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Sample records for iatrogenic tension pneumothorax

  1. Iatrogenic tension pneumothorax in children: two case reports

    Directory of Open Access Journals (Sweden)

    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. Iatrogenic pneumothorax related to mechanical ventilation

    OpenAIRE

    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...

  3. [Tension pneumomediastinum and tension pneumothorax following tracheal perforation during cardiopulmonary resuscitation].

    Science.gov (United States)

    Buschmann, C T; Tsokos, M; Kurz, S D; Kleber, C

    2015-07-01

    Tension pneumothorax can occur at any time during cardiopulmonary resuscitation (CPR) with external cardiac massage and invasive ventilation either from primary or iatrogenic rib fractures with concomitant pleural or parenchymal injury. Airway injury can also cause tension pneumothorax during CPR. This article presents the case of a 41-year-old woman who suffered cardiopulmonary arrest after undergoing elective mandibular surgery. During CPR the upper airway could not be secured by orotracheal intubation due to massive craniofacial soft tissue swelling. A surgical airway was established with obviously unrecognized iatrogenic tracheal perforation and subsequent development of tension pneumomediastinum and tension pneumothorax during ventilation. Neither the tension pneumomediastinum nor the tension pneumothorax were decompressed and accordingly resuscitation efforts remained unsuccessful. This case illustrates the need for a structured approach to resuscitate patients with ventilation problems regarding decompression of tension pneumomediastinum and/or tension pneumothorax during CPR.

  4. Giant bullae mimicking tension pneumothorax

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    Ahmet Erbey

    2012-12-01

    Full Text Available Giant bullae may mimic tension pneumothorax radiologicallyso that it may expand completely to hemithorax,increase of radiolucency mediastinal shift, flattening ofdiaphragm and printing on trachea. Sixty one year oldmale patient with giant bullae misdiagnosed as tensionpneumothorax and underwent to tube thoracostomy. Thedifferential diagnosis of giant bullae and tension pneumothoraxmay be confusing. The therapeutic approaches ofthese two radiologically similar entities differ significantly.Thus proper physical assessment and radiological examinationis crucial in the differential diagnosis and computedtomography examination should be performed before theadjustment of therapy. J Clin Exp Invest 2012; 3(4: 548-551Key words: Tension pneumothorax, giant bullae, computedtomography, tube thoracostomy

  5. A case of iatrogenic pneumothorax in which chest tube placement could be avoided by intraoperative evaluation with transthoracic ultrasonography

    Directory of Open Access Journals (Sweden)

    Sato I

    2017-07-01

    Full Text Available Izumi Sato, Hirotsugu Kanda, Megumi Kanao-Kanda, Atsushi Kurosawa, Takayuki Kunisawa Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa, Hokkaido, Japan Abstract: We report a case of iatrogenic pneumothorax in which chest tube placement was avoided by continuous intraoperative evaluation with transthoracic ultrasonography. A 53-year-old man had undergone a subsegmentectomy. While attempting to place a central venous catheter in the right internal jugular vein after the induction of anesthesia, we identified gas absorption during the puncture and suspected a pneumothorax. Chest X-ray revealed an ~5-mm collapse of the right lung apex. Tension pneumothorax was a concern during surgery because of the long-term positive pressure ventilation, but we decided to start the operation without preventative chest tube placement. During the operation, we regularly observed the midclavicular line of the second intercostal space using ultrasound. The operation was completed uneventfully. In this case, we effectively utilized ultrasound and avoided preventive chest tube placement and the associated complications. Transthoracic ultrasonography could be performed easily and continuously during surgery and was effective for evaluating the progression of an intraoperative pneumothorax. Keywords: transthoracic ultrasonography, iatrogenic pneumothorax, central venous catheterization

  6. Tension pneumothorax following an accidental kerosene poisoning: A case report

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    G M Ashir

    2009-01-01

    Full Text Available 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 poisioning that responded to needle thoracocentesis is presented.

  7. Tension pneumothorax following an accidental kerosene poisoning: A case report

    OpenAIRE

    2009-01-01

    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 poisioning that responded to needle thoracocentesis is presented.

  8. [Pneumothorax].

    Science.gov (United States)

    Swierzy, M; Helmig, M; Ismail, M; Rückert, J; Walles, T; Neudecker, J

    2014-09-01

    The presence of air between the visceral pleura and the parietal pleura with consecutive retraction of the lung from the chest wall is called pneumothorax. Regarding the genesis of the pneumothorax, a distinction is drawn between spontaneous and traumatic pneumothorax. The spontaneous pneumothorax is, depending on whether a congenital or an acquired pulmonary disease can be found, grouped into a primary spontaneous pneumothorax (PSP) without underlying lung disease and a secondary spontaneous pneumothorax (SSP) with the presence of a known lung disease. The traumatic pneumothorax is classified, depending on the cause, into penetrating and non-penetrating (blunt) traumatic events. A special form of the traumatic pneumothorax is the iatrogenic pneumothorax occurring as a result of diagnostic and/or therapeutic interventions. Clinically, a pneumothorax can range from an asymptomatic to an acute life-threatening situation. The required initial measures depend primarily on the patient's clinical condition. They vary from immediate insertion of a chest tube to wait and see with monitoring. The insertion of a chest tube is still the accepted therapeutic standard, but other procedures like aspiration of air through a needle or small catheter, particularly for small spontaneous pneumothoraces, represent alternative therapy options as well. The short-term goal is to treat possibly existing dyspnea and pain; in the long run a recurrence of the pneumothorax should be prevented. Until now, no uniform treatment algorithms or standardised therapy principles exist to achieve the therapeutic intentions of lung expansion and freedom from pain and late relapse.

  9. Failed needle decompression of bilateral spontaneous tension pneumothorax.

    Science.gov (United States)

    Bach, P T; Sølling, C

    2015-07-01

    This case report presents a young male admitted with primary bilateral spontaneous tension pneumothorax and severe respiratory distress. This is an extremely rare condition. The patient was on the verge of hypoxic cardiac arrest and the attempted needle thoracocentesis was unsuccessful. Needle thoracocentesis in the midclavicular line of the second intercostal space is widely used and recommended as first-line treatment of tension pneumothorax. Reviewing the literature, the procedure is not based on solid evidence. It has high failure rates and potentially serious complications. Alternatives to this approach are perhaps more appropriate. Correctly done, needle thoracocentesis has its place in the presence of a diagnosed or suspected tension pneumothorax when no other options are available. If needle thoracocentesis is chosen, then insertion in the mid-anterior axillary line of the 3rd-5th intercostal space is an appropriate alternative site. Otherwise, lateral thoracostomy, with or without chest tube insertion, is a safe procedure with a high success rate. It should be considered as the first-line treatment of tension pneumothorax, particularly in the unstable patient.

  10. Tension pneumoperitoneum complicated with tension pneumothorax in a patient with diaphragmatic eventration

    Science.gov (United States)

    Akoglu, Haldun; Coban, Erkan; Guneysel, Ozlem

    2012-01-01

    Tension pneumothorax complicating a pneumoperitoneum is a rare but known entity. However, all previously published articles report an air leak through defects in the diaphragm connecting the pneumoperitoneum and the pneumothorax. Here, the case of a 36-year-old man in whom the pneumoperitoneum acted like a tension pneumothorax because of a congenital eventration of the left diaphragm without penetration is presented. Emergency needle decompression of the abdomen was performed. A gastric ulcer that had passed through the diaphragm to the right lung was diagnosed intraoperatively. Unfortunately, the patient developed a ventricular fibrillation that remained resistant to all resuscitative efforts, and the patient died shortly afterwards. PMID:22604199

  11. 医源性气胸28例临床分析%The prevention of iatrogenic pneumothorax

    Institute of Scientific and Technical Information of China (English)

    徐国荣

    2009-01-01

    Objective To investigate the reasons and preventive measures of iatrogenic pneumothorax. Methods Retrospective analysis was done in 28 cases suffering from iatrogenic pneumothorax diagnosed from October 1998 to December 2008. Results The reasons of iatrogenic pneumothorax were various, but mainly related to improper operation. Conclusion Rigorous and normative operations and timely treatments are critical to prevent the iatrogenic pneumothorax.%目的 探讨医源性气胸的发生原因及预防措施.方法 对1998年10月至2008年12月我院诊治的28例医源性气胸患者进行回顾性分析.结果 医源性气胸的发生原因较多,但主要与医务人员操作不当有关.结论 严谨规范的操作技巧和恰当及时的处置是预防医源性气胸的关键.

  12. Surgical tension pneumothorax during laparoscopic repair of massive hiatus hernia: a different situation requiring different management

    National Research Council Canada - National Science Library

    Phillips, S; Falk, G L

    2011-01-01

    During laparoscopic repair of massive hiatus hernia, surgical dissection can breach the parietal pleura allowing insufflating carbon dioxide to rapidly expand the pleural space, causing a tension pneumothorax...

  13. 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.

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

    Science.gov (United States)

    Al Saif, Narjis; Hammodi, Adel; Al-Azem, M Ali; Al-Hubail, Rasheed

    2015-01-01

    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.

  15. Anesthetic Complication during Maxillofacial Trauma Surgery: A Case Report of Intraoperative Tension Pneumothorax.

    Science.gov (United States)

    Al Shetawi, Al Haitham; Golden, Leonard; Turner, Michael

    2016-09-01

    Tension pneumothorax is a life-threatening emergency that requires a high index of suspension and immediate intervention to prevent circulatory collapse and death. Only five cases of pneumothorax were described in the Oral and Maxillofacial Surgery literature. All cases were postoperative complications associated with orthognathic surgery. We report a case of intraoperative tension pneumothorax during a routine facial trauma surgery requiring emergency chest decompression. The possible causes, classification, and reported cases will be presented.

  16. Chest wall thickness may limit adequate drainage of tension pneumothorax by needle thoracocentesis.

    OpenAIRE

    1996-01-01

    Tension pneumothorax in a large man was inadequately drained by needle thoracocentesis with a 4.5 cm cannula. Unsuccessful needle thoracocentesis of a clinical tension pneumothorax in a large patient should be followed immediately by chest drain insertion, without local anaesthetic, as dictated by clinical urgency. If the clinical situation is still not improved other diagnoses should be considered.

  17. Dependent Lung Tension Pneumothorax During 1-Lung Ventilation: Treatment by Transmediastinal Thoracentesis.

    Science.gov (United States)

    Kenta, Okitsu; Shoko, Arimoto; Takeshi, Iritakenishi; Satoshi, Hagihira; Yuji, Fujino; Yasushi, Shintani; Masato, Minami; Meinoshin, Okumura

    2015-08-15

    Contralateral tension pneumothorax during 1-lung ventilation is rare but life threatening. We report the case of a patient who developed tension pneumothorax of the dependent lung during 1-lung ventilation while the surgeon was anastomosing the bronchi after sleeve lobectomy. Ventilation was not possible in either the dependent or nondependent lung, leading to severe desaturation and cardiac arrest. While the surgeons were administering direct cardiac compression, we suspected tension pneumothorax. As soon as the surgeons pierced the mediastinal pleura, adequate circulation was restored. Immediate diagnosis and treatment is important for this complication.

  18. 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 < 0.001). A 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.

  19. Tension pneumothorax complicating endoscopic retrograde cholangiopancreatography: case report and systematic literature review.

    Science.gov (United States)

    Al-Ashaal, Yousef I; Hefny, Ashraf F; Safi, Farouk; Abu-Zidan, Fikri M

    2011-01-01

    Perforation of the duodenum, which is usually retroperitoneal, is a known complication of endoscopic retrograde cholangiopancreatography (ERCP). Association of the duodenal perforation with pneumothorax is rare and the development of tension pneumothorax is even rarer. We report a case of tension pneumothorax following an ERCP, which we successfully treated with chest tube insertion and laparotomy, and systematically review the other 10 cases reported in the literature. Four of these 10 cases had tension pneumothorax. All were to the right side of the chest. Patients were mainly female (7/10). The median (range) age was 70.5 (55-89) years. Four patients required surgery (40%) and one patient, who was not operated on, died (10%). Clinicians should be aware of this serious complication. Unexplained chest pain, dyspnoea, and oxygen desaturation with abdominal distension during ERCP must raise this possibility. Early clinical recognition and prompt management is essential to improve the outcome.

  20. 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.

  1. Tension Pneumothorax After Ultrasound-Guided Interscalene Block and Shoulder Arthroscopy.

    Science.gov (United States)

    Li, Robert; Lall, Ajay; Lai, Everett; Gruson, Konrad I

    2015-10-01

    Interscalene brachial plexus anesthesia is commonly used for outpatient arthroscopic shoulder procedures. Ultrasound guidance has helped to minimize the cardiac, neurologic, and pulmonary complications associated with this block. Although rarely reported, pneumothorax may occur as a result of direct lung injury and even in a delayed fashion. We present a case of tension pneumothorax in a patient undergoing arthroscopic rotator cuff repair under both interscalene regional and general anesthesia. Surgeons and anesthesiologists must remain aware that ultrasound-guided interscalene blocks may be associated with pneumothorax and must initiate treatment expeditiously.

  2. Tension Pneumothorax as a Complication of Inadvertent Pleural Tears During Posterior Spinal Surgery.

    Science.gov (United States)

    Lewis, Stephen J; Keshen, Sam G N; Lewis, Noah D H; Dear, Taylor E; Mehrkens, Arne; Niazi, Ahtsham U

    2014-07-01

    To review and expose the occurrences of tension pneumothorax as a result of pleural tear during posterior spinal surgery. Intraoperative reports were retrospectively reviewed for 2 patients who underwent posterior spinal fusion and experienced pleural tear and subsequent tension pneumothorax. Surgical decisions for recognition and treatment were also reviewed. Unrecognized pleural tearing led to the formation of tension pneumothorax in both patients studied. Onset of respiratory signs and symptoms were delayed, occurring in the recovery room for the first patient and intraoperatively for the second. Both patients were successfully treated with conversion to open pneumothorax and placement of chest tubes. Tension pneumothorax is a complication that can arise during posterior thoracic spinal surgery as a result of an inadvertent pleural tear. Awareness of this potentially fatal complication will greatly help in the timely recognition and treatment of this condition if this situation occurs. The authors recommend a low threshold for chest tube placement in patients with known or suspected pleural tears or in patients with undiagnosed respiratory failure undergoing posterior thoracic spine surgery. Copyright © 2014 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  3. 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...... but later developing with tension pneumothorax, and mediastinitis caused by esophageal perforation. The patient was treated with thoracotomy with primary suture and oesophageal stent placement. He had a long period of recovery and was discharged after 98 days. Boerhaaves syndrome is often delayed and must...

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

    Science.gov (United States)

    2012-07-06

    JG, Kerr ST, et al.: Needle versus tube thoracostomy in a swine model of traumatic tension hemopneumpothorax Prehosp Emerg Care. 2009; 13:18-27 3...Zengerink I, Brink PR, Laupland KB, et al: Needle thoracostomy in the treatment of tension pneumothorax in trauma patients: What size needle? J Trauma...2008; 64:111-114 5. Inaba K, Branco B, Eckstein M, et al: Optimal positioning for emergent needle thoracostomy : a cadaver-based study. J Trauma

  5. [The treatment of iatrogenic pneumothorax with small-gauge catheters. The author's personal experience in 30 cases].

    Science.gov (United States)

    Pancione, L

    2000-01-01

    Pneumothorax (PNX) is the most frequent complication in patients who have undergone lung biopsy. If PNX is asymptomatic and 30% and the patient is symptomatic treatment is needed. As a rule surgery is required and patients are hospitalized and undergo intrathoracic drainage with positioning of a large gauge catheter--i.e. over 15 French (F). In the last 10 years radiologists have begun treating PNX with much smaller catheters (7-10 F). We report the execution technique using 6.3 F catheters and the results obtained in 30 patients with symptomatic iatrogenic PNX and/or iatrogenic PNX > 30%. All the patients underwent CT-guided lung biopsy. Immediately after the procedure some follow-up scans were performed and a further expiratory radiograph with the patient in upright position was carried out after at least 2 hours. If an asymptomatic PNX 30% an intrathoracic drainage catheter was positioned. Under fluoroscopic or CT guidance we positioned a 5.7 F intrathoracic pig-tail catheter at a point corresponding to the 3rd or 4th intercostal space on the midclavear line. After manual suction of intrathoracic air we connected the catheter to a Hemlick valve and repeated the chest radiograph 4 hours later. If the PNX had not reformed the patient was discharged and submitted to radiographic follow-up every 24 hours for 3-5 days. On the contrary if the PNX had reformed, or if pain and/or dyspnea symptoms or signs persisted, the catheter was connected to a continuous-suction system and the patient rehospitalized for about 6 days. Oximetry was performed in all patients before biopsy, on PNX diagnosis, and after pulmonary re-expansion. All the cases were resolved and 9 patients were followed-up in the outpatients department. Drainage had to be repeated in 2 patients only and the 5.7 F catheters replaced with an 8 F and a 10 F catheters. Oximetric data were always correlated with the presence/absence of PNX. In particular, in PNX > 30% we found over 10% reduction relative to

  6. 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.

  7. Thoracic needle decompression for tension pneumothorax: clinical correlation with catheter length

    Science.gov (United States)

    Ball, Chad G.; Wyrzykowski, Amy D.; Kirkpatrick, Andrew W.; Dente, Christopher J.; Nicholas, Jeffrey M.; Salomone, Jeffrey P.; Rozycki, Grace S.; Kortbeek, John B.; Feliciano, David V.

    2010-01-01

    Background Tension pneumothorax requires emergent decompression. Unfortunately, some needle thoracostomies (NTs) are unsuccessful because of insufficient catheter length. All previous studies have used thickness of the chest wall (based on cadaver studies, ultrasonography or computed tomography [CT]) to extrapolate probable catheter effectiveness. The objective of this clinical study was to identify the frequency of NT failure with various catheter lengths. Methods We evaluated the records of all patients with severe blunt injury who had a prehospital NT before arrival at a level-1 trauma centre over a 48-month period. Patients were divided into 2 groups: helicopter (4.5-cm catheter sheath) and ground ambulance (3.2 cm) transport. Success of the NT was confirmed by the absence of a large pneumothorax on subsequent thoracic ultrasonography and CT. Results Needle thoracostomy decompression was attempted in 1.5% (142/9689) of patients. Among patients with blunt injuries, the incidence was 1.4% (101/7073). Patients transported by helicopter (74%) received a 4.5-cm sheath. The remainder (26% ground transport) received a 3.2-cm catheter. A minority in each group (helicopter 15%, ground 28%) underwent immediate chest tube insertion (before thoracic ultrasound) because of ongoing hemodynamic instability. Failure to decompress the pleural space by NT was observed via ultrasound and/or CT in 65% (17/26) of attempts with a 3.2-cm catheter, compared with only 4% (3/75) of attempts with a 4.5-cm catheter (p < 0.001). Conclusion Tension pneumothorax decompression using a 3.2-cm catheter was unsuccessful in up to 65% of cases. When a larger 4.5-cm catheter was used, fewer procedures (4%) failed. Thoracic ultrasonography can be used to confirm NT placement. PMID:20507791

  8. Spontaneous tension pneumothorax during laparoscopic cholecystectomy secondary to congenital diaphragm defects

    Institute of Scientific and Technical Information of China (English)

    Zhengnian Ding; Qinhai Zhou; Bo Gui

    2009-01-01

    A 67-year-old woman with chronic cholecystitis was scheduled to have laparoscopic cholecystectomy under general anesthesia. About 5~10 min after the CO2 intraperitoneal insufflation, the peak airway pressure gradually increased from 15 cmH2O to 27 cmH2O, the end-tidal CO2(EtCO2) from 32 mmHg to 56 mmHg. The SpO2 decreased from 100% to 96%, and blood pressure from 135/80 mmHg to 80/ 52 mmHg. A fight side tension pneumothorax was confirmed and a drainage tube was placed in the fight pleura] cavity. As the continuous gas leakage from the drainage tube was noted, even as ventilation was withheld, the diaphragm was carefully examined and a porous diaphragm was found. These defects were then patched with biomedical materials. The operation was finished uneventfully. It was concluded that in a patient with a tension pneumothorax during laparoscopic surgery, a diaphragm defect should be taken into consideration.

  9. Is routine tube thoracostomy necessary after prehospital needle decompression for tension pneumothorax?

    Science.gov (United States)

    Dominguez, Kathleen M; Ekeh, A Peter; Tchorz, Kathryn M; Woods, Randy J; Walusimbi, Mbaga S; Saxe, Jonathan M; McCarthy, Mary C

    2013-03-01

    Thoracic needle decompression is lifesaving in tension pneumothorax. However, performance of subsequent tube thoracostomy is questioned. The needle may not enter the chest, or the diagnosis may be wrong. The aim of this study was to test the hypothesis that routine tube thoracostomy is not required. A prospective 2-year study of patients aged ≥18 years with thoracic trauma was conducted at a level 1 trauma center. Forty-one patients with chest trauma, 12 penetrating and 29 blunt, had 47 needled hemithoraces for evaluation; 85% of hemithoraces required tube thoracostomy after needle decompression of the chest (34 of 41 patients [83%]). Patients undergoing needle decompression who do not require placement of thoracostomy for clinical indications may be assessed using chest radiography, but thoracic computed tomography is more accurate. Air or blood on chest radiography or computed tomography of the chest is an indication for tube thoracostomy. Copyright © 2013 Elsevier Inc. All rights reserved.

  10. Point-of-care pleural and lung ultrasound in a newborn suffering from cardiac arrest due to tension pneumothorax after cardiac surgery.

    Science.gov (United States)

    Polito, Angelo; Biasucci, Daniele G; Cogo, Paola

    2016-02-01

    We report the case of a 12-day-old newborn affected by coarctation of the aorta and intraventricular defect who underwent coarctectomy and pulmonary artery banding. On post-operative day 7, the patient suffered from pulseless electric activity due to tension pneumothorax. Point-of-care ultrasound was performed during cardiopulmonary resuscitation in an attempt to diagnose pneumothorax. The diagnosis was made without delaying or interrupting chest compressions, and the pneumothorax was promptly treated.

  11. Do mannequin chests provide an accurate representation of a human chest for simulated decompression of tension pneumothoraxes?

    Institute of Scientific and Technical Information of China (English)

    Malcolm J Boyle; Brett Williams; Simon Dousek

    2012-01-01

    BACKGROUND:Tension pneumothorax(TPX) is an uncommon but life-threatening condition.It is important that this uncommon presentation,managed by needle decompression,is practised by paramedics using a range of educationally sound and realistic mannequins.The objective of this study is to identify if the chest wall thickness(CWT) of training mannequins used for chest decompression is an anatomically accurate representation of a human chest.METHODS:This is a two-part study.A review of the literature was conducted to identify chest wall thickness in humans and measurement of chest wall thickness on two commonly used mannequins.The literature search was conducted using the Cochrane Central Register of Controlled Trials,MEDLINE,CINAHL,and EMBASE databases from their beginning until the end of May 2012.Key words included chest wall thickness,tension pneumothorax,pneumothorax,thoracostomy,needle thoracostomy,decompression,and needle test.Studies were included if they reported chest wall thickness.RESULTS:For the literature review,4 461 articles were located with 9 meeting the inclusion criteria.Chest wall thickness in adults varied between 1.3 cm and 9.3 cm at the area of the second intercostal space mid clavicular line.The Laerdal? manikin in the area of the second intercostal space mid clavicular line,right side of the chest was 1.1 cm thick with the left 1.5 cm.The MPL manikin in the same area or on the right side of the chest was 1.4 cm thick but on the left 1.0 cm.CONCLUSION:Mannequin chests are not an accurate representation of the human chest when used for decompressing a tension pneumothorax and therefore may not provide a realistic experience.

  12. Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax?

    Science.gov (United States)

    Martin, Matthew; Satterly, Steven; Inaba, Kenji; Blair, Kelly

    2012-12-01

    Tension pneumothorax (tPTX) is a common and potentially fatal event after thoracic trauma. Needle decompression is the currently accepted first-line intervention but has not been well validated. The purpose of this study was to evaluate the effectiveness of a properly placed and patent needle thoracostomy (NT) compared with standard tube thoracostomy (TT) in a swine model of tPTX. Six adult swine underwent instrumentation and creation of tPTX using thoracic CO2 insufflation via a balloon trocar. A continued 1 L/min insufflation was maintained to simulate an ongoing air leak. The efficacy and failure rate of NT (14 gauge) compared with TT (34F) was assessed in two separate arms: (1) tPTX with hemodynamic compromise and (2) tPTX until pulseless electrical activity (PEA) obtained. Hemodynamics was assessed at 1 and 5 minutes after each intervention. A reliable and highly reproducible tPTX was created in all animals with a mean insufflation volume of 2441 mL. tPTX resulted in the systolic blood pressure declining 54% from baseline (128-58 mm Hg), cardiac output declining by 77% (7-1.6 L/min), and equalization of central venous pressure and wedge pressures. In the first arm, there were 19 tPTX events treated with NT placement. All NTs were patent on initial placement, but 5 (26%) demonstrated mechanical failure (due to kinking, obstruction, or dislodgment) within 5 minutes of placement, all associated with hemodynamic decline. Among the 14 NTs that remained patent at 5 minutes, 6 (43%) failed to relieve tension physiology for an overall failure rate of 58%. Decompression with TT was successful in relieving tPTX in 100%. In the second arm, there were 21 tPTX with PEA events treated initially with either NT (n = 14) or TT (n = 7). The NT failed to restore perfusion in nine events (64%), whereas TT was successful in 100% of events as a primary intervention and restored perfusion as a rescue intervention in eight of the nine NT failures (88%). Thoracic insufflation produced

  13. Clinical characteristics, hospital outcome and prognostic factors of patients with ventilator-related pneumothorax.

    Science.gov (United States)

    Hsu, C-W; Sun, S-F; Lee, D L; Chu, K-A; Lin, H-S

    2014-01-01

    Mechanical ventilation is a common cause of iatrogenic pneumothorax in intensive care units (ICU). Most of the patients with ventilator-related pneumothorax (VRP) have underlying lung diseases and is associated with increased morbidity and mortality. The prognostic factors of VRP are not clear. The objective of this study was to find the possible prognostic factors. Analysis of retrospectively collected data of patients with pneumothorax induced by mechanical ventilation. Data were obtained concerning demographics, acute physiology and chronic health evaluation (APACHE) II score, organ failure, underlying diseases, interval between the start of mechanical ventilation and pneumothorax, arterial blood gas, respiratory parameters and patient outcomes. One hundred and twenty-four patients with VRP were included for analysis. The incidence rate of VRP was 0.4% (124/31,660), and the mortality rate was 77.4%. The patients with VRP had higher hospital mortality rate than that of mechanically ventilated patients without pneumothorax (77.4% vs. 13.7%, PVRP occurred in the early phase of mechanical ventilation, and 8.9% of the patients had a later episode of pneumothorax on the opposite lung. The interval between two episodes of VRP was short, at a median time of 2 days. Cox regression analysis showed that tension pneumothorax (P=0.001), PaO2/FiO2VRP patients with tension pneumothorax or PaO2/FiO2VRP patients with PaO2/FiO2≥200 mmHg.

  14. Pneumopericardium, pneumomediastinum, pneumothorax and pneumoretroperitoneum complicating pulmonary metastatic carcinoma in a cat.

    Science.gov (United States)

    Greci, V; Baio, A; Bibbiani, L; Caggiano, E; Borgonovo, S; Olivero, D; Rocchi, P M; Raiano, V

    2015-11-01

    This report describes a case of severe spontaneous tension pneumopericardium with concurrent pneumomediastinum, pneumothorax and retropneumoperitoneum in a cat presenting with dyspnoea and signs of cardiac tamponade secondary to metastatic pulmonary carcinoma. Spontaneous pneumopericardium is an extremely uncommon condition consisting of pericardial gas in the absence of iatrogenic/traumatic causes. In humans, it has been described secondary to pneumonia or lung abscess and very rarely secondary to pulmonary neoplasia.

  15. 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

  16. 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).

  17. Heimlich valve orientation error leading to radiographic tension pneumothorax: analysis of an error and a call for education, device redesign and regulatory action.

    Science.gov (United States)

    Broder, Joshua S; Fox, James W; Milne, Judy; Theiling, Brent Jason; White, Ann

    2016-04-01

    Medical errors are commonly multifactorial, with adverse clinical consequences often requiring the simultaneous failure of a series of protective layers, termed the Swiss Cheese model. Remedying and preventing future medical errors requires a series of steps, including detection, mitigation of patient harm, disclosure, reporting, root cause analysis, system modification, regulatory action, and engineering and manufacturing reforms. We describe this process applied to two cases of improper orientation of a Heimlich valve in a thoracostomy tube system, resulting in enlargement of an existing pneumothorax and the development of radiographic features of tension pneumothorax. We analyse elements contributing to the occurrence of the error and depict the implementation of reforms within our healthcare system and with regulatory authorities and the manufacturer. We identify features of the Heimlich valve promoting this error and suggest educational, design, and regulatory reforms for enhanced patient safety. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  18. Chemical pleurodesis for spontaneous pneumothorax.

    Science.gov (United States)

    How, Cheng-Hung; Hsu, Hsao-Hsun; Chen, Jin-Shing

    2013-12-01

    Pneumothorax is defined as the presence of air in the pleural cavity. Spontaneous pneumothorax, occurring without antecedent traumatic or iatrogenic cause, is sub-divided into primary and secondary. The severity of pneumothorax could be varied from asymptomatic to hemodynamically compromised. Optimal management of this benign disease has been a matter of debate. In addition to evacuating air from the pleural space by simple aspiration or chest tube drainage, the management of spontaneous pneumothorax also focused on ceasing air leakage and preventing recurrences by surgical intervention or chemical pleurodesis. Chemical pleurodesis is a procedure to achieve symphysis between the two layers of pleura by sclerosing agents. In the current practice guidelines, chemical pleurodesis is reserved for patients unable or unwilling to receive surgery. Recent researches have found that chemical pleurodesis is also safe and effective in preventing pneumothorax recurrence in patients with the first episode of spontaneous pneumothorax or after thoracoscopic surgery and treating persistent air leakage after thoracoscopic surgery. In this article we aimed at exploring the role of chemical pleurodesis for spontaneous pneumothorax, including ceasing air leakage and preventing recurrence. The indications, choice of sclerosants, safety, effects, and possible side effects or complications of chemical pleurodesis are also reviewed here.

  19. [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.

  20. Spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Davari R

    1996-07-01

    Full Text Available A case with bilateral spontaneous pneumothorax was presented. Etiology, mechanism, and treatment were discussed on the review of literature. Spontaneous Pneumothorax is a clinical entity resulting from a sudden non traumatic rupture of the lung. Biach reported in 1880 that 78% of 916 patients with spontaneous pneumothorax had tuberculosis. Kjergaard emphasized 1932 the primary importance of subpleural bleb disease. Currently the clinical spectrum of spontaneous pneumothorax seems to have entered a third era with the recognition of the interstitial lung disease and AIDS as a significant etiology. Standard treatment is including: observation, thoracocentesis, tube thoracostomy. Chemical pleurodesis, bullectomy or wedge resection of lung with pleural abrasion and occasionally pleurectomy. Little information has been reported regarding the efficacy of such treatment in spontaneous pneumothorax secondary to non bleb disease

  1. Iatrogenic neurology.

    Science.gov (United States)

    Sposato, Luciano A; Fustinoni, Osvaldo

    2014-01-01

    Iatrogenic disease is one of the most frequent causes of hospital admissions and constitutes a growing public health problem. The most common type of iatrogenic neurologic disease is pharmacologic, and the central and peripheral nervous systems are particularly vulnerable. Despite this, iatrogenic disease is generally overlooked as a differential diagnosis among neurologic patients. The clinical picture of pharmacologically mediated iatrogenic neurologic disease can range from mild to fatal. Common and uncommon forms of drug toxicity are comprehensively addressed in this chapter. While the majority of neurologic adverse effects are listed and referenced in the tables, the most relevant issues are further discussed in the text.

  2. Catamenial Pneumothorax.

    Science.gov (United States)

    Kolos, Anatoliy; Dzhieshev, Zhaksilik; Dikolaev, Vladimir; Amangaliev, Almaz

    2015-11-01

    The Spanish congress of the European association of pulmonologists and thoracic surgeons, held in 2009, confirmed the international classification of spontaneous pneumothorax in which catamenial (menstrual) pneumothorax was identified. Different from usual pneumothorax, its reason is not because of bleb disease in the lungs, but rather, caused by menstrual cycle in women. The cause was partly studied and explained by several theories. By the first of them, congenital defects (holes, fenestrations) in the diaphragm allow air to get into pleural space because of increased permeability of the fallopian tubes during menstruation. The second hypothesis, the same mechanism is considered, but it has been supposed that a hole in the diaphragm can be caused by endometriosis. The third theory, endometriosis of a pulmonary parenchyma can create leak of air during menstruation. The fourth theory, significance is attached to production of F2 prostaglandin, which is a powerful broncho- and vasoconstriction agent, causing ruptures of alveoli in women in the period of the woman's menstrual cycle. Two groups of patients were identified: with a defect in the diaphragm and without. Existence of such defects is described in 50% of cases. Having a wide clinical experience in the field of thoracic surgery, we, for the first time in practice, diagnosed catamenial pneumothorax in patients with the recurrence course of the disease.

  3. Iatrogenic disease

    NARCIS (Netherlands)

    Nikkels, PGJ

    2015-01-01

    Injury is a feature of all medical practice, but it is perhaps nowhere more accepted as an unavoidable consequence of therapy than in obstetric and neonatal medicine. Treatment is usually benefi cial, but therapeutic procedures may sometimes result in adverse side effects or cause iatrogenic damage.

  4. Iatrogenic meningitis

    Directory of Open Access Journals (Sweden)

    Eduardo Genaro Mutarelli

    2013-09-01

    Full Text Available Iatrogenic meningitis can be caused by a number of mechanisms. The recent case reports of fungal meningitis after application of epidural methylprednisolone caused warning in the medical community. Cases were caused by contaminated lots of methylprednisolone from a single compounding pharmacy. Several medications can cause meninigitis by probable hypersensitivity mechanism. Neurologists should be alert to the recent description of the use of lamotrigine and development of aseptic meningitis.

  5. 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

    OpenAIRE

    2016-01-01

    Introduction: 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. Presentation of case: A 72 year 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 × 3 cm) at the rig...

  6. Catamenial pneumothorax with bullae.

    Science.gov (United States)

    Kawaguchi, Yo; Fujita, Takuya; Hanaoka, Jun

    2015-03-01

    The physiologic mechanisms and diagnostic approach of catamenial pneumothorax remain controversial. We report 3 patients with catamenial pneumothorax with bullae. Endometrial cells in these patients were located around the bullae, suggesting a possible new mechanism for catamenial pneumothorax in which cyclic endometrial shedding in the lung causes destruction of the lining of alveolar epithelial cells and forms bullae. Because intrathoracic endometriosis is considered an underrecognized cause of secondary spontaneous pneumothorax, we performed careful histologic examination for definitive diagnosis of thoracic endometriosis.

  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. Simultaneous bilateral primary spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Arife Zeybek

    2014-04-01

    Full Text Available Simultaneous bilateral primary pneumothorax is a very rare (1.6 / 100,000 and life-threatening condition. Clinical presentation may vary from mild dyspnea to tension pneumothorax. It may be milder particularly in younger patients, but more severe in patients with advanced age, and tube thoracostomy is a life preserver in the latter group. Since mortality and recurrence rates following tube thoracostomy are high, endoscopic approaches to bilateral hemithorax have been reported in literature. Apical wedge resection and pleural procedures are recommended in video thoracoscopy or mini thoracotomy even if no bulla and/or bleb are detected. Bilateral surgical interventions and additional pleural procedures are associated with increased rate of post-operative complications and longer postoperative hospital-stays. As a first-line approach, the surgical method toward any side of lung with air leakage following a previous tube thoracostomy is considered less invasive, especially in younger patients. Here, we present a case of simultaneous bilateral primary spontaneous pneumothorax (SBPSP in a 21-year old male with no history of smoking and chronic pulmonary disease. A unilateral surgical intervention was performed, and no recurrence was observed during 5-year follow up.

