings, treatment, angiography findings, embolization performed, clinical status on follow-up, and requirement for repeat embolization were recorded. The outcomes were clinical resolution, nephrectomy, or death. Clinical findings were recorded on follow-up visits to the clinic. Statistical analysis was performed using descriptive statistics. Seventy patients were included in this study between January 2000 and June 2012. A bleeding lesion (a pseudoaneurysm or arteriovenous fistula) was detected during the first angiogram in 55 patients (78.6%) and was selectively embolized. Fifteen required a second angiography as there was no clinical improvement and five required a third angiography. Overall, 66 patients (94.3%) showed complete resolution and 4 patients (5.7%) died. Three patients (4.3%) underwent nephrectomy for clinical stabilization even after embolization. There were no major complications. The two minor complications resolved spontaneously. Angiography and embolization is the treatment of choice in iatrogenic renal hemorrhage. Upto 20% of initial angiograms may not reveal the bleed and repeat angiography is required to identify a recurrent or unidentified bleed. The presence of multiple punctate bleeders on angiography suggests an enlarging subcapsular hematoma and requires preoperative embolization and nephrectomy

  7. Radiological findings and interventions for iatrogenic vascular injuries

    International Nuclear Information System (INIS)

    Lee, Kyoung Ho; Chung, Jin Wook; Kim, Tae Kyoung; Han, Sang Wook; Lee, Jong Seog; Park, Jae Hyung; Kim, Jong Hyo; Han, Man Chung

    1998-01-01

    The purpose of this study is to evaluate the radiological findings and effectiveness of radiological interventions in patients with iatrogenic vascular injuries. We analyzed 50 patients with iatrogenic vascular injuries treated with radiological intervention. The causes of injuries were surgery (n=20), cardiovascular intervention (n=15), non-cardiovascular radiological intervention (n=14), and endoscopic intervention (n=1). The injury had resulted in hemorrhage in 35 cases. The iliac and/or femoral, hepatic, and renal vessels were commonly injured. Angiography, ultrasonography with Doppler examination, CT, and CT angiography were performed to diagnose vascular injuries and guide the radiological intervention. The mean follow-up period was 23 months and in 16 cases was more than one year. the major radiological findings were extravasation, pseudoaneurysm, arteriovenous shunt, or vascular obstruction. To control these lesions, radiological interventions such as embolization (n=36), local urokinase administration, stent insertion, foreign body removal, ultrasonography-guided compression, or stent-graft insertion were performed. The clinical problems were immediately controlled by the single trials of radiological interventions and did not recur in 40 cases (80%). Radiological examinations and interventions are useful in cases with iatrogenic vascular injuries. (author). 14 refs., 4 figs

  8. Iatrogenic Hepatitis C Virus Transmission and Safe Injection Practices.

    Science.gov (United States)

    Defendorf, Charles M; Paul, Sindy; Scott, George J

    2018-05-01

    Hepatitis C virus (HCV) infection poses significant adverse health effects. Improper use of vials, needles, syringes, intravenous bags, tubing, and connectors for injections and infusions is a current preventable cause of iatrogenic HCV transmission. Numerous cases have demonstrated the need for continued vigilance and the widespread nature of this iatrogenic infection risk across a variety of medical practice settings in the United States. Failure to implement the evidence-based Centers for Disease Control and Prevention (CDC) infection prevention guidelines exposes patients to preventable harm. The guidelines establish the requirement to notify patients in cases of suspected virus transmission, as well as to screen those patients who would not otherwise have been at risk for HCV seroconversion and other bloodborne pathogens. Legal and regulatory ramifications, including state, criminal, and tort laws, hold physicians and other health care professionals accountable to use safe injection practices. This article reviews the major health risks of HCV infection, significant effects of iatrogenic infection transmission, CDC guidelines for safe injection practices, and legal regulations and ramifications designed to promote safe injection practices.

  9. [Evaluation of iatrogenic accessory nerve injury in forensic medical practice].

    Science.gov (United States)

    Somogyi, E; Irányi, J

    1996-04-14

    The authors give a survey of the clinical and medical-legal characteristics of the accessory nerve injury. In the past two decades the conception of the successfulness of the surgical treatment of the accessory nerve injury became prevailing. About the medical-legal aspects of the iatrogenic injury of the nerve reported in connection of the reconstructive surgery chiefly also departments of neurosurgery, orthopedics and traumatology. In the case of the authors a 70 year old patient suffered 10 years ago a iatrogenic accessory nerve injury. The mild trapezius palsy recovered spontaneously practically with cosmetic disadvantage. In connection with the development of extreme dorso-lumbal scoliosis associated with torsion the trapezius atrophy worsened. Physical therapy was partly successful. But the patient became unfit for manual work. Their observations sustain the data of authors who established that in the case of accessory nerve injury not only the surgical but also conservative treatment is usually successful. In opposite to certain data of the literature the authors establish that the iatrogenic injuries of the accessory nerve may lead to significant lifelong disability. The diagnosis is not always made in time with consequent delay in repair. This may be regarded as an unfavorable issue during medical-legal discussions. The authors recommend in interest to prevent nerve injury in the posterior triangle of the neck to perform operation in special department.

  10. Iatrogenic Skin Disorders and Related Factors in Newborn Infants.

    Science.gov (United States)

    Csoma, Zsanett Renáta; Meszes, Angéla; Ábrahám, Rita; Kemény, Lajos; Tálosi, Gyula; Doró, Péter

    2016-09-01

    Recent technological advances and diagnostic and therapeutic innovations have resulted in an impressive improvement in the survival of newborn infants requiring intensive care. Consequently, with the use of modern invasive diagnostic and therapeutic procedures, the incidence of iatrogenic events has also increased. The aim of this study was to assess various iatrogenic complications in neonates requiring intensive care and determine possible contributing factors to the injuries. Our prospective cross-sectional cohort survey was conducted in a central regional level III neonatal intensive care unit (NICU). Correlations between intensive therapeutic interventions, complications, factors influencing attendance and prognosis, and the prevalence of iatrogenic skin injuries (ISIs) were investigated over a 2-year study period. Between January 31, 2012, and January 31, 2014, 460 neonates were admitted to the NICU, 83 of whom exhibited some kind of ISI. The major risk factors for ISIs were low birthweight, young gestational age, long NICU stay, use of the intubation-surfactant-extubation (INSURE) technique, surfactant use, mechanical ventilation, insertion of an umbilical arterial catheter, circulatory and cardiac support with dopamine or dobutamine, pulmonary hemorrhage, intracranial hemorrhage, patent ductus arteriosus, bronchopulmonary dysplasia, and positive microbiology culture results. To prevent ISIs, careful consideration of risk factors and the creation of protocols ensuring efficient treatment of injuries are needed. © 2016 Wiley Periodicals, Inc.

  11. The angiographic findings and interventional treatment of the iatrogenic hemobilia

    International Nuclear Information System (INIS)

    Wen feng; Lu Zaiming; Sun Wei; Li Wei; Guo Qiyong

    2012-01-01

    Objective: To evaluate the angiography and interventional embolization in diagnosing and treating the iatrogenic hemobilia. Methods: A total of 21 patients with iatrogenic hemobilia were enrolled in this study. The clinical data were retrospectively analyzed. Percutaneous selective superior mesenteric artery angiography, celiac angiography and common hepatic artery angiography were carried out in all patients. After the bleeding sites were clarified, selective or super-selective catheterization and embolization were performed. The clinical results were analyzed. Results: Active bleeding was confirmed by angiography in all the 21 cases. Angiographic findings included pseudoaneurysm (n=17, 81.0%) and extravasation of contrast medium (n=4, 19.0%). The embolic agents used in this study included polyvinyl alcohol particles (n=2), pure coils (n=8) or Gelfoam particles plus coils (n=11). The success rate of hemostasis after single embolization was 85.7% (18/21), and second embolization procedure had to be carried out in three patients as recurrent massive bleeding occurred in them. All the patients were followed up for 5 to 28 months, and no recurrent hemobilia was observed. No serious complications such as non-targeted vessel embolization, liver function failure, embolization-related infection, etc. occurred. Conclusion: For the treatment of iatrogenic hemobilia, percutaneous selective angiography together with interventional embolization is safe, minimally-invasive, reliable and effective, and this technique should be regarded as the treatment of first choice. (authors)

  12. Human Thrombin Injection for the Percutaneous Treatment of Iatrogenic Pseudoaneurysms

    International Nuclear Information System (INIS)

    Elford, Julian; Burrell, Christopher; Freeman, Simon; Roobottom, Carl

    2002-01-01

    Purpose: Thrombin injection is becoming well established for the percutaneous management of iatrogenic pseudoaneurysms. All the published series to date use bovine thrombin,and there have been reports of adverse immunologic effects following its use. Our study aimed to assess the efficacy of human thrombin injection for pseudoaneurysm occlusion. Methods:Fourteen patients with iatrogenic pseudoaneurysms underwent a color Doppler ultrasound examination to assess their suitability for percutaneous human thrombin injection. Human thrombin 1000 IU was then injected into the pseudoaneurysm sac under sterile conditions and with ultrasound guidance. A further color Doppler ultrasound examination was performed 24 hr later to confirm occlusion. Results: All 14 pseudoaneurysms were successfully occluded by human thrombin injection. In two cases a second injection of thrombin was required,but there were no other complications, and all pseudoaneurysms remained occluded at 24 hr. Conclusion: Ultrasound-guided human thrombin injection is simple to perform, effective and safe. We recommend that human thrombin becomes the agent of choice for percutaneous injection into iatrogenic pseudoaneurysms

  13. Marfan syndrome with multiseptate pneumothorax and mandibular fibrous dysplasia

    Directory of Open Access Journals (Sweden)

    Kate A

    2009-01-01

    Full Text Available We describe a rare case of pneumothorax due to Marfan syndrome associated with fibrous dysplasia of the mandible. Marfan syndrome and fibrous dysplasia were possibly due to a common etiological factor. The association between the two and other tumors described in literature related to Marfan syndrome is discussed.

  14. Thoracoscopic Surgery for Pneumothorax Following Outpatient Drainage Therapy.

    Science.gov (United States)

    Sano, Atsushi; Yotsumoto, Takuma

    2017-10-20

    We investigated the outcomes of surgery for pneumothorax following outpatient drainage therapy. We reviewed the records of 34 patients who underwent operations following outpatient drainage therapy with the Thoracic Vent at our hospital between December 2012 and September 2016. Indications for outpatient drainage therapy were pneumothorax without circulatory or respiratory failure and pleural effusion. Indications for surgical treatment were persistent air leakage and patient preference for surgery to prevent or reduce the incidence of recurrent pneumothorax. Intraoperatively, 9 of 34 cases showed loose adhesions around the Thoracic Vent, all of which were dissected bluntly. The preoperative drainage duration ranged from 5 to 13 days in patients with adhesions and from 3 to 19 days in those without adhesions, indicating no significant difference. The duration of preoperative drainage did not affect the incidence of adhesions. The operative duration ranged from 30 to 96 minutes in patients with adhesions and from 31 to 139 minutes in those without adhesions, also indicating no significant difference. Outpatient drainage therapy with the Thoracic Vent was useful for spontaneous pneumothorax patients who underwent surgery, and drainage for less than 3 weeks did not affect intraoperative or postoperative outcomes.

  15. Association Between BMI and Recurrence of Primary Spontaneous Pneumothorax.

    Science.gov (United States)

    Tan, Juntao; Yang, Yang; Zhong, Jianhong; Zuo, Chuantian; Tang, Huamin; Zhao, Huimin; Zeng, Guang; Zhang, Jianfeng; Guo, Jianji; Yang, Nuo

    2017-05-01

    Whether body mass index (BMI) is a significant risk factor for recurrence of primary spontaneous pneumothorax (PSP) remains controversial. The purpose of this study was to examine whether BMI and other factors are linked to risk of PSP recurrence. A consecutive cohort of 273 patients was retrospectively evaluated. Patients were divided into those who experienced recurrence (n = 81) and those who did not (n = 192), as well as into those who had low BMI (n = 75) and those who had normal or elevated BMI (n = 198). The two pairs of groups were compared in terms of baseline data, and Cox proportional hazards modeling was used to identify predictors of PSP recurrence. Rates of recurrence among all 273 patients were 20.9% at 1 year, 23.8% at 2 years, and 28.7% at 5 years. Univariate analysis identified the following significant predictors of PSP recurrence: height, weight, BMI, size of pneumothorax, and treatment modality. Multivariate analyses identified several risk factors for PSP recurrence: low BMI, pneumothorax size ≥50%, and non-surgical treatment. Kaplan-Meier survival analysis indicated that patients with low BMI showed significantly lower recurrence-free survival than patients with normal or elevated BMI (P pneumothorax size ≥50%, and non-surgical treatment were risk factors for PSP recurrence in our cohort. Low BMI may be a clinically useful predictor of PSP recurrence.

  16. Surgical treatment for elderly patients with secondary spontaneous pneumothorax.

    Science.gov (United States)

    Igai, Hitoshi; Kamiyoshihara, Mitsuhiro; Ibe, Takashi; Kawatani, Natsuko; Shimizu, Kimihiro

    2016-05-01

    Our objective was to evaluate the validity of surgery for secondary spontaneous pneumothorax (SSP) by comparison with other treatments or with perioperative results for primary spontaneous pneumothorax (PSP). Between January 2009 and March 2015, 144 patients with SSP, aged 60 years or over, were treated in our institution. We reviewed the patients' characteristics, perioperative results, and relapse rate. Treatment to arrest air-leakage included surgery (n = 79), drainage only (n = 30), and pleurodesis (n = 35), and the pneumothorax relapse rate or mortality before discharge was compared for each. Additionally, we compared the perioperative results or relapse rate between SSP (n = 70) and PSP (n = 70) in patients who underwent 3-port thoracoscopic surgery. There was a significant difference in the relapse rate between the surgery and non-surgery groups (5.3 vs. 27.4 %, p = 0.0006). However, no significant difference in mortality before discharge was determined (p = 0.66). Significant differences were identified between the SSP and PSP groups for operation time, duration of chest drainage, and the length of postoperative hospitalization, and the postoperative morbidity were greater in the SSP group (p pneumothorax relapse, compared with drainage or pleurodesis, and is feasible if the appropriate perioperative management is performed.

  17. Pneumothorax as a Complication of Apnea Testing for Brain Death.

    Science.gov (United States)

    Gorton, Lauren Elizabeth; Dhar, Rajat; Woodworth, Lindsey; Anand, Nitin J; Hayes, Benjamin; Ramiro, Joanna Isabelle; Kumar, Abhay

    2016-10-01

    Pneumothorax is an under-recognized complication of apnea testing performed as part of the neurological determination of death. It may result in hemodynamic instability or even cardiac arrest, compromising ability to declare brain death (BD) and viability of organs for transplantation. We report three cases of pneumothorax with apnea testing (PAT) and review the available literature of this phenomenon. Series of three cases supplemented with a systematic review of literature (including discussion of apnea testing in major brain death guidelines). Two patients were diagnosed with PAT due to immediate hemodynamic compromise, while the third was diagnosed many hours after BD. An additional nine cases of PAT were found in the literature. Information regarding oxygen cannula diameter was available for nine patients (range 2.3-5.3 mm), and flow rate was available for ten patients (mean 11 L/min). Pneumothorax was treated to resolution in the majority of patients (n = 8), although only six completed apnea testing following diagnosis/treatment of pneumothorax and only three patients became organ donors afterward. Review of major BD guidelines showed that although use of low oxygen flow rate (usually ≤ 6 L/min) during apnea testing is suggested, the risk of PAT was explicitly mentioned in just one. Development of PAT may adversely affect the process of BD determination and could limit the opportunity for organ donation. Each institution should have preventive measures in place.

  18. Anesthetic management of a horse with traumatic pneumothorax

    OpenAIRE

    Chesnel, Maud-Aline; Aprea, Francesco; Clutton, R. Eddie

    2012-01-01

    A traumatic pneumothorax and severe hemorrhage were present in a mare with a large thoracic wall defect, lung perforation, and multiple rib fractures. General anesthesia was induced to allow surgical exploration. We describe the anesthetic technique, and discuss the management of the ventilatory, hemodynamic, and metabolic disturbances encountered.

  19. A method to detect occult pneumothorax with chest radiography.

    Science.gov (United States)

    Matsumoto, Shokei; Kishikawa, Masanobu; Hayakawa, Koichi; Narumi, Atsushi; Matsunami, Katsutoshi; Kitano, Mitsuhide

    2011-04-01

    Small pneumothoraces are often not visible on supine screening chest radiographs because they develop anteriorly to the lung. These pneumothoraces are termed occult. Occult pneumothoraces account for an astonishingly high 52% to 63% of all traumatic pneumothoraces. A 19-year-old obese woman was involved in a head-on car accident. The admission anteroposterior chest radiographs were unremarkable. Because of the presence of right chest tenderness and an abrasion, we suspected the presence of a pneumothorax. Thus, we decided to take a supine oblique chest radiograph of the right side of the thorax, which clearly revealed a visceral pleural line, consistent with a diagnosis of traumatic pneumothorax. A pneumothorax may be present when a supine chest radiograph reveals either an apparent deepening of the costophrenic angle (the "deep sulcus sign") or the presence of 2 diaphragm-lung interfaces (the "double diaphragm sign"). However, in practice, supine chest radiographs have poor sensitivity for occult pneumothoraces. Oblique chest radiograph is a useful and fast screening tool that should be considered for cases of blunt chest trauma, especially when transport of critically ill patients to the computed tomographic suite is dangerous or when imminent transfer to another hospital is being arranged and early diagnosis of an occult pneumothorax is essential. Copyright © 2010 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  20. Clinical and pathological analysis of 10 cases of secondary pneumothorax due to angiosarcoma of the scalp

    International Nuclear Information System (INIS)

    Goto, Hideto; Watanuki, Yuji; Miyazawa, Naoki; Kudo, Makoto; Inoue, Satoshi; Kobayashi, Nobuaki; Kaneko, Takeshi; Ishigatsubo, Yoshiaki

    2008-01-01

    Angiosarcoma of the scalp is a very rare disease. Secondary pneumothorax is known as a characteristic complication in this disease due to lung metastasis. In this study, 17 patients of angiosarcoma of the scalp, diagnosed at our hospital between 1996 and 2006, were analyzed. Secondary pneumothorax was observed in 10 of these patients, among which bilateral pneumothorax occurred in 5 relapse of pneumothorax occurred in 6 and pneumothorax with bloody pleural fluid occurred in 7 patients. Characteristic findings on chest CT were multiple thin-wall cavities and ground-glass attenuation around the cavity, located in bilateral subpleural lung fields. It is suggested that the subpleural thin-wall cavities cause pneumothorax. Although pleurosclerosis were performed in 5 patients and one of them bad a subsequent partial resection of the lung, pneumothorax reocurred within a short period of time in all patients. The average survival time from the first pneumothorax episode was only 4.1 months. Secondary pneumothorax caused by this disease was intractable, resulting in an unfavorable outcome. It is necessary to develop a proper treatment strategy for secondary pneumothorax to create a favorable prognosis in this disease. (author)

  1. Contribution of optical coherence tomography imaging in management of iatrogenic coronary dissection

    Energy Technology Data Exchange (ETDEWEB)

    Barber-Chamoux, Nicolas, E-mail: nbarber-chamoux@chu-clermontferrand.fr [Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand (France); Souteyrand, Géraud; Combaret, Nicolas [Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand (France); ISIT, CaVITI, CNRS (UMR-6284), Auvergne University, Clermont-Ferrand (France); Ouedraogo, Edgar; Lusson, Jean René [Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand (France); Motreff, Pascal [Department of Cardiology, Gabriel Montpied University Hospital, Clermont-Ferrand (France); ISIT, CaVITI, CNRS (UMR-6284), Auvergne University, Clermont-Ferrand (France)

    2016-03-15

    Iatrogenic coronary dissection is a rare but potentially serious complication of coronary angiography and angioplasty. Treatment with angioplasty guided only by angiography is often difficult. Optical coherence tomography imaging seems to be an interesting technique to lead the management of iatrogenic coronary dissection. Diagnosis can be made by optical coherence tomography; it can also eliminate differential diagnosis. Furthermore, this technique can guide safely the endovascular treatment. - Highlights: • Iatrogenic coronary dissection remains a challenging problem in angiography. • Endocoronary imaging is helpful for the diagnosis of iatrogenic coronary dissection. • OCT is a safe option to manage the endovascular treatment of coronary dissection.

  2. Impact of oxygen concentration on time to resolution of spontaneous pneumothorax in term infants: a population based cohort study

    Science.gov (United States)

    2014-01-01

    Background Little evidence exists regarding the optimal concentration of oxygen to use in the treatment of term neonates with spontaneous pneumothorax (SP). The practice of using high oxygen concentrations to promote “nitrogen washout” still exists at many centers. The aim of this study was to identify the time to clinical resolution of SP in term neonates treated with high oxygen concentrations (HO: FiO2 ≥ 60%), moderate oxygen concentrations (MO: FiO2 pneumothorax admitted to all neonatal intensive care units in Calgary, Alberta, Canada, within 72 hours of birth between 2006 and 2010. Newborns with congenital and chromosomal anomalies, meconium aspiration, respiratory distress syndrome, and transient tachypnea of newborn, pneumonia, tension pneumothorax requiring thoracocentesis or chest tube drainage or mechanical ventilation before the diagnosis of pneumothorax were excluded. The primary outcome was time to clinical resolution (hours) of SP. A Cox proportional hazards model was developed to assess differences in time to resolution of SP between treatment groups. Results Neonates were classified into three groups based on the treatment received: HO (n = 27), MO (n = 35) and RA (n = 30). There was no significant difference in time to resolution of SP between the three groups, median (range 25th-75th percentile) for HO = 12 hr (8–27), MO = 12 hr (5–24) and RA = 11 hr (4–24) (p = 0.50). A significant difference in time to resolution of SP was also not observed after adjusting for inhaled oxygen concentration [MO (a HR = 1.13, 95% CI 0.54-2.37); RA (a HR = 1.19, 95% CI 0.69-2.05)], gender (a HR = 0.87, 95% CI 0.53-1.43) and ACoRN respiratory score (a HR = 0.7, 95% CI 0.41-1.34). Conclusions Supplemental oxygen use or nitrogen washout was not associated with faster resolution of SP. Infants treated with room air remained stable and did not require supplemental oxygen at any point of their admission. PMID

  3. Tension type headache

    Directory of Open Access Journals (Sweden)

    Debashish Chowdhury

    2012-01-01

    Full Text Available Tension type headaches are common in clinical practice. Earlier known by various names, the diagnosis has had psychological connotations. Recent evidence has helped clarify the neurobiological basis and the disorder is increasingly considered more in the preview of neurologists. The classification, clinical features, differential diagnosis and treatment of tension type headache are discussed in this paper.

  4. Tensions in Distributed Leadership

    Science.gov (United States)

    Ho, Jeanne; Ng, David

    2017-01-01

    Purpose: This article proposes the utility of using activity theory as an analytical lens to examine the theoretical construct of distributed leadership, specifically to illuminate tensions encountered by leaders and how they resolved these tensions. Research Method: The study adopted the naturalistic inquiry approach of a case study of an…

  5. Iatrogenic Cushing's syndrome caused by intranasal steroid use.

    Science.gov (United States)

    Dursun, Fatma; Kirmizibekmez, Heves

    2017-01-01

    Cushing's syndrome (CS) is common after oral steroid use and has also been reported following topical or inhaled use, but it is extremely uncommon after intranasal administration. This is the case of a 6-year-old child who developed Cushing's syndrome after intranasal application of dexamethasone sodium phosphate for a period of 6 months. Pediatricians and other clinical practitioners should be aware that high-dose and long-term nasal steroid administration may cause iatrogenic Cushing's syndrome characterized by complications of glucocorticoid excess as well as serious and even life-threatening complications of adrenal insufficiency.

  6. Iatrogenic giant cell tumor at bone graft harvesting site

    Directory of Open Access Journals (Sweden)

    Zile S Kundu

    2013-01-01

    Full Text Available 30 year old female patient with giant cell tumor of the distal tibia initially treated at a peripheral nononcological center by curettage and autologous bone grafting from the ipsilateral iliac crest reported to us with local recurrence and an implantation giant cell tumor at the graft harvesting site which required extensive surgeries at both sites. The risk of iatrogenic direct implantation of tumor, often attributable to inadequate surgical planning or poor surgical techniques, and the steps to prevent such complication is reported here.

  7. Spontaneous pneumothorax in paracoccidioidomycosis patients from an endemic area in Midwestern Brazil.

    Science.gov (United States)

    Cabrera, Lucas G G; Santos, Aline F; Andrade, Ursulla V; Guedes, Carlos Ivan A; Oliveira, Sandra M V L; Chang, Marilene R; Mendes, Rinaldo P; Paniago, Anamaria M M

    2017-02-01

    Paracoccidioidomycosis (PCM) is the most important systemic mycosis in Latin America. About 80% of PCM patients are present with its chronic form. The lungs are affected in most patients with the chronic form; however, pleural involvement has rarely been reported. We describe nine cases of PCM that presented with lung involvement and spontaneous pneumothorax. All patients, except one whose condition was not investigated, were smokers. PCM was diagnosed during the pneumothorax episode in three patients, and from 3 to 16 years before the pneumothorax episode in six patients. A total of six patients underwent chest drainage and one died as a direct result of the pneumothorax. We suggest that pneumothorax, although rare, should be considered in PCM patients who present with suddenly worsening dyspnoea. PCM should also be investigated in cases of pneumothorax in adult men from mycosis-endemic areas. © 2016 Blackwell Verlag GmbH.

  8. Anteroposterior chest radiograph vs. chest CT scan in early detection of pneumothorax in trauma patients

    OpenAIRE

    Omar, Hesham R; Mangar, Devanand; Khetarpal, Suneel; Shapiro, David H; Kolla, Jaya; Rashad, Rania; Helal, Engy; Camporesi, Enrico M

    2011-01-01

    Abstract Pneumothorax is a common complication following blunt chest wall trauma. In these patients, because of the restrictions regarding immobilization of the cervical spine, Anteroposterior (AP) chest radiograph is usually the most feasible initial study which is not as sensitive as the erect chest X-ray or CT chest for detection of a pneumothorax. We will present 3 case reports which serve for better understanding of the entity of occult pneumothorax. The first case is an example of a tru...

  9. [Treatment of the first episode of spontaneous pneumothorax].

    Science.gov (United States)

    Moubachir, H; Zaghba, N; Benjelloun, H; Bakhatar, A; Yassine, N

    2016-11-01

    The management of a first episode of spontaneous pneumothorax is controversial and the best technique to be used as an initial intervention, aspiration or intercostal drainage, is still debated. We present a retrospective case series during two and a half consecutive years describing the immediate management of spontaneous pneumothoraces, comparing aspiration versus thoracic drainage. One hundred and thirty-three clinical files from patients with spontaneous pneumothoraces were analyzed (17 primary and 116 secondary). The pneumothoraces were of varying size and different etiologies. Patients were initially treated with simple aspiration in 68 cases, with an immediate success rate of 37.5%, intercostal drainage in 49 cases, and by rest alone in 16 cases. In case of secondary pneumothorax, aspiration appeared to offer advantages as an initial strategy over intercostal drainage in terms of hospital stay (11 versus 22 days), and with significant effectiveness (37.5%). Copyright © 2016 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  10. TRAUMATIC GASTROPLEURAL FISTULA COMPLICATED BY EMPYEMA AND PNEUMOTHORAX

    Directory of Open Access Journals (Sweden)

    Vijay Kumar

    2015-02-01

    Full Text Available We herein report a case of traumatic gastropleural fistula complicated by empyema and pneumothorax which is a rare entity. A 22 year old male was admitted with alleged history of stab injury to left lower chest. Patient was f ound to have left sided pneumothorax, for which intercostal drainage tube was inserted and the patient stabilised. Chest radiograph taken three days after the chest tube insertion showed persistent hydropneumothorax for which the patient underwent a contra st enhanced computed tomography of thorax (CECT. CECT of thorax revealed herniation of fundus of stomach through a defect in the left dome of diaphragm into the left thoracic cavity with leakage of oral contrast into the left pleural cavity. Preoperative diagnosis of gastropleural fistula was made and the same was confirmed in the intraoperative findings. The patient underwent laparotomy with repair of the diaphragmatic defect and closure of the gastric perforation. The patient made an uneventful recovery

  11. EARLY IDENTIFICATION AND BASIC LIFE SUPPORT FOR PNEUMOTHORAX

    Directory of Open Access Journals (Sweden)

    I Wayan Ade Punarbawa

    2013-04-01

    Full Text Available Chest injury is one injury that often occurs and need immediate and precise handling that prevent people from death. Chest trauma 1/4 of the trauma that caused the death and 1/3 of those deaths occur in hospitals. One chest injury that often we get to the health center is pneumothorax. WHO declared in 2020 the level of morbidity and mortality from chest injuries will increase, to become the second leading cause of death in the world. From this data that need to know the signs and symptoms of peneumotoraks, identify the signs and symptoms so we can provide basic life support to the patient before the patient was referred to a medical center nearby so as to reduce the morbidity and mortality in patients with pneumothorax.

  12. Bedside Ultrasonography: A Useful Tool For Traumatic Pneumothorax

    International Nuclear Information System (INIS)

    Mumtaz, U.; Zahur, Z.; Chaudhry, M. A.; Warraich, R. A.

    2016-01-01

    Objective: To compare the diagnostic accuracy of bedside ultrasound and supine chest radiography for the diagnosis of traumatic pneumothorax. Study Design: Analytical study. Place and Duration of Study: PIMS and PAEC General Hospital, Islamabad, from November 2014 to August 2015. Methodology: Patients coming to emergency departments of the study centres, who had sustained chest injuries, were inducted. Their portable bedside ultrasound and supine chest radiographs were taken for assessing pneumothorax and subsequently CT chest was done for confirmation as gold standard. Result: Based on CT findings, sensitivity for ultrasonography and chest radiography was found to be 83.33 percentage and 54.76 percentage, respectively and specificity of 100 percentage for both modalities. Conclusion: Ultrasound can be used as a useful and suitable adjunct to CT in trauma patients as it is easily available, non-invasive, bedside, easily examined with no radiation risk. (author)

  13. Aortic Graft Infection Secondary to Iatrogenic Transcolonic Graft Malposition.

    Science.gov (United States)

    Blank, Jacqueline J; Rothstein, Abby E; Lee, Cheong Jun; Malinowski, Michael J; Lewis, Brian D; Ridolfi, Timothy J; Otterson, Mary F

    2018-01-01

    Aortic graft infections are a rare but devastating complication of aortic revascularization. Often infections occur due to contamination at the time of surgery. Iatrogenic misplacement of the limbs of an aortobifemoral graft is exceedingly rare, and principles of evaluation and treatment are not well defined. We report 2 cases of aortobifemoral bypass graft malposition through the colon. Case 1 is a 54-year-old male who underwent aortobifemoral bypass grafting for acute limb ischemia. He had previously undergone a partial sigmoid colectomy for diverticulitis. Approximately 6 months after vascular surgery, he presented with an occult graft infection. Preoperative imaging and intraoperative findings were consistent with graft placement through the sigmoid colon. Case 2 is a 60-year-old male who underwent aortobifemoral bypass grafting due to a nonhealing wound after toe amputation. His postoperative course was complicated by pneumonia, bacteremia thought to be secondary to the pneumonia, general malaise, and persistent fevers. Approximately 10 weeks after the vascular surgery, he presented with imaging and intraoperative findings of graft malposition through the cecum. Aortic graft infection is usually caused by surgical contamination and presents as an indolent infection. Case 1 presented as such; Case 2 presented more acutely. Both grafts were iatrogenically misplaced through the colon at the index operation. The patients underwent extra-anatomic bypass and graft explantation and subsequently recovered.

  14. Iatrogenic popliteal artery injury in non arthroplasty knee surgery.

    Science.gov (United States)

    Bernhoff, K; Björck, M

    2015-02-01

    We have investigated iatrogenic popliteal artery injuries (PAI) during non arthroplasty knee surgery regarding mechanism of injury, treatment and outcomes, and to identify successful strategies when injury occurs. In all, 21 iatrogenic popliteal artery injuries in 21 patients during knee surgery other than knee arthroplasty were identified from the Swedish Vascular Registry (Swedvasc) between 1987 and 2011. Prospective registry data were supplemented with case-records, including long-term follow-up. In total, 13 patients suffered PAI during elective surgery and eight during urgent surgery such as fracture fixation or tumour resection. Nine injuries were detected intra-operatively, five within 12 to 48 hours and seven > 48 hours post-operatively (two days to 23 years). There were 19 open vascular and two endovascular surgical repairs. Two patients died within six months of surgery. One patient required amputation. Only six patients had a complete recovery of whom had the vascular injury detected at time of injury and repaired by a vascular surgeon. Patients sustaining vascular injury during elective procedures are more likely to litigate (p = 0.029). We conclude that outcomes are poorer when there is a delay of diagnosis and treatment, and that orthopaedic surgeons should develop strategies to detect PAI early and ensure rapid access to vascular surgical support. ©2015 The British Editorial Society of Bone & Joint Surgery.

  15. Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Sildiroglu, Onur; Saad, Wael E.; Hagspiel, Klaus D.; Matsumoto, Alan H.; Turba, Ulku Cenk, E-mail: Turba@me.com [University of Virginia Health System, Department of Radiology (United States)

    2012-12-15

    Purpose: Our purpose was to evaluate iatrogenic renal pseudoaneurysms, endovascular treatment, and outcomes. Methods: This retrospective study (2003-2011) reported the technical and clinical outcomes of endovascular therapy for renal pseudoaneurysms in eight patients (mean age, 46 (range 24-68) years). Renal parenchymal loss evaluation was based on digital subtraction angiography and computed tomography. Results: We identified eight iatrogenic renal pseudoaneurysm patients with symptoms of hematuria, pain, and hematoma after renal biopsy (n = 3), surgery (n = 3), percutaneous nephrolithotomy (n = 1), and endoscopic shock-wave lithotripsy (n = 1). In six patients, the pseudoaneurysms were small-sized (<20 mm) and peripherally located and were treated solely with coil embolization (n = 5). In one patient, coil embolization was preceded by embolization with 500-700 micron embospheres to control active bleeding. The remaining two patients had large-sized ({>=}50 mm), centrally located renal pseudoaneurysms treated with thrombin {+-} coils. Technical success with immediate bleeding cessation was achieved in all patients. There were no procedure-related deaths or complications (mean follow-up, 23.5 (range, 1-67) months). Conclusions: Treatment of renal pseudoaneurysms using endovascular approach is a relatively safe and viable option regardless of location (central or peripheral) and size of the lesions with minimal renal parenchymal sacrifice.

  16. Frequency of Iatrogenic Changes Caused from Overhang Restorations

    Directory of Open Access Journals (Sweden)

    Boteva E.

    2015-11-01

    Full Text Available Overhangs from different restorations are an iatrogenic error with different results, short and long term consequences related to bone changes and periodontal diseases. Amalgam “tattoos”, idiopathic subgingival hypertrophy, marginal periodontitis and bone reductions in the intradental septum are major problems. The aim of the present study is to evaluate the frequency of traumatic restorations in distal teeth and clinical criteria, related to the x-ray findings. Evaluating criteria, for repairing the overhangs or for replacement of the restorations, is also a goal. Three hundred and sixteen - 316 patients from both sexes, 632 dental x-rays with 948 distal teeth and 632 restorations, at least two radiographs for each patient, were analyzed. Overhangs are classified in three groups: small, middle and large. In the criteria bone changes from the overhangs are analyzed separately from the existing or nonexisting bone changes from a generalized periodontal diseases. The frequency of iatrogenic changes in this cohort group is 10.6% from 632 restored teeth. This is a relatively small number compared with the other published studies. These overhangs are on distal teeth in sound teeth arches which makes them difficult for corrections. The evaluated criteria for replacement based on x-ray findings and clinical experience includes: operative and nonoperative corrections, restoration replacement, perio- and endo-therapy and follow up terms for secondary caries.

  17. Infectious prion diseases in humans: cannibalism, iatrogenicity and zoonoses.

    Science.gov (United States)

    Haïk, Stéphane; Brandel, Jean-Philippe

    2014-08-01

    In contrast with other neurodegenerative disorders associated to protein misfolding, human prion diseases include infectious forms (also called transmitted forms) such as kuru, iatrogenic Creutzfeldt-Jakob disease and variant Creutzfeldt-Jakob disease. The transmissible agent is thought to be solely composed of the abnormal isoform (PrP(Sc)) of the host-encoded prion protein that accumulated in the central nervous system of affected individuals. Compared to its normal counterpart, PrP(Sc) is β-sheet enriched and aggregated and its propagation is based on an autocatalytic conversion process. Increasing evidence supports the view that conformational variations of PrP(Sc) encoded the biological properties of the various prion strains that have been isolated by transmission studies in experimental models. Infectious forms of human prion diseases played a pivotal role in the emergence of the prion concept and in the characterization of the very unconventional properties of prions. They provide a unique model to understand how prion strains are selected and propagate in humans. Here, we review and discuss how genetic factors interplay with strain properties and route of transmission to influence disease susceptibility, incubation period and phenotypic expression in the light of the kuru epidemics due to ritual endocannibalism, the various series iatrogenic diseases secondary to extractive growth hormone treatment or dura mater graft and the epidemics of variant Creutzfeldt-Jakob disease linked to dietary exposure to the agent of bovine spongiform encephalopathy. Copyright © 2014 Elsevier B.V. All rights reserved.

  18. A Total Pleural Covering for Lymphangioleiomyomatosis Prevents Pneumothorax Recurrence.

    Directory of Open Access Journals (Sweden)

    Masatoshi Kurihara

    Full Text Available Spontaneous pneumothorax is a major and frequently recurrent complication of lymphangioleiomyomatosis (LAM. Despite the customary use of pleurodesis to manage pnenumothorax, the recurrence rate remains high, and accompanying pleural adhesions cause serious bleeding during subsequent lung transplantation. Therefore, we have developed a technique of total pleural covering (TPC for LAM to wrap the entire visceral pleura with sheets of oxidized regenerated cellulose (ORC mesh, thereby reinforcing the affected visceral pleura and preventing recurrence.Since January 2003, TPC has been applied during video-assisted thoracoscopic surgery for the treatment of LAM. The medical records of LAM patients who had TPC since that time and until August 2014 are reviewed.TPC was performed in 43 LAM patients (54 hemithoraces, 11 of whom required TPC bilaterally. Pneumothorax recurred in 14 hemithoraces (25.9% from 11 patients (25.6% after TPC. Kaplan-Meier estimates of recurrence-free hemithorax were 80.8% at 2.5 years, 71.7% at 5 years, 71.7% at 7.5 years, and 61.4% at 9 years. The recurrence-free probability was significantly better when 10 or more sheets of ORC mesh were utilized for TPC (P = 0.0018. TPC significantly reduced the frequency of pneumothorax: 0.544 ± 0.606 episode/month (mean ± SD before TPC vs. 0.008 ± 0.019 after TPC (P<0.0001. Grade IIIa postoperative complications were found in 13 TPC surgeries (24.1%.TPC successfully prevented the recurrence of pneumothorax in LAM, was minimally invasive and rarely caused restrictive ventilatory impairment.

  19. A clinical and radiological study on spontaneous pneumothorax

    International Nuclear Information System (INIS)

    Jang, Kyung Jae; Kim, Jin Wook; Kim, Byung Soo; Choi, Myung Gwon

    1982-01-01

    A clinical and radiological study was done on 96 cases of spontaneous pneumothorax, encountered in the Dept. of Radiology, Busan National University Hospital during last 3 years from March 1979 to March 1982. The result were summarized as follows: 1. In the age distribution, the ages between 20 and 39 years were most highest, as 54 cases (56.3%). In the sex distribution, the ratio of male to female was 5 : 1 in male predominance. 2. The underlying pathology of the total 96 cases of spontaneous pneumothorax were of tuberculous origin in 33.3 % and non-tuberculous origin in 66.7%. And below 20 years, most were of non- tuberculous origin. 3. In the cases of lung collapse over 2/3, non-tuberculous origin was more than tuberculous origin and had characteristics of significant mediastinal shifting, in contrast to lower percentage of fluid level by chest radiography. 4. The rupture of biebs or bullae was the main immediate causes of spontaneous pneumothorax, independent of the underlying pathology. 5. In only 27 cases (28.1%) among total 96 cases, bullae or biebs could be detected on the chest radiography. 6. In treatment of spontaneous pneumothorax, the closed thoracotomy with under water seal drainage is accepted to be the general method of treatment. But open thoracotomy is considered as the best useful therapeutic procedure to prevent the recurrence, whenever bullae or blebs are found on the chest radiography. 7. In the cases of closed thoracotomy, the recurrent rate was 25.0% and most cases were found at the ipsilateral side of the first attack. 8. Within a week, the collapsed lung were well expanded in most cases of total 96 cases, after closed thoracotomy

  20. Pneumoperitoneum in a patient with pneumothorax and blunt neck trauma

    Directory of Open Access Journals (Sweden)

    Suhail Yaqoob Hakim

    2014-01-01

    CONCLUSION: Free air in the abdomen after blunt traumatic neck injury is very rare. If pneumoperitoneum is suspected in the presence of pneumothorax, exploratory laparotomy should be performed to rule out intraabdominal injury. As, there is no consensus for this plan yet, further prospective studies are warrant. Conservative management for pneumoperitoneum in the absence of viscus perforation is still a safe option in carefully selected cases.

  1. Clinical characteristics and outcome of pneumothorax after stereotactic body radiotherapy for lung tumors.

    Science.gov (United States)

    Asai, Kaori; Nakamura, Katsumasa; Shioyama, Yoshiyuki; Sasaki, Tomonari; Matsuo, Yoshio; Ohga, Saiji; Yoshitake, Tadamasa; Terashima, Kotaro; Shinoto, Makoto; Matsumoto, Keiji; Hirata, Hidenari; Honda, Hiroshi

    2015-12-01

    We retrospectively investigated the clinical characteristics and outcome of pneumothorax after stereotactic body radiotherapy (SBRT) for lung tumors. Between April 2003 and July 2012, 473 patients with lung tumors were treated with SBRT. We identified 12 patients (2.5 %) with pneumothorax caused by SBRT, and evaluated the clinical features of pneumothorax. All of the tumors were primary lung cancers. The severity of radiation pneumonitis was grade 1 in 10 patients and grade 2 in two patients. Nine patients had emphysema. The planning target volume and pleura overlapped in 11 patients, and the tumors were attached to the pleura in 7 patients. Rib fractures were observed in three patients before or at the same time as the diagnosis of pneumothorax. The median time to onset of pneumothorax after SBRT was 18.5 months (4-84 months). The severity of pneumothorax was grade 1 in 11 patients and grade 3 in one patient. Although pneumothorax was a relatively rare late adverse effect after SBRT, some patients demonstrated pneumothorax after SBRT for peripheral lung tumors. Although most pneumothorax was generally tolerable and self-limiting, careful follow-up is needed.

  2. Recurrent Primary Spontaneous Pneumothorax is Common Following Chest Tube and Conservative Treatment.

    Science.gov (United States)

    Olesen, Winnie Hedevang; Lindahl-Jacobsen, Rune; Katballe, Niels; Sindby, Jesper Eske; Titlestad, Ingrid Louise; Andersen, Poul Erik; Licht, Peter Bjørn

    2016-09-01

    Previous studies on primary spontaneous pneumothorax reported variable recurrence rates, but they were based on heterogeneous patient populations including secondary pneumothorax. We investigated young patients with primary spontaneous pneumothorax exclusively and used a national registry to track readmissions and calculate independent predictors of recurrence. A prospective cohort study of consecutive young patients who were admitted over a 5-year period with their first episode of primary spontaneous pneumothorax and treated conservatively with a chest tube. Baseline characteristics were obtained from questionnaires presented on admittance. All patients were discharged with fully expanded lungs on chest radiography. Patient charts were identified in the national electronic patient registry for detailed information on readmissions due to recurrent spontaneous pneumothorax. We included 234 patients. Male/female = ratio 5/1. After a median observation period of 3.6 years (range 1-6 years), recurrent pneumothorax was observed in 54 %. Ipsilateral recurrence was the most common (79 %) but 30 % also experienced contralateral pneumothorax during the study period. Females had a significantly higher age at debut (p pneumothorax in younger patients with their first episode had a much higher recurrence rate than previously reported. Every doctor who treats patients with primary spontaneous pneumothorax should be aware and patients informed.

  3. Effect of needle tract bleeding on occurrence of pneumothorax after transthoracic needle biopsy

    International Nuclear Information System (INIS)

    Topal, U.; Berkman, Yahya M.

    2005-01-01

    Purpose: Occasionally bleeding along the needle trajectory is observed at post-biopsy computed tomographic sections. This study was designed to evaluate the possible effect of needle tract bleeding on the occurrence of pneumothorax and on requirement of chest tube insertion. Materials and methods: Two hundred eighty-four needle biopsies performed in 275 patients in whom the needle traversed the aerated lung parenchyma were retrospectively reviewed. Bleeding along the needle tract, occurrence of pneumothorax and need for chest tube insertion, type and size of the needle, size of the lesion, length of the lung traversed by the needle, presence or absence of emphysema were noted. Effect of these factors on the rate of pneumothorax and needle-tract bleeding was evaluated. The data were analyzed by χ 2 test. Results: Pneumothorax developed in 100 (35%) out of 284 procedures requiring chest tube placement in 16 (16%). Variables that were significantly associated with an increased risk of pneumothorax were depth of the lesion (P 0.05). However, analysis of the relation between length of lung traversed by the needle, tract-bleeding and pneumothorax rate indicated that tract-bleeding had a preventive effect on development of pneumothorax (P 0.05). Conclusion: Bleeding in the needle tract has a preventive effect on the occurrence of the pneumothorax in deep-seated lesions and in the presence of emphysema, although it does not affect the overall rate of pneumothorax

  4. Pneumothorax Secondary to Septic Pulmonary Emboli in a Long-term Hemodialysis Patient with Psoas Abscess.

    Science.gov (United States)

    Okabe, Masahiro; Kasai, Kenji; Yokoo, Takashi

    2017-12-01

    Pneumothorax secondary to septic pulmonary embolism (SPE) is rare but life-threatening. We herein report a long-term hemodialysis patient with psoas abscess caused by methicillin-resistant Staphylococcus aureus, associated with other muscle and splenic abscesses and SPE. Intravenous vancomycin treatment and percutaneous drainage of the psoas abscess rapidly improved her condition. However, the SPE lesions continued to increase, and right-sided pneumothorax occurred 10 days after treatment. The pneumothorax resolved after two months and SPE and all abscesses after four months of treatment. Since late-onset pneumothorax caused by SPE can occur despite successful treatment of the primary infection, care should be taken with such patients.

  5. Minimal pneumothorax with dynamic changes in ST segment similar to myocardial infarction.

    Science.gov (United States)

    Yeom, Seok-Ran; Park, Sung-Wook; Kim, Young-Dae; Ahn, Byung-Jae; Ahn, Jin-Hee; Wang, Il-Jae

    2017-08-01

    Pneumothorax can cause a variety of electrocardiographic changes. ST segment elevation, which is mainly observed in myocardial infarction, can also be induced by pneumothorax. The mechanism is presumed to be a decrease in cardiac output, due to increased intra-thoracic pressure. We encountered a patient with ST segment elevation with minimal pneumothorax. Coronary angiography with ergonovine provocation test and echocardiogram had normal findings. The ST segment elevation was normalized by decreasing the amount of pneumothorax. We reviewed the literature and present possible mechanisms for this condition. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. The role of pneumothorax CT for the evaluation of aortic invasion by lung cancer

    International Nuclear Information System (INIS)

    Yokoi, Kohei; Mori, Kiyoshi; Miyazawa, Naoto; Magota, Seizo; Honda, Kazuyoshi; Sasagawa, Michizo

    1987-01-01

    To improve the accuracy of T3 diagnosis in lung cancer, Pneumothorax CT was carried out in four patients having diagnosis of plain CT and enhanced CT. Both plain and enhanced CT demonstrated obliteration of low density zone between tumor and the aorta in all cases. In three of four cases, Pneumothorax CT, however, demonstrated free air space where tumor was evaluated to be invaded. Remaining one presented the loss of such free air space even by Pneumothorax CT and was made the diagnosis of aortic invasion, which was confirmed by surgicopathological finding. Pneumothorax CT is useful for the diagnosis of ruling out tumor invasion to the aorta. (author)

  7. Incidence of Pneumothorax in Patients With Lymphangioleiomyomatosis Undergoing Pulmonary Function and Exercise Testing.

    Science.gov (United States)

    Taveira-DaSilva, Angelo M; Julien-Williams, Patricia; Jones, Amanda M; Moss, Joel

    2016-07-01

    Because pneumothorax is frequent in lymphangioleiomyomatosis, patients have expressed concerns regarding the risk of pneumothorax associated with pulmonary function or exercise testing. Indeed, pneumothorax has been reported in patients with lung disease after both of these tests. The aim of this study was to determine the incidence of pneumothorax in patients with lymphangioleiomyomatosis during admissions to the National Institutes of Health Clinical Research Center between 1995 and 2015. Medical records were reviewed to identify patients who had a pneumothorax during their stay at the National Institutes of Health. A total of 691 patients underwent 4,523 pulmonary function tests and 1,900 exercise tests. Three patients developed pneumothorax after pulmonary function tests and/or exercise tests. The incidence of pneumothorax associated with lung function testing was 0.14 to 0.29 of 100 patients or 0.02 to 0.04 of 100 tests. The incidence of pneumothorax in patients undergoing exercise testing was 0.14 to 0.28 of 100 patients or 0.05 to 0.10 of 100 tests. The risk of pneumothorax associated with pulmonary function or exercise testing in patients with lymphangioleiomyomatosis is low. Published by Elsevier Inc.

  8. Iatrogenic displacement of tumor cells to the sentinel node after surgical excision in primary breast cancer

    DEFF Research Database (Denmark)

    Tvedskov, Tove F; Jensen, Maj-Britt; Kroman, Niels

    2012-01-01

    Isolated tumor cells (ITC) are more common in the sentinel node (SN) after needle biopsy of a breast cancer, indicating iatrogenic displacement of tumor cells. We here investigate whether similar iatrogenic displacement occurs after surgical excision of a breast tumor. We compared the incidence...

  9. Surgical treatment of catamenial pneumothorax: Report of three cases

    Directory of Open Access Journals (Sweden)

    Yoshinobu Ichiki

    2015-07-01

    Full Text Available Catamenial pneumothorax (CP is a rare entity of spontaneous, recurring pneumothorax in females. Although it has been known to be associated with thoracic endometriosis, varying clinical course and the lack of consistent intraoperative findings have led to conflicting etiological theories. We herein discuss the etiology, clinical course, and surgical treatment of three patients with CP. Three females (aged 40 years, 28 years, and 34 years had recurrent right-sided spontaneous pneumothoraces that coincided with their menses. They had undergone video-assisted thoracoscopic surgery (VATS previously. Blueberry spots in the right diaphragm were detected in all three cases. Two patients had recurrence, postoperatively. The other patient, who received luteinizing hormone-releasing hormone analog therapy for an abdominal endometriosis in the perioperative period and postoperative chemical pleurodesis to prevent recurrence, has been free of recurrence for 15 months, postoperatively. However, pelvic endometriosis was detected in this patient only. Therefore, CP should be suspected in ovulating females with spontaneous pneumothorax, even in the absence of any symptoms associated with pelvic endometriosis. In addition, while performing VATS, careful inspection of the diaphragmatic surface is important. In complicated cases, hormonal suppression therapy and chemical pleurodesis might also be helpful adjunct modalities.

  10. Pneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.

    LENUS (Irish Health Repository)

    Browne, J

    2012-02-03

    PURPOSE: Videoscopic herniorrhaphy is being performed more frequently with advantages claimed over the conventional open approach. This clinical report describes a pneumothorax, pneumomediastinum and subcutaneous emphysema occurring at the end of an extraperitoneal videoscopic herniorrhaphy. CLINICAL FEATURES: A 25 yr old ASA I man presented for elective extraperitoneal videoscopic hernia repair. Following intravenous induction with fentanyl, midazolam and propofol a balanced anesthetic technique using enflurane in N2O and O2 was used. Apart from a prolonged operating time (195 min), the procedure and anesthetic was uneventful. At the conclusion of the operation, prior to reversal of neuromuscular blockade extensive subcutaneous emphysema was noted on removal of the surgical drapes. Chest radiography revealed a pneumomediastinum and pneumothorax. A 25 FG intercostal tube was inserted and connected to an underwater seal drain. Sedation and positive pressure ventilation was maintained overnight to permit resolution and avoid airway compromise. The clinical and radiological features had resolved by the next morning and the patient\\'s trachea was extubated. His subsequent recovery was uneventful. CONCLUSION: Pneumothorax and pneumomediastinum are well recognised complications of laparoscopic techniques but have not been described following extraperitoneal herniorrhaphy. In this report we postulate possible mechanisms which may have contributed to their development, including inadvertent breach of the peritoneum and leakage of gas around the diaphragmatic herniae or tracking of gas retroperitoneally. The case alerts us to the possibility of this complication occurring in patients undergoing videoscopic herniorrhaphy.

  11. Surgical treatment of catamenial pneumothorax: Report of three cases.

    Science.gov (United States)

    Ichiki, Yoshinobu; Nagashima, Akira; Yasuda, Manabu; Takenoyama, Mitsuhiro; Toyoshima, Satoshi

    2015-07-01

    Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in females. Although it has been known to be associated with thoracic endometriosis, varying clinical course and the lack of consistent intraoperative findings have led to conflicting etiological theories. We herein discuss the etiology, clinical course, and surgical treatment of three patients with CP. Three females (aged 40 years, 28 years, and 34 years) had recurrent right-sided spontaneous pneumothoraces that coincided with their menses. They had undergone video-assisted thoracoscopic surgery (VATS) previously. Blueberry spots in the right diaphragm were detected in all three cases. Two patients had recurrence, postoperatively. The other patient, who received luteinizing hormone-releasing hormone analog therapy for an abdominal endometriosis in the perioperative period and postoperative chemical pleurodesis to prevent recurrence, has been free of recurrence for 15 months, postoperatively. However, pelvic endometriosis was detected in this patient only. Therefore, CP should be suspected in ovulating females with spontaneous pneumothorax, even in the absence of any symptoms associated with pelvic endometriosis. In addition, while performing VATS, careful inspection of the diaphragmatic surface is important. In complicated cases, hormonal suppression therapy and chemical pleurodesis might also be helpful adjunct modalities. Copyright © 2013. Published by Elsevier Taiwan.

  12. A Total Pleural Covering for Lymphangioleiomyomatosis Prevents Pneumothorax Recurrence

    Science.gov (United States)

    Kurihara, Masatoshi; Mizobuchi, Teruaki; Kataoka, Hideyuki; Sato, Teruhiko; Kumasaka, Toshio; Ebana, Hiroki; Yamanaka, Sumitaka; Endo, Reina; Miyahashira, Sumika; Shinya, Noriko; Seyama, Kuniaki

    2016-01-01

    Background Spontaneous pneumothorax is a major and frequently recurrent complication of lymphangioleiomyomatosis (LAM). Despite the customary use of pleurodesis to manage pnenumothorax, the recurrence rate remains high, and accompanying pleural adhesions cause serious bleeding during subsequent lung transplantation. Therefore, we have developed a technique of total pleural covering (TPC) for LAM to wrap the entire visceral pleura with sheets of oxidized regenerated cellulose (ORC) mesh, thereby reinforcing the affected visceral pleura and preventing recurrence. Methods Since January 2003, TPC has been applied during video-assisted thoracoscopic surgery for the treatment of LAM. The medical records of LAM patients who had TPC since that time and until August 2014 are reviewed. Results TPC was performed in 43 LAM patients (54 hemithoraces), 11 of whom required TPC bilaterally. Pneumothorax recurred in 14 hemithoraces (25.9%) from 11 patients (25.6%) after TPC. Kaplan-Meier estimates of recurrence-free hemithorax were 80.8% at 2.5 years, 71.7% at 5 years, 71.7% at 7.5 years, and 61.4% at 9 years. The recurrence-free probability was significantly better when 10 or more sheets of ORC mesh were utilized for TPC (P = 0.0018). TPC significantly reduced the frequency of pneumothorax: 0.544 ± 0.606 episode/month (mean ± SD) before TPC vs. 0.008 ± 0.019 after TPC (Ppneumothorax in LAM, was minimally invasive and rarely caused restrictive ventilatory impairment. PMID:27658250

  13. Outcomes of Contralateral Bullae in Primary Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Dongsub Noh

    2015-12-01

    Full Text Available Background: The management of contralateral bullae incidentally found in radiological studies is controversial, largely due to the unpredictability of the natural course of incidentally found contralateral bullae. This study aimed to identify the factors associated with the contralateral occurrence of primary spontaneous pneumothorax (PSP, and to characterize the outcomes of contralateral bullae incidentally found in radiological studies. Methods: From January 2005 to December 2008, 285 patients were admitted to our institution for PSP, and the patients underwent follow- up until August 2012. The relationships between the following variables and contralateral pneumothorax occurrence were evaluated: age, sex, smoking history, body mass index, ipsilateral recurrence, ipsilateral bullae size, the number of ipsilateral bullae, contralateral bullae size, and the number of contralateral bullae. Results: The study group consisted of 233 males and 29 females. The mean age and mean body index of the patients were 23.85± 9.50 years and 19.63±2.50 kg/m2. Contralateral PSP occurred in 26 patients. The five-year contralateral PSP occurrence- free survival rate was 64.3% in patients in whom contralateral bullae were found. Conclusion: The occurrence of contralateral PSP was associated with younger age, ipsilateral recurrence, and the presence of contralateral bullae. Contralateral PSP occurrence was more common in young patients and patients with recurrent PSP. Single-stage bilateral surgery should be considered if an operation is needed in young patients, patients with recurrent pneumothorax, and patients with contralateral bullae.

  14. Management of paediatric spontaneous pneumothorax: a multicentre retrospective case series.

    Science.gov (United States)

    Robinson, Paul D; Blackburn, Carol; Babl, Franz E; Gamage, Lalith; Schutz, Jacquie; Nogajski, Rebecca; Dalziel, Stuart; Donald, Colin B; Druda, Dino; Krieser, David; Neutze, Jocelyn; Acworth, Jason; Lee, Mark; Ngo, Peter K

    2015-10-01

    Paediatric guidelines are lacking for management of spontaneous pneumothorax. Adult patient-focused guidelines (British Thoracic Society 2003 and 2010) introduced aspiration as first-line intervention for primary spontaneous pneumothorax (PSP) and small secondary spontaneous pneumothoraces (SSP). Paediatric practice is unclear, and evidence for aspiration success rates is urgently required to develop paediatric-specific recommendations. Retrospective analysis of PSP and SSP management at nine paediatric emergency departments across Australia and New Zealand (2003-2010) to compare PSP and SSP management. 219 episodes of spontaneous pneumothorax occurred in 162 children (median age 15 years, 71% male); 155 PSP episodes in 120 children and 64 SSP episodes in 42 children. Intervention in PSP vs SSP episodes occurred in 55% (95% CI 47% to 62%) vs 70% (60% to 79%), pmanagement, PSP and SSP management did not differ and ICC insertion was the continuing preferred intervention. Overall success of aspiration was lower than reported results for adults, although success was greater for small than for large pneumothoraces. Paediatric prospective studies are urgently required to determine optimal paediatric interventional management strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  15. Open pneumothorax: the spectrum and outcome of management based on Advanced Trauma Life Support recommendations.

    Science.gov (United States)

    Kong, V Y; Liu, M; Sartorius, B; Clarke, D L

    2015-08-01

    The current management of open pneumothorax (OPTX) is based on Advanced Trauma Life Support (ATLS) recommendations and consists of the application of a three-way occlusive dressing, followed by intercostal chest drain insertion. Very little is known regarding the spectrum and outcome of this approach, especially in the civilian setting. We conducted a retrospective review of 58 consecutive patients with OPTX over a four-year period managed in a high volume metropolitan trauma service in South Africa. Of the 58 patients included, 95% (55/58) were male, and the mean age for all patients was 21 years. Ninety-seven percent of all injuries were inflicted by knives and the remaining 3% (2/58) of injuries were inflicted by unknown weapons. 59% of injuries were left sided. In six patients (10%) a protocol violation was present in their management. Five of the six patients (83%) in whom protocol violation occurred developed a life-threatening event (tension PTX) compared to none amongst those where the protocol was followed (p < 0.001). There was no mortality as a direct result of management of OPTX following ATLS recommendations. ATLS recommendations for OPTX are safe and effective. Any deviation from this standard practice is associated with avoidable morbidity and potential mortality.

  16. Chest Computed Tomography (CT) Immediately after CT-Guided Transthoracic Needle Aspiration Biopsy as a Predictor of Overt Pneumothorax

    Science.gov (United States)

    Noh, Tae June; Lee, Chang Hoon; Kang, Young Ae; Kwon, Sung-Youn; Yoon, Ho-Il; Kim, Tae Jung; Lee, Kyung Won; Lee, Jae Ho

    2009-01-01

    Background/Aims This study examined the correlation between pneumothorax detected by immediate post-transthoracic needle aspiration-biopsy (TTNB) chest computed tomography (CT) and overt pneumothorax detected by chest PA, and investigated factors that might influence the correlation. Methods Adult patients who had undergone CT-guided TTNB for lung lesions from May 2003 to June 2007 at Seoul National University Bundang Hospital were included. Immediate post-TTNB CT and chest PA follow-up at 4 and 16 hours after CT-guided TTNB were performed in 934 patients. Results Pneumothorax detected by immediate chest CT (CT-pneumothorax) was found in 237 (25%) and overt pneumothorax was detected by chest PA follow-up in 92 (38.8%) of the 237 patients. However, overt pneumothorax was found in 18 (2.6%) of the 697 patients without CT-pneumothorax. The width and depth of CT-pneumothorax were predictive risk factors for overt pneumothorax. Conclusions CT-pneumothorax is very sensitive for predicting overt pneumothorax, and the width and depth on CT-pneumothorax are reliable risk factors for predicting overt pneumothorax. PMID:19949733

  17. Parachute Cord Tension Sensor

    Data.gov (United States)

    National Aeronautics and Space Administration — To design and fabricate a light weight (few oz), very small (~2 inch length) parachute cord tension sensor demonstrator device.A major challenge for the CPAS (The...

  18. Leadership. Using Creative Tension.

    Science.gov (United States)

    Cook, David L.

    1986-01-01

    Leadership involves maintaining a balance of the variables which comprise leadership. Love and fear, types of power, success and effectiveness, and driving and restraining forces are discussed as sources of the creative tension a leader uses to influence others. (MT)

  19. Is single port enough in minimally surgery for pneumothorax?

    Science.gov (United States)

    Ocakcioglu, Ilhan; Alpay, Levent; Demir, Mine; Kiral, Hakan; Akyil, Mustafa; Dogruyol, Talha; Tezel, Cagatay; Baysungur, Volkan; Yalcinkaya, Irfan

    2016-01-01

    Video-assisted thoracoscopic surgery is a widespread used procedure for treatment of primary spontaneous pneumothorax patients. In this study, the adaptation of single-port video-assisted thoracoscopic surgery approach to primary spontaneous pneumothorax patients necessitating surgical treatment, with its pros and cons over the traditional two- or three-port approaches are examined. Between January 2011 and August 2013, 146 primary spontaneous pneumothorax patients suitable for surgical treatment are evaluated prospectively. Indications for surgery included prolonged air leak, recurrent pneumothorax, or abnormal findings on radiological examinations. Visual analog scale and patient satisfaction scale score were utilized. Forty triple-port, 69 double-port, and 37 single-port operations were performed. Mean age of 146 (126 male, 20 female) patients was 27.1 ± 16.4 (range 15-42). Mean operation duration was 63.59 ± 26 min; 61.7 for single, 64.2 for double, and 63.8 min for triple-port approaches. Total drainage was lower in the single-port group than the multi-port groups (P = 0.001). No conversion to open thoracotomy or 30-day hospital mortality was seen in our group. No recurrence was seen in single-port group on follow-up period. Visual analog scale scores on postoperative 24th, 48th, and 72nd hours were 3.42 ± 0.94, 2.46 ± 0.81, 1.96 ± 0.59 in the single-port group; significantly lower than the other groups (P = 0.011, P = 0.014, and P = 0.042, respectively). Patient satisfaction scale scores of patients in the single-port group on 24th and 48th hours were 1.90 ± 0.71 and 2.36 ± 0.62, respectively, indicating a significantly better score than the other two groups (P = 0.038 and P = 0.046). This study confirms the competency of single-port procedure in first-line surgical treatment of primary spontaneous pneumothorax.

  20. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    la Cour, M; Kiilgaard, Jens Folke; Eysteinsson, T

    2000-01-01

    To investigate the influence of acute changes in intraocular pressure on the oxygen tension in the vicinity of the optic nerve head under control conditions and after intravenous administration of 500 mg of the carbonic anhydrase inhibitor dorzolamide.......To investigate the influence of acute changes in intraocular pressure on the oxygen tension in the vicinity of the optic nerve head under control conditions and after intravenous administration of 500 mg of the carbonic anhydrase inhibitor dorzolamide....

  1. Emergent endovascular embolization of iatrogenic renal vascular injuries

    International Nuclear Information System (INIS)

    Liu Fengyong; Wang Maoqiang; Duan Feng; Wang Zhijun; Wang Zhongpu

    2007-01-01

    Objective: To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries. Methods: Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization. The causes of renal injury included post-renal biopsy in 5 patients, endovascular interventional procedure-related in 2, post-renal surgery in 1, and post-percutaneous nephrostomy in 1 patient. The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patients, severe flank pain in 7, and hematuria in 8 patients. Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography. The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients, associated with polyvinyl alcohol particles (PVA) in 5, and gelfoam particles in 2 cases. Results: Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases, intrarenal pseudoaneurysm in 2 cases, and the contrast media extravasation in 1 patient. The technical success of the arterial embolization was achieved in all 9 cases within a single session. All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent. Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms, and another 7 with severe flank pain got relief progressively.. Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases, including transient aggravation (n=3 )and developed new renal dysfunction (n=2). Two of these patients required hemodialysis. Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures. Follow-up time ranged from 6-78 months (mean, 38 months), 4 patients died of other primary diseases of renal and multi-organ failures. Five patients are

  2. Iatrogenia em Medicina Intensiva Iatrogenic in Intensive Care Medicine

    Directory of Open Access Journals (Sweden)

    Rafael Canineu

    2006-03-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Define-se iatrogenia ou afecções iatrogênicas como decorrentes da intervenção médica, correta ou não e justificada ou não, da qual resultam conseqüências prejudiciais ao paciente. Os cuidados em Medicina Intensiva apresentam desafios substanciais com relação à segurança do paciente. O objetivo deste artigo foi apresentar uma breve revisão da literatura sobre a iatrogenia em seus conceitos e termos básicos e suas taxas de prevalência em Medicina Intensiva. CONTEÚDO: A Medicina Intensiva fornece subsídios que melhoram a morbidade e a mortalidade, mas que também se associam a riscos significativos de eventos adversos e erros graves; as iatrogenias podem ser diminuídos com monitoração adequada ou podem ser rotuladas como agravante esperado, idiopatia e se perpetuarem no anonimato CONCLUSÕES: É fundamental reconhecer a necessidade do constante aprendizado, reciclagem e consciência da susceptibilidade ao erro; neste contexto, o respeito pelo ser humano deve nortear a conduta profissional.BACKGROUND AND OBJECTIVES: Iatrogenic conditions was due of the medical, correctly intervention or not, justified or not, which harmful consequences to the patient. The cares in Intensive Care Medicine present substantial challenges with relation to the security of the patient. The objective of this article is to make one brief revision of literature on the iatrogenic in its concepts and basic terms and its taxes prevalence in Intensive Care Medicine. CONTENTS: Intensive Care Medicine supplies subsidies that improve the morbidity and mortality, but that also the significant risks of adverse events and serious errors associate. The Iatrogenic can be minimized with the adequate monitorization or can be friction as waited aggravation, idiopathic and if to perpetuate in the anonymity. CONCLUSIONS: It is basic to recognize the necessity of the constant learning and recycling and conscience of the susceptibilities to the

  3. Pneumothorax associated with nontuberculous mycobacteria: A retrospective study of 69 patients.

    Science.gov (United States)

    Ueyama, Masako; Asakura, Takanori; Morimoto, Kozo; Namkoong, Ho; Matsuda, Shuichi; Osawa, Takeshi; Ishii, Makoto; Hasegawa, Naoki; Kurashima, Atsuyuki; Goto, Hajime

    2016-07-01

    The incidence of nontuberculous mycobacterial pulmonary disease (NTMPD) is increasing worldwide. Secondary spontaneous pneumothorax occurs as a complication of underlying lung disease and is associated with higher morbidity, mortality, and recurrence than primary spontaneous pneumothorax. We here investigated the clinical features and long-term outcomes of pneumothorax associated with NTMPD.We conducted a retrospective study on consecutive adult patients with pneumothorax associated with NTMPD at Fukujuji Hospital and Keio University Hospital from January 1992 to December 2013. We reviewed the medical records of 69 such patients to obtain clinical characteristics, radiological findings, and long-term outcomes, including pneumothorax recurrence and mortality.The median age of the patients was 68 years; 34 patients were women. The median body mass index was 16.8 kg/m. Underlying pulmonary diseases mainly included chronic obstructive pulmonary disease and pulmonary tuberculosis. On computed tomography, nodules and bronchiectasis were observed in 46 (98%) and 45 (96%) patients, respectively. Consolidation, pleural thickening, interlobular septal thickening, and cavities were most common, and observed in 40 (85%), 40 (85%), 37 (79%), and 36 (77%) patients, respectively. Regarding pneumothorax treatment outcomes, complete and incomplete lung expansion were observed in 49 patients (71%) and 15 patients (22%), respectively. The survival rate after pneumothorax was 48% at 5 years. By the end of the follow-up, 33 patients had died, and the median survival was 4.4 years with a median follow-up period of 1.7 years. The rate of absence of recurrence after the first pneumothorax was 59% at 3 years. By the end of the follow-up, 18 patients had experienced pneumothorax recurrence. Furthermore, 12/18 patients (66%) with recurrent pneumothorax died during the study period. Twenty-three patients (70%) died because of NTMPD progression. Low body mass index (BMI) was a negative

  4. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT

    International Nuclear Information System (INIS)

    Chami, H.A.; Faraj, W.; Yehia, Z.A.; Badour, S.A.; Sawan, P.; Rebeiz, K.; Safa, R.; Saade, C.; Ghandour, B.; Shamseddine, A.; Mukherji, D.; Haydar, A.A.

    2015-01-01

    Aim: To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors. Materials and methods: One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below −950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored. Results: Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01–1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB. Conclusion: Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax. - Highlights: • Examine the association between quantitative emphysema measures & post NLB pneumothorax. • The risk of post-NLB pneumothorax increases with every unit increase in percent emphysema. • Percent emphysema is a significant predictor of pneumothorax post transthoracic NLB. • Quantitative analysis of chest CT offers clinicians' objective measures to assess pneumothorax risk.

  5. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report

    OpenAIRE

    Idris, Baig M.; Hefny, Ashraf F.

    2016-01-01

    Introduction: Pneumothorax is the most common potentially life-threatening blunt chest injury. The management of pneumothorax depends upon the etiology, its size and hemodynamic stability of the patient. Most clinicians agree that chest drainage is essential for the management of traumatic large pneumothorax. Herein, we present a case of large pneumothorax in blunt chest trauma patient that resolved spontaneously without a chest drain. Presentation of case: A 63- year- old man presented...

  6. Occult pneumothorax in the blunt trauma patient: tube thoracostomy or observation?

    Science.gov (United States)

    Wilson, Heather; Ellsmere, James; Tallon, John; Kirkpatrick, Andrew

    2009-09-01

    The term occult pneumothorax (OP) describes a pneumothorax that is not suspected on the basis of either clinical examination or initial chest radiography, but is subsequently detected on computed tomography (CT) scan. The optimal management of OP in the blunt trauma setting remains controversial. Some physicians favour placement of a thoracostomy tube for patients with OP, particularly those undergoing positive pressure ventilation (PPV), while others favour close observation without chest drainage. This study was conducted both to determine the incidence of OP and to describe its current treatment status in the blunt trauma population at a Canadian tertiary trauma centre. Of interest were the rates of tube thoracostomy vs. observation without chest drainage and their respective outcomes. A retrospective review was conducted of the Nova Scotia Trauma Registry. The data on all consecutive blunt trauma patients between October 1994 and March 2003 was reviewed. Outcome measures evaluated include length of stay, discharge status-dead vs. alive, intervention and time to intervention (tube thoracostomy and its relation to institution of PPV). Direct comparison was made between the OP with tube thoracostomy group and OP without tube thoracostomy group (observation or control group). They were compared in terms of their baseline characteristics and outcome measures. In 1881 consecutive blunt trauma patients over a 102-month period there were 307 pneumothoraces of which 68 were occult. Thirty five patients with OP underwent tube thoracostomy, 33 did not. Twenty nine (82.8%) with tube thoracostomy received positive pressure ventilation (PPV), as did 16 (48.4%) in the observation group. Mean injury severity score (ISS) for tube thoracostomy and observation groups were similar (25.80 and 22.39, p=0.101) whereas length of stay (LOS) was different (17.4 and 10.0 days, p=0.026). Mortality was similar (11.4% and 9.1%). There were no tension pneumothoraces. The natural history of

  7. Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia

    Energy Technology Data Exchange (ETDEWEB)

    Vazquez, Jose L.; Vazquez, Ignacio; Garcia-Tejedor, Jose L. [Complejo Hospitalario Universitario de Vigo, Department of Radiology, Vigo (Spain); Gonzalez, Maria L.; Reparaz, Alfredo [Complejo Hospitalario Universitario de Vigo, Department of Pediatrics, Vigo (Spain)

    2007-12-15

    We present a 3-year-old child with severe extensive Mycoplasma pneumoniae pneumonia complicated with pneumomediastinum and pneumothorax. Pneumothorax and pneumomediastinum have only exceptionally been described in mild cases of the disease. The radiological findings, differential diagnosis and clinical course are discussed. (orig.)

  8. Pleural Adhesion Assessment as a Predictor for Pneumothorax after Endobronchial Valve Treatment

    NARCIS (Netherlands)

    van Geffen, Wouter H.; Klooster, Karin; Hartman, Jorine E.; Ten Hacken, Nick H. T.; Kerstjens, Huib A. M.; Wolf, Rienhart F. E.; Slebos, Dirk-Jan

    Background: Pneumothorax after bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) in patients with advanced emphysema occurs in approximately 20% of patients. It is not well known which factors predict the development of pneumothorax.  Objective: To assess whether pleural

  9. Lung ultrasound accurately detects pneumothorax in a preterm newborn lamb model.

    Science.gov (United States)

    Blank, Douglas A; Hooper, Stuart B; Binder-Heschl, Corinna; Kluckow, Martin; Gill, Andrew W; LaRosa, Domenic A; Inocencio, Ishmael M; Moxham, Alison; Rodgers, Karyn; Zahra, Valerie A; Davis, Peter G; Polglase, Graeme R

    2016-06-01

    Pneumothorax is a common emergency affecting extremely preterm. In adult studies, lung ultrasound has performed better than chest x-ray in the diagnosis of pneumothorax. The purpose of this study was to determine the efficacy of lung ultrasound (LUS) examination to detect pneumothorax using a preterm animal model. This was a prospective, observational study using newborn Border-Leicester lambs at gestational age = 126 days (equivalent to gestational age = 26 weeks in humans) receiving mechanical ventilation from birth to 2 h of life. At the conclusion of the experiment, LUS was performed, the lambs were then euthanised and a post-mortem exam was immediately performed. We used previously published ultrasound techniques to identify pneumothorax. Test characteristics of LUS to detect pneumothorax were calculated, using the post-mortem exam as the 'gold standard' test. Nine lambs (18 lungs) were examined. Four lambs had a unilateral pneumothorax, all of which were identified by LUS with no false positives. This was the first study to use post-mortem findings to test the efficacy of LUS to detect pneumothorax in a newborn animal model. Lung ultrasound accurately detected pneumothorax, verified by post-mortem exam, in premature, newborn lambs. © 2016 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

  10. Pneumomediastinum and pneumothorax as presenting signs in severe Mycoplasma pneumoniae pneumonia

    International Nuclear Information System (INIS)

    Vazquez, Jose L.; Vazquez, Ignacio; Garcia-Tejedor, Jose L.; Gonzalez, Maria L.; Reparaz, Alfredo

    2007-01-01

    We present a 3-year-old child with severe extensive Mycoplasma pneumoniae pneumonia complicated with pneumomediastinum and pneumothorax. Pneumothorax and pneumomediastinum have only exceptionally been described in mild cases of the disease. The radiological findings, differential diagnosis and clinical course are discussed. (orig.)

  11. Pneumothorax size measurements on digital chest radiographs: Intra- and inter- rater reliability.

    Science.gov (United States)

    Thelle, Andreas; Gjerdevik, Miriam; Grydeland, Thomas; Skorge, Trude D; Wentzel-Larsen, Tore; Bakke, Per S

    2015-10-01

    Detailed and reliable methods may be important for discussions on the importance of pneumothorax size in clinical decision-making. Rhea's method is widely used to estimate pneumothorax size in percent based on chest X-rays (CXRs) from three measure points. Choi's addendum is used for anterioposterior projections. The aim of this study was to examine the intrarater and interrater reliability of the Rhea and Choi method using digital CXR in the ward based PACS monitors. Three physicians examined a retrospective series of 80 digital CXRs showing pneumothorax, using Rhea and Choi's method, then repeated in a random order two weeks later. We used the analysis of variance technique by Eliasziw et al. to assess the intrarater and interrater reliability in altogether 480 estimations of pneumothorax size. Estimated pneumothorax sizes ranged between 5% and 100%. The intrarater reliability coefficient was 0.98 (95% one-sided lower-limit confidence interval C 0.96), and the interrater reliability coefficient was 0.95 (95% one-sided lower-limit confidence interval 0.93). This study has shown that the Rhea and Choi method for calculating pneumothorax size has high intrarater and interrater reliability. These results are valid across gender, side of pneumothorax and whether the patient is diagnosed with primary or secondary pneumothorax. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Characteristics of the patients undergoing surgical treatment for pneumothorax: A descriptive study.

    Science.gov (United States)

    Cakmak, Muharrem; Yuksel, Melih; Kandemir, Mehmet Nail

    2016-05-01

    To identify the characteristic features of pneumothorax patients treated surgically. The retrospective study was conducted at Gazi Yasargil Education and Research Hospital Thoracic Surgery Clinic, Diyarbakir, Turkey and comprised records of pneumothorax patients from January 2004 to December 2014. They were divided into two groups as spontaneous and traumatic. Patients who had not undergone any surgical intervention were excluded. Mean age, gender distribution, location of the disease, type of pneumothorax, and treatment method were noted. Among patients with spontaneous pneumothorax, age and months distribution, smoking habits, pneumothorax size, and treatment method were assessed. The effect of gender, location, comorbid disease, smoking, subgroup of disease, and pneumothorax size on surgical procedures were also investigated. The mean age of the 672 patients in the study was 34.5±6.17 years. There were 611(91%) men and 61(9%) women. Disease was on the right side in 360(53.6%) patients, on the left side in 308(45.8%), and bilateral in 4(0.59%). Besides, 523(77.8%) patients had spontaneous, and 149(22.7%) had traumatic pneumothorax. Overall, 561(83.5%) patients had been treated with tube thoracostomy, whereas 111(16.5%) were treated with thoracotomy/thoracoscopic surgery. The presence of comorbid diseases, being primary, and being total or subtotal according to partial were found to create predisposition to thoracotomy/ thoracoscopic surgery (ppneumothorax being total, the presence of comorbid diseases, and the increase in pneumothorax size, thoracotomy or thoracoscopic surgery is preferred.

  13. Analysis of an Internet Community about Pneumothorax and the Importance of Accurate Information about the Disease.

    Science.gov (United States)

    Kim, Bong Jun; Lee, Sungsoo

    2018-04-01

    The huge improvements in the speed of data transmission and the increasing amount of data available as the Internet has expanded have made it easy to obtain information about any disease. Since pneumothorax frequently occurs in young adolescents, patients often search the Internet for information on pneumothorax. This study analyzed an Internet community for exchanging information on pneumothorax, with an emphasis on the importance of accurate information and doctors' role in providing such information. This study assessed 599,178 visitors to the Internet community from June 2008 to April 2017. There was an average of 190 visitors, 2.2 posts, and 4.5 replies per day. A total of 6,513 posts were made, and 63.3% of them included questions about the disease. The visitors mostly searched for terms such as 'pneumothorax,' 'recurrent pneumothorax,' 'pneumothorax operation,' and 'obtaining a medical certification of having been diagnosed with pneumothorax.' However, 22% of the pneumothorax-related posts by visitors contained inaccurate information. Internet communities can be an important source of information. However, incorrect information about a disease can be harmful for patients. We, as doctors, should try to provide more in-depth information about diseases to patients and to disseminate accurate information about diseases in Internet communities.

  14. Recurrent Primary Spontaneous Pneumothorax is Common Following Chest Tube and Conservative Treatment

    DEFF Research Database (Denmark)

    Olesen, Winnie Hedevang; Lindahl-Jacobsen, Rune; Katballe, Niels

    2016-01-01

    INTRODUCTION: Previous studies on primary spontaneous pneumothorax reported variable recurrence rates, but they were based on heterogeneous patient populations including secondary pneumothorax. We investigated young patients with primary spontaneous pneumothorax exclusively and used a national...... registry to track readmissions and calculate independent predictors of recurrence. METHODS: A prospective cohort study of consecutive young patients who were admitted over a 5-year period with their first episode of primary spontaneous pneumothorax and treated conservatively with a chest tube. Baseline...... characteristics were obtained from questionnaires presented on admittance. All patients were discharged with fully expanded lungs on chest radiography. Patient charts were identified in the national electronic patient registry for detailed information on readmissions due to recurrent spontaneous pneumothorax...

  15. Pleural Covering Application for Recurrent Pneumothorax in a Patient with Birt-Hogg-Dubé Syndrome.

    Science.gov (United States)

    Ebana, Hiroki; Otsuji, Mizuto; Mizobuchi, Teruaki; Kurihara, Masatoshi; Takahashi, Kazuhisa; Seyama, Kuniaki

    2016-06-20

    Birt-Hogg-Dubé syndrome (BHDS) is a rare hereditary disease that presents with multiple lung cysts and recurrent pneumothorax. These cysts occupy predominantly the lower-medial zone of the lung field adjacent to the interlobar fissure, and some of them abut peripheral pulmonary vessels. For the surgical management of pneumothorax with BHDS, the conventional approach of resecting all subpleural cysts and bullae is not feasible. Thus, after handling several bullae by using a stapler or performing ligation as a standardized treatment, we applied to a pleural covering technique to thicken the affected visceral pleura and then to prevent recurrence of pneumothorax. We herein report the successful application of a pleural covering technique via thoracoscopic surgery to treat the recurrent pneumothorax of a 30-year-old man with BHDS. This technique is promising for the management of intractable pneumothorax secondary to BHDS.

  16. Clinical experience of intrapleural administration of fibrin glue for secondary pneumothorax with advanced lung cancer

    International Nuclear Information System (INIS)

    Nishino, Takeshi; Takizawa, Hiromitsu; Yoshida, Mitsuteru; Kawakami, Yukikiyo; Sakiyama, Shoji; Kondo, Kazuya

    2014-01-01

    Secondary pneumothorax with advanced lung cancer is an intractable and serious pathosis, which directly aggravates patients' Quality of Life (QOL) and prognosis. We first select the intrapleural administration of fibrin glue for secondary pneumothorax with advanced lung cancer. From April 2009 to May 2012, we encountered 5 patients who developed secondary pneumothorax during treatment for advanced lung cancer. Their average age was 60.8 years old, and 4 of them had squamous cell carcinoma, 1 had adenocarcinoma, and all had unresectable advanced lung cancer. In 4 of them, the point of air leakage could be detected by pleurography, and leakage could be stopped by the intrapleural administration of fibrin glue. All of them could receive chemotherapy or radiotherapy after treatment for secondary pneumothorax. The intrapleural administration of fibrin glue may be an effective and valid treatment for intractable secondary pneumothorax with advanced lung cancer. (author)

  17. Diagnostic accuracy of general physician versus emergency medicine specialist in interpretation of chest X-ray suspected for iatrogenic pneumothorax: a brief report

    Directory of Open Access Journals (Sweden)

    Ghane Mohammad-reza

    2012-03-01

    Conclusion: These findings indicate that the diagnostic accuracy of emergency medicine specialists is significantly higher than those of general physicians. The diagnostic accuracy of both physician groups was higher than the values in similar studies that signifies the role of relevant training given in the emergency departments of the Hospital.

  18. Prospective Evaluation of Thoracic Ultrasound in the Detection of Pneumothorax

    Science.gov (United States)

    Schwarz, K. W.; Hamilton, D. R.; Kirkpatrick, A. W.; Billica, R. D.; Williams, D. R.; Diebel, L. N.; Sargysan, A. E.; Dulchavsky, S. A.