  9. The Experience of 20 Cases of Neonatal Pneumothorax Diagnosis and Treatment%20例新生儿气胸的病因分析及治疗体会

    Institute of Scientific and Technical Information of China (English)

    毛旭琴

    2015-01-01

    Objective To investigate the etiology, clinical manifestations, and prevention measures of neonatal pneumothorax.Methods From January 2010 to May 2014, the clinical data of a total of 20 cases of neonatal pneumothorax were retrospectively analyzed.Results 20 cases of pneumothorax patients suffered from the primary disease of the lungs. Among them, the pathologic pneumothorax in 6cases, 5 cases with spontaneous pneumothorax, 9 cases of iatrogenic pneumothorax. 18 patients were cured, in addition, family members in 2 cases give up treatment including 1 tension pneumothorax and hypoxia ischemic encephalopathy in 1 case. 12 cases got a remission by chest closed drainage, 1 case take a turn for the better after puncture extraction, 6 cases are absorbed by itself with conservative treatment.Conclusion We should strengthen the perinatal period health care, prevent preterm birth, reduce asphyxia, the intake of meconium or amniotic fluid. All the same time, it is also necessary to proper recovery and the reasonable application of breathing machine. These all can effectively reduce the occurrence of pneumothorax. To different degree and types of pneumothorax using corresponding treatment measures in time, can significantly reduce the case fatality rate.%目的 探讨新生儿气胸的发病原因、临床表现及防治措施.方法 对2010年1月至2014年5月共20例新生儿气胸的临床资料进行回顾性分析.结果 20例气胸患儿均有肺部原发病,包括病理性气胸6例,自发性气胸5例,医源性气胸9例.治愈18例,家属放弃治疗2例(其中张力性气胸1例,合并缺氧缺血性脑病1例).其中12例经胸腔闭式引流缓解,1例经穿刺抽气后好转,6例经保守治疗自行吸收.结论 应加强围生期保健,防止早产、减少窒息、胎粪及羊水吸入,正确进行复苏,合理应用呼吸机,可有效降低气胸的发生.对不同程度、不同类型的气胸及时采用相应的治疗措施,可显著降低病死率.

  10. 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.

  11. Sonographic diagnosis of pneumothorax.

    Science.gov (United States)

    Volpicelli, Giovanni

    2011-02-01

    Over the last decade, the use of ultrasound as a technique to look for pneumothorax has rapidly evolved. This review aims to analyze and synthesize current knowledge on lung ultrasound targeted at the diagnosis of pneumothorax. The technique and its usefulness in different scenarios are explained, and its merits over conventional radiology are highlighted. A systematic literature search (1995-2010) was performed, involving PubMed, to describe the more recent scientific evidence on the topic. Moreover, this review is also a synopsis of experts' opinion and personal clinical experience. Ultrasound diagnosis of pneumothorax relies on the recognition of four sonographic artifact signs: the lung sliding, the B lines, the lung point, and the lung pulse. Combining these few signs, it is possible to accurately rule in or rule out pneumothorax at the bedside in several different clinical scenarios. Sensitivity of a lung ultrasound in the detection of pneumothorax is higher than that of conventional anterior-posterior chest radiography, and similar to that of computerized tomography. A major benefit of a lung ultrasound is that it can be used quickly to diagnose pneumothorax at the bedside in any critical situation, like cardiac arrest and hemodynamically unstable patients. Moreover, it can be used to detect radio-occult pneumothorax and to quantify the extension of the air layer. Advantages in terms of reduced complexity, feasibility at the bedside, and absence of exposure to ionizing radiation make lung ultrasound the method of choice in several common clinical situations.

  12. 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.

  13. Pneumomediastinum, bilateral pneumothorax, pleural effusion, and surgical emphysema after routine apicectomy caused by vomiting.

    Science.gov (United States)

    Gulati, Archita; Baldwin, Andrew; Intosh, Ian Mc; Krishnan, A

    2008-03-01

    Mediastinal and subcutaneous emphysema may occur after dental and oral surgery as a result of iatrogenic introduction of air or injury to the tracheobronchial tree. We report a patient who developed emphysema and pneumothorax after dentoalveolar surgery, which made diagnosis and management difficult. We suggest that persistent postoperative vomiting caused inhalation of mediastinal and intrathoracic air.

  14. Surgical pneumothorax under spontaneous ventilation—effect on oxygenation and ventilation

    OpenAIRE

    David, Piero; Pompeo, Eugenio; Fabbi, Eleonora; Dauri, Mario

    2015-01-01

    Surgical pneumothorax allows obtaining comfortable surgical space for minimally invasive thoracic surgery, under spontaneous ventilation and thoracic epidural anesthesia, without need to provide general anesthesia and neuromuscular blockade. One lung ventilation (OLV) by iatrogenic lung collapse, associated with spontaneous breathing and lateral position required for the surgery, involves pathophysiological consequences for the patient, giving rise to hypoxia, hypercapnia, and hypoxic pulmona...

  15. Occult pneumothorax, revisited

    Directory of Open Access Journals (Sweden)

    Mangar Devanand

    2010-10-01

    Full Text Available 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 in most patients can be tolerated while other more urgent trauma needs are attended to. However, in certain patients, especially those on mechanical ventilation (with subsequent increase of intrapleural air with positive pressure ventilation, missing the diagnosis of pneumothorax can be deleterious with fatal consequences. This review will discuss the occult pneumothorax in the context of 3 radiological examples, which will further emphasize the entity. Because a negative AP chest radiograph can dangerously delay its recognition, we recommend that any trauma victim presenting to the emergency department with symptoms of respiratory distress should be screened with either thoracic ultrasonography or chest CT scan to avoid missing a pneumothorax.

  16. [Thoracoscopic treatment of recurrent pneumothorax].

    Science.gov (United States)

    Suter, M; Berner, M; Vandoni, R; Cuttat, J F

    1994-04-01

    Spontaneous pneumothorax (PNO) is usually due to rupture of a small subpleural bleb into the pleural cavity and affects mainly young men. After simple drainage, recurrence occurs in about 50% of cases. The risk of recurrence increases after each new PNO. Secondary PNO complicates an underlying pulmonary disease, especially chronic obstructive pulmonary disease with emphysema. A new form of secondary PNO has emerged in the recent years in AIDS patients with pneumocystis carinii pneumonia. We have shifted to a thoracoscopic therapy of PNO since May 1991. 25 PNO in 24 patients (1 bilateral) have been treated since that time up to April 1993. 19 PNO were primary, whereas 6 were secondary, included 3 iatrogenic PNO. Resection of the leaking parenchymal area was performed in 20 patients, and parietal partial pleurectomy was done in 20 cases. In the remaining cases, fibrin glue was applied on the lesion and in 3 cases, chemical pleurodesis was attempted using silver nitrate or talc. 1 AIDS patient died of ARDS. 3 patients had recurrent PNO and had thoracotomy without complication. 21 patients did well. Partial PNO recurred in one of them 4 months later, and was treated by simple needle aspiration. Thoracoscopy is a useful method to treat recurrent or persistent spontaneous PNO. After only 25 cases, our success rate in primary PNO is 90%. There should be a learning curve. On the basis of our experience, we believe that recognition of the lesion and its resection as well as apical parietal pleurectomy are necessary to obtain good results and a low recurrence rate.

  17. Finite Elements Modeling in Diagnostics of Small Closed Pneumothorax.

    Science.gov (United States)

    Lorkowski, J; Mrzygłód, M; Grzegorowska, O

    2015-01-01

    Posttraumatic pneumothorax still remains to be a serious clinical problem and requires a comprehensive diagnostic and monitoring during treatment. The aim of this paper is to present a computer method of modeling of small closed pneumothorax. Radiological images of 34 patients of both sexes with small closed pneumothorax were taken into consideration. The control group consisted of X-rays of 22 patients treated because of tension pneumothorax. In every single case the model was correlated with the clinical manifestations. The procedure of computational rapid analysis (CRA) for in silico analysis of surgical intervention was introduced. It included implementation of computerize tomography images and their automatic conversion into 3D finite elements model (FEM). In order to segmentize the 3D model, an intelligent procedure of domain recognition was used. In the final step, a computer simulation project of fluid-structure interaction was built, using the ANSYS\\Workbench environment of multi-physics analysis. The FEM model and computer simulation project were employed in the analysis in order to optimize surgical intervention. The model worked out well and was compatible with the clinical manifestations of pneumothorax. We conclude that the created FEM model is a promising tool for facilitation of diagnostic procedures and prognosis of treatment in the case of small closed pneumothorax.

  18. Pneumothorax complicating isolated clavicle fracture.

    Science.gov (United States)

    Hani, Redouane; Ennaciri, Badr; Jeddi, Idriss; El Bardouni, Ahmed; Mahfoud, Mustapha; Berrada, Mohamed Saleh

    2015-01-01

    Isolated clavicle fractures are among the commonest of traumatic fractures in the emergency department. Complications of isolated clavicle fractures are rare. Pneumothorax has been described as a complication of a fractured clavicle only rarely in English literature. In all the reported cases, the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, the pneumothorax required a chest drain insertion and the clavicle fracture was treated surgically with good result.

  19. 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...... patients who received their first pacemaker (PM) or cardiac resynchronization device from 1997 to 2008. Multiple logistic regression was used to estimate adjusted odds ratios (aOR) with 95% confidence intervals for the association between risk factors and pneumothorax treated with a chest tube. The median...... 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...

  20. Managing iatrogenic tracheal injuries

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    A. Goonasekera C

    2005-01-01

    Full Text Available We present three cases of iatrogenic tracheal injury. Two patients suffered acute tracheal injuries during anesthesia/surgery, one was managed surgically and the other conservatively. The third case is a delayed tracheal injury presenting as a fistula. The reasons for surgical vs conservative management of tracheal injuries and preventive measures are discussed.

  1. STUDY OF FACTORS INFLUENCING THE NONCLOSURE OF BRONCHOPLEURAL FISTULA IN PATIENTS WITH SPONTANEOUS PNEUMOTHORAX

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    Ejaj Ahmed

    2015-11-01

    Full Text Available A pneumothorax is an abnormal collection of air or gas in the pleural space. Pneumothoraces are essentially of two types, spontaneous and tramautic pneumothoraces, based on whether the lung is diseased or not. Spontaneous pneumothoraces are further of two types- primary and secondary spontaneous pneumothoraces. A subcategory of traumatic pneumothorax is iatrogenic pneumothorax. Hydro-pneumothorax, pyo-pneumothorax and hemo-pneumothorax result from collection of clear fluid, pus and blood respectively in the pleural cavity. A bronchopleural fistula is a communication between the pleural space and the lung. MATERIAL AND METHODS A prospective study of 54 cases of spontaneous pneumothorax with bronchopleural fistula, which were admitted in Department of Pulmonary Medicine, SVRRGGH, Tirupathi, over a period of 1 year from July 2014 to July 2015 was undertaken. Patients with pneumothorax were identified by clinical and radiological examination, where it was necessary for CT chest to be performed. Depending on the chest x ray and CT chest findings, the patients were subjected to tube thoracotomy. Patients who had persistent bronchopleural fistula after 15 days had to be referred to the CT surgeon for decortication or pleurectomy. For all those whose bronchopleural fistula closed by itself, the intercostal tube was removed at the earliest. After completion of the study, the findings and results were analysed and compared with those of the previous studies. RESULTS In the study period, out of 120 pneumothorax patients 54 patients with bronchopleural fistula were diagnosed. In 34 of the 54 patients, that is in 63% the bronchopleural fistula healed spontaneously in 2 weeks’ time. In 16 of the patients even after 15 days of intercostal tube drainage, the bronchopleural fistula did not heal and they had to be referred to the cardiothoracic surgeon for decortication/pleurectomy; 46 of the 54(85.2% were males and 8(14.8% were females; 45 patients (83% had TB

  2. Pneumothorax following ERCP: Report of Two Cases with Different Pathophysiology

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    Kyriakos Neofytou

    2013-01-01

    Full Text Available In the last thirty years, the widespread use of endoscopic retrograde cholangiopancreatography (ERCP has radically changed the management of patients with diseases of the extrahepatic biliary tract and pancreas. Pneumothorax is a rare complication of ERCP. We report two cases of pneumothorax following elective ERCP for ductal stone clearance. The first patient was a 45-year-old female, who developed respiratory distress, abdominal pain, and profoundly abdominal distention immediately after the procedure. Imaging studies revealed the presence of a right-side pneumothorax, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum. The second patient was a 94-year-old female, who developed tension pneumothorax with clinical signs of shock during the procedure. Imaging studies revealed the presence of a right-side pneumothorax without free air in the mediastinum and retroperitoneal space. The imaging findings suggest that the occurrence of this rare complication in our patients was caused by entirely different pathophysiological mechanisms. Both patients were successfully treated with chest tube insertion, and no further intervention was required. Clinicians should be aware of this serious complication because delayed diagnosis may involve significant morbidity and mortality risks.

  3. Subacute Tension Hemopneumothorax with Novel Electrocardiogram Findings

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    Saks, Mark A

    2010-02-01

    Full Text Available This case report describes a patient with a subacute right-sided tension hemopneumothorax following an occult stab. The patient’s electrocardiogram (ECG, performed as part of a standardized triage process, demonstrated significant abnormalities that misguided initial resuscitation, but resolved following evacuation of the tension hemopneumothorax. Tension pneumothorax is typically regarded as an immediately life-threatening condition that requires emergent management with needle or tube thoracostomy. However, we believe that subacute tension pneumothorax may be a rarely observed clinical phenomenon and may lead to unique ECG findings. We believe that the ECG changes we observed provided an early clue to the eventual diagnosis of a subacute tension pneumothorax and have not been previously described in this setting. . [West J Emerg Med. 2010; 11(1:86-89].

  4. [Neonatal pneumothorax and urinary tract malformation. 3 cases].

    Science.gov (United States)

    Chabrolle, J P; Brioude, R; Guerin, J; de Montis, G

    1976-10-01

    Three newborn male infants are reported who presented with a tension pneumothorax in the first few hours of life. Early in one case and after intervals of one month and eight months in the others attention was drawn to the urinary tract. Radiological investigations revealed morphological abnormalities of the kidneys and the urinary tract itself. The pathogenesis is discussed and an intravenous pyelogram is recommended before the development of clinical features. In this way early diagnosis might allow treatment prior to renal involvement.

  5. Iatrogenic Tumor Implantation

    Institute of Scientific and Technical Information of China (English)

    Ying Ma; Ping Bai

    2008-01-01

    Iatrogenic tumor implantation is a condition that results from various medical procedures used during diagnosis or treatment of a malignancy. It involves desquamation and dissemination of tumor cells that develop into a local recurrence or distant metastasis from the tumor under treatment. The main clinical feature of the condition is nodules at the operation's porous channel or incision, which is easily diagnosed in accordance with the case history. Final diagnosis can be made based on pathological examination. Tumor implantation may occur in various puncturing porous channels, including a laparoscopic port, abdominal wall incision, and perineal incision, etc. Besides a malignant tumor,implantation potential exists with diseases, such as a borderline tumor and endometriosis etc. Once a tumor implantation is diagnosed, or suspected, surgical resection is usually conducted.During the diagnosis and treatment of diseases, avoiding and reducing iatrogenic implantation and dissemination has been regarded as an important principle for surgical treatment of tumors. In a clinical practice setting, if possible, excisional biopsy should be employed, if a biopsy is needed. Repeated puncturing should be avoided during a paracentesis. In a laparoscopic procedure, the tissue is first put into a sample bag and then is taken out from the point of incision. After a laparoscopic procedure, the peritoneum, abdominal muscular fasciae, and skin should be carefully closed, and/or the punctured porous channel be excised. In addition, the sample/tissue should be rinsed with distilled water before surgical closure of the abdominal cavity,allowing the exfoliated tumor cells to swell and rupture in the hypo-osmolar solution. Then surgical closure can be conducted following a change of gloves and equipment. The extent of hysteromyomectomy should as far as possible be away from the uterine cavity. The purpose of this study is to make clinicians aware of the possibility of tumor implantation

  6. Iatrogenic Lens Injuries

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    Ümit Kamış

    2012-12-01

    Full Text Available During intraocular surgery, undesired damages of various etiology may occur in adjacent tissues. One of these tissues is the crystalline lens, which may be traumatized both in anterior segment and posterior segment surgeries, and when damaged, it usually causes marked decrease in visual acuity. The leading causes of iatrogenic lens injuries are intravitreal injection, laser iridotomy, phakic intraocular lens implantation, anterior chamber paracentesis, and vitreoretinal surgery. When crystalline lens damage occurs, its negative effect on visual function may be eliminated by performing cataract surgery intraoperatively or in elective conditions. (Turk J Ophthalmol 2012; 42: Supplement 27-30

  7. [Exceptional iatrogenic ureteral rupture].

    Science.gov (United States)

    Martínez-Vieira, Almudena; Valera-Sánchez, Zoraida; Sousa-Vaquero, José María; Palacios-González, Carmen; García-Poley, Antonio; Bernal-Bellido, Carmen; Alamo-Martínez, José María; Millán-López, Ana; Blanco-Domínguez, Manuel; Galindo-Galindo, Antonio

    2005-08-01

    Rupture of the ureter is an infrequent event that can have serious consequences. The most frequent cause is surgical iatrogenic ureter disease. Other possible causes are urological procedures and urographic studies. In our patient, which, to our knowledge, is the first to be reported in the literature, the ureteral rupture was produced by a traumatic urinary catheterism, because the balloon was filled inside the ureter. The normal presentation is nephritic colic, although acute abdomen is also a possibility. The possibility of ureteral rupture in abdominopelvic surgery or in urological techniques should be evaluated when patients present these clinical symptoms. Treatment is surgical, although in some cases conservative measures can be used.

  8. Iatrogenic causes of infertility.

    Science.gov (United States)

    Schoysman, R; Segal, L

    1990-01-01

    The Authors review the list of the iatrogenic causes of infertility. In their opinion the more delicate the structure, the more heavy the price paid to clumsy or erroneous investigation. Such eventual incompetence may lead to further damage of the already existing situation. The Authors however look at the future with relative optimism: incidents become rarer, specialists in gynecology and infertility pay more attention to the delicacy of genital structures and there is an encouraging tendency to refer to infertility specialists those cases who need adequate work-up of their condition.

  9. Severe iatrogenic nostril stenosis

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    Ali Ebrahimi

    2015-01-01

    Full Text Available Nostril stenosis (narrowing of the nasal inlet is an uncommon deformity which results in aesthetic and breathing discomfort in patients. The literature review shows that trauma, infection, iatrogenic insults and congenital lesions are major causes of stenosis. Nowadays, rhinoplasty is one of most popular aesthetic surgeries which may have complications such as bleeding, swelling, bruising, asymmetry, obstruction of nasal airways. We present a 30-year-old female patient, who complained about breathing and aesthetic difficulties due to external nasal valve obstruction and nasal deformity. Past medical history showed that the patient had undergone three unsuccessful rhinoplasty surgeries with aesthetic goals.

  10. 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....

  11. [Primary heterotopic pleural hydatid cyst presenting as a pneumothorax].

    Science.gov (United States)

    Marghli, A; Ayadi-Kaddour, A; Ouerghi, S; Boudaya, M S; Zairi, S; Smati, B; Mestiri, T; Kilani, T

    2011-03-01

    Hydatid cyst is a parasitic disease that is endemic in many countries. Pneumothorax may be a presentation of this disease that presents urgent problems of diagnosis and treatment. We report the case of a 23-year-old woman, amenorrheic for 22 weeks, who presented with chest pain and dyspnoea. Chest x-ray revealed a right-sided tension pneumothorax. A check x-ray after drainage showed a homogeneous opacity of water density occupying the lower 2/3 of the right hemithorax. Thoracic ultrasound suggested an uncomplicated hydatid cyst at the right base. Surgical exploration revealed a hydatid cyst 14cm in diameter in the pleural space, and a cavity in the right lower lobe with two bronchial fistulae. Treatment consisted of removal of the cyst intact, closure of the bronchial fistulae and capitonnage of the residual cavity. The postoperative course was uncomplicated. Primary heterotopic pleural hydatid cyst is an exceptional cause of pneumothorax that should considered in countries where hydatid disease is endemic. Treatment is surgical following drainage of the pneumothorax. Copyright © 2011 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  12. Acupuncture-Related Pneumothorax.

    Science.gov (United States)

    Hampton, David A; Kaneko, Robert T; Simeon, Erika; Moren, Alexis; Rowell, Susan; Watters, Jennifer M

    2014-08-01

    Background: Acupuncture-related pneumothorax (PTX) is a poorly reported complication of thoracic needling. Recent Chinese literature reviews cited PTXs as the most common adverse outcome. Because of delayed presentation, this complication is thought to be underrecognized by acupuncturists and is largely addressed by hospital and emergency room personnel. The goal of this case study was to demonstrate common risk factors for a PTX, the mechanisms for its development, and protocols to use if one is suspected. Case: A 43-year-old, athletic female with chronic neck pain that was poorly managed with oral medications sought an alternative intervention for pain control. Her treatment plan consisted of weekly acupuncture sessions in the prone and supine positions targeting points along the Bladder, Gall Bladder, and Small Intestine meridians, as well as the right scapular Ah Shi point. She also received infrared lamp therapy. The aim of this approach was to help the patient achieve subjective pain reduction and increased range of motion. Results: One hour after her third treatment session, this patient experienced pleuritic chest pain and dyspnea. She was transported to a local Level-1 trauma center by emergency medical services and was diagnosed with a right-sided PTX. Conclusions: The acupoints addressed, a practitioner's knowledge of variations in anatomy, and a patient's body habitus and medical history are risk factors for PTX development. A patient's initial presentation does not predict future outcome. A benign presentation can evolve into a potentially life-threatening cardiovascular collapse. When PTX is suspected, discussing it with the patient and facilitating appropriate evaluation and intervention by a tertiary-care facility is warranted.

  13. 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......: An 84-year-old Caucasian woman with dysphagia and at risk of aspiration underwent routine insertion of a nasogastric feeding tube; however, shortly after insertion she developed respiratory distress. A chest X-ray showed the tube had been misplaced into our patient's right lung. The tube was removed......, 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...

  14. 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

  15. EAU guidelines on iatrogenic trauma.

    Science.gov (United States)

    Summerton, Duncan J; Kitrey, Noam D; Lumen, Nicolaas; Serafetinidis, Efraim; Djakovic, Nenad

    2012-10-01

    The European Association of Urology (EAU) Trauma Guidelines Panel presents an updated iatrogenic trauma section of their guidelines. Iatrogenic injuries are known complications of surgery to the urinary tract. Timely and adequate intervention is key to their management. To assess the optimal evaluation and management of iatrogenic injuries and present an update of the iatrogenic section of the EAU Trauma Guidelines. A systematic search of the literature was conducted, consulting Medline and the Cochrane Register of Systematic reviews. No time limitations were applied, although the focus was on more recent publications. The expert panel developed statements and recommendations. Statements were rated according to their level of evidence, and recommendations received a grade following a rating system modified from the Oxford Centre for Evidence-based Medicine. Currently, only limited high-powered studies are available addressing iatrogenic injuries. Because the reporting of complications or sequelae of interventions is now increasingly becoming a standard requirement, this situation will likely change in the future. This section of the trauma guidelines presents an updated overview of the treatment of iatrogenic trauma that will be incorporated in the trauma guidelines available at the EAU Web site (http://www. uroweb.org/guidelines/online-guidelines/). Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  16. Pneumothorax, music and balloons: A case series

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    Shiferaw Dejene

    2013-01-01

    Full Text Available We describe two cases of spontaneous pneumothorax in young healthy adults with no underlying structural lung disease. The onset of pneumothorax was following physical activity including playing musical instruments and blowing of balloons. There is sparse data evaluating the pathophysiology of primary spontaneous pneumothorax in relation to increased mouth pressures. These cases highlight the possible physical effect of valsalva manoeuvre on transpulmonary pressures, and the potential risk of developing pneumothorax in otherwise healthy individuals. This aspect of pneumothorax development is worthy of further exploration, to better elucidate the mechanism and enhance our understanding of this common respiratory presentation.

  17. Iatrogenic nutritional deficiencies.

    Science.gov (United States)

    Young, R C; Blass, J P

    1982-01-01

    This article catalogs the nutritional deficiencies inadvertently introduced by certain treatment regimens. Specifically, the iatrogenic effects on nutrition of surgery, hemodialysis, irradiation, and drugs are reviewed. Nutritional problems are particularly frequent consequences of surgery on the gastrointestinal tract. Gastric surgery can lead to deficiencies of vitamin B12, folate, iron, and thiamine, as well as to metabolic bone disease. The benefits of small bowel bypass are limited by the potentially severe nutritional consequences of this procedure. Following bypass surgery, patients should be monitored for signs of possible nutritional probems such as weight loss, neuropathy, cardiac arrhythmias, loss of stamina, or changes in mental status. Minimal laboratory tests should include hematologic evaluation, B12, folate, iron, albumin, calcium, phosphorus, alkaline phosphatase, transaminases, sodium, potassium, chloride, and carbon dioxide levels. Roentgenologic examination of the bone should also be obtained. Loss of bone substance is a major consequence of many forms of treatment, and dietary supplementation with calcium is warranted. Patients undergoing hemodialysis have shown carnitine and choline deficiencies, potassium depletion, and hypovitaminosis, as well as osteomalacia. Chronic drug use may alter intake, synthesis, absorption, transport, storage, metabolism, or excretion of nutrients. Patients vary markedly in the metabolic effects of drugs, and recommendations for nutrition must be related to age, sex, reproductive status, and genetic endowment. Moreover, the illness being treated can itself alter nutritional requirements and the effect of the treatment on nutrient status. The changes in nutritional levels induced by use of estrogen-containing oral contraceptives (OCs) are obscure; however, the effects on folate matabolism appear to be of less clinical import than previously suggested. Reduction in pyridoxine and serum vitamin B12 levels has been

  18. Bilateral Spontaneous Pneumothorax, Pneumomediastinum, and Subcutaneous Emphysema: Rare and Fatal Complications of Asthma

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    Zeynep Karakaya

    2012-01-01

    Full Text Available Simultaneous bilateral spontaneous pneumothorax (SBSP and pneumomediastinum are complications rarely observed synchronously during an acute asthma attack. It is a clinical condition that manifests itself with serious respiratory distress and must be rapidly diagnosed and treated. Although bilateral spontaneous pneumothorax has already been reported in asthma patients in the literature, its concurrence with subcutaneous emphysema and pneumomediastinum is extremely rare except for iatrogenic conditions. By sharing this case about a 39-year-old patient who presented to the emergency room with severe respiratory distress and developed cardiopulmonary arrest during his physical examination, our aim is to emphasize that a rapid diagnosis and treatment by the emergency physicians is the only way for survival in these patients.

  19. Iatrogenic addiction and its treatment.

    Science.gov (United States)

    Walker, L

    1978-04-01

    Iatrogenic addictions, in contrast to illicit drug addictions, are commonly maintained for years before being brought to the attention of mental health professionals. Typically, by the time treatment is sought, both the physiological addiction and its related psychological problems have encapsulated the patient's life-style. The case histories described here illustrate some of the problems which typify treatment of the iatrogenically drug-dependent patient. Psychotherapeutic strategies utilizing life review, assertion training, and didactic teaching of alternative pain relief methods are often useful. The use of methadone for brief or more extended periods is sometimes helpful as an adjunct to psychotherapy.

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

    Science.gov (United States)

    Riber, Lars P. S.; Olesen, Winnie H.; Licht, Peter B.

    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. Results We identified 134 patients with PSP. Baseline characteristics were similar for patients treated with surgical chest tubes and pigtail catheters. Chest tube duration was not significantly influenced by position of the chest tube tip, but was significantly longer in females (P<0.01), patients <30 years (P=0.01), larger pneumothoraxes (P<0.01), use of surgical chest tubes (P=0.03) and a history of previous pneumothorax (P=0.04). Conclusions Contrary to common belief and guidelines recommendation the position of a chest tube in the pleural cavity did not significantly influence chest tube duration, but it was significantly longer in patients who were treated with a surgical chest tube. PMID:28275481

  1. MESOTHELIOMA PRESENTING WITH PNEUMOTHORAX AND INTERLOBAR TUMOR

    NARCIS (Netherlands)

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

    1991-01-01

    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.

  2. Genetics Home Reference: primary spontaneous pneumothorax

    Science.gov (United States)

    ... Spontaneous pneumothorax. BMJ. 2014 May 8;348:g2928. doi: 10.1136/bmj.g2928. Review. Citation on PubMed Chiu HT, Garcia CK. Familial spontaneous pneumothorax. Curr Opin Pulm Med. 2006 Jul;12(4):268-72. ... 2008 Nov;32(5):1316-20. doi: 10.1183/09031936.00132707. Epub 2008 Jun 25. ...

  3. Pneumothorax: A rare presentation of pulmonary mycetoma

    Directory of Open Access Journals (Sweden)

    Gupta Prem

    2007-01-01

    Full Text Available Pneumothorax due to mycetoma is extremely rare and has been described only in patients undergoing intensive cytotoxic therapy for hematologic malignancies. A non-immunocompromised subject presenting with pneumothorax due to rupture of the mycetoma into the pleural cavity is being described here.

  4. 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.

  5. 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.

  6. Intraoperative Pneumothorax Presenting as Abdominal Distention.

    Science.gov (United States)

    Yang, Stephen Su; Kardash, Kenneth; Sirois, Christian

    2016-01-01

    A 74-year-old man with a history of lung cancer presented for right upper lobectomy. After induction of anesthesia, it was noted that the abdomen became progressively more distended. Soon afterward, there was a significant decrease in tidal volume. Ultrasonography of the lung showed no sign of pneumothorax at the anterior second intercostal space. However, the roentgenograms showed a massive right-sided pneumothorax and extensive pneumoperitoneum. Both the pneumothorax and the pneumoperitoneum were decompressed in the operating room, and the elective lobectomy proceeded as previously planned. The patient was extubated at the end of the operation, and there were no sequelae postoperatively.

  7. Pneumothorax in Liberia: Complications of Tuberculosis

    Directory of Open Access Journals (Sweden)

    Erin Nasrallah

    2013-05-01

    Full Text Available Tuberculosis (TB is a known cause of secondary pneumothorax. In areas with endemic TB, complications from the disease, including pneumothorax, are increasing in prevalence. We present the cases of 3 patients (ages 32 years, 17 years, and 3 months seen in the emergency department at John F. Kennedy Medical Center in Monrovia, Liberia, West Africa. Each presented with shortness of breath and cough, and with some degree of respiratory distress. Airway compromise was present with tracheal or mediastinal deviation. Each patient underwent tube thoracostomy with improvement in pneumothorax and respiratory status. [West J Emerg Med. 2013;14(3:233-235

  8. Spontaneous pneumothorax: time to rethink management?

    Science.gov (United States)

    Bintcliffe, Oliver J; Hallifax, Rob J; Edey, Anthony; Feller-Kopman, David; Lee, Y C Gary; Marquette, Charles H; Tschopp, Jean-Marie; West, Douglas; Rahman, Najib M; Maskell, Nick A

    2015-07-01

    There are substantial differences in international guidelines for the management of pneumothorax and much geographical variation in clinical practice. These discrepancies have, in part, been driven by a paucity of high-quality evidence. Advances in diagnostic techniques have increasingly allowed the identification of lung abnormalities in patients previously labelled as having primary spontaneous pneumothorax, a group in whom recommended management differs from those with clinically apparent lung disease. Pathophysiological mechanisms underlying pneumothorax are now better understood and this may have implications for clinical management. Risk stratification of patients at baseline could help to identify subgroups at higher risk of recurrent pneumothorax who would benefit from early intervention to prevent recurrence. Further research into the roles of conservative management, Heimlich valves, digital air-leak monitoring, and pleurodesis at first presentation might lead to an increase in their use in the future.

  9. A Young Man with Bilateral Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Liese Lieve Willemien Verhaert

    2011-01-01

    Full Text Available Case. A 33-year-old male nonsmoker presented with sudden onset of dyspnoea and thoracic pain. Chest radiograph showed a left-sided pneumothorax. Few days later he developed a right-sided pneumothorax. He had a positive family history of pneumothorax. High-resolution computed tomography of the chest showed multiple pulmonary cysts predominantly located in the lower lung regions. We suspected Birt-Hogg-Dubé syndrome (BHD. Conclusion. Birt-Hogg-Dubé syndrome is a rare autosomal dominant inherited genodermatosis and characterised by clinical manifestations including hamartomas of the skin, renal tumors, and pulmonary cysts with spontaneous pneumothorax. BHD is probably underdiagnosed because of the wide variability in its clinical expression. It is important to recognize these patients because of the possibility of developing renal cancer.

  10. Acupuncture-induced haemothorax: a rare iatrogenic complication of acupuncture.

    Science.gov (United States)

    Karavis, Miltiades Y; Argyra, Erifili; Segredos, Venieris; Yiallouroy, Aneza; Giokas, Georgios; Theodosopoulos, Thedosios

    2015-06-01

    This paper reports a rare iatrogenic complication of acupuncture-induced haemothorax and comments on the importance and need for special education of physicians and physiotherapists in order to apply safe and effective acupuncture treatment. A 37-year-old healthy woman had a session of acupuncture treatments for neck and right upper thoracic non-specific musculoskeletal pain, after which she gradually developed dyspnoea and chest discomfort. After some delay while trying other treatment, she was eventually transferred to the emergency department where a chest X-ray revealed a right pneumothorax and fluid collection. She was admitted to hospital and a chest tube inserted into the right hemithorax (under ultrasound guidance) drained 800 mL of bloody fluid (haematocrit (Hct) 17.8%) in 24 h and 1200 mL over the following 3 days. Her blood Hct fell from 39.0% to 30.8% and haemoglobin from 12.7 to 10.3 g/dL. The patient recovered completely and was discharged after 9 days of hospitalisation. When dyspnoea, chest pain and discomfort occur during or after an acupuncture treatment, the possibility of secondary (traumatic) pneumo- or haemopneumothorax should be considered and the patient should remain under careful observation (watchful waiting) for at least 48 h. To maximise the safety of acupuncture, specific training should be given for the safe use of acupuncture points of the anterior and posterior thoracic wall using dry needling, trigger point acupuncture or other advanced acupuncture techniques.

  11. Five cases of asymptomatic spontaneous pneumothorax.

    Science.gov (United States)

    Kadokura, M; Nonaka, M; Yamamoto, S; Kataoka, D; Tanio, N; Iyano, K; Oki, A; Kawada, T; Takaba, T

    1999-06-01

    Asymptomatic spontaneous pneumothorax (ASPT) is an uncommon condition. Between January 1, 1989 and December 31, 1997, 269 patients were admitted to our department with spontaneous pneumothorax. Of the 269 patients, 5 had no symptoms at the time of discovery. Their ages ranged from 15 to 61 years (mean, 37.8 years), and all of them were male. Of the 5 patients with no complaints, 2 had bilateral metachronous pneumothoraces and 3 had hemilateral pneumothorax. All of these ASPTs were revealed by chest roentgenographs taken during medical examinations or follow-up studies relating to other diseases. The mean value of body mass index (BMI) was 19.96 +/- 1.4 (range 18.7 - 22.1). Two of the 5 patients underwent bilateral partial lung resection. Histopathological examination of the resected specimens showed elastofibrosis, scar formation, and an interruption of the elastic fiber of the pleura. In these 5 cases, clinical courses were uneventful, and relapse of the pneumothorax did not occur. Clinical physicians should be aware of the possibility of asymptomatic pneumothorax, as well as the optimal radiographic techniques for revealing small pneumothoraces.

  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. Can a pneumothorax break your heart?

    Directory of Open Access Journals (Sweden)

    Stylianos Mavridis

    2015-04-01

    Full Text Available Takotsubo cardiomyopathy or apical ballooning is a condition characterized by transitory left ventricular dysfunction, affecting commonly postmenopausal females after foregoing acute emotional or physical stress. We report a case of a 63 year old female presenting with severe dyspnea and right-sided secondary spontaneous pneumothorax, initially treated with tube thoracostomy. Despite the fact that pneumothorax resolved, shortness of breath persisted and due to ST-segment elevation and increased Troponin I levels, she was admitted to cardiac catheterization. A significant coronary stenosis was ruled out and the diagnosis of a Takotsubo cardiomyopathy was established. Electrocardiographic findings were normalized within three days and attributable to prolonged air leakage. A thoracoscopic apex resection followed by a partial parietal pleurectomy was performed. Although Takotsubo cardiomyopathy is a rare syndrome, it should always be considered as a potential cardiac complication of a pneumothorax.

  14. [Pneumothorax revealed by postoperative computed tomography].