    2000-01-01

    Introduction: Pneumothorax (PTX) occurs commonly in trauma patients and is confirmed by examination and radiography. Thoracic ultrasound (VIS) has been suggested as an alternative method for rapidly diagnosing PTX when X-ray is unavailable as in rural, military, or space flight settings; however, its accuracy and specificity are not known. Methods: We evaluated the accuracy of thoracic U/S detection of PTX compared to radiography in stable, emergency patients with a high suspicion of PTX at a Level-l trauma center over a 6-month period. Following University and NASA Institutional Review Board approval, informed consent was obtained from patients with penetrating or blunt chest trauma, or with a history consistent with PTX. Whenever possible, the presence or absence of the " lung sliding" sign or the "comet tail" artifact were determined by U/S in both hemithoraces by residents instructed in thoracic U/S before standard radiologic verification of PTX. Results were recorded on data sheets for comparison to standard radiography. Results: Thoracic VIS had a 94% sensitivity; two PTX could not be reliably diagnosed due to subcutaneous air; the true negative rate was 100%. In one patient, the VIS exam was positive while X ray did not confirm PTX; a follow-up film 1 hour later demonstrated a small PTX. The average time for bilateral thoracic VIS examination was 2 to 3 minutes. Conclusions: Thoracic ultrasound reliably diagnoses pneumothorax. Presence of the "lung sliding" sign conclusively excludes pneumothorax. Expansion of the FAST examination to include the thorax should be investigated.

  19. Pleurectomy versus pleural abrasion for primary spontaneous pneumothorax in children.

    Science.gov (United States)

    Joharifard, Shahrzad; Coakley, Brian A; Butterworth, Sonia A

    2017-05-01

    Primary spontaneous pneumothorax (PSP) represents a common indication for urgent surgical intervention in children. First episodes are often managed with thoracostomy tube, whereas recurrent episodes typically prompt surgery involving apical bleb resection and pleurodesis, either via pleurectomy or pleural abrasion. The purpose of this study was to assess whether pleurectomy or pleural abrasion was associated with lower postoperative recurrence. The records of patients undergoing surgery for PSP between February 2005 and December 2015 were retrospectively reviewed. Recurrence was defined as an ipsilateral pneumothorax requiring surgical intervention. Bivariate logistic regressions were used to identify factors associated with recurrence. Fifty-two patients underwent 64 index operations for PSP (12 patients had surgery for contralateral pneumothorax, and each instance was analyzed separately). The mean age was 15.7±1.2years, and 79.7% (n=51) of patients were male. In addition to apical wedge resection, 53.1% (n=34) of patients underwent pleurectomy, 39.1% (n=25) underwent pleural abrasion, and 7.8% (n=5) had no pleural treatment. The overall recurrence rate was 23.4% (n=15). Recurrence was significantly lower in patients who underwent pleurectomy rather than pleural abrasion (8.8% vs. 40%, p<0.01). In patients who underwent pleural abrasion without pleurectomy, the relative risk of recurrence was 2.36 [1.41-3.92, p<0.01]. Recurrence of PSP is significantly reduced in patients undergoing pleurectomy compared to pleural abrasion. Level III, retrospective comparative therapeutic study. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Usefulness of CT fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy

    International Nuclear Information System (INIS)

    O, Dong Hyun; Cho, Young Jun; Park, Yong Sung; Hwang, Cheol Mok; Kim, Keum Won; Kim, Ji Hyung

    2006-01-01

    When pneumothorax occurs during a percutaneous needle biopsy, the radiologist usually stops the biopsy. We evaluated the usefulness of computed tomographic (CT) fluoroscopy-guided percutaneous needle biopsy in the presence of pneumothorax during biopsy. We performed 288 CT fluoroscopy guided percutaneous needle biopsies to diagnose the pulmonary nodules. Twenty two of these patients had pneumothorax that occurred during the biopsy without obtaining an adequate specimen. After pneumothorax occurred, we performed immediate CT fluoroscopy guided percutaneous needle biopsies using an 18-gauge cutting needle. We evaluated the success rate of the biopsies and also whether or not the pneumothorax progressed. We classified these patients into two groups according to whether the pneumothorax progressed (Group 2) or not (Group 1) by measuring the longest distance between the parietal pleura and the visceral pleura both in the early and late pneumothorax. Additionally, we analyzed the relationship between the progression of pneumothorax after biopsy and 1) the depth of the pulmonary nodule; 2) the number of biopsies; 3) the presence or absence of emphysema at the biopsy site; and 4) the size of the pulmonary nodule. Biopsy was successful in 19 of 22 nodules (86.3%). Of the 19 nodules, 12 (63.2%) were malignant and 7 (36.8%) were benign. Twelve patients (54.5%) were classified as group 1 and 10 patients (45.4%) as group 2. The distance between the lung lesion and pleura showed a statistically significant difference between these two groups: ≤ 1 cm in distance for group 1 (81.8%) and group 2 (18.2%), and > 1 cm in distance for group 1 (30%) and group 2 (70%), ρ 0.05). When early pneumothorax occurs during a biopsy, CT fluoroscopy guided percutaneous needle biopsy is an effective and safe procedure. Aggravation of pneumothorax after biopsy is affected by the depth of the pulmonary nodule

  1. Pneumothorax Risk Factors in Smokers with and without Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Hobbs, Brian D.; Foreman, Marilyn G.; Bowler, Russell; Jacobson, Francine; Make, Barry J.; Castaldi, Peter J.; San José Estépar, Raúl; Silverman, Edwin K.

    2014-01-01

    Rationale: The demographic, physiological, and computed tomography (CT) features associated with pneumothorax in smokers with and without chronic obstructive pulmonary disease (COPD) are not clearly defined. Objectives: We evaluated the hypothesis that pneumothorax in smokers is associated with male sex, tall and thin stature, airflow obstruction, and increased total and subpleural emphysema. Methods: The study included smokers with and without COPD from the COPDGene Study, with quantitative chest CT analysis. Pleural-based emphysema was assessed on the basis of local histogram measures of emphysema. Pneumothorax history was defined by subject self-report. Measurements and Main Results: Pneumothorax was reported in 286 (3.2%) of 9,062 participants. In all participants, risk of prior pneumothorax was significantly higher in men (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.08–2.22) and non-Hispanic white subjects (OR, 1.90; 95% CI, 1.34–2.69). Risk of prior pneumothorax was associated with increased percent CT emphysema in all participants and participants with COPD (OR, 1.04 for each 1% increase in emphysema; 95% CI, 1.03–1.06). Increased pleural-based emphysema was independently associated with risk of past pneumothorax in all participants (OR, 1.05 for each 1% increase; 95% CI, 1.01–1.10). In smokers with normal spirometry, risk of past pneumothorax was associated with non-Hispanic white race and lifetime smoking intensity (OR, 1.20 for every 10 pack-years; 95% CI, 1.09–1.33). Conclusions: Among smokers, pneumothorax is associated with male sex, non-Hispanic white race, and increased percentage of total and subpleural CT emphysema. Pneumothorax was not independently associated with height or lung function, even in participants with COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00608764). PMID:25295410

  2. Pneumothorax risk factors in smokers with and without chronic obstructive pulmonary disease.

    Science.gov (United States)

    Hobbs, Brian D; Foreman, Marilyn G; Bowler, Russell; Jacobson, Francine; Make, Barry J; Castaldi, Peter J; San José Estépar, Raúl; Silverman, Edwin K; Hersh, Craig P

    2014-11-01

    The demographic, physiological, and computed tomography (CT) features associated with pneumothorax in smokers with and without chronic obstructive pulmonary disease (COPD) are not clearly defined. We evaluated the hypothesis that pneumothorax in smokers is associated with male sex, tall and thin stature, airflow obstruction, and increased total and subpleural emphysema. The study included smokers with and without COPD from the COPDGene Study, with quantitative chest CT analysis. Pleural-based emphysema was assessed on the basis of local histogram measures of emphysema. Pneumothorax history was defined by subject self-report. Pneumothorax was reported in 286 (3.2%) of 9,062 participants. In all participants, risk of prior pneumothorax was significantly higher in men (odds ratio [OR], 1.55; 95% confidence interval [CI], 1.08-2.22) and non-Hispanic white subjects (OR, 1.90; 95% CI, 1.34-2.69). Risk of prior pneumothorax was associated with increased percent CT emphysema in all participants and participants with COPD (OR, 1.04 for each 1% increase in emphysema; 95% CI, 1.03-1.06). Increased pleural-based emphysema was independently associated with risk of past pneumothorax in all participants (OR, 1.05 for each 1% increase; 95% CI, 1.01-1.10). In smokers with normal spirometry, risk of past pneumothorax was associated with non-Hispanic white race and lifetime smoking intensity (OR, 1.20 for every 10 pack-years; 95% CI, 1.09-1.33). Among smokers, pneumothorax is associated with male sex, non-Hispanic white race, and increased percentage of total and subpleural CT emphysema. Pneumothorax was not independently associated with height or lung function, even in participants with COPD. Clinical trial registered with www.clinicaltrials.gov (NCT00608764).

  3. Orthorexia nervosa with hyponatremia, subcutaneous emphysema, pneumomediastimum, pneumothorax, and pancytopenia.

    Science.gov (United States)

    Park, Sang Won; Kim, Jeong Yup; Go, Gang Ji; Jeon, Eun Sil; Pyo, Heui Jung; Kwon, Young Joo

    2011-06-01

    30-year-old male was admitted with general weakness and drowsy mental status. He had eaten only 3-4 spoons of brown rice and fresh vegetable without salt for 3 months to treat his tic disorder, and he had been in bed-ridden state. He has had weight loss of 14 kg in the last 3 months. We report a patient with orthorexia nervosa who developed hyponatremia, metabolic acidosis, subcutaneous emphysema, mediastinal emphysema, pneumothorax, and pancytopenia and we will review the literature. Also, we mention to prevent refeeding syndrome, and to start and maintain feeding in malnourished patients.

  4. Pneumomediastinum and bilateral pneumothorax following near drowning in shallow water

    Directory of Open Access Journals (Sweden)

    Santhiya Govindaraj

    2011-10-01

    Full Text Available We report pneumomediastinum, bilateral pneumothorax and acute respiratory distress syndrome in a victim of near drowning who was intoxicated and did not have thoracic or neck trauma. Chest radiograph revealed the above findings, later confirmed by computed tomography. He was in shock and also had gastrointestinal (GI bleeding and renal dysfunction. With adequate resuscitative measures including fluids, blood transfusions, intercostal tube drainage and mechanical ventilation he made a complete recovery. Good prognostic indicators in near drowning patients include higher Glasgow Coma Scale, short submersion time and quick resuscitative measures even in the presence of serious cardiorespiratory or hemodynamic compromise.

  5. Pneumomediastinum and bilateral pneumothorax following near drowning in shallow water

    Directory of Open Access Journals (Sweden)

    Stalin Viswanathan

    2011-09-01

    Full Text Available We report pneumomediastinum, bilateral pneumothorax and acute respiratory distress syndrome in a victim of near drowning who was intoxicated and did not have thoracic or neck trauma. Chest radiograph revealed the above findings, later confirmed by computed tomography. He was in shock and also had gastrointestinal (GI bleeding and renal dysfunction. With adequate resuscitative measures including fluids, blood transfusions, intercostal tube drainage and mechanical ventilation he made a complete recovery. Good prognostic indicators in near drowning patients include higher Glasgow Coma Scale, short submersion time and quick resuscitative measures even in the presence of serious cardiorespiratory or hemodynamic compromise.

  6. Clinical and radiological outcome following pneumothorax after endoscopic lung volume reduction with valves

    Directory of Open Access Journals (Sweden)

    Gompelmann D

    2016-12-01

    Full Text Available D Gompelmann,1,2 N Benjamin,1 K Kontogianni,1 FJF Herth,1,2 CP Heussel,2–4 H Hoffmann,2,5 R Eberhardt1,2 1Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, 2German Center for Lung Research, 3Diagnostic and Interventional Radiology, Thoraxklinik at University of Heidelberg, 4Diagnostic and Interventional Radiology, University Hospital Heidelberg, 5Thoracic Surgery, Thoraxklinik at University of Heidelberg, Heidelberg, Germany Introduction: Valve implantation has evolved as a therapy for patients with advanced emphysema. Although it is a minimally invasive treatment, it is associated with complications, the most common being pneumothorax. Pneumothorax occurs due to the rapid target lobe volume reduction and may be a predictor of clinical benefit despite this complication. Objective: The objective of this study was to conduct an exploratory data analysis of patients who developed a pneumothorax following endoscopic valve therapy for emphysema. Materials and methods: This study performed a retrospective evaluation of pneumothorax management and the impact of pneumothorax on clinical outcomes in 70 patients following valve therapy in 381 consecutive patients. Results: Pneumothorax rate following valve therapy was 18%. Pneumothorax management consisted of chest tube insertion, valve removal, and surgical intervention in 87% (61/70, 44% (31/70, and 19% (13/70 of the patients, respectively. Despite pneumothorax, patients experienced modest but significant improvements in lung function parameters (forced expiratory volume in 1 second: 55±148 mL, residual volume: -390±964 mL, total lung capacity: -348±876; all P<0.05. Persistent lobar atelectasis 3 months after recovering from pneumothorax, which was associated with relevant clinical improvement, was observed in only 21% (15/70 of the patients. Conclusion: Pneumothorax is a frequent severe complication following valve therapy that requires further intervention

  7. Creating Tension in Writing.

    Science.gov (United States)

    Folta, Bernarr

    This paper discusses the rationale and teaching methods for a six-week unit, for a high school freshman English Class, on perception, semantics, and writing, which places special focus on developing tension in student writing. The first four objectives of the course focus on perception and the next two focus on semantics. The seventh…

  8. Tension-filled Governance?

    DEFF Research Database (Denmark)

    Celik, Tim Holst

    on the statesituated tension-filled functional relationship between legitimation and accumulation, the study both historically and theoretically reworks this approach and reapplies it for the post-1970s/1990s governance period. It asks whether and to what extent governance has served as a distinctive post- 1970s/1990s...

  9. Rein tension during canter

    NARCIS (Netherlands)

    Egenvall, Agneta; Eisersiö, Marie; Rhodin, Marie; van Weeren, P.R.; Roepstorff, Lars

    2015-01-01

    Riders generally use reins as a means for communication with the horse. At present, the signalling pattern is poorly understood. The aim of this study was to illustrate and analyse the rein tension patterns in a number of rider/horse combinations across a variety of exercises in the canter gait. Our

  10. Optic nerve oxygen tension

    DEFF Research Database (Denmark)

    Kiilgaard, Jens Folke; Pedersen, D B; Eysteinsson, T

    2004-01-01

    The authors have previously reported that carbonic anhydrase inhibitors such as acetazolamide and dorzolamide raise optic nerve oxygen tension (ONPO(2)) in pigs. The purpose of the present study was to investigate whether timolol, which belongs to another group of glaucoma drugs called beta...

  11. Reducing duplex examinations in patients with iatrogenic pseudoaneurysms.

    Science.gov (United States)

    Stone, Patrick A; Aburahma, Ali F; Flaherty, Sarah K

    2006-06-01

    Ultrasound-guided thrombin injection has become the initial treatment of choice for femoral access-related pseudoaneurysms. Patients typically undergo serial duplex examinations to assess for spontaneous resolution of small iatrogenic pseudoaneurysms (IPSAs) (IPSAs (>2.5 cm). We evaluated the impact of a revised treatment algorithm that includes primary treatment of both small (2.5 cm), rather than observation of smaller ones, and attempts to establish a single duplex examination via a point-of-care treatment strategy. We reviewed 105 consecutive patients treated with ultrasound-guided thrombin injection from July 2001 through September 2004. Patient, IPSAs, characteristics, and treatment methods were examined. The number of duplex examinations per patient was evaluated over the treatment interval. Also, published cost data were used to compare primary treatment of small ISPAs vs observation with serial duplex examinations. Successful thrombosis occurred in 103 (98.1%) of 105 treated pseudoaneurysms. No minor or major complications occurred after thrombin injection in either small or large ISPAs, and both failures requiring operation were in the large aneurysm group. The recurrence rate for the series was 1.9% (2/105), and both recurrences were successfully treated with an additional thrombin injection. A single injection was successful in treating 43 (97.7%) of 44 small (IPSAs, and one required a second injection. Patients had an average of 3.3 duplex examinations in our first year of treatment experience, which declined to 1.5 by our third year with the institution of a point-of-care service model for all pseudoaneurysms. Based on this decreased use of duplex examination and an average treatment cohort of 35 IPSA patients per year our institution, we determined this results in a reduction of 35 hours of laboratory time and nearly 70 ultrasounds per year. Similarly for small pseudoaneurysms, a point-of-service primary treatment program rather than observation

  12. Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: the best alternative? Case report and review of literature.

    Science.gov (United States)

    Sebastian, Raul; Ghanem, Omar; Diroma, Frank; Milner, Stephen M; Gerold, Kevin B; Price, Leigh A

    2015-05-01

    Multiple factors place burn patients at a high risk of pneumothorax development. Currently, no specific recommendations for the management of pneumothorax in large total body surface area (TBSA) burn patients exist. We present a case of a major burn patient who developed pneumothorax after central line insertion. After the traditional large bore (24 Fr) chest tube failed to resolve the pneumothorax, the pneumothorax was ultimately managed by a percutaneous placed pigtail catheter thoracostomy placement and resulted in its complete resolution. We will review the current recommendations of pneumothorax treatment and will highlight on the use of pigtail catheters in pneumothorax management in burn patients. Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.

  13. Pneumomediastinum and Pneumothorax Associated with Herpes Simplex Virus (HSV) Pneumonia.

    Science.gov (United States)

    López-Rivera, Fermín; Colón Rivera, Xavier; González Monroig, Hernán A; Garcia Puebla, Juan

    2018-01-30

    BACKGROUND Pneumonia is one of the most common causes of death from infectious disease in the United States (US). Although most cases of community-acquired pneumonia (CAP) are secondary to bacterial infection, up to one-third of cases are secondary to viral infection, most commonly due to rhinovirus and influenza virus. Pneumonia due to herpes simplex virus (HSV) is rare, and there is limited knowledge of the pathogenesis and clinical complications. This report is of a fatal case of HSV pneumonia associated with bilateral pneumothorax and pneumomediastinum. CASE REPORT A 36-year-old homeless male Hispanic patient, who was a chronic smoker, with a history of intravenous drug abuse and a medical history of chronic hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection, not on highly active antiretroviral therapy (HAART), was admitted to hospital as an emergency with a seven-day history of productive purulent cough. The patient was admitted to the medical intensive care unit (MICU) with a diagnosis of CAP, with intubation and mechanical ventilation. Broncho-alveolar lavage (BAL) was performed and was positive for HSV. The patient developed bilateral pneumothorax with pneumomediastinum, which was fatal, despite aggressive clinical management. CONCLUSIONS Pneumonia due to HSV infection is uncommon but has a high mortality. Although HSV pneumonia has been described in immunocompromised patients, further studies are required to determine the pathogenesis, early detection, identification of patients who are at risk and to determine the most effective approaches to prophylaxis and treatment for HSV pneumonia.

  14. The floating cardiac fat pad-sign of occult pneumothorax.

    Science.gov (United States)

    Kaufman, Claire; Bokhari, S A Jamal

    2016-08-01

    Pneumothoraces are a possible sequela of chest trauma with potential morbidity and mortality if not recognized and treated promptly. A portable supine chest radiograph is frequently the first radiologic study performed in the setting of trauma. While large pneumothoraces can be readily recognized on these radiographs, smaller pneumothoraces are missed in up to 15 % of trauma patients. There are many radiographic signs of occult pneumothoraces, and we are presenting a new radiographic sign of occult pneumothorax. The floating cardiac fat pad sign occurs when pleural air collects anteriorly and superiorly in the most non-dependent portion of the chest lifting the pericardial fat pad off the diaphragm. Lung markings are still seen surrounding the pericardial fat pad due to the inflated lower lobe of the lung resting dependently. Rapid and accurate identification of pneumothoraces is critical but often difficult on chest radiographs. Although there are many existing radiographic signs for identification of pneumothorax, prospective identification of small pneumothoraces is still relatively poor. Here, we describe an additional sign which aides in the detection of pneumothoraces, the floating cardiac fat pad. When present, this should prompt further evaluation with chest CT or upright chest radiograph.

  15. Flexibility in Men's Sexual Practices in Response to Iatrogenic Erectile Dysfunction after Prostate Cancer Treatment

    Directory of Open Access Journals (Sweden)

    Gary W. Dowsett, PhD

    2014-08-01

    Conclusions: Flexibility in sexual practice is possible for some men, both nonheterosexual and heterosexual, in the face of iatrogenic ED. Advising PCa patients of the possibilities of sexual strategies that include AI may help them in reestablishing a sex life that is not erection dependent. Dowsett GW, Lyons A, Duncan D, and Wassersug RJ. Flexibility in men's sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sex Med 2014;2:115–120.

  16. Massive Thoracoabdominal Aortic Thrombosis in a Patient with Iatrogenic Cushing Syndrome

    International Nuclear Information System (INIS)

    Kim, Dong Hun; Choi, Dong Hyun; Lee, Young Min; Kim, Bo Bae; Ki, Young Jae; Kim, Jin Hwa; Chung, Joong Wha; Koh, Young Youp; Kang, Joon Tae; Chae, Seung Seok

    2014-01-01

    Massive thoracoabdominal aortic thrombosis is a rare finding in patients with iatrogenic Cushing syndrome in the absence of any coagulation abnormality. It frequently represents an urgent surgical situation. We report the case of an 82-year-old woman with massive aortic thrombosis secondary to iatrogenic Cushing syndrome. A follow-up computed tomography scan showed a decreased amount of thrombus in the aorta after anticoagulation therapy alone.

  17. Effects of socioeconomic position and clinical risk factors on spontaneous and iatrogenic preterm birth.

    Science.gov (United States)

    Joseph, K S; Fahey, John; Shankardass, Ketan; Allen, Victoria M; O'Campo, Patricia; Dodds, Linda; Liston, Robert M; Allen, Alexander C

    2014-03-27

    The literature shows a variable and inconsistent relationship between socioeconomic position and preterm birth. We examined risk factors for spontaneous and iatrogenic preterm birth, with a focus on socioeconomic position and clinical risk factors, in order to explain the observed inconsistency. We carried out a retrospective population-based cohort study of all singleton deliveries in Nova Scotia from 1988 to 2003. Data were obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax T1 Family Files. Separate logistic models were used to quantify the association between socioeconomic position, clinical risk factors and spontaneous preterm birth and iatrogenic preterm birth. The study population included 132,714 singleton deliveries and the rate of preterm birth was 5.5%. Preterm birth rates were significantly higher among the women in the lowest (versus the highest) family income group for spontaneous (rate ratio 1.14, 95% confidence interval (CI) 1.03, 1.25) but not iatrogenic preterm birth (rate ratio 0.95, 95% CI 0.75, 1.19). Adjustment for maternal characteristics attenuated the family income-spontaneous preterm birth relationship but strengthened the relationship with iatrogenic preterm birth. Clinical risk factors such as hypertension were differentially associated with spontaneous (rate ratio 3.92, 95% CI 3.47, 4.44) and iatrogenic preterm (rate ratio 14.1, 95% CI 11.4, 17.4) but factors such as diabetes mellitus were not (rate ratio 4.38, 95% CI 3.21, 5.99 for spontaneous and 4.02, 95% CI 2.07, 7.80 for iatrogenic preterm birth). Socioeconomic position and clinical risk factors have different effects on spontaneous and iatrogenic preterm. Recent temporal increases in iatrogenic preterm birth appear to be responsible for the inconsistent relationship between socioeconomic position and preterm birth.

  18. Coulomb string tension, asymptotic string tension, and the gluon chain

    OpenAIRE

    Greensite, Jeff; Szczepaniak, Adam P.

    2014-01-01

    We compute, via numerical simulations, the non-perturbative Coulomb potential of pure SU(3) gauge theory in Coulomb gauge. We find that that the Coulomb potential scales nicely in accordance with asymptotic freedom, that the Coulomb potential is linear in the infrared, and that the Coulomb string tension is about four times larger than the asymptotic string tension. We explain how it is possible that the asymptotic string tension can be lower than the Coulomb string tension by a factor of four.

  19. The frequency and treatment of pneumothorax associated with pulmonary nontuberculous mycobacterial infection.

    Science.gov (United States)

    Ikeda, Masaki; Takahashi, Koji; Komatsu, Teruya; Tanaka, Toru; Kato, Tatsuo; Fujinaga, Takuji

    2017-02-01

    Characteristics of pneumothorax associated with nontuberculous mycobacterium (NTM) infection are rarely reported, especially in terms of surgical treatments. Our objectives were to show the tendency and clinical courses of pneumothorax due to NTM and discuss the way of therapy in our hospital. We retrospectively analyzed 557 patients with NTM infection over a period of 5 years at the Nagara Medical Center. A total of 12 out of the 557 patients (2.2%) suffered from pneumothorax caused by NTM infection without other pulmonary diseases. The diagnosis of all NTM cases was mycobacterium avium complex. Of these 12 patients, three required observation only (25%), five required drainage only (42%), and four required surgery after drainage (33%). The four surgically treated patients suffered from empyema as well as pneumothorax. They were in worse nutritional condition than non-surgically treated patients. For the patients requiring surgery, we selected reasonable surgical methods; we sutured the fistula of lung in all cases and covered it with muscle or omentum or polyglycolic acid sheets without a case in which endobronchial embolization was performed in advance before surgery. Finally, all pneumothorax healed. Thereafter, three of these four patients took unfavorable courses: progressing malnutrition, complications worsening or contralateral pneumothorax. We should select an appropriate treatment including surgery against NTM-associated pneumothorax without losing an opportunity because of its intractability and exhausting effect.

  20. Predictors of pneumothorax after CT-guided transthoracic needle lung biopsy: the role of quantitative CT.

    Science.gov (United States)

    Chami, H A; Faraj, W; Yehia, Z A; Badour, S A; Sawan, P; Rebeiz, K; Safa, R; Saade, C; Ghandour, B; Shamseddine, A; Mukherji, D; Haydar, A A

    2015-12-01

    To evaluate the association of quantitative computed tomography (CT) measures of emphysema with the occurrence of pneumothorax after CT-guided needle lung biopsy (NLB) accounting for other risk factors. One hundred and sixty-three CT-guided NLBs performed between 2008 and 2013 with available complete chest CT within 30 days were reviewed for the occurrence of post-procedure pneumothorax. Percent emphysema was determined quantitatively as the percentage of lung voxels below -950 HU on chest CT images using automated software. Multivariable regression was used to assess the association of percent emphysema volume with the occurrence of post-procedure pneumothorax. The association of percent emphysema volume with the pneumothorax size and need for chest tube placement after NLB was also explored. Percent emphysema was significantly associated with the incidence of post-NLB pneumothorax (OR=1.10 95% confidence interval: 1.01-1.15; p=0.03) adjusting for lower-lobe lesion location, needle path length, lesion size, number of passes, and pleural needle trajectory angle. Percent emphysema was not associated with the size of the pneumothorax, nor the need for chest tube placement after NLB. Percent emphysema determined quantitatively from chest CT is a significant predictor of post-NLB pneumothorax. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  1. Three-step management of pneumothorax: time for a re-think on initial management†

    Science.gov (United States)

    Kaneda, Hiroyuki; Nakano, Takahito; Taniguchi, Yohei; Saito, Tomohito; Konobu, Toshifumi; Saito, Yukihito

    2013-01-01

    Pneumothorax is a common disease worldwide, but surprisingly, its initial management remains controversial. There are some published guidelines for the management of spontaneous pneumothorax. However, they differ in some respects, particularly in initial management. In published trials, the objective of treatment has not been clarified and it is not possible to compare the treatment strategies between different trials because of inappropriate evaluations of the air leak. Therefore, there is a need to outline the optimal management strategy for pneumothorax. In this report, we systematically review published randomized controlled trials of the different treatments of primary spontaneous pneumothorax, point out controversial issues and finally propose a three-step strategy for the management of pneumothorax. There are three important characteristics of pneumothorax: potentially lethal respiratory dysfunction; air leak, which is the obvious cause of the disease; frequent recurrence. These three characteristics correspond to the three steps. The central idea of the strategy is that the lung should not be expanded rapidly, unless absolutely necessary. The primary objective of both simple aspiration and chest drainage should be the recovery of acute respiratory dysfunction or the avoidance of respiratory dysfunction and subsequent complications. We believe that this management strategy is simple and clinically relevant and not dependent on the classification of pneumothorax. PMID:23117233

  2. Relationship of spontaneous pneumothorax cases seen in Eastern Black Sea region with meteorological changes

    Science.gov (United States)

    Yamac, Mustafa Esat; Karapolat, Sami; Turkyilmaz, Atila; Seyis, Kubra Nur; Tekinbas, Celal

    2017-08-01

    The relationship of climate changes or weather conditions with the incidence of pneumothorax has been explored for many years. We aimed at revealing the effects of meteorological changes on the incidence of pneumothorax in the Eastern Black Sea region where spontaneous pneumothorax cases are seen relatively more frequently. The records of 195 subjects (179 males and 16 females) who had been monitored and treated due to spontaneous pneumothorax between January 2006 and December 2012 at our clinic were reviewed retrospectively, and their relationship was investigated with the meteorological data obtained by going through the database archive records of the 11th Regional Meteorology Directorate for the years between 2006 and 2012. Wind velocity was observed to be less in the days of having spontaneous pneumothorax than in the days of having no spontaneous pneumothorax, and the difference was found statistically significant ( P = 0.026). The people of our region whose active lifestyle is reflected in their working life, social life, and even in their folk dances usually take a rest in the days of slower wind speed. We think that this state of resting leads to an increase in the frequency of spontaneous pneumothorax.

  3. Ketorolac does not reduce effectiveness of pleurodesis in pediatric patients with spontaneous pneumothorax.

    Science.gov (United States)

    Lizardo, Radhames E; Langness, Simone; Davenport, Katherine P; Kling, Karen; Fairbanks, Timothy; Bickler, Stephen W; Grabowski, Julia

    2015-12-01

    Antiinflammatory medications are thought to reduce the effectiveness of pleurodesis performed for the treatment of spontaneous pneumothorax. We reviewed our experience with children undergoing video-assisted thorascopic surgery (VATS) with pleurodesis for pneumothorax to determine if ketorolac administration influences patient outcomes. A retrospective review of patients who underwent VATS pleurodesis for spontaneous pneumothorax from 2009 to 2013 at a pediatric hospital was performed. Length of stay, radiographic pneumothorax resolution prior to discharge, and ipsilateral recurrence rates were compared in patients who did and did not receive perioperative ketorolac. Over a 50-month period, 51 patients underwent VATS with mechanical pleurodesis for spontaneous pneumothorax. The average age was 15.5years, and 76% were male. Ketorolac was administered to 26/51 patients. There were no differences in average length of stay (11.3 vs 10.9days, p=0.36), incidence of residual pneumothorax at discharge (22/41 vs 19/41, p=0.48), or ipsilateral recurrence (5/10 vs 5/10, p=1). Despite the intrinsic antiinflammatory properties of ketorolac, our data suggests that its use for patients undergoing pleurodesis for spontaneous pneumothorax does not detrimentally influence the outcomes of surgery. Therefore, we conclude that ketorolac can be used for pain control in this population. Large-scale studies are warranted to validate these findings. Published by Elsevier Inc.

  4. Evaluation of chest computed tomography in patients after pneumonectomy to predict contralateral pneumothorax

    International Nuclear Information System (INIS)

    Maniwa, Tomohiro; Saito, Yukihito; Saito, Tomohito; Kaneda, Hiroyuki; Imamura, Hiroji

    2009-01-01

    Contralateral pneumothorax is a severe complication after pneumonectomy. We evaluated the mediastinal shift and the residual lung in patients who had undergone pneumonectomy to predict the incidence of contralateral pneumothorax. We evaluated 21 cases of pneumonectomy performed from 1996 to 2006. For this study, we excluded patients with recurrent neoplasm, empyema, or hemothorax. We reviewed the computed tomography (CT) results of 13 patients who had undergone pneumonectomy to compare the bullae in the residual lungs, carina shifts, and herniation of the residual lungs before and after pneumonectomy. When evaluating the degree of herniation 4-6 cm below the carina, the anterior and posterior pulmonary hernias were classified as grade A, B, or C. We also investigated the preoperative respiratory function in all 13 patients. Two patients suffered contralateral pneumothorax after left pneumonectomy. Both patients who suffered contralateral pneumothorax after pneumonectomy had bullae. The percentage forced expiratory volume in 1 s (FEV 1.0% ) was <70% in these two patients. Carina shifts and lung herniation were found to be greater after left pneumonectomy than after right pneumonectomy. The bullae in the lung and obstructive pulmonary disease are associated not only with spontaneous pneumothorax but also with contralateral pneumothorax after pneumonectomy. Lung herniation and mediastinal shift are greater after left pneumonectomy than after right pneumonectomy, which may be related to contralateral pneumothorax after pneumonectomy. (author)

  5. A novel structural risk index for primary spontaneous pneumothorax: Ankara Numune Risk Index.

    Science.gov (United States)

    Akkas, Yucel; Peri, Neslihan Gulay; Kocer, Bulent; Kaplan, Tevfik; Alhan, Aslihan

    2017-07-01

    In this study, we aimed to reveal a novel risk index as a structural risk marker for primary spontanoeus pneumothorax using body mass index and chest height, structural risk factors for pneumothorax development. Records of 86 cases admitted between February 2014 and January 2015 with or without primary spontaneous pneumothorax were analysed retrospectively. The patients were allocated to two groups as Group I and Group II. The patients were evaluated with regard to age, gender, pneumothorax side, duration of hospital stay, treatment type, recurrence, chest height and transverse diameter on posteroanterior chest graphy and body mass index. Body mass index ratio per cm of chest height was calculated by dividing body mass index with chest height. We named this risk index ratio which is defined first as 'Ankara Numune Risk Index'. Diagnostic value of Ankara Numune Risk Index value for prediction of primary spontaneous pneumothorax development was analysed with Receiver Operating Characteristics curver. Of 86 patients, 69 (80.2%) were male and 17 (19.8%) were female. Each group was composed of 43 (50%) patients. When Receiver Operating Characteristics curve analysis was done for optimal limit value 0.74 of Ankara Numune Risk Index determined for prediction of pneumothorax development risk, area under the curve was 0.925 (95% Cl, 0.872-0.977, p pneumothorax development however it is insufficient for determining recurrence. Copyright © 2015. Published by Elsevier Taiwan.

  6. Partial pleural covering for intractable pneumothorax in patients with Birt-Hogg-Dubé Syndrome.

    Science.gov (United States)

    Okada, Akira; Hirono, Tatsuhiko; Watanabe, Takehiro; Hasegawa, Go; Tanaka, Reiko; Furuya, Mitsuko

    2017-03-01

    Birt-Hogg-Dubé syndrome (BHD) is an inherited disorder associated with a germline mutation of the folliculin (FLCN) gene. Most patients with BHD have multiple pulmonary cysts, and are at high risk of repeated pneumothorax. Although an increasing number of patients are diagnosed with BHD by genetic testing, therapeutic approaches for intractable pneumothorax have not yet been described. We treated three patients who had repeated episodes of pneumothorax. All had multiple pulmonary cysts in the lower lobes, and two had a family history of pneumothorax. Video-assisted thoracic surgery was used to perform wedge resections and partial pleural covering of the cystic lesions. The partial pleural covering technique used sheets of polyglycolic acid felt or regenerative oxidized cellulose mesh. The resected tissues underwent histopathological evaluation, and peripheral blood leukocytes were tested for FLCN mutations. The operative times were less than 2 h, and there were no complications. The resected cysts had histopathological features characteristic of BHD lung. All patients were found to have FLCN germline mutations; thus their repeated pneumothoraces were a manifestation of BHD. None of the patients developed respiratory problems after undergoing the partial pleural covering procedure, and they have all been well without pneumothorax for 30 months or more. Partial pleural covering combined with resection of protruding cysts should be a safe and effective therapeutic approach for BHD patients with intractable pneumothorax. Further investigation is needed to establish a detailed protocol for treatment of pneumothorax that results in minimal functional impairment. © 2015 John Wiley & Sons Ltd.

  7. Oblique Chest X-Ray: An Alternative Way to Detect Pneumothorax.

    Science.gov (United States)

    Tulay, Cumhur Murat; Yaldız, Sadık; Bilge, Adnan

    2018-03-16

    To identify occult pneumothorax with oblique chest X-ray (OCXR) in clinically suspected patients. In this retrospective study, we examined 1082 adult multitrauma patients who were admitted to our emergency service between January 2016 and January 2017. Clinical findings that suggest occult pneumothorax were rib fracture, flail chest, chest pain, subcutaneous emphysema, abrasion or ecchymosis and moderate to severe hypoxia in clinical parameters. All of these patients underwent anteroposterior chest X-ray (APCXR), but no pneumothorax could be detected. Upon this, OCXR was performed using mobile X-ray equipment. Traumatic pneumothorax was observed in 421 (38.9%) of 1082 patients. We applied OCXR to 26 multitrauma patients. Occult pneumothorax was evaluated at 22 patients (2.03%) in 1082 multitrauma patients. The 22 patients who had multitrauma occult pneumothorax on OCXR were internated at intensive care unit (ICU) and follow-up was done using OCXR and APCXR. OCXR can be an alternative imaging technique to identify occult pneumothorax in some trauma patients at emergency room and also follow period at ICU.

  8. Iatrogenic splenic injury: review of the literature and medico-legal issues

    Directory of Open Access Journals (Sweden)

    Feola Alessandro

    2016-01-01

    Full Text Available Iatrogenic splenic injury is a recognized complication in abdominal surgery. The aim of this paper is to understand the medico-legal issues of iatrogenic splenic injuries. We performed a literature review on PubMed and Scopus using iatrogenic splenic or spleen injury and iatrogenic splenic rupture as keywords. Iatrogenic splenic injury cases were identified. Most cases were related to colonoscopy, but we also identified cases related to upper gastrointestinal procedures, colonic surgery, ERCP, left nephrectomy and/or adrenalectomy, percutaneous nephrolithotomy, vascular operations involving the abdominal aorta, gynecological operation, left lung biopsy, chest drain, very rarely spinal surgery and even cardiopulmonary resuscitation. There are several surgical procedures that can lead to a splenic injury. However, from a medico-legal point of view, it is important to assess whether the cause can be attributed to a technical error of the operator rather than being an unpredictable and unpreventable complication. It is important for the medico-legal expert to have great knowledge on iatrogenic splenic injuries because it is important to evaluate every step of the first procedure performed, how a splenic injury is produced, and whether the correct treatment for the splenic injury was administered in a judgment.

  9. Endovascular management for significant iatrogenic portal vein bleeding.

    Science.gov (United States)

    Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

    2017-11-01

    Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.

  10. Closure Devices for Iatrogenic Thoraco-Cervical Vascular Injuries

    International Nuclear Information System (INIS)

    Makris, Gregory C.; Patel, Rafiuddin; Little, Mark; Tyrrell, Carina; Sutcliffe, James; Allouni, Kader; Bratby, Mark; Anthony, Susan; Uberoi, Raman

    2017-01-01

    IntroductionThe unintentional arterial placement of a central venous line can have catastrophic complications. The purpose of this systematic review is to assess and analyse the available evidence regarding the use of the various vascular closure devices (VCDs) for the management of iatrogenic thoraco-cervical arterial injuries (ITCAI).MethodsA systematic review was performed according to PRISMA guidelines.ResultsThirty-two relevant case series and case reports were identified with a total of 69 patients having being studied. In the majority of the studies, plug-based VCDs were used (81%) followed by suture-based devices (19%). The majority of studies reported successful outcomes from the use of VCDs in terms of achieving immediate haemostasis without any acute complications. Long-term follow-up data were only available in nine studies with only one case of carotid pseudoaneurysm being reported after 1-month post-procedure. All other cases had no reported long-term complications. Five studies performed direct or indirect comparisons between VCDs and other treatments (open surgery or stent grafting) suggesting no significant differences in safety or effectiveness.ConclusionAlthough there is limited evidence, VCDs appear to be safe and effective for the management of ITCAIs. Further research is warranted regarding the effectiveness of this approach in comparison to surgery and in order to identify those patients who are more likely to benefit from this minimally invasive approach.

  11. First do no harm: iatrogenic maintaining factors in anorexia nervosa.

    Science.gov (United States)

    Treasure, Janet; Crane, Anna; McKnight, Rebecca; Buchanan, Emmakate; Wolfe, Melissa

    2011-01-01

    The aim of this paper is to reflect on the way that we as clinicians may play an inadvertent role in perpetuating eating disordered behaviour. This is considered within the theoretical framework of Schmidt and Treasures' maintenance model of anorexia nervosa (AN). The model includes four main domains; interpersonal factors, pro-AN beliefs, emotional style and thinking style. Interpersonal reactions are of particular relevance as clinicians (as with family members) may react with high expressed emotion and unknowingly encourage eating disorder behaviours to continue. Hostility in the form of coercive refeeding in either a hospital or outpatient setting may strengthen conditioned food avoidance and pessimism may hamper motivation to change. Negative schema common to eating disorders, for example low self-esteem, perfectionism and striving for social value may augment existing or initiate new eating disorder behaviour. Services can become a reinforcing influence by providing an overly protective, palliating environment which ensures safety, security and acceptance whilst reducing loneliness and isolation. This stifles the need for an individual to develop their own sense of responsibility, autonomy and independence allowing avoidance to dominate. Furthermore, the highly structured environment of inpatient care supports the rigid attention to detail and inflexibility that is characteristic of people with eating disorders, and allows these negative behaviours to thrive. Careful planning of service provision, reflective practice, supervision and regular team feedback is essential to prevent iatrogenic harm. Copyright © 2011 John Wiley & Sons, Ltd and Eating Disorders Association.

  12. Closure Devices for Iatrogenic Thoraco-Cervical Vascular Injuries

    Energy Technology Data Exchange (ETDEWEB)

    Makris, Gregory C., E-mail: g.makris09@doctors.org.uk; Patel, Rafiuddin; Little, Mark; Tyrrell, Carina; Sutcliffe, James; Allouni, Kader; Bratby, Mark; Anthony, Susan; Uberoi, Raman [Oxford University Hospitals, NHS Foundation Trust, Interventional Radiology Department (United Kingdom)

    2017-03-15

    IntroductionThe unintentional arterial placement of a central venous line can have catastrophic complications. The purpose of this systematic review is to assess and analyse the available evidence regarding the use of the various vascular closure devices (VCDs) for the management of iatrogenic thoraco-cervical arterial injuries (ITCAI).MethodsA systematic review was performed according to PRISMA guidelines.ResultsThirty-two relevant case series and case reports were identified with a total of 69 patients having being studied. In the majority of the studies, plug-based VCDs were used (81%) followed by suture-based devices (19%). The majority of studies reported successful outcomes from the use of VCDs in terms of achieving immediate haemostasis without any acute complications. Long-term follow-up data were only available in nine studies with only one case of carotid pseudoaneurysm being reported after 1-month post-procedure. All other cases had no reported long-term complications. Five studies performed direct or indirect comparisons between VCDs and other treatments (open surgery or stent grafting) suggesting no significant differences in safety or effectiveness.ConclusionAlthough there is limited evidence, VCDs appear to be safe and effective for the management of ITCAIs. Further research is warranted regarding the effectiveness of this approach in comparison to surgery and in order to identify those patients who are more likely to benefit from this minimally invasive approach.

  13. Iatrogenic possibilities of orthodontic treatment and modalities of prevention

    Science.gov (United States)

    Meeran, Nazeer Ahmed

    2013-01-01

    The benefits of orthodontic treatment are numerous and in most cases, the benefits outweigh the possible disadvantages. Orthodontic treatment can play an important role in enhancing esthetics, function, and self-esteem in patients. However, it carries with it the risks of enamel demineralization, tissue damage, root resorption, open gingival embrasures in the form of triangular spaces, allergic reactions to nickel, and treatment failure in the form of relapse. These potential complications are easily avoidable by undertaking certain precautions and timely interventions by both the orthodontist and the patient. The orthodontist must ensure that the patient is aware of the associated risks and stress the importance of the patient's role in preventing these untoward outcomes. The decision whether to proceed with the orthodontic treatment is essentially a risk-benefit analysis, where the perceived benefits of commencing treatment outweigh the potential risks. This article provides an overview of the iatrogenic possibilities of orthodontic treatment and the role of the patient as well as the orthodontist in preventing the associated risks. PMID:24987646

  14. War, traffic and iatrogenic injuries of D3 duodenal segment

    Directory of Open Access Journals (Sweden)

    Ignjatović Dragan

    2005-01-01

    Full Text Available Background. Injuries of the duodenum at the level of aortomesenteric clamp (segment D3 are with a high incidence of death due to the development of fistula and peritonitis. In three successfully managed cases, we applied the biliary surgery method. Case reports. All three cases were with the injuries of D3 duodenal segment. The first patient suffered from the blast perforation of duodenum at the level of the aortomesenteric clamp which occurred at the 7th day after the injury. The second patient suffered from the duodenal injury caused in a traffic accident. The third patient suffered from an iatrogenic injury at the beginning of D3 duodenal segment inflicted during ureterolithotomy. The described surgical procedure included basically the suture to narrow the site of the injury, then lateroterminal anastomosis with the Roux-en-Y jejunal flexure and, finally, the placement of a silicone prosthesis starting from the duodenum through the site of injury and the Roux-en-Y out. Octreotide and the total parenteral nutrition were administered to the patients postoperatively. Conclusion. The use of the releasing silicone prosthesis in all three patients provided the repair of the site of the injury with anastomosed Reux-en-Y jejunum.

  15. Iatrogenic Rectal Injury During Radical Prostatectomy: Is Colostomy Inevitable End?

    Directory of Open Access Journals (Sweden)

    Ramazan Topaktas

    2014-12-01

    Full Text Available Aim: Radical prostatectomy (RP is the gold standard treatment method for localized prostate cancer, because of its high oncological success. Iatrogenic rectal injury (IRI during RP is rarely seen, but it may causes serious complications because of the close anatomic relationship between the prostate and rectum. Aim is to present our series about management of IRI without colostomy. Material and Method: Between June 1999 and June 2013, radical retropubic prostatectomy (RRP was performed to 372 patients by a single surgeon. 10 cases (%2,6 were complicated by a rectal injury during RRP. Instant rectal closure was performed in 3 layers without a diverting colostomy, at the time of surgery. Omental vascular flap was placed between rectum and vesicourethral anastomosis. Results: The clinical stages of IRI cases were T1c, T2a and T2c in 2, 3 and 5 patients, respectively. Their preoperative Gleason scores were 6, 7 and 8 in 3, 5 and 2 patient, respectively. None of the 10 had undergone previous prostatic or rectal surgery, or received preoperative radiotherapy or hormonal therapy. Discussion: Instant diagnosis and rectal wall closures by three layers are essential for successful repair. Our technique seems as a safe, minimal invasive and highly effective option for the management of IRI.

  16. Iatrogenic Subclinical Hyperthyroidism Does Not Promote Weight Loss.

    Science.gov (United States)

    Kedia, Rohit; Lowes, Alicia; Gillis, Sarah; Markert, Ronald; Koroscil, Thomas

    2016-02-01

    Among patients who have undergone total thyroidectomy, do those with thyroid cancer being kept iatrogenically subclinical hyperthyroid (SCH) differ from euthyroid patients in long-term weight change? In a retrospective study, medical records identified 291 patients who had undergone a thyroidectomy for differentiated thyroid cancer or benign thyroid disease. Weight, thyroid-stimulating hormone, and levothyroxine dose were measured presurgery and 1, 2, and 3 years postsurgery. Of 291 patients, 147 were in the SCH group and 144 were in the euthyroid group. At all 3 years both groups gained weight from baseline, but the two groups did not differ in weight change from baseline at any time period: year 1 (SCH mean 0.4% ± 6.2% weight gain vs euthyroid group mean 2.2% ± 6.6% weight gain; P = 0.12), year 2 (SCH mean 1.1% ± 9.1% weight gain vs euthyroid mean 2.9% ± 7.8% weight gain; P = 0.22), and year 3 (SCH mean 2.6% ± 9.2% weight gain vs euthyroid mean 3.1% ± 11.1% weight gain; P = 0.49). Among total thyroidectomy patients, weight change did not differ between SCH patients and euthyroid patients at years 1 through 3. As such, the use of levothyroxine to induce SCH did not lead to long-term weight change when compared with euthyroid patients.

  17. The factor analysis of the incidence of pneumothorax after CT-guided transthoracic needle aspiration biopsy

    International Nuclear Information System (INIS)

    Zhong Tao; Yu Hongguang; Wang Yong; Yang Sifu; Wang Xiaoxuan

    2007-01-01

    Objective: To analyze the impact of multiple factors on the incidence of pneumothorax associated with CT-guided transthoracic needle aspiration biopsy. Methods: The sign of pneumothorax after 162 cases (lesion diameter from 1 cm to 6 cm) CT-guided transthoracic needle aspiration biopsy was observed and its relationship with multivariate factors were analyzed by multivariate logistic regression model. Results: Thirty-two cases presented pneumothorax accounting for 19. 8%. Single variate analysis showed that the sign of pneumothorax related to intercurrent COPD, distance from lesion and chest wall, needle dwelling time and lesion diameter. 67 patients of intercurrent COPD with postoperative pneumothorax occurred in 22 cases (32.8%); With respect to those having lesions close to the chest wall (48 cases), and the cases with the distance between the chest wall and lesions less than 2 cm (55 cases) and greater than 2 cm (59 cases), the postoperative pneumothorax occurred in 0, 14 (25.5%), 18 (30.5%) cases respectively; For those patients with needle in the chest residence time of less than 10 minutes (82 cases), 10-20 minutes (51 cases), more than 20 minutes (28 cases) after the occurrence of pneumothorax were 8 (9.6%), 10(19.6%), 14 (50%) cases respectively; In contrast, those with lesion diameter less than 2 cm (65 cases), 2-4 cm(52 cases), more than 4cm(45 cases) were 19 (29.2%), 8 (15.4%) and 5 (11.1% ) respectively. The multivariate logistic regression analysis showed that the prior three factor's were risk factors of pneumothorax (OR=4.652, 4.030, 2.855 respectively). Conclusions: To avoid the pneumothorax, caution must be taken with respect to CT-guided transthoracic needle aspiration biopsy, patients with intercurrent COPD, long distance between lesion and chest wall, and smaller lesion diameter. For operation the needle dwell time within thorax should be minimized. (authors)

  18. Variables affecting the risk of pneumothorax and intrapulmonal hemorrhage in CT-guided transthoracic biopsy

    International Nuclear Information System (INIS)

    Khan, M.F.; Straub, R.; Moghaddam, S.R.; Maataoui, A.; Gurung, J.; Thalhammer, A.; Vogl, T.J.; Jacobi, V.; Wagner, T.O.F.; Ackermann, H.

    2008-01-01

    The influence of various variables on the rate of pneumothorax and intrapulmonal hemorrhage associated with computed tomography (CT)-guided transthoracic needle biopsy of the lung were evaluated retrospectivly. One hundred and thirty-three patients underwent CT guided biopsy of a pulmonary lesion. Two patients were biopsied twice. Variables analyzed were lesion size, lesion location, number of pleural needle passes, lesion margin, length of intrapulmonal biopsy path and puncture time. Eighteen-gauge (18G) cutting needles (Trucut, Somatex, Teltow, Germany) were used for biopsy. Pneumothorax occured in 23 of 135 biopsies (17%). Chest tube placement was required in three out of 23 cases of pneumothorax (2% of all biopsies). Pneumothorax rate was significantly higher when the lesions were located in the lung parenchyma compared with locations at the pleura or chest wall (P < 0.05), but all pneumothorax cases which required chest tube treatment occured in lesions located less than 2 cm from the pleura. Longer puncture time led to an increase in pneumothorax rate (P < 0.05). Thirty-seven (27%) out of 135 biopsies showed perifocal hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage and pneumothorax (P < 0.05). Significantly more hemorrhage occured when the pleura was penetrated twice during the puncture (P < 0.05). Lesion size <4 cm is strongly correlated with higher occurence of perifocal hemorrhage (P < 0.05). Lesion margination showed no significant effect on complication rate. CT-guided biopsy of smaller lesions correlates with a higher bleeding rate. Puncture time should be minimized to reduce pneumothorax rate. Passing the pleura twice significantly increases the risk of hemorrhage. Intrapulmonal biopsy paths longer than 4 cm showed significantly higher numbers of perifocal hemorrhage as well as pneumothorax. (orig.)

  19. The evaluation of cases with pneumothorax in the neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Müsemma Karabel

    2013-09-01

    Full Text Available Objectives: Early diagnosis and treatment is essentialin reducing mortality in newborns with pneumothorax. Inthis study, newborns with a diagnosis of pneumothorax inneonatal intensive care unit of our hospital were evaluatedand aimed to increase the awareness of physicians.Methods: 12 cases with pneumothorax were evaluatedretrospectively. The gender, birth weight, gestational age,mode of delivery, the presence of underlying disease,pneumothorax localization, implementation of the surfactantand mechanical ventilation and existence or absenceof mortality were recorded.Results: During the study, pneumothorax was detected12 patients. Male/female ratio was 1.4. Eight of the patientshad born with cesarean delivery, the mean birthweight of cases was 2623±912 g and, 66.7% of caseswere term babies. Pneumothorax was observed in thefirst week of life in all patients and it occurred spontaneouslyin 4 patients. The frequency of bilateral pneumothoraxwas 41.7%. For the treatment, closed tube drainagewas performed in 9 patients. The overall mortality ratewas 66.7%. Half of the patients who died had congenitalanomalies such as diaphragmatic eventration (n=1,hydrocephalus (n=1, encephalocel (n=1, non-immunehydrops fetalis (n=1.Conclusion: Additional congenital anomalies, such asPDAs and persistent pulmonary hypertension were foundto be effective on mortality in neonates with pneumothorax.Although, it is a life-threatening condition, the emergencytreatment is life saving. Therefore, in patients withrisk factors, keeping pneumothorax in mind is also thefirst step of the treatment. J Clin Exp Invest 2013; 4 (3:289-292Key words: Newborn, respiratuar distress, pneumothorax,treatment, outcome

  20. Scintigraphic pattern of pneumothorax complicating Pneumocystis carinii pneumonia in patients with AIDS

    International Nuclear Information System (INIS)

    Finestone, H.; Goldfarb, C.R.; Ongseng, F.; Wasserman, I.; Garcia, H.

    1990-01-01

    Spontaneous pneumothorax is a serious though infrequently reported pulmonary complication of AIDS. An unsuspected lung collapse was discovered via gallium scintigraphy for the study of Pneumocystis carinii pneumonia. Neither the pneumonia nor the pneumothorax were apparent on the most recent chest roentgenogram. In evaluating gallium images during the work-up of AIDS patients with associated pulmonary pathology, the possible complication of lung collapse should be considered. If pneumothorax is suspected on gallium imaging, a chest roentgenogram in expiration must be obtained for prompt delineation of this serious, yet correctable, condition

  1. Algoritmo para el tratamiento del neumotórax traumático: experiencia de 10 años Algorithm for treatment of traumatic pneumothorax: ten-years experience

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    Gimel Sosa Martín

    2010-12-01

    diseases. The objective of present paper was to analyze the behavior of he spontaneous and traumatic pneumothorax and also to assess its treatment. METHODS. A multi-center study was conducted using analytical, descriptive, retrospective and prospective, cross-sectional elements in 154 patients with clinical, radiological diagnosis of the pneumothorax seen between October, 1998 and December, 2008, following the work algorithm designed for this aim. Study sample included 154 patients. RESULTS. In present study there was predominance of male sex, smoking and the type of traumatic pneumothorax. The minimal pleurotomy was effective in the 94,8% of patients. The traumatic pneumothorax were 126 (81,2%. From these, 120 (77,9% were caused by firearms wounds and contusions and six were of iatrogenic type (3,8%. The more frequent complication after pleurotomy was the pleural tube obstruction. CONCLUSIONS. The medical treatment, indifferent minimal pleurotomy, the high minimal pleurotomy and the chemical pleurodesis had a effectiveness between the 90 and the 100%. There was predominance of several types of traumatic pneumothorax In this series, thoracotomy indications were due to a persistent, traumatic, relapsing pneumothorax.

  2. Risk of cardiovascular events in people prescribed glucocorticoids with iatrogenic Cushing’s syndrome: cohort study

    Science.gov (United States)

    Petersen, Irene; Nazareth, Irwin

    2012-01-01

    Objective To investigate whether there is an increased risk of cardiovascular events in people who exhibit iatrogenic Cushing’s syndrome during treatment with glucocorticoids. Design Cohort study. Setting 424 UK general practices contributing to The Health Improvement Network database. Participants People prescribed systemic glucocorticoids and with a diagnosis of iatrogenic Cushing’s syndrome (n=547) and two comparison groups: those prescribed glucocorticoids and with no diagnosis of iatrogenic Cushing’s syndrome (n=3231) and those not prescribed systemic glucocorticoids (n=3282). Main outcome measures Incidence of cardiovascular events within a year after diagnosis of iatrogenic Cushing’s syndrome or after a randomly selected date, and association between iatrogenic Cushing’s syndrome and risk of cardiovascular events. Results 417 cardiovascular events occurred in 341 patients. Taking into account only the first event by patient (coronary heart disease n=177, heart failure n=101, ischaemic stroke n=63), the incidence rates of cardiovascular events per 100 person years at risk were 15.1 (95% confidence interval 11.8 to 18.4) in those prescribed glucocorticoids and with a diagnosis of iatrogenic Cushing’s syndrome, 6.4 (5.5 to 7.3) in those prescribed glucocorticoids without a diagnosis of iatrogenic Cushing’s syndrome, and 4.1 (3.4 to 4.8) in those not prescribed glucocorticoids. In multivariate analyses adjusted for sex, age, intensity of glucocorticoid use, underlying disease, smoking status, and use of aspirin, diabetes drugs, antihypertensive drugs, lipid lowering drugs, or oral anticoagulant drugs, the relation between iatrogenic Cushing’s syndrome and cardiovascular events was strong (adjusted hazard ratios 2.27 (95% confidence interval 1.48 to 3.47) for coronary heart disease, 3.77 (2.41 to 5.90) for heart failure, and 2.23 (0.96 to 5.17) for ischaemic cerebrovascular events). The adjusted hazard ratio for any cardiovascular event was 4

  3. Risk of cardiovascular events in people prescribed glucocorticoids with iatrogenic Cushing's syndrome: cohort study.

    Science.gov (United States)

    Fardet, Laurence; Petersen, Irene; Nazareth, Irwin

    2012-07-30

    To investigate whether there is an increased risk of cardiovascular events in people who exhibit iatrogenic Cushing's syndrome during treatment with glucocorticoids. Cohort study. 424 UK general practices contributing to The Health Improvement Network database. People prescribed systemic glucocorticoids and with a diagnosis of iatrogenic Cushing's syndrome (n = 547) and two comparison groups: those prescribed glucocorticoids and with no diagnosis of iatrogenic Cushing's syndrome (n = 3231) and those not prescribed systemic glucocorticoids (n = 3282). Incidence of cardiovascular events within a year after diagnosis of iatrogenic Cushing's syndrome or after a randomly selected date, and association between iatrogenic Cushing's syndrome and risk of cardiovascular events. 417 cardiovascular events occurred in 341 patients. Taking into account only the first event by patient (coronary heart disease n = 177, heart failure n = 101, ischaemic stroke n = 63), the incidence rates of cardiovascular events per 100 person years at risk were 15.1 (95% confidence interval 11.8 to 18.4) in those prescribed glucocorticoids and with a diagnosis of iatrogenic Cushing's syndrome, 6.4 (5.5 to 7.3) in those prescribed glucocorticoids without a diagnosis of iatrogenic Cushing's syndrome, and 4.1 (3.4 to 4.8) in those not prescribed glucocorticoids. In multivariate analyses adjusted for sex, age, intensity of glucocorticoid use, underlying disease, smoking status, and use of aspirin, diabetes drugs, antihypertensive drugs, lipid lowering drugs, or oral anticoagulant drugs, the relation between iatrogenic Cushing's syndrome and cardiovascular events was strong (adjusted hazard ratios 2.27 (95% confidence interval 1.48 to 3.47) for coronary heart disease, 3.77 (2.41 to 5.90) for heart failure, and 2.23 (0.96 to 5.17) for ischaemic cerebrovascular events). The adjusted hazard ratio for any cardiovascular event was 4.16 (2.98 to 5.82) when the group prescribed glucocorticoids and with

  4. Iatrogenic parasitic leiomyoma and leiomyomatosis peritonealis disseminata following uterine morcellation.

    Science.gov (United States)

    Lu, Bingjian; Xu, Jing; Pan, Zimin

    2016-08-01

    To assess the impact of morcellation on the spread of uterine leiomyoma. Cases of parasitic leiomyoma involving prior laparoscopy were collected between 2012 and 2015 in a tertiary women's hospital in China. Their clinicopathological features and the associated reports were reviewed. All six patients with parasitic leiomyoma had laparoscopic myomectomy or hysterectomy with power morcellation 39-132 months previously. Patient 1 had widely disseminated tumors in the peritoneum and pelvis, in keeping with leiomyomatosis peritonealis disseminata (LPD). She received debulking of peritoneal tumors and lived with disease for 22 months. The implanting sites of the other parasitic tumors (patients 2-6) included the mesentery (n = 2), intestine (n = 1), pelvic parietal (n = 1), bladder (n = 1), and musculus rectus abdominis (n = 1). The diameter varied from 1 cm to 6 cm. The patients underwent abdominal subtotal hysterectomy, cervicectomy or tumor debulking and the postoperative course was unremarkable for a period of 2-32 months. Pathologically, these disseminated or parasitic leiomyomas did not show any evidence of malignancy. There were no morphological or immunohistochemical differences between the original tumor and the following seeding tumors. On literature review, 11 iatrogenic LPD have been reported after laparoscopic surgery for uterine leiomyoma. These cases may provide an alternative pathogenic mechanism for a distinct variant of LPD. Laparoscopic hysterectomy with tumor morcellation may increase the chance of tumor implantation and dissemination. Both clinicians and pathologists should be alert to this rare complication. © 2016 Japan Society of Obstetrics and Gynecology.

  5. Experimental and iatrogenic poisoning by sodium selenite in pigs

    Directory of Open Access Journals (Sweden)

    Paulo V. Peixoto

    Full Text Available ABSTRACT: Following a case of iatrogenic selenium poisoning in a young pig, an experimental study was carry out. Sodium selenite was orally and parenterally administered to 13 pigs that were subdivided into three groups (G1, G2 and G3. The animals in groups G1 and G3 received sodium selenite intramuscularly (IM, G1 received a comercial formula, and G3 received sodium selenite mixed with distilled water at different dosages, and those in group G2 were fed commercial sodium selenite. Acute and subacute poisoning was observed in both groups, although the onset of clinical signs was slower in group G2. Only one pig (in group G1 that had received the highest dose showed a peracute course. Apathy, anorexia, dyspnea, vomiting, muscular tremors, proprioceptive deficit, ataxia and paresis of the hind limbs progressing to the front limbs evolving to tetraplegia were observed. Postmortem findings differed whether the animals received the injected (G1 and G3 or oral (G2 sodium selenite. The liver was moderately atrophic in some animals of G2. Some of the animals in groups G1 and G3 presented with lung edema. One pig in G3 had yellowish-brown areas in the ventral horns of the cervical intumescences of the spinal cord. The most important histological changes were present in the ventral horns of the cervical and lumbar intumescences of the spinal cord. In one animal, changes were present in the brainstem and mesencephalon. The initial lesion was a perivascular and astrocyte edema that progressing to lysis and death of astrocytes and neurons. In the chronic stage of the lesions, there were extensive areas of liquefaction necrosis with perivascular lymphocytic and histiocytic infiltration and occasional eosinophils. It seems that disruption of the blood-brain barrier due to astrocyte edema is the most likely mechanism of CNS lesion.

  6. Pneumothorax as a complication of lung volume recruitment

    Directory of Open Access Journals (Sweden)

    Erik J.A. Westermann

    2013-06-01

    Full Text Available Lung volume recruitment involves deep inflation techniques to achieve maximum insufflation capacity in patients with respiratory muscle weakness, in order to increase peak cough flow, thus helping to maintain airway patency and improve ventilation. One of these techniques is air stacking, in which a manual resuscitator is used in order to inflate the lungs. Although intrathoracic pressures can rise considerably, there have been no reports of respiratory complications due to air stacking. However, reaching maximum insufflation capacity is not recommended in patients with known structural abnormalities of the lungs or chronic obstructive airway disease. We report the case of a 72-year-old woman who had poliomyelitis as a child, developed torsion scoliosis and post-polio syndrome, and had periodic but infrequent asthma attacks. After performing air stacking for 3 years, the patient suddenly developed a pneumothorax, indicating that this technique should be used with caution or not at all in patients with a known pulmonary pathology

  7. [Pulmonary Langerhans' cell histiocytosis (PLCH) revealed by pneumothorax: about a case].

    Science.gov (United States)

    Sajiai, Hafsa; Rachidi, Mariam; Serhane, Hind; Aitbatahar, Salma; Amro, Lamyae

    2016-01-01

    Langerhans cell histiocytosis is a rare disease of unknown etiology characterized by the infiltration of Langerhans cells in one or more organs. It has a polymorphic clinical presentation. We report the case of Mr R.Y, age 22, with 8 pack year history of smoking, admitted to hospital with complete spontaneous right-sided pneumothorax. Chest drainage was performed with good evolution. Control chest CT scan showed multiple diffuse cyst formations, predominant in the upper lobes. Lab and imaging tests were performed in order to detect systemic histiocytosis with negative results. Patient's evolution was marked by pneumothorax recurrence; pleurodesis and lung biopsy were performed which confirmed the diagnosis. The diagnosis of Langerhans cell histiocytosis should be evoked in front of pneumothorax associated with lung cystic. The diagnosis is easy in front of a suggestive clinical and radiological picture. Nevertheless, therapeutic options are limited and pneumothorax recurrence is common.

  8. Pneumothorax following Endobronchial Valve Therapy and Its Impact on Clinical Outcomes in Severe Emphysema

    NARCIS (Netherlands)

    Gompelmann, Daniela; Herth, Felix J. F.; Slebos, Dirk Jan; Valipour, Arschang; Ernst, Armin; Criner, Gerard J.; Eberhardt, Ralf

    2014-01-01

    Background: Patients who achieve significant target lobe volume reduction (TLVR) following endobronchial valve (EBV) treatment may experience substantial improvements in clinical outcome measures. However, in cases of rapid TLVR, the risk of pneumothorax increases due to parenchymal rupture of the

  9. Recidiverende pneumothorax på grund af traumatisk diafragmalæsion

    DEFF Research Database (Denmark)

    Lehnert, Per; Christensen, Merete; Ravn, Jesper

    2011-01-01

    We present a case where a patient is diagnosed with a traumatic right-sided diaphragmatic rupture ten years after the trauma, after eight incidences of pneumothorax and two thoracoscopic operations. Ten years before the current case, the female patient was the victim of a blunt thoraco-abdominal ......We present a case where a patient is diagnosed with a traumatic right-sided diaphragmatic rupture ten years after the trauma, after eight incidences of pneumothorax and two thoracoscopic operations. Ten years before the current case, the female patient was the victim of a blunt thoraco......-abdominal trauma. In the following years, she had recurrent right-sided pneumothorax and no effect of thoracoscopic surgery. In connection with the third thoracoscopic operation, a right-sided diaphragm lesion was discovered. We believe that part of the syndrome catamenial pneumothorax, where air is thought...

  10. Computed tomography and blood gas analysis of anesthetized bloodhounds with induced pneumothorax

    International Nuclear Information System (INIS)

    Walker, M.; Hartsfield, S.; Matthews, N.; White, G.; Slater, M.; Thoos, J.

    1993-01-01

    Increasingly severe degrees of pneumothorax were produced in 6 adult anesthetized bloodhounds. Computed tomography (CT) of the thorax was performed on each dog to evaluate the effects of pneumo thorax on thoracic and on pulmonary cross-sectional area (TA and PA). Arterial PO 2 (PaO 2 ) and PCO 2 (PaCO 2 ), heart rate (HR), and mean arterial blood pressure (MAP) were determined and related to the severity of pneumothorax. Volumes of air equal to 1, 1.5 and 2 times functional residual capacity of the lung produced approximately 33%, 40%, and 50% reductions in pulmonary area respectively. These amounts of atelectasis correspond to a radiographically “moderate” degree of pneumothorax. As severity of pneumothorax increased, thoracic area consistently increased, PaO 2 consistently decreased, and PaCO 2 consistently increased, with all being statistically significant relationships (p 0.2)

  11. Left-Sided Catamenial Pneumothorax with Thoracic Endometriosis and Bullae in the Alveolar Wall.

    Science.gov (United States)

    Takahashi, Ryo; Kurihara, Masatoshi; Mizobuchi, Teruaki; Ebana, Hiroki; Yamanaka, Sumitaka

    2017-04-20

    Catamenial pneumothorax (CP) is generally caused by intraperitoneal air leaking from the uterus into the thoracic cavity via a defect in the endometrial tissue of the diaphragm and is usually detected in the right thorax. We report a case of left-sided CP caused by endometriosis in the visceral pleura and with no abnormal findings in the diaphragm. A 33-year-old female patient presented at the end of a course of low-dose contraceptive pills for pelvic endometriosis, with spontaneous pneumothorax in the left chest. Chest CT revealed a bulla in the left upper lung lobe. The patient underwent partial resection of the lung. Immunohistochemistry confirmed the presence of endometrial stromal tissue in the visceral pleura and confirmed this as the cause of pneumothorax since there were no observable abnormalities in the diaphragm. This case suggests that immunohistochemical examination of patients with spontaneous pneumothorax can detect alternative endometrial lesions.

  12. A case of simultaneous bilateral spontaneous pneumothorax after the Nuss procedure.

    Science.gov (United States)

    Matsuoka, Shunichiro; Miyazawa, Masahisa; Kashimoto, Kentaro; Kobayashi, Hiroaki; Mitsui, Fumihiko; Tsunoda, Hajime; Kunitomo, Kazuyoshi; Chisuwa, Hisanao; Haba, Yoshiaki

    2016-06-01

    We present a case of simultaneous bilateral spontaneous pneumothorax caused by a pleuro-pleural communication formed from Nuss procedure for pectus excavatum. A 17-year-old man with a history of Nuss operation complained chest pain and dyspnea. A chest roentgenogram demonstrated a tiny bilateral pneumothorax and two metallic bars inserted at the Nuss procedure. Computed tomography revealed furthermore a bulla in the apex of the left lung. The bilateral pneumothorax critically deteriorated after 4 days from onset and urgent bilateral chest drainages were performed. Nevertheless the drainages the full expansion of both lungs was not obtained and air leakage only from left side was continued. A video-assisted left bullectomy was performed 9 days after the tube insertion. The two bars penetrating anterior mediastinal pleura were thought to be a cause of the simultaneous bilateral spontaneous pneumothorax.

  13. Spontaneous pneumothorax after intensive chemotherapy in endometrial cancer: A rare complication

    Directory of Open Access Journals (Sweden)

    Jen-Ruei Chen

    2014-06-01

    Conclusion: Rapid shrinkage of a pulmonary space-occupying tumor sometimes causes rare but life-threatening spontaneous pneumothoraces. We report the first case of a spontaneous pneumothorax after using paclitaxel plus carboplatin in the treatment of endometrial cancer.

  14. Relationship between onset of spontaneous pneumothorax and weather conditions.

    Science.gov (United States)

    Mishina, Taijiro; Watanabe, Atsushi; Miyajima, Masahiro; Nakazawa, Junji

    2017-09-01

    Spontaneous pneumothorax (SP) results from the rupture of blebs or bullae. It has been suggested that changes in weather conditions may trigger the onset of SP. Our aim was to examine the association between the onset of primary SP with weather changes in the general population in Sapporo, Japan. From January 2008 through September 2013, 345 consecutive cases with a diagnosis of primary SP were reviewed. All cases of primary SP developed in the area within 40 km from the Sapporo District Meteorological Observatory. Climatic measurements were obtained from the Observatory, which included 1-h readings of weather conditions. Logistic regression model was used to obtain predicted risks for the onset of SP with respect to weather conditions. SP occurred significantly when the atmospheric pressure decreased by - 18 hPa or less during 96 h before the survey date (odds ratio = 1.379, P = 0.026), when the pressure increased by 15 hPa or more during 72 h before the survey date (odds ratio = 1.095, P = 0.007) and when maximum fluctuation in atmospheric pressure over 22 hPa was observed during 96 h before the survey date (odds ratio = 1.519, P = 0.001). Other weather conditions, including the presence of thunderstorms, were not significantly correlated with the onset of pneumothorax. Changes in atmospheric pressure influence the onset of SP. Future studies on the relationship between the onset of SP and weather conditions on days other than before the onset and with large number of patients may enable us to predict the onset of SP in various regions and weather conditions. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  15. Influence of atmospheric pressure on the incidence of spontaneous pneumothorax.

    Science.gov (United States)

    Díaz, Raúl; Díez, Manuel Mariano; Medrano, María José; Vera, Cristina; Guillamot, Paloma; Sánchez, Ana; Ratia, Tomás; Granell, Javier

    2014-01-01

    This study analyses the relationship between the incidence of idiopathic spontaneous pneumothorax (ISP) and atmospheric pressure (AP). A total of 288 cases of ISP were included, 229 men and 59 women. The AP of the day of diagnosis, of the 3 prior days and the monthly average was registered. The association between the incidence of ISP and AP was analyzed by calculating standardized incidence ratio (SIR) and Poisson regression. The AP on the day of admission (mean±standard deviation) (1,017.9±7 hectopascals [hPa]) was higher than the monthly average AP (1,016.9±4.1 hPa) (P=.005). There was a monthly distribution pattern of ISP with the highest incidence in the months of January, February and September and the lowest in April. When AP was less than 1,014 hPa, there were fewer cases registered than what would statistically have been expected (58/72 cases). In contrast, when the pressure was higher than 1,019 hPa, the registered cases were more than expected (109/82 cases) (SIR=1.25; 95% CI: 1.04 to 1.51). The risk of ISP increased 1.15 times (95% CI: 1.05 to 1.25, P=.001) for each hPa of AP, regardless of sex, age and monthly average AP. A dose-response relationship was observed, with progressive increases in risk (IRR=1.06 when the AP was 1,014-1016 hPa; 1.17 hPa when the AP was 1,016-1,019 hPa and 1.69 when AP was superior to 1,019 hPa) (P for trend=.089). The AP is a risk factor for the onset of idiopathic spontaneous pneumothorax. Copyright © 2012 AEC. Published by Elsevier Espana. All rights reserved.

  16. Predictors of pneumothorax following endoscopic valve therapy in patients with severe emphysema.

    Science.gov (United States)

    Gompelmann, Daniela; Lim, Hyun-Ju; Eberhardt, Ralf; Gerovasili, Vasiliki; Herth, Felix Jf; Heussel, Claus Peter; Eichinger, Monika

    2016-01-01

    Endoscopic valve implantation is an effective treatment for patients with advanced emphysema. Despite the minimally invasive procedure, valve placement is associated with risks, the most common of which is pneumothorax. This study was designed to identify predictors of pneumothorax following endoscopic valve implantation. Preinterventional clinical measures (vital capacity, forced expiratory volume in 1 second, residual volume, total lung capacity, 6-minute walk test), qualitative computed tomography (CT) parameters (fissure integrity, blebs/bulla, subpleural nodules, pleural adhesions, partial atelectasis, fibrotic bands, emphysema type) and quantitative CT parameters (volume and low attenuation volume of the target lobe and the ipsilateral untreated lobe, target air trapping, ipsilateral lobe volume/hemithorax volume, collapsibility of the target lobe and the ipsilateral untreated lobe) were retrospectively evaluated in patients who underwent endoscopic valve placement (n=129). Regression analysis was performed to compare those who developed pneumothorax following valve therapy (n=46) with those who developed target lobe volume reduction without pneumothorax (n=83). Low attenuation volume% of ipsilateral untreated lobe (odds ratio [OR] =1.08, P=0.001), ipsilateral untreated lobe volume/hemithorax volume (OR =0.93, P=0.017), emphysema type (OR =0.26, P=0.018), pleural adhesions (OR =0.33, P=0.012) and residual volume (OR =1.58, P=0.012) were found to be significant predictors of pneumothorax. Fissure integrity (OR =1.16, P=0.075) and 6-minute walk test (OR =1.05, P=0.077) were also indicative of pneumothorax. The model including the aforementioned parameters predicted whether a patient would experience a pneumothorax 84% of the time (area under the curve =0.84). Clinical and CT parameters provide a promising tool to effectively identify patients at high risk of pneumothorax following endoscopic valve therapy.

  17. Presenting hydrothorax predicts failure of needle aspiration in primary spontaneous pneumothorax.

    Science.gov (United States)

    Wu, Kwok Kei; Lui, Chun Tat; Ho, Chik Leung; Tsui, Kwok Leung; Fung, Hin Tat

    2016-06-01

    The objective was to evaluate if existence of hydrothorax in initial chest radiograph predicts treatment outcome in patients with primary spontaneous pneumothorax who received needle thoracostomy. This is a retrospective cohort study carried out from January 2011 to August 2014 in 1 public hospital in Hong Kong. All consecutive adult patients aged 18years or above who attended the emergency department with the diagnosis of primary spontaneous pneumothorax with needle aspiration performed as primary treatment were included. Age, smoking status, size of pneumothorax, previous history of pneumothorax, aspirated gas volume and presence of hydropneumothorax in initial radiograph were included in the analysis. The outcome was success or failure of the needle aspiration. Logistic regression was used to identify the predicting factors of failure of needle aspiration. There were a total of 127 patients included. Seventy-three patients (57.5%) were successfully treated with no recurrence upon discharge. Among 54 failure cases, 13 patients (10.2%) failed immediately after procedure as evident by chest radiograph and required second treatment. Forty-one patients (32.3%) failed upon subsequent chest radiographs. Multivariate logistic regression showed factors independently associated with the failure of needle aspiration, which included hydropneumothorax in the initial radiograph (odds ratio [OR]=4.47 [1.56i12.83], P=.005), previous history of pneumothorax (OR=3.92 [1.57-9.79], P=.003), and large size of pneumothorax defined as apex-to-cupola distance ≥5cm (OR=2.75 [1.21-6.26], P=.016). Hydropneumothorax, previous history of pneumothorax, and large size were independent predictors of failure of needle aspiration in treatment of primary spontaneous pneumothorax. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Outcome of primary spontaneous pneumothorax: Could drug abuse have an effect?

    OpenAIRE

    Esmaeel, Hend M.; Radwan, Rania A.

    2016-01-01

    Background: The progressively rising issue of drug abuse in Egypt among young adults could affect the outcome of a well known problem encountered in such age group as primary spontaneous pneumothorax (PSP). Objective: To assess the impact of an oral drug abuse on the outcome of primary spontaneous pneumothorax. Methods: This prospective observational study was conducted on 65 male patients, mean age 25.85 ± 5.08, admitted to the inpatient chest department, Sohag University hospital with...

  19. Pneumothorax in premature infants with respiratory distress syndrome: focus on risk factors

    Directory of Open Access Journals (Sweden)

    Sabina Terzic

    2016-02-01

    Full Text Available Introduction: Pneumothorax is a life threatening condition, more often seen in immature infants receiving mechanical ventilation. It carries a significant risk of death and impaired outcome.Objective: To determine predictive factors for the occurrence of pneumothorax in preterm infants with respiratory distress syndrome (RDS.Patients and methods: The present study was conducted in a tertiary research and educational hospital, NICU, Pediatric Clinic UKC Sarajevo, from January 2010 to December 2013. All infants had chest X-ray at admission, and were treated due to RDS with nasal continuous positive airway pressure (CPAP, mechanical ventilation, or high frequency oscillatory ventilation. At admission we registered data regarding birth weight, gestational age, Apgar score, prenatally given steroids. Inclusion criteria were fulfilled by 417 infants. Data about timing, circumstances, side and treatment of pneumothorax were gathered from medical records.Results: Mean birth weight was 1,477 g, mean gestational age 29.6 weeks. We report 98 infants who did not survive. We also report incidence of pneumothorax in 5% of the infants with RDS. In this study pneumothorax and non-pneumothorax groups didn’t differ regarding sex, gestational age (median 29 and 30 nor birth weight (p = 0.818. Apgar score at the 1st and 5th minute of life had no influence in genesis of pulmonary air leak, neither prenatally given steroids (p = 0.639, nor surfactant administration. There was a low coverage of preterm infants with prenatal steroids (overall 28.29%. We found that FiO2 ≥ 0.4 in the first 12 hours of life, and need for mechanical ventilation are predicting factors for developing pneumothorax (p < 0.05.Conclusion: Together with mechanical ventilation, inspired fraction of oxygen higher than 40%, needed to provide adequate oxygenation in the first 12 hours of life in preterm infants, could be a predictive factor in selecting the highest risk babies for development of

  20. Tension-type headache

    DEFF Research Database (Denmark)

    Bendtsen, Lars; Jensen, Rigmor; Bendtsen, Lars

    2009-01-01

    The substantial societal and individual burdens associated with tension-type headache (TTH) constitute a previously overlooked major public health issue. TTH is prevalent, affecting up to 78% of the general population, and 3% suffer from chronic TTH. Pericranial myofascial nociception probably...... is important for the pathophysiology of episodic TTH, whereas sensitization of central nociceptive pathways seems responsible for the conversion of episodic to chronic TTH. Headache-related disability usually can be reduced by identification of trigger factors combined with nonpharmacologic and pharmacologic...... treatments, but effective treatment modalities are lacking. Benefits can be gained by development of specific and effective treatment strategies....

  1. Clinical characteristics of catamenial and non-catamenial thoracic endometriosis-related pneumothorax.

    Science.gov (United States)

    Fukuoka, Mizuki; Kurihara, Masatoshi; Haga, Takahiro; Ebana, Hiroki; Kataoka, Hideyuki; Mizobuchi, Teruaki; Tatsumi, Koichiro

    2015-11-01

    A major pathogenic factor for catamenial pneumothorax is thoracic endometriosis. However, thoracic endometriosis-related pneumothorax (TERP) can develop as either catamenial or non-catamenial pneumothorax (CP). Therefore, the aim of this study was to elucidate the clinical differences between catamenial and non-catamenial TERP. The clinical and pathological data in female patients who underwent video-assisted thoracoscopic surgery at the Pneumothorax Research Center during an 8-year period were retrospectively reviewed. This study included 150 female patients with surgico-pathologically confirmed TERP. The subjects were divided into two groups, those having all of the pneumothorax episodes in the catamenial period (CP group) and those who did not (non-CP group). We compared the clinical characteristics and surgico-pathological findings between these two groups. Of the 150 TERP patients, 55 (36.7%) were classified in the CP group, and 95 (63.3%) in the non-CP group. In regard to the locations of endometriosis, all TERP patients had diaphragmatic endometriosis, while pleural implantation was recognized in 34 of the 55 (61.8%) patients in the CP group and 42 of the 95 (44.2%) patients in the non-CP group (P pneumothorax episodes. © 2015 Asian Pacific Society of Respirology.

  2. Hormonal therapy after the operation for catamenial pneumothorax - is it always necessary?

    Science.gov (United States)

    Subotic, D; Mikovic, Z; Atanasijadis, N; Savic, M; Moskovljevic, D; Subotic, D

    2016-04-14

    Our recent clinical observations put into question the routine hormonal therapy for pneumothorax recurrence prevention, in patients operated for catamenial pneumothorax (CP). Retrospective review of the treatment of four women operated for CP in a recent 32-months period. The four presented patients with CP represent 4.8 % of the overall number of patients operated for spontaneous pneumothorax and 19 % of women operated for pneumothorax in the same period. In all patients, typical multiple diaphragm holes existed. The involved part of the diaphragm was removed with diaphragm suture in three patients, whilst in one patient, a diaphragm placation was done. Endometriosis was histologically confirmed in two patients. During the follow-up period of 6-43 months, none of the patients underwent a postoperative hormonal therapy for different reasons, and in none of them the pneumothorax recurrence occurred. The clinical course of these patients, with the absence of the pneumothorax recurrence despite the omission of the hormonal treatment, suggests that the appropriateness of the routine hormonal treatment with gonadotrophin-releasing hormone analogues for 6-12 months, should be reconsidered and re-evaluated in further studies.

  3. Effectiveness of Alveolar Opening in Patients with Acute Lung Injury and Concomitant Pneumothorax

    Directory of Open Access Journals (Sweden)

    Yu. V. Marchenkov

    2009-01-01

    Full Text Available Objective: to study the efficiency of a lung opening maneuver in patients with acute lung injury (ALI and concomitant pneumothorax, who were on biphasic positive airway pressure ventilation (BIPAP and synchronized intermittent mandatory ventilation. Subject and methods. Seventy-three patients with acute lung injury and concomitant pneumoth-orax resulting from blunt chest trauma were examined. Their condition was an APACHE II of 18—24 scores. After elimination of pneumothorax, an open lung maneuver was made using different modes of lung support 3—5 times daily. Results. The study has shown that BIPAP used in patients with ALI and concomitant pneumothorax reduces the time of pleural cavity drainage, which allows the lung opening maneuver to be applied earlier. The employment of the latter in patients with ALI and pneumothorax permits a prompter recovery of lung function during different types of respiratory support, which is attended by reductions in the number of complications, artificial ventilation, and mortality. When the lung opening maneuver is combined with BIPAP, its efficiency considerably increases. Key words: acute lung injury, pneumothorax, BIPAP, lung opening maneuver.