    Science.gov (United States)

    Ikeda, Shizuka; Katori, Kiyoshi; Fujimoto, Minoru; Nitahara, Keiichi; Higa, Kazuo

    2005-11-01

    We report a case of pneumothorax revealed by postoperative computed tomography. A 39-year-old obese woman (height 153 cm, weight 70 kg) with fractures of the radius, ulna, clavicle, and femur in a traffic accident, was scheduled for osteosynthesis. Anesthesia was induced with thiopental and maintained with 50% nitrous oxide in oxygen and sevoflurane. The Spo2 decreased from 99% to 94% during the surgery. Bilateral chest sounds were symmetrical. The Spo2 increased to 100% after discontinuation of nitrous oxide. Pneumothorax was not evident on a postoperative chest X-ray, but computed tomography of the chest demonstrated right-sided pneumothorax. An ECG electrode had overlapped the fractured rib on the preoperative chest X-ray.

  15. Medical image of the week: coccidioidomycosis pneumothorax

    Directory of Open Access Journals (Sweden)

    Poojary I

    2013-10-01

    Full Text Available A 36-year-old man with AIDS and disseminated coccidioidomycosis presented with severe right chest pain, shortness of breath, and a right-sided pneumothorax on CXR. A pigtail catheter was placed with near resolution of the pneumothorax. A bronchoscopy with bronchoalveolar lavage revealed spherules on cytology as well as coccidioidomycosis on culture. No other pathogens were identified. The pigtail catheter was removed three days later with resolution of the pneumothorax. Rupture of subpleural coccidioidomycosis cavity into the pleural space resulting in pyopneumothorax and/or bronchopleural fistula is rare with reported rates of 1.4 – 2.6% for cavitary lesions (1. Despite antiretroviral therapy and an undetectable viral load, disease was unresponsive to fluconazole. Therapy was subsequently initiated with amphotericin B lipid complex, which resulted in significant improvement of his disease.

  16. [Iatrogenic evolutive skull fracture (author's transl)].

    Science.gov (United States)

    Villarejo, F; Pascual Castroviejo, I; Dabdoub, C; Bordes, M; Jover, P

    1977-03-01

    A case of growing skull fracture secondary to a maxilofacial operation is reported. Frequency, clinical symptoms, phisiopathology and treatment of growing skull fractures are reviewed and the rarity of the iatrogenic mechanism is stressed.

  17. Iatrogenics in Orthodontics and its challenges

    Science.gov (United States)

    Barreto, Gustavo Mattos; Feitosa, Henrique Oliveira

    2016-01-01

    ABSTRACT Introduction: 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? Objective: 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. PMID:27901237

  18. Infantile iatrogenic cushing′s syndrome

    Directory of Open Access Journals (Sweden)

    Katar Selahattin

    2008-01-01

    Full Text Available High potency or/and extended use of topical corticosteroids, particularly in children, may cause suppression of the hypothalamopituitary-adrenal axis. However, iatrogenic Cushing′s syndrome in infantile age group is very rare and only a few patients have been reported to date in the literature. Here, we report a case of iatrogenic Cushing′s syndrome in a 6-month-old male child whose parents have admitted to the hospital for overweight and skin fragility.

  19. Iatrogenics in Orthodontics and its challenges

    OpenAIRE

    Gustavo Mattos Barreto; Henrique Oliveira Feitosa

    2016-01-01

    ABSTRACT Introduction: 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 ter...

  20. 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.

  1. 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....

  2. Acupuncture-induced pneumothorax: the hidden complication.

    Science.gov (United States)

    Brogan, R J; Mushtaq, F

    2015-05-01

    Acupuncture can be associated with potentially life-threatening complications. Although rare, we feel that potential complications are not being conveyed to patients. We present a case of acupuncture-induced pneumothorax and describe some changes to acupuncture practice that we would like to see implemented.

  3. 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 pneumothora

  4. 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

  5. Iatrogenic intravascular pneumocephalus secondary to intravenous catheterization

    Energy Technology Data Exchange (ETDEWEB)

    Yildiz, Altan; Oezer, Caner; Egilmez, Hulusi; Duce, Meltem Nass; Apaydin, Demir F.; Yalcinoglu, Orhan [Department of Radiology, Faculty of Medicine, Mersin University (Turkey)

    2002-03-01

    The presence of pneumocephalus without a history of intracranial or intrathecal procedures is a significant radiographic finding. Although pneumocephalus means a violation of the dural barrier or the presence of infection, intravascular pneumocephalus is different from intraparenchymal pneumocephalus and its benign nature must be known in the presence of intravenous catheterization. Herein, we present a case of iatrogenic intravascular pneumocephalus with CT findings. To our knowledge, there are only a few reported cases of iatrogenic intravascular pneumocephalus in the literature. Careful intravenous catheterization and diagnosis of the condition on imaging helps to prevent unnecessary treatment procedures. (orig.)

  6. 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

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eui Min; Kim, Hyun Lee; Kim, Dong Hyun [Chosun University, Gwangju (Korea, Republic of)

    2009-02-15

    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.

  7. Endobronchial Watanabe Spigot Placement for a Secondary Pneumothorax.

    Science.gov (United States)

    Ueda, Yuichiro; Huang, Cheng-Long; Itotani, Ryo; Fukui, Motonari

    2015-07-01

    Although bevacizumab has several adverse effects, pneumothorax is rare. This is the first case of initial treatment using an Endobronchial Watanabe Spigot (EWS) for pneumothorax after bevacizumab-containing chemotherapy. A 56-year-old woman with recurrent breast cancer was treated with bevacizumab. Pneumothorax occurred 6 days after the last administration of bevacizumab. The pneumothorax failed to resolve after the chest tube drainage. This was because the bronchopleural fistula formed at the site of the subpleural metastatic lesion. Patient was in need of a surgical repair of the bronchopleural fistula, which could not be carried out due to the recent bevacizumab administration. After the insertion of the EWS, the air leak stopped immediately. A lobectomy was successfully performed for the recurrent pneumothorax and for the resection of the metastatic lung lesion; at a most appropriate duration since the chemotherapy. EWS is useful as the initial palliation of pneumothorax after the treatment with medication causing delayed wound healing.

  8. [Complications in the therapy of spontaneous pneumothorax].

    Science.gov (United States)

    Eggeling, S

    2015-05-01

    The therapy of spontaneous pneumothorax is a common necessity in hospitals of all care hierarchies In addition to sufficient primary treatment by placement of a thorax drainage, knowledge of complicationg constellations, recognition of complications and irregular courses during the therapy of spontaneous pneumothorax are of fundamental importance for achieving a satisfactory treatment outcome. Furthermore, the enlightenment of patients regarding the pathogenesis of the disease, possible measures for influencing the recurrence rate and information about future behavioral and lifestyle modifications are important. The principal complications during hospital treatment can be subdivided into complications of the surgical placement of the thorax drain and relief of the pleural cavity, problems in the management of treatment of the pleural negative pressure, the possibly demanding management of a persisting air leak and the individualized decision-making with respect to an interventional or operative procedure. The most common complicating constellations and possible complications during the inpatient hospital stay are described, the.

  9. 慢性阻塞性肺病合并气胸130例临床分析%Clinical analysis of 130 cases of chronic obstructive pulmonary disease combined with pneumothorax

    Institute of Scientific and Technical Information of China (English)

    谢亦欢; 许衍硕; 叶国辉

    2014-01-01

    Objective To explore clinical features and treatment effect of chronic obstructive pulmonary disease (COPD) combined with pneumothorax.Method 130 cases of COPD combined with pneumothorax in our hospital from August 2008 to August 2013 were analyzed retrospectively.Results In 130 cases of COPD combined with pneumothorax,there were 67 cases of closed pneumothorax,45 cases of traffic pneumothorax,and 18 cases of tension pneumothorax.120 cases cured and 10 cases died,with the mortality rate of 7.69%.Conclusion Patients with COPD and pneumothorax have complex clinical manifestations,serious illness and high mortality rate.%目的 探讨慢性阻塞性肺病(COPD)合并气胸的临床特点和治疗效果.方法 回顾分析本院2008年8月至2013年8月收治入院的130例COPD合并气胸患者的临床资料.结果 130例COPD合并气胸的患者中,闭合性气胸67例,交通型气胸45例,张力型气胸18例.120例患者经治疗后痊愈出院,10例死亡,死亡率7.69%.结论 COPD合并气胸时,临床表现复杂,病情较重,死亡率高.

  10. Short wave diathermy for small spontaneous pneumothorax

    OpenAIRE

    1997-01-01

    BACKGROUND: The treatment of small spontaneous pneumothorax can involve observation, tube thoracostomy, and surgery. This study evaluated the use of short wave diathermy as a method of accelerating the resolution of small pneumothoraces. METHODS: Twenty two patients with pneumothoraces of less than 30% by volume were randomly allocated to receive short wave diathermy for 25 minutes each day (n = 11) or observation with bed rest (n = 11). Chest radiographs were taken until the pneumothor...

  11. Pneumothorax Causing Pneumoperitoneum: Role of Surgical Intervention

    Directory of Open Access Journals (Sweden)

    Fernanda Duarte

    2016-01-01

    Full Text Available The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment is an exploratory laparotomy; nevertheless, not all pneumoperitoneums are due to a perforation and not all of them need surgical intervention. We hereby present a case of pneumoperitoneum due to a diaphragmatic defect, which allowed air from a pneumothorax to escape through the diaphragmatic hernia into the abdominal cavity.

  12. Pneumothorax Causing Pneumoperitoneum: Role of Surgical Intervention

    Science.gov (United States)

    Wentling, Jessica; Anjum, Humayun

    2016-01-01

    The most common cause of a pneumoperitoneum is a perforation of a hollow viscus and the treatment is an exploratory laparotomy; nevertheless, not all pneumoperitoneums are due to a perforation and not all of them need surgical intervention. We hereby present a case of pneumoperitoneum due to a diaphragmatic defect, which allowed air from a pneumothorax to escape through the diaphragmatic hernia into the abdominal cavity. PMID:27656300

  13. 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.

  14. 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 assess...

  15. 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

  16. 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.

  17. Video-Assisted Thoracic Surgery in Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    Calvin SH Ng

    2002-01-01

    Full Text Available The proven safety and efficacy of minimal access video-assisted thoracic surgery has changed the way that spontaneous pneumothorax is managed. This review presents some of the experiences of the decade, discusses the controversies and reviews the current video-assisted thoracic surgical management of spontaneous pneumothorax.

  18. 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.

  19. Biphasic cuirass ventilation for treatment of an air leak after pneumothorax in a patient with nemaline myopathy: a case report.

    Science.gov (United States)

    Hino, Hitomi; Suzuki, Yuka; Ishii, Eiichi; Fukuda, Mitsumasa

    2016-12-01

    We describe an 11-year-old boy with nemaline myopathy who developed tension pneumothorax while undergoing noninvasive positive-pressure ventilation (NIPPV). The patient developed a persistent air leak after pleurodesis with minocycline hydrochloride and lowering of the NIPPV inspiratory pressure. He required additional respiratory support without the high airway pressures that may aggravate pneumothorax. We provided adequate respiratory support without increasing the positive airway pressure using biphasic cuirass ventilation (BCV), which moved the patient's chest wall by negative pressure. The air leak was resolved without any additional treatment. We should provide BCV for patients in whom surgery may have a risk of both extubation failure and postoperative complications before deciding on surgery.

  20. [Principle histoclinical forms of iatrogenic eruptions].

    Science.gov (United States)

    Duperrat, B

    1976-01-01

    The staggering multiplication of chemotherapy and polychemotherapy, in addition to artificial substances introduced into foodstuffs (such as saccharin in certain so-called fruit juices), has resulted in innumerable visceral and cutaneous disorders. Confining ourselves to "iatrogenic" rashes, the mechanism of which is far from being a single entity, we have riviewed the six most common varieties: recurrent fixed pigmented erythema, in which stovarsol has given way to the sulphaguanidines; pigmentogenic rashes with the renewed use of amiodarone; eczema and erythrodermia which may be due to any drug, with or without the influence of the sun; iatrogenic lichens, atebrine having provided all types; bullous conditions, sometimes the final stage of the previous group; finally, Lyell's syndrome. Our aim was to study skin biopsies in all these problems, in order to attempt to discover typical lesions.

  1. 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 each...... center implements a written policy regarding the management of iatrogenic perforation, including the definition of procedures that carry a high risk of this complication. This policy should be shared with the radiologists and surgeons at each center. 2 In the case of an endoscopically identified...... perforation after an endoscopic procedure should be carefully evaluated and documented, possibly with a computed tomography (CT) scan, in order to prevent any diagnostic delay. 4 ESGE recommends that endoscopic closure should be considered depending on the type of perforation, its size, and the endoscopist...

  2. [Spontaneous pneumothorax: unusual manifestation of pulmonary hamartochondroma].

    Science.gov (United States)

    Serhane, Hind; Afandi, Oussama Abdessalam; Msougar, Yassine; Amro, Lamyae

    2016-01-01

    Hamartochondroma is a benign tumor of the tracheobronchial tree, often found incidentally and rarely symptomatic. It is more common in men than in women. Its radiological aspect is often evocative. Surgery is indicated for large and/or symptomatic tumors. Histological diagnosis usually poses no difficulty We report the case of a 30-year-old young patient with no particular past medical history and with spontaneous pneumothorax revealing a large sized hamartochondroma. This rare association could be explained by the fact that tumors of fairly anarchic composition may contain cyst formations that may rupture into the pleura causing effusions.

  3. 新生儿气胸91例临床分析%Clinical Analysis of 91 Cases of Newborn Pneumothorax

    Institute of Scientific and Technical Information of China (English)

    姚海娟; 孙斌

    2013-01-01

    Objective:To investigate the common cause,clinical manifestation,prevention and prognosis of newborn pneumothorax. Method:Ninety-one cases of pneumothorax neonates hospitalized from January 2007 to December 2012 were analyzed retrospectively. Result:There were 23 spontaneous pneumothorax cases(25.3%),68 secondary pneumothorax cases(74.7%)according to the pneumothorax type. The ratio was 52:39 male to female,the average birthweight was 2515.7 g;there were difference of gestation age between spontaneous and secondary pneumothorax(P=0.002). The ratio of unilateral pneumothorax was higher than bilateral(80.2%vs 19.8%). Among secondary pneumothorax,meconium aspiration had the highest percentage. There were differences in treatments of the two types,far stronger treatments were needed for secondary pneumothorax(P=0.026). There were including sedation and oxygen inhalation,puncture and intensity vacuum aspiration,mechanical ventilation;then 80 cases improved(87.9%),7 cases died(7.7%),4 cases discharged on request,there were no statistical differences in death rate between the two groups(P>0.05). Conclusion:Newborn pneumothorax is not rare,secondary pneumothorax,especially caused by medical operation accounts for a large proportion. Doctors should develop the standard clinical manipulation,and try to avoid iatrogenic injury.%目的:研究新生儿气胸常见发病原因、临床表现、防治及预后。方法:回顾性分析本院2007年1月-2012年12月诊断新生儿气胸的91例患儿临床资料,对所搜集病例的临床资料进行统计分析。结果:在91例临床病例中,按气胸类型分类,自发性气胸23例(25.3%),继发性气胸68例(74.7%);男女比例为52:39,平均出生体重2515.7 g;继发性气胸及自发性气胸患儿胎龄构成之间存在差异(P=0.002);单侧气胸比例高于双侧气胸(80.2% vs 19.8%)。继发性气胸中胎粪吸入比例最高;两种类型气胸的临床治

  4. Vented Versus Unvented Chest Seals for Treatment of Pneumothorax and Prevention of Tension Pneumothorax in a Swine Model

    Science.gov (United States)

    2013-07-01

    PTx was limited to 5 minutes to mimic the time lapse that such chest injuries may be covered with a CS in the field . Longer PTx condition without CS...presented as a poster at the 26th annual meeting of the Eastern Association for the Surgery of Trauma (EAST), January 15Y19, 2013, in Scottsdale, Arizona...mediastinum. These findings were consistent with a previous report where a one-way valve dressing was compared with occlusive gauze dressing in a canine

  5. [THE SPONTANEOUS PNEUMOTHORAX INTERPRETATION, DIFFICULTIES DURING HISTIOCYTOSIS X].

    Science.gov (United States)

    Duzhyi, I D; Holubnychyi, S A; Holubnucha, V N; Pustovoy, I A

    2014-01-01

    Since spontaneous pneumothorax can be a complication, and sometimes a manifestation of significant amount of intrathoracic and extrathoracic diseases, verifying the process can be very difficult. One of these diseases is the local (pulmonary) histiocytosis X. Authors cite the etiological diagnosis experience of spontaneous pneumothorax during current pathology. According to their data, spontaneous pneumothorax on the histiocytosis X background found in 3 patients. Complications developed during the disease later stages, and therefore the verification was complex and based on morphological data, consistent with the clinical and radiographic changes.

  6. Iatrogenic urological triggers of autonomic dysreflexia

    DEFF Research Database (Denmark)

    Liu, N; Zhou, M; Biering-Sørensen, F

    2015-01-01

    Med search using AD/ autonomic hyperreflexia and spinal cord injury (SCI). Studies selected for review involved iatrogenic urological triggers of AD in individuals with SCI, including original articles, previous practice guidelines, case reports and literature reviews. Studies that did not report AD or blood...... dyssynergia. Without anesthesia, the majority of individuals develop AD during cystoscopy, transurethral litholapaxy and ESWL. The effectiveness of different anesthesia methods relies on blocking the nociceptive signals from the lower urinary tract (LUT) below the level of the neurological lesion. Other...

  7. 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...

  8. Differentiating Pneumothorax from the Common Radiographic Skinfold Artifact.

    Science.gov (United States)

    Kattea, M Obadah; Lababede, Omar

    2015-06-01

    Pneumothorax can be a critical medical condition. The radiographic curvilinear appearance of pneumothorax can be mimicked by a skinfold artifact. Radiographic differentiation of the two entities is achieved in most cases by careful analysis of the characteristics of the linear shadow and its course. A thin, sharply defined opaque density representing the visceral pleura is the hallmark of pneumothorax. The added density of a skinfold presents as a broad opacity, which is outlined laterally by a sharply defined lucent line as a result of the Mach band effect and adjacent air. Unlike pneumothorax, a skinfold produces a line that does not follow the expected course of visceral pleura. Additional features, such as the absence of increased lucency laterally and the projection of lung markings across the curvilinear shadow, can help in the correct identification of skinfolds. Repeating the chest radiograph or using other imaging modalities can be considered in difficult cases.

  9. PNEUMOTHORAX AFTER MODIFIED RADICAL MASTECTOMY UNDER GENERAL ANESTHESIA

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    Amminikutty

    2014-11-01

    Full Text Available A 67 yrs old lady who underwent modified Radical mastectomy under General Anesthesia developed pneumothorax in the immediate post-operative period. She was treated with chest tube insertion and was discharged from hospital 8 days later

  10. Coexistence of pneumothorax and chilaiditi sign:A case report

    Institute of Scientific and Technical Information of China (English)

    Tangri Nitin; Singhal Sameer; Sharma Priyanka; Mehta Dinesh; Bansal Sachin; Bhushan Neeraj; Singla Sulbha; Singh Puneet

    2014-01-01

    We present a case of 50 year old male patient with coexistence of Pneumothorax and Chilaiditi sign. Chilaiditi sign is an incidental radiographic finding of a usually asymptomatic condition in which a part of intestine is located between the liver and diaphragm; however, the term“Chilaiditi syndrome”is used for symptomatic hepatodiaphragmatic interposition. The patient had no symptoms of abdominal pain, constipation, diarrhea, or emesis. Incidentally, Chilaiditi sign was diagnosed on chest radiography. Pneumothorax is defined as air in the pleural space. Pneumothoraces are classified as spontaneous or traumatic. Spontaneous pneumothorax is labelled as primary when no underlying lung disease is present, or secondary, when it is associated with pre-existing lung disease. Our case is the rare in the literature indicating the coexistence of Chilaiditi sign and pneumothorax.

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

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    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.

  12. Poland's syndrome and recurrent pneumothorax: is there a connection?

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    Stamoulis Konstantinos

    2011-03-01

    Full Text Available Abstract Aim. To investigate the possible connection of Poland's syndrome with the presence of lung bullae and, thus, with an increased risk for recurrent pneumothorax. Patients-methods. Two male patients, aged 19 and 21 years respectively were submitted to our department after their second incident of pneumothorax. Both had Poland's syndrome (unilaterally hypoplastic chest wall with pectoralis major muscle atrophy and both had multiple bullae to the ipsilateral lung based on CT findings. The patients were treated operatively (bullectomy, lung apicectomy, partial parietal pleurectomy and chemical pleurodesis due to the recurrent state of their pneumothorax. Results. The patients had good results with total expansion of the affected lung. Conclusions. Poland's syndrome can be combined with ipsilateral presence of lung bullae, a common cause of pneumothorax. Whether this finding is part or a variation of the syndrome needs to be confirmed by a larger number of similar cases.

  13. Poland's syndrome and recurrent pneumothorax: is there a connection?

    Science.gov (United States)

    2011-01-01

    Aim. To investigate the possible connection of Poland's syndrome with the presence of lung bullae and, thus, with an increased risk for recurrent pneumothorax. Patients-methods. Two male patients, aged 19 and 21 years respectively were submitted to our department after their second incident of pneumothorax. Both had Poland's syndrome (unilaterally hypoplastic chest wall with pectoralis major muscle atrophy) and both had multiple bullae to the ipsilateral lung based on CT findings. The patients were treated operatively (bullectomy, lung apicectomy, partial parietal pleurectomy and chemical pleurodesis) due to the recurrent state of their pneumothorax. Results. The patients had good results with total expansion of the affected lung. Conclusions. Poland's syndrome can be combined with ipsilateral presence of lung bullae, a common cause of pneumothorax. Whether this finding is part or a variation of the syndrome needs to be confirmed by a larger number of similar cases. PMID:21418595

  14. Catamenial pneumothorax due to solitary localization of diaphragmatic endometriosis

    Directory of Open Access Journals (Sweden)

    Stefano Elia

    2015-01-01

    Conclusion: Catamenial pneumothorax is the most common presentation of thoracic endometriosis syndrome and should always be suspected in women in childbearing age. Treatment option are still debated but best results are achieved by videothoracoscopic pleurodesis combined with hormonal therapy.

  15. Double-lung point sign in traumatic pneumothorax.

    Science.gov (United States)

    Aspler, Anne; Pivetta, Emanuele; Stone, Michael B

    2014-07-01

    Lung ultrasound has emerged as a rapid and accurate screening tool for pneumothorax. The lung point sign, a sonographic representation of the point on the chest wall where the pleural layers re-adhere, is 100% specific to confirm the diagnosis. Double lung point sign for a single pneumothorax is extremely unusual and has only been reported twice in the literature. A 49-year-old woman was transported to the emergency department (ED) intubated and sedated with severe head injury. She remained hemodynamically stable without respiratory compromise throughout her ED course. Chest computed tomography was notable for an anterior left pneumothorax with underlying pulmonary contusion. Bedside ultrasound of this region revealed a double lung point sign. Our case report is the first to confirm association of the double lung point sign with a single pneumothorax on corresponding computed tomographic imaging.

  16. A Review of our Clinical Experience: 107 Spontaneus Pneumothorax Cases

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    Ufuk Cobanoglu

    2011-09-01

    Full Text Available Aim: Pneumothorax is the common and life threatening problem of thoracic surgery, needs urgent intervention. In this study, spontaneous pneumothorax (SP cases were divided into two groups and evaluated retrospectively according to age, sex, diagnostic methods, treatments, and results. Material and Methods: Between June 2003 and May 2006, 107 patients with SP were enrolled into our study. There were 44 (41.13% primary spontaneous pneumothorax (PSP and 74 (58.87% secondary spontaneous pneumothorax (SSP patients. Age, gender, underlying lung disease, smoking history, symptoms, diagnosis, treatment type, surgical indication, morbidity, recurrence, mortality, and hospital stay of the patients were reviewed. Results: 77 patients (71.96 % were male and 30 patients (28.04 % were female and their mean age was 45.7±19.1 years. Chronic obstructive lung disease (COLD was the most common (39.68% cause detected in the cases with secondary spontaneous pneumothorax. In twenty (18.695% patients recurrence was observed and sixteen (14.95 % of these patients underwent surgery. Whereas 49 (%45.79 patients were managed by tube thoracostomy,21(19.62% patients were managed by tube thoracostomy+surgery and 19 (17.75% patients were managed by tube thoracostomy+ pleurodesis. Operative indications were prolonged air leak and bullae + recurrence. Hospital mortality was 1.86%. The mean postoperative hospitalization time of the patients was 9.1±3.5 days. Conclusions: Spontaneous pneumothorax is a pathology with low mortality and curable disease when diagnosed and treated in time. The primary treatment modality for spontaneus pneumothorax is conservative treatment or the thoracotomy depending on the degree of pneumothorax. Surgical procedures can be applied safely, with low recurrence rate, when the tube thoracostomy remains unsuccessful.

  17. Using augmented reality as a clinical support tool to assist combat medics in the treatment of tension pneumothoraces.

    Science.gov (United States)

    Wilson, Kenneth L; Doswell, Jayfus T; Fashola, Olatokunbo S; Debeatham, Wayne; Darko, Nii; Walker, Travelyan M; Danner, Omar K; Matthews, Leslie R; Weaver, William L

    2013-09-01

    This study was to extrapolate potential roles of augmented reality goggles as a clinical support tool assisting in the reduction of preventable causes of death on the battlefield. Our pilot study was designed to improve medic performance in accurately placing a large bore catheter to release tension pneumothorax (prehospital setting) while using augmented reality goggles. Thirty-four preclinical medical students recruited from Morehouse School of Medicine performed needle decompressions on human cadaver models after hearing a brief training lecture on tension pneumothorax management. Clinical vignettes identifying cadavers as having life-threatening tension pneumothoraces as a consequence of improvised explosive device attacks were used. Study group (n = 13) performed needle decompression using augmented reality goggles whereas the control group (n = 21) relied solely on memory from the lecture. The two groups were compared according to their ability to accurately complete the steps required to decompress a tension pneumothorax. The medical students using augmented reality goggle support were able to treat the tension pneumothorax on the human cadaver models more accurately than the students relying on their memory (p augmented reality group required more time to complete the needle decompression intervention (p = 0.0684), this did not reach statistical significance.

  18. Iatrogenic traumatic brain injury during tooth extraction.

    Science.gov (United States)

    Troxel, Mark

    2015-01-01

    An 8 yr old spayed female Yorkshire terrier was referred for evaluation of progressive neurological signs after a routine dental prophylaxis with tooth extractions. The patient was circling to the left and blind in the right eye with right hemiparesis. Neurolocalization was to the left forebrain. MRI revealed a linear tract extending from the caudal oropharynx, through the left retrobulbar space and frontal lobe, into the left parietal lobe. A small skull fracture was identified in the frontal bone through which the linear tract passed. Those findings were consistent with iatrogenic trauma from slippage of a dental elevator during extraction of tooth 210. The dog was treated empirically with clindamycin. The patient regained most of its normal neurological function within the first 4 mo after the initial injury. Although still not normal, the dog has a good quality of life. Traumatic brain injury is a rarely reported complication of extraction. Care must be taken while performing dental cleaning and tooth extraction, especially of the maxillary premolar and molar teeth to avoid iatrogenic damage to surrounding structures.

  19. Update on strategies limiting iatrogenic hypoglycemia.

    Science.gov (United States)

    Bonaventura, Aldo; Montecucco, Fabrizio; Dallegri, Franco

    2015-09-01

    The prevalence of type 2 diabetes mellitus (T2DM) is increasing all over the world. Targeting good glycemic control is fundamental to avoid the complications of diabetes linked to hyperglycemia. This narrative review is based on material searched for and obtained via PubMed up to April 2015. The search terms we used were: 'hypoglycemia, diabetes, complications' in combination with 'iatrogenic, treatment, symptoms.' Serious complications might occur from an inappropriate treatment of hyperglycemia. The most frequent complication is iatrogenic hypoglycemia that is often associated with autonomic and neuroglycopenic symptoms. Furthermore, hypoglycemia causes acute cardiovascular effects, which may explain some of the typical symptoms: ischemia, QT prolongation, and arrhythmia. With regards to the latter, the night represents a dangerous period because of the major increase in arrhythmias and the prolonged period of hypoglycemia; indeed, sleep has been shown to blunt the sympatho-adrenal response to hypoglycemia. Two main strategies have been implemented to reduce these effects: monitoring blood glucose values and individualized HbA1c goals. Several drugs for the treatment of T2DM are currently available and different combinations have been recommended to achieve individualized glycemic targets, considering age, comorbidities, disease duration, and life expectancy. In conclusion, according to international guidelines, hypoglycemia-avoiding therapy must reach an individualized glycemic goal, which is the lowest HbA1c not causing severe hypoglycemia and preserving awareness of hypoglycemia. © 2015 The authors.

  20. Spontaneous globe luxation in iatrogenic Cushing syndrome.

    Science.gov (United States)

    Ortega-Evangelio, Leticia; Navarrete-Sanchis, Javier; Williams, Basil K; Tomas-Torrent, Juan Miguel

    2015-10-01

    We report a rare case of spontaneous eyeball luxation associated with exophthalmos due to iatrogenic Cushing syndrome (CS). The normalization of serum hormones led to the regression of the picture. A 64-year-old man presented with spontaneous globe luxation of the left eye after a 6-month history of bilateral, painless, and slowly progressive exophthalmos. The patient had been receiving weekly infusions of methylprednisone over the previous 6 months. His best-corrected visual acuity (BCVA) at presentation was 20/40 in the right eye and 20/20 in the left eye. The patient demonstrated full extraocular motility. The intraocular pressure (IOP) was elevated in the right eye (24 mHg) and normal in the left eye (18 mmHg). Exophthalmometry demonstrated bilateral proptosis with measurements of 27 mm in the right eye and 28 mm in the left eye. Computed tomography scan of the brain and orbits revealed increased orbital and cervical fat. Clinical, radiographic and serologic findings ruled out potential diagnoses including orbital metastasis, thyroid orbitopathy, carotid-cavernous fistula, and idiopathic orbital pseudotumor. Clinical suspicion of iatrogenic CS was high, and additional serologic testing confirmed the diagnosis. Exophthalmos is an uncommon sign of CS, but to our knowledge, this is the first reported case of spontaneous globe luxation secondary to CS. In our case, normalization of cortisol was sufficient to resolve the clinical symptoms and eliminated the need for surgical intervention such as orbital decompression surgery.

  1. Spontaneous pneumothorax as a first sign of pulmonary carcinoma

    Directory of Open Access Journals (Sweden)

    Cicėnas Saulius

    2009-06-01

    Full Text Available Abstract Background Spontaneous pneumothorax (SP is a rare manifestation of lung cancer. The mechanisms by which pneumothorax occurs in lung cancer is not clear, resulting in different views being expressed. Case presentation Here we present a case in which pneumothorax occurred as a first manifestation of lung cancer. The chest x-ray of a 68 year old man revealed a right partial pneumothorax. VATS was then performed: the visceral pleura lying over segment S3 was destroyed and air leaks were found in this section. Pathologic examination of the biopsy specimen revealed non-small cell carcinoma. Thoracoscopic talc pleurodesis was performed. Conclusion Spontaneous pneumothorax in association with lung cancer is rarely seen. Pneumothorax can be the first sign of lung cancer. The most common possibility for SP complicating lung cancer is the tumor necrosis mechanism or, in separate cases, rupture of the emphysematous bullae. Lung cancer should always be considered as a possible cause of SP in elderly patients or in heavy smokers.

  2. The Role of Incentive Spirometry in Primary Spontaneous Pneumothorax

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    Rabbinu R Pribadi

    2016-09-01

    Full Text Available 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.

  3. Post tubal ligation syndrome or iatrogenic hydrosalpinx.

    Science.gov (United States)

    Gregory, M G

    1981-10-01

    The purpose of this case report is as follows: to attempt to establish an association between the observed increase in hydrosalpinx and the phenomenal increase in surgical sterilization; to present a credible etiology for iatrogenic hydrosalpinx; and to discuss the pathogenesis of a disease process henceforth referred to as post tubal ligation syndrome. A 36-year-old white woman was admitted to Park View Hospital in Nashville, Tennessee on January 7, 1981 for evaluation of continuous lower abdominal pain, abdominal pressure, and dyspareunia for several months. The woman had 2 children who were delivered vaginally. An abdominal tubal ligation was performed for sterilization when she was 27, and vaginal hysterectomy, with anterior and posterior colporrhaphy, was done for symptomatic pelvic relaxation at age 33. Physical examination showed tenderness without palpable masses in the pelvic adnexal areas. Laboratory studies were within normal limits. On January 9, 1981, the patient underwent exploratory laparotomy, and bilateral salpingo-oophorectomy. She was found to have bilateral hydrosalpinx. Historically, hydrosalpinx has been considered an intermediary step in pelvic inflammatory disease. Iatrogenic hydrosalpinx is, in essence, initiated by an initial insult, e.g., tubal ligation, fulguration, or application of a mechanical clip or band. Theoretically, single point interruption of a fallopian tube should produce no ill effects. The popularity and success of tubal ligation attest to single point interruption of an otherwise normal fallopian tube as an innocuous procedure. A schematic drawing is provided of the same tube insulted a 2nd time and consequently the situation is prefactory to development of hydrosalpinx, i.e., a tube lined with secretory epithelium is closed at both ends. Secretion within this closed system will produce dilatation. This "2nd" insult to the normal fallopian tube, post tubal ligation, may take 1 of several forms. The symptoms of iatrogenic

  4. [Traumatic and iatrogenic lesions of abdominal vessels].

    Science.gov (United States)

    Farah, I; Tarabula, P; Voirin, L; Magne, J L; Delannoy, P; Gattaz, F; Guidicelli, H

    1997-01-01

    Gravity of abdominal vessels traumatisms is secondary to multiple factors. It depends on the type of injured vessels, aetiology and associated lesions. Between September 1984 and March 1995, 22 abdominal vessel traumatisms in 16 patients (mean age: 39 years) were treated. At surgical exploration, 4 aortic and 2 renal vein lesions, 7 iliac artery and 3 renal artery contusions, 2 superior mesenteric artery dissections; 3 infra-renal vena cava ruptures and 1 superior mesenteric vein dilaceration were found. All lesions were caused by penetrant wounds secondary to firearm or blade injury or secondary to injuries due to ski or traffic accidents. In 5 cases, lesions were iatrogenic. There was no mortality in the post-operative period, 14 patients out of the 16 patients operated on have been followed during a period from 1 to 120 months.

  5. Iatrogenic Sinistral Hypertension Complicating Screening Colonoscopy

    Directory of Open Access Journals (Sweden)

    Oliver J. Ziff

    2013-01-01

    Full Text Available Colonoscopy is widely accepted as the gold-standard screening technique for detecting malignancies in the distal gastrointestinal tract in patients with symptoms suggestive of colon cancer. However, this procedure is not without risk, including colonic perforation. We report a patient who was managed conservatively after colonoscopy induced perforation. Eighteen months after appearing to make a full recovery, he presented with an upper gastrointestinal bleed. Oesophago-gastro-duodenoscopy (OGD revealed large gastric fundal varices and computed tomography (CT revealed splenic vein thrombosis. The ensuing left-sided (sinistral hypertension explains the development of the fundal varices in the presence of normal liver function. At surgery, a persistent abscess cavity was identified and cultures from this site grew Streptococcus anginosus. Curative splenectomy was performed and the patient made a full recovery. We advocate more prompt operative intervention in selected cases of iatrogenic colonic perforation with primary repair to prevent late complications.

  6. [Necrotizing enterocolitis. Pathogenesis and iatrogenic factors].

    Science.gov (United States)

    Obladen, M

    1986-08-01

    Following clinical observations, measurements of osmolarity of liquid drugs, and determination of blood loss due to sampling in very low birthweight infants, the following hypothesis on iatrogenic factors contributing to the pathogenesis of necrotizing enterocolitis is proposed: Due to diagnostic blood sampling during intensive care, premature infants may become severely anemic. Therefore their intestinal perfusion is reduced, causing hypoxia and hypoperfusion in the submucosa. Especially in infants with oral feeding and hyperosmolar medication, mechanical factors, hyperosmolarity and infection can affect the mucosa from the luminal side. Simultaneous hypoperfusion and hyperosmolar load may contribute to the pathogenesis of necrotizing enterocolitis. This hypothesis, which needs experimental verification, explains the different incidence of the disease in different hospitals.

  7. 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.