  4. [Pneumothorax Caused by Multiple Pulmonary Metastases of a Uterine Endometrial Stromal Sarcoma;Report of a Case].

    Science.gov (United States)

    Shomura, Shin; Suzuki, Hitoshi; Yada, Masaki; Kondo, Chiaki

    2017-09-01

    A 53-year-old woman who had undergone hystero-oophorectomy for uterine endometrial stromal sarcoma in our hospital 9 months previously was referred to our hospital because of bilateral pneumothorax. Chest computed tomography scan on admission revealed multiple thin-walled cavity nodules in both lung and a bilateral pneumothorax, suggesting pulmonary metastases of the uterine endometrial stromal sarcoma. We surgically treated the pneumothorax and diagnosed the nodules as metastatic lesions. They were pathologically diagnosed as metastatic uterine endometrial stromal sarcoma.

  5. The two-way relationship between iatrogenic factor and periodontal tissues

    Directory of Open Access Journals (Sweden)

    Sri Oktawati

    2016-06-01

    Full Text Available Iatrogenic factors refer to anyinadequate medical treatment or diagnostic proceduresconducted inadvertently by practitioners who precipitate adverse injuries or symptoms. The unavoidable consequences of these factors should be corrected promptly, as they may result in erroneous treatment or new injury either on the tooth or the periodontium or both. Periodontal disease has a multifactorial etiology, which results from the interaction of local and systemic factors, intrinsically or extrinsically. Therefore, in most cases of periodontal disease, aninterdisciplinary approach is needed, such as restorative treatment of interproximal cavities that may induced food impacted. In contrary, a periodontal therapy could also act as an iatrogenic factor in the case of dentinal hypersensitivity or gingival recessionthat frequently creates an adverse effect in esthetic. Our discussion here is presented so that dentists could treat carefully and give a lot of attention to potential danger of other consequences of iatrogenic factors.

  6. Does Radar Technology Support the Diagnosis of Pneumothorax? PneumoScan—A Diagnostic Point-of-Care Tool

    Directory of Open Access Journals (Sweden)

    T. Lindner

    2013-01-01

    Full Text Available Background. A nonrecognized pneumothorax (PTX may become a life-threatening tension PTX. A reliable point-of-care diagnostic tool could help in reduce this risk. For this purpose, we investigated the feasibility of the use of the PneumoScan, an innovative device based on micropower impulse radar (MIR. Patients and Methods. addition to a standard diagnostic protocol including clinical examination, chest X-ray (CXR, and computed tomography (CT, 24 consecutive patients with chest trauma underwent PneumoScan testing in the shock trauma room to exclude a PTX. Results. The application of the PneumoScan was simple, quick, and reliable without functional disorder. Clinical examination and CXR each revealed one and PneumoScan three out of altogether four PTXs (sensitivity 75%, specificity 100%, positive predictive value 100%, and negative predictive value 95%. The undetected PTX did not require intervention. Conclusion. The PneumoScan as a point-of-care device offers additional diagnostic value in patient management following chest trauma. Further studies with more patients have to be performed to evaluate the diagnostic accuracy of the device.

  7. General definition of gravitational tension

    International Nuclear Information System (INIS)

    Harmark, T.; Obers, N.A.

    2004-01-01

    In this note we give a general definition of the gravitational tension in a given asymptotically translationally-invariant spatial direction of a space-time. The tension is defined via the extrinsic curvature in analogy with the Hawking-Horowitz definition of energy. We show the consistency with the ADM tension formulas for asymptotically-flat space-times, in particular for Kaluza-Klein black hole solutions. Moreover, we apply the general tension formula to near-extremal branes, constituting a check for non-asymptotically flat space-times. (author)

  8. Management of iatrogenically exposed maxillary sinus with a broken periosteal elevator trapped inside

    Directory of Open Access Journals (Sweden)

    Nureldeen Elhammali

    2017-01-01

    Full Text Available Foreign bodies may be ingested after being inserted into an oral cavity or deposited in the body by traumatic or iatrogenic injury. Accidentally left out foreign materials are common complications of dental procedures including apical deposition of endodontic materials, sub-mucosal amalgam pieces, graphite tattoos and traumatically introduced dental materials and instruments. Once a foreign material is left behind within a soft and/or hard tissue, it promotes local inflammation and infection that may cause pain and/or destruction within the surrounding tissues. This article presents a case of retrieval of iatrogenically broken periosteal elevator trapped in the maxillary sinus.

  9. Hypothalamic-Pituitary-Adrenal Suppression and Iatrogenic Cushing's Syndrome as a Complication of Epidural Steroid Injections

    Directory of Open Access Journals (Sweden)

    Joyce Leary

    2013-01-01

    Full Text Available Epidural steroid injections are well accepted as a treatment for radicular back pain in appropriate candidates. While overall incidence of systemic side effects has not been well established, at least five biochemically proven cases of iatrogenic Cushing's Syndrome have been reported as complications of epidural steroid treatment. We present an additional case of iatrogenic Cushing's Syndrome and adrenal suppression in a middle-aged woman who received three epidural steroid injections over a four-month period. We review this case in the context of previous cases and discuss diagnostic and management issues.

  10. Iatrogenic blood-borne viral infections in refugee children from war and transition zones.

    Science.gov (United States)

    Goldwater, Paul N

    2013-06-01

    Pediatric infectious disease clinicians in industrialized countries may encounter iatrogenically transmitted HIV, hepatitis B virus, and hepatitis C virus infections in refugee children from Central Asia, Southeast Asia, and sub-Saharan Africa. The consequences of political collapse and/or civil war-work migration, prostitution, intravenous drug use, defective public health resources, and poor access to good medical care-all contribute to the spread of blood-borne viruses. Inadequate infection control practices by medical establishments can lead to iatrogenic infection of children. Summaries of 4 cases in refugee children in Australia are a salient reminder of this problem.

  11. Prevalence of iatrogenic admissions to the Departments of Medicine/Cardiology/ Pulmonology in a 1,250 bed general hospital

    NARCIS (Netherlands)

    Atiqi, R.; van Bommel, E.; Cleophas, T. J.; Zwinderman, A. H.

    2010-01-01

    A recent meta-analysis in this journal showed incidences between 3.4 and 33.9%. Studies performed by pharmacists and epidemiologists produced lower incidences than internists' studies. We reassessed the prevalence of iatrogenic admissions in a study of internists. Iatrogenic disease was defined as

  12. When Is the Optimal Timing of the Surgical Treatment for Secondary Spontaneous Pneumothorax?

    Science.gov (United States)

    Jeon, Hyun Woo; Kim, Young-Du; Choi, Si Young; Park, Jae Kil

    2017-01-01

    Objectives  The definition of spontaneous pneumothorax is accumulation of air in the pleural space, resulting in dyspnea or chest pain. Unlike primary spontaneous pneumothorax, secondary pneumothorax can be a life-threatening condition and spontaneous healing rate is uncommon. Although surgery is the most effective treatment modality for pneumothorax, surgical management and timing is difficult where there is underlying lung disease and/or medical comorbidities. Prolonged air leakage increases the morbidity and mortality in thoracic surgery. We hypothesized that duration of air leakage before operation may lead to increase in complications. Methods  This study is a retrospective review of 155 consecutive patients with air leakage who underwent bullectomy for secondary spontaneous pneumothorax from January 2005 to July 2013. The patients were divided according to the duration of preoperative air leakage. The patients were followed-up until the time of last visit or death. Postoperative morbidity and mortality were assessed and the risk factors for complications were analyzed. Results  The median age was 65 years (range, 52-88) with male predominance (96.13%). The median duration of preoperative air leakage was 6 days (range, 1-30). The median surgery time was 90 minutes (range, 25-300) and median hospital stay after operation was 7 days (range, 3-75). Postoperative complications occurred in 38 patients (24.52%) and postoperative recurrence was shown to have occurred in 8 patients (5.16%). With multivariate analysis, risk factors for postoperative complications were: underlying interstitial lung disease and air leakage > 5 days before operation. Conclusion  Persistent air leakage was a major surgical indication for pneumothorax. Early surgical treatment reduced postoperative complications for secondary spontaneous pneumothorax. Georg Thieme Verlag KG Stuttgart · New York.

  13. Neonatal Pneumothorax Pressures Surpass Higher Threshold in Lung Recruitment Maneuvers: An In Vivo Interventional Study.

    Science.gov (United States)

    González-Pizarro, Patricio; García-Fernández, Javier; Canfrán, Susana; Gilsanz, Fernando

    2016-02-01

    Causing pneumothorax is one of the main concerns of lung recruitment maneuvers in pediatric patients, especially newborns. Therefore, these maneuvers are not performed routinely during anesthesia. Our objective was to determine the pressures that cause pneumothorax in healthy newborns by a prospective experimental study of 10 newborn piglets (pneumothorax. Animals under anesthesia and bilateral chest tube catheterization were randomly allocated to 2 groups: one with PEEP and fixed inspiratory driving pressure of 15 cm H2O (PEEP group) and the second one with PEEP = 0 cm H2O and non-fixed inspiratory driving pressure (zero PEEP group). In both groups, the ventilation mode was pressure-controlled, and PIP was raised at 2-min intervals, with steps of 5 cm H2O until air leak was observed through the chest tubes. The PEEP group raised PIP through 5-cm H2O PEEP increments, and the zero PEEP group raised PIP through 5-cm H2O inspiratory driving pressure increments. Pneumothorax was observed with a PIP of 90.5 ± 15.7 cm H2O with no statistically significant differences between the PEEP group (92 ± 14.8 cm H2O) and the zero PEEP group (89 ± 18.2 cm H2O). The zero PEEP group had hypotension, with a PIP of 35 cm H2O; the PEEP group had hypotension, with a PIP of 60 cm H2O (P = .01). The zero PEEP group presented bradycardia, with PIP of 40 cm H2O; the PEEP group presented bradycardia, with PIP of 70 cm H2O (P = .002). Performing recruitment maneuvers in newborns without lung disease is a safe procedure in terms of pneumothorax. Pneumothorax does not seem to occur in the clinically relevant PIPs of pneumothorax PIP in poorly compliant lungs. Copyright © 2016 by Daedalus Enterprises.

  14. Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital

    Science.gov (United States)

    Hefny, Ashraf F; Kunhivalappil, Fathima T; Matev, Nikolay; Avila, Norman A; Bashir, Masoud O; Abu-Zidan, Fikri M

    2018-01-01

    INTRODUCTION Diagnoses of pneumothorax, especially occult pneumothorax, have increased as the use of computed tomography (CT) for imaging trauma patients becomes near-routine. However, the need for chest tube insertion remains controversial. We aimed to study the management of pneumothorax detected on CT among patients with blunt trauma, including the decision for tube thoracostomy, in a community-based hospital. METHODS Chest CT scans of patients with blunt trauma treated at Al Rahba Hospital, Abu Dhabi, United Arab Emirates, from October 2010 to October 2014 were retrospectively studied. Variables studied included demography, mechanism of injury, endotracheal intubation, pneumothorax volume, chest tube insertion, Injury Severity Score, hospital length of stay and mortality. RESULTS CT was performed in 703 patients with blunt trauma. Overall, pneumothorax was detected on CT for 74 (10.5%) patients. Among the 65 patients for whom pneumothorax was detected before chest tube insertion, 25 (38.5%) needed chest tube insertion, while 40 (61.5%) did not. Backward stepwise likelihood regression showed that independent factors that significantly predicted chest tube insertion were endotracheal intubation (p = 0.01), non-United Arab Emirates nationality (p = 0.01) and pneumothorax volume (p = 0.03). The receiver operating characteristic curve showed that the best pneumothorax volume that predicted chest tube insertion was 30 mL. CONCLUSION Chest tube was inserted in less than half of the patients with blunt trauma for whom pneumothorax was detected on CT. Pneumothorax volume should be considered in decision-making regarding chest tube insertion. Conservative treatment may be sufficient for pneumothorax of volume < 30 mL. PMID:28741012

  15. Management of computed tomography-detected pneumothorax in patients with blunt trauma: experience from a community-based hospital.

    Science.gov (United States)

    Hefny, Ashraf F; Kunhivalappil, Fathima T; Matev, Nikolay; Avila, Norman A; Bashir, Masoud O; Abu-Zidan, Fikri M

    2018-03-01

    Diagnoses of pneumothorax, especially occult pneumothorax, have increased as the use of computed tomography (CT) for imaging trauma patients becomes near-routine. However, the need for chest tube insertion remains controversial. We aimed to study the management of pneumothorax detected on CT among patients with blunt trauma, including the decision for tube thoracostomy, in a community-based hospital. Chest CT scans of patients with blunt trauma treated at Al Rahba Hospital, Abu Dhabi, United Arab Emirates, from October 2010 to October 2014 were retrospectively studied. Variables studied included demography, mechanism of injury, endotracheal intubation, pneumothorax volume, chest tube insertion, Injury Severity Score, hospital length of stay and mortality. CT was performed in 703 patients with blunt trauma. Overall, pneumothorax was detected on CT for 74 (10.5%) patients. Among the 65 patients for whom pneumothorax was detected before chest tube insertion, 25 (38.5%) needed chest tube insertion, while 40 (61.5%) did not. Backward stepwise likelihood regression showed that independent factors that significantly predicted chest tube insertion were endotracheal intubation (p = 0.01), non-United Arab Emirates nationality (p = 0.01) and pneumothorax volume (p = 0.03). The receiver operating characteristic curve showed that the best pneumothorax volume that predicted chest tube insertion was 30 mL. Chest tube was inserted in less than half of the patients with blunt trauma for whom pneumothorax was detected on CT. Pneumothorax volume should be considered in decision-making regarding chest tube insertion. Conservative treatment may be sufficient for pneumothorax of volume < 30 mL. Copyright: © Singapore Medical Association.

  16. Occult pneumothorax in trauma patients: should this be sought in the focused assessment with sonography for trauma examination?

    Science.gov (United States)

    Tam, Michael M K

    2005-01-01

    At present, CT scan is the gold standard for detecting occult traumatic pneumothorax not apparent on supine chest X-ray radiograph. Recently there were suggestions to expand focused assessment with sonography for trauma (FAST) to include thoracic ultrasound for detecting pneumothorax. The aim of the present study is to determine the incidence of occult pneumothorax (as shown by CT) in the subgroup of trauma patients undergoing FAST. Review of all trauma patients with FAST done from 1 June 2001 to 31 October 2002. Incidence of occult pneumothorax as diagnosed by CT was determined. Patients were not counted as having true occult pneumothorax if they had chest drains inserted before arrival or imaging studies. Selected clinical findings were tested for association with occult pneumothorax. In total, 143 patients underwent FAST, of whom 137 (95.8%) had chest X-ray examination performed. Of the 137 patients 59 required CT abdomen and/or thorax. Occult pneumothorax was found in three patients (2.1%). A history of thorax and/or abdominal injury plus one or more of: (i) mechanisms potentially causing major trauma; (ii) abnormal chest examination; and (iii) chest X-ray radiograph abnormality in the absence of pneumothorax, was significantly associated with the presence of occult pneumothorax (P = 0.03, Fisher's exact test; sensitivity: 100%; specificity: 71%; likelihood ratio: 3.42). The incidence of occult pneumothorax in the subgroup of trauma patients undergoing FAST is low. It implies that routine screening for its presence by adding thoracic ultrasound to FAST is unnecessary. Identifying those at risk of occult pneumothorax for further investigation appeared feasible.

  17. Tension type headaches: a review

    African Journals Online (AJOL)

    Location of the pain:There is often a typical location for tension- type headaches, as ... Cranial nerve abnormalities, including papilloedema. • Signs of ... peripheral and central mechanisms underlie tension-type ... Physiotherapy has been shown to be an effective management option for .... Acupuncture in primary headache.

  18. Atmospheric temperature and pressure influence the onset of spontaneous pneumothorax.

    Science.gov (United States)

    Motono, Nozomu; Maeda, Sumiko; Honda, Ryumon; Tanaka, Makoto; Machida, Yuichiro; Usuda, Katsuo; Sagawa, Motoyasu; Uramoto, Hidetaka

    2018-02-01

    The aim of the study was to examine the influence of the changes in the atmospheric temperature (ATemp) and the atmospheric pressure (APres) on the occurrence of a spontaneous pneumothorax (SP). From January 2000 to March 2014, 192 consecutive SP events were examined. The ATemp and APres data at the onset of SP, as well as those data at 12, 24, 36, 48, 60, and 72 h prior to the onset time, were analyzed. The frequencies of SP occurrence were not statistically different according to the months or seasons, but were statistically different according to the time period (P < .01) and SP events occurred most frequently from 12:00 to 18:00. SP events frequently occurred at an ATemp of 25 degrees Celsius or higher. There was a significantly negative correlation between the APres and the ATemp at the SP onset time. The values of change in the APres from 36 to 24 h prior to SP onset were significantly lower than the preceding values. In this study, we observed that a SP event was likely to occur in the time period from 12:00 to 18:00, at an ATemp of 25 degrees Celsius or higher, and at 24-36 h after a drop of APres. © 2016 John Wiley & Sons Ltd.

  19. Location of Ruptured Bullae in Secondary Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Jinseok Choi

    2017-12-01

    Full Text Available Background: The surgical treatment of secondary spontaneous pneumothorax (SSP can be complicated by fragile lung parenchyma. The preoperative prediction of air leakage could help prevent intraoperative lung in-jury during manipulation of the lung. Common sites of bulla development and ruptured bullae were inves-tigated based on computed tomography (CT and intraoperative findings. Methods: The study enrolled 208 patients with SSP who underwent air leak control through video-assisted thoracoscopic surgery (VATS. We retrospectively reviewed the sites of bulla development on preoperative CT and the rupture sites during VATS. Results: Of the 135 cases of right-sided SSP, the most common rupture site was the apical segment (31.9%, followed by the azygoesophageal recess (27.4%. Of the 75 cases on the left side, the most com-mon rupture site was the apical segment (24.0%, followed by the anterior basal segment (17.3%. Conclusion: The azygoesophageal recess and parenchyma along the cardiac border were common sites of bul-la development and rupture. Studies of respiratory lung motion to measure the pleural pressure at the lung surface could help to determine the relationship between cardiogenic and diaphragmatic movement and bulla formation or rupture.

  20. Pneumothorax detection in chest radiographs using convolutional neural networks

    Science.gov (United States)

    Blumenfeld, Aviel; Konen, Eli; Greenspan, Hayit

    2018-02-01

    This study presents a computer assisted diagnosis system for the detection of pneumothorax (PTX) in chest radiographs based on a convolutional neural network (CNN) for pixel classification. Using a pixel classification approach allows utilization of the texture information in the local environment of each pixel while training a CNN model on millions of training patches extracted from a relatively small dataset. The proposed system uses a pre-processing step of lung field segmentation to overcome the large variability in the input images coming from a variety of imaging sources and protocols. Using a CNN classification, suspected pixel candidates are extracted within each lung segment. A postprocessing step follows to remove non-physiological suspected regions and noisy connected components. The overall percentage of suspected PTX area was used as a robust global decision for the presence of PTX in each lung. The system was trained on a set of 117 chest x-ray images with ground truth segmentations of the PTX regions. The system was tested on a set of 86 images and reached diagnosis accuracy of AUC=0.95. Overall preliminary results are promising and indicate the growing ability of CAD based systems to detect findings in medical imaging on a clinical level accuracy.

  1. Videothorascopic laser therapy with bullectomy and pleurodesis for spontaneous pneumothorax

    International Nuclear Information System (INIS)

    Tos, M.; Corsi, M.; Bellaviti, N.; Giuliani, L.; Santambrogio, L.; Mezzetti, M.

    1992-01-01

    Use of Nd:YAG laser in thoracic surgery has been suggested and mainly employed for recanalization of the airways through bronchoscopy in patients affected by inoperable bronchial cancer. Lo Cicero et al described laser effects and effectiveness on lung tissue to control or seal air leaks, using both CO 2 or Nd:YAG equipment. This first report is positively confirmed by experience when performing atypical lung resections with aid of Nd:YAG laser beam, especially concerning hemostasis and air leakage control. In a previous report authors suggested that laser fiber could not be inserted into the operative channel of the thorascope or mediastinalscope. A superb exposure of the pleural cavity is nowadays obtainable linking thorascope to a videocamera with external monitor and videothorascopy has been suggested and described in the management of spontaneous pneumothorax. Ablation of blebs and pleurodesis were earlier treated by application of electrocautery, but many experiences indicate possible advantages related with the use of the laser instead of traditional methods. (author). 10 refs

  2. Risk factors of pneumothorax in percutaneous fine needle aspiration biopsy of the lung

    International Nuclear Information System (INIS)

    Kim, Sang Jin; Park, Kwang Joo; Shin, Hyung Cheol; Kwon, Ryang; Jo, Byung June; Oh, Sei Jung; Ahn, Chang Su; Kim, Hyung Jung

    1997-01-01

    Percutaneous fine needle aspiration biopsy is known to be a useful diagnostic method for the diagnosis of various pulmonary diseases. Its diagnostic yield is high, and it is safe, but complications such as pneumothorax can occasionally occur. We reviewed the complications arising after needle aspiration biopsy and analyzed the risk factors of pneumothorax. The medical records and radiographic studies of 157 patients with various pulmonary diseases who underwent needle aspiration biopsy of the lung between 1990 and 1996 were retrospectively reviewed. The clinical features, treatment, and courses of complications were reviewed, and risk factors of pneumothorax such as depth and size of lesion, diameter of needle, number of punctures, and obstructive pulmonary abnormalities were analyzed. Complications occurred in 40 of 157cases(25.5%), namely pneumothorax in 26(16.6%), hemoptysis in 11(7%), hemothorax in two(1.3%), and recurrence of malignancy at the site of aspiration in one(0.6%). When the patients were divided into three groups according to depth of lesion, there were significant difference in the incidence of pneumothorax;the results were as follows:less than 2cm, 12.9%;between 2 and 4cm, 24.1%;and larger than 4cm, 57.1%(p<0.05). In pulmonary function testing, FVC(Forced Vital Capacity) of patients with pneumothorax was less than that of patients without(2.6±0.9L vs 3.1±0.8L, p<0.05), but FEV1(Forced Expiratory Volume in 1 second), FEV1%(percentage of predicted FEV1), FEV1/FVC, and FVC% (percentage of predicted FVC) were not different between the two groups. The incidence of pneumothorax in patients with pleura-at-tached lesion (9%) was lower than that of those with non-attached lesion(26%, p=3D0.01). The age of patients, size of lesion, diameter of the needle, guidance methods and number of aspirations showed no significant relationship with pneumothorax. In needle aspiration biopsy of the lung, depth of lesion and passage of a needle through aerated lung are

  3. Efficacy of an opposite position aspiration on resolution of pneumothorax following CT-guided lung biopsy

    Science.gov (United States)

    Zeng, L-C; Du, Y; Yang, H-F; Xie, M-G; Liao, H-Q; Zhang, Y-D; Li, L; Wang, Q; Hu, L

    2015-01-01

    Objective: To evaluate the efficacy of aspiration in an opposite position to deal with pneumothorax after CT-guided lung biopsy. Methods: A retrospective study was developed involving 210 patients with pneumothorax who had undergone CT-guided percutaneous core biopsies from January 2012 to March 2014 for various pulmonary lesions. Asymptomatic patients with minimal pneumothorax were treated conservatively. Simple manual aspiration was performed for symptomatic patients with minimal pneumothorax and for all patients with moderate to large pneumothorax. An opposite position aspiration was performed when simple manual aspiration failed. The efficacy of simple manual aspiration and the opposite position aspiration was observed. Results: Among 210 patients with pneumothorax, 128 (61.0%) asymptomatic patients with minimal pneumothorax were treated conservatively. The remaining 82 were treated with attempted simple manual aspiration. Out of these 82 patients, simple manual aspiration was successful in 58 (70.7%, 58/82) cases. The complete and partial regression rates were 17.2% (10/58) and 82.8% (48/58), respectively. In the other 24 patients (29.3%, 24/82), simple aspiration technique was ineffective. An opposite position (from prone to supine or vice versa) was applied, and a new biopsy puncture site was chosen for reaspiration. This procedure was successful in 22 patients but not in 2 patients who had to have a chest tube insertion. The complete and partial regression rates were 25.0% (6/24) and 66.7% (16/24), respectively. Applying the new method, the total effective rate of aspiration improved significantly from 70.7% (58/82) to 97.6% (80/82). Conclusion: The opposite position aspiration can be safe, effective and minimally invasive treatment for CT-guided lung biopsy-induced pneumothorax thus reducing the use of chest tube significantly. Advances in knowledge: (1) Opposite position aspiration can elevate the success rate of aspiration significantly (from 70.7% to 97

  4. An 18-year-old man with recurrent pneumothorax since he was 10-year-old.

    Science.gov (United States)

    Demir, Meral; Çobanoğlu, Nazan

    2016-12-01

    An 18-year-old male patient was referred to the department of pediatric pulmonology with a history of recurrent pneumothorax. Initial pneumothorax occurred at the age of 10. Following diagnosis of congenital lobar emphysema, he had five episodes of pneumothorax and subsequently underwent right-lower lobe anterobasal segmentectomy. Based on thoracic computed tomography (CT) and clinical manifestation, Birt-Hogg-Dube (BHD) syndrome was suspected and confirmed following genetic testing. BHD syndrome is a rare tumor predisposition syndrome first described in 1977. The syndrome is characterized by skin fibrofolliculomas, lung cysts, recurrent spontaneous pneumothorax, and renal cell cancer. The underlying cause is a germline mutation in the folliculin (FLCN) gene located on chromosome 17p11.2. Clinical manifestation usually appears after the age of 20 years. In this case, we report a case of BHD with episodes of recurrent pneumothorax, the first of which occurred at the age of 10 years. Pulmonologists should be aware of this syndrome in patients with a personal and family history of pneumothoraces and CT findings of multiple pulmonary cysts as additional evaluation and testing may be warranted. Pediatr Pulmonol. 2016;51:E41-E43. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  5. 86Rb Distribution in the Lung of the Rabbit with Pneumothorax

    International Nuclear Information System (INIS)

    Huh, Kap To

    1972-01-01

    86 Rb uptake of some organs and tissues, eg. both lungs, both renal cortices. small intestine, liver and skeletal muscle were studied in the control and the rabbit subjected to pneumothorax. 86 Rb in the form of chloride mixed with physiological saline was intravenously injected. The doses were 100 μc for a rabbit. The rabbits were sacrificed at intervals of 10, 20, 40, and 60 seconds after the injection of 86 Rb, by the injection of saturated KCI solution. After scarification, the organ and tissue sample were quickly removed. 86 Rb uptake in gm of the organs and tissues were measured. On the basis of uptake value, administered doses and body weight, % dose/gm tissues per 200 gm body weight was calculated. Followings were the results: 1. Pneumothorax resulted in a marked elevation in 86 Rb uptake value of collapsed lung and returned to normal level lately. 2. Contralateral lung of pneumothorax also showed marked elevation in 86 Rb uptake value and recovered to normal level. 3. Initial 86 Rb uptake value of liver, small intestine of the rabbit with pneumothorax showed some elevation as compared to control, but that of late stage were similar with control. 4. Local blood flow determination by means of 86 Rb uptake were inadequate in the collapsed lung of pneumothorax. 5. It was suggested that the mechanism for the initial elevation of 86 Rb uptake value in each organs and tissue were different from each other.

  6. Pneumothorax and the Value of Chest Radiography after Ultrasound-Guided Thoracocentesis

    International Nuclear Information System (INIS)

    Pihlajamaa, K.; Bode, M.K.; Puumalainen, T.; Lehtimaeki, A.; Marjelund, S.; Tikkakoski, T.

    2004-01-01

    Purpose: To determine the incidence, the operator's experience, and other variables that may influence the development of pneumothorax or re-expansion edema after ultrasound (US)-guided thoracocentesis. Material and Methods: The medical records of 264 procedures in 212 patients who had undergone US-guided thoracocentesis in our radiology department or intensive care unit during the period 1996-2001 were retrospectively reviewed. Results: Post-thoracocentesis pneumothorax occurred in 11 cases, the incidence being 4.2% (11/264). None of the pneumothoraces occurred in the 10 mechanically ventilated patients. All but one patient with pneumothorax were asymptomatic or had only minor symptoms. Chest tube drainage was needed in one patient with a large pneumothorax. No re-expansion edema was recorded, although 1500 ml or more pleural fluid was aspirated in 29 patients. The operator's experience had no effect on the complication rate. Needle size was the only significant variable that contributed to the pneumothorax rate. Conclusion: US-guided thoracocentesis can be done equally as safely by residents as by senior radiologists. The safety and feasibility of the method are evident among mechanically ventilated intensive care patients. Our results do not support the routine use of post-thoracocentesis chest radiography

  7. Retained guidewire penetrating through the aorta into the thorax: an unusual cause of recurrent bilateral pneumothorax.

    Science.gov (United States)

    Kim, YongHun; Yu, JunSik; Kim, YoHan; Lee, WooSurng

    2016-01-01

    Although numerous complications of the Seldinger technique have been reported in the literature, only a few complications are related to guidewires. We here report a case of a patient with a guidewire lost and retained in the aorta during vertebral artery stenting. Unfortunately, the guidewire in the aorta was not detected for 5 years, and it penetrated through the aorta into the left thorax, leading to recurrent left pneumothorax. No physician identified the wandering guidewire in the left thorax, and the recurrent left pneumothorax was only managed with closed thoracostomy drainage several times. After 4 months, the patient presented to our hospital with repeated severe chest pain, and newly developed right pneumothorax was diagnosed on chest X-rays. We meticulously evaluated the radiological findings of the other hospitals to identify the cause of the recurrent pneumothorax and discovered that the lost and wandering guidewire had crossed over from the left to the right thorax through the anterior mediastinum. The guidewire was identified as the cause of the recurrent bilateral pneumothorax, and the patient was successfully treated with video-assisted thoracoscopic surgery without any events. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  8. Changes in electrocardiographic findings after closed thoracostomy in patients with spontaneous pneumothorax

    Science.gov (United States)

    Lee, Wonjae; Lee, Yoonje; Kim, Changsun; Choi, Hyuk Joong; Kang, Bossng; Lim, Tae Ho; Oh, Jaehoon; Kang, Hyunggoo; Shin, Junghun

    2017-01-01

    Objective We aimed to describe electrocardiographic (ECG) findings in spontaneous pneumothorax patients before and after closed thoracostomy. Methods This is a retrospective study which included patients with spontaneous pneumothorax who presented to an emergency department of a tertiary urban hospital from February 2005 to March 2015. The primary outcome was a difference in ECG findings between before and after closed thoracostomy. We specifically investigated the following ECG elements: PR, QRS, QTc, axis, ST segments, and R waves in each lead. The secondary outcomes were change in ST segment in any lead and change in axis after closed thoracostomy. Results There were two ECG elements which showed statistically significant difference after thoracostomy. With right pneumothorax volume of greater than 80%, QTc and the R waves in aVF and V5 significantly changed after thoracostomy. With left pneumothorax volume between 31% and 80%, the ST segment in V2 and the R wave in V1 significantly changed after thoracostomy. However, majority of ECG elements did not show statistically significant alteration after thoracostomy. Conclusion We found only minor changes in ECG after closed thoracostomy in spontaneous pneumothorax patients. PMID:28435901

  9. A deep azygoesophageal recess may increase the risk of secondary spontaneous pneumothorax.

    Science.gov (United States)

    Takahashi, Tsuyoshi; Kawashima, Mitsuaki; Kuwano, Hideki; Nagayama, Kazuhiro; Nitadori, Jyunichi; Anraku, Masaki; Sato, Masaaki; Murakawa, Tomohiro; Nakajima, Jun

    2017-09-01

    The azygoesophageal recess (AER) is known as a possible cause of bulla formation in patients with spontaneous pneumothorax. However, there has been little focus on the depth of the AER. We evaluated the relationship between the depth of the AER and pneumothorax development. We conducted a retrospective study of 80 spontaneous pneumothorax patients who underwent surgery at our institution. We evaluated the depth of the AER on preoperative computed tomography scans. Ruptured bullae at the AER were found in 12 patients (52.2%) with secondary spontaneous pneumothorax (SSP) and 8 patients (14.0%) with primary spontaneous pneumothorax (PSP) (p < 0.001). In patients with ruptured bullae at the AER, 10 SSP patients (83.3%) had a deep AER while only 2 PSP patients (25%) had a deep AER (p = 0.015). A deep AER was more frequently associated with SSP than with PSP. A deep AER may contributes to bulla formation and rupture in SSP patients.

  10. Recurrent Spontaneous Pneumothorax during the Recovery Phase of ARDS Due to H1N1 Infection

    Directory of Open Access Journals (Sweden)

    Canan Bor

    2013-03-01

    Full Text Available The pregnant patients are prone to influenza A (H1N1 virus infection, which may rapidly progress to lower respiratory tract infection and subsequent respiratory failure and acute respiratory distress syndrome (ARDS. Pneumothorax might develop in ARDS under mechanical ventilation. But post-ARDS pneumothorax in spontaneously breathing patient has not been reported in the literature. We report a 31-year old pregnant woman infected with influenza A (H1N1 virus and progressed to ARDS. Mechanical ventilation with high PEEP improved patient's gas exchange parameters within 3 weeks. However spontaneous pneumothorax was developed one week after she weaned off the ventilator. After successful drainage therapy, the patient was discharged. However she re-admitted to the hospital because of a recurrent pneumothorax one week later. She was discharged in good health after being treated with negative continuous pleural aspiration for 10 days. Influenza might cause severe pulmonary infection and death. In addition to diffuse alveolar damage, sub-pleural and intrapulmonary air cysts might occur in influenza-related ARDS and may lead to spontaneous pneumothorax. This complication should always be considered during the recovery period of ARDS and a long-term close follow-up is necessary.

  11. Iatrogenic anemia/Twenty-five million liters of blood into the sewer : comment

    NARCIS (Netherlands)

    Coene, K.L.M.; Roos, A.N.; Scharnhorst, V.

    2015-01-01

    With great interest, we have read the articles by Stefanini [1] and Levi [2] on the waste of patient blood that is left over after laboratory testing. Especially in vulnerable patient populations that are subjected to frequent laboratory testing, iatrogenic anaemia can become a significant problem.

  12. CT and MRI in iatrogenic and sporadic Creutzfeldt-Jakob disease: as far as imaging perseives

    Energy Technology Data Exchange (ETDEWEB)

    Garcia Santos, J.M. [Servicio de Radiodiagnostico, HU Dr. Morales Meseguer, Murcia (Spain)]|[Section of Neuroradiology, HU Virgen de la Arrixaca, Murcia (Spain); Lopez Corbalan, J.A. [Section of Neuroradiology, HU Virgen de la Arrixaca, Murcia (Spain); Martinez-Lage, J.F. [Service of Neurosurgery, HU Virgen de la Arrixaca, Murcia (Spain); Sicilis Guillen, J. [Service of Neurology, HU Virgen de la Arrixaca, Murcia (Spain)

    1996-04-01

    Creutzfeldt-Jakob Disease (CJD), an invariably fatal dementing illness, affects patients in middle and old age (sporadic form). However, the association of CJD with certain treatments (iatrogenic form) has been described in younger patients. The clinical onset of the two forms seems to differ; in the iatrogenic form a high frequency of the ataxic CJD variant has been reported. Nowadays, a definitive diagnosis of CJD is exclusively histological. We present five cases of CJD, one sporadic and the others iatrogenic, following dura mater grafts and analyse their CT and MRI features. CT typically demonstrates brain atrophy, generally progressive, but in sporadic CJD midfield MRI also showed abnormal signal, with predominant deep grey matter involvement. The use of narrow windows with proton-density sequences may reveal subtle cortical signal abnormalities not clearly visible with conventional windows. The early demonstration of these changes, in the appropriate clinical context, may suggest CJD and this supports the use of mid- or high magnetic fields in the diagnosis of CJD and other forms of dementia. In our cases of iatrogenic CJD, low-field MRI did not reveal more than the progressive atrophy displayed by CT, and raises the question on the one hand of possible differences, based on imaging, from the sporadic form, and on the other of the lack of sensitivity of low-field magnets to signal changes in CJD. (orig.)

  13. CT and MRI in iatrogenic and sporadic Creutzfeldt-Jakob disease: as far as imaging perseives

    International Nuclear Information System (INIS)

    Garcia Santos, J.M.; Lopez Corbalan, J.A.; Martinez-Lage, J.F.; Sicilis Guillen, J.

    1996-01-01

    Creutzfeldt-Jakob Disease (CJD), an invariably fatal dementing illness, affects patients in middle and old age (sporadic form). However, the association of CJD with certain treatments (iatrogenic form) has been described in younger patients. The clinical onset of the two forms seems to differ; in the iatrogenic form a high frequency of the ataxic CJD variant has been reported. Nowadays, a definitive diagnosis of CJD is exclusively histological. We present five cases of CJD, one sporadic and the others iatrogenic, following dura mater grafts and analyse their CT and MRI features. CT typically demonstrates brain atrophy, generally progressive, but in sporadic CJD midfield MRI also showed abnormal signal, with predominant deep grey matter involvement. The use of narrow windows with proton-density sequences may reveal subtle cortical signal abnormalities not clearly visible with conventional windows. The early demonstration of these changes, in the appropriate clinical context, may suggest CJD and this supports the use of mid- or high magnetic fields in the diagnosis of CJD and other forms of dementia. In our cases of iatrogenic CJD, low-field MRI did not reveal more than the progressive atrophy displayed by CT, and raises the question on the one hand of possible differences, based on imaging, from the sporadic form, and on the other of the lack of sensitivity of low-field magnets to signal changes in CJD. (orig.)

  14. Diagnosis and outcome of a dog with iatrogenic hyperadrenocorticism and secondary pulmonary mineralization.

    Science.gov (United States)

    Blois, Shauna L; Caron, Isabelle; Mitchell, Colleen

    2009-04-01

    A 6-year-old, spayed female dog was evaluated for a history of chronic coughing, excessive panting, and lethargy. Iatrogenic hyperadrenocorticism was diagnosed, and pulmonary mineralization was documented with a 99m Technitium-methylene diphosphonate (99mTc-MDP) scan. Blood gas analysis showed hypoxia. Clinical signs resolved and blood gas values returned to normal when corticosteroid therapy was discontinued.

  15. An unusual case of herniation of small bowel through an iatrogenic defect of the falciform ligament

    International Nuclear Information System (INIS)

    Sourtzis, S.; Canizares, C.; Damry, N.; Thibeau, J.F.; Philippart, P.

    2002-01-01

    Internal herniation through a congenital defect in the falciform ligament is extremely rare. We report an unusual observation of small bowel obstruction through an iatrogenic defect of the falciform ligament. Prompt diagnosis was made by helical CT, permitting a rapid surgical procedure to preserve the viability of the obstructed segment. (orig.)

  16. MUSCLE TENSION DYSPHONIA

    Directory of Open Access Journals (Sweden)

    Irena Hočevar Boltežar

    2004-07-01

    Full Text Available Background. Muscle tension dysphonia (MTD is the cause of hoarseness in almost one half of the patients with voice disorders. The otorhinolaryngologic examination discovers no evident organic lesions in the larynx at least in the beginning of the voice problems. The reason for the hoarse voice is a disordered and maladjusted activity of the muscles taking part in phonation and/or articulation. In some patients, the irregular function of the larynx results in mucosal lesions on vocal folds. The factors participating in the development of MTD, directly or indirectly influence the quality of laryngeal mucosa, the activity of the phonatory muscles and/or increase of the vocal load. In the diagnostics and treatment of the MTD a phoniatrician, a speech and language therapist and a psychologist closely cooperate with the patient who must take an active role. The treatment is a long-lasting one but resulted in a high percentage of clinical success.Conclusions. Most likely, MTD is not a special disease but only a reflection of any disorder in the complicated system of regulation and realization of phonation. The prognosis of treatment is good when all unfavourable factors participating in development of MTD are eliminated and a proper professional voice- and psychotherapy started.

  17. Pneumothorax as a complication of combination antiangiogenic therapy in children and young adults with refractory/recurrent solid tumors.

    Science.gov (United States)

    Interiano, Rodrigo B; McCarville, M Beth; Wu, Jianrong; Davidoff, Andrew M; Sandoval, John; Navid, Fariba

    2015-09-01

    Antiangiogenic agents show significant antitumor activity against various tumor types. In a study evaluating the combination of sorafenib, bevacizumab, and low-dose cyclophosphamide in children with solid tumors, an unexpectedly high incidence of pneumothorax was observed. We evaluated patient characteristics and risk factors for the development of pneumothorax in patients receiving this therapy. Demographics, clinical course, and radiographic data of 44 patients treated with sorafenib, bevacizumab and cyclophosphamide were reviewed. Risk factors associated with the development of pneumothorax were analyzed. Pneumothorax likely related to study therapy developed in 11 of 44 (25%) patients of whom 33 had pulmonary abnormalities. Median age of patients was 14.7 years (range, 1.08-24.5). Histologies associated with pneumothorax included rhabdoid tumor, synovial sarcoma, osteosarcoma, Ewing sarcoma, Wilms tumor, and renal cell carcinoma. Cavitation of pulmonary nodules in response to therapy was associated with pneumothorax development (Ppneumothorax was 5.7 weeks (range, 2.4-31). The development of cavitary pulmonary nodules in response to therapy is a risk factor for pneumothorax. As pneumothorax is a potentially life-threatening complication of antiangiogenic therapy in children with solid tumors, its risk needs to be evaluated when considering this therapy. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. The role of iatrogenic disease of cattle in admission to veterinary hospital

    Directory of Open Access Journals (Sweden)

    Giulia Sala

    2017-05-01

    Full Text Available Iatrogenic diseases are due to negligence or malpractice (Pezza et al.,2008. In human medicine, these conditions are widely described (Weingart et al., 2000, mostly for insurance issues related to hospitalization, while in veterinary medicine are reported only occasional case reports. 4155 clinical records related to cattle admitted to the Clinic for Ruminants and Swine of the University of Milan between 2005 and 2017 were analyzed. Clinical cases that required admission because of an iatrogenic related disease were selected for this study. For case selection, 3 experienced veterinarians examined the clinical records, cross-compared the selection and pick 114 cases (2,7%. The iatrogenic diseases were primarily caused by farmers (93% than veterinary practitioner (7%. Iatrogenic diseases were caused mostly by erroneous administration of drugs (47,4%, excessive traction at birth (17,5%, improper milk or colostrum administration, frequently performed by oroesophageal tubing (16,7% or by forced administration using a nipple bottle (12,3%. As verified by our study, farmers often performs medical, nursing and zootechnical procedures without adequate competences and sometimes choose medical treatment for sick animals without professional consultation of veterinarians.The veterinarian rule is fundamental in farmer education. Clinicians, especially in some professional branches as neonatology, should be more responsible of their assignments, avoiding delegation of specific procedures to unskilled staff. The importance of communication in improving management and health in dairy farms has been recently demonstrated (Jansen and Lam, 2012; Jansen et al., 2010. Effective communication has a key role in dairy herd health and communication strategies are required to support diseases control programs (Lievaart et al., 2008. More attention to iatrogenic issue may have a positive impact on animal and public health. Moreover, a decrease of unnecessary and injurious

  19. [Iatrogenic hyperthyroidism secondary to weight loss medication. Predictive factors for their precocious detention].