  8. A Retrospective Review of Iatrogenic Skin and Soft Tissue Injuries

    Directory of Open Access Journals (Sweden)

    Tae Geun Lee

    2012-07-01

    Full Text Available BackgroundEven though the quality of medical and surgical care has improved remarkably over time, iatrogenic injuries that require surgical treatment including injuries caused by cast and elastic bandage pressure, extravasation, and dopamine-induced ischemia still frequently occur. The goal of this study was to estimate the incidence and analyze the distribution of iatrogenic injuries referred to our department.MethodsA retrospective clinical review was performed from April 2006 to November 2010. In total, 196 patients (116 females and 80 males were referred to the plastic surgery department for the treatment of iatrogenic injuries. We analyzed the types and anatomic locations of iatrogenic complications, along with therapeutic results.ResultsAn extravasation injury (65 cases, 37.4% was the most common iatrogenic complication in our study sample, followed by splint-induced skin ulceration, dopamine-induced necrosis, prefabricated pneumatic walking brace-related wounds and elastic bandage-induced wounds. Among these, prefabricated pneumatic walking brace-related complication incidence increased the most during the 5-year study period.ConclusionsThe awareness of the very common iatrogenic complications and its causes may allow physicians to reduce their occurrence and allow for earlier detection and referral to a plastic surgeon. We believe this is the first study to analyze iatrogenic complications referred to a plastic surgery department in a hospital unit.

  9. Pneumothorax effects on pulmonary acoustic transmission.

    Science.gov (United States)

    Mansy, Hansen A; Balk, Robert A; Warren, William H; Royston, Thomas J; Dai, Zoujun; Peng, Ying; Sandler, Richard H

    2015-08-01

    Pneumothorax (PTX) is an abnormal accumulation of air between the lung and the chest wall. It is a relatively common and potentially life-threatening condition encountered in patients who are critically ill or have experienced trauma. Auscultatory signs of PTX include decreased breath sounds during the physical examination. The objective of this exploratory study was to investigate the changes in sound transmission in the thorax due to PTX in humans. Nineteen human subjects who underwent video-assisted thoracic surgery, during which lung collapse is a normal part of the surgery, participated in the study. After subjects were intubated and mechanically ventilated, sounds were introduced into their airways via an endotracheal tube. Sounds were then measured over the chest surface before and after lung collapse. PTX caused small changes in acoustic transmission for frequencies below 400 Hz. A larger decrease in sound transmission was observed from 400 to 600 Hz, possibly due to the stronger acoustic transmission blocking of the pleural air. At frequencies above 1 kHz, the sound waves became weaker and so did their changes with PTX. The study elucidated some of the possible mechanisms of sound propagation changes with PTX. Sound transmission measurement was able to distinguish between baseline and PTX states in this small patient group. Future studies are needed to evaluate this technique in a wider population.

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

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    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.

  11. 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.

  12. Tension Structure

    Science.gov (United States)

    1978-01-01

    The fabric structure pictured is the Campus Center of La Verne College, La Verne, California. Unlike the facilities shown on the preceding pages, it is not air-supported. It is a "tension structure," its multi-coned fabric membrane supported by a network of cables attached to steel columns which function like circus tent poles. The spider-web in the accompanying photo is a computer graph of the tension pattern. The designers, Geiger-Berger Associates PC, of New York City, conducted lengthy computer analysis to determine the the best placement of columns and cables. The firm also served as structural engineering consultant on the Pontiac Silverdome and a number of other large fabric structures. Built by Birdair Structures, Inc., Buffalo, New York, the La Verne Campus Center was the first permanent facility in the United States enclosed by the space-spinoff fabric made of Owens-Corning Beta fiber glass coated with Du Pont Teflon TFE. The flexible design permits rearrangement of the interior to accommodate athletic events, student activities, theatrical productions and other recreational programs. Use of fabric covering reduced building cost 30 percent below conventional construction.

  13. 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.)

  14. Steroid-induced iatrogenic disease after treating for pseudothrombocytopenia.

    Science.gov (United States)

    Sharma, A; Pinto Pereira, Lexley M; Capildeo, K; Charles, K; Teelucksingh, S

    2011-02-01

    Pseudothrombocytopenia, a spontaneous in vitro occurrence after the addition of anticoagulant to blood, causes clumping of platelets resulting in a spurious observation of low platelet counts (pseudothrombocytopenia. Failure to recognize this phenomenon may lead to debilitating iatrogenic disease.

  15. Genetic analysis of familial spontaneous pneumothorax in an Indian family.

    Science.gov (United States)

    Ray, Anindita; Paul, Suman; Chattopadhyay, Esita; Kundu, Susmita; Roy, Bidyut

    2015-06-01

    Familial spontaneous pneumothorax is one of the phenotypes of Birt-Hogg-Dubé syndrome (BHDS), an autosomal dominant condition associated with folliculin (FLCN). We investigated clinical and genetic data of an Indian family having two patients suffering from spontaneous pneumothorax in the absence of skin lesions or renal tumors. HRCT scan of patient's lung revealed paracardiac cysts, and DNA sequencing of all 14 exons of FLCN from patients showed the presence of heterozygous "C allele" deletion in the poly-cytosine (poly-C) tract of exon 11 leading to truncated folliculin. This mutation was also observed in four asymptomatic members of the family. Our results confirmed the presence of deletion mutation in poly-C tract of FLCN in members of BHDS family. This is the first report of genetic insight in a BHDS family from India but in-depth studies with a larger sample set are necessary to understand mechanism of familial pneumothorax.

  16. Recurrent pneumothorax associated with bronchial atresia: report of a case.

    Science.gov (United States)

    Tanaka, Kazuhisa; Suzuki, Hidemi; Nakajima, Takahiro; Tagawa, Tetsuzo; Iwata, Takekazu; Mizobuchi, Teruaki; Yoshida, Shigetoshi; Yoshino, Ichiro

    2015-10-01

    We herein report a case of recurrent pneumothorax associated with congenital bronchial atresia. A 26-year-old male presented with chest pain. Chest roentgenograms showed left pneumothorax, a left apical bulla and an area of hyperlucency in the left upper lung field, and chest computed tomography revealed a discontinuation of the left superior bronchus. Additionally, both ventilation and perfusion scintigraphy showed a defect in the left superior segment. A thoracoscopy-assisted left superior segmentectomy was performed, and a pathological examination indicated left superior segmental bronchial atresia, which might have predisposed the peripheral lung to emphysematous conditions. No relapse was observed 6 months after the operation. Although this entity is rare, congenital bronchial atresia should be considered in the differential diagnosis when a patient has suffered from a recurrent spontaneous pneumothorax.

  17. Bilateral Spontaneous Pneumothorax in Chronic Silicosis: A Case Report

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    Pritinanda Mishra

    2014-01-01

    Full Text Available Silicosis is an occupational lung disease caused by inhalation of crystalline silica. People working in occupations like sandblasting, surface drilling, tunneling, silica flour milling, ceramic making, and so forth are predisposed to develop silicosis. Crystalline forms of silica are more fibrogenic than the amorphous forms, highlighting the importance of the physical form in pathogenesis. Lung biopsy is rarely performed for the diagnosis of silicosis as it can easily be detected by occupational history and radiological features. Patients with silicosis can develop complications like tuberculosis, lung cancer, progressive massive fibrosis, cor pulmonale, broncholithiasis, or tracheobronchial compression by lymph nodes. Pleural involvement in silicosis is rare. Spontaneous pneumothorax is a pleural complication that can develop in such patients. Usually in silicosis pneumothorax is unilateral. We hereby report the lung biopsy findings and discuss the mechanism of pneumothorax development in a case of chronic silicosis who, later on died during the course of the disease.

  18. A Case of Spontaneously Resolved Bilateral Primary Spontaneous Pneumothorax

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    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.

  19. AN INTERESTING CASE OF PNEUMOTHORAX IN RHEUMATOID ARTHRITIS

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    Shruthi

    2014-11-01

    Full Text Available : Rheumatoid Arthritis is a multisystem disease with pulmonary manifestations including idiopathic pulmonary fibrosis, obliterative bronchiolitis, pneumonitis, bronchiectasis as well as pneumothorax. Cases of rheumatoid arthritis with active tuberculosis disease have been documented as well as reactivation of latent tuberculosis as a result of methotrexate therapy with or without systemic steroids has led to a renewed interest in the association of the two diseases. We report the case of rheumatoid arthritis in a young female patient who presented with cough and fever of fortnight duration and rapidly developed spontaneous pneumothorax that eventually required surgical pneumonectomy. CONCLUSION: Even though patients with rheumatoid arthritis can present with spontaneous pneumothorax due to rupture of rheumatic nodules, Common diseases like tuberculosis should be kept in mind while treating pulmonary complaints in patients with rheumatoid arthritis, especially those who are on methotrexate therapy

  20. Iatrogenic diaphragmatic hernia in infants: Potentially catastrophic when overlooked

    Directory of Open Access Journals (Sweden)

    Yousef El-Gohary

    2014-11-01

    Full Text Available Acquired diaphragmatic hernias are a rare occurrence. They can result from blunt, penetrating or inadvertent iatrogenic injury. When overlooked they can potentially be catastrophic. We report a case of iatrogenic diaphragmatic hernia in a six-month old infant presenting with acute respiratory distress as a result of strangulated bowel herniating into the left hemithorax caused from a traumatic chest tube insertion in the neonatal period.

  1. 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. PMID:25674177

  2. Needlescopic video-assisted thoracic surgery pleurodesis for primary pneumothorax.

    Science.gov (United States)

    Sihoe, Alan D L; Hsin, Michael K Y; Yu, Peter S Y

    2014-01-01

    Conventional video-assisted thoracic surgery (VATS) is already well established as the approach of choice for definitive surgical management for primary pneumothorax. However, VATS itself is a constantly evolving technique. The needlescopic VATS (nVATS) approach uses the existing chest drain wound as a working port and adds only two 3-mm ports to provide equally effective pleurodesis as conventional VATS. Staple resection of bullae or blebs plus complete mechanical parietal pleural abrasion is achievable using nVATS. By potentially reducing morbidity for the individual patient, the nVATS approach may lower thresholds for surgical candidacy-even for first episodes of primary pneumothorax.

  3. 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.

  4. Pneumothorax Caused by an Isolated Midshaft Clavicle Fracture

    Directory of Open Access Journals (Sweden)

    Najla Feriani

    2016-01-01

    Full Text Available Patients with isolated clavicle fractures are frequent in the emergency department. However, unusual clavicle fractures complications, such as pneumothorax, are rare. Previous reports indicated that all pneumothorax cases were treated via performing thoracostomy. Conservatively, the treatment of the clavicle fracture, like in our case, was successful. Despite the fact that isolated clavicle fractures rarely cause complications and generally heal with immobilization, serious complications may occur requiring urgent treatment. It has been proven that physical examinations, with particular attention to the neurovascular and chest examinations, and radiographs of the clavicle are necessary to prevent overlooking these potentially dangerous complications.

  5. Endobronchial Primitive Neuroectodermal Tumor With Pneumothorax Ex Vacuo.

    Science.gov (United States)

    Han, Wongyeong; Huh, Dongmyung; Kim, Byoungho; Kwak, Eunkyoung; Lee, Sunah

    2015-10-01

    We experienced a rare case of an endobronchial primitive neuroectodermal tumor of the left main bronchus. Initially we suspected pneumothorax caused by a collapsed left upper lobe and an air-entrapped lower lobe. After tube thoracostomy, the pneumothorax persisted without air leakage. A tumor was detected at the left main bronchus on computed tomography and bronchoscopy, and diagnosed pathologically as small cell lung cancer. Under the presumed diagnosis of limited-stage small cell lung cancer, we performed a left pneumonectomy. The tumor was eventually identified pathologically as a primitive neuroectodermal tumor. Although adjuvant chemoradiotherapy was not performed, no recurrence was observed.

  6. 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.

  7. INTRAOPERATIVE PNEUMOTHORAX COMPLICATING TOTALLY EXTRAPERITONEAL INGUINAL HERNIA REPAIR

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    Charulatha

    2015-07-01

    Full Text Available Laparoscopic inguinal hernia repair compared with open procedure is associated with reduced recurrence rate and earlier return to work. [1,2] Though insufflation of carbon dioxide is limited to preperitoneal space, higher insufflation pressures and longer operative times have been associated with pneumothorax and pneumomediastinum even during totally extra peritoneal patchplasty (TEP . [3] We present a patient who developed pneumothorax due to inadvertent peritoneal tear during hernial sac dissection that resolved with conservative management in the postoperative period. This case report highlights the importance of peritoneal tear closure before proceeding with the rest of the procedure during extra peritoneal inguinal hernia repair.

  8. 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.

  9. Mesenteric infarction due to iatrogenic polycythemia.

    Science.gov (United States)

    Skoog, Katrina; Carmelle-Elie, Marie; Ferguson, Kevin

    2013-01-01

    Polycythemia vera is defined as a chronic myeloproliferative disorder characterized by increased red blood cell count. There have been no reports on mesenteric thrombosis resulting from iatrogenic polycythemia. We present a patient with a history of non-small cell lung cancer undergoing maintenance oral chemotherapy on tarceva and adjunctive use of procrit. The patient presented to our emergency department with an acute abdomen and was found to have ischemic bowel from unmonitored procrit, which lead to hyperviscosity of blood and mesenteric infarction. The patient remained intubated with ventilator support. He refused a tracheostomy. He continued on feeding through the J port of the nasojejunal tube. His white cell count, and hematocrit and creatinine levels remained normal. Procrit use and chemotherapy were not restarted. He was transferred to a subacute nursing facility for further treatment. Procrit and other erythropoiesis stimulating drugs can cause significant morbidity and mortality with an increased risk of cardiovascular events, gastrointestinal bleeding, thromboembolism and stroke. This case report suggests that without closely monitoring hematocrit levels, epoetin may also be associated with an increased risk of mesenteric infarction.

  10. Iatrogenic causes of salivary gland dysfunction

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-02-01

    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).

  11. 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.

  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.

  13. An analysis of and new risk factors for reexpansion pulmonary edema following spontaneous pneumothorax

    Science.gov (United States)

    Kawabata, Tsutomu; Ichi, Takaharu; Yohena, Tomofumi; Kawasaki, Hidenori; Ishikawa, Kiyoshi

    2014-01-01

    Background The major risk factor for reexpansion pulmonary edema (RPE) following the treatment of spontaneous pneumothorax is thought to be chronic lung collapse. However, a long-term collapsed lung does not always cause RPE. The purpose of this study was to define other risk factors for RPE among patients undergoing drainage for the treatment of spontaneous pneumothorax. Methods We retrospectively reviewed all the patients with spontaneous pneumothorax who had been treated at our hospital during a 5-year period. The duration of symptoms, location and size of the pneumothorax, size of the chest tube, and pleural effusion, which can occur coincidentally with pneumothorax, were compared in patients who did and did not experience RPE. Results Forty patients were underwent drainage for the treatment of a spontaneous pneumothorax between January 2007 and December 2012. RPE developed in 13 of the 40 (32.5%) patients. In the multivariate analysis, the presence of pleural effusion coincident with pneumothorax contributed to the risk for RPE [odds ratios (OR), 1.557; 95% confidence intervals (CI), 1.290-1.880]. The duration of symptoms, location and size of the pneumothorax and size of the chest tube were similar between the groups. Symptomatic RPE was associated with a larger pneumothorax size. Conclusions The rate of RPE following spontaneous pneumothorax is higher than was previously reported. Our findings suggest the presence of pleural effusion coincidentally with pneumothorax may therefore be a new risk factor for RPE. PMID:25276359

  14. Neurofibromatosis Type I presenting with Spontaneous Pneumothorax: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, So Youn; Lee, Young Kyung; Moon, Ah Lim; Sung, Dong Wook [Kyunghee University College of Medicine, East-West Neo Medical Center, Seoul (Korea, Republic of)

    2010-08-15

    Neurofibromatosis type I is an autosomal dominant disease with variable clinical manifestations related to dermatologic, neurologic, skeletal, and endocrine system. Lung parenchymal involvement such as lung fibrosis and massive bullous emphysema is infrequent. Here, we report on a 36-year-old man with symptoms of dyspnea, and who has a spontaneous pneumothorax, multiple bullae, and pathologically confirmed neurofibromatosis type I

  15. 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...

  16. 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.

  17. 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.

  18. Risk of infection by iatrogenic asplenia

    Energy Technology Data Exchange (ETDEWEB)

    Slanina, J.; Wannenmacher, M.; Heidemann, S.

    1982-07-01

    A retrospective evaluation of the data of all patients with Hodgkin's disease (collective of Freiburg) treated between 1964 and 1977 was made in order to find out if there was an increased risk of infection after a diagnostic laparotomy with splenectomy (LS). Among a total number of 592 patients, 277 had been submitted to LS (since 1969). 185 patients had a total remission, 130 of them after primary LS, 34 after secondary LS, and 21 without any treatment of the spleen. An inquiry conducted by means of a questionnaire showed no differences between the compared groups as to the frequency of not septic infections such as pulmonary tuberculosis, angina tonsillaris, pyodermia, sinusitis, complications in wound healing, urinary tract infections, and infections of the intestine. However, there was a significant increase of unspecific pneumonias and herpes zoster manifestations after (long-term observation) secondary LS. There were no differences regarding the frequency of febrile and not febrile colds, but after LS, the colds had a longer and more severe course. - The analysis of the cause of death in the 277 patients who died showed a lethal septicaemia in seven cases. All these patients had been submitted to LS. In three of these patients, a recurrence was proved or could not be excluded, four presented as total remission with respect to Hodgkin's disease. - These results and the communications of literature permit to conclude that the iatrogenic asplenia represents an additional immunological risk. They suggest a further reduction of the indication for LS, the criteria of which are discussed.

  19. Classiifcation of iatrogenic bile duct injur y

    Institute of Scientific and Technical Information of China (English)

    Wan-Yee Lau; Eric C.H. Lai

    2007-01-01

    BACKGROUND: Iatrogenic bile duct injury continues to be an important clinical problem, resulting in serious morbidity, and occasional mortality, to patients. The ease of management, operative risk, and outcome of bile duct injuries vary considerably, and are highly dependent on the type of injury and its location. This article reviews the various classiifcation systems of bile duct injury. DATA SOURCES: A Medline, PubMed database search was performed to identify relevant articles using the keywords"bile duct injury", "cholecystectomy", and “classiifcation”. Additional papers were identiifed by a manual search of the references from the key articles. RESULTS: Traditionally, biliary injuries have been classiifed using the Bismuth's classiifcation. This classiifcation, which originated from the era of open surgery, is intended to help the surgeons to choose the appropriate technique for the repair, and it has a good correlation with the ifnal outcome after surgical repair. However, the Bismuth's classiifcation does not encompass the whole spectrum of injuries that are possible. Bile duct injury during laparoscopic cholecystectomy tends to be more severe than those with open cholecystectomy. Strasberg’s classiifcation made Bismuth’s classiifcation much more comprehensive by including various other types of extrahepatic bile duct injuries. Our group, Bergman et al, Neuhaus et al, Csendes et al, and Stewart et al have also proposed other classiifcation systems to complement the Bismuth's classiifcation. CONCLUSIONS:None of the classiifcation system is universally accepted as each has its own limitation. Hopefully, a universally accepted comprehensive classiifcation system will be published in the near future.

  20. Role of Manual Aspiration in Treating Pneumothorax after Computed Tomography-Guided Lung Biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Yamagami, T.; Terayama, K.; Yoshimatsu, R.; Matsumoto, T.; Miura, H.; Nishimura, T. (Dept. of Radiology, Graduate School of Medical Science, Kyoto Prefectural Univ. of Medicine, Kyoto (Japan)). e-mail: yamagami@koto.kpu-m.ac.jp

    2009-12-15

    Background: Pneumothorax is the most common complication after computed tomography (CT)-guided lung biopsy. The presence of a pneumothorax per se does not complicate patient management, but an increasing pneumothorax, making chest tube placement necessary, is highly problematic. Purpose: To evaluate the efficacy and limitations of simple aspiration of air from the pleural space to prevent increased pneumothorax and avoid chest tube placement in cases of pneumothorax following CT-guided lung biopsy. Material and Methods: The subjects of our study were 642 consecutive lung lesions in 594 patients for which percutaneous needle lung biopsies were performed using CT guidance. While patients were on the CT scanner table, percutaneous manual aspiration was performed in all patients with a non-small pneumothorax demonstrated on post-biopsy chest CT images. The frequency of pneumothorax, management of each such case, and factors influencing the incidence of worsening pneumothorax that finally required chest tube placement were evaluated. Results: Post-biopsy pneumothorax occurred in 243 of 642 (38%) procedures. Of the 243 cases, 112 were treated with manual aspiration immediately after biopsy. In 210 (86.4%), the pneumothorax had resolved completely on follow-up chest radiographs without chest tube placement. Only 33 patients required chest tube placement. Requirement of chest tube insertion significantly increased in parallel with the degree of pneumothorax as shown on post-biopsy CT images. The rate of chest tube insertion was statistically higher in subjects with values for aspirated air above 543 ml. Conclusion: Percutaneous manual aspiration of biopsy-induced pneumothorax performed immediately after biopsy may prevent worsening of pneumothorax and avoid chest tube placement. The amount of aspirated air can be predictive of the requirement for chest tube placement

  1. Axitinib Induced Recurrent Pneumothorax following Near-Complete Response of Renal Cell Carcinoma Lung Metastasis: An Unexpected Complication

    Directory of Open Access Journals (Sweden)

    Francisco Socola

    2012-01-01

    Full Text Available We report a case of a Caucasian male with a history of renal cell carcinoma metastatic (mRCC to the lungs refractory despite aggressive treatment with several lines of targeted therapy. He was started on axitinib palliative targeted therapy with a good clinical and radiological response; however one month after treatment initiation he presented to the emergency department with severe dyspnea and hypoxemia. Physical exam and chest X-ray revealed left-sided tension pneumothorax which required emergent thoracostomy with subsequent improvement; however it recurred requiring video assisted thoracoscopy. A left-sided 4 × 3 cm cavitated necrotic lesion was found at the level of the main pulmonary artery. Repair with pericardial fat flap was performed. Surgical biopsies from this lesion revealed mRCC with extensive necrosis. Imaging studies before and after axitinib use showed an initial 4 × 3 cm mass seen in the same location of this large cavitated necrotic tumor. Pneumothorax has not been described as a potential major complication from the use of axitinib. Complete or near-complete responses of mRCC to axitinib targeted therapy may lead to this potential life-threatening complication, particularly if the metastatic lesions are located near to pleural structures. We also review pertinent clinical trial data on axitinib.

  2. Iatrogenic Uterine Diverticulum in Pregnancy After Robotic-assisted Myomectomy.

    Science.gov (United States)

    DeStephano, Christopher C; Jernigan, Amelia M; Szymanski, Linda M

    2015-01-01

    Uterine diverticula are rare outpouchings of the uterus associated with abnormal uterine bleeding, pelvic pain, dysmenorrhea, and adverse obstetric events. At the time of cesarean delivery at 36 5/7 weeks' gestation during the patient's first pregnancy and 36 6/7 weeks during the second pregnancy, a fundal iatrogenic uterine diverticulum at the site of a prior robotic-assisted myomectomy was noted. The outpouching communicated with the endometrial cavity and was extremely attenuated, palpably 2 to 3 mm thick. Further research is needed to determine the incidence of iatrogenic uterine diverticulum after robotic myomectomy and whether these malformations increase the risk of adverse obstetric outcomes.

  3. Post-thyroidectomy iatrogenic Horner's syndrome with heterochromia

    OpenAIRE

    2016-01-01

    Purpose To present a case of iatrogenic Horner's syndrome seen together with the heterochromia in the post-thyroidectomy period. Methods A 23-year-old female patient was admitted to our clinic with complaints of low vision in the eye and difference in eye color that developed over the past two years. In the left eye, myosis and minimal ptosis (∼1 mm) was detected, and the color of the iris was lighter than the right eye. Results The pre-diagnosis of left iatrogenic Horner's syndrome was final...

  4. Bilateral spontaneous pneumothorax secondary to aspiration pneumonia induced by a wristwatch lodged at the pharyngoesophageal junction.

    Science.gov (United States)

    Kawai, Chihiro; Miyao, Masashi; Kotani, Hirokazu; Tamaki, Keiji

    2015-06-01

    Bilateral spontaneous pneumothorax secondary to disease is rare and seldom encountered in forensic autopsies; however, traumatic bilateral pneumothorax occurs often. Herein, we present a forensic case involving a 50-year-old woman who died 4 days after ingesting a wristwatch. Postmortem computed tomography and autopsy findings demonstrated that the wristwatch was lodged at the pharyngoesophageal junction, that she had a bilateral pneumothorax unaccompanied by any thoracic wound, and that macular hemorrhagic lesions on the lung surfaces were responsible for the pneumothorax. A histological examination of the macular lesions revealed that they were aspiration pneumonia foci with many birefringent foreign materials. Furthermore, a necrotic process secondary to aspiration pneumonia with a one way check-valve hyperinflation caused by foreign materials in the bronchioles was the most probable pathogenesis of her pneumothorax. To our knowledge, this is the first reported case of a bilateral secondary spontaneous pneumothorax caused by a large foreign body at the pharyngoesophageal junction leading to death.

  5. 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

  6. Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax in a Patient with Dermatomyositis

    Science.gov (United States)

    Bakhshaee, Mehdi; Jokar, Mohammad Hassan; Mirfeizi, Zahra; Atabati, Elham; Tarighat, Somayeh

    2017-01-01

    Introduction: Spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema are rare, but serious complications of inflammatory myopathies and occur more commonly in DM than PM. complications of dermatomyositis (DM) and polymyositis (PM), both of which can be fatal. Case Report: A 20-year-old woman was admitted with neck pain, dyspnea, cough, and fever. She had been diagnosed with dermatomyositis 21 months prior. A thorax computed tomography (CT) scan revealed ground glass opacities in her lungs, pneumomediastinum, pneumothorax, and subcutaneous emphysema. Despite intensive immunosuppressive therapy, clinical deterioration and radiological progression were observed, ultimately the patient died. Conclusion: During the care for a patient with dermatomyositis, the otorhinolaryngologist should be cautious of rapidly progressive and fatal neck subcutaneous emphysema. For a patient with dermatomyositis and with normal bronchoscopy and esophagoscopy, the main treatment is control of dermatomyositis with medical therapy. Therefore, a tracheostomy and/or mechanical ventilation may not be necessary.

  7. Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax in a Patient with Dermatomyositis

    Directory of Open Access Journals (Sweden)

    Mehdi Bakhsaee

    2017-03-01

    Full Text Available Introduction:Spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema are rare, but serious complications of inflammatory myopathies and occur more commonly in DM than PM. complications of dermatomyositis (DM and polymyositis (PM, both of which can be fatal. Case Report:A 20-year-old woman was admitted with neck pain, dyspnea, cough, and fever. She had been diagnosed with dermatomyositis 21 months prior. A thorax computed tomography (CT scan revealed ground glass opacities in her lungs, pneumomediastinum, pneumothorax, and subcutaneous emphysema. Despite intensive immunosuppressive therapy, clinical deterioration and radiological progression were observed, ultimately the patient died. Conclusion:During the care for a patient with dermatomyositis, the otorhinolaryngologist should be cautious of rapidly progressive and fatal neck subcutaneous emphysema. For a patient with dermatomyositis and with normal bronchoscopy and esophagoscopy, the main treatment is control of dermatomyositis with medical therapy. Therefore, a tracheostomy and/or mechanical ventilation may not be necessary.

  8. [Congenital Defect of the Left Pericardium with Spontaneous Pneumothorax;Report of a Case].

    Science.gov (United States)

    Murasawa, Masaki; Yoshizawa, Masatoshi; Ishida, Hisao; Kuwabara, Masayoshi

    2016-08-01

    Congenital cardiac membrane deficiency is a relatively rare condition. Here, we report a case of congenital cardiac membrane deficiency that manifested as left spontaneous pneumothorax. A 72-year-old man was hospitalized for recurrence of the spontaneous pneumothorax. Computed tomography findings led us to suspect pericardial deficits, and the perioperative findings during thoracoscopic surgery for the pneumothorax confirmed complete absence of the left pericardium. We resected a lung cyst but did not treat the pericardial deficit. The patient's postoperative course was uneventful.

  9. RIGHT PNEUMOTHORAX SECONDARY TO REMOVAL OF NASOGASTRIC TUBE

    Directory of Open Access Journals (Sweden)

    Francesco Inzirillo

    2016-08-01

    Full Text Available Malpositioning of the nasogastric tube into the airway is one of the most frequent complications and the consequences of improper positioning of the tube in the airways depend on several factors: creation or not of a pleuro-pulmonary fistula, introduction or not of drugs into the tube, the overall clinical condition of the patient. A pneumonia caused by instillation of drugs or a pneumothorax or a mediastinitis may precipitate a clinical situation already basically compromised.

  10. RIGHT PNEUMOTHORAX SECONDARY TO REMOVAL OF NASOGASTRIC TUBE

    OpenAIRE

    Francesco Inzirillo; Ravalli Eugenio; Casimiro Giorgetta; Francesco Sangrigoli; Alessia Marziani

    2016-01-01

    Malpositioning of the nasogastric tube into the airway is one of the most frequent complications and the consequences of improper positioning of the tube in the airways depend on several factors: creation or not of a pleuro-pulmonary fistula, introduction or not of drugs into the tube, the overall clinical condition of the patient. A pneumonia caused by instillation of drugs or a pneumothorax or a mediastinitis may precipitate a clinical situation already basically compromised.

  11. Conservative versus interventional management for primary spontaneous pneumothorax in adults.

    Science.gov (United States)

    Ashby, Michael; Haug, Greg; Mulcahy, Pete; Ogden, Kathryn J; Jensen, Oliver; Walters, Julia A E

    2014-12-18

    Primary spontaneous pneumothorax is widely managed according to size with interventional techniques based on practice guidelines. Interventional management is not without complications and observational data suggest conservative management works. The current guidelines are based on expert consensus rather than evidence, and a systematic review may help in identifying evidence for this practice. The objective of the review is to compare conservative and interventional treatments of adult primary spontaneous pneumothorax for outcomes of clinical efficacy, tolerability and safety. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 6, 2014); MEDLINE via Ovid SP (1920 to 26th June 2014); EMBASE via Ovid SP (1947 to 26th June 2014); CINAHL via EBSCO host (1980 to 26th June 2014); and ISI Web of Science (1945 to 26th June 2014). We searched ongoing trials via the relevant databases and contacted authors. We also searched the 'grey literature'. We included randomized controlled trials (RCTs) and we accepted quasi-RCTs if a systematic method of allocation was used. Participants were limited to adults aged 18 to 50 years, with their first symptomatic primary spontaneous pneumothorax with radiological evidence and no underlying lung disease. Two of five authors independently reviewed all studies in the search criteria and made inclusions and exclusions according to the selection criteria. No statistical methods were necessary as there were no included trials. We identified 358 studies with duplicates removed. There were three potentially relevant studies that we excluded as they were not randomized controlled trials. There was one ongoing trial that was relevant and we contacted the authors and confirmed the study is ongoing at June 2014. We will update this review when this ongoing study is completed. There are no completed randomized controlled trials comparing conservative and interventional management for primary

  12. Subcutaneous Emphysema, Pneumomediastinum and Pneumothorax in a Patient with Dermatomyositis

    OpenAIRE

    Mehdi Bakhsaee; Mohammad Hassan Jokar; Zahra Mirfeizi; Elham Atabati; Somayeh Tarighat

    2017-01-01

    Introduction:Spontaneous pneumomediastinum, pneumothorax, and subcutaneous emphysema are rare, but serious complications of inflammatory myopathies and occur more commonly in DM than PM. complications of dermatomyositis (DM) and polymyositis (PM), both of which can be fatal. Case Report:A 20-year-old woman was admitted with neck pain, dyspnea, cough, and fever. She had been diagnosed with dermatomyositis 21 months prior. A thorax computed tomography (CT) scan revealed ground glass opacities i...

  13. BILATERAL PNEUMOTHORAX AS A COMPLICATION OF PERCUTANEOUS TRACHEOSTOMY: CASE REPORT.

    Science.gov (United States)

    Klancir, Tino; Adam, Višnja Nesek; Mršić, Viviana; Marin, Damjan; Goranović, Tatjana

    2016-03-01

    Percutaneous dilatational tracheostomy is a common surgical procedure that is becoming the method of choice in critically ill patients whenever prolonged airway secure and/or ventilation support is needed. Although adverse events are relatively uncommon, serious life threatening complications can arise from this bedside procedure. We report a case of a 70-year-old female who developed extensive subcutaneous emphysema and bilateral pneumothorax immediately after a percutaneous dilatational tracheostomy procedure. Different mechanisms, such as damage to posterior or anterior tracheal wall, false passage or paratracheal placement or dislocation of the cannula are considered to be responsible for the development of pneumothorax and subcutaneous emphysema. Although bronchoscopic control after the tracheostomy procedure did not reveal any tracheal injury, we believe that subcutaneous emphysema and bilateral pneumothorax are most likely caused by procedure induced injuries of the trachea in addition to the applied high airway pressure induced by excessive or inappropriate ventilation. In our case report, we would like to emphasize that continuous bronchoscopic guidance during percutaneous tracheostomy is invaluable in decreasing the incidence of its overall complications, especially during enhancing the team experience.

  14. 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.

  15. 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.

  16. 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.

  17. Iatrogenic skin injury in the neonatal intensive care unit.

    Science.gov (United States)

    Sardesai, Smeeta R; Kornacka, Maria K; Walas, Wojciech; Ramanathan, Rangasamy

    2011-02-01

    Although neonatal care has become more and more meticulous with significant changes in technology in the neonatal intensive care unit (NICU) in the past 50 years, iatrogenic cutaneous injuries continue to occur. Although the incidence of severe injuries is decreasing because the more difficult procedures are being replaced by improved techniques, skin injuries have not yet been completely eliminated. However, the nature and causes of cutaneous injuries have changed, and the injuries are frequent but generally minor. The major risk factors are low birth weight, gestational age, length of stay, a central venous line, mechanical ventilation, and support with continuous positive airway pressure. The rate of iatrogenic events is about 57% at gestational ages of 24-27 weeks, compared with 3% at term. There are no current comprehensive reviews of iatrogenic cutaneous injury. The purpose of this review is to describe the iatrogenic cutaneous injuries that may occur in the newborns as a consequence of perinatal and postnatal medical procedures. With increased survival of extremely-low-birth-weight (ELBW) infants and changing modes of management in the NICU, neonatologists must make every effort to recognize injuries and prevent their occurrence in the NICU.

  18. A Retrospective Review of Iatrogenic Skin and Soft Tissue Injuries

    Directory of Open Access Journals (Sweden)

    Tae Geun Lee

    2012-07-01

    Full Text Available Background Even though the quality of medical and surgical care has improved remarkablyover time, iatrogenic injuries that require surgical treatment including injuries caused by castand elastic bandage pressure, extravasation, and dopamine-induced ischemia still frequentlyoccur. The goal of this study was to estimate the incidence and analyze the distribution ofiatrogenic injuries referred to our department.Methods A retrospective clinical review was performed from April 2006 to November 2010. Intotal, 196 patients (116 females and 80 males were referred to the plastic surgery departmentfor the treatment of iatrogenic injuries. We analyzed the types and anatomic locations ofiatrogenic complications, along with therapeutic results.Results An extravasation injury (65 cases, 37.4% was the most common iatrogeniccomplication in our study sample, followed by splint-induced skin ulceration, dopamineinducednecrosis, prefabricated pneumatic walking brace-related wounds and elasticbandage-induced wounds. Among these, prefabricated pneumatic walking brace-relatedcomplication incidence increased the most during the 5-year study period.Conclusions The awareness of the very common iatrogenic complications and its causes mayallow physicians to reduce their occurrence and allow for earlier detection and referral to aplastic surgeon. We believe this is the first study to analyze iatrogenic complications referredto a plastic surgery department in a hospital unit.

  19. Lung ultrasound-guided emergency pneumothorax needle aspiration in a very preterm infant.

    Science.gov (United States)

    Migliaro, Fiorella; Sodano, Angela; Capasso, Letizia; Raimondi, Francesco

    2014-12-14

    Pneumothorax is a frequent critical situation in the neonatal intensive care unit. Diagnosis relies on clinical judgement, transillumination and chest radiogram. We report the case of a very preterm infant suddenly developing significant and persistent desaturation and bradycardia. Re-intubation and cardiopulmonary resuscitation were performed. Clinical and cold light examination were not suggestive of pneumothorax according to two experienced neonatologists. A lung ultrasound scan showed evidence of right pneumothorax that was promptly aspirated. Approximately 20 min later, a chest radiogram confirmed the ultrasound diagnosis. Point-of-care lung ultrasound is a useful tool for detecting symptomatic pneumothorax and accelerating its treatment.