    Science.gov (United States)

    Goday, A; Recasens, A; Manresa, J M; Vila, J; Moix, S

    1998-05-01

    To establish the differential clinical characteristics between the Iatrogenic hyperthyroidism for not conventional medication for obesity treatment (weight losers) and the endogenous by Graves Basedow disease. Observational and analytical study, populational based, in the one which prospectively were compared cases with Iatrogenic hyperthyroidism (secondary to weight losers) with those with endogenous hyperthyroidism (Graves Basedow disease) as controls. Consisted of the variable clinical record of 100 correlative patients that consulted in specialized attention of endocrinology for Iatrogenic hyperthyroidism secondary to weight losers and for Graves Basedow disease. The differences observed between Iatrogenic hyperthyroidism (secondary to weight losers) (n = 43) as compared to endogenous hyperthyroidism (Graves Basedow disease) (n = 57) were: smaller age (31.8 +/- 10 as compared to 37.8 +/- 12.6 years), greater body mass index (27.6 +/- 7.2 as compared to 23.4 +/- 3.1), smaller goiter frequency (16.3% as compared to 84.2%) as well as absence of signs of ophthalmopathy (0% as compared to 57.9%). Both groups had low levels of TSH, and the difference rests in the values of free T4, low in the first group and increased in the endogenous hyperthyroidism. The odds ratio were: IMC > 27: 3.92 (0.91-16.72), age weight losers use was not selective of the first group, being detected in a 12.3% of cases of endogenous hyperthyroidism, though in periods of time remoter in relationship to the beginning of the clinic. In the differential diagnosis of a case of hyperthyroidism, it can be suspected Iatrogenic hyperthyroidism (secondary to weight losers) for medication for the obesity in patients of the feminine sex with overweight, without previous or familiar history of thyroid disease, and in those which in the physical exploration is not verified goiter neither ophthalmopathy.

  20. A prospective survey on the incidence of chest malignancies after repeated fluoroscopy during artificial pneumothorax therapy for pulmonary tuberculosis

    International Nuclear Information System (INIS)

    Kitabatake, Takashi; Kurokawa, Shigeki; Yamasaki, Michio; Sato, Toshiro; Kurokawa, Hisae

    1975-01-01

    Patients with pulmonary tuberculosis treated in 4 sanatoria in Niigata Prefecture between 1941 and 1961 were followed up by a mail questionnaire. Of 2756 patients, 1193 responded and sent back effective information, letters to 1224 were returned because of uncertain or unknown new address, 326 did not respond, and 13 were excluded because of incomplete answers. Out of the 1193 effective responders, 568 had been treated by artificial pneumothorax (the pneumothorax group), and 552 had not been treated by pneumothorax (the control group). There were 65 deaths in the pneumothorax group, but none of them were from chest malignancies; and 40 deaths in the control group with 4 from chest malignancies. In this survey, there was no evidence of an increased number of chest malignancies (including leukemia) after pneumothorax fluoroscopy. (auth.)

  1. Prospective survey on the incidence of chest malignancies after repeated fluoroscopy during artificial pneumothorax therapy for pulmonary tuberculosis

    Energy Technology Data Exchange (ETDEWEB)

    Kitabatake, T; Kurokawa, S; Yamasaki, M; Sato, T; Kurokawa, H [Niigata Univ. (Japan). School of Medicine

    1975-10-01

    Patients with pulmonary tuberculosis treated in 4 sanatoria in Niigata Prefecture between 1941 and 1961 were followed up by a mail questionnaire. Of 2756 patients, 1193 responded and sent back effective information, letters to 1224 were returned because of uncertain or unknown new address, 326 did not respond, and 13 were excluded because of incomplete answers. Out of the 1193 effective responders, 568 had been treated by artificial pneumothorax (the pneumothorax group), and 552 had not been treated by pneumothorax (the control group). There were 65 deaths in the pneumothorax group, but none of them were from chest malignancies; and 40 deaths in the control group with 4 from chest malignancies. In this survey, there was no evidence of an increased number of chest malignancies (including leukemia) after pneumothorax fluoroscopy.

  2. Cannabis increased the risk of primary spontaneous pneumothorax in tobacco smokers

    DEFF Research Database (Denmark)

    Hedevang Olesen, Winnie; Katballe, Niels; Sindby, Jesper Eske

    2017-01-01

    OBJECTIVES: Previous smaller case series suggested that cannabis smoking may cause spontaneous pneumothorax, but this finding remains controversial. We investigated the possible association between smoking tobacco and cannabis and the risk of having a primary spontaneous pneumothorax in a large...... tobacco and cannabis were obtained from questionnaires presented on admittance. We compared our findings with those of a population-based control group matched by age, sex and geographical area. Calculated odds ratios were compared using the Fisher’s exact test for small frequencies and the χ2 test.......61–14.14, P cannabis and tobacco in men increased the risk of spontaneous pneumothorax significantly (odds ratio = 8.74, 95% confidence interval: 4.30–19.51, P 

  3. Total pleural covering technique for intractable pneumothorax in patient with Ehlers-Danlos syndrome.

    Science.gov (United States)

    Kadota, Yoshihisa; Fukui, Eriko; Kitahara, Naoto; Okura, Eiji; Ohta, Mitsunori

    2016-07-01

    We report a patient with vascular-type Ehlers-Danlos syndrome (vEDS) who developed pneumothorax and was treated with a total pleural covering technique (TPC). A 24-year-old man developed repeat pneumothorax with intermittent hemo-sputum. Based on unusual radiological manifestations of lung lesions and physical findings, EDS was suspected as an underlying cause of the pneumothorax. Surgical treatment was performed using a mediastinal fat pad and TPC, and no relapse was seen up to 2 years after surgery. TPC is a less invasive surgical approach for selected patients with vEDS. Accurate underlying diagnosis of vEDS and systemic evaluation of vascular complications are necessary before planning surgery.

  4. Surgical treatment versus conventional chest tube drainage in primary spontaneous pneumothorax

    DEFF Research Database (Denmark)

    Olesen, Winnie Hedevang; Katballe, Niels; Sindby, Jesper Eske

    2018-01-01

    OBJECTIVES: Primary spontaneous pneumothorax frequently recurs after chest tube management. Evidence is lacking whether patients may benefit from surgery following their first episode. METHODS: We performed a multicentre, randomized trial and enrolled young, otherwise healthy patients admitted...... with their first episode of primary spontaneous pneumothorax and treated using conventional chest tube drainage. Patients underwent high-resolution computed tomography on fully expanded lungs, and using web-based randomization, we assigned patients to continued conservative chest tube treatment or chest tube...... treatment to prevent recurrence in patients with their first presentation of primary spontaneous pneumothorax and should be the standard of care when high-resolution computed tomography demonstrates bullae ≥2 cm. Clinical trial registration: ClinicalTrial.gov: NCT 02866305....

  5. Ultrasound as a Screening Tool for Central Venous Catheter Positioning and Exclusion of Pneumothorax.

    Science.gov (United States)

    Amir, Rabia; Knio, Ziyad O; Mahmood, Feroze; Oren-Grinberg, Achikam; Leibowitz, Akiva; Bose, Ruma; Shaefi, Shahzad; Mitchell, John D; Ahmed, Muneeb; Bardia, Amit; Talmor, Daniel; Matyal, Robina

    2017-07-01

    Although real-time ultrasound guidance during central venous catheter insertion has become a standard of care, postinsertion chest radiograph remains the gold standard to confirm central venous catheter tip position and rule out associated lung complications like pneumothorax. We hypothesize that a combination of transthoracic echocardiography and lung ultrasound is noninferior to chest radiograph when used to accurately assess central venous catheter positioning and screen for pneumothorax. All operating rooms and surgical and trauma ICUs at the institution. Single-center, prospective noninferiority study. Patients receiving ultrasound-guided subclavian or internal jugular central venous catheters. During ultrasound-guided central venous catheter placement, correct positioning of central venous catheter was accomplished by real-time visualization of the guide wire and positive right atrial swirl sign using the subcostal four-chamber view. After insertion, pneumothorax was ruled out by the presence of lung sliding and seashore sign on M-mode. Data analysis was done for 137 patients. Chest radiograph ruled out pneumothorax in 137 of 137 patients (100%). Lung ultrasound was performed in 123 of 137 patients and successfully screened for pneumothorax in 123 of 123 (100%). Chest radiograph approximated accurate catheter tip position in 136 of 137 patients (99.3%). Adequate subcostal four-chamber views could not be obtained in 13 patients. Accurate positioning of central venous catheter with ultrasound was then confirmed in 121 of 124 patients (97.6%) as described previously. Transthoracic echocardiography and lung ultrasound are noninferior to chest x-ray for screening of pneumothorax and accurate central venous catheter positioning. Thus, the point of care use of ultrasound can reduce central venous catheter insertion to use time, exposure to radiation, and improve patient safety.

  6. Outcome and risk factors of recurrence after thoracoscopic bullectomy in young adults with primary spontaneous pneumothorax.

    Science.gov (United States)

    Nakayama, Takashi; Takahashi, Yusuke; Uehara, Hirofumi; Matsutani, Noriyuki; Kawamura, Masafumi

    2017-07-01

    To investigate the risk factors of recurrence of pneumothorax following thoracoscopic bullectomy in young adults. Between January, 2005 and September, 2015, 167 patients aged ≤40 years underwent initial thoracoscopic bullectomy for primary spontaneous pneumothorax (PSP) at our hospital. Recurrence-free probability was calculated from the date of surgery to recurrence or last follow-up, using the Kaplan-Meier method. Sixteen (9.6%) of the 167 patients suffered a recurrence (collective total, 16 recurrences). The recurrence-free intervals were 3-107 months (median 25.8 months), and the 5-year recurrence-free probability was 85.9%. Multivariate Cox analysis demonstrated that age ≤23 years (p = 0.029) and a history of ipsilateral pneumothorax before surgery (p = 0.029) were significantly associated with higher risk of recurrence. The 5-year recurrence-free probability was 72.3% for patients aged ≤23 years and a history of ipsilateral pneumothorax before surgery and 94.1% for those with neither of these factors (p = 0.001). Recurrence developed within 3 years after surgery in 14 of the 16 patients. Patients ≤23 years of age with a history of ipsilateral pneumothorax before surgery are at significantly high risk of its recurrence, frequently within 3 years; thus, the risk of postoperative recurrence of a pneumothorax must be kept in mind.

  7. Surgical Intervention for Primary Spontaneous Pneumothorax in Pediatric Population: When and Why?

    Science.gov (United States)

    Yeung, Fanny; Chung, Patrick H Y; Hung, Esther L Y; Yuen, Chi Sum; Tam, Paul K H; Wong, Kenneth K Y

    2017-08-01

    Spontaneous pneumothorax in pediatric patients is relatively uncommon. The management strategy varies in different centers due to dearth of evidence-based pediatric guidelines. In this study, we reviewed our experience of thoracoscopic management of primary spontaneous pneumothorax (PSP) in children and identified risk factors associated with postoperative air leakage and recurrence. We performed a retrospective analysis of pediatric patients who had PSP and underwent surgical management in our institution between April 2008 and March 2015. Demographic data, radiological findings, interventions, and surgical outcomes were analyzed. A total of 92 patients with 110 thoracoscopic surgery for PSP were identified. The indications for surgery were failed nonoperative management with persistent air leakage in 32.7%, recurrent ipsilateral pneumothorax in 36.4%, first contralateral pneumothorax in 14.5%, bilateral pneumothorax in 10%, and significant hemopneumothorax in 5.5%. Bulla was identified in 101 thoracoscopy (91.8%) with stapled bullectomy performed. 14.5% patients had persistent postoperative air leakage and treated with reinsertion of thoracostomy tube and chemical pleurodesis. 17.3% patients had postoperative recurrence occurred at mean time of 11 months. Operation within 7 days of symptoms onset was associated with less postoperative air leakage (P = .04). Bilateral pneumothorax and those with abnormal radiographic features had significantly more postoperative air leakage (P = .002, P < .01 respectively) and recurrence (P < .01, P = .007). Early thoracoscopic mechanical pleurodesis and stapled bullectomy after thoracostomy tube insertion could be offered as a primary option for management of large PSP in pediatric population, since most of these patients had bulla identified as the culprit of the disease.

  8. Diagnostic accuracy of a novel software technology for detecting pneumothorax in a porcine model.

    Science.gov (United States)

    Summers, Shane M; Chin, Eric J; April, Michael D; Grisell, Ronald D; Lospinoso, Joshua A; Kheirabadi, Bijan S; Salinas, Jose; Blackbourne, Lorne H

    2017-09-01

    Our objective was to measure the diagnostic accuracy of a novel software technology to detect pneumothorax on Brightness (B) mode and Motion (M) mode ultrasonography. Ultrasonography fellowship-trained emergency physicians performed thoracic ultrasonography at baseline and after surgically creating a pneumothorax in eight intubated, spontaneously breathing porcine subjects. Prior to pneumothorax induction, we captured sagittal M-mode still images and B-mode videos of each intercostal space with a linear array transducer at 4cm of depth. After collection of baseline images, we placed a chest tube, injected air into the pleural space in 250mL increments, and repeated the ultrasonography for pneumothorax volumes of 250mL, 500mL, 750mL, and 1000mL. We confirmed pneumothorax with intrapleural digital manometry and ultrasound by expert sonographers. We exported collected images for interpretation by the software. We treated each individual scan as a single test for interpretation by the software. Excluding indeterminate results, we collected 338M-mode images for which the software demonstrated a sensitivity of 98% (95% confidence interval [CI] 92-99%), specificity of 95% (95% CI 86-99), positive likelihood ratio (LR+) of 21.6 (95% CI 7.1-65), and negative likelihood ratio (LR-) of 0.02 (95% CI 0.008-0.046). Among 364 B-mode videos, the software demonstrated a sensitivity of 86% (95% CI 81-90%), specificity of 85% (81-91%), LR+ of 5.7 (95% CI 3.2-10.2), and LR- of 0.17 (95% CI 0.12-0.22). This novel technology has potential as a useful adjunct to diagnose pneumothorax on thoracic ultrasonography. Published by Elsevier Inc.

  9. Occult pneumothorax in Chinese patients with significant blunt chest trauma: incidence and management.

    Science.gov (United States)

    Lee, Ka L; Graham, Colin A; Yeung, Janice H H; Ahuja, Anil T; Rainer, Timothy H

    2010-05-01

    Occult pneumothorax (OP) is a pneumothorax not visualised on a supine chest X-ray (CXR) but detected on computed tomography (CT) scanning. With increasing CT use for trauma, more OP may be detected. Management of OP remains controversial, especially for patients undergoing mechanical ventilation. This study aimed to identify the incidence of OP using thoracic CT as the gold standard and describe its management amongst Hong Kong Chinese trauma patients. Analysis of prospectively collected trauma registry data. Consecutive significantly injured trauma patients admitted through the emergency department (ED) suffering from blunt chest trauma who underwent thoracic computed tomography (TCT) between in calendar years 2007 and 2008 were included. An OP was defined as the identification (by a specialist radiologist) of a pneumothorax on TCT that had not been previously detected on supine CXR. 119 significantly injured patients were included. 56 patients had a pneumothorax on CXR and a further 36 patients had at least one OP [OP incidence 30% (36/119)]. Bilateral OP was present in 8/36 patients, so total OP numbers were 44. Tube thoracostomy was performed for 8/44 OP, all were mechanically ventilated in the ED. The remaining 36 OP were managed expectantly. No patients in the expectant group had pneumothorax progression, even though 8 patients required subsequent ventilation in the operating room for extrathoracic surgery. The incidence of OP (seen on TCT) in Chinese patients in Hong Kong after blunt chest trauma is higher than that typically reported in Caucasians. Most OP were managed expectantly without significant complications; no pneumothorax progressed even though some patients were mechanically ventilated. (c) 2010 Elsevier Ltd. All rights reserved.

  10. Ultrasound detection of pneumothorax compared with chest X-ray and computed tomography scan.

    Science.gov (United States)

    Nagarsheth, Khanjan; Kurek, Stanley

    2011-04-01

    Pneumothorax after trauma can be a life threatening injury and its care requires expeditious and accurate diagnosis and possible intervention. We performed a prospective, single blinded study with convenience sampling at a Level I trauma center comparing thoracic ultrasound with chest X-ray and CT scan in the detection of traumatic pneumothorax. Trauma patients that received a thoracic ultrasound, chest X-ray, and chest CT scan were included in the study. The chest X-rays were read by a radiologist who was blinded to the thoracic ultrasound results. Then both were compared with CT scan results. One hundred and twenty-five patients had a thoracic ultrasound performed in the 24-month period. Forty-six patients were excluded from the study due to lack of either a chest X-ray or chest CT scan. Of the remaining 79 patients there were 22 positive pneumothorax found by CT and of those 18 (82%) were found on ultrasound and 7 (32%) were found on chest X-ray. The sensitivity of thoracic ultrasound was found to be 81.8 per cent and the specificity was found to be 100 per cent. The sensitivity of chest X-ray was found to be 31.8 per cent and again the specificity was found to be 100 per cent. The negative predictive value of thoracic ultrasound for pneumothorax was 0.934 and the negative predictive value for chest X-ray for pneumothorax was found to be 0.792. We advocate the use of chest ultrasound for detection of pneumothorax in trauma patients.

  11. Missed diagnosis of atresia of the right pulmonary artery in woman with left-sided pneumothorax

    DEFF Research Database (Denmark)

    Dagnegård, Hanna; Ryom, Philip

    2016-01-01

    Isolated pulmonary atresia is an uncommon condition, which can go undiagnosed for a long time in asymptomatic patients. Sometimes, diagnosis can be made at pregnancy due to respiratory symptoms. There is no known increased risk of pneumothorax. We here present a case where a second-time pregnant...... woman with an unknown atresia of the right pulmonary artery received a left-sided pneumothorax. The diagnosis was initially missed in spite of adequate imaging and the condition progressed to respiratory stop. We describe the course of diagnostics and the chosen strategy of treatment....

  12. Spontaneous Interlobar Pneumothorax in a Localized Fibrous Tumor of in the Pleura

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Young Tong [Dept. of Radiology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan (Korea, Republic of)

    2012-03-15

    We report a case of a localized fibrous tumor of in the pleura pleura; this tumor was associated with interlobar pneumothorax, which, to our knowledge, has not been reported to date. A 63-year-old woman presented with an incidentally-detected nodule, which was seen on her chest radiograph. It presented as a mural nodule within a cystic lesion, on the chest radiograph and axial CT, and a reformatted sagittal CT image could then be diagnosed as a pleural tumor associated with interlobar pneumothorax.

  13. Spontaneous Interlobar Pneumothorax in a Localized Fibrous Tumor of in the Pleura

    International Nuclear Information System (INIS)

    Kim, Young Tong

    2012-01-01

    We report a case of a localized fibrous tumor of in the pleura pleura; this tumor was associated with interlobar pneumothorax, which, to our knowledge, has not been reported to date. A 63-year-old woman presented with an incidentally-detected nodule, which was seen on her chest radiograph. It presented as a mural nodule within a cystic lesion, on the chest radiograph and axial CT, and a reformatted sagittal CT image could then be diagnosed as a pleural tumor associated with interlobar pneumothorax.

  14. Risk factors for postoperative recurrence of spontaneous pneumothorax treated by video-assisted thoracoscopic surgery†.

    Science.gov (United States)

    Imperatori, Andrea; Rotolo, Nicola; Spagnoletti, Marco; Festi, Luigi; Berizzi, Fabio; Di Natale, Davide; Nardecchia, Elisa; Dominioni, Lorenzo

    2015-05-01

    Over the past two decades, video-assisted thoracoscopic blebectomy and pleurodesis have been used as a safe and reliable option for treatment of spontaneous pneumothorax. The aim of this study is to evaluate the long-term outcome of video-assisted thoracoscopic surgery (VATS) treatment of spontaneous pneumothorax in young patients, and to identify risk factors for postoperative recurrence. We retrospectively analysed the outcome of VATS treatment of spontaneous pneumothorax in our institution in 150 consecutive young patients (age ≤ 40 years) in the years 1997-2010. Treatment consisted of stapling blebectomy and partial parietal pleurectomy. After excluding 16 patients lost to follow-up, in 134 cases [110 men, 24 women; mean age, 25 ± 7 standard deviation years; median follow-up, 79 months (range: 36-187 months)], we evaluated postoperative complications, focusing on pneumothorax recurrence, thoracic dysaesthesia and chronic chest pain. Risk factors for postoperative pneumothorax recurrence were analysed by logistic regression. Of 134 treated patients, 3 (2.2%) required early reoperation (2 for bleeding; 1 for persistent air leaks). Postoperative (90-day) mortality was nil. Ipsilateral pneumothorax recurred in 8 cases (6.0%) [median time of recurrence, 43 months (range: 1-71 months)]. At univariate analysis, the recurrence rate was significantly higher in women (4/24) than in men (4/110; P = 0.026) and in patients with >7-day postoperative air leaks (P = 0.021). Multivariate analysis confirmed that pneumothorax recurrence correlated independently with prolonged air leaks (P = 0.037) and with female gender (P = 0.045). Chronic chest wall dysaesthesia was reported by 13 patients (9.7%). In 3 patients, (2.2%) chronic thoracic pain (analogical score >4) was recorded, but only 1 patient required analgesics more than once a month. VATS blebectomy and parietal pleurectomy is a safe procedure for treatment of spontaneous pneumothorax in young patients, with a 6% long

  15. Pulmonary lymphangioleiomyomatosis presenting as spontaneous pneumothorax treated with sirolimus - A case report

    Science.gov (United States)

    Verma, Ajay Kumar; Joshi, Ambarish; Mishra, Amritesh Ranjan; Kant, Surya; Singh, Arpita

    2018-01-01

    Spontaneous pneumothorax is a very common medical emergency. Patients are often treated without treating the underlying cause. Lymphangioleiomyomatosis (LAM) is a rare cystic lung disease. Until recently, diagnosis of LAM was a challenge with nearly 100% mortality in 10 years, but better understanding of the disease through research and better radiological techniques and newer drugs such as sirolimus has improved the survival in such patients. We are presenting a rare case of LAM presenting as a secondary spontaneous pneumothorax treated with sirolimus. PMID:29487252

  16. Bilateral pneumothorax with extensive subcutaneous emphysema manifested during third molar surgery. A case report.

    Science.gov (United States)

    Sekine, J; Irie, A; Dotsu, H; Inokuchi, T

    2000-10-01

    This report describes a case of bilateral pneumothorax with extensive subcutaneous emphysema in a 45-year-old man that occurred during surgery to extract the left lower third molar, performed with the use of an air turbine dental handpiece. Computed tomographic scanning showed severe subcutaneous emphysema extending bilaterally from the cervicofacial region and the deep anatomic spaces (including the pterygomandibular, parapharyngeal, retropharyngeal, and deep temporal spaces) to the anterior wall of the chest. Furthermore, bilateral pneumothorax and pneumomediastinum were present. In our patient, air dissection was probably caused by pressurized air being forced through the operating site into the surrounding connective tissue.

  17. Tension pneumocephalus: Mount Fuji sign

    Directory of Open Access Journals (Sweden)

    Pulastya Sanyal

    2015-01-01

    Full Text Available A 13-year-old male was operated for a space occupying lesion in the brain. A noncontrast computed tomography scan done in the late postoperative period showed massive subdural air collection causing compression of bilateral frontal lobes with widening of interhemispheric fissure and the frontal lobes acquiring a peak like configuration - causing tension pneumocephalus-"Mount Fuji sign." Tension pneumocephalus occurs when air enters the extradural or intradural spaces in sufficient volume to exert a mass or pressure effect on the brain, leading to brain herniation. Tension pneumocephalus is a surgical emergency, which needs immediate intervention in the form of decompression of the cranial cavity by a burr hole or needle aspiration. The Mount Fuji sign differentiates tension pneumocephalus from pneumocephalus.

  18. Mitochondrial Respiration and Oxygen Tension.

    Science.gov (United States)

    Shaw, Daniel S; Meitha, Karlia; Considine, Michael J; Foyer, Christine H

    2017-01-01

    Measurements of respiration and oxygen tension in plant organs allow a precise understanding of mitochondrial capacity and function within the context of cellular oxygen metabolism. Here we describe methods that can be routinely used for the isolation of intact mitochondria, and the determination of respiratory electron transport, together with techniques for in vivo determination of oxygen tension and measurement of respiration by both CO 2 production and O 2 consumption that enables calculation of the respiratory quotient [CO 2 ]/[O 2 ].

  19. Assessment of bullae with high-resolution CT in patients with spontaneous pneumothorax: comparison with video-assisted thoracoscopy

    International Nuclear Information System (INIS)

    Kim, Kyoung Rae; Oh, Yu Whan; Noh, Hyung Jun; Cho, Kyu Ran; Lee, Ki Yeol; Kang, Eun Young; Kim, Jung Hyuk

    2004-01-01

    The purpose of this study was to compare the findings on high-resolution CT (HRCT) of the chest with those on video-assisted thoracoscopy for the detection of bullae in patients who had undergone an operation for spontaneous pneumothorax, and we also wished to evaluate the relationship between the characteristics of bullae on HRCT and development of spontaneous pneumothorax. Fifty patients with spontaneous pneumothorax who had undergone both HRCT of the chest and video-assisted thoracoscopic surgery were included in the study. Spontaneous pneumothoraces were classified as either primary or secondary pneumothorax, and as initial or recurrent pneumothorax. The HRCT scans were obtained with 1 mm slice thickness and a 5 mm scan interval. Two radiologists retrospectively compared the HRCT findings of the chest with those findings on video-assisted thoracoscopy for the detection of bullae, and they evaluated the value of HRCT for diagnosing bullae. In addition, we assessed the size and number of bullae in these patients, and we also evaluated the relationship between those findings of bullae and the development of spontaneous pneumothorax. Bullae were detected in 40 patients by using video-assisted thoracoscopy, and HRCT showed bullae in 38 of these patients. Bullae were not identified with video-assisted thoracoscopy in the remaining ten patients, and among these ten patients, bullae were not demonstrated by HRCT in eight of them. Therefore, the sensitivity and specificity of HRCT for the detection of bullae were 95% (38/40| and 80% (8/10), respectively. The average size of the bullae of the affected hemithorax and the contralateral un-affected hemithorax was 1.97 cm ± 2.30 and 1.24 cm±1.46, respectively. Pneumothorax was more frequently observed in the hemithorax with larger bullae (p 0.05). The average size of bullae in patients with secondary pneumothorax and those bullae of patients with primary pneumothorax was 4.44 cm±4.06 and 1.42 cm±1.26, respectively. The

  20. Covered stents for endovascular repair of iatrogenic injuries of iliac and femoral arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kufner, Sebastian, E-mail: kufners@dhm.mhn.de [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); Cassese, Salvatore; Groha, Philipp; Byrne, Robert A. [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); Schunkert, Heribert; Kastrati, Adnan [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich (Germany); Ott, Ilka; Fusaro, Massimiliano [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany)

    2015-04-15

    Background: The growing number of complex endovascular procedures is expected to increase the risk of iatrogenic injuries of peripheral arteries. A strategy of percutaneous transluminal angioplasty (PTA) with covered stent (CS) may represent a valuable alternative to open surgery. However, systematic evaluations of CS in this setting represent a scientific gap. In the present study, we investigate the procedural and clinical outcomes associated with PTA and CS implantation to repair iatrogenic injuries of peripheral arteries. Methods: All patients undergoing PTA with CS for endovascular repair of iatrogenic injuries of peripheral arteries between August 2010 and July 2013 at our Institution were retrospectively analyzed. The primary endpoint was the technical success. Secondary endpoints were in-hospital mortality and cumulative death, target lesion revascularization (TLR), amputation and major stroke at 12-month follow-up. Results: During the period of observation, a total of 30 patients underwent PTA with either self-expandable (43.3%) or balloon-expandable CS (56.7%) for iatrogenic injuries of peripheral arteries. Injuries consisted of perforation/rupture (76.7%), arteriovenous fistula (16.7%) and pseudoaneurysm (6.7%) of iliac–femoral arteries. Technical success was achieved in all cases. Median follow-up was 409 days [210–907]. The incidence of in-hospital mortality was 10.0%. At 12-month follow-up, the incidence of death, TLR, amputation and major stroke was 20.0%, 17.0%, 3.3% and 6.7%, respectively. Conclusion: The use of covered stents for endovascular repair of iatrogenic injuries of peripheral arteries shows a high technical success and may be alternative to surgery. Further studies with larger populations are needed to confirm these preliminary findings. - Highlights: • The growing number of complex endovascular procedures is expected to increase the risk of iatrogenic injuries of peripheral arteries. • Percutaneous transluminal angioplasty with

  1. Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method.

    Science.gov (United States)

    Kakizawa, Hideaki; Toyota, Naoyuki; Hieda, Masashi; Hirai, Nobuhiko; Tachikake, Toshihiro; Matsuura, Noriaki; Oda, Miyo; Ito, Katsuhide

    2010-09-01

    The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: "none", "mild", "moderate" and "severe". The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p < 0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax.

  2. Risk factors for severity of pneumothorax after CT-guided percutaneous lung biopsy using the single-needle method

    International Nuclear Information System (INIS)

    Kakizawa, Hideaki; Hieda, Masashi; Oda, Miyo; Toyota, Naoyuki; Hirai, Nobuhiko; Tachikake, Toshihiro; Matsuura, Noriaki; Ito, Katsuhide

    2010-01-01

    The purpose of this study is to evaluate the risk factors for the severity of pneumothorax after computed tomography (CT)-guided percutaneous lung biopsy using the single-needle method. We reviewed 91 biopsy procedures for 90 intrapulmonary lesions in 89 patients. Patient factors were age, sex, history of ipsilateral lung surgery and grade of emphysema. Lesion factors were size, location and pleural contact. Procedure factors were position, needle type, needle size, number of pleural punctures, pleural angle, length of needle passes in the aerated lung and number of harvesting samples. The severity of pneumothorax after biopsy was classified into 4 groups: 'none', 'mild', 'moderate' and 'severe'. The risk factors for the severity of pneumothorax were determined by multivariate analyzing of the factors derived from univariate analysis. Pneumothorax occurred in 39 (43%) of the 91 procedures. Mild, moderate, and severe pneumothorax occurred in 24 (26%), 8 (9%) and 7 (8%) of all procedures, respectively. Multivariate analysis showed that location, pleural contact, number of pleural punctures and number of harvesting samples were significantly associated with the severity of pneumothorax (p<0.05). In conclusion, lower locations and non-pleural contact lesions, increased number of pleural punctures and increased number of harvesting samples presented a higher severity of pneumothorax. (author)

  3. Iatrogenic Cushing’s syndrome with inhaled steroid plus antidepressant drugs

    Directory of Open Access Journals (Sweden)

    Celik Ozlem

    2012-08-01

    Full Text Available Abstract Current guidelines recommend the use of inhaled corticosteroids (ICS for suppression of airway inflammation in patients with asthma. Although it is well known that ICS cause dose-related adrenocortical suppression, it is less known that they can lead to iatrogenic Cushing’s syndrome (CS. Fluticasone propionate (FP is an ICS more potent than beclomethasone and budesonide. FP is metabolized as mediated by cytochrome P450 3A4 in the liver and the gut. Systemic bioactivity of FP can increase with the use of drugs that affect the cytochrome P450. Herein, we report the rapid development of iatrogenic CS in a patient receiving paroxetine and mirtazepine for 12 weeks in addition to inhaled FP.

  4. Iatrogenic Creutzfeldt-Jakob disease following human growth hormone therapy: case report.

    Science.gov (United States)

    Caboclo, Luís Otávio Sales Ferreira; Huang, Nancy; Lepski, Guilherme Alves; Livramento, José Antônio; Buchpiguel, Carlos Alberto; Porto, Cláudia Sellitto; Nitrini, Ricardo

    2002-06-01

    We report the case of a 41-year-old man with iatrogenic Creutzfeldt-Jakob disease (CJD) acquired after the use of growth hormone (GH) obtained from a number of pituitary glands sourced from autopsy material. The incubation period of the disease (from the midpoint of treatment to the onset of clinical symptoms) was rather long (28 years). Besides the remarkable cerebellar and mental signs, the patient exhibited sleep disturbance (excessive somnolence) from the onset of the symptoms, with striking alteration of the sleep architecture documented by polysomnography. 14-3-3 protein was detected in the CSF, and MRI revealed increased signal intensity bilaterally in the striatum, being most evident in diffusion-weighted (DW-MRI) sequences. This is the second case of iatrogenic CJD associated with the use of GH reported in Brazil.

  5. Acute iatrogenic polycythemia induced by massive red blood cell transfusion during subtotal abdominal colectomy

    Directory of Open Access Journals (Sweden)

    David Chiapaikeo

    2015-03-01

    Full Text Available A 46 year old man was transfused ten units of packed red blood cells during subtotal colectomy after intraoperative point-of-care testing values demonstrated hemoglobin values less than seven grams per deciliter (g/dL. A post-operative hemoglobin analyzed in a standard hematologic laboratory revealed a hemoglobin value of 27.8 g/dL. He underwent emergent red blood cell depletion therapy which decreased his hemoglobin to 7.5 g/dL. The physiologic consequences of iatrogenic polycythemia caused by massive transfusion during major abdominal surgery must take into account the fluid shifts that interplay between the osmotic load, viscosity of blood, and postoperative third spacing of fluid. Treatment of acute iatrogenic polycythemia can be effectively accomplished by red blood cell depletion therapy. However, fluid shifts caused by massive transfusion followed by rapid red cell depletion produce a unique physiologic state that is without a well-described algorithm for management.

  6. Iatrogenic Creutzfeldt-Jakob disease following human growth hormone therapy: case report

    Directory of Open Access Journals (Sweden)

    Caboclo Luís Otávio Sales Ferreira

    2002-01-01

    Full Text Available We report the case of a 41-year-old man with iatrogenic Creutzfeldt-Jakob disease (CJD acquired after the use of growth hormone (GH obtained from a number of pituitary glands sourced from autopsy material. The incubation period of the disease (from the midpoint of treatment to the onset of clinical symptoms was rather long (28 years. Besides the remarkable cerebellar and mental signs, the patient exhibited sleep disturbance (excessive somnolence from the onset of the symptoms, with striking alteration of the sleep architecture documented by polysomnography. 14-3-3 protein was detected in the CSF, and MRI revealed increased signal intensity bilaterally in the striatum, being most evident in diffusion-weighted (DW-MRI sequences. This is the second case of iatrogenic CJD associated with the use of GH reported in Brazil.

  7. Triple-Tube-Ostomy: A Novel Technique for the Surgical Treatment of Iatrogenic Duodenal Perforation

    Directory of Open Access Journals (Sweden)

    Nobuaki Fujikuni

    2011-12-01

    Full Text Available Although duodenal perforation is currently an infrequent complication of medical procedures, its incidence in the future predictably will increase as endoscopic treatment of duodenal neoplasms becomes more frequently used. In some cases, duodenal perforation is difficult to treat even surgically. We report here a novel technique called ‘triple-tube-ostomy’ for the treatment of iatrogenic duodenal perforation. Since November 2009, there have been three cases of iatrogenic perforation of the duodenum, due to various causes, which we have treated with our novel technique. The main principles of the technique are biliary diversion, decompression of the duodenum, and early enteral nutrition. All patients who underwent the triple-tube-ostomy procedure had good postoperative courses, with few complications. The novel surgical technique we describe in this report is safe, reliable, easy to learn and perform, and led to a good postoperative course in all cases where we performed it.

  8. Delayed pneumothorax after laparoscopic sigmoid colectomy in a patient without underlying lung disease

    Directory of Open Access Journals (Sweden)

    Richie K Huynh

    2014-10-01

    Full Text Available We present an unusual case of a delayed pneumothorax occurring approximately 72 h post-operatively in a patient without any underlying lung disease who had undergone laparoscopic sigmoid colon resection. The patient was in her mid-40s with a body mass index of 28.0 and had no history of smoking. Her spontaneous pneumothorax manifested without any precipitating events or complications during recovery. There was no evidence of any infectious process. There were no central line attempts and all ports were placed intra-peritoneally, and there was no evidence of any subcutaneous emphysema. One possible mechanism of injury that we propose is barotrauma from an extended period of time in Trendelenburg position. Notably, the only abnormal finding throughout the entire post-operative period preceding the delayed pneumothorax was a PO 2 desaturation the day before. This case highlights the necessity to examine and investigate any desaturation post-operatively and deliberate its possible significance. Furthermore, it demonstrates that, even during a normal recovery period for a patient without any underlying lung disease or risk factors, spontaneous pneumothorax could still develop in a delayed fashion multiple days post-operatively from a laparoscopic procedure.

  9. Micropower Impulse Radar: A Novel Technology for Rapid, Real-Time Detection of Pneumothorax

    Directory of Open Access Journals (Sweden)

    Phillip D. Levy

    2011-01-01

    Full Text Available Pneumothorax detection in emergency situations must be rapid and at the point of care. Current standards for detection of a pneumothorax are supine chest X-rays, ultrasound, and CT scans. Unfortunately these tools and the personnel necessary for their facile utilization may not be readily available in acute circumstances, particularly those which occur in the pre-hospital setting. The decision to treat therefore, is often made without adequate information. In this report, we describe a novel hand-held device that utilizes Micropower Impulse Radar to reliably detect the presence of a pneumothorax. The technology employs ultra wide band pulses over a frequency range of 500 MHz to 6 GHz and a proprietary algorithm analyzes return echoes to determine if a pneumothorax is present with no user interpretation required. The device has been evaluated in both trauma and surgical environments with sensitivity of 93% and specificity of 85%. It is has the CE Mark and is available for sale in Europe. Post market studies are planned starting in May of 2011. Clinical studies to support the FDA submission will be completed in the first quarter of 2012.

  10. Le pneumothorax spontané comme une manifestation évolutive de ...

    African Journals Online (AJOL)

    Le pneumothorax spontané comme une manifestation évolutive de la polyarthrite rhumatoide: à propos d'une observation clinique et revue de la litterature. Magaye Gaye, Assane Ndiaye, Mouhamed Lamine Fall, Souleymane Diatta, Papa Adama Dieng, Papa Salmane Ba, Amadou Gabriel Ciss, Mouhamadou Ndiaye ...

  11. Pneumothorax complicating botulinum toxin injection in the body of a dilated oesophagus in achalasia

    NARCIS (Netherlands)

    Weusten, Bas L. A. M.; Samsom, Melvin; Smout, André J. P. M.

    2003-01-01

    Botulinum toxin is used for an increasing number of indications in the field of gastroenterology. We report a case in which injection of botulinum toxin in the dilated tubular oesophagus in a patient with achalasia was complicated by a pneumothorax necessitating suction drainage

  12. Emphysema and pneumothorax after percutaneous tracheostomy: case reports and an anatomic study.

    NARCIS (Netherlands)

    Fikkers, B.G.; Veen, J.A. van; Kooloos, J.G.M.; Pickkers, P.; Hoogen, F.J.A. van den; Hillen, B.; Hoeven, J.G. van der

    2004-01-01

    STUDY OBJECTIVE: Part 1: To describe cases of emphysema (subcutaneous and/or mediastinal) and pneumothorax after percutaneous dilational tracheostomy (PDT) in a series of 326 patients, and to review the existing literature describing the incidence and possible mechanisms. Part 2: To analyze the

  13. Surgical management of spontaneous pneumothorax: are there any prognostic factors influencing postoperative complications?

    Science.gov (United States)

    Delpy, Jean-Philippe; Pagès, Pierre-Benoit; Mordant, Pierre; Falcoz, Pierre-Emmanuel; Thomas, Pascal; Le Pimpec-Barthes, Francoise; Dahan, Marcel; Bernard, Alain

    2016-03-01

    There are no guidelines regarding the surgical approach for spontaneous pneumothorax. It has been reported, however, that the risk of recurrence following video-assisted thoracic surgery is higher than that following open thoracotomy (OT). The objective of this study was to determine whether this higher risk of recurrence following video-assisted thoracic surgery could be attributable to differences in intraoperative parenchymal resection and the pleurodesis technique. Data for 7647 patients operated on for primary or secondary spontaneous pneumothorax between 1 January 2005 and 31 December 2012 were extracted from Epithor®, the French national database. The type of pleurodesis and parenchymal resection was collected. Outcomes were (i) bleeding, defined as postoperative pleural bleeding; (ii) pulmonary and pleural complications, defined as atelectasis, pneumonia, empyema, prolonged ventilation, acute respiratory distress syndrome and prolonged air leaks; (iii) in-hospital length of stay and (iv) recurrence, defined as chest drainage or surgery for a second pneumothorax. Of note, 6643 patients underwent videothoracoscopy and 1004 patients underwent OT. When compared with the thoracotomy group, the videothoracoscopy group was associated with more parenchymal resections (62.4 vs 80%, P = 0.01), fewer mechanical pleurodesis procedures (93 vs 77.5%, P pneumothorax, videothoracoscopy is associated with a higher rate of recurrence than OT. This difference might be attributable to differences in the pleurodesis technique rather than differences in the parenchymal resection. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  14. Pneumothorax in a Preterm Infant Monitored by Electrical Impedance Tomography: A Case Report

    NARCIS (Netherlands)

    Miedema, M.; Frerichs, I.; de Jongh, F. H. C.; van Veenendaal, M. B.; van Kaam, A. H.

    2011-01-01

    Electrical impedance tomography (EIT) is a noninvasive bedside tool for monitoring regional changes in ventilation. We report, for the first time, the EIT images of a ventilated preterm infant with a unilateral pneumothorax, showing a loss of regional ventilation in the affected lung during both

  15. Effect of Needle Aspiration of Pneumothorax on Subsequent Chest Drain Insertion in Newborns

    DEFF Research Database (Denmark)

    Murphy, Madeleine C; Heiring, Christian; Doglioni, Nicoletta

    2018-01-01

    Importance: Treatment options for a symptomatic pneumothorax in newborns include needle aspiration (NA) and chest drain (CD) insertion. There is little consensus as to the preferred treatment, reflecting a lack of evidence from clinical trials. Objective: To investigate whether treating pneumotho......Importance: Treatment options for a symptomatic pneumothorax in newborns include needle aspiration (NA) and chest drain (CD) insertion. There is little consensus as to the preferred treatment, reflecting a lack of evidence from clinical trials. Objective: To investigate whether treating...... was 5 tertiary European neonatal intensive care units. Infants receiving respiratory support (endotracheal ventilation, continuous positive airway pressure, or supplemental oxygen >40%) who had a pneumothorax on CR that clinicians deemed needed treatment were eligible for inclusion. Interventions...... was inserted if clinicians deemed that the response was inadequate. For CD insertion, a drain was inserted between the ribs and was left in situ. Main Outcomes and Measures: The primary outcome was whether a CD was inserted on the side of the pneumothorax within 6 hours of diagnosis. Results: A total of 76...

  16. [Gas tamponade following intraoperative pneumothorax on a single lung: A case study].

    Science.gov (United States)

    El Jaouhari, S D; Mamane Nassirou, O; Meziane, M; Bensghir, M; Haimeur, C

    2017-04-01

    Intraoperative pneumothorax is a rare complication with a high risk of cardiorespiratory arrest by gas tamponade especially on a single lung. We report the case of a female patient aged 53 years who benefited from a left pneumonectomy on pulmonary tuberculosis sequelae. The patient presented early postoperative anemia with a left hemothorax requiring an emergency thoracotomy. In perioperative, the patient had a gas tamponade following a pneumothorax of the remaining lung, and the fate has been avoided by an exsufflation. Intraoperative pneumothorax can occur due to lesions of the tracheobronchial airway, of the brachial plexus, the placement of a central venous catheter or barotrauma. The diagnosis of pneumothorax during unipulmonary ventilation is posed by the sudden onset of hypoxia associated with increased airway pressures and hypercapnia. The immediate life-saving procedure involves fine needle exsufflation before the placement of a chest tube. Prevention involves reducing the risk of barotrauma by infusing patients with low flow volumes and the proper use of positive airway pressure, knowing that despite protective ventilation, barotraumas risk still exists. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  17. Pneumothorax following ERCP: Report of four cases and review of the literature

    NARCIS (Netherlands)

    N.J. Schepers (Nicolien); H.R. van Buuren (Henk)

    2012-01-01

    textabstractWe report four patients with pneumothorax as a complication of ERCP with sphincterotomy. With conservative treatment all patients recovered. Previously, 16 comparable cases have been reported in the literature. The main risk factor for this rare complication seems (pre-cut)

  18. Management approach for recurrent spontaneous pneumothorax in consecutive pregnancies based on clinical and radiographic findings

    Directory of Open Access Journals (Sweden)

    Dixson George R

    2006-10-01

    Full Text Available Abstract Objective To describe management and clinical features observed in a patient's seven spontaneous pneumothoraces that developed during two consecutive pregnancies involving both hemithoraces. Materials and methods A 21 year old former smoker developed three spontaneous left pneumothoraces in the index pregnancy, having already experienced four right pneumothorax events in a prior pregnancy at age 19. Results Chest tubes were required in several (but not all hospitalizations during these two pregnancies. Following her fourth right pneumothorax, thoracoscopic excision of right apical lung blebs and mechanical pleurodesis was performed. The series of left pneumothoraces culminated in mini-thoracotomy and thoracoscopically directed mechanical pleurodesis. For both pregnancies unassisted vaginal delivery was performed with no adverse perinatal sequelae. With the exception of multiple pneumothoraces, there were no additional pregnancy complications. Conclusion Spontaneous pneumothorax in pregnancy is believed to be a rare phenomenon, yet the exact incidence is unknown. Here we present the first known case of multiple spontaneous pneumothoraces in two consecutive pregnancies involving both hemithoraces. Clinical management coordinated with obstetrics and surgical teams facilitated a satisfactory outcome for both pregnancies. The diagnosis of pneumothorax should be contemplated in any pregnant patient with dyspnea and chest pain, followed by radiographic confirmation.

  19. Pneumothorax monitoring by remittance measurement: Comparison between experimental model and animal studies

    NARCIS (Netherlands)

    Beek, J. F.; Menovsky, T.; van Straaten, H. L.; Sterenborg, H. J.; Koppe, J. G.; van Gemert, M. J.

    1999-01-01

    Pneumothorax monitoring by remittance measurement in neonatology is investigated using model experiments. The results are compared to previous animal experiments. A multifibre probe is used to measure the change in remittance at 632.8 nm and 790 nm as a function of the thickness of a layer of air

  20. Localized air foci in the lower thorax in the patients with pneumothorax: skip pneumothoraces.

    Science.gov (United States)

    Higuchi, Takeshi; Takahashi, Naoya; Kiguchi, Takao; Shiotani, Motoi; Maeda, Haruo

    2013-08-01

    To investigate the characteristics and imaging features of localized air foci in the lower thorax in patients with pneumothorax using thin-section multidetector computed tomography. Of 10,547 consecutive CT examinations comprising the chest, the CT scans of 146 patients with ordinary pneumothoraces were identified and retrospectively evaluated. The study group included 110 male and 36 female patients (mean age, 50 years; range, 1-93 years). All examinations were performed at our institution between January 2009 and December 2009. Cause of pneumothorax was classified as traumatic or non-traumatic. Localized air foci in the lower thorax were defined as being localized air collections in the lower thorax that did not appear to be adjacent to the lung. If these criteria were met, the shape, size, location laterality, and number of foci were evaluated. Associations with trauma, sex, severity of the pneumothorax, and laterality were evaluated using the χ(2) test. All P values pneumothorax commonly had localized air foci in the lower thorax. Because such foci can mimic pneumoperitoneum, accurate recognition of them is required to avoid confusion with free intraperitoneal air, especially in traumatic cases. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  1. Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: a systematic review and conceptual model.

    Science.gov (United States)

    Best, Kaitlin M; Boullata, Joseph I; Curley, Martha A Q

    2015-02-01

    Analgesia and sedation are common therapies in pediatric critical care, and rapid titration of these medications is associated with iatrogenic withdrawal syndrome. We performed a systematic review of the literature to identify all common and salient risk factors associated with iatrogenic withdrawal syndrome and build a conceptual model of iatrogenic withdrawal syndrome risk in critically ill pediatric patients. Multiple databases, including PubMed/Medline, EMBASE, CINAHL, and the Cochrane Central Registry of Clinical Trials, were searched using relevant terms from January 1, 1980, to August 1, 2014. Articles were included if they were published in English and discussed iatrogenic withdrawal syndrome following either opioid or benzodiazepine therapy in children in acute or intensive care settings. Articles were excluded if subjects were neonates born to opioid- or benzodiazepine-dependent mothers, children diagnosed as substance abusers, or subjects with cancer-related pain; if data about opioid or benzodiazepine treatment were not specified; or if primary data were not reported. In total, 1,395 articles were evaluated, 33 of which met the inclusion criteria. To facilitate analysis, all opioid and/or benzodiazepine doses were converted to morphine or midazolam equivalents, respectively. A table of evidence was developed for qualitative analysis of common themes, providing a framework for the construction of a conceptual model. The strongest risk factors associated with iatrogenic withdrawal syndrome include duration of therapy and cumulative dose. Additionally, evidence exists linking patient, process, and system factors in the development of iatrogenic withdrawal syndrome. Most articles were prospective observational or interventional studies. Given the state of existing evidence, well-designed prospective studies are required to better characterize iatrogenic withdrawal syndrome in critically ill pediatric patients. This review provides data to support the

  2. Iatrogenic nerve injury in a national no-fault compensation scheme: an observational cohort study.

    Science.gov (United States)

    Moore, A E; Zhang, J; Stringer, M D

    2012-04-01

    Iatrogenic nerve injury causes distress and disability, and often leads to litigation. The scale and profile of these injuries has only be estimated from published case reports/series and analyses of medicolegal claims.   To determine the current spectrum of iatrogenic nerve injury in New Zealand by analysing treatment injury claims accepted by a national no-fault compensation scheme. The Accident Compensation Corporation (ACC) provides national no-fault personal accident insurance cover, which extends to patients who have sustained a treatment injury from a registered healthcare professional. Nerve injury claims identified from 5227 treatment injury claims accepted by the ACC in 2009 were analysed. From 327 claims, 292 (89.3%) documenting 313 iatrogenic nerve injuries contained sufficient information for analysis. Of these, 211 (67.4%) occurred in 11 surgical specialties, particularly orthopaedics and general surgery; the remainder involved phlebotomy services, anaesthesia and various medical specialties. The commonest causes of injury were malpositioning (n = 40), venepuncture (n = 26), intravenous cannulation (n = 21) and hip arthroplasty (n = 21). Most commonly injured were the median nerve and nerve roots (n = 32 each), brachial plexus (n = 26), and the ulnar nerve (n = 25). At least 34 (11.6%) patients were referred for surgical management of their nerve injury. Iatrogenic nerve injuries are not rare and occur in almost all branches of medicine, with malpositioning under general anaesthesia and venepuncture as leading causes. Some of these injuries are probably unavoidable, but greater awareness of which nerves are at risk and in what context should facilitate the development and/or wider implementation of preventive strategies. © 2012 Blackwell Publishing Ltd.

  3. Evaluation of late stage iatrogenic extrahepatic bile duct stricture by using magnetic resonance cholangiopancreagraphy

    International Nuclear Information System (INIS)

    Sun Changjin; Zhou Xiangping; Liu Rongbo; Song Bin; Yan Zhihan; Chen Xian; Wang Wentao; Xiong Yan; Xu Minsheng; Gu Jianping

    2003-01-01

    Objective: To assess the role of magnetic resonance cholangiopancreagraphy (MRCP) in the preoperative evaluation of late stage iatrogenic extrahepatic bile duct stricture. Methods: Eighteen cases, which were diagnosed as late stage iatrogenic extrahepatic bile duct strictures only by MRCP and proved by surgery and pathology, were classified according to Bismuth classification and the surgical operation strategy was planed on the basis of MR cholangiopancreagraphic findings before surgery. The results were compared with surgery. Results: Diagnostic MR Cholangiopancreagrams were acquired in 18 patients. Among all 18 patients, the level of stricture was classified as Bismuth I in 3 patients, Bismuth II in 7 patients, Bismuth III in 3 patients, and Bismuth IV in 3 patients. A Bismuth II stricture was incorrectly classified as a Bismuth III lesion. On the basis of MR cholangiopancreagraphic findings, a surgical operation strategy can be planed. The therapeutic plan anticipated with MRCP matched the actually used procedure in 16 of 18 patients. conclusion: MRCP plays an important role in the evaluation of late stage iatrogenic extrahepatic bile duct stricture

  4. Percutaneous Ultrasound-Guided Thrombin Injection in Iatrogenic Arterial Pseudoaneurysms: Effectiveness and Complications

    International Nuclear Information System (INIS)

    Koh, Young Hwan; Kim, Hak Soo; Kim, Hyung Sik; Min, Seung Kee

    2005-01-01

    To evaluate and describe the efficacy and side effects of a percutaneous thrombin injection under ultrasonography guidance for the treatment of iatrogenic pseudo aneurysms Eighteen consecutive iatrogenic pseudo aneurysm cases were treated with a thrombin injection. The thrombin was injected into the pseudo aneurysm cavity using a 22-gauge needle under ultrasonographic guidance. The causes of the pseudo aneurysms are as follows: post coronary angiography (9 cases), percutaneous coronary balloon angioplasty (5 cases), cerebral angiography (1 case), transhepatic chemo embolization (1 case), percutaneous trans femoral arterial stent insertion (1 case) and bone marrow aspiration for a marrow transplant (1 case). Only one case required a secondary thrombin injection due to recurrent flow in the pseudo aneurysm lumen, which was detected at the follow up Doppler ultrasound. Other seventeen cases were successfully treated on the first trial. There were no technical failures or complication related to the procedure. The average amount of thrombin injected was 733 IU. Nine out of 18 treated patients (50%) showed mild reactions to the thrombin including mild fever (4 cases), chilling sensation (3 cases), a chilling sensation with mild dyspnea (1 case), mild chest discomfort (1 case) after the thrombin injection. All these side effects were transient and improved several hours later. All the iatrogenic pseudo aneurysms were treated successfully with an ultrasound-guided percutaneous thrombin injection. There was a high rate of hypersensitivity to the bovine thrombin, which precaution should be taken to prevent more serious side effects

  5. Percutaneous Ultrasound-Guided Thrombin Injection in Iatrogenic Arterial Pseudoaneurysms: Effectiveness and Complications

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Young Hwan [Boramae Hospital, Seoul (Korea, Republic of); Kim, Hak Soo; Kim, Hyung Sik; Min, Seung Kee [Gachon Medical School, Incheon (Korea, Republic of)

    2005-09-15

    To evaluate and describe the efficacy and side effects of a percutaneous thrombin injection under ultrasonography guidance for the treatment of iatrogenic pseudo aneurysms Eighteen consecutive iatrogenic pseudo aneurysm cases were treated with a thrombin injection. The thrombin was injected into the pseudo aneurysm cavity using a 22-gauge needle under ultrasonographic guidance. The causes of the pseudo aneurysms are as follows: post coronary angiography (9 cases), percutaneous coronary balloon angioplasty (5 cases), cerebral angiography (1 case), transhepatic chemo embolization (1 case), percutaneous trans femoral arterial stent insertion (1 case) and bone marrow aspiration for a marrow transplant (1 case). Only one case required a secondary thrombin injection due to recurrent flow in the pseudo aneurysm lumen, which was detected at the follow up Doppler ultrasound. Other seventeen cases were successfully treated on the first trial. There were no technical failures or complication related to the procedure. The average amount of thrombin injected was 733 IU. Nine out of 18 treated patients (50%) showed mild reactions to the thrombin including mild fever (4 cases), chilling sensation (3 cases), a chilling sensation with mild dyspnea (1 case), mild chest discomfort (1 case) after the thrombin injection. All these side effects were transient and improved several hours later. All the iatrogenic pseudo aneurysms were treated successfully with an ultrasound-guided percutaneous thrombin injection. There was a high rate of hypersensitivity to the bovine thrombin, which precaution should be taken to prevent more serious side effects

  6. Time-dependent analysis of incidence, risk factors and clinical significance of pneumothorax after percutaneous lung biopsy.

    Science.gov (United States)

    Lim, Woo Hyeon; Park, Chang Min; Yoon, Soon Ho; Lim, Hyun-Ju; Hwang, Eui Jin; Lee, Jong Hyuk; Goo, Jin Mo

    2018-03-01

    To evaluate the time-dependent incidence, risk factors and clinical significance of percutaneous lung biopsy (PLB)-related pneumothorax. From January 2012-November 2015, 3,251 patients underwent 3,354 cone-beam CT-guided PLBs for lung lesions. Cox, logistic and linear regression analyses were performed to identify time-dependent risk factors of PLB-related pneumothorax, risk factors of drainage catheter insertion and those of prolonged catheter placement, respectively. Pneumothorax occurred in 915/3,354 PLBs (27.3 %), with 230/915 (25.1 %) occurring during follow-ups. Risk factors for earlier occurrence of PLB-related pneumothorax include emphysema (HR=1.624), smaller target (HR=0.922), deeper location (HR=1.175) and longer puncture time (HR=1.036), while haemoptysis (HR=0.503) showed a protective effect against earlier development of pneumothorax. Seventy-five cases (8.2 %) underwent chest catheter placement. Mean duration of catheter placement was 3.2±2.0 days. Emphysema (odds ratio [OR]=2.400) and longer puncture time (OR=1.053) were assessed as significant risk factors for catheter insertion, and older age (parameter estimate=1.014) was a predictive factor for prolonged catheter placement. PLB-related pneumothorax occurred in 27.3 %, of which 25.1 % developed during follow-ups. Smaller target size, emphysema, deeply-located lesions were significant risk factors of PLB-related pneumothorax. Emphysema and older age were related to drainage catheter insertion and prolonged catheter placement, respectively. • One-fourth of percutaneous lung biopsy (PLB)-related pneumothorax occurs during follow-up. • Smaller, deeply-located target and emphysema lead to early occurrence of pneumothorax. • Emphysema is related to drainage catheter insertion for PLB-related pneumothorax. • Older age may lead to prolonged catheter placement for PLB-related pneumothorax. • Tailored management can be possible with time-dependent information of PLB-related pneumothorax.

  7. Outcomes of the Tower Crane Technique with a 15-mm Trocar in Primary Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Yooyoung Chong

    2016-04-01

    Full Text Available Background: Video-assisted thoracoscopic surgery (VATS pulmonary wedge resection has emerged as the standard treatment for primary spontaneous pneumothorax. Recently, single-port VATS has been introduced and is now widely performed. This study aimed to evaluate the outcomes of the Tower crane technique as novel technique using a 15-mm trocar and anchoring suture in primary spontaneous pneumothorax. Methods: Patients who underwent single- port VATS wedge resection in Chungnam National University Hospital from April 2012 to March 2014 were enrolled. The medical records of the enrolled patients were reviewed retrospectively. Results: A total of 1,251 patients were diagnosed with pneumothorax during this period, 270 of whom underwent VATS wedge resection. Fifty-two of those operations were single-port VATS wedge resections for primary spontaneous pneumothorax performed by a single surgeon. The median age of the patients was 19.3±11.5 years old, and 43 of the patients were male. The median duration of chest tube drainage following the operation was 2.3±1.3 days, and mean postoperative hospital stay was 3.2±1.3 days. Prolonged air leakage for more than three days following the operation was observed in one patient. The mean duration of follow-up was 18.7±6.1 months, with a recurrence rate of 3.8%. Conclusion: The tower crane technique with a 15-mm trocar may be a promising treatment modality for patients presenting with primary spontaneous pneumothorax.

  8. Do atmospheric conditions influence the first episode of primary spontaneous pneumothorax?

    Science.gov (United States)

    Heyndrickx, Maxime; Le Rochais, Jean-Philippe; Icard, Philippe; Cantat, Olivier; Zalcman, Gérard

    2015-09-01

    Several studies suggest that changes in airway pressure may influence the onset of primary spontaneous pneumothorax (PSP). The aim of this study was to investigate the influence of atmospheric changes on the onset of the first episode of PSP. We retrospectively analysed cases of pneumothorax admitted to our department between 1 January 2009 and 31 October 2013. Patients with recurrent pneumothorax, traumatic pneumothorax, older than 35 years or presenting history of underlying pulmonary disease were excluded. Meteorological data were collected from the Météo-France archives. Variation (Δ) of mean atmospheric pressure, and relative humidity, were calculated for each day between the day at which symptoms began (D-day), the day before first symptoms (D-1), 2 days before the first symptoms (D-2) and 3 days before the first symptoms (D-3). Six hundred and thirty-eight cases of pneumothorax were observed during the period of this study; 106 of them (16.6%) were a first episode of PSP. We did not observe any significant differences between days with or without PSP admission for any of the weather parameters that we tested. We could not find any thresholds in the variation of atmospheric pressure that could be used to determine the probability of PSP occurrence. Variation of atmospheric pressure, relative humidity, rainfall, wind speed and temperature were not significantly related to the onset of the first episode of PSP in healthy patients. These results suggest that the scientific community should focus on other possible aetiological factors than airway pressure modifications. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  9. Perinatal risk factors for pneumothorax and morbidity and mortality in very low birth weight infants.

    Science.gov (United States)

    García-Muñoz Rodrigo, Fermín; Urquía Martí, Lourdes; Galán Henríquez, Gloria; Rivero Rodríguez, Sonia; Tejera Carreño, Patricia; Molo Amorós, Silvia; Cabrera Vega, Pedro; Rodríguez Ramón, Fernando

    2017-11-01

    To determine the perinatal risk factors for pneumothorax in Very-Low-Birth-Weight (VLBW) infants and the associated morbidity and mortality in this population. Retrospective analysis of data collected prospectively from a cohort of VLBW neonates assisted in our Unit (2006-2013). We included all consecutive in-born patients with ≤ 1500 g, without severe congenital anomalies. Perinatal history, demographics, interventions and clinical outcomes were collected. Associations were evaluated by logistic regression analysis. During the study period, 803 VLBW infants were assisted in our Unit, of whom 763 were inborn. Ten patients (1.2%) died in delivery room, and 18 (2.2%) with major congenital anomalies were excluded. Finally, 735 (91.5%) neonates were included in the study. Seventeen (2.3%) developed pneumothorax during the first week of life [median (IQR): 2 (1-2) days]. After correcting for GA and other confounders, prolonged rupture of membranes [aOR =1.002 (95% CI 1.000-1.003); p = 0.040] and surfactant administration [aOR = 6.281 (95% CI 1.688-23.373); p = 0.006] were the independent risk factors associated with pneumothorax. Patients with pneumothorax had lower probabilities of survival without major brain damage (MBD): aOR = 0.283 (95% CI = 0.095-0.879); p = 0.029. Pneumothorax in VLBW seems to be related to perinatal inflammation and surfactant administration, and it is significantly associated with a reduction in the probabilities of survival without MBD.

  10. Analysis of the factors associated with radiofrequency ablation-induced pneumothorax

    International Nuclear Information System (INIS)

    Gillams, A.R.; Lees, W.R.

    2007-01-01

    Aim: To define the characteristics most likely to result in radiofrequency ablation (RFA)-induced pneumothorax. Methods and materials: CT-guided RFA was performed in 79 tumours in 55 lungs in 37 patients, 16 were women, mean age 62 years (range 34-83). Three had primary lung cancer, 34 had metastases. The number, size, and location of tumours, electrode type, treatment parameters, length of electrode trajectory through aerated lung, background emphysema, prior interventions, and use of positive-pressure ventilation were analysed. The size, timing of any pneumothoraces, and intervention were recorded. Results: Pneumothorax occurred in 21 of the 25 lungs treated (38%), 18 immediate and three delayed. Seventeen of the 21 (81%) occupied less than 30% of the hemithorax, whereas in four cases >31% was involved. Eight of the 55 (15%) pneumothoraces required aspiration. The length of the electrode trajectory through aerated lung in those who developed a pneumothorax was 5.4 ± 4.7 cm versus 1.9 ± 2.7 in those who did not (p = 0.001). The mean number of tumours ablated was higher in the pneumothorax group, 1.7 ± 1 versus 1.3 ± 0.6 (p = 0.03), as was the number of electrode positions, 6 ± 3.9 versus 3.6 ± 2.2 (p = 0.01). On multivariate analysis only the needle trajectory through aerated lung was significant (p = 0.04). Conclusions: The number of tumours, electrode positions, and the anticipated electrode trajectory through aerated lung impacts on the likelihood of a pneumothorax. These considerations should be factored into patient selection, the choice of approach, and trajectory used in RFA

  11. Randomized clinical trial of pigtail catheter versus chest tube in injured patients with uncomplicated traumatic pneumothorax.

    Science.gov (United States)

    Kulvatunyou, N; Erickson, L; Vijayasekaran, A; Gries, L; Joseph, B; Friese, R F; O'Keeffe, T; Tang, A L; Wynne, J L; Rhee, P

    2014-01-01

    Small pigtail catheters appear to work as well as the traditional large-bore chest tubes in patients with traumatic pneumothorax, but it is not known whether the smaller pigtail catheters are associated with less tube-site pain. This study was conducted to compare tube-site pain following pigtail catheter or chest tube insertion in patients with uncomplicated traumatic pneumothorax. This prospective randomized trial compared 14-Fr pigtail catheters and 28-Fr chest tubes in patients with traumatic pneumothorax presenting to a level I trauma centre from July 2010 to February 2012. Patients who required emergency tube placement, those who refused and those who could not respond to pain assessment were excluded. Primary outcomes were tube-site pain, as assessed by a numerical rating scale, and total pain medication use. Secondary outcomes included the success rate of pneumothorax resolution and insertion-related complications. Forty patients were enrolled. Baseline characteristics of 20 patients in the pigtail catheter group were similar to those of 20 patients in the chest tube group. No patient had a flail chest or haemothorax. Pain scores related to chest wall trauma were similar in the two groups. Patients with a pigtail catheter had significantly lower mean(s.d.) tube-site pain scores than those with a chest tube, at baseline after tube insertion (3.2(0.6) versus 7.7(0.6); P pneumothorax, use of a 14-Fr pigtail catheter is associated with reduced pain at the site of insertion, with no other clinically important differences noted compared with chest tubes. NCT01537289 (http://clinicaltrials.gov). © 2013 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  12. Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma?

    Science.gov (United States)

    Donmez, Halil; Tokmak, Turgut Tursem; Yildirim, Afra; Buyukoglan, Hakan; Ozturk, Mehmet; Yaşar Ayaz, Umit; Mavili, Ertugrul

    2012-01-01

    BACKGROUND.: Our purpose was to evaluate the effectiveness of bedside sonography (US) in the detection of pneumothorax secondary to blunt thoracic trauma. METHODS.: In this prospective study, 240 hemithoraces of 120 consecutive patients with multiple trauma were evaluated with chest radiographs (CXR) and bedside thoracic US for the diagnosis of pneumothorax. CT examinations were performed in 68 patients. Fifty-two patients who did not undergo CT examinations were excluded from the study. US examinations were performed independently at bedside by two radiologists who were not informed about CXR and CT findings. CXRs were interpreted by two radiologists who were unaware of the US and CT results. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR and US were calculated. RESULTS.: One hundred thirty-six hemithoraces were assessed in 68 patients. A total of 35 pneumothoraces were detected in 33 patients. On US, the diagnosis of pneumothorax was correct in 32 hemithoraces. In 98 hemithoraces without pneumothorax, US was normal. With US examination, there were three false-positive and three false-negative results. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of US were 91.4%, 97%, 91.4%, 97%, and 97%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR were 82.7%, 89.7%, 68.5%, 95%, and 89.5%, respectively. CONCLUSIONS.: Bedside thoracic US is an accurate method that can be used in trauma patients instead of CXR for the detection of pneumothorax. Copyright © 2012 Wiley Periodicals, Inc.

  13. Non-Invasive Pneumothorax Detector Final Report CRADA No. TC02110.0

    Energy Technology Data Exchange (ETDEWEB)

    Chang, J. T. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States); Purcell, R. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2017-08-29

    This was a collaborative effort between Lawrence Livermore National Security, LLC as manager and operator of Lawrence Livermore National Laboratory (LLNL) and ElectroSonics Medical Inc. (formerly known as BIOMEC, Inc.), to develop a non-invasive pneumothorax detector based upon the micropower impulse radar technology invented at LLNL. Under a Work for Others Subcontract (L-9248), LLNL and ElectroSonics successfully demonstrated the feasibility of a novel device for non-invasive detection of pneumothorax for emergency and long-term monitoring. The device is based on Micropower Impulse Radar (MIR) Ultra Wideband (UWB) technology. Phase I experimental results were promising, showing that a pneumothorax volume even as small as 30 ml was clearly detectable from the MIR signals. Phase I results contributed to the award of a National Institute of Health (NIH) SBIR Phase II grant to support further research and development. The Phase II award led to the establishment of a LLNL/ElectroSonics CRADA related to Case No. TC02045.0. Under the subsequent CRADA, LLNL and ElectroSonics successfully demonstrated the feasibility of the pneumothorax detection in human subject research trials. Under this current CRADA TC02110.0, also referred to as Phase II Type II, the project scope consisted of seven tasks in Project Year 1; five tasks in Project Year 2; and four tasks in Project Year 3. Year 1 tasks were aimed toward the delivery of the pneumothorax detector design package for the pre-production of the miniaturized CompactFlash dockable version of the system. The tasks in Project Years 2 and 3 critically depended upon the accomplishments of Task 1. Since LLNL’s task was to provide subject matter expertise and performance verification, much of the timeline of engagement by the LLNL staff depended upon the overall project milestones as determined by the lead organization ElectroSonics. The scope of efforts were subsequently adjusted accordingly to commensurate with funding

  14. Magnetic tension and gravitational collapse

    International Nuclear Information System (INIS)

    Tsagas, Christos G

    2006-01-01

    The gravitational collapse of a magnetized medium is investigated by studying qualitatively the convergence of a timelike family of non-geodesic worldlines in the presence of a magnetic field. Focusing on the field's tension, we illustrate how the winding of the magnetic forcelines due to the fluid's rotation assists the collapse, while shear-like distortions in the distribution of the field's gradients resist contraction. We also show that the relativistic coupling between magnetism and geometry, together with the tension properties of the field, lead to a magneto-curvature stress that opposes the collapse. This tension stress grows stronger with increasing curvature distortion, which means that it could potentially dominate over the gravitational pull of the matter. If this happens, a converging family of non-geodesic worldlines can be prevented from focusing without violating the standard energy conditions

  15. Computed tomography or necropsy diagnosis of multiple bullae and the treatment of pneumothorax in rhesus macaques (Macaca mulatta).

    Science.gov (United States)

    Kim, Jong-Min; Han, Sungyoung; Shin, Jun-Seop; Min, Byoung-Hoon; Jeong, Won Young; Lee, Ga Eul; Kim, Min Sun; Kim, Ju Eun; Chung, Hyunwoo; Park, Chung-Gyu

    2017-10-01

    Pulmonary bullae and pneumothorax have various etiologies in veterinary medicine. We diagnosed multiple pulmonary bullae combined with or without pneumothorax by computed tomography (CT) or necropsy in seven rhesus macaques (Macaca mulatta) imported from China. Two of seven rhesus macaques accompanied by pneumothorax were cured by fixation of ruptured lung through left or right 3rd intercostal thoracotomy. Pneumonyssus simicola, one of the etiologies of pulmonary bullae, was not detected from tracheobronchiolar lavage. To the best of our knowledge, this is the first case report on the CT-aided diagnosis of pulmonary bullae and the successful treatment of combined pneumothorax by thoracotomy in non-human primates (NHPs). © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. Expert Statement : Pneumothorax Associated with Endoscopic Valve Therapy for Emphysema - Potential Mechanisms, Treatment Algorithm, and Case Examples

    NARCIS (Netherlands)

    Valipour, Arschang; Slebos, Dirk-Jan; de Oliveira, Hugo G.; Eberhardt, Ralf; Freitag, Lutz; Criner, Gerard J.; Herth, Felix J. F.

    2014-01-01

    The use of endoscopically placed unidirectional valves for the treatment of emphysema is increasing. With better patient selection, there is also an increased likelihood of complications associated with the procedure, such as postprocedural pneumothorax. There is, however, little evidence of

  17. Large pneumothorax in blunt chest trauma: Is a chest drain always necessary in stable patients? A case report

    Directory of Open Access Journals (Sweden)

    Baig M. Idris

    2016-01-01

    Conclusion: Blunt traumatic large pneumothorax in a clinically stable patient can be managed conservatively. Current recommendations for tube placement may need to be reevaluated. This may reduce morbidity associated with chest tube thoracostomy.

  18. AUTOGENIC THERAPY IN TENSION HEADACHE

    Science.gov (United States)

    Amruthraj, Brunda; Mishra, H.; Kumaraiah, V.

    1987-01-01

    SUMMARY Ten subjects diagnosed as Psychalgia were taken for study. A multiple baseline design was adapted and clients were subjected to 30 sessions of autogenic training. They were assessed using physiological (EMG and thermal change) and behavioural measures (Visual analogue scale and behavioural symptom checklist). Findings revealed autogenic therapy to be effective in reducing tension headache. PMID:21927245

  19. Tensions of Corporate Social Responsibility

    DEFF Research Database (Denmark)

    Strand, Robert

    , and formally rational tools like key performance indicators (KPIs) can be developed and employed in service of the selected substantively rational ends. I show how these KPIs can serve to highlight tensions between substantively rational ends. As such, I argue the CSR bureaucracy can create a space...

  20. AUTOGENIC THERAPY IN TENSION HEADACHE

    OpenAIRE

    Amruthraj, Brunda; Mishra, H.; Kumaraiah, V.

    1987-01-01

    SUMMARY Ten subjects diagnosed as Psychalgia were taken for study. A multiple baseline design was adapted and clients were subjected to 30 sessions of autogenic training. They were assessed using physiological (EMG and thermal change) and behavioural measures (Visual analogue scale and behavioural symptom checklist). Findings revealed autogenic therapy to be effective in reducing tension headache.

  1. Small-bore chest tubes seem to perform better than larger tubes in treatment of spontaneous pneumothorax

    DEFF Research Database (Denmark)

    Iepsen, Ulrik Winning; Ringbæk, Thomas

    2013-01-01

    The aim of this study was to compare the efficacy and complications of surgical (large-bore) chest tube drainage with smaller and less invasive chest tubes in the treatment of non-traumatic pneumothorax (PT). ......The aim of this study was to compare the efficacy and complications of surgical (large-bore) chest tube drainage with smaller and less invasive chest tubes in the treatment of non-traumatic pneumothorax (PT). ...

  2. Clinical assessment compared with chest X-Ray after removal of chest tube to diagnose pneumothorax

    International Nuclear Information System (INIS)

    Majeed, F. A.; Noor, Q. U. H.; Mehmood, U.; Imtiaz, T.; Zafar, U.

    2017-01-01

    Objective: To evaluate clinical judgment in ruling out pneumothorax during the removal of the chest tube by auscultating the chest before removal and after the extubation of the chest tube in comparison to x ray radiological results. Study Design: Descriptive cross sectional study. Place and Duration of Study: Combined Military Hospital (CMH) Lahore Pakistan, from August 2015 to March 2016. Material and Methods: A sample size of 100 was calculated. Patients were selected via non probability purposive sampling. Children under 14 years were not included. The patients with mal-positioned chest tube, surgical site infection, air leak and the patients with more than one chest tube on one side were excluded. A proforma was made and filled by one person. Chest tubes were removed by two trained senior registrars according to a protocol devised. It was ensured that there was no air leak present before removal clinically and radiologically. Another chest x-ray was done within 24 hours of extubation to detect any pathology that might have occurred during the process. Any complication in the patient clinically was observed till the x-ray film became available. Two sets of readings were obtained. Set A included auscultation findings and set B included x ray results. Results: Out of 100 patients, 60 (60 percent) were males and 40 (40 percent) females. The ages of the patients ranged between 17-77 years. Mean age of the patient was 43.27 ± 17.05 years. In set A out of 100 (100 percent) no pneumothorax developed clinically. In set B out of 100 patients 99 (99 percent) showed no pneumothorax on chest x ray, only 1 (1 percent) showed pneumothorax which was not significant (less than 15 percent on X ray). However, the patient remained asymptomatic clinically and there was no need of reinsertion of the chest tube. Conclusion: Auscultatory findings in diagnosing a significant pneumothorax are justified. Hence, if the chest tube is removed according to the protocol, clinically by

  3. Catamenial pneumothorax: a rare entity? Report of 5 cases and review of the literature

    Science.gov (United States)

    Visouli, Aikaterini N.; Darwiche, Kaid; Mpakas, Andreas; Papagiannis, Antonios; Tsakiridis, Kosmas; Machairiotis, Nikolaos; Stylianaki, Aikaterini; Katsikogiannis, Nikolaos; Courcoutsakis, Nicolaos; Zarogoulidis, Konstantinos

    2012-01-01

    Objective Spontaneous recurrent pneumothorax during menstruation is reported as catamenial pneumothorax. It is encountered in 3-6% of spontaneous pneumothorax cases among menstruating women. The percentage among women referred for surgery is significantly higher (25-30%). Although it usually involves the right-side (85-95%) it can be left-sided or bilateral. It is associated with diaphragmatic perforations and/or thoracic endometriosis. There is pelvic endometriosis in up to 30-51% of cases. The lesions that are not always found may present as small or larger holes at the central tendon of the diaphragm, as red, blueberry, brown spots or larger nodules at the diaphragm, the visceral or parietal pleura. Lesion histology may reveal endometriosis. We present 5 cases of catamenial pneumothorax treated surgically during the last 6 years. Patients and methods Five women, with a mean age of 34+/-9.9 years (median 38, range, 19-45 years) presented with right-sided recurrent catamenial pneumothorax. In 3 patients diaphragmatic perforation(s) were found; perforation suturing (n=1), and diaphragmatic plication reinforced with bovine pericardial patch (n=1) were performed. All patients underwent atypical resection of upper and/or middle lobe segments of lung parenchyma that appeared abnormal (haemorrhagic/emphysematous or blebs). Four patients underwent pleurodesis and 1 patient underwent pleurectomy. Four interventions were performed through video assisted thoracoscopic surgery, while diaphragmatic plication was performed through a video assisted mini-thoracotomy. Histology did not reveal endometriosis tissue. Results The postoperative course was uneventful. The patients were extubated in theatre and were discharged home at a mean of 7+/-4 days (median 6 days, range, 4-14 days). Two of them received hormonal therapy [Gonadotropin Releasing Hormone (GnRH) analogue] postoperatively. At a follow-up of 14.16 patient-years (mean 2.83+/-1.08 years, range, 1.33-3.83 years) there was

  4. Apex-to-Cupola Distance Following VATS Predicts Recurrence in Patients With Primary Spontaneous Pneumothorax

    Science.gov (United States)

    Chang, Jia-Ming; Lai, Wu-Wei; Yen, Yi-Ting; Tseng, Yau-Lin; Chen, Ying-Yuan; Wu, Ming-Ho; Chen, Wei; Light, Richard W.

    2015-01-01

    Abstract Our study sought to determine whether the size of the residual apical pleural space in young patients with primary spontaneous pneumothorax (PSP) following video-assisted thoracoscopic surgery is associated with the risk of recurrence. We retrospectively reviewed patients (≤30 years’ old) with primary spontaneous pneumothorax following thoracoscopic surgery (2002–2010) in a university-affiliated hospital. The size of residual apical pleural space was estimated by measuring the apex-to-cupola distance on a postoperative chest radiograph at 2 time windows: first between postoperative day (POD) 0 and 3, and second between POD 4 and 14. A total of 149 patients were enrolled with a median follow-up of 11.2 months (interquartile range, 0.95–29.5 months), of whom 141 (94.6%) were male with a mean age of 20 years. The postoperative recurrence rate was 11.4%. Comparing the characteristics between the patients with and without recurrent pneumothorax, the patients with recurrence were younger (18.2 + 2.4 vs 20.7 + 3.7 years, P = 0.008), with a lower rate of pleurodesis (35% vs1 69%, P = 0.037), longer apex-to-cupola distance at POD 0 to 3 (22.41 ± 19.56 vs 10.07 ± 10.83 mm, P pneumothorax, age 10 mm (P = 0.027, OR: 5.319), and no pleurodesis during VATS (P = 0.022, OR: 5.042) were independent risk factors for recurrent pneumothorax. The recurrence rate was not low (11.4%) in young patients with PSP following VATS. Residual apical pleural space with apex-to-cupola distance of 10 mm or greater at POD 0 to 3, younger age, and no pleurodesis would increase postoperative recurrence of primary spontaneous pneumothorax. PMID:26376396

  5. Misdiagnosis and management of iatrogenic pseudoaneurysm of vertebral artery after Harms technique of C1-C2 fixation

    Directory of Open Access Journals (Sweden)

    MIN Li

    2012-12-01

    Full Text Available 【Abstract】 Harms technique of C1-C2 fixation for atlantoaxial complex becomes more popular due to good fusion rate and low vertebral artery injury (VAI rate. But considering the unique and variable anatomy of atlanto-axial complex, iatrogenic VAI will result in catastrophic con-sequences and provides particular surgical challenges for surgeons. To our knowledge, comparing with iatrogenic VAI in the screw hole, iatrogenic VAI in the “open space” is much rarer during the Harms technique of C1-C2 fixation. In this article, we present a case of iatrogenic vertebral artery pseudoaneurysm after Harms technique of posterior C1-C2 fixation. This case of iatrogenic VAI effectively treated by endovascular coil occlusion and external local compression was initially misdiagnosed as VAI by pedicle screw perforation. It can be concluded that intraoperative or post-operative computed angiography is very helpful to diag-nose the exact site of VAI and the combination of endovascular coil occlusion as well as external local com-pression can further prevent bleeding and abnormal verte-bral artery flow in the pseudoaneurysm. However, patients treated require further follow-up to confirm that there is no recurrence of the pseudoaneurysm. Key words: Vertebral artery; Aneurysm, false; Endovascular procedures

  6. Differentiating Delirium From Sedative/Hypnotic-Related Iatrogenic Withdrawal Syndrome: Lack of Specificity in Pediatric Critical Care Assessment Tools.

    Science.gov (United States)

    Madden, Kate; Burns, Michele M; Tasker, Robert C

    2017-06-01

    To identify available assessment tools for sedative/hypnotic iatrogenic withdrawal syndrome and delirium in PICU patients, the evidence supporting their use, and describe areas of overlap between the components of these tools and the symptoms of anticholinergic burden in children. Studies were identified using PubMed and EMBASE from the earliest available date until July 3, 2016, using a combination of MeSH terms "delirium," "substance withdrawal syndrome," and key words "opioids," "benzodiazepines," "critical illness," "ICU," and "intensive care." Review article references were also searched. Human studies reporting assessment of delirium or iatrogenic withdrawal syndrome in children 0-18 years undergoing critical care. Non-English language, exclusively adult, and neonatal intensive care studies were excluded. References cataloged by study type, population, and screening process. Iatrogenic withdrawal syndrome and delirium are both prevalent in the PICU population. Commonly used scales for delirium and iatrogenic withdrawal syndrome assess signs and symptoms in the motor, behavior, and state domains, and exhibit considerable overlap. In addition, signs and symptoms of an anticholinergic toxidrome (a risk associated with some common PICU medications) overlap with components of these scales, specifically in motor, cardiovascular, and psychiatric domains. Although important studies have demonstrated apparent high prevalence of iatrogenic withdrawal syndrome and delirium in the PICU population, the overlap in these scoring systems presents potential difficulty in distinguishing syndromes, both clinically and for research purposes.

  7. In vitro sealing of iatrogenic fetal membrane defects by a collagen plug imbued with fibrinogen and plasma.

    Science.gov (United States)

    Engels, A C; Hoylaerts, M F; Endo, M; Loyen, S; Verbist, G; Manodoro, S; DeKoninck, P; Richter, J; Deprest, J A

    2013-02-01

    We aimed to demonstrate local thrombin generation by fetal membranes, as well as its ability to generate fibrin from fibrinogen concentrate. Furthermore, we aimed to investigate the efficacy of collagen plugs, soaked with plasma and fibrinogen, to seal iatrogenic fetal membrane defects. Thrombin generation by homogenized fetal membranes was measured by calibrated automated thrombography. To identify the coagulation caused by an iatrogenic membrane defect, we analyzed fibrin formation by optical densitometry, upon various concentrations of fibrinogen. The ability of a collagen plug soaked with fibrinogen and plasma was tested in an ex vivo model for its ability to seal an iatrogenic fetal membrane defect. Fetal membrane homogenates potently induced thrombin generation in amniotic fluid and diluted plasma. Upon the addition of fibrinogen concentrate, potent fibrin formation was triggered. Measured by densiometry, fibrin formation was optimal at 1250 µg/mL fibrinogen in combination with 4% plasma. A collagen plug soaked with fibrinogen and plasma sealed an iatrogenic membrane defect about 35% better than collagen plugs without these additives (P = 0.037). These in vitro experiments suggest that the addition of fibrinogen and plasma may enhance the sealing efficacy of collagen plugs in closing iatrogenic fetal membrane defects. © 2013 John Wiley & Sons, Ltd.