  20. Pneumothorax triggered by the combination of gefitinib and amrubicin and treated with endobronchial silicone spigots

    Directory of Open Access Journals (Sweden)

    Fumio Imamura

    2015-01-01

    Full Text Available Pneumothorax is a rare complication in cancer chemotherapy. We report a case in which a male patient with advanced non-small cell lung cancer (NSCLC developed repetitive pneumothorax after receiving a combination of the chemotherapeutic drugs gefitinib and amrubicin (GEF + AMR. Both episodes of pneumothorax occurred on the 3rd day of GEF + AMR administration. Tube thoracostomy was performed, but pulmonary air leaks persisted in the second pneumothorax. Whereas surgical intervention was not applicable because of poor respiratory reserve, the chest tube was successfully removed by endoscopic occlusion of bronchopleural fistula with endobronchial Watanabe spigots (EWSs, a type of silicone bronchial blocker.

  1. Skin tension related to tension reduction sutures.

    Science.gov (United States)

    Hwang, Kun; Kim, Han Joon; Kim, Kyung Yong; Han, Seung Ho; Hwang, Se Jin

    2015-01-01

    The aim of this study was to compare the skin tension of several fascial/subcutaneous tensile reduction sutures. Six upper limbs and 8 lower limbs of 4 fresh cadavers were used. At the deltoid area (10 cm below the palpable acromion) and lateral thigh (midpoint from the palpable greater trochanter to the lateral border of the patella), and within a 3 × 6-cm fusiform area of skin, subcutaneous tissue defects were created. At the midpoint of the defect, a no. 5 silk suture was passed through the dermis at a 5-mm margin of the defect, and the defect was approximated. The initial tension to approximate the margins was measured using a tensiometer.The tension needed to approximate skin without any tension reduction suture (S) was 6.5 ± 4.6 N (Newton). The tensions needed to approximate superficial fascia (SF) and deep fascia (DF) were 7.8 ± 3.4 N and 10.3 ± 5.1 N, respectively. The tension needed to approximate the skin after approximating the SF was 4.1 ± 3.4 N. The tension needed to approximate the skin after approximating the DF was 4.9 ± 4.0 N. The tension reduction effect of approximating the SF was 38.8 ± 16.4% (2.4 ± 1.5 N, P = 0.000 [ANOVA, Scheffé]). The tension reduction effect of approximating the DF was 25.2% ± 21.9% (1.5 ± 1.4 N, P = 0.001 [ANOVA, Scheffé]). The reason for this is thought to be that the SF is located closely to the skin unlike the DF. The results of this study might be a basis for tension reduction sutures.

  2. [Clinical investigation of detecting the bronchi responsible for pulmonary air leakage by injecting methylene blue saline in 27 cases with intractable pneumothorax and bronchial fistula].

    Science.gov (United States)

    Jin, Pule; Ge, Hui; Peng, Luanshun; Wang, Guojun; Hu, Wenxia; Song, Shan

    2014-11-01

    To establish a new method for detecting the bronchus responsible for pulmonary air leakage by injecting methylene blue saline and to evaluate its efficacy and safety in cases with intractable pneumothorax and bronchial fistula. From January 2006 to October 2013, a total of 19 cases of intractable spontaneous pneumothorax and 8 cases of bronchial fistula were recruited in the study at the Fourth Hospital affiliated to Hebei Medical University. Of all the cases, 15 were diagnosed as having tension pneumothorax and 12 as having communicating pneumothorax. All the cases failed to respond to continuous pleural suction for more than 5 days and consented to the proposed treatment. Before procedure, chest suction was established to allow sustained airflow through the drainage tube while the patients breathed normally. Under direct vision through fiberoptic bronchoscope, injection catheter was inserted into the bronchoscopy channel, and methylene blue saline was slowly injected into the potentially leaking segmental or sub-segmental bronchi. When a steady decline or disappearance in the amount of methylene blue saline in the airways was observed, or methylthionine-tainted saline was detected within the chest drainage tube, the bronchus responsible for air leakage was indicated. Before blocking the target bronchus, the negative pressure level of pleural suction should be reduced or stopped, and then porcine fibrin glue or a-cyanoacrylate was used for sealing the bronchi associated with air leakage. When the air was absent from the drainage tube, and lung recruitment was indicated in the chest X-ray for 5 days, and bronchial blockade of air leakage was proved successful. The bronchi responsible for air leakage were successfully located in all 27 cases, among them segmental bronchi were located in 16, subsegmental bronchi in 10, and small subsegmental bronchus in only one. Multiple adjacent segmental involvement occurred in 3, and multiple adjacent subsegmental involvement in

  3. Were Pneumothorax and Its Management Known in 15th-Century Anatolia?

    OpenAIRE

    Kaya, Seyda Ors; Karatepe, Mustafa; TOK, Turgut; Onem, Gokhan; Dursunoglu, Nese; Goksin, Ibrahim

    2009-01-01

    Jean-Marc Gaspard Itard, a student of René Laennec's, first recognized pneumothorax in 1803, and Laennec himself described the full clinical picture of the condition in 1819. Treatment of pneumothorax was not begun as a standard procedure until World War II, but we think that Serefeddin Sabuncuoglu recognized the condition and applied treatment in the 15th century.

  4. 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.)

  5. 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

  6. 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...

  7. 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.

  8. Iatrogenic Cushing's syndrome in children following nasal steroid.

    Science.gov (United States)

    Oluwayemi, Isaac Oludare; Oduwole, Abiola Olufunmilayo; Oyenusi, Elizabeth; Onyiriuka, Alphonsus Ndidi; Abdullahi, Muhammad; Fakeye-Udeogu, Olubunmi Benedicta; Achonwa, Chidozie Jude; Kouyate, Moustapha

    2014-01-01

    Cushing syndrome is a hormonal disorder caused by prolonged exposure of body tissue to cortisol. We report two cases of iatrogenic Cushing's syndrome in two Nigerian children following intranasal administration of aristobed-N (Betamethasone + Neomycin) given at a private hospital where the children presented with feature of adenoidal hypertrophy. Two months into treatment children were noticed to have developed clinical and laboratory features of iatrogenic Cushing's syndrome with critical adrenal suppression. Serum cortisol (at presentation): 1(st) patient: 12nmol/L (reference range 240-618), 2(nd) 1.69nmol/L. Serum cortisol (3 months after weaning off steroid): 343.27 nmol/L (within normal range for the first patient; second patient newly presented and has just begun steroid weaning off process. The serum cortisol level one month into weaninig off process was 128 nmol/L). Unsupervised topical steroid administration in children can cause adrenal suppression with clinical features of Cushing's syndrome.

  9. 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.

  10. 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.

  11. 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

  12. Iatrogenic Mandibular Fracture Associated with Third Molar Removal

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    Abdulkadir Burak Cankaya, Mehmet Ali Erdem, Sirmahan Cakarer, Muhsin Cifter, Cuneyt Korhan Oral

    2011-01-01

    Full Text Available Third molar extraction is one of the most common procedures performed in oral and maxillofacial surgery units. It is sometimes accompanied by complications such as alveolar osteitis, secondary infection, hemorrhage, dysesthesia and, most severely, iatrogenic fracture. This article describes two mandibular angle fractures that occurred in two patients during the surgical extraction of one erupted and one unerupted third molar, including a brief review of the literature.

  13. Iatrogenic Mandibular Fracture Associated with Third Molar Removal

    OpenAIRE

    Abdulkadir Burak Cankaya, Mehmet Ali Erdem, Sabri Cemil Isler, Sabit Demircan, Merva Soluk, Cetin Kasapoglu, Cuneyt Korhan Oral

    2011-01-01

    Third molar extraction is one of the most common procedures performed in oral and maxillofacial surgery units. It is sometimes accompanied by complications such as alveolar osteitis, secondary infection, hemorrhage, dysesthesia and, most severely, iatrogenic fracture. This article describes two mandibular angle fractures that occurred in two patients during the surgical extraction of one erupted and one unerupted third molar, including a brief review of the literature.

  14. Embolis cutis medicamentosa, a rare preventable iatrogenic complication

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    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.

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

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    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.

  16. 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.

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

    Science.gov (United States)

    Govindaraj, Santhiya; Viswanathan, Stalin

    2011-07-01

    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.

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

    Science.gov (United States)

    Govindaraj, Santhiya; Viswanathan, Stalin

    2011-01-01

    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. PMID:24765331

  19. Pyo-pneumothorax tuberculeux: à propos de 18 cas

    Science.gov (United States)

    Hicham, Souhi; Hanane, El Ouazzani; Hicham, Janah; Ismaïl, Rhorfi; Ahmed, Abid

    2016-01-01

    Le pyo-pneumothorax tuberculeux est une complication rare mais grave de la tuberculose pulmonaire évolutive. Nous rapportons une série de 18 cas de pyo-pneumothorax tuberculeux colligés au service de Pneumo-Phtisiologie de l'Hôpital Militaire d'Instruction Mohammed V de Rabat entre janvier 2005 et décembre 2009. Il s'agit de 15 hommes et 3 femmes d’âge moyen de 35 ans ±7 ans. 4 patients étaient diabétiques. Le tabagisme était retrouvé chez 9 cas. Le pyo-pneumothorax était du coté droit dans 13 cas. La radiographie thoracique avait montré des lésions cavitaires chez 15 patients et des lésions étendues et bilatérales chez 8 cas. La recherche de BK dans le liquide de tubage gastrique était positive chez 16 cas. Un drainage thoracique associé à un traitement antituberculeux selon le régime 2SRHZ/7RH et une kinésithérapie respiratoire ont été instaurés chez tous les cas. La durée moyenne de drainage pleural était de 4 semaines. Chez 3 cas on avait noté la persistance de la suppuration pleurale ayant nécessité une toilette pleurale sous thoracoscopie avec pleurectomie et exérèse pulmonaire limitée emportant la lésion parenchymateuse tuberculeuse et la persistance d'une volumineuse poche pleurale avec trouble ventilatoire restrictif ayant nécessité une décortication pleurale chirurgicale chez deux cas. L’évolution était favorable avec pachypleurite séquellaire minime chez le reste des cas. Le pyo-pneumothorax tuberculeux est une forme grave, qui est souvent en rapport avec une tuberculose cavitaire active. L’évolution est généralement trainante malgré le traitement antituberculeux et le drainage thoracique, d'où la nécessité d'un diagnostic et un traitement précoce de toute forme de tuberculose. PMID:27583090

  20. 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.

  1. Prevention of Iatrogenic Anemia in Critical and Neonatal Care.

    Science.gov (United States)

    Jakacka, Natalia; Snarski, Emilian; Mekuria, Selamawit

    2016-01-01

    Iatrogenic anemia caused by diagnostic blood sampling is a common problem in the intensive care unit, where continuous monitoring of blood parameters is very often required. Cumulative blood loss associated with phlebotomy along with other factors render this group of patients particularly susceptible to anemia. As it has been proven that anemia in this group of patients leads to inferior outcomes, packed red blood cell transfusions are used to alleviate possible threats associated with low hemoglobin concentration. However, the use of blood components is a procedure conferring a set of risks to the patients despite improvements in safety. Iatrogenic blood loss has also gained particular attention in neonatal care, where cumulative blood loss due to samples taken during the first week of life could easily equal or exceed circulating blood volume. This review summarizes the current knowledge on the causes of iatrogenic anemia and discusses the most common preventive measures taken to reduce diagnostic blood loss and the requirement for blood component transfusions in the aforementioned clinical situations.

  2. Clinical Analysis of 37 Cases of Neonatal Pneumothorax and Pneumomediastinum%37例新生儿气胸及纵隔气肿的临床及治疗分析

    Institute of Scientific and Technical Information of China (English)

    唐先莉; 包蕾; 刘万琼

    2011-01-01

    目的:探讨新生儿气胸、纵隔气肿的发生原因及防治措施.方法:对37例新生儿气胸及纵隔气肿病例的临床资料进行回顾性分析.结果:自发性4例,肺源性20例,医源性13例.保守治疗20例,胸腔穿刺抽气2例,胸腔闭式引流15例,痊愈33例,3例放弃治疗.结论:新生儿气胸、纵隔气肿的高危因素:剖宫产、羊水胎粪吸入及新生儿呼吸窘迫综合征、呼吸机的使用.通过做好围产期保健、防止宫内及分娩窒息、及时应用肺表现活性物质可预防此病的发生.%Objective:To study the neonates with pneumothorax and pneumomediastinum, and the cause and prevention measures. Methods: Thirty seven neonates with pneumothorax and pneumomediastinum were retrospectively analyzed. Results: Spontaneous in 4 cases, pulmonary in 20 cases, iatrogenic in 13 cases. Conservative treatment in 20 cases, pleural puncture exhaust in 2 cases, thoracic close drainage in 15 cases. Thirty three cases were cured, while three cases gave up treatment. Conclusions: The risk factors of neonatal pneumothorax, pneumomediastinum are: cesarean section, amniotic fluid meconium aspiration, transient respiratory distress of the newborn and the use of ventilators.

  3. Lignification and tension wood.

    Science.gov (United States)

    Pilate, Gilles; Chabbert, Brigitte; Cathala, Bernard; Yoshinaga, Arata; Leplé, Jean-Charles; Laurans, Françoise; Lapierre, Catherine; Ruel, Katia

    2004-01-01

    Hardwood trees are able to reorient their axes owing to tension wood differentiation. Tension wood is characterised by important ultrastructural modifications, such as the occurrence in a number of species, of an extra secondary wall layer, named gelatinous layer or G-layer, mainly constituted of cellulose microfibrils oriented nearly parallel to the fibre axis. This G-layer appears directly involved in the definition of tension wood mechanical properties. This review gathers the data available in the literature about lignification during tension wood formation. Potential roles for lignin in tension wood formation are inferred from biochemical, anatomical and mechanical studies, from the hypotheses proposed to describe tension wood function and from data coming from new research areas such as functional genomics.

  4. 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.

  5. 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

  6. Thoracoscopic reoperation for recurrent pneumothorax after single-incision thoracoscopic surgery.

    Science.gov (United States)

    Sano, Atsushi; Kawashima, Mitsuaki

    2015-11-01

    An 18-year-old male patient who had undergone single-incision thoracoscopic surgery for left spontaneous pneumothorax was diagnosed with bilateral recurrent pneumothorax. We performed thoracoscopic reoperation and observed adhesions between the previous incision and the left lung. A bulla that was thought to be the cause of the recurrent left pneumothorax was found on the mediastinal side of previously ligated lesions. Longer incisions during single-incision thoracoscopic surgery may be more likely to cause adhesions. Despite the restricted view during surgery, care must be taken to identify all bullae. Use of reinforcement techniques is also important to prevent recurrence.

  7. Fatal re-expansion pulmonary edema in a young adult following tube thoracostomy for spontaneous pneumothorax.

    Science.gov (United States)

    Sharma, Sunil; Madan, Karan; Singh, Navneet

    2013-06-05

    Re-expansion pulmonary edema (RPE) is a rare but potentially fatal complication that can occur following rapid lung expansion while managing patients with pleural effusion or pneumothorax. In this case, fatal outcome occurred due to RPE in a previously healthy young adult male patient subsequent to tube thoracostomy for spontaneous pneumothorax. While managing patients with pneumothorax or large pleural effusions, precautions should be taken to avoid rapid re-expansion of the previously collapsed lung in order to reduce the probability of development of this complication.

  8. Recurrent pneumothorax as a presenting manifestation of active sarcoidosis: a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    LIU Yan; DAI Hua-ping; XU Li-li; LI Xue

    2010-01-01

    @@ Sarcoidosis is a systemic granulomatous disease of unknown cause. It commonly affects young to middle-aged adults and frequently presents with bilateral hilar lymphadenopathy, pulmonary infiltration, and ocular and skin lesions. Pleural involvement is relatively uncommon. Pneumothorax is a rare complication of sarcoidosis, occurring usually in the late fibrotic stages of the disease with associated bullous changes. There are only scattered case reports on pneumothorax as the first manifestation of sarcoidosis in medical literature. The present case study reports a young man who presented first with recurrent spontaneous pneumothorax during the early stage and relapse of sarcoidosis.

  9. Chondroblastoma with pulmonary metastasis in a patient presenting with spontaneous bilateral pneumothorax: Report of a case.

    Science.gov (United States)

    Tamura, Masaya; Oda, Makoto; Matsumoto, Isao; Sawada-Kitamura, Seiko; Watanabe, Go

    2011-10-01

    Chondroblastoma is a benign bone tumor with a relatively high incidence in older children and adolescents. Although it is generally regarded as a benign neoplasm, it sometimes grows aggressively or recurs but rarely metastasizes to the lung. We herein present a very rare case of a bilateral pneumothorax due to a pulmonary metastasis from a chondroblastoma. A 21-year-old man developed a bilateral pneumothorax 20 months after an operation for a chondroblastoma of the right ischium. A pertinent literature review revealed similar cases of chondroblastoma with pulmonary metastasis, but revealed no reports of a pneumothorax caused by a metastatic chondroblastoma.

  10. Iatrogenic Cushing's Syndrome Due to Topical Ocular Glucocorticoid Treatment.

    Science.gov (United States)

    Fukuhara, Daisuke; Takiura, Toshihiko; Keino, Hiroshi; Okada, Annabelle A; Yan, Kunimasa

    2017-02-01

    Iatrogenic Cushing's syndrome (CS) is a severe adverse effect of systemic glucocorticoid (GC) therapy in children, but is extremely rare in the setting of topical ocular GC therapy. In this article, we report the case of a 9-year-old girl suffering from idiopathic uveitis who developed CS due to topical ocular GC treatment. She was referred to the ophthalmology department with a complaint of painful eyes, at which time she was diagnosed with bilateral iridocyclitis and started on a treatment of betamethasone sodium phosphate eye drops. Six months after the initiation of topical ocular GC treatment, she was referred to our pediatric department with stunted growth, truncal obesity, purple skin striate, buffalo hump, and moon face. Because her serum cortisol and plasma adrenocorticotropic hormone levels were undetectable, she was diagnosed with iatrogenic CS. After the doses of topical ocular GC were reduced, the clinical symptoms of CS were improved. The fact that the amount of topical ocular GC with our patient was apparently less than that of similar previous cases tempted us to perform genetic analysis of her NR3C1 gene. We found that our patient had a single heterozygous nucleotide substitution in the 3' untranslated region of the NR3C1 gene, which may explain why she developed CS. However, additional investigations are required to determine if our findings can be extrapolated to other patients. In conclusion, clinicians should be aware that even extremely low doses of topical ocular steroid therapy can cause iatrogenic CS. Copyright © 2017 by the American Academy of Pediatrics.

  11. Air transport of patients with pneumothorax: is tube thoracostomy required before flight?

    Science.gov (United States)

    Braude, Darren; Tutera, Dominic; Tawil, Issac; Pirkl, Gregory

    2014-01-01

    It is conventionally thought that patients with pneumothorax (PTX) require tube thoracostomy (TT) before air medical transport (AMT), especially in unpressurized rotor-wing (RW) aircraft, to prevent deterioration from expansion of the PTX or development of tension PTX. We hypothesize that patients with PTX transported without TT tolerate RW AMT without serious deterioration, as defined by hypotension, hypoxemia, respiratory distress, intubation, bag valve mask ventilation, needle thoracostomy (NT), or cardiac arrest during transport. We conducted a retrospective review of a case-series of trauma patients transported to a single Level 1 trauma center via RW with confirmed PTX and no TT. Using standardized abstraction forms, we reviewed charts for signs of deterioration. Those patients identified as having clinical deterioration were independently reviewed for the likelihood that the clinical deterioration was a direct consequence of PTX. During the study period, 66 patients with confirmed PTX underwent RW AMT with an average altitude gain of 1890 feet, an average barometric pressure 586-600 mmHg, and average flight duration of 28 minutes. All patients received oxygen therapy; 14/66 patients (21%) were supported with positive pressure ventilation. Eleven of 66 patients (17%) had NT placed before flight and 4/66 (6%) had NT placed during flight. Four of 66 patients (6% CI0.3-11.7) may have deteriorated during AMT as a result of PTX; all were successfully managed with NT. In this series, 6% of patients with PTX deteriorated as result of AMT without TT, yet all patients were managed successfully with NT. Routine placement of TT in patients with PTX before RW AMT may not be necessary. Further prospective evaluation is warranted. Copyright © 2014 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

  12. Iatrogenic mid-root perforation of fused teeth

    Directory of Open Access Journals (Sweden)

    Vijay Kumar

    2012-01-01

    Full Text Available Fusion is defined as a union between the dentin and/or enamel of two or more distinct dental sprouts that occurs at any stage of the dental organ. Its prevalence ranges from 0.5%-2.5% in the primary dentition alone and 0.1%-1% of the primary as well as the permanent dentition. These fused teeth can cause various problems such as caries, periodontal disease, abnormal eruption, impaction or an ectopic eruption of an adjacent tooth and reported in the literature. However this paper documented an unusual case of iatrogenic root perforation of fused permanent lower anterior teeth during inter maxillary fixation.

  13. Radiofrequency Ablation for Iatrogenic Thyroid Artery Pseudoaneurysm: Initial Experience.

    Science.gov (United States)

    Jun, Ye Kyeong; Jung, So Lyung; Byun, Ho Kyun; Baek, Jung Hwan; Sung, Jin Yong; Sim, Jung Suk

    2016-10-01

    Eight iatrogenic thyroid pseudoaneurysms (ITPAs) after thyroid biopsy are reported. The mean ITPA diameter was 7.2 mm (range 4 to 12 mm). Ultrasound (US)-guided compression was initially performed at the neck of the ITPA in all cases. Among them, 4 ITPAs persisted (50%) in which radiofrequency (RF) ablation was performed. Mean RF ablation time and power were 13.5 seconds (range 5 to 24 seconds) and 20 W (range 10 to 50 W), respectively. All 4 cases were treated with RF ablation without any complications.

  14. Surgical replacement of iatrogenically prolapsed penis in a dromedary camel

    Directory of Open Access Journals (Sweden)

    S.A.T. Al-Qubati

    2012-11-01

    Full Text Available Prolapse of the penis through an iatrogenic incision on the right side of the preputial base in a five year old dromedary camel was handled surgically and the organ was successfully replaced into the preputial cavity. The condition occurred as a result of draining an abscess at the base of the prepuce by a quack about eight months earlier. The reason to report this case lies in its peculiarity that although the penis remained outside the preputial cavity for about eight months exposed to the external environment, yet no complications pertaining to its fragile tissue and urination occurred during this long period as seen in cases of paraphimosis.

  15. Iatrogenic Penile Glans Amputation: Major Novel Reconstructive Procedure

    Directory of Open Access Journals (Sweden)

    Rami Nasr

    2013-01-01

    Full Text Available Circumcision is a very common urological practice. Even though it is relatively safe, it is not a complication-free procedure. We describe a patient that underwent a neonatal circumcision complicated by iatrogenic complete glans amputation. Reconstructive repair of a neoglans using a modified traditional method was used. Postoperative followup to 90 days is illustrated. Despite being a simple procedure, circumcision in unprofessional hands can have major complication impacting the emotional and sexual life of patients. Surgical reconstruction is possible with varying satisfactory results.

  16. Iatrogenic granulomas of the prostate and the urinary bladder

    DEFF Research Database (Denmark)

    Sørensen, Flemming Brandt; Marcussen, N

    1987-01-01

    In 1059 patients who had transurethral resections (TUR) of the prostate 8 cases (0.8%) with nonspecific granulomas were found. In another group of 280 patients treated by TUR for tumours of the urinary bladder 5 cases (1.8%) had granulomatous lesions in the resectates. The granulomas were observed...... was observed in the granulomas. The findings are compared to previously reported cases of iatrogenic granulomas in the prostate, the urinary bladder and other organs. It is concluded that the granulomas arise as a local reaction to previous surgery, maybe involving hypersensitivity to locally altered collagen....

  17. 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

  18. [Pneumothorax during right-sided nephrectomy in a heifer].

    Science.gov (United States)

    Nuss, K; Muggli, E; Gerspach, C; Schramm, S; Dettwiler, M; Bach, F; Ringer, S

    2016-01-01

    A 250-kg heifer had signs of colic attributable to urolithiasis of the right kidney. Medical treatment did not result in resolution of clinical signs, and nephrectomy was carried out. The surgery was started with the heifer standing, and the 13th rib was resected. However, during blunt dissection of the kidney, air suddenly entered the pleural space and the heifer had acute severe dyspnoea. The hole in the pleural cavity was sutured and a chest drain was placed. Inhalation anaesthesia was then induced and nephrectomy could be completed without further complications. The heifer was discharged 11 days postoperatively, and was healthy and had been integrated into the herd 12 months after surgery. Pneumothorax must be considered a possible complication of rib resection in right-sided nephrectomy in cattle.

  19. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

  1. 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...

  2. [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.

  3. [Pneumothorax after treatment with bevacizumab-containing chemotherapy for breast cancer - a case report].

    Science.gov (United States)

    Makino, Takatoshi; Kudo, Shun; Ogata, Takashi

    2014-02-01

    A 62-year-old woman presented with a right breast tumor. Examination yielded a diagnosis of right breast cancer (T4bN3bM1[lung]). After right breast mastectomy for local control, 9 sessions of chemotherapy containing an anthracycline and taxane were administered. Because of progression of lung metastasis, bevacizumab and paclitaxel were administered. Follow-up computed tomography(CT)scans showed that the multiple solid lung metastases had reduced in size, but a hollowing effect was noted. Eight months later, the patient developed left pneumothorax. The origin of the pneumothorax was unclear, but the hollowing due to the lung metastases seen after bevacizumab treatment was thought to be the cause. The pneumothorax resolved after tube thoracostomy, but disease progression occurred because of the lack of chemotherapy, and the patient's general condition worsened. Although rare, we speculate that there is a risk of pneumothorax after bevacizumab- containing chemotherapy.

  4. 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.

  5. 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.

  6. 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.

  7. 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.

  8. Iatrogenic Cushing syndrome caused by ocular glucocorticoids in a child.

    Science.gov (United States)

    Messina, Maria Francesca; Valenzise, Mariella; Aversa, Salvatore; Arrigo, Teresa; De Luca, Filippo

    2009-01-01

    A boy aged 7.6 years presented to our Unit of Paediatric Endocrinology for evaluation of obesity. Progressive weight gain (10 kg) started 6 months earlier after an accidental penetrating orbital injury on the right eye. During this period the child has been treated with oral betamethasone (0.5 mg/day) for 1 month and dexamethasone 2% ocular drops (2 hourly by day) for 6 months. Physical examination showed he was 113.5 cm in height (-1.5 SD), weight 36.0 kg, blood pressure 110/90 mmHg (90th centile), body mass index 28 (+5 SD), truncal obesity, buffalo hump, "moon-face", increased lanugo hair and supraclavicular fullness. Endocrinological work-up revealed undetectable levels of basal adrenocorticotropic hormone (ACTH), basal and ACTH-stimulated cortisol and 24 h urine excretion cortisol, confirming the diagnosis of iatrogenic Cushing syndrome. The abrupt withdrawal of ocular glucocorticoids by the parents evoked two adrenal crises; 4 months later the patient recovered. In conclusion, we would alert doctors that every formulation of glucocorticoids, no ocular drops excluded, can determine severe systemic side effects and iatrogenic Cushing syndrome.

  9. Tuberous sclerosis presenting with spontaneous pneumothorax secondary to lymphangioleiomyomatosis; previously mistaken for asthma

    OpenAIRE

    Gosein, Maria Angela; Ameeral, Anthony; Konduru, Siva Krishna Prasad; Dola, Venkata Naga Srinivas

    2013-01-01

    A middle-aged female patient, previously diagnosed with asthma, presented with a large spontaneous left pneumothorax. She had a history of nephrectomy for a ruptured renal angiomyolipoma (AML) with a postoperative spontaneous pneumothorax when she was an adolescent. High-resolution CT chest revealed multiple scattered thin-walled lung parenchyma cysts consistent with lymphangioleiomyomatosis (LAM). Hepatic AMLs and adenoma sebaceum skin lesions were also noted, consistent with an overall diag...

  10. The pathogenesis of pneumothorax in Birt-Hogg-Dubé syndrome: a hypothesis.

    Science.gov (United States)

    Johannesma, Paul Christiaan; Houweling, Arjan C; van Waesberghe, Jan-Hein T M; van Moorselaar, R J Jeroen A; Starink, Theo M; Menko, Fred H; Postmus, Pieter E

    2014-11-01

    The development and natural course of lung cysts in patients with Birt-Hogg-Dubé syndrome (BHD) is still unclear, and the relationship between lung cysts and pneumothorax is not fully clarified. Based on the follow-up results of thoracic imaging in six patients with BHD, we hypothesize that decreased potential for stretching of the cysts' wall and extensive contact with the visceral pleura are probably responsible for rupture of the cyst wall resulting in increased risk for pneumothorax.

  11. 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

  12. "Recurrent Bilateral Spontaneous Pneumothorax in Early Infancy: A Case of Langerhans Cell Histiocytosis"

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    S. Alavi

    2005-07-01

    Full Text Available Langerhans cell histiocytosis (LCH is a rare disorder characterized by infiltration of either single or multiple organs by S100 and CD1a positive cells. Patients with pulmonary LCH are predisposed to pneumothorax due to destructive changes in the lung parenchyma. Here, we report a case of multisystem LCH who presented at 2 months of age with simultaneous bilateral spontaneous pneumothorax.

  13. On the Stability of Lung Parenchymal Lesions with Applications to Early Pneumothorax Diagnosis

    OpenAIRE

    Bhandarkar, Archis R.; Rohan Banerjee; Padmanabhan Seshaiyer

    2013-01-01

    Spontaneous pneumothorax, a prevalent medical challenge in most trauma cases, is a form of sudden lung collapse closely associated with risk factors such as lung cancer and emphysema. Our work seeks to explore and quantify the currently unknown pathological factors underlying lesion rupture in pneumothorax through biomechanical modeling. We hypothesized that lesion instability is closely associated with elastodynamic strain of the pleural membrane from pulsatile air flow and collagen-elastin ...

  14. 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...

  15. [Pneumothorax Secondary to Pulmonary Metastasis of Angiosarcoma of the Scalp;Report of a Case].

    Science.gov (United States)

    Naomi, Akira; Oyamatsu, Yasunori; Narita, Kunio; Nakayama, Masao; Maeda, Matsuyoshi

    2015-07-01

    Angiosarcoma has been reported as a rare case, having high potential of hematogeneous lung metastasis and then developing to pneumothorax with ease. The patient was a 74-year-old man afflicted with a malignant hemangio endothelioma (MHE) of the scalp. His MHE of the scalp was resected and skin grafting was made, then, he was administered docetaxel hydrate intravenously as adjuvant setting. Three years after, he complainted left chest pain and dyspnea, so his chest Xp was checked up and showed left pneumothorax. Chest computed tomography revealed multiple thin walled cavities of right and left lung and bullae with slightly thick walled cavity at apex legion of the left lung. We resected bullae with tumor of the left apex legion under video assisted thoracic surgery. After operation, He was administerd ricombinant interleukin-2 intravenously in order to control lung metastasis of the scalp, but his condition deteriorated and 6 months after pneumothorax he died. The average survival time from the 1st pneumothorax episode was only 4.7 months. He kept a good activities of daily living without reccurrence of pneumothorax by operation, so we thought that the operaion for pneumothorax with MHE was one option for therapy.

  16. Risk factors for recurrence of primary spontaneous pneumothorax after thoracoscopic surgery.

    Science.gov (United States)

    Huang, Haibo; Ji, Hua; Tian, Hui

    2015-06-01

    Primary spontaneous pneumothorax recurs at a certain rate after thoracoscopic surgery, and risk factors for that recurrence are in question. The medical records of 248 patients with primary spontaneous pneumothorax who were followed for more than 2 years after thoracoscopic surgery were reviewed and retrospectively analyzed. Univariate and multivariate binary logistic regression analysis were used to identify possible risk factors. Twelve patients experienced the recurrence of primary spontaneous pneumothorax. Patients who experienced the recurrence of primary spontaneous pneumothorax were younger than patients who experienced no recurrence. A larger proportion of the patients who experienced recurrence did not undergo pleurodesis. The variables age, height, weight, body mass index, duration of air leakage, and pleurodesis (performed or not) with a p value less than 0.2 in univariate analysis were entered in multivariate analysis. A younger age and not undergoing pleurodesis were associated with a higher risk of postoperative ipsilateral recurrence of primary spontaneous pneumothorax. Not undergoing pleurodesis and a younger age are possible risk factors for recurrence of primary spontaneous pneumothorax after thoracoscopic surgery. Thoracic surgeons should pay more attention to pleurodesis, especially in younger patients.

  17. Iatrogenic illness in the paediatric intensive care unit at Gharian teaching hospital, Libya.

    Science.gov (United States)

    Ismail, A M; Shedeed, S A

    2012-02-01

    The aim of this prospective follow-up study wasto determine the incidence and risk factors of iatrogenic illness and the outcome among cases admitted to the paediatric intensive care unit in ateaching hospital in Libya. The incidence of iatrogenic complications was 22.9% among 423 cases admitted over a 1-year period. Human error (18.4%) followed by machine defects (4.5%) were the most common causes of complications. The overall mortality rate was 7.6% and was significantly higher in iatrogenic cases than others (13.4% versus 5.8%). Paediatric risk of mortality (PRISM) score was a good predictor of risk of iatrogenic illness. Both mortality and occurrence of iatrogenic illness were significantly associated with: higher PRISM score, use of mechanical ventilation, higher bed occupancy rate in the unit, presence of respiratory and neurological diseases, prolonged duration of stay in the intensive care unit and younger age of the child.

  18. Tension chylothorax following pneumonectomy

    Directory of Open Access Journals (Sweden)

    Hemang Yadav

    2015-01-01

    Full Text Available Post-pneumonectomy chylothorax is an uncommon complication following surgery, with an estimated incidence of less than 0.7%. Post-pneumonectomy tension chylothorax, where rapid accumulation of chyle in the post-pneumonectomy space results in hemodynamic compromise, is exceedingly rare, with just 7 cases previously reported. All prior cases of tension chylothorax were managed operatively with decompressive chest tube placement followed by open thoracic duct repair. Our case is the first reported tension chylothorax to be managed conservatively by thoracostomy drainage coupled with a period of parenteral nutrition followed by a medium chain triglyceride-restricted diet.

  19. 针刺及穴位注射致气胸38例临床分析%Clinical analysis on 38 cases of pneumothorax induced by acupuncture or acupoint injection

    Institute of Scientific and Technical Information of China (English)

    赵东勇; 张国良

    2009-01-01

    Objective To probe into the mechanism of pneumothorax caused by acupuncture or acupoint injection and the preventive methods. Methods Retrospectively analyze the clinical original symptoms of 38 cases with pneumothorax caused by acupuncture and acupoint injection, which were divided into four clinical types: dyspnea type, shock type, thoracalgia type and tardy type. Illustrate the relation of the clinical types with severe degrees of pneumothorax, and the mechanism of pneumothorax inducing death of the patient. Results In the series there were 38 cases with pneumothorax induced by acupuncture or acupoint injection, including 4 cases of dyspnea type, 16 cases of shock type, 14 cases of thoracalgia type, 4 cases of tardy type. After proper treatment, 37 cases were cured and one case of dyspnea type died of tension pneumothorax. Conclusion The mechanism of pneumothorax caused by acupuncture or acupoint injection is that due to the filiform needle tip or the syringe's needle tip inserting into the lung tissue at the patient's respiration in acupuncture or acupoint injection, the filiform needle tip or the syringe's needle tip lacerates the lung tissue. Air in alveolus goes into the thorax pleura cavity to form pneumothorax. In acupuncture or acupoint injection, the needle tip must not insert into the lung tissue, which is a key for prevention of pneumothorax.%目的:探讨针刺或穴位注射疗法继发气胸的发病机制及其预防方法.方法:回顾性分析38例针刺或穴位注射疗法继发气胸的初起临床征象并将其分为4型:呼吸困难型、休克型、胸痛型和迟发型.阐明各临床型与气胸严重程度的关系以及气胸造成患者死亡的机制.结果:本组报告针刺和穴位注射后发生气胸38例,其中有呼吸困难型4例、休克型16例、胸痛型14例、迟发型4例.经适当处理治疗,38例中痊愈37例,1例呼吸困难型患者死于张力性气胸.结论:针刺或穴位注射疗法继发气胸的发病机

  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....

  1. 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

  2. Pneumothorax in neonates: a level III Neonatal Intensive Care Unit experience

    Directory of Open Access Journals (Sweden)

    Íris Santos Silva

    2016-09-01

    Full Text Available Introduction: Pneumothorax occurs more frequently in the neonatal period than in any other period of life and is associated with increased mortality and morbidity. Several risk factors for pneumothorax, including respiratory pathology, invasive and non-invasive respiratory support, and predictors of mortality have been described.Objective: To evaluate the prevalence of pneumothorax, to assess risk factors and to describe the clinical characteristics, management and outcome of newborn infants with pneumothorax, as well as to identify predictors of mortality in these newborns.Methods: This retrospective case-control study included all newborns hospitalized in the Neonatal Intensive Care Unit (NICU of “Centro Hospitalar São João”, Porto, Portugal, between 2003 and 2014, with the diagnosis of pneumothorax. A control group was selected among the newborns without pneumothoraces, admitted to the same NICU during the same period. The collected data included: demographics and perinatal data, pneumothorax characteristics, classification, treatment and clinical outcomes.Results: Our study included 240 neonates (80 with pneumothoraces and 160 controls, of whom 145 were male (60.4%. Median gestational age was 37 (24-40 weeks and median birthweight 2,613 (360-4,324 grams. The prevalence in our NICU was 1.5%. Pneumothorax was significantly associated with respiratory distress syndrome (RDS (p = 0.010 and transient tachypnea of the newborn (TTN (p < 0.001. Invasive mechanical ventilation (MV (p = 0.016 and FiO2 ≥ 0.4 (p = 0.003, were independent risk factors for the development of pneumothoraces. The mortality rate was 13.8%. Hypotension, MV and thoracentesis followed by a chest tube insertion were found to be predictors of mortality in newborns with pneumothoraces, but pneumothorax per se was not a predictor of mortality.Conclusion: Pneumothorax is relatively frequent in the NICU. Its risk factors and predictors of mortality should be known in order to

  3. Is Iatrogenic Cushing s a New Form of Child Neglect?

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    Habip Almis

    2016-02-01

    Full Text Available Child abuse is an increasingly important issue. One of the main types of abuse is child neglect, that is, behavior in which the child is knowingly or unknowingly injured. In this article; we report a case of iatrogenic Cushing%u2019s syndrome due to clobetasol 17-propionate treatment that was used inappropriately, in order to discuss whether or not this is a form of child neglect. It is one of the basic tasks of families to protect the health of the child and learn how to treat that child when he or she is ill. We believe that by being adequately informed by the health professionals, families may reduce the risk of child neglect.

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

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    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.

  5. FLCN intragenic deletions in Chinese familial primary spontaneous pneumothorax.

    Science.gov (United States)

    Ding, Yibing; Zhu, Chengchu; Zou, Wei; Ma, Dehua; Min, Haiyan; Chen, Baofu; Ye, Minhua; Pan, Yanqing; Cao, Lei; Wan, Yueming; Zhang, Wenwen; Meng, Lulu; Mei, Yuna; Yang, Chi; Chen, Shilin; Gao, Qian; Yi, Long

    2015-05-01

    Primary spontaneous pneumothorax (PSP) is a significant clinical problem, affecting tens of thousands patients annually. Germline mutations in the FLCN gene have been implicated in etiology of familial PSP (FPSP). Most of the currently identified FLCN mutations are small indels or point mutations that detected by Sanger sequencing. The aim of this study was to determine large FLCN deletions in PSP families that having no FLCN sequence-mutations. Multiplex ligation-dependent probe amplification (MLPA) assays and breakpoint analyses were used to detect and characterize the deletions. Three heterozygous FLCN intragenic deletions were identified in nine unrelated Chinese families including the exons 1-3 deletion in two families, the exons 9-14 deletion in five families and the exon 14 deletion in two families. All deletion breakpoints are located in Alu repeats. A 5.5 Mb disease haplotype shared in the five families with exons 9-14 deletion may date the appearance of this deletion back to approximately 16 generations ago. Evidences for founder effects of the other two deletions were also observed. This report documents the first identification of founder mutations in FLCN, as well as expands mutation spectrum of the gene. Our findings strengthen the view that MLPA analysis for intragenic deletions/duplications, as an important genetic testing complementary to DNA sequencing, should be used for clinical molecular diagnosis in FPSP.

  6. Pneumothorax as a complication of central venous catheter insertion.

    Science.gov (United States)

    Tsotsolis, Nikolaos; Tsirgogianni, Katerina; Kioumis, Ioannis; Pitsiou, Georgia; Baka, Sofia; Papaiwannou, Antonis; Karavergou, Anastasia; Rapti, Aggeliki; Trakada, Georgia; Katsikogiannis, Nikolaos; Tsakiridis, Kosmas; Karapantzos, Ilias; Karapantzou, Chrysanthi; Barbetakis, Nikos; Zissimopoulos, Athanasios; Kuhajda, Ivan; Andjelkovic, Dejan; Zarogoulidis, Konstantinos; Zarogoulidis, Paul

    2015-03-01

    The central venous catheter (CVC) is a catheter placed into a large vein in the neck [internal jugular vein (IJV)], chest (subclavian vein or axillary vein) or groin (femoral vein). There are several situations that require the insertion of a CVC mainly to administer medications or fluids, obtain blood tests (specifically the "central venous oxygen saturation"), and measure central venous pressure. CVC usually remain in place for a longer period of time than other venous access devices. There are situations according to the drug administration or length of stay of the catheter that specific systems are indicated such as; a Hickman line, a peripherally inserted central catheter (PICC) line or a Port-a-Cath may be considered because of their smaller infection risk. Sterile technique is highly important here, as a line may serve as a port of entry for pathogenic organisms, and the line itself may become infected with organisms such as Staphylococcus aureus and coagulase-negative Staphylococci. In the current review we will present the complication of pneumothorax after CVC insertion.

  7. Medical image of the week: pneumothorax with air bronchograms

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    Ateeli H

    2016-09-01

    Full Text Available No abstract available. Article truncated at 150 words. Development of pneumothoraces in critically ill patients is commonly encountered in the critical care unit (ICU. Incidence has been reported between 4-15% of patients. In most instances, pneumothorax in the ICU is considered a medical emergency especially when the patient is mechanically ventilated (1. Here, we present a 61-year-old man with a past medical history of insulin dependent diabetes and paraplegia from prior spine injury who presented with acute respiratory distress after a pulseless electrical activity cardiac arrest. Cardiopulmonary resuscitation (CPR was initiated by emergency medical services at home, and continued and the emergency department (ED for a total of 30 minutes. The patient presented previously to the ED, one week prior, for a mild respiratory illness and tested positive for influenza B. He was sent home on oseltamivir. His family is unsure of compliance with medication but reported he was clinically stable up to the morning of presentation. The ...

  8. Blood Vessel Tension Tester

    Science.gov (United States)

    1978-01-01

    In the photo, a medical researcher is using a specially designed laboratory apparatus for measuring blood vessel tension. It was designed by Langley Research Center as a service to researchers of Norfolk General Hospital and Eastern Virginia Medical School, Norfolk, Virginia. The investigators are studying how vascular smooth muscle-muscle in the walls of blood vessels-reacts to various stimulants, such as coffee, tea, alcohol or drugs. They sought help from Langley Research Center in devising a method of measuring the tension in blood vessel segments subjected to various stimuli. The task was complicated by the extremely small size of the specimens to be tested, blood vessel "loops" resembling small rubber bands, some only half a millimeter in diameter. Langley's Instrumentation Development Section responded with a miniaturized system whose key components are a "micropositioner" for stretching a length of blood vessel and a strain gage for measuring the smooth muscle tension developed. The micropositioner is a two-pronged holder. The loop of Mood vessel is hooked over the prongs and it is stretched by increasing the distance between the prongs in minute increments, fractions of a millimeter. At each increase, the tension developed is carefully measured. In some experiments, the holder and specimen are lowered into the test tubes shown, which contain a saline solution simulating body fluid; the effect of the compound on developed tension is then measured. The device has functioned well and the investigators say it has saved several months research time.

  9. 新生儿气胸临床分析%Clinical analysis of pneumothorax in neonates

    Institute of Scientific and Technical Information of China (English)

    黄先杰; 李晓艳; 宫红梅; 许松涛; 张冰; 安丽花

    2013-01-01

    目的:探讨新生儿自发性气胸与非自发性气胸患儿的病因、临床表现、治疗及预后的差异。方法对2011年7月~2013年9月郑州市第一人民医院新生儿科收治的36例新生儿气胸临床资料进行回顾性分析,36例患儿分为自发性气胸组(16例),非自发性气胸组(20例),比较两组患儿胎龄、性别、出生体重、分娩方式、气胸发生部位、压缩面积、治疗及结局有何差异。结果两组间胎龄、性别、出生体重、压缩面积、气胸部位及治疗结局均无显著性差异。自发性气胸组患儿中剖宫产儿所占比例高于非自发性气胸组(P=0.018),而需闭式引流比例低于非自发性气胸组(P=0.023)。结论剖宫产可能是自发性气胸的危险因素。与非自发性气胸相比,自发性气胸经保守治疗更易于自行吸收。%Objective To explore the difference between the neonates with spontaneous pneumothorax and non-spontaneous pneumothorax in the etiology, clinical manifestations, treatment and prognosis. Methods The clinical data of 36 neonates with pneummothorax that were diagnosed and treated from July 2011 to September 2013 were analysed.36 neonates with pneummothorax were divided into two groups: spontaneous pneumothorax and non-spontaneous pneumothorax.The difference in the gestation age,gender,birth weight,delivery type,site of the pneumothorax, compressed area,method of treatment and outcom between two groups were analysed. Result There was no significant difference in gestation age,gender,birth weight,site of the pneumothorax,compressed area and treatment outcom.Compared with the group of non-spontaneous pneumothorax, more neonates were born by cesarean section in the spontaneous pneumothorax group(P=0.018).The ratio of closed thoracic drainage in the spontaneous pneumothorax group was lower than it in the non-spontaneous pneumothorax. Conclusion Cesarean section may be a risk factor for spontaneous

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

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    Gompelmann D

    2016-08-01

    Full Text Available Daniela Gompelmann,1,2,* Hyun-ju Lim,3,4,* Ralf Eberhardt,1,2 Vasiliki Gerovasili,5 Felix JF Herth,1,2 Claus Peter Heussel,2–4 Monika Eichinger3,4 1Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, 2Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research, 3Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik at University of Heidelberg, 4Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany; 5First Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece *These authors contributed equally to this work Background: 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. Methods: 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. Finding: Low attenuation volume% of ipsilateral untreated lobe (odds ratio [OR] =1.08, P=0.001, ipsilateral

  11. 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.

  12. Pneumothorax and the Value of Chest Radiography after Ultrasound-Guided Thoracocentesis

    Energy Technology Data Exchange (ETDEWEB)

    Pihlajamaa, K.; Bode, M.K.; Puumalainen, T.; Lehtimaeki, A.; Marjelund, S.; Tikkakoski, T. [Keski-Pohjanmaan sairaanhoitopiiri, Kokkola (Finland). Rontgenosasto

    2004-12-01

    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.

  13. 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

    2017-03-01

    We aimed to describe electrocardiographic (ECG) findings in spontaneous pneumothorax patients before and after closed thoracostomy. 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. 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. We found only minor changes in ECG after closed thoracostomy in spontaneous pneumothorax patients.

  14. Surface Tension of Spacetime

    Science.gov (United States)

    Perko, Howard

    2017-01-01

    Concepts from physical chemistry and more specifically surface tension are introduced to spacetime. Lagrangian equations of motion for membranes of curved spacetime manifold are derived. The equations of motion in spatial directions are dispersion equations and can be rearranged to Schrodinger's equation where Plank's constant is related to membrane elastic modulus. The equation of motion in the time-direction has two immediately recognizable solutions: electromagnetic waves and corpuscles. The corpuscular membrane solution can assume different genus depending on quantized amounts of surface energy. A metric tensor that relates empty flat spacetime to energetic curved spacetime is found that satisfies general relativity. Application of the surface tension to quantum electrodynamics and implications for quantum chromodynamics are discussed. Although much work remains, it is suggested that spacetime surface tension may provide a classical explanation that combines general relativity with field theories in quantum mechanics and atomic particle physics.

  15. [Mucosecretor adenocarcinoma of the lung with pleural involvement presenting as a pneumothorax. Presentation of a clinical case].

    Science.gov (United States)

    Hermida Pérez, J A; Hernández Guerra, J S; Bermejo Hernandez, Á; Sobenes Gutierrez, R J

    2013-10-01

    The combination of a pneumothorax and lung cancer is rare and diagnosis is complex. Clinical suspicion of cancer must be based on radiological findings and the existence of risk factors. We discuss the mechanisms involved in the development of pneumothorax in patients with lung cancer, as well as the clinical significance, the recommended diagnostic approach, and therapeutic guidelines.

  16. The Pilgaard-Dahl syndrome: laughter-induced pneumothorax - one of the many potentially detrimental consequences of laughter

    DEFF Research Database (Denmark)

    Andreasen, Dorthe Bach; El Fassi, Daniel

    2010-01-01

    In this article we propose the eponym Pilgaard-Dahl syndrome (named after two Danish revue actors). The syndrome consists of laughter-induced pneumothorax in smoking middle-aged men when exposed to hearty humour. The epidemiology and pathophysiology of spontaneous pneumothorax - in particular...

  17. 气胸的临床治疗体会%Clinical Treatment Experience of Pneumothorax

    Institute of Scientific and Technical Information of China (English)

    肖广海

    2015-01-01

    Objective To investigate the clinical treatment of pneumothorax. Methods May to December 2012 in our hospital 37 cases of pneumothorax in patients with data analysis. Results 37 patients were cured 34 cases , 3 cases of recurrence. Conclusion Attention should be pay to the treatment of recurrent pneumothorax after treatment before the onset of the number of recurrent clear risk factors.%目的:探讨气胸的临床治疗体会。方法对2012年5月~12月我院收治的37例气胸患者进行资料分析。结果37例患者治愈34例,3例复发。结论气胸治疗后要预防复发,治疗前发次数是复发明确的危险因素。

  18. Radiographically Severe but Clinically Mild Reexpansion Pulmonary Edema following Decompression of a Spontaneous Pneumothorax

    Directory of Open Access Journals (Sweden)

    William E. Harner

    2014-01-01

    Full Text Available The case is a 48-year-old female who presented with mild dyspnea on exertion and cough with unremarkable vital signs and was found to have a large right sided pneumothorax. She underwent small bore chest tube decompression with immediate reexpansion of the collapsed lung. However, she rapidly developed moderate hypoxemia and radiographic evidence of reexpansion pulmonary edema (REPE on both the treated and contralateral sides. Within a week, she had a normal chest X-ray and was asymptomatic. This case describes a rare complication of spontaneous pneumothorax and highlights the lack of correlation between symptoms, sequelae, and radiographic severity of pneumothorax and reexpansion pulmonary edema. Proposed pathophysiologic mechanisms include increased production of reactive oxygen species with subsequent loss of surfactant and increased vascular permeability, and loss of vasoregulatory tone.

  19. Cannabis increased the risk of primary spontaneous pneumothorax in tobacco smokers: a case–control study

    DEFF Research Database (Denmark)

    Olesen, Winnie Hedevang; 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 

  20. A Neonatal Pneumonia Presented with Spontaneous Pneumothorax Due to Listeria Monositogenes

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    Mehmet Karaci

    2016-01-01

    Full Text Available Listeria Monositogenes is a facultative anaerob gram(+ agents that presents in soil, water, plants and in many mammals intestinal system.  Listeria Monositogenes is one of the most common factors of early neonatal sepsis and neonatal pneumonia during the perinatal period. Maternal obstetric complications are frequently seen in patients. Patients are often premature and have low birth weight. Responsible microorganisms frequently originate from maternal. The disease involes multisystems and the prognosis is usually fulminant.  In the congenital pneumonia, respiratory distress syndrome is prominent. Symptomatic spontaneous pneumothorax  brings about serious morbidity and mortality in newborns. The cause and risk factors of symptomatic pneumothorax in term newborns are not completely understood. The risk factors were reported as prematurity, male sex, high birth weight and birth the use of vacuum. We aimed to present a case with neonatal pneumonia associated with symptomatic spontaneous pneumothorax due to Listeria Monositogenes.

  1. 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 χ 2 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  

  2. Were pneumothorax and its management known in 15th-century anatolia?

    Science.gov (United States)

    Kaya, Seyda Ors; Karatepe, Mustafa; Tok, Turgut; Onem, Gokhan; Dursunoglu, Nese; Goksin, Ibrahim

    2009-01-01

    Jean-Marc Gaspard Itard, a student of René Laennec's, first recognized pneumothorax in 1803, and Laennec himself described the full clinical picture of the condition in 1819. Treatment of pneumothorax was not begun as a standard procedure until World War II, but we think that Serefeddin Sabuncuoglu recognized the condition and applied treatment in the 15th century.Sabuncuoglu (1385-1470) was a surgeon who lived in Amasya (in Anatolia). In 1465, he completed Cerrahiyyetül Haniyye (Imperial Surgery), the 1st illustrated surgical textbook in the Turkish-Islamic medical literature. We describe the highlights of the book's recommendations concerning treatment of thoracic trauma, particularly of pneumothorax. We reproduce 2 of the colored miniature illustrations and add our comments regarding the advice of Sabuncuoglu. Most notably, he advocated "mihceme," a cupping therapy, as a simple technique of thoracic aspiration.

  3. Transient elevation of ST-segment due to pneumothorax and pneumopericardium

    Directory of Open Access Journals (Sweden)

    Rodrigo Martins Brandão

    2013-03-01

    Full Text Available ST-segment elevation, observed in the critically ill patients, almost always raises the suspicion of ischemic heart disease. However, nonischemic myocardial and non-myocardial problems in these patients may also lead to ST-segment elevation. Pneumothorax and pneumopericardium have been rarely reported as a cause of transient ST-segment elevation. The authors report the case of a patient admitted to the emergency care unit because of a respiratory failure requiring mechanical ventilatory support. As the patient showed signs of clinical deterioration, a pneumothorax was clinically diagnosed. Chest radiography after thorax drainage also disclosed a pneumopericardium. The 12-lead electrocardiogram recorded before the thoracic drainage revealed an ST-segment elevation, which normalized after the surgical procedure. Ischemic myocardial biomarkers were negative. The authors call attention to the right-sided pneumothorax associated with pneumopericardium as an unusual cause of ST-segment elevation.

  4. Posteroanterior chest X-ray for the diagnosis of pneumothorax: methods, usage, and resolution

    Directory of Open Access Journals (Sweden)

    Denise Rossato Silva

    2010-08-01

    Full Text Available Denise Rossato Silva, Sandra Jungblut Schuh, Paulo de Tarso Roth DalcinUniversidade Federal do Rio Grande do Sul, Porto Alegre-RS, BrazilAbstract: Most pneumothoraces are demonstrated on fully inspired erect posteroanterior (PA chest X-ray (CXR. Expiratory films may have a role in the clinical management of patients with a small respiratory reserve in whom pneumothorax is suspected and not demonstrated on the inspiratory film. PA CXR can be used for the diagnosis of spontaneous and ­nonspontaneous pneumothoraces. When digital radiography is used, for most authors, a 2.5-lp/mm spatial ­resolution is satisfactory to detect a pneumothorax.Keywords: radiography, computed tomography, pneumothorax, posteroanterior chest X-ray

  5. PULMONARY LANGERHANS CELL HISTIOCYTOSIS PRESENTING AS SIMULTANEOUS BILATERAL SPONTANEOUS PNEUMOTHORAX IN A NON-SMOKER PATIENT

    Directory of Open Access Journals (Sweden)

    M. Vaziri

    2008-06-01

    Full Text Available Pulmonary Langerhans Cell Histiocytosis (PLCH is a rare idiopathic disorder that primarily affects young adult cigarette smokers. Affected patients often present with cough and dyspnea and about 20% of patients present with or later develop pneumothorax. It is striking that more than 90% of patients are smokers. We report a very unusual case of PLCH in a 20-year- old male patient with no smoking history in whom a life- threatening complication such as simultaneous bilateral pneumothorax was the presenting feature. The final diagnosis was made by open surgical biopsy and recurrent pneumothoraces necessitated surgical management with pleurodesis. We emphasize the early use of pleurodesis in managing patients with PLCH and spontaneous pneumothorax.

  6. An unusual cause of recurrent spontaneous pneumothorax: the Mounier-Kuhn syndrome.

    Science.gov (United States)

    Unlu, Elif Nisa; Annakkaya, Ali Nihat; Balbay, Ege Gulec; Aydın, Leyla Yilmaz; Safcı, Sinem; Boran, Mertay; Guclu, Derya

    2016-01-01

    We present a case of 63-year-old man who was referred to the emergency department with a right-sided pneumothorax. He had a history of spontaneous pneumothorax for 2 times. The chest computed tomographic scan showed tracheobronchomegaly with an increase in the diameter of the trachea and right and left main bronchus. Fiberoptic bronchoscopy revealed enlarged trachea and both main bronchus with diverticulas. These findings are consistent with a diagnosis of Mounier-Kuhn syndrome. Mounier-Kuhn syndrome is a rare clinical and radiologic condition. It is characterized by a tracheal and bronchial dilation. Diagnosis is made by computed tomography and bronchoscopy. Mounier-Kuhn syndrome should be kept in mind in the differential diagnosis of recurrent spontaneous pneumothorax.

  7. A case of pneumothorax due to non-invasive mechanical ventilation

    Directory of Open Access Journals (Sweden)

    İbrahim Koç

    2014-09-01

    Full Text Available Emphysema is enlargement of alveolus, alveolary ducts and destruction of alveolary wall. One of complications of non-invasive mechanical ventilation (NIMV is barotrauma of damaged lung. Here we present a 75 years old male who had Chronic Obstructive Pulmonary Disease (COPD, emphysema for 5 years and suffered from pneumothorax after NIMV. During treatment with NIMV his general condition deteriorated and oxygen saturation decreased immediately. Chest X-ray and tomography revealed pneumothorax. Chest tube inserted under local anesthesia. Although NIMV might seem like innocent, in patients whose general condition immediately worsens, oxygen saturation decreases, has emphysema and bullous lesions pneumothorax must be excluded. J Clin Exp Invest 2014; 5 (3: 469-471

  8. Radiographically Severe but Clinically Mild Reexpansion Pulmonary Edema following Decompression of a Spontaneous Pneumothorax

    Science.gov (United States)

    Harner, William E.; Crawley, Eric A.

    2014-01-01

    The case is a 48-year-old female who presented with mild dyspnea on exertion and cough with unremarkable vital signs and was found to have a large right sided pneumothorax. She underwent small bore chest tube decompression with immediate reexpansion of the collapsed lung. However, she rapidly developed moderate hypoxemia and radiographic evidence of reexpansion pulmonary edema (REPE) on both the treated and contralateral sides. Within a week, she had a normal chest X-ray and was asymptomatic. This case describes a rare complication of spontaneous pneumothorax and highlights the lack of correlation between symptoms, sequelae, and radiographic severity of pneumothorax and reexpansion pulmonary edema. Proposed pathophysiologic mechanisms include increased production of reactive oxygen species with subsequent loss of surfactant and increased vascular permeability, and loss of vasoregulatory tone. PMID:25165607

  9. 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.

  10. Massive thoracoabdominal aortic thrombosis in a patient with iatrogenic Cushing syndrome.

    Science.gov (United States)

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

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hun; Choi, Dong Hyun; Lee, Young Min; Kim, Bo Bae; Ki, Young Jae; Kim, Jin Hwa; Chung, Joong Wha; Koh, Young Youp [Chosun University School of Medicine, Gwangju (Korea, Republic of); Kang, Joon Tae; Chae, Seung Seok [Dept. of nternal Medicine, Mokpo Jung-Ang General Hospital, Mokpo (Korea, Republic of)

    2014-10-15

    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.

  12. The Tension Literature.

    Science.gov (United States)

    Frederick, A. B.

    This is a bibliography of literature on the subject of tension. Books, films, and periodicals with a bearing on stress, relaxation, anxiety, and/or methods of controlling stress are listed from the fields of physiology, psychology, and philosophy. New methods such as transcendental meditation and biofeedback are analyzed briefly and criteria are…

  13. 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

  14. 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...

  15. 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 block...

  16. 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.

  17. 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.

  18. Catamenial pneumothorax associated with multiple diaphragmatic perforations and pneumoperitoneum in a reproductive woman.

    Science.gov (United States)

    Baoquan, Lin; Liangjian, Zou; Qiang, Wang; Hai, Jin; Hezhong, Chen; Zhiyun, Xu

    2014-06-01

    Catamenial pneumothorax (CP) is considered to be an extremely rare entity, characterized by recurrent pneumothorax occurring between the day before and within 72 hours after the onset of menses, usually in the right-side thorax cavity in women of reproductive age.The etiology remains obscure. We report a rare case of CP complicated with multiple diaphragmatic perforations as the only thoracoscopy finding, and also with right-side isolated pneumoperitoneum confirmed by a chest X-ray. This case strongly supports the hypothesis that CP may be caused by the air through the perforations of the diaphragm.

  19. LYMP HANGIOMYOMATOSIS PRESENTING AS RECURRENT PNEUMOTHORAX IN A FEMALE CHILD: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Meenakshi

    2015-06-01

    Full Text Available Lymphangiomyomatosis (LAM is a rare, idiopathic, cystic, progressive disease seen almost exclusively in women of child bearing age which occurs sporadically or in association with tuberous sclerosis. It is clinically characterized by progressive dyspnea, recurrent pneumothorax, hemoptysis and chylous effusions. Due to its unusual and nonspecific symptoms, patients often receive a delayed diagnosis and despite a variety of treatments many patients require lung transplantation. Here we report the case of a 1 6 year s old girl with lymphangiomyomatosis presenting as recurrent pneumothorax.

  20. Spontaneous pneumothorax as the first manifestation of lung cancer: two case report.

    Science.gov (United States)

    Choi, Yun-Kyung; Kim, Kwan-Chang

    2015-08-01

    Spontaneous pneumothorax (SP), as the first manifestation of lung cancer, is relatively rare, with reported occurrence rate of between 0.03% and 0.05%. The mechanism of concurrent pneumothorax with lung cancer is not clear, however several theories were proposed, including tumor necrosis mechanism and rupture of the bulla which contains tumor. We herein report two cases of lung cancer, in which the initial manifestations was only limited to SP. Without any radiologic abnormalities preoperatively, wedge resection of bullatous lung and subsequent histologic study followed. Pathologic study revealed the presence of bullatous change of the lung and combined lung cancer.

  1. Pulmonary Langerhans cell histiocytosis causing spontaneous bilateral pneumothorax in a child

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    Anupam Patra

    2015-01-01

    Full Text Available Bilateral pneumothorax is very rare in childhood. Moreover, if it is due to pulmonary involvement of Langerhans cell histiocytosis, it is even rarer in childhood. In our case, a nonsmoker 12-year-old boy presented with bilateral pneumothorax, whose high-resolution computed tomography scan was highly suggestive of pulmonary Langerhans cell histiocytosis. Excision biopsy of a clinically palpable cervical lymph node and histopathological examination and immunohistochemistry positivity for CD1a indicated a diagnosis of Langerhans cell histiocytosis. Clinicians should consider pulmonary Langerhans cell histiocytosis in differential diagnoses in dealing such a case.

  2. Reexpansion pulmonary edema following a posttraumatic pneumothorax: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Bechtold Barbara

    2011-09-01

    Full Text Available Abstract The reexpansion pulmonary edema is a rare, but life threatening complication of a pneumothorax. Early recognition and a fast symptom orientated therapy are necessary for a good outcome. Several cases after non traumatic pneumothoraces are reported. We describe a patient who presented with a post-traumatic right pneumothorax. After the insertion of a chest tube he developed a reexpansion pulmonary edema, which had to be treated by an intubation. Additionally, a review of the literature regarding case reports of reexpansion pulmonary edema is presented.

  3. Wegener′s granulomatosis presenting as spontaneous pneumothorax in young adult

    Directory of Open Access Journals (Sweden)

    Sunil Kumar

    2014-01-01

    Full Text Available Pulmonary involvement in Wegener′s granulomatosis (WG usually starts with nonspecific symptoms such as cough, dyspnea, hemoptysis, and pleuritis. Spontaneous pneumothorax as initial presentation is extremely rare. Although its real incidence is unknown, according to different classic series, it ranges between 3 and 5% of the cases. In this case, a 28-year-old male presented with complaints of epistaxis and breathlessness, which was diagnosed as WG with pneumothorax on the basis of chest X-ray and computed tomography (CT chest and pathological confirmation by high level of serum cytoplasmic antineutrophil cytoplasmic antibody (ANCA.

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

    Science.gov (United States)

    Greensite, Jeff; Szczepaniak, Adam P.

    2015-02-01

    We compute, via numerical simulations, the nonperturbative Coulomb potential of pure SU(3) gauge theory in Coulomb gauge. We find 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.

  5. 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.

  6. 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.

  7. Iatrogenic Pulmonary Nodule in a Heart Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Atul C. Mehta

    2014-01-01

    Full Text Available A 58-year-old female with a history of non-Hodgkin lymphoma and end-stage nonischemic cardiomyopathy from Adriamycin toxicity underwent orthotic heart transplantation during June 2013. She developed shortness of breath in September 2013 and was suspected to have invasive pulmonary aspergillosis. A flexible bronchoscopy (FB with a transbronchial biopsy (TBBx was performed. She was found to have a focal lung nodule in the same location at the site of the TBBx on day 13 after the FB. Spontaneous resolution of the nodule was confirmed on the computed tomography (CT scan of chest performed at 3 months. We believe that this nodule was as a consequence of the TBBx. Formation of a peripheral pulmonary nodule (PPN following a TBBx is occasionally encountered among the recipients of the lung transplantation. To our knowledge, this is the first case of TBBx producing a pulmonary nodule in a heart transplant recipient. Physicians caring for the patients with heart transplantation should be cognizant of the iatrogenic nature of such nodule to avoid unnecessary diagnostic work-up.

  8. Iatrogenic bile duct injuries from biliar y tract surger y

    Institute of Scientific and Technical Information of China (English)

    Umar Ali; Zhen-Hua Ma; Cheng-En Pan; Qing-Yong Ma

    2007-01-01

    BACKGROUND:Cholecystectomy is the most commonly performed procedure in general surgery. However, bile duct injury is a rare but still one of the most common complications. These injuries sometimes present variably after primary surgery. Timely detection and appropriate management decrease the morbidity and mortality of the operation. METHODS:Five cases of iatrogenic bile duct injury (IBDI) were managed at the Department of Surgery, First Afifliated Hospital, Xi'an Jiaotong University. All the cases who underwent both open and laparoscopic cholecystectomy had persistent injury to the biliary tract and were treated accordingly. RESULTS: Recovery of the patients was uneventful. All patients were followed-up at the surgical outpatient department for six months to three years. So far the patients have shown good recovery. CONCLUSIONS:In cases of IBDI it is necessary to perform the operation under the supervision of an experienced surgeon who is specialized in the repair of bile duct injuries, and it is also necessary to detect and treat the injury as soon as possible to obtain a satisfactory outcome.

  9. Iatrogenic displacement of impacted third molar. Case report

    Directory of Open Access Journals (Sweden)

    Konstantinos TSIKLAKIS

    2013-08-01

    Full Text Available Peri-operative complications may occur during the surgical extraction of impacted mandibular third molars such as the iatrogenic displacement of the whole tooth or a tooth fragment in to the adjacent anatomical structures. The purpose of this case report is to present the diagnosis and treatment planning, as well as the surgical management required for the removal of a 3rd molar displaced in the soft tissues of the floor of the mouth. A 38-year old male patient presented to the Dental School, complaining of pain around the left submandibular area that started three months after the extraction of the impacted mandibular left third molar. At the radiographic examination the tooth was detected in the soft tissues of the floor of the mouth and in close proximity to the lingual plate. It is noteworthy that the patient was under the assumption that the tooth had been extracted successfully. Radiographically the tooth appeared at an 180° turnaround from its original position. Surgical extraction of the displaced third molar took place under local anaesthesia. No post-operative complications were reported. Thorough clinical and radiographic examination, as well as competency at surgical procedures are prerequisites for the appropriate surgical management of impacted third molars.

  10. Femoral head-neck junction reconstruction, after iatrogenic bone resection.

    Science.gov (United States)

    Guevara-Alvarez, Alberto; Lash, Nicholas; Beck, Martin

    2015-07-01

    Arthroscopic over-resection of the head-neck junction during the treatment of a cam deformity can be a devastating complication and is difficult to treat. Large defects of the femoral head-neck junction (FHNJ) increase the risk of femoral neck fracture and can also affect hip biomechanics. We describe a case of an iatrogenic defect of the FHNJ due to excessive bone resection, and a previously non-described treatment using iliac crest autograft to restore femoral head-neck sphericity and hip joint stability. After protecting the femoral neck with an angled blade plate, the large anterior FHNJ defect was reconstructed using autogenous iliac crest bone graft; sphericity was restored by contouring the graft using spherical templates. Clinical and radiographic follow-up was performed up to 2 years. Results at 2 years showed no residual groin pain and normal range of motion. The Oxford Hip Score was 46/48, rated as excellent. Computed tomography (CT) scanning showed union of bone graft without resorption, and CT arthrogram indicating retained sphericity of the FHNJ without evidence of degenerative changes in the articular surface. This novel surgical technique can be used to restore the structural integrity and contour of the FHNJ that contains a significant anterior defect.

  11. Iatrogenic bile duct injuries: Etiology, diagnosis and management

    Institute of Scientific and Technical Information of China (English)

    Beata Jab(l)o(n)ska; Pawe(l) Lampe

    2009-01-01

    Iatrogenic bile duct injuries (IBDI) remain an important problem in gastrointestinal surgery. They are most frequently caused by laparoscopic cholecystectomy which is one of the commonest surgical procedures in the world. The early and proper diagnosis of IBDI isvery important for surgeons and gastroenterologists,because unrecognized IBDI lead to serious complications such as biliary cirrhosis, hepatic failure and death.Laboratory and radiological investigations play an important role in the diagnosis of biliary injuries. There are many classifications of IBDI. The most popularand simple classification of IBDI is the Bismuth scale.Endoscopic techniques are recommended for initial treatment of IBDI. When endoscopic treatment is not effective, surgical management is considered.Different surgical reconstructions are performed in patients with IBDI. According to the literature, Rouxen-Y hepaticojejunostomy is the most frequent surgical reconstruction and recommended by most authors.In the opinion of some authors, a more physiological and equally effective type of reconstruction is endto-end ductal anastomosis. Long term results are the most important in the assessment of the effectiveness of IBDI treatment. There are a few classifications for the long term results in patients treated for IBDI;the Terblanche scale, based on clinical biliary symptoms,is regarded as the most useful classification. Proper diagnosis and treatment of IBDI may avoid many serious complications and improve quality of life.

  12. 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

    2017-01-01

    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.

  13. 慢性阻塞性肺疾病并发气胸者患侧肺预后影响因素的临床分析附94例报告%Clinical analysis of diseased-lung reexpansion in secondary pneumothorax patients with chronic obstructive pulmonary disease and 94 case report

    Institute of Scientific and Technical Information of China (English)

    李毅; 李月川; 马晖; 谷松涛; 焦丽娜

    2012-01-01

    ).Methods We observe four factors:the type of pneumothorax,the pneumothorax size,the hours from the onset of symptoms to undergo air drainages,and the CAT scores.Furthmore,we evaluated the correlation between those four factors and the diseased-lung reexpansion time.Results In totle of 94 patients completed the study end point.There were 47 patients in tension pneumothorax group,27 patients in closed pneumothorax group,and 20 patients in traffic pneumothorax group,the reexpansion time was (91.91 ±45.68) h,(56.89±27.56) h and (120.00 ± 46.07) h.There were significant differences among these three groups( F =13.800,P <0.01).In accordance with pneumothorax size,the reexpansion time in two subgroups were (84.80±54.16) h and (98.52±41.08) h( t =-0.988,P >0.05,tension pneumothorax group),(64.00±27.71) h and (51.43±28.02) h( t =1.146,P >0.05,closed pneumothorax group),(111.00±36.14) hand (126.00±52.31) h( t =-0.704,P >0.05,traffic pneumothorax group).Accoding to the hours from the onset of symptoms to undergo air drainages,the reexpansion time in two subgroups were (102.18±50.27) h and (70.29±28.96) h( t =2.214,P <0.05,tension pneumothorax group),(72.00±28.95) h and (44.80±20.01) h ( t =2.884,P <0.05,closed pneumothorax group),(135.43±46.70) hand (84.00±[13.15) h ( t =2.616,P <0.05,traffic pneumothorax group).Under the CAT scores,the reexpansion time in two subgroups were (73.09±[33.52) h and (109.92±50.95) h ( t =-2.884,P <0.05,tension pneumothorax group),(46.50±23.95) h and (72.00±26.29) h ( t =-2.613,P <0.05,closed pneumothorax group),(85.33±27.13) h and (148.36±38.43) h ( t =-4.140,P <0.05,traffic pneumothorax group).Conclusions In secondary pneumothorax patients with COPD,the diseased-lung reexpansion time have association with the type of pneumothorax,the hours from the onset of symptoms to undergo air draiages,and the CAT scores,however,there is no relationship with the pneumothorax size.