  8. Percutaneous Treatment of Iatrogenic Pseudoaneurysms by Cyanoacrylate-Based Wall-Gluing

    Energy Technology Data Exchange (ETDEWEB)

    Del Corso, Andrea, E-mail: adelcorso2000@hotmail.com [Universita di Pisa, Division of General and Vascular Surgery, Ospedale Cisanello (Italy); Vergaro, Giuseppe [Fondazione G. Monasterio CNR-Regione Toscana, Division of Cardiovascular Medicine (Italy)

    2013-06-15

    Purpose. Although the majority of iatrogenic pseudoaneurysms (PSAs) are amenable to ultrasound (US)-guided thrombin injection, patients with those causing neuropathy, claudication, significant venous compression, or soft tissue necrosis are considered poor candidates for this option and referred to surgery. We aimed to test the effectiveness and feasibility of a novel percutaneous cyanoacrylate glue (NBCA-MS)-based technique for treatment of symptomatic and asymptomatic iatrogenic PSA. Material and Methods. During a 3-year period, we prospectively enrolled 91 patients with iatrogenic PSA [total n = 94 (femoral n = 76; brachial n = 11; radial n = 6; axillary n = 1)]. PSA were asymptomatic in 66 % of cases, and 34 % presented with symptoms due to neuropathy, venous compression, and/or soft tissue necrosis. All patients signed informed consent. All patients received NBCA-MS-based percutaneous treatment. PSA chamber emptying was first obtained by US-guided compression; superior and inferior walls of the PSA chamber were then stuck together using NBCA-MS microinjections. Successfulness of the procedure was assessed immediately and at 1-day and 1-, 3-, and 12-month US follow-up. Results. PSA occlusion rate was 99 % (93 of 94 cases). After treatment, mean PSA antero-posterior diameter decrease was 67 {+-} 22 %. Neuropathy and vein compression immediately disappeared in 91 % (29 of 32) of cases. Patients with tissue necrosis (n = 6) underwent subsequent outpatient necrosectomy. No distal embolization occurred, nor was conversion to surgery necessary. Conclusion. PSA treatment by way of NBCA-MS glue injection proved to be safe and effective in asymptomatic patients as well as those with neuropathy, venous compression, or soft-tissue necrosis (currently candidates for surgery). Larger series are needed to confirm these findings.

  9. Emergency and elective implantation of covered stent systems in iatrogenic arterial injuries

    International Nuclear Information System (INIS)

    Goltz, J.P.; Kickuth, R.; Bastuerk, P.; Hoppe, H.; Triller, J.

    2011-01-01

    Purpose: To evaluate the effectiveness and safety of covered stents for the management of iatrogenic arterial injury. Materials and Methods: Between 03/1998 and 12/2009, 31 patients underwent selective covered stent implantation after iatrogenic arterial injury. 12/31 of these patients (38.7 %) were hemodynamically unstable. Six different endovascular covered stent types were utilized. The primary endpoints of this study were technical and clinical success and rates of minor and major complications. Results: Initial angiograms demonstrated active extravasation in 19 (61.3 %) patients and pseudoaneurysms in 12 (38.7 %) patients. The following sites of bleeding origin were detected: axillary artery, subclavian artery, common iliac artery, external iliac artery, internal iliac artery, common femoral artery, superficial femoral artery, popliteal and fibular artery, femoro-popliteal and popliteo-crural bypasses, common hepatic artery, aberrant hepatic artery, cystic and gastroduodenal artery. In all patients bleeding was effectively controlled by covered stent implantation resulting in an immediate technical success of 100 %. Clinical success attributed to covered stent implantation was documented in 30 of the 31 patients (96.8 %). Major complications included death in four patients (11.1 %), acute thrombosis with arm ischemia in one patient (2.8 %) and stent fracture with associated pseudoaneurysm in another patient (2.8 %). In 2/31 patients (6.5 %) covered stent failure was detected and successfully treated by implantation of a second covered stent. Conclusion: Emergency and elective implantation of covered stents may be used for minimally invasive and effective management of iatrogenic arterial injury. (orig.)

  10. Peripheral Venous Waveform Analysis for Detecting Hemorrhage and Iatrogenic Volume Overload in a Porcine Model.

    Science.gov (United States)

    Hocking, Kyle M; Sileshi, Ban; Baudenbacher, Franz J; Boyer, Richard B; Kohorst, Kelly L; Brophy, Colleen M; Eagle, Susan S

    2016-10-01

    Unrecognized hemorrhage and unguided resuscitation is associated with increased perioperative morbidity and mortality. The authors investigated peripheral venous waveform analysis (PIVA) as a method for quantitating hemorrhage as well as iatrogenic fluid overload during resuscitation. The authors conducted a prospective study on Yorkshire Pigs (n = 8) undergoing hemorrhage, autologous blood return, and administration of balanced crystalloid solution beyond euvolemia. Intra-arterial blood pressure, electrocardiogram, and pulse oximetry were applied to each subject. Peripheral venous pressure was measured continuously through an upper extremity standard peripheral IV catheter and analyzed with LabChart. The primary outcome was comparison of change in the first fundamental frequency (f1) of PIVA with standard and invasive monitoring and shock index (SI). Hemorrhage, return to euvolemia, and iatrogenic fluid overload resulted in significantly non-zero slopes of f1 amplitude. There were no significant differences in heart rate or mean arterial pressure, and a late change in SI. For the detection of hypovolemia the PIVA f1 amplitude change generated an receiver operator curves (ROC) curve with an area under the curve (AUC) of 0.93; heart rate AUC = 0.61; mean arterial pressure AUC = 0.48, and SI AUC = 0.72. For hypervolemia the f1 amplitude generated an ROC curve with an AUC of 0.85, heart rate AUC = 0.62, mean arterial pressure AUC = 0.63, and SI AUC = 0.65. In this study, PIVA demonstrated a greater sensitivity for detecting acute hemorrhage, return to euvolemia, and iatrogenic fluid overload compared with standard monitoring and SI. PIVA may provide a low-cost, minimally invasive monitoring solution for monitoring and resuscitating patients with perioperative hemorrhage.

  11. Ipsilateral reexpansion pulmonary edema after drainage of a spontaneous pneumothorax: a case report

    Directory of Open Access Journals (Sweden)

    Conen Anna

    2007-09-01

    Full Text Available Abstract We report a case of ipsilateral reexpansion pulmonary edema occurring after the insertion of a chest tube in a patient with spontaneous pneumothorax. The patient received supplemental oxygen via a non-rebreather face mask to compensate for hypoxemia. 24 hours after the acute event, the patient recovered completely without residual hypoxemia. Reexpansion pulmonary edema after the insertion of a thoracic drainage for pneumothorax or pleural effusion is a rare complication with a high mortality rate up to 20%. It should be considered in case of hypoxemia following the insertion of a chest tube. The exact pathophysiology leading to this complication is not known. Risk factors for reexpansion pulmonary edema should be evaluated and considered prior to the insertion of chest tubes. Treatment is supportive.

  12. Spontaneous Pneumothorax in Birt-Hogg-Dube' Syndrome: Two Case Reports

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Hyoung Ju; Woo, Ok Hee; Yong, Hwan Seok; Kang, Eun Young; Kim, Hyun Koo; Choi, Young Ho; Shin, Bong Kyung; Kim, Yoon Kyung [Korea University School of Medicine, Korea University Guro Hospital, Seoul (Korea, Republic of)

    2011-01-15

    Birt-Hogg-Dube'(BHD) syndrome is a rare autosomal dominant inherited disorder that is characterized by skin fibrofolliculomas, renal tumors and multiple lung cysts with or without spontaneous pneumothorax. The disease is caused by germline mutations in the FLCN gene that codes for a protein of unknown function called folliculin. Patients with BHD syndrome do not always have all three manifestations of the skin, kidney and lung. To the best of our knowledge, there has been no case report of the radiologic findings of the lung manifestation in a patient with BHD syndrome in Korea. We report here on two cases of BHD syndrome that presented with spontaneous pneumothorax. The pulmonary abnormalities consisted of multiple thin-walled cysts of various sizes and shapes in both lungs

  13. Catamenial pneumothorax revealing diaphragmatic endometriosis: a case report and revue of literature.

    Science.gov (United States)

    Aissa, Sana; Benzarti, Wafa; Alimi, Faouzi; Gargouri, Imen; Salem, Halima Ben; Aissa, Amène; Fathallah, Khadija; Abdelkade, Atef Ben; Alouini, Rafika; Garrouche, Abdelhamid; Hayoun, Abdelaziz; Abdelghani, Ahmed; Benzarti, Mohamed

    2017-01-01

    Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in women. We aim to discuss the etiology, clinical course, and surgical treatment of a 42-year-old woman with CP. This patient had a right-sided spontaneous pneumothoraces occurred one week after menses. She had under-gone video-assisted thoracoscopic surgery (VATS) because of a persistent air leak under chest tube. VATS revealed multiple diaphragmatic fenestrations with an upper right nodule. Defects were removed and a large part of the diaphragm was resected. Pleural abrasion was then performed over the diaphragm. Diaphragmatic endometriosis was confirmed by microscopic examination. Medical treatment with GnRH agonists was prescribed, and after recovery, the patient has been symptoms free for 20 months.

  14. A case report of displaced anterior junction line mimicking pneumothorax and pneumomediastinum

    International Nuclear Information System (INIS)

    Jeon, Yang Hyun; Sung, Dong Wook; Hong, Hyun Pyo; Yoon, Yup; Lee, Eil Seong

    1998-01-01

    On PA chest radiography, the anterior junction line (AJL) is seen to project from the upper right to the lower left of the upper third of the body of the sternum and represents the visceral and parietal pleura of each lung and a small quantity of mediastinal fat. In a patient with volume loss or expansion of a hemithorax, the AJL shows considerable shift and on PA chest radiography may mimic pneumothroax, the AJL shows considerable shift and on PA chest radiography may mimic pneumothorax or pneumomediastimum. In such cases, widening and hyperlucency of the retrosternal space, seen on lateral view, which represents herniated lung with a shift of AJL, may be helpful for differentiation from pneumothorax or pneumomediastinum. (author). 8 refs., 2 figs

  15. Trauma-induced "Macklin effect" with pneumothorax and large pneumomediastinum, disguised by allergy.

    Science.gov (United States)

    Di Saverio, Salomone; Kawamukai, Kenji; Biscardi, Andrea; Villani, Silvia; Zucchini, Luca; Tugnoli, Gregorio

    2013-09-01

    A 56-year-old man presented spontaneously to the Emergency Department complaining of facial and neck oedema after assumption of nonsteroidal anti-inflammatory drugs (NSAIDS). The triage nurse assigned the patient to Accident & Emergency (A&E) doctor as probable allergic reaction to NSAIDS. Chest X-ray (CXR), ordered after 24 hours, revealed a huge subcutaneous chest and neck emphysema without clearly visible pneumothorax. Subsequent chest CT scan showed a small left pneumothorax and a large amount of air in the mediastinum. The patient was conservatively treated since he was eupnoeic and hemodynamically stable. The pathophysiology of pneumomediastinum was first described by Macklin in 1939. The Macklin effect involves alveolar ruptures with air dissection along bronchovascular sheaths to the mediastinum. In this case the patient did not report in his history a recent blunt thoracic trauma and the initial suspicion of an allergic reaction has prevented physicians to immediately achieve the correct diagnosis.

  16. Urinary incontinence - tension-free vaginal tape

    Science.gov (United States)

    ... ency/article/007377.htm Urinary incontinence - tension-free vaginal tape To use the sharing features on this page, please enable JavaScript. Placement of tension-free vaginal tape is surgery to help control stress urinary ...

  17. Holmium Laser Enucleation of the Prostate and Iatrogenic Arteriovenous Fistula Treated by Superselective Arterial Embolization

    Directory of Open Access Journals (Sweden)

    Anastasios D. Asimakopoulos

    2016-01-01

    Full Text Available Iatrogenic pelvic pseudoaneurysm with concomitant arteriovenous fistula has been described as a rare and challenging complication, which may occur during transurethral resection of the prostate. We provide the first report of this complication after holmium laser enucleation of the prostate for the treatment of benign prostatic hyperplasia. The attempt to control the bleeding by conversion to open surgery and placement of haemostatic stitches into the prostatic fossa failed. Angiography with superselective arterial embolization proved to be a modern, quick, safe, and efficient treatment of this uncommon complication.

  18. Five cases of iatrogenic foreign body in the heart and/or great vessels

    International Nuclear Information System (INIS)

    Uda, Mitsunobu; Sawada, Satoshi; Oshima, Taichi; Kato, Tsutomu; Harima, Keizo; Tanaka, Yoshimasa

    1988-01-01

    5 cases of iatrogenic foreign body in the heart and/or great vessels were reported. We retrieved these foreign bodies (broken catheters) percutaneously by interventional radiologic technique. We detected foreign bodies by chest X-ray film, echogram and DSA. Echogram was useful in the case of radiopague foreign bodies. DSA revealed foreign bodies more clearly than chest X-ray films. We used multipurpose grasping forceps and loop snare combined with pigtail catheter to retrieve. We could retrieve foreign bodies percutaneously in all cases. (author)

  19. Iatrogenic effects of psychosocial interventions: treatment, life context, and personal risk factors.

    Science.gov (United States)

    Moos, Rudolf H

    2012-01-01

    Between 7% and 15% of individuals who participate in psychosocial interventions for substance use disorders may be worse off after treatment than before. Intervention-related predictors of iatrogenic effects include lack of bonding; lack of goal direction and monitoring; confrontation, criticism, and high emotional arousal; models and norms for substance use; and stigma and inaccurate expectations. Life context and personal predictors include lack of support, criticism, and more severe substance use and psychological problems. Ongoing monitoring and safety standards are needed to identify and counteract adverse consequences of intervention programs.

  20. Strategy for use of biliary scintigraphy in non-iatrogenic biliary trauma

    International Nuclear Information System (INIS)

    Zeman, R.K.; Lee, C.H.; Stahl, R.; Viscomi, G.N.; Baker, C.; Cahow, C.E.; Dobbins, J.; Neumann, R.; Burrell, M.I.

    1984-01-01

    Biliary scintigraphy was used to examine 21 patients who had suspected non-iatrogenic biliary trauma. Seven patients (33%) had scintigraphic evidence of biliary leakage. Ultimately, surgical biliary repair was required for only three of these patients. Visualization of the gallbladder did not occur in eight trauma patients, but only one patient was shown to have cholecystitis. In this series, 16 patients had Tc-99m sulfur colloid scans that offered no significant advantage over cholescintigraphy in the detection of hepatic parenchymal defects. Biliary scintigraphy provides clinically useful information in cases both of blunt and penetrating trauma

  1. Strategy for the use of biliary scintigraphy in non-iatrogenic biliary trauma

    International Nuclear Information System (INIS)

    Zeman, R.K.; Lee, C.H.; Stahl, R.; Viscomi, G.N.; Baker, C.; Cahow, C.E.; Dobbins, J.; Neumann, R.; Burrell, M.I.

    1984-01-01

    Biliary scintigraphy was used to examine 21 patients who had suspected non-iatrogenic biliary trauma. Seven patients (33%) had scintigraphic evidence of biliary leakage. Ultimately, surgical biliary repair was required for only three of these patients. Visualization of the gallbladder did not occur in eight trauma patients, but only one patient was shown to have cholecystitis. In this series, 16 patients had Tc-99m sulfur colloid scans that offered no significant advantage over cholescintigraphy in the detection of hepatic parenchymal defects. Biliary scintigraphy provides clinically useful information in cases both of blunt and penetrating trauma

  2. Spontaneous pneumothorax associated with pulmonary fibrosis in a patient with neurofibromatosis type 2

    International Nuclear Information System (INIS)

    Alcala Cerra, Gabriel; Moscote-Salazar, Luis Rafael; Lozano Tagua, Carlos Fernando; Sabogal Barrios, Ruben

    2010-01-01

    Pulmonary involvement in patients with neurofibromatosis has been repetitively reported as a very rare complication in type 1 variety. It is characterized by pulmonary interstitial disease, pulmonary fibrosis and bullaes, the last with high risk of rupture. We described a case of spontaneous pneumothorax in a patient with type 2 neurofibromatosis, as consequence of pulmonary fibrotic changes. To our knowledge this association had not been reported.

  3. Localized air foci in the lower thorax in the patients with pneumothorax: Skip pneumothoraces

    Energy Technology Data Exchange (ETDEWEB)

    Higuchi, Takeshi, E-mail: higuchi@hosp.niigata.niigata.jp [Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Chuo-ku, Shumoku, Niigata 950-1197 (Japan); Takahashi, Naoya, E-mail: nandtr@hosp.niigata.niigata.jp [Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Chuo-ku, Shumoku, Niigata 950-1197 (Japan); Kiguchi, Takao, E-mail: takakig@gmail.com [Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Chuo-ku, Shumoku, Niigata 950-1197 (Japan); Shiotani, Motoi, E-mail: Shiotani14@gmail.com [Department of Radiology, Niigata Cancer Center Hospital, 2-15-3 Chuo-ku, Kawagishicho, Niigata 951-8566 (Japan); Maeda, Haruo, E-mail: h-maeda@hosp.niigata.niigata.jp [Department of Diagnostic Radiology, Niigata City General Hospital, 463-7 Chuo-ku, Shumoku, Niigata 950-1197 (Japan)

    2013-08-15

    Purpose: To investigate the characteristics and imaging features of localized air foci in the lower thorax in patients with pneumothorax using thin-section multidetector computed tomography. Materials and methods: Of 10,547 consecutive CT examinations comprising the chest, the CT scans of 146 patients with ordinary pneumothoraces were identified and retrospectively evaluated. The study group included 110 male and 36 female patients (mean age, 50 years; range, 1–93 years). All examinations were performed at our institution between January 2009 and December 2009. Cause of pneumothorax was classified as traumatic or non-traumatic. Localized air foci in the lower thorax were defined as being localized air collections in the lower thorax that did not appear to be adjacent to the lung. If these criteria were met, the shape, size, location laterality, and number of foci were evaluated. Associations with trauma, sex, severity of the pneumothorax, and laterality were evaluated using the χ{sup 2} test. All P values <0.05 were considered significant. Results: Localized air foci in the lower thorax presented as slit-like or small ovoid air collections in the lowest part of the pleural space. These foci were observed in 79/146 (54.1%) patients. The traumatic pneumothoraces group showed a higher prevalence of these features than the non-traumatic group. Some foci that were situated in the anterior part mimicked the appearance of free intraperitoneal air. Conclusion: Patients with pneumothorax commonly had localized air foci in the lower thorax. Because such foci can mimic pneumoperitoneum, accurate recognition of them is required to avoid confusion with free intraperitoneal air, especially in traumatic cases.

  4. Massive Emphysema and Pneumothorax Following Shoulder Arthroscopy under General Anaesthesia: A Case Report.

    Science.gov (United States)

    Shariyate, Mohammad J; Kachooei, Amir R; Ebrahimzadeh, Mohammad H

    2017-11-01

    The patient was a 61-year-old female with massive rotator cuff tear who had no history of smoking, COPD, asthma, or other pulmonary diseases. Four hours following shoulder arthroscopy, the patient developed progressive dyspnea, which was diagnosed as pneumothorax with subcutaneous emphysema extending to the neck and face. Chest tube was inserted promptly. The patient was discharged with a good condition after 7 days. Follow up of the patient for the next 3 months was uneventful.

  5. Massive Emphysema and Pneumothorax Following Shoulder Arthroscopy under General Anaesthesia: A Case Report

    Directory of Open Access Journals (Sweden)

    Mohammad J. Shariati

    2017-11-01

    Full Text Available The patient was a 61-year-old female with massive rotator cuff tear who had no history of smoking, COPD, asthma, or other pulmonary diseases. Four hours following shoulder arthroscopy, the patient developed progressive dyspnea, which was diagnosed as pneumothorax with subcutaneous emphysema extending to the neck and face. Chest tube was inserted promptly. The patient was discharged with a good condition after 7 days. Follow up of the patient for the next 3 months was uneventful.

  6. Single-staged uniportal VATS in the supine position for simultaneous bilateral primary spontaneous pneumothorax.

    Science.gov (United States)

    Kim, Kyung Soo

    2017-05-15

    Simultaneous bilateral primary spontaneous pneumothorax (SBPSP) is rare, but requires surgery on both sides, in patients with definite bilateral bullae to prevent life-threatening conditions. Recently, uniportal video-assisted thoracoscopic surgery (VATS) has been widely accepted as a less invasive technique for the treatment of pneumothorax. Thus, we introduced single-staged uniportal VATS technique in the supine position, for the management of two cases of SBPSP. A 17-year-old boy presented with bilateral spontaneous pneumothorax and he underwent single-staged uniportal VATS in the supine position. Single wide draping in consecutive bilateral approaches removes the needs of changing patients' position. Whole thoracoscopic procedure for wedge resection of bullae lesions was conducted without difficulty. The total operation time took 65 min and the patient discharged 3 days after the operation. The patient was followed for 24 months without recurrence of both sides. Another 18-year-old boy was admitted with bilateral spontaneous pneumothorax and single-staged uniportal VATS was also performed in the supine position. The total operation time took 79 min and the patient discharged on postoperative day 4. He was followed for 19 months without recurrence of both sides. Single-staged uniportal VATS approach yielded satisfactory results from simplicity that not requires position change compared to conventional multi-ports VATS in the lateral position, and with better cosmetics. This technique is thought to be a feasible procedure in selective patients with SBPSP or with contralateral bullae for preventive role.

  7. Localized air foci in the lower thorax in the patients with pneumothorax: Skip pneumothoraces

    International Nuclear Information System (INIS)

    Higuchi, Takeshi; Takahashi, Naoya; Kiguchi, Takao; Shiotani, Motoi; Maeda, Haruo

    2013-01-01

    Purpose: To investigate the characteristics and imaging features of localized air foci in the lower thorax in patients with pneumothorax using thin-section multidetector computed tomography. Materials and methods: Of 10,547 consecutive CT examinations comprising the chest, the CT scans of 146 patients with ordinary pneumothoraces were identified and retrospectively evaluated. The study group included 110 male and 36 female patients (mean age, 50 years; range, 1–93 years). All examinations were performed at our institution between January 2009 and December 2009. Cause of pneumothorax was classified as traumatic or non-traumatic. Localized air foci in the lower thorax were defined as being localized air collections in the lower thorax that did not appear to be adjacent to the lung. If these criteria were met, the shape, size, location laterality, and number of foci were evaluated. Associations with trauma, sex, severity of the pneumothorax, and laterality were evaluated using the χ 2 test. All P values <0.05 were considered significant. Results: Localized air foci in the lower thorax presented as slit-like or small ovoid air collections in the lowest part of the pleural space. These foci were observed in 79/146 (54.1%) patients. The traumatic pneumothoraces group showed a higher prevalence of these features than the non-traumatic group. Some foci that were situated in the anterior part mimicked the appearance of free intraperitoneal air. Conclusion: Patients with pneumothorax commonly had localized air foci in the lower thorax. Because such foci can mimic pneumoperitoneum, accurate recognition of them is required to avoid confusion with free intraperitoneal air, especially in traumatic cases

  8. Rapid needle-out patient-rollover approach after cone beam CT-guided lung biopsy: effect on pneumothorax rate in 1,191 consecutive patients

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Im [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of); Seoul National University Medical Research Center, Institute of Radiation Medicine, Seoul (Korea, Republic of); Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Department of Radiology, Seoul (Korea, Republic of); Park, Chang Min; Goo, Jin Mo [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of); Seoul National University, Cancer Research Institute, Seoul (Korea, Republic of); Lee, Sang Min [Seoul National University College of Medicine, Department of Radiology, Jongno-gu, Seoul (Korea, Republic of)

    2015-07-15

    To investigate the effect of rapid needle-out patient-rollover approach on the incidence of pneumothorax and drainage catheter placement due to pneumothorax in C-arm Cone-beam CT (CBCT)-guided percutaneous transthoracic needle biopsy (PTNB) of lung lesions. From May 2011 to December 2012, 1227 PTNBs were performed in 1191 patients with a 17-gauge coaxial needle. 617 biopsies were performed without (conventional-group) and 610 with rapid-rollover approach (rapid-rollover-group). Overall pneumothorax rates and incidences of pneumothorax requiring drainage catheter placement were compared between two groups. There were no significant differences in overall pneumothorax rates between conventional and rapid-rollover groups (19.8 % vs. 23.1 %, p = 0.164). However, pneumothorax rate requiring drainage catheter placement was significantly lower in rapid-rollover-group (1.6 %) than conventional-group (4.2 %) (p = 0.010). Multivariate analysis revealed male, age > 60, bulla crossed, fissure crossed, pleura to target distance > 1.3 cm, emphysema along needle tract, and pleural punctures ≥ 2 were significant risk factors of pneumothorax (p < 0.05). Regarding pneumothorax requiring drainage catheter placement, fissure crossed, bulla crossed, and emphysema along needle tract were significant risk factors (p < 0.05), whereas rapid-rollover approach was an independent protective factor (p = 0.002). The rapid needle-out patient-rollover approach significantly reduced the rate of pneumothorax requiring drainage catheter placement after CBCT-guided PTNB. (orig.)

  9. Use of endobronchial valve insertion to treat relapsing pneumothorax: a case report and literature review.

    Science.gov (United States)

    Qi, Fei; Tian, Qing; Chen, Liang'an; Li, Chunyan; Zhang, Shu; Liu, Xingchen; Xiao, Binbin

    2017-07-01

    Backgorund and Aims: Unidirectional endobronchial valves have recently been shown to be beneficial as treatment for persistent air leaks. This report presents a first case of endobronchial valve implantation to treat relapsing pneumothorax in a Chinese patient, and also presents a review of the literature on the use of one-way valve insertion for the treatment of persistent air leaks. The patient did undergo a recent but failed chest tube intervention. By bronchoscopy and using Chartis® system measurements, the upper left lobe (including the left apical bronchus) was closed using a catheter. After the expected decrease in airflow following bronchial occlusion, increased air pressure and decreased spilled air were noted; it was concluded that the pneumothorax was located in the left upper lobe. A Zephyr ® endobronchial valve was placed in the left upper apical bronchus. The health benefits of the procedure were noticed in the following days. Our review suggests that the use of endobronchial valves could be used as an effective, minimally invasive, low-risk intervention for patients with pneumothorax that cannot be treated surgically. © 2015 John Wiley & Sons Ltd.

  10. Thoracoscopic CO laser coagulation shrinkage of blebs in treatment of spontaneous pneumothorax

    Science.gov (United States)

    Sensaki, Koji; Arai, Tsunenori; Kikuchi, Keiichi; Takagi, Keigo; Tanaka, Susumu; Kikuchi, Makoto

    1992-06-01

    Spontaneous pneumothorax is a common disease in young people. Operative intervention has been done in most of the recurrent cases. Recently thoracoscopic treatment has been tested as a less invasive treatment modarity. We adopted carbon monoxide (CO) laser for thoracoscopic treatment of recurrent spontaneous pneumothorax. CO laser (wavelength; 5.4 micrometers ) could be delivered by chalcogenide glass (As - S) covered with a teflon sheath and ZnSe fiber tip. The sterilized flexible bronchoscope was inserted through the thoracoscopic outer sheath under local anesthesia. Shrinkage of blebs was obtained by non-contact method of CO laser irradiation. Laser power at the tip was 2.5 - 5 W and irradiation duration was 0.5 s each. Excellent shrinkage of bleb and bulla could be obtained by CO laser without perforation complication. Advantages of CO laser as a thoracoscopic treatment were: (1) capability of fiber delivery (flexible thoracoscopy was easy to operate and clear to visualize the blebs which were frequently found at the apical portion of the lung, and (2) shallow extinction length (good shrinkage of blebs, low risk of perforation, and thin layer of carbonization). In conclusion, our new technique of thoracoscopic CO laser irradiation was found to be a safe and effective treatment of spontaneous pneumothorax.

  11. Laryngeal fracture due to blunt trauma presenting with pneumothorax and pneumomediastinum.

    Science.gov (United States)

    Narcı, Adnan; Embleton, Didem Baskın; Ayçiçek, Abdullah; Yücedağ, Fatih; Cetinkurşun, Salih

    2011-01-01

    Injuries due to traffic accidents are frequent in childhood, and they have high mortality and morbidity. Laryngeal injury due to a traffic accident is a rare pathology and might be missed if not suspected. Here we present a laryngeal fracture in a child after a blunt chest trauma during a traffic accident that presented with pneumomediastinum and pneumothorax. A 14-year-old girl was referred for pneumomediastinum. Her physical examination was normal except subcutaneous emphysema, edema and tenderness in the cervical area, hoarseness, facial and extremity abrasions and ecchymoses. Chest tomography revealed pneumothorax and pneumomediastinum, and cranial tomography revealed maxillofacial fractures. Upper airway damage was suspected, flexible endoscopy revealed right vocal cord paralysis and cervical tomography revealed thyroid cartilage fracture. The fracture was repaired and tracheotomy was performed. She was discharged on postoperative day 6. Facial fractures were repaired in another center. Tracheotomy was removed on postoperative day 20. Her hoarseness, although decreased, still persists. Pneumomediastinum is a rare result of a laryngeal fracture and if not suspected, the fracture can easily be missed. It should be kept in mind after blunt cervical trauma with pneumomediastinum and/or pneumothorax. Direct endoscopy and cervical tomography may be necessary for the differential diagnosis. Copyright © 2011 S. Karger AG, Basel.

  12. Traumatic Hemothorax and Pneumothorax Detected by EFAST Compared with Chest Radio- graphy at Siriraj Hospital

    Directory of Open Access Journals (Sweden)

    Lertpong Somcharit

    2016-05-01

    Full Text Available Objective: EFAST is the evaluation of thoracoabdominal injury in trauma patients. This study aimed to evaluate the diagnostic utility of EFAST for detection of traumatic pneumothorax and hemothorax compared to standard routine chest radiography at Siriraj Hospital. Methods: From January 2013 to April 2015, 119 patients who visited the Division of Trauma, Siriraj Hospital were included in the study. EFAST was performed during the initial resuscitation of the injured patients and plain chest radiographs were obtained as routine hospital protocols. Patients’ charts were retrospectively reviewed and real-time EFAST examinations were compared to the results of chest radiographs. EFAST diagnosis was con- sidered positive when there was absence of normal sliding lung signs (pneumothorax and presence of free fluid above the diaphragm (hemothorax. Results: The sensitivity, specificity, PPV, and NPV of EFAST for the diagnosis of pneumothorax and hemothorax were 76%, 100%, 100%, and 93%, respectively, whereas the sensitivity, specificity, PPV and NPV of plain chest radiographs were 80%, 100%, 100% and 94.9%, respectively. Conclusion: EFAST shows similar diagnostic accuracy compared to plain supine AP chest radiograph. The results are operator-dependent and higher accuracy can be achieved by well-trained emergency health care personnel. EFAST can be performed during resuscitation, and still provides promising results which can lead to early treat- ment procedure. Under experienced hands, EFAST is considered effective. This study suggests that it should be used as a complimentary procedure in all thoracic injured patients’ evaluations.

  13. Spontaneous Pneumothorax: A retrospective study of twenty-five patients and literature review

    International Nuclear Information System (INIS)

    Batouk, A.; Jastaniah, S.; Grillo, I.A.; Malatani, T.S.; Al-Saigh, A.H.; Al-Shehri, M.Y.; Softah, A.; Ali, K.A.M.; Teklu, B.

    1996-01-01

    We present a retrospective study of 25 patients with spontaneous pneumothorax (three recurrent) comprising 16 Saudis (nine males and seven females) and eight non-Saudi's (eight males and one female), seen at the Asir Central Hospital, Abha, over a period of 45 months. Almost one-third of patients (9/25) had no underlying cause discernible by our investigational facilities (chest x-ray, ultrasonography, computed tomographic scan and flexible bronchofiberscopy). Underlying pneumonia (three patients), pulmonary tuberculosis (two patients), lung abscess (one patient) and congenital bullae (one patient) constituted the etiology in another third of the spontaneous pneumothorax patients. Other underlying pulmonary diseases, precipitating spontaneous pneumothorax in the group included pulmonary fibrosis, metastatic mesothelioma and immunosuppression in a medulloblastoma patient undergoing chemotherapy with the development of chickenpox. Closed thoracostomy tube drainage was the only method of treatment in 20 out of 25 patients, with three failures of closed thoracostomy tube drainage needing thoractomy and resection of blebs/bullae. The only complication was empyema in two of the patients. Two patients were successfully treated conservatively with observation alone. (author)

  14. Robust Tensioned Kevlar Suspension Design

    Science.gov (United States)

    Young, Joseph B.; Naylor, Bret J.; Holmes, Warren A.

    2012-01-01

    One common but challenging problem in cryogenic engineering is to produce a mount that has excellent thermal isolation but is also rigid. Such mounts can be achieved by suspending the load from a network of fibers or strings held in tension. Kevlar fibers are often used for this purpose owing to their high strength and low thermal conductivity. A suite of compact design elements has been developed to improve the reliability of suspension systems made of Kevlar.

  15. Surface Tension Confines Cryogenic Liquid

    Science.gov (United States)

    Castles, Stephen H.; Schein, Michael E.

    1989-01-01

    New type of Dewar provides passive, constant-temperature cryogenic cooling for scientific instruments under normal-to low-gravity conditions. Known as Surface-Tension-Contained Liquid Cryogen Cooler (STCLCC), keeps liquid cryogen in known location inside the Dewar by trapping liquid inside spongelike material. Unique sponge material fills most of volume of inner tank. Sponge is all-silica, open-cell material similar to that used for Space Shuttle thermal-protection tiles.

  16. Iatrogenic gastric perforation in a misdiagnosed case of late presenting congenital diaphragmatic hernia: Report of an avoidable complication

    Directory of Open Access Journals (Sweden)

    Pradeep Kajal

    Full Text Available Introduction: Congenital diaphragmatic hernia (CDH is a defect in diaphragm which usually presents with severe respiratory distress in neonatal period. Presentation of case: We present a case of congenital diaphragmatic hernia presenting at an age of 2.5 years in a male child. It was misdiagnosed as a case of pyothorax for which chest tube was attempted on left side resulting in iatrogenic gastric perforation. The patient was managed by early and prompt surgery. Discussion: Late presentation is usually rare with vast array of respiratory and gastrointestinal symptoms. It often leads to clinical and radiological misdiagnosis. Conclusion: Surgical intervention in misdiagnosed cases can lead to catastrophic iatrogenic complications. Keywords: Case report, Congenital diaphragmatic hernia, Pyothorax, Chest tube, Iatrogenic gastric perforation

  17. Chest Computed Tomographic Image Screening for Cystic Lung Diseases in Patients with Spontaneous Pneumothorax Is Cost Effective.

    Science.gov (United States)

    Gupta, Nishant; Langenderfer, Dale; McCormack, Francis X; Schauer, Daniel P; Eckman, Mark H

    2017-01-01

    Patients without a known history of lung disease presenting with a spontaneous pneumothorax are generally diagnosed as having primary spontaneous pneumothorax. However, occult diffuse cystic lung diseases such as Birt-Hogg-Dubé syndrome (BHD), lymphangioleiomyomatosis (LAM), and pulmonary Langerhans cell histiocytosis (PLCH) can also first present with a spontaneous pneumothorax, and their early identification by high-resolution computed tomographic (HRCT) chest imaging has implications for subsequent management. The objective of our study was to evaluate the cost-effectiveness of HRCT chest imaging to facilitate early diagnosis of LAM, BHD, and PLCH. We constructed a Markov state-transition model to assess the cost-effectiveness of screening HRCT to facilitate early diagnosis of diffuse cystic lung diseases in patients presenting with an apparent primary spontaneous pneumothorax. Baseline data for prevalence of BHD, LAM, and PLCH and rates of recurrent pneumothoraces in each of these diseases were derived from the literature. Costs were extracted from 2014 Medicare data. We compared a strategy of HRCT screening followed by pleurodesis in patients with LAM, BHD, or PLCH versus conventional management with no HRCT screening. In our base case analysis, screening for the presence of BHD, LAM, or PLCH in patients presenting with a spontaneous pneumothorax was cost effective, with a marginal cost-effectiveness ratio of $1,427 per quality-adjusted life-year gained. Sensitivity analysis showed that screening HRCT remained cost effective for diffuse cystic lung diseases prevalence as low as 0.01%. HRCT image screening for BHD, LAM, and PLCH in patients with apparent primary spontaneous pneumothorax is cost effective. Clinicians should consider performing a screening HRCT in patients presenting with apparent primary spontaneous pneumothorax.

  18. Pulmonary emphysema is a predictor of pneumothorax after CT-guided transthoracic pulmonary biopsies of pulmonary nodules.

    Science.gov (United States)

    Lendeckel, Derik; Kromrey, Marie-Luise; Ittermann, Till; Schäfer, Sophia; Mensel, Birger; Kühn, Jens-Peter

    2017-01-01

    Pneumothoraces are the most frequently occurring complications of CT-guided percutaneous transthoracic pulmonary biopsies (PTPB). The aim of this study was to evaluate the influence of pre-diagnostic lung emphysema on the incidence and extent of pneumothoraces and to establish a risk stratification for the evaluation of the pre-procedure complication probability. CT-guided PTPB of 100 pre-selected patients (mean age 67.1±12.8 years) were retrospectively enrolled from a single center database of 235 PTPB performed between 2012-2014. Patients were grouped according to pneumothorax appearance directly after PTPB (group I: without pneumothorax, n = 50; group II: with pneumothorax, n = 50). Group II was further divided according to post-interventional treatment (group IIa: chest tube placement, n = 24; group IIb: conservative therapy, n = 26). For each patient pre-diagnostic percentage of emphysema was quantified using CT density analysis. Emphysema stages were compared between groups using bivariate analyses and multinomial logistic regression analyses. Emphysema percentage was significantly associated with the occurrence of post-interventional pneumothorax (p = 0.006). Adjusted for potential confounders (age, gender, lesion size and length of interventional pathway) the study yielded an OR of 1.07 (p = 0.042). Absolute risk of pneumothorax increased from 43.4% at an emphysema rate of 5% to 73.8% at 25%. No differences could be seen in patients with pneumothorax between percentage of emphysema and mode of therapy (p = 0.721). The rate of lung emphysema is proportionally related to the incidence of pneumothorax after CT-guided PTPB and allows pre-interventional risk stratification. There is no association between stage of emphysema and post-interventional requirement of chest tube placement.

  19. COMPARISON OF THORACIC ULTRASONOGRAPHY AND RADIOGRAPHY FOR THE DETECTION OF INDUCED SMALL VOLUME PNEUMOTHORAX IN THE HORSE.

    Science.gov (United States)

    Partlow, Jessica; David, Florent; Hunt, Luanne Michelle; Relave, Fabien; Blond, Laurent; Pinilla, Manuel; Lavoie, Jean-Pierre

    2017-05-01

    Small volume pneumothorax can be challenging to diagnose in horses. The current standard method for diagnosis is standing thoracic radiography. We hypothesized that thoracic ultrasonography would be more sensitive. Objectives of this prospective, experimental study were to describe a thoracic ultrasound method for detection of small volume pneumothorax in horses and to compare results of radiography and ultrasound in a sample of horses with induced small volume pneumothorax. Six mature healthy horses were recruited for this study. For each horse, five 50 ml air boluses were sequentially introduced via a teat cannula into the pleural space. Lateral thoracic radiographs and standardized ultrasound (2D and M-mode) examinations of both hemithoraces were performed following administration of each 50 ml air bolus. Radiographs and ultrasound images/videos were analyzed for detection of pneumothorax by four independent investigators who were unaware of treatment status. Sensitivity, specificity, positive predictive values, negative predictive values, and agreement among investigators (Kappa test, κ) were calculated for radiography, 2D and M-mode ultrasound. Comparisons were made using a chi-squared exact test with significance set at P pneumothorax detection (P = 0.02 and P = 0.04, respectively). Specificity and positive predictive values were similar for all three imaging modalities (P = 1). Agreement between investigators for pneumothorax detection was excellent for 2D ultrasound (κ = 1), very good for M-mode ultrasound (κ = 0.87), and good for radiography (κ = 0.79). Findings from this experimental study supported the use of thoracic ultrasonography as a diagnostic method for detecting pneumothorax in horses. © 2017 American College of Veterinary Radiology.

  20. Perioperative deaths: a further comparative review of coroner's autopsies with particular reference to the occurrence of fatal iatrogenic injury.

    Science.gov (United States)

    Lau, G

    2000-07-01

    In previous triennial reviews of Coroner's perioperative autopsies conducted during the periods 1989 to 1991 and 1992 to 1994, it was observed that the necropsy incidence of such deaths rose from 2% to 2.6% (P 1) interventions, which were initially classified as elective procedures in 27 cases. There were 66 (24.4%) iatrogenic deaths, of which 2 (0.7%) were due to anaesthetic mishaps; 18/64 iatrogenic deaths, unrelated to anaesthesia, occurred after the first postoperative day. The proportions of such deaths amongst patients subjected to multiple interventions, or initial elective procedures, were more than twice as high as amongst those undergoing single procedures, and those initially classified as emergencies (35.6% versus 16.6% and 33.3% versus 13.2%, respectively; P negligence was recorded during the period in question. There appears to have been a steady increase in the number of perioperative deaths reported to the Coroner over the previous triennia (1989 to 1997) for which autopsies were conducted. While this observation may not denote an increase in perioperative morality rates per se, it may be indicative of an increasingly "aggressive" or defensive approach to the clinical management of seriously ill patients, particularly over the past decade. Although the rate of iatrogenic deaths appears to have stabilised, it is too early to say whether this apparent trend will persist in the future. It is perhaps not surprising that the risk of iatrogenic injury appears to increase with the number of interventions performed; however, it is not clear why initial, supposedly elective, interventions should be associated with an apparently greater risk of iatrogenic injury than those classified as emergency procedures. The substantial divergence between the autopsy finding of an iatrogenic death and the corresponding Coroner's verdict of misadventure may be comforting to clinicians, but certainly warrants further examination.