  14. Feasibility of the maxillary sinus ultrasonic study in patients with iatrogenic sinusitis

    Directory of Open Access Journals (Sweden)

    S. D. Varzhapetyan

    2016-03-01

    Full Text Available Objective: to study the effectiveness of ultrasonic diagnostic imaging in the diagnostics of the iatrogenic maxillary sinusitis. Materials and Methods. 68 (100.0% patients of iatrogenic maxillary sinusitis undergone Sonographic Study in B-mode (ultrasonic diagnostic apparatus FCUSON X 500, ATSmod.539 (SIEMENS, USA. For this purpose, we used linear sensors with a working surface of 37 mm long with 7.10 MHz frequency regime. The findings were compared with the results of clinical (rhinoscopy, sinus lavage through perforation, diagnostic puncture and radiological (cone-beam computed tomography examination. The results were recorded according The accuracy of the two-dimensional sonography in the detection of pathological formations (polyps, cysts, foreign bodies, iatrogenic and inflammatory origin in the sinus was detected as lower than in clinical methods. Sensitivity of the two-dimensional sonography was 8.3%, specificity – 95.4% overall accuracy – 64.7%. Informativity of the cone beam tomography in the detection of exudation, effusion and thickening of the sinus mucosa during sinus iatrogenic sinusitis was detected as lower than in sonography. The sensitivity of the two-dimensional sonography in the detection of exudation in the sinus with iatrogenic maxillary sinus was 96.8%, specificity – 91.7% overall accuracy – 94.1%. The sensitivity of the cone beam tomography to thicken (sclerotic changes mucosa was 37.5%, specificity – 92.8%, accuracy – 52.9%. Conclusions. Feasibility of the ultrasound sonography in patients with iatrogenic sinusitis is less than in computer tomography. Maxillary sinuses sonography in addition to CT will improve the quality of the examination in patients with iatrogenic maxillary sinusitis.

  15. Iatrogenic genitourinary fistula: an 18-year retrospective review of 805 injuries.

    Science.gov (United States)

    Raassen, Thomas J I P; Ngongo, Carrie J; Mahendeka, Marietta M

    2014-12-01

    Genitourinary fistula poses a public health challenge in areas where women have inadequate access to quality emergency obstetric care. Fistulas typically develop during prolonged, obstructed labor, but providers can also inadvertently cause a fistula when performing obstetric or gynecological surgery. This retrospective study analyzes 805 iatrogenic fistulas from a series of 5,959 women undergoing genitourinary fistula repair in 11 countries between 1994 and 2012. Injuries fall into three categories: ureteric, vault, and vesico-[utero]/-cervico-vaginal. This analysis considers the frequency and characteristics of each type of fistula and the risk factors associated with iatrogenic fistula development. In this large series, 13.2 % of genitourinary fistula repairs were for injuries caused by provider error. A range of cadres conducted procedures resulting in iatrogenic fistula. Four out of five iatrogenic fistulas developed following surgery for obstetric complications: cesarean section, ruptured uterus repair, or hysterectomy for ruptured uterus. Others developed during gynecological procedures, most commonly hysterectomy. Vesico-[utero]/-cervico-vaginal fistulas were the most common (43.6 %), followed by ureteric injuries (33.9 %) and vault fistulas (22.5 %). One quarter of women with iatrogenic fistulas had previously undergone a laparotomy, nearly always a cesarean section. Among these women, one quarter had undergone more than one previous cesarean section. Women with previous cesarean sections are at an increased risk of iatrogenic injury. Work environments must be adequate to reduce surgical error. Training must emphasize the importance of optimal surgical techniques, obstetric decision-making, and alternative ways to deliver dead babies. Iatrogenic fistulas should be recognized as a distinct genitourinary fistula category.

  16. Clinical analysis of 52 newborns with pneumothorax%新生儿气胸52例临床分析

    Institute of Scientific and Technical Information of China (English)

    聂春霞

    2009-01-01

    目的 探讨新生儿气胸的临床特点,以提高气胸的诊治和管理水平.方法 对本院2005至2007年收治的新生儿气胸52例的临床资料进行回顾性分析.结果 新生儿气胸多见于足月儿,绝大部分继发于肺部疾病,不适当的正压通气亦导致气胸的发生.早期发现并采取积极的治疗措施,治疗效果良好.结论 防止肺部疾病的发生,避免错误的气道加压,可减少气胸的发生.%Objective To evaluate the diversity of pneumothorax in newborn and to improve the clinical diagnosis and management of pneumothorax in newborn. Methods Retrospective analysis of the database was performed on patients diagnosed as pneumothorax in 52 newborns at my hospital between 2005 and 2007.Results Most newborns with pneumothorax were full term infants. Most pneumothorax was the result of other lung disease,and incorrect positive pressure ventilation also leaded to pneumothorax. Good treatment effect depends on diagnosis and therapy in time. Conclusions To prevent the incidence of severe lung disease and incorrect pressure ventilation can significantly reduce pneumothorax occurrence.

  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) sphincterotom

  18. 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 a

  19. 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 PO2 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.

  20. 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 pote

  1. [Anesthetic management of nephrectomy in a chronic obstructive pulmonary disease patient with recurrent spontaneous pneumothorax].

    Science.gov (United States)

    Santhosh, Mysore Chandramouli Basappaji; Bhat Pai, Rohini; Rao, Raghavendra P

    2016-01-01

    Nephrectomies are usually performed under general anesthesia alone or in combination with regional anesthesia and rarely under regional anesthesia alone. We report the management of a patient with chronic obstructive pulmonary disease with a history of recurrent spontaneous pneumothorax undergoing nephrectomy under regional anesthesia alone. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  2. Anesthetic management of nephrectomy in a chronic obstructive pulmonary disease patient with recurrent spontaneous pneumothorax.

    Science.gov (United States)

    Santhosh, Mysore Chandramouli Basappaji; Bhat Pai, Rohini; Rao, Raghavendra P

    2016-01-01

    Nephrectomies are usually performed under general anesthesia alone or in combination with regional anesthesia and rarely under regional anesthesia alone. We report the management of a patient with chronic obstructive pulmonary disease with a history of recurrent spontaneous pneumothorax undergoing nephrectomy under regional anesthesia alone. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  3. 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

    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....

  4. Treatment of spontaneous pneumothorax in a patient with right pulmonary agenesis.

    Science.gov (United States)

    Boulton, Bryon J; Force, Seth D

    2011-08-01

    Pulmonary agenesis is a rare congenital disease that is associated with many other congenital anomalies. We present the case of a patient, with right pulmonary agenesis and transmediastinal lung herniation, who presented with a spontaneous pneumothorax. This congenital anomaly and the treatment for this rare presentation is discussed in detail.

  5. Primary spontaneous pneumothorax in Arabs: does its frequency differ from elsewhere?

    Science.gov (United States)

    El Sonbaty, M R; Bitar, Z I; Marafie, A A; Sharma, P N

    2000-06-01

    No data are available on primary spontaneous pneumothorax (PSP) in Arabs. Hence we sought to determine its characteristics in Arabs of the Al-Ahmadi Governorate in Kuwait. All patients over 10 years of age with pneumothorax who were admitted to the only free general hospital serving Ahmadi area from 1985 to 1996 were reviewed retrospectively. The study included all patients' medical records, investigations, treatment, morbidity, and mortality. Any patient with secondary pneumothorax was excluded. Primary spontaneous pneumothorax was rare in female Arabs, as they are almost never smokers. There were only two females out of total 58 patients with an incidence of 0.3 per 100,000 per year. Its incidence in male Arabs was 8.8 per 100,000 per year, similar to that in other studies. The distribution had a monophasic pattern, the average age being 23 (+/- 7.3 SD) years at the first episode. Smoking, a tall, asthenic (slim, relatively weak in appearance, ectomorphic) body build, and a positive family history are the most important risk factors and are not different from most studies conducted in other parts of the world.

  6. 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.

  7. The management of pneumothorax in patients with anorexia nervosa: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Gaudiani Jennifer L

    2010-02-01

    Full Text Available Abstract Of the many body systems adversely affected by severe anorexia nervosa (AN, the pulmonary system is relatively spared. However, in the face of severe malnutrition of AN, the lung may undergo architectural changes that adversely affect its integrity and healing capacity. We report herein a case of a pneumothorax in a patient with severe AN, in which standard approaches to manage the pneumothorax were unsuccessful. Despite prolonged tube thoracostomy drainage, and subsequent thoracoscopic pleuredesis, the patient continued to have an air leak and non-resolution of her pneumothorax. We review the literature and discuss alternative approaches in this patient population.

  8. 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

    2015-09-01

    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 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.

  9. Severe lactic acidosis after an iatrogenic propylene glycol overdose.

    Science.gov (United States)

    Zosel, Amy; Egelhoff, Elizabeth; Heard, Kennon

    2010-02-01

    . Although the patient's outcome was death, his lactic acidosis was treated successfully with fomepizole and CVVH. Clinicians should be aware that an iatrogenic overdose of lorazepam may result in severe propylene glycol toxicity, which may be treated with fomepizole and CVVH.

  10. [Spontaneous Pneumothorax During Pregnancy Successfully Managed with a Thoracic Vent before Surgical Therapy; Report of a Case].

    Science.gov (United States)

    Yotsumoto, Takuma; Sano, Atsushi; Sato, Yoichi

    2015-11-01

    A 34-year-old pregnant woman presented to our department at 31 weeks of gestation after being diagnosed as spontaneous pneumothorax based on chest X-ray findings. We inserted a Thoracic Vent( TV), and she was followed as an outpatient. However, since pneumothorax recurred twice after the TV was removed, she was finally admitted to the Department of Obstetrics because threatened premature delivery was suspected. The collapsed lung did not re-expand, and the surgery for pneumothorax was done before childbirth. After thoracic surgery, she safely gave birth to a girl at 40 weeks of gestation. Outpatient therapy for spontaneous pneumothorax with TV is concerned to be a useful treatment even for pregnant women.

  11. 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.

  12. Carbon dioxide pneumothorax occurring during laparoscopy-assisted gastrectomy due to a congenital diaphragmatic defect: a case report.

    Science.gov (United States)

    Park, Hye-Jin; Kim, Duk-Kyung; Yang, Mi-Kyung; Seo, Jeong-Eun; Kwon, Ji-Hye

    2016-02-01

    During laparoscopic surgery, carbon dioxide (CO2) pneumothorax can develop due to a congenital defect in the diaphragm. We present a case of a spontaneous massive left-sided pneumothorax that occurred during laparoscopy-assisted gastrectomy, because of an escape of intraperitoneal CO2 gas, under pressure, into the pleural cavity through a congenital defect in the esophageal hiatus of the left diaphragm. This was confirmed on intraoperative chest radiography and laparoscopic inspection. This CO2 pneumothorax caused tolerable hemodynamic and respiratory consequences, and was rapidly reversible after release of the pneumoperitoneum. Thus, a conservative approach was adopted, and the remainder of the surgery was completed, laparoscopically. Due to the high solubility of CO2 gas and the extra-pulmonary mechanism, CO2 pneumothorax with otherwise hemodynamically stable conditions can be managed by conservative modalities, avoiding unnecessary chest tube insertion or conversion to an open procedure.

  13. Is Video-Assited Thoracoscopic Surgery Superior to Limited Axillary Thoracotomy in the Management of Spontaneous Pneumothorax?

    Directory of Open Access Journals (Sweden)

    Meaghen J Hyland

    2001-01-01

    Full Text Available OBJECTIVE: To evaluate bullectomy and pleurectomy in the treatment of spontaneous pneumothorax (PNO using video-assisted thoracoscopic surgery (VATS, and to compare the outcome with that of the same procedure performed using limited axillary thoracotomy (LAT.

  14. Endovascular treatment of iatrogenic penetrating trauma of the carotid artery: case report

    Directory of Open Access Journals (Sweden)

    Eduardo Lichtenfels

    2014-04-01

    Full Text Available Carotid trauma demands early diagnosis and treatment. Open repair may be technically challenging if the trauma is at the base of the neck. We present a case of iatrogenic penetrating carotid trauma caused by insertion of a hemodialysis catheter. Treatment was accomplished by placement of a covered stent-graft in the common carotid artery, covering the puncture site. This case suggests that placement of a covered stent-graft is a good option for treatment of iatrogenic injury to the carotid artery.

  15. 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.

  16. Iatrogenic aortic pseudoaneurysm following anterior thoracic spine surgery masquerading as chronic infection

    Directory of Open Access Journals (Sweden)

    Goni Vijay

    2013-12-01

    Full Text Available 【Abstract】Late vascular complications involving aorta are rare but devastating adversities following anterior thoracic spine operations are present. The current article describes our experience with one such patient who had an iatrogenic pseudoaneurysm of the thoracic aorta, mimick- ing infection. The patient was treated successfully follow- ing concomitant efforts by multidisciplinary experts with shunting. We wish to highlight upon the significance of recognizing the possible sinister consequences of a dan- gerously prominent spinal implant and the role of a suspi- cious surgeon in identifying these menacing complications at the right time. Key words: Fractures, bone; Aorta, thoracic; Aneurysm, false; Iatrogenic disease

  17. Iatrogenic cushing syndrome to facial nerve palsy: via intracranial tuberculoma-an interesting journey.

    Science.gov (United States)

    Chakrabarti, Subrata

    2014-12-01

    Isolated Facial nerve palsy is a less common neurological manifestation of intracranial tuberculoma. Again, tuberculoma can arise following development of Cushing syndrome after prolonged intake of steroids due to origin of immunosuppressed state. Thus exogenous steroid administration leading to iatrogenic Cushing Syndrome which again causing tuberculoma, with facial nerve palsy developing as a manifestation of tuberculoma is not unnatural but definitely a unique scenario. The author reports an interesting case where a patient developed left sided facial palsy following development of intracranial tuberculoma from iatrogenic Cushing syndrome after longterm intake of Dexamethasone as a treatment for low back pain. This situation is rarely reported before.

  18. Iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus:A rare injury

    Institute of Scientific and Technical Information of China (English)

    Kumar Vishal; R.H.H.Arjun; Aggarwal Sameer; John Rakesh; Kishan Rama

    2015-01-01

    Complications following supracondylar fracture of humerus are well-known.Pre-and post-operative complications have been documented in the literature.Neurovascular injury due to fracture fragments following this type of fracture is described,Iatrogenic brachial artery during surgical treatment of this fracture is unknown to the literature.So we report a rare case of iatrogenic brachial artery injury during pinning of supracondylar fracture of humerus and try to create awareness to the surgeons that such injuries can occur with improper operative techniques.

  19. Undetected iatrogenic lesions of the anterior femoral shaft during intramedullary nailing: a cadaveric study

    Directory of Open Access Journals (Sweden)

    Shepherd Lane

    2008-07-01

    Full Text Available Abstract Background The incidence of undetected radiographically iatrogenic longitudinal splitting in the anterior cortex during intramedullary nailing of the femur has not been well documented. Methods Cadaveric study using nine pairs of fresh-frozen femora from adult cadavers. The nine pairs of femora underwent a standardized antegrade intramedullary nailing and the detection of iatrogenic lesions, if any, was performed macroscopically and by radiographic control. Results Longitudinal splitting in the anterior cortex was revealed in 5 of 18 cadaver femora macroscopically. Anterior splitting was not detectable in radiographic control. Conclusion Longitudinal splitting in the anterior cortex during intramedullary nailing of the femur cannot be detected radiographically.

  20. AN UNCOMMON COMPLICATION OF A COMMON DISORDER: PNEUMOTHORAX, PNEUMOMEDIASTINUM AND SUBCUTANEOUS EMPHYSEMA COMPLICATING ACUTE SEVERE ASTHMA: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Urvinderpal

    2014-05-01

    Full Text Available Pneumomediastinum (air in the mediastinum was first described as a complication of trauma in 1819 by Laennec. Although subcutaneous emphysema, pneumothorax and pneumomediastinum are relatively uncommon, but are important complications of bronchial asthma. Their sudden and usually unexpected onset may herald an emergency. We are reporting a case of a 72 year old male presenting with pneumothorax, pneumo- mediastinum and subcutaneous emphysema as a complication of acute severe asthma

  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. Fragmentation in Biaxial Tension

    Energy Technology Data Exchange (ETDEWEB)

    Campbell, G H; Archbold, G C; Hurricane, O A; Miller, P L

    2006-06-13

    We have carried out an experiment that places a ductile stainless steel in a state of biaxial tension at a high rate of strain. The loading of the ductile metal spherical cap is performed by the detonation of a high explosive layer with a conforming geometry to expand the metal radially outwards. Simulations of the loading and expansion of the metal predict strain rates that compare well with experimental observations. A high percentage of the HE loaded material was recovered through a soft capture process and characterization of the recovered fragments provided high quality data, including uniform strain prior to failure and fragment size. These data were used with a modified fragmentation model to determine a fragmentation energy.

  3. Tension-filled Governance?

    DEFF Research Database (Denmark)

    Celik, Tim Holst

    Since the crisis-engrossed 1970s, and especially the 1990s, ‘governance’ has become a dominant concern and concept; notably, within particularly political science, a certain diagnosis explicitly or implicitly focused on a shift ‘from government to governance’ has become increasingly popular....... This study examines the governance phenomenon of the post-1970/1990s period from a state-situated and historically informed perspective. Specifically, taking initial analytical departure in an approach of the early 1970s associated with James O’Connor, Jürgen Habermas and Claus Offe focused...... 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...

  4. Social and environmental tensions

    DEFF Research Database (Denmark)

    Saito, Moeko; Rutt, Rebecca Leigh; Chhetri, Bir Bahadur Khanal

    2014-01-01

    them, receive payments not only to address inequities but also for resource conservation. Drawing on a case study of a NORAD pilot project in Nepal, this paper investigates how affirmative measures adopted under the project affect different social actors and their perceptions and behaviors in relation......REDD + is a mitigation measure against global climate change that offers payments to developing countries based on the increased volume of forest carbon. It has been argued that affirmative measures should be adopted to ensure that communities, particularly the socially disadvantaged groups among...... to forests. Our case highlights the risk that the mere application of affirmative measures may give rise to difficult social and environmental tensions. Thus, this paper calls for such measures to effectively incorporate local perspectives in their designs and to be reflective, by allowing for regular...

  5. Research on Web Press Tension Control System

    OpenAIRE

    Chen Sheng Jiang; Zhang Chun Feng; Wang Zhong You; Li Qing Lin

    2016-01-01

    Tension control of press is a key and difficult point of the whole machine control. The stand or fall of tension is directly related to the quality of the products. According to the characteristics of the web press tension control, this paper expounds the main factors influencing tension and the purpose of tension control, researches on the tension control principle of web tape, analyzes control rule and control circuit of tension control system, illustrates the advantages of PID control law ...

  6. Tuberous sclerosis presenting with spontaneous pneumothorax secondary to lymphangioleiomyomatosis; previously mistaken for asthma.

    Science.gov (United States)

    Gosein, Maria Angela; Ameeral, Anthony; Konduru, Siva Krishna Prasad; Dola, Venkata Naga Srinivas

    2013-05-31

    A middle-aged female patient, previously diagnosed with asthma, presented with a large spontaneous left pneumothorax. She had a history of nephrectomy for a ruptured renal angiomyolipoma (AML) with a postoperative spontaneous pneumothorax when she was an adolescent. High-resolution CT chest revealed multiple scattered thin-walled lung parenchyma cysts consistent with lymphangioleiomyomatosis (LAM). Hepatic AMLs and adenoma sebaceum skin lesions were also noted, consistent with an overall diagnosis of tuberous sclerosis. Her acute management included lung re-expansion via chest tube insertion, antibiotics for concurrent chest infection, nebulisation and chest physiotherapy. Since discharge, the patient had only occasional shortness of breath, relieved by bronchodilators. She is considering expanded immunisation as well as enrolment in a clinical trial. Her hepatic AMLs will be monitored via ultrasound for growth. LAM treatment is generally aimed at its complications with lung transplantation reserved for severe disease; however, hormonal therapy and the mTOR inhibitor aim at targeting systemic disease.

  7. Boerhaave Syndrome, Pneumothorax, and Chylothorax in a Critically Ill Patient with Tuberous Sclerosis Complex

    Science.gov (United States)

    Ijaz, Mohsin; Rafiq, Arsalan; Venkatram, Sindhaghatta; Diaz-Fuentes, Gilda

    2015-01-01

    Tuberous sclerosis complex (TSC) is an autosomal dominant, variably expressed multisystem disease. The predominant pulmonary features of TSC are identical to those of lymphangioleiomyomatosis (LAM). Pneumothorax, multifocal micronodular pneumocyte hyperplasia, and chylothorax are rare complications of TSC. We report a young male with pneumothorax, lung nodules, and chylous effusion who developed empyema thoracis after esophageal rupture. Hospital course was complicated by respiratory failure. Family opted to transfer to hospice care. Chylothorax is a rare complication of TSC with few scattered reports mostly in female patients. Patients with TSC are usually managed by multispecialists and it is important to be aware of the rare pulmonary manifestations of this disease. A male patient with TSC having lung nodules presenting with chylothorax and empyema thoracis from Boerhaave syndrome makes our case unique. PMID:26550497

  8. Successful management of occult pneumothorax without tube thoracostomy despite positive pressure ventilation.

    Science.gov (United States)

    Barrios, Cristobal; Tran, Tuan; Malinoski, Darren; Lekawa, Michael; Dolich, Matthew; Lush, Stephanie; Hoyt, David; Cinat, Marianne E

    2008-10-01

    The objective of this study was to determine whether tube thoracostomy can be safely avoided in a subset of patients with blunt occult pneumothorax. A retrospective review was performed. Management without tube thoracostomy was attempted for 59 occult pneumothoraces and was successful in 51 (86%). Observation was successful in 16 of 20 occult pneumothoraces (80%) exposed to positive pressure ventilation within 72 hours of admission. Eight delayed tube thoracostomies were required an average of 19.7 hours post admission. Patients who failed observant management had more significant physiologic derangement on admission (revised trauma score 6.96 vs 7.66, P = 0.04), were more likely to have significant multisystem trauma (88% vs 37%, P = 0.007), but were not more likely to require positive pressure ventilation (PPV) (50% vs 31%, P = 0.31). This study demonstrates that a subset of patients with blunt occult pneumothorax requiring positive pressure ventilation may be safely managed without tube thoracostomy.

  9. 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.

  10. Reexpansion pulmonary edema after chest drainage for pneumothorax: A case report and literature overview

    Science.gov (United States)

    Verhagen, M.; van Buijtenen, J.M.; Geeraedts, L.M.G.

    2014-01-01

    Background Reexpansion pulmonary edema (RPE) is a rare complication that may occur after treatment of lung collapse caused by pneumothorax, atelectasis or pleural effusion and can be fatal in 20% of cases. The pathogenesis of RPE is probably related to histological changes of the lung parenchyma and reperfusion-damage by free radicals leading to an increased vascular permeability. RPE is often self-limiting and treatment is supportive. Case report A 76-year-old patient was treated by intercostal drainage for a traumatic pneumothorax. Shortly afterwards he developed reexpansion pulmonary edema and was transferred to the intensive care unit for ventilatory support. Gradually, the edema and dyspnea diminished and the patient could be discharged in good clinical condition. Conclusion RPE is characterized by rapidly progressive respiratory failure and tachycardia after intercostal chest drainage. Early recognition of signs and symptoms of RPE is important to initiate early management and allow for a favorable outcome. PMID:26029567

  11. 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

  12. 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.

  13. [Very rare and life-threatening complications of bocavirus bronchiolitis: pneumomediastinum and bilateral pneumothorax].

    Science.gov (United States)

    Yeşilbaş, Osman; Kıhtır, Hasan Serdar; Talip Petmezci, Mey; Balkaya, Seda; Hatipoğlu, Nevin; Meşe, Sevim; Şevketoğlu, Esra

    2016-01-01

    Human bocavirus (HBoV), that was first identified in 2005 and classified in Parvoviridae family, is a small, non-enveloped, single-stranded DNA virus, responsible for upper and lower respiratory tract infections, especially in young children. Although HBoV generally causes self-limited influenza-like illness, it may also lead to pneumonia, bronchiolitis, croup and asthma attacks. In this report, a case of acute bronchiolitis complicated with pneumomediastinum and bilateral pneumothorax caused by HBoV has been presented. A three-year-old boy was referred to our pediatric intensive care unit with a two day history of fever, tachypnea, hypoxia and respiratory failure. On auscultation, there were widespread expiratory wheezing and inspiratory crackles. The chest radiography yielded paracardiac infiltration and air trapping on the right lung and infiltration on the left lung. The patient had leukocytosis and elevated C-reactive protein level. On the second day of admission, respiratory distress worsened and chest radiography revealed right pneumothorax and subcutaneous emphysema in bilateral cervical region and left chest wall. He was intubated because of respiratory failure. In the thorax computed tomography, pneumomediastinum and bilateral pneumothorax were detected and right chest tube was inserted. Repetitive blood and tracheal aspirate cultures were negative. A nasopharyngeal swab sample was analyzed by multiplex real-time polymerase chain reaction method with the use of viral respiratory panel (FTD(®) Respiratory Pathogens 21 Kit, Fast-Track Diagnostics), and positive result was detected for only HBoV. On the ninth day of admission, pneumomediastinum and bilateral pneumothorax improved completely and he was discharged with cure. In conclusion, HBoV bronchiolitis may progress rare but severe complications, it should be kept in mind as an etiological agent of the respiratory tract infections especially children younger than five years old.

  14. 家族性自发性气胸%Familial spontaneous pneumothorax

    Institute of Scientific and Technical Information of China (English)

    刘长宏; 薛欣

    2005-01-01

    家族性自发性气胸(familial spontaneous pneumothorax,FSP)是指家族中存在二人以上患有自发性气胸疾病.临床上较为少见,目前被认为是一种遗传疾病.作者自1995年以来共治疗4个FSP家族中8位患者,总结如下.

  15. 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 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. 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. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  16. Pneumothorax necessitans in a patient with trapped lung and rheumatoid arthritis

    OpenAIRE

    Ahmed, Rumman; Ahmed, Usama; Syed, Imran

    2013-01-01

    The authors report the case of a patient with a background of trapped lung following thoracocentesis who developed an anterolateral intercostal pneumothoracocele resulting in a pneumothorax necessitans (PN). Our purpose is to highlight the pathophysiology and interesting radiological features associated with PN in trapped lung. Our case is particularly unique due to the subacute nature of its presentation in a patient with rheumatoid arthritis and unusual pre-existing lung pathology.

  17. Iatrogenic surgical microscope skin burns: A systematic review of the literature and case report.

    Science.gov (United States)

    Lopez, Joseph; Soni, Ashwin; Calva, Daniel; Susarla, Srinivas M; Jallo, George I; Redett, Richard

    2016-06-01

    Cutaneous burns associated with microscope-use are perceived to be uncommon adverse events in microsurgery. Currently, it is unknown what factors are associated with these iatrogenic events. In this report, we describe the case of a 1-year-old patient who suffered a full thickness skin burn from a surgical microscope after a L4-S1 laminectomy. Additionally, we present a systematic review of the literature that assessed the preoperative risk, outcome, and management of iatrogenic microscope skin burns. Lastly, a summary of the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database of voluntary adverse events was reviewed and analyzed for clinical cases of microscope thermal injuries. The systematic literature review identified only seven articles related to microsurgery-related cutaneous burns. From these seven studies, 15 clinical cases of iatrogenic skin burns were extracted for analysis. The systematic review of the FDA MAUDE database revealed only 60 cases of cutaneous burns associated with surgical microscopes since 2004. Few cases of microscope burns have been described in the literature; this report is, to our knowledge, one of the first comprehensive reports of this iatrogenic event in the literature. Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.

  18. Iatrogenic vascular injuries in Sweden. A nationwide study 1987-2005.

    Science.gov (United States)

    Rudström, H; Bergqvist, D; Ogren, M; Björck, M

    2008-02-01

    To study the epidemiology of vascular injuries, with special focus on iatrogenic vascular injuries (IVIs) and time-trends. From the Swedish national vascular registry, Swedvasc, prospectively registered data on vascular injuries during 1987-2005 were analysed and cross-referenced for mortality against the population registry. Of 1853 injuries, 48% were caused by iatrogenic, 29% penetrating and 23% blunt trauma. In the three groups median age was 68, 35 and 40 years, respectively. The annual incidence of procedures for vascular injuries increased from 1.2-1.6 per 100 000 inhabitants and the proportion of IVIs increased from 41 to 51%, during the period. Mortality was higher after IVI (4.9%) compared to non-IVI (2.5%). Patients with IVI also had more co-morbidities; 58% cardiac disease, 44% hypertension, and 18% renal dysfunction. Among 888 IVIs, right femoral arterial injury was the most frequent (37%). The most common vascular reconstruction was direct suture (39%) followed by by-pass or interposition graft (19%, of which prosthetics were used in over half the cases). Endovascular repair increased from 4.6% to 15% between 1987 and 2005. Vascular injuries, in particular iatrogenic ones, appear to be increasing. Iatrogenic injuries affect vulnerable patients with co-morbidities and are associated with a high mortality.

  19. Protected stent retriever thrombectomy prevents iatrogenic emboli in new vascular territories

    Energy Technology Data Exchange (ETDEWEB)

    Klinger-Gratz, Pascal P. [Bern University Hospital and University of Bern, Department of Diagnostic and Interventional Neuroradiology, Inselspital, Freiburgstrasse 10, Bern (Switzerland); University of Basel, Department of Radiology, Basel (Switzerland); Schroth, Gerhard; Gralla, Jan; Weisstanner, Christian; Verma, Rajeev K.; Mordasini, Pasquale; Kellner-Weldon, Frauke; Hsieh, Kety; El-Koussy, Marwan [Bern University Hospital and University of Bern, Department of Diagnostic and Interventional Neuroradiology, Inselspital, Freiburgstrasse 10, Bern (Switzerland); Jung, Simon [Bern University Hospital and University of Bern, Department of Diagnostic and Interventional Neuroradiology, Inselspital, Freiburgstrasse 10, Bern (Switzerland); Bern University Hospital and University of Bern, Department of Neurology, Inselspital, Bern (Switzerland); Heldner, Mirjam R.; Fischer, Urs; Arnold, Marcel; Mattle, Heinrich P. [Bern University Hospital and University of Bern, Department of Neurology, Inselspital, Bern (Switzerland)

    2015-10-15

    Diagnostic tools to show emboli reliably and protection techniques against embolization when employing stent retrievers are necessary to improve endovascular stroke therapy. The aim of the present study was to investigate iatrogenic emboli using susceptibility-weighted imaging (SWI) in an open series of patients who had been treated with stent retriever thrombectomy using emboli protection techniques. Patients with anterior circulation stroke examined with MRI before and after stent retriever thrombectomy were assessed for iatrogenic embolic events. Thrombectomy was performed in flow arrest and under aspiration using a balloon-mounted guiding catheter, a distal access catheter, or both. In 13 of 57 patients (22.8 %) post-interventional SWI sequences detected 16 microemboli. Three of them were associated with small ischemic lesions on diffusion-weighted imaging (DWI). None of the microemboli were located in a new vascular territory, none showed clinical signs, and all 13 patients have been rated as Thrombolysis in Cerebral Infarction (TICI) 2b (n = 3) or 3 (n = 10). Retrospective reevaluation of the digital subtraction angiography (DSA) detected discrete flow stagnation nearby the iatrogenic microemboli in four patients with a positive persistent collateral sign in one. Our study demonstrates two things: First, SWI seems to be more sensitive to detect emboli than DWI and DSA and, second, proximal or distal protected stent retriever thrombectomy seems to prevent iatrogenic embolization into new vascular territories during retraction of the thrombus, but not downstream during mobilization of the thrombus. Both techniques should be investigated and refined further. (orig.)

  20. Iatrogenic adrenal insufficiency as a side-effect of combined treatment of itraconazole and budesonide

    DEFF Research Database (Denmark)

    Skov, M; Main, K M; Sillesen, Ida Blok

    2002-01-01

    A recent case of iatrogenic Cushing's syndrome and complete suppression of the pituitary-adrenal-axis in a patient with cystic fibrosis (CF) and allergic bronchopulmonary aspergillosis treated with itraconazole as an antifungal agent, and budesonide as an anti-inflammatory agent led to a systematic...

  1. Iatrogenic adrenal insufficiency as a side-effect of combined treatment of itraconazole and budesonide

    DEFF Research Database (Denmark)

    Skov, M; Main, K M; Sillesen, Ida Blok

    2002-01-01

    A recent case of iatrogenic Cushing's syndrome and complete suppression of the pituitary-adrenal-axis in a patient with cystic fibrosis (CF) and allergic bronchopulmonary aspergillosis treated with itraconazole as an antifungal agent, and budesonide as an anti-inflammatory agent led to a systemat...

  2. A Case of Iatrogenic Subclavian Artery Injury Successfully Treated with Endovascular Procedures

    Science.gov (United States)

    Yamagami, Takuji; Yoshimatsu, Rika; Tanaka, Osamu; Miura, Hiroshi; Kawahito, Yutaka; Oka, Katsuhiko; Yaku, Hitoshi; Nishimura, Tsunehiko

    2011-01-01

    We report a case of a life-threatening massive hemothorax caused by iatrogenic injury of the right subclavian artery. The patient was successfully treated with placement of a covered stent. During the procedure, occlusion balloon catheters rapidly controlled the massive bleeding. PMID:23555430

  3. Research on Web Press Tension Control System

    Directory of Open Access Journals (Sweden)

    Chen Sheng Jiang

    2016-01-01

    Full Text Available Tension control of press is a key and difficult point of the whole machine control. The stand or fall of tension is directly related to the quality of the products. According to the characteristics of the web press tension control, this paper expounds the main factors influencing tension and the purpose of tension control, researches on the tension control principle of web tape, analyzes control rule and control circuit of tension control system, illustrates the advantages of PID control law adopted in the tension control system, and concludes the influencing factors of paper tape tension control system and the corresponding problems needed to solve in the control.

  4. Longwall AFC chain tension meter

    Energy Technology Data Exchange (ETDEWEB)

    Peter Lugg; Zhiqiang Guan; Bart Pienaar [CRC Mining (Australia)

    2008-02-15

    Evaluation of the downtime statistics of two longwall mines studied as part of the Landmark Automation Project showed that AFC (Armoured Face Conveyor) and BSL (Beam Stage Loader) chain related failures accounted for 27% of all downtime. A chain tension meter was designed, certified Ex ia for use in ERZ0 sections of Australian coal mines and successfully field trialled on a longwall face during production. The dynamic behaviour and unequal sharing of load between the chains were recorded and found to be significant. The changing format of tension distribution around the conveyor as it is loaded was recorded and the implications of the change in the location of the point of minimum tension from tailgate to maingate as the conveyor is unloaded emphasised. The trial was run monitoring AFC chain tensions over a few shifts. The project successfully demonstrated that the measurement of AFC chain tensions on a working face can be achieved reliably.

  5. Significant influence of biometeorological conditions on the incidence of spontaneous pneumothorax in the Kragujevac city

    Directory of Open Access Journals (Sweden)

    Marko Spasić

    2011-08-01

    Full Text Available Aim To explore and establish an influence of biometeorological conditions on the occurrence of spontaneous pneumothorax (SP in the city of Kragujevac (Serbia in a five-year period. Methods According to the type of series of cases, this was a retrospective,non interventional study. The data collected from the medical records and operative protocols of the Thoracic Surgery Department in the period between 01.01.2005 and 31.12.2009, as well as the data on daily biometeorological phases for the Kragujevac city obtained from the Hydrometeorological Service of Serbia, and afterwards a comparative analysis of the data were performed. Results A total number of 159 patients with spontaneous pneumothorax were hospitalized. Most patients were treated in 2009(55, 34.6%, least in 2005 (22, 13.8%. Most cases occurred in March (20, 12.6%, on Tuesdays (33, 20.7%, and in the biometeorological phase 2 (0.15 SP/day. The least number of cases occurred in September (9, 5.7%, on Saturdays (6, 3.8% and in phase 8 (0.04/day (p<0.01. Conclusion There was an evident biometeorological influence onthe occurrence of spontaneous pneumothorax in our area, so mostcases were in the phase with sunny weather (atmospheric pressurefalling, air temperature and moisture rising, while the lowestnumber was in the phase with a fall of atmospheric pressure, moistureand air temperature. The results of this research suggest a necessity of further investigations on this field.

  6. Pleural Complications of Hydatid Cyst: Cases Presenting with Pneumothorax and Empyema

    Directory of Open Access Journals (Sweden)

    Ufuk Cobanoglu

    2016-01-01

    Full Text Available Aim: The present study discussed cases of pulmonary hydatid cysts with pleural complications presenting with pneumothorax and empyema, which were retrospectively reviewed in terms of diagnostic and therapeutic procedures and for which the authors%u2019 clinical experience was presented. Material and Method: A total of 23 cases of pulmonary hydatid cysts with pleural complications that were treated at our clinic between 2007 and 2014 were retrospectively reviewed. The pleural complications in these patients included pneumothorax (34.78%, pyothorax (17.39%, pyopneumothorax (26.08%, hydropneumothorax (21.75%, and severe pleural thickening (17.39%. Results: At the initial step, 19 patients (82.61% underwent tube thoracostomy and drainage, and 4 cases (17.39% underwent thoracentesis. The cystotomy and capitonnage were the most commonly performed procedures in open surgery (89.95%. The prolonged air leakage was the most common (30.43% postoperative complication, and cases that developed massive air leakage and broncho-pleural fistula were re-operated, and of these cases, three (10.5% underwent lobectomy and one patient (4.34% underwent segmentectomy. None of the cases in our series developed mortality. Discussion: A clinical picture involving empyema, pneumothorax, or both will constitute a diagnostic conundrum for hydatid cyst. Early recognition of the hydatid cysts will prevent the development of complications and reduce postoperative morbidity and mortality.

  7. Antibiotics are not needed during tube thoracostomy for spontaneous pneumothorax: an observational case study

    Directory of Open Access Journals (Sweden)

    Mulazimoglu Lutfiye

    2006-11-01

    Full Text Available Abstract Background Usefulness of prophylactic antibiotics following tube thoracostomy remains controversial in the literature. In this study, we aimed to investigate the consequences of closed tube thoracostomy for primary spontaneous pneumothorax without the use of antibiotics. Methods One-hundred and nineteen patients underwent tube thoracostomy for primary spontaneous pneumothorax. None of them received prophylactic antibiotic treatment. Eight patients with prolonged air leak undergoing either video assisted thoracoscopic surgery or thoracotomy were excluded. Results Of the remaining 111 (104 male and 7 female, 28 (25% patients developed some induration around the entry site of chest tube that settled without further treatment. White blood cell count was high without any other evidence of infection in 12 (11% patients and returned to its normal levels before discharge home in all. There was also some degree of fever not lasting for more than 48 hours in 8 (7% patients. Bacterial cultures from suspected sites did not reveal any significant growth in these patients. Conclusion Prophylactic antibiotic treatment seems avoidable during closed tube thoracostomy for primary spontaneous pneumothorax. This policy was not only cost-effective but also prevented our patients from detrimental properties of unnecessary antibiotic use, such as development of drug resistance and undesirable side effects.

  8. Antibiotics are not needed during tube thoracostomy for spontaneous pneumothorax: an observational case study

    Science.gov (United States)

    Olgac, Guven; Aydogmus, Umit; Mulazimoglu, Lutfiye; Kutlu, Cemal Asim

    2006-01-01

    Background Usefulness of prophylactic antibiotics following tube thoracostomy remains controversial in the literature. In this study, we aimed to investigate the consequences of closed tube thoracostomy for primary spontaneous pneumothorax without the use of antibiotics. Methods One-hundred and nineteen patients underwent tube thoracostomy for primary spontaneous pneumothorax. None of them received prophylactic antibiotic treatment. Eight patients with prolonged air leak undergoing either video assisted thoracoscopic surgery or thoracotomy were excluded. Results Of the remaining 111 (104 male and 7 female), 28 (25%) patients developed some induration around the entry site of chest tube that settled without further treatment. White blood cell count was high without any other evidence of infection in 12 (11%) patients and returned to its normal levels before discharge home in all. There was also some degree of fever not lasting for more than 48 hours in 8 (7%) patients. Bacterial cultures from suspected sites did not reveal any significant growth in these patients. Conclusion Prophylactic antibiotic treatment seems avoidable during closed tube thoracostomy for primary spontaneous pneumothorax. This policy was not only cost-effective but also prevented our patients from detrimental properties of unnecessary antibiotic use, such as development of drug resistance and undesirable side effects. PMID:17101034

  9. 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.)

  10. Mediastinitis and pneumomediastinum in a preterm infant with iatrogenic esophageal perforation: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Min Ji; Kim, Ok Hwa [College of Medicine, Ajou University, Suwon (Korea, Republic of)

    2006-06-15

    Introgenic esophageal perforation is very rare in pediatric patients. Preterm infants or low birth weight babies are more susceptible to esophageal perforation due to performing frequent tracheal intubation and/or gastric tube installation. When perforation occurs, it may present as pneumothorax and pulmonary interstitial emphysema. However, isolated pneumomediastinum without pneumothorax is a rare finding. Furthermore, the mediastinitis after esophageal perforation is rare complication, but it can be a critical complication. Therefore, making an immediate and precise diagnosis as well as instituting proper treatment of esophageal perforation and mediastinitis are important. To the best of our kowledge, few reports have described mediastinitis after pneumomediastinum that was secondary to esophageal perforation. We describe here the radiologic findings of a rare case of mediastinitis after pneumomediastinum is a preterm infant with esophageal perforation.

  11. 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

  12. Treatment of pneumothorax following acupuncture: is a closed thoracostomy necessary for a first choice of treatment modality?

    Science.gov (United States)

    Kim, Eung-Soo; Kang, Jong-Yael; Pyo, Chang-Hae; Rhee, Gwang-Woo

    2009-02-01

    Acupuncture is currently the most popular of all forms of complementary and alternative medicine, and acupuncture is not dangerous in the hands of a trained practitioner. However, complications of acupuncture including pneumothorax have been reported. Despite the use of fine needles in acupuncture, the lung-collapsed degree of acupuncture pneumothorax is relatively high. In general, the treatment modality of acupuncture pneumothorax is closed thoracostomy with a chest tube of larger diameter. However, the treatment of acupuncture pneumothorax frequently faces controversy concerning the necessity of a standard chest drain insertion. This was a retrospective study from March 1994 to February 2004. Nine (9) patients were admitted due to pneumothorax following acupuncture from March 1994 to February 2004 in Hanil General Hospital, KEPCO Medical Foundation (Seoul, Republic of Korea). Five (5) patients had a moderate degree of pneumothoraces, while 4 patients had a severe degree of pneumothoraces. Four (4) patients were treated by closed thoracostomy with a standard chest drain and the other four patients were treated by the percutaneous chest drainage with a narrow-bore central venous catheter. One (1) patient with a mild degree of pneumothorax was treated only by nasal oxygen inhalation. One (1) patient was treated by video-assisted thoracic surgery after the closed thoracostomy due to continuous air leak. We treated the acupuncture pneumothorax by making a choice between the closed thoracostomy and the percutaneous chest drainage based on a smoking history and chest radiographic findings. In the absence of smoking history and pulmonary emphysema or bullae, we got favorable results, not by the closed thoracostomy but only by the percutaneous chest drainage with a narrow-bore central venous catheter.

  13. Bond Tension in Tethered Macromolecules.

    Science.gov (United States)

    Sheiko, Sergei S; Panyukov, Sergey; Rubinstein, Michael

    2011-06-14

    The paper presents scaling analysis of mechanical tension generated in densely branched macromolecules tethered to a solid substrate with a short linker. Steric repulsion between branches results in z-fold amplification of tension in the linker, where z is the number of chain-like arms. At large z ~ 100-1000, the generated tension may exceed the strength of covalent bonds and sever the linker. Two types of molecular architectures were considered: polymer stars and polymer "bottlebrushes" tethered to a solid substrate. Depending on the grafting density, one distinguishes the so-called mushroom, loose grafting, and dense grafting regimes. In isolated (mushroom) and loosely tethered bottlebrushes, the linker tension is by a factor of [Formula: see text] smaller than the tension in a tethered star with the same number of arms z. In densely tethered stars, the effect of interchain distance (d) and number of arms (z) on the magnitude of linker tension is given by f ≅ f0z(3/2)(b/d) for stars in a solvent environment and f ≅ f0z(2) (b/d)(2) for dry stars, where b is the Kuhn length and f0 ≅ kBT/b is intrinsic bond tension. These relations are also valid for tethered bottlebrushes with long side chains. However, unlike molecular stars, bottlebrushes demonstrate variation of tension along the backbone f ≅ f0s z(1/2) / d as a function of distance s from the free end of the backbone. In dense brushes [Formula: see text] with z ≅ 1000, the backbone tension increases from f ≅ f0 = 1 pN at the free end of the backbone (s ≅ b) to its maximum f ≅ zf0 ≅ 1 nN at the linker to the substrate (s ≅ zb).

  14. Spontaneous Pneumothorax as a Complication of Septic Pulmonary Embolism in an Intravenous Drug User: A Case Report

    Directory of Open Access Journals (Sweden)

    Chau-Chyun Sheu

    2006-02-01

    Full Text Available Infective endocarditis has been the major cause of morbidity and mortality among intravenous drug users (IDUs with infections, mostly involving the tricuspid valve and presenting multiple septic pulmonary embolisms. Numerous pulmonary complications of septic pulmonary embolism have been described, but only a few have reported spontaneous pneumothorax. Our patient, a 23-year-old heroin addict, was hospitalized for tricuspid endocarditis and septic pulmonary embolism. Acute onset of respiratory distress occurred on his seventh hospital day and rapidly resulted in hypoxemia. Immediate bedside chest radiograph demonstrated left pneumothorax. It was thought to be a spontaneous pneumothorax, because he had not undergone any invasive procedure before the occurrence of pneumothorax. His clinical condition improved after the insertion of an intercostal chest tube. He later underwent surgery to replace the tricuspid valve as a result of the large size of the vegetation and poor control of infection. He ultimately survived. Pneumothorax is a possible lethal complication of septic pulmonary embolism in IDUs with right-sided endocarditis and should be considered in such patients when respiratory distress occurs acutely during their hospitalization.

  15. Horizon Thermodynamics and Gravitational Tension

    CERN Document Server

    Widom, A; Srivastava, Y N

    2016-01-01

    We consider the thermodynamics of a horizon surface from the viewpoint of the vacuum tension $\\tau =(c^4/4G )$. Numerically, $\\tau \\approx 3.026\\times 10^{43}$ Newton. In order of magnitude, this is the tension that has been proposed for microscopic string models of gravity. However, after decades of hard work on string theory models of gravity, there is no firm scientific evidence that such models of gravity apply empirically. Our purpose is thereby to discuss the gravitational tension in terms of the conventional Einstein general theory of relativity that apparently does explain much and maybe all of presently known experimental gravity data. The central result is that matter on the horizon surface is bound by the entropy-area law by tension in the closely analogous sense that the Wilson action-area law also describes a surface confinement.

  16. 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

  17. Renal cancer and pneumothorax risk in Birt-Hogg-Dubé syndrome; an analysis of 115 FLCN mutation carriers from 35 BHD families

    NARCIS (Netherlands)

    A.C. Houweling; L.M. Gijezen; M.A. Jonker; M.B.A. van Doorn; R.A. Oldenburg; K.Y. van Spaendonck-Zwarts; E.M. Leter; T.A. van Os; N.C.T. van Grieken; E.H. Jaspars; M.M. de Jong; E.M.H.F. Bongers; P.C. Johannesma; P.E. Postmus; R.J.A. van Moorselaar; J.H.T.M. van Waesberghe; T.M. Starink; M.A.M. van Steensel; J.J.P. Gille; F.H. Menko

    2011-01-01

    Birt-Hogg-Dubé (BHD) syndrome is an autosomal dominant condition caused by germline FLCN mutations, and characterised by fibrofolliculomas, pneumothorax and renal cancer. The renal cancer risk, cancer phenotype and pneumothorax risk of BHD have not yet been fully clarified. The main focus of this st

  18. Renal cancer and pneumothorax risk in Birt-Hogg-Dubé syndrome; An analysis of 115 FLCN mutation carriers from 35 BHD families

    NARCIS (Netherlands)

    A.C. Houweling (Arjan); L.M. Gijezen (L.); M.A. Jonker (Marianne); M.B. van Doorn (Martijn); R.A. Oldenburg (Rogier); K.Y. van Spaendonck-Zwarts (Karin); E.M. Leter (Edward); T.A.M. van Os (Theo); N.C.T. Grieken (Nicole); J.J. Jaspars (Joris); M.M. de Jong (Mirjam); E. Bongers (Ernie); P.C. Johannesma (P.); D. Postmus (Douwe); R.J.A. van Moorselaar; J.-H. van Waesberghe (J.); T.M. Starink; M.A.M. van Steensel; J.J. Gille (Johan); F. Menko

    2011-01-01

    textabstractBackground: Birt-Hogg-Dubé (BHD) syndrome is an autosomal dominant condition caused by germline FLCN mutations, and characterised by fibrofolliculomas, pneumothorax and renal cancer. The renal cancer risk, cancer phenotype and pneumothorax risk of BHD have not yet been fully clarified. T

  19. Renal cancer and pneumothorax risk in Birt-Hogg-Dube syndrome; an analysis of 115 FLCN mutation carriers from 35 BHD families

    NARCIS (Netherlands)

    Houweling, A. C.; Gijezen, L. M.; Jonker, M. A.; van Doorn, M. B. A.; Oldenburg, R. A.; van Spaendonck-Zwarts, K. Y.; Leter, E. M.; van Os, T. A.; van Grieken, N. C. T.; Jaspars, E. H.; de Jong, M. M.; Johannesma, P. C.; Postmus, P. E.; van Moorselaar, R. J. A.; van Waesberghe, J-H T. M.; Starink, T. M.; van Steensel, M. A. M.; Gille, J. J. P.; Menko, F. H.; Bongers, Ernie M. H. F.

    2011-01-01

    BACKGROUND: Birt-Hogg-Dube (BHD) syndrome is an autosomal dominant condition caused by germline FLCN mutations, and characterised by fibrofolliculomas, pneumothorax and renal cancer. The renal cancer risk, cancer phenotype and pneumothorax risk of BHD have not yet been fully clarified. The main focu

  20. Simple aspiration versus intercostal tube drainage for primary spontaneous pneumothorax in adults.

    Science.gov (United States)

    Carson-Chahhoud, Kristin V; Wakai, Abel; van Agteren, Joseph Em; Smith, Brian J; McCabe, Grainne; Brinn, Malcolm P; O'Sullivan, Ronan

    2017-09-07

    For management of pneumothorax that occurs without underlying lung disease, also referred to as primary spontaneous pneumothorax, simple aspiration is technically easier to perform than intercostal tube drainage. In this systematic review, we seek to compare the clinical efficacy and safety of simple aspiration versus intercostal tube drainage for management of primary spontaneous pneumothorax. This review was first published in 2007 and was updated in 2017. To compare the clinical efficacy and safety of simple aspiration versus intercostal tube drainage for management of primary spontaneous pneumothorax. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 1) in the Cochrane Library; MEDLINE (1966 to January 2017); and Embase (1980 to January 2017). We searched the World Health Organization (WHO) International Clinical Trials Registry for ongoing trials (August 2017). We checked the reference lists of included trials and contacted trial authors. We imposed no language restrictions. We included randomized controlled trials (RCTs) of adults 18 years of age and older with primary spontaneous pneumothorax that compared simple aspiration versus intercostal tube drainage. Two review authors independently selected studies for inclusion, assessed trial quality, and extracted data. We combined studies using the random-effects model. Of 2332 publications obtained through the search strategy, seven studies met the inclusion criteria; one study was ongoing and six studies of 435 participants were eligible for inclusion in the updated review. Data show a significant difference in immediate success rates of procedures favouring tube drainage over simple aspiration for management of primary spontaneous pneumothorax (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.69 to 0.89; 435 participants, 6 studies; moderate-quality evidence). Duration of hospitalization however was significantly less for patients treated by simple aspiration (mean

  1. Sleep-disordered breathing as a delayed complication of iatrogenic vocal cord trauma.

    Science.gov (United States)

    Faiz, Saadia A; Bashoura, Lara; Kodali, Lavanya; Hessel, Amy C; Evans, Scott E; Balachandran, Diwakar D

    2016-06-01

    A case of a 55-year-old woman with iatrogenic vocal cord trauma and sleep-related symptoms is reported. In particular, this case highlights sleep-disordered breathing as a delayed complication after iatrogenic vocal cord trauma. The patient developed acute stridor from a contralateral vocal cord hematoma following vocal fold injection for right vocal cord paralysis. Acute respiratory symptoms resolved with oxygen, steroids, and nebulized therapy, but nocturnal symptoms persisted and polysomnography revealed sleep-related hypoventilation and mild obstructive sleep apnea. Positive pressure therapy was successfully used to ameliorate her symptoms and treat sleep-disordered breathing until her hematoma resolved. In addition to the typically acute respiratory symptoms that may result from vocal cord dysfunction, sleep-disordered breathing may also present as a significant subacute or chronic problem. Management of the acute respiratory symptoms is relatively well established, but clinicians should be alert for more subtle nocturnal symptoms that may require further study with polysomnography.

  2. 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.

  3. Topical-steroid-induced iatrogenic Cushing syndrome in the pediatric age group: A rare case report

    Directory of Open Access Journals (Sweden)

    Ashish Tiwari

    2013-01-01

    Full Text Available Cushing syndrome, a systemic disorder, is the result of abnormally high blood level of cortisol or other glucocorticoids. The most common cause of Cushing syndrome is prolonged exogenous administration of glucocorticoid hormones. Prolonged use of topical corticosteroids, particularly in children, may cause Cushing syndrome and suppression of the hypothalamopituitory-adrenal axis, which is less common than that of oral or parenteral route. However, iatrogenic Cushing syndrome in the infantile age group due to topical steroid is very rare and only a few patients have been reported to date in the literature. Here we report a case of iatrogenic Cushing syndrome due to topical steroid application in a 5-month-old female child admitted to the hospital for repeated episodes of fever and cough.

  4. Topical-steroid-induced iatrogenic Cushing syndrome in the pediatric age group: A rare case report.

    Science.gov (United States)

    Tiwari, Ashish; Goel, Manjusha; Pal, Pankaj; Gohiya, Poorva

    2013-10-01

    Cushing syndrome, a systemic disorder, is the result of abnormally high blood level of cortisol or other glucocorticoids. The most common cause of Cushing syndrome is prolonged exogenous administration of glucocorticoid hormones. Prolonged use of topical corticosteroids, particularly in children, may cause Cushing syndrome and suppression of the hypothalamopituitory-adrenal axis, which is less common than that of oral or parenteral route. However, iatrogenic Cushing syndrome in the infantile age group due to topical steroid is very rare and only a few patients have been reported to date in the literature. Here we report a case of iatrogenic Cushing syndrome due to topical steroid application in a 5-month-old female child admitted to the hospital for repeated episodes of fever and cough.

  5. [Iatrogenic extravasations of cytotoxic or hyperosmolar aqueous solutions. Value of surgical emergency by aspiration and lavage].

    Science.gov (United States)

    Lambert, F; Couturaud, B; Arnaud, E; Champeau, F; Revol, M; Servant, J M

    1997-08-01

    Iatrogenic extravasations are characterized by their unpredictable course, the possible repercussions of functional, cosmetic and psychological sequelae, and the absence of a therapeutic consensus. The authors present the protocol used in Hôpital Saint-Louis, based on a synthesis of current procedures, consisting of emergency conservative surgical aspiration and lavage, performed in a context of close collaboration with oncolosits, intensive care physicians and radiologists. From 1994 to March 1997, fifteen patients were operated following extravasation during seven chemotherapeutic protocols, three radiographic examinations with injection of contrast agents and five resuscitation procedures. This simple protocol, applied systematically, achieved cure without cutaneous or functional sequelae in all patients. Aspiration-lavage during the first twelve hours therefore constitutes the treatment of choice of iatrogenic extravasation with cytotoxic or hyperosmolar aqueous solutions.

  6. Iatrogenic injury to oral branches of the trigeminal nerve: records of 449 cases

    DEFF Research Database (Denmark)

    Hillerup, Søren

    2007-01-01

    The aims of this study were threefold: (1) to describe iatrogenic lesions to oral branches of the trigeminal nerve, signs and symptoms, and functional status, (2) to report on a simple neurosensory examination method, and (3) to discuss means of prevention of iatrogenic injury. The etiology...... and functional status of 449 injuries to oral branches collected over 18 years were retrospectively reviewed. A simple scheme of a clinical neurosensory examination was applied to enable a quantified rating of the perception. Injury to the lingual nerve (n = 261) is not only the most prevalent type of lesion...... was affected more frequently and severely than other oral branches of the trigeminal nerve. The female gender was overrepresented in incidence of injured nerves but no difference was found in the severity of affection between females and males. All grades of loss of neurosensory functions were found...

  7. Iatrogenic neonatal type B aortic dissection: comprehensive MRI-based diagnosis and follow-up

    Energy Technology Data Exchange (ETDEWEB)

    Geiger, Julia; Markl, M. [University Hospital Freiburg, Department of Diagnostic Radiology and Medical Physics, Freiburg (Germany); Stiller, B.; Arnold, R. [University Hospital Freiburg, Department of Congenital Heart Disease and Pediatric Cardiology, Freiburg (Germany); Schlensak, C. [University Hospital Freiburg, Department of Cardiovascular Surgery, Freiburg (Germany)

    2011-10-15

    Neonatal aortic dissection is rare and most frequently iatrogenic. Decision making and appropriate imaging are highly challenging for pediatric cardiologists and radiologists. We present MRI and echocardiographic findings in the follow-up at 6 months of age of a boy with a conservatively treated iatrogenic neonatal aortic dissection (type B). To evaluate the morphology of the aortic arch and descending aorta, we carried out multidirectional time-resolved three-dimensional flow-analysis and contrast-enhanced MR angiography (CE-MRA). The MRI and Doppler echocardiographic results were closely comparable. Three-dimensional visualization helped assess details of blood flow acceleration and alteration caused by the dissection, and played a key role in our deciding not to treat surgically. (orig.)

  8. 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.

  9. Iatrogenic visual aura: a case report and a brief review of the literature.

    Science.gov (United States)

    Buture, Alina; Khalil, Modar; Ahmed, Fayyaz

    2017-01-01

    Iatrogenic migraine aura following transseptal catheterization has only rarely been reported in the literature. We report the case of a 60-year-old female who presented with new onset of migraine with visual aura 1 day after transseptal cryoballoon catheter ablation for atrial fibrillation. The patient had a 5-year history of typical migraine without aura and had never experienced visual aura before the cardiac intervention. The neurological examination, fundoscopy, and blood tests were normal. The magnetic resonance imaging of the brain showed small vessel ischemia without evidence of vessel ischemic changes in the occipital lobes and large blood vessel disease. A change in the characteristics of existing migraine could occur following an iatrogenic episode, which in this case was catheter ablation for atrial fibrillation. A new onset of aura is considered an indication for a brain scan as it may signify underlying new pathology.

  10. [Transbronchoscopic end-tidal carbon dioxide detection for location of the leading bronchus in patients with pneumothorax].

    Science.gov (United States)

    Zeng, Yiming; Lin, Huihuang

    2015-04-01

    To evaluate the effect of end-tidal carbon dioxide (EtCO2) detection for location of the leading bronchus in patients with pneumothorax. Transbronchoscopic EtCO2 detection was performed in 4 patients with intractable pneumothorax in whom transbronchoscopic balloon detection failed to localize the leading bronchus. A specific bronchus was suspected to be the leading bronchus when its EtCO2 value was significantly lower than that of the main bronchus of the affected lung. After the pleural air leakage was successfully sealed by bronchial occlusion of the suspected bronchus, the EtCO2 was confirmed to indicate the leading bronchus. Transbronchoscopic EtCO2 detection successfully located the leading bronchus in all 4 patients. Transbronchoscopic EtCO2 detection is a new method of locating the leading bronchus in patients with intractable pneumothorax.

  11. Iatrogenic subclavian artery pseudoaneurysm close to the origin of the vertebral artery: an endovascular strategy

    Institute of Scientific and Technical Information of China (English)

    XU Gao-feng; Dae Chul Suh

    2006-01-01

    Subclavian artery pseudoaneurysm that induced from central venous catheterization through the internal jugular vein is relatively uncommon. However, the management of subclavian artery pseudoaneurysm remains a challenge because of their non-compressibility of deep locality and relationship to important surrounding anatomy, such as the origin of vertebral artery. In this paper, the authors report a patient with larger iatrogenic subclavian arterial pseudoaneurysm near the origin of vertebral artery, that was treated successfully by endovascular covered stent and coils.

  12. Endoscopic Diagnosis and Management of Iatrogenic Cervical Esophageal Perforation in Extremely Premature Infants

    Directory of Open Access Journals (Sweden)

    Wen-Jue Soong

    2007-04-01

    Full Text Available Blind oro-(naso-pharyngeal suction and feeding catheter intubation are very common practices in pediatric critical care. However, these simple procedures may produce unexpected complications in friable tiny patients. We encountered 3 extremely premature infants in whom cervical esophageal perforation and further submucosal excavation were caused by traumatic catheter injury and subsequently led to catastrophes. These episodes of iatrogenic trauma were all successfully diagnosed early, documented and managed with the aid of ultrathin flexible endoscopy.

  13. An unusual cause of spontaneous pneumothorax: the Mounier-Kuhn syndrome.

    LENUS (Irish Health Repository)

    Kent, B D

    2011-05-01

    We present the case of a 54-year old woman referred to our service with an unusual presentation of an under-diagnosed condition. A life-long non-smoker, she was referred to respiratory services by our emergency department with a left sided pneumothorax, progressive dyspnoea on exertion, and recurrent chest infections. Subsequent investigation yielded findings consistent with Mounier-Kuhn syndrome (Tracheobronchomegaly), a condition characterised by marked dilatation of the proximal airways, recurrent chest infection, and consequent emphysema and bronchiectasis. Although rarely diagnosed, some degree of Mounier-Kuhn syndrome may occur in up to 1 in 500 adults.

  14. Transthoracic Adrenal Biopsy Procedure Using Artificial Carbon Dioxide Pneumothorax as Outpatient Procedure

    Energy Technology Data Exchange (ETDEWEB)

    Favelier, Sylvain [CHU (University Hospital), Department of Radiology (France); Guiu, Severine [Georges-Francois Leclerc Cancer Center, Department of Oncology (France); Cherblanc, Violaine; Cercueil, Jean-Pierre; Krause, Denis; Guiu, Boris, E-mail: boris.guiu@chu-dijon.fr [CHU (University Hospital), Department of Radiology (France)

    2013-08-01

    Many routes have been described for percutaneous adrenal gland biopsy. They require either a complex non-axial path or a long hydrodissection or even pass through an organ thereby increasing complications. We describe here an approach using an artificially-induced carbon dioxide (CO{sub 2}) pneumothorax, performed as an outpatient procedure in a 57-year-old woman. Under local anaesthesia, 200 ml of CO{sub 2} was injected in the pleural space through a Veress needle under computed tomography fluoroscopy, to clear the lung parenchyma from the biopsy route. Using this technique, transthoracic adrenal biopsy can be performed under simple local anaesthesia as an safely outpatient procedure.

  15. Recurrent Pneumothorax after Etanercept Therapy in a Rheumatoid Arthritis Patient: A Case Report

    Science.gov (United States)

    Kim, Sang Hoon; Seo, Young Ho; Kim, Ji Hyoung; Jeong, Il Woo; Sohn, Sung Birm

    2014-01-01

    The use of anti-tumor necrosis factor (anti-TNF) agents for rheumatoid arthritis (RA) patients who are refractory to disease-modifying anti-rheumatic drugs is gradually increasing. Etanercept is the first anti-TNF agent to be approved for RA treatment and is also the most widely used. However, aggravation of interstitial lung disease after etanercept treatment in RA patients has been reported recently. We report the first case of recurrent spontaneous pneumothorax with progression of interstitial lung disease after initiating etanercept therapy. The withdrawal of etanercept and a change to adalimumab, a different class of TNF inhibitor, achieved clinical stabilization. PMID:25568848

  16. Homer syndrome after thoracoscopic apicectomy for spontaneous pneumothorax as a complication of chest tube placement.

    Science.gov (United States)

    Piccoli, Micaela; Golinelli, Marco; Colli, Giovanni; Mullineris, Barbara; Melotti, Gianluigi

    2007-01-01

    We describe a case of Horner syndrome occurring secondary only to the high insertion of a chest tube after video-thoracoscopic apicectomy for spontaneous pneumothorax. Because all other causes could be ruled out, the Authors assume that the lesion to the sympathetic nerve fibres was caused by pressure exerted by the tip of the chest tube. Horner syndrome due to this cause can easily be avoided. The tip of the chest tube should be kept at the level of, or below, the third posterior rib, unless the clinical situation dictates otherwise. This cause of Horner syndrome must be taken into account because, if recognized and treated promptly, it can be fully resolved.

  17. An unusual cause of spontaneous pneumothorax: the Mounier-Kuhn syndrome.

    LENUS (Irish Health Repository)

    Kent, B D

    2012-02-01

    We present the case of a 54-year old woman referred to our service with an unusual presentation of an under-diagnosed condition. A life-long non-smoker, she was referred to respiratory services by our emergency department with a left sided pneumothorax, progressive dyspnoea on exertion, and recurrent chest infections. Subsequent investigation yielded findings consistent with Mounier-Kuhn syndrome (Tracheobronchomegaly), a condition characterised by marked dilatation of the proximal airways, recurrent chest infection, and consequent emphysema and bronchiectasis. Although rarely diagnosed, some degree of Mounier-Kuhn syndrome may occur in up to 1 in 500 adults.

  18. 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

  19. Virally mediated cervical cancer in the iatrogenically immunocompromised: applications for psychoneuroimmunology.

    Science.gov (United States)

    Jensen, Sally E; Lehman, Brandy; Antoni, Michael H; Pereira, Deidre B

    2007-08-01

    Oncogenic or high-risk (HR) human papillomavirus (HPV) infection is implicated in the pathogenesis of a number of cancers, including cervical cancer. HPV infected individuals who are immunocompromised secondary to acquired (e.g., human immunodeficiency virus [HIV]) or iatrogenic (e.g., systemic lupus erythematosus [SLE] patients and organ and hematopoeitic stem cell transplant recipients undergoing immunosuppressive therapy) immune deficiency are particularly at risk for HPV-initiated cervical neoplasia and cancer. Psychoneuroimmunologic (PNI) research has demonstrated that psychosocial factors such as stress, pessimism, and sleep quality may play a role in the promotion of HPV-mediated cervical neoplasia in HIV-positive women. However, no research to our knowledge has examined PNI mechanisms of HPV-mediated cervical neoplasia and cancer in women who are undergoing iatrogenic immunosuppressive therapy for the treatment of autoimmune disease or the prevention of graft-rejection. This article reviews the PNI mechanisms that may underlie the promotion of HPV-mediated cervical neoplasia and applies this model to HPV-infected women who are iatrogenically immunosuppressed, an understudied population at-risk for cervical cancer. Female transplant recipients, one such group, may provide a unique paradigm in which to explore further PNI mechanisms of HPV-mediated cervical neoplasia.

  20. Cosmic Strings with Small Tension

    CERN Document Server

    Halyo, Edi

    2009-01-01

    We describe cosmic F--term strings with exponentially small tension which are D3 branes wrapped on deformed $A_3$ singularities. We show that brane instanton effects which can be calculated after a geometric transition give rise to an exponentially small volume for the node on which the D3 branes wrap leading to a string with small tension. We generalize our description to the case of non--Abelian cosmic strings and argue that these strings are stable against monopole--anti monopole pair creation.

  1. Promoter methylation is not associated with FLCN irregulation in lung cyst lesions of primary spontaneous pneumothorax.

    Science.gov (United States)

    Ding, Yibing; Zou, Wei; Zhu, Chengchu; Min, Haiyan; Ma, Dehua; Chen, Baofu; Ye, Minhua; Pan, Yanqing; Cao, Lei; Wan, Yueming; Zhu, Qiuxiang; Xia, Haizhen; Zhang, Wenwen; Feng, Ying; Gao, Qian; Yi, Long

    2015-11-01

    Germline mutations in FLCN are responsible for ~10% of patients with primary spontaneous pneumothorax (PSP), characterized by multiple lung cysts in the middle/lower lobes and recurrent pneumothorax. These clinical features are also observed in a substantial portion of patients with sporadic PSP exhibiting no FLCN coding mutations. To assess the potential underlying mechanisms, 71 patients with PSP were selected, including 69 sporadic and 2 familial cases, who bared FLCN mutation‑like lung cysts, however, harbored no FLCN protein‑altering mutations. Notably, in a significant proportion of the patients, FLCN irregulation was observed at the transcript and protein levels. Genetic analyses of the cis‑regulatory region of FLCN were performed by sequencing and multiplex ligation‑dependent probe amplification assay. No inheritable DNA defect was detected, with the exception of a heterozygous deletion spanning the FLCN promoter, which was identified in a family with PSP. This mutation caused a reduction in the expression of FLCN in the lung cysts. Pedigree analysis demonstrated that haploinsufficiency of FLCN was pathogenic. To determine whether epigenetic mechanisms may be involved in the irregulation of FLCN, the promoter methylation status was measured in the remainder of the patients. No evidence of FLCN promoter methylation was demonstrated. The present study suggested that FLCN irregulation in lung cysts of PSP is not associated with promoter methylation.

  2. Pneumothorax detection in chest radiographs using local and global texture signatures

    Science.gov (United States)

    Geva, Ofer; Zimmerman-Moreno, Gali; Lieberman, Sivan; Konen, Eli; Greenspan, Hayit

    2015-03-01

    A novel framework for automatic detection of pneumothorax abnormality in chest radiographs is presented. The suggested method is based on a texture analysis approach combined with supervised learning techniques. The proposed framework consists of two main steps: at first, a texture analysis process is performed for detection of local abnormalities. Labeled image patches are extracted in the texture analysis procedure following which local analysis values are incorporated into a novel global image representation. The global representation is used for training and detection of the abnormality at the image level. The presented global representation is designed based on the distinctive shape of the lung, taking into account the characteristics of typical pneumothorax abnormalities. A supervised learning process was performed on both the local and global data, leading to trained detection system. The system was tested on a dataset of 108 upright chest radiographs. Several state of the art texture feature sets were experimented with (Local Binary Patterns, Maximum Response filters). The optimal configuration yielded sensitivity of 81% with specificity of 87%. The results of the evaluation are promising, establishing the current framework as a basis for additional improvements and extensions.

  3. Rare case of pneumorrhachis, pneumomediastinum, pneumothorax, and surgical emphysema secondary to bronchial asthma

    Directory of Open Access Journals (Sweden)

    Mahajan PS

    2014-03-01

    Full Text Available Parag Suresh Mahajan,1 Nasser Jassim Al Maslamani,1 Nishan K Purayil2 1Department of Radiology, 2Accident and Emergency Department, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar Abstract: Air localized within the spinal canal is called pneumorrhachis. In the case of pneumorrhachis, air can be present in the extradural, the intradural, or the subarachnoid space of the spinal canal. The air within the soft tissue of the posterior mediastinum may dissect along fascial planes, through the intervertebral neural foramina, and into the extradural or the subarachnoid space. Nontraumatic pneumorrhachis is a rare presentation. Most of the time, pneumorrhachis is asymptomatic, remains localized, and resolves spontaneously. There are very few reports of combined presence of pneumomediastinum and extradural pneumorrhachis not associated with thoracic injury in the published literature. We report a rare case of pneumorrhachis, pneumomediastinum, pneumothorax, and surgical emphysema in an adult female patient developed after a bout of violent cough related to bronchial asthma. Keywords: pneumorrhachis, pneumomediastinum, pneumothorax, surgical emphysema, asthma

  4. On the Stability of Lung Parenchymal Lesions with Applications to Early Pneumothorax Diagnosis

    Directory of Open Access Journals (Sweden)

    Archis R. Bhandarkar

    2013-01-01

    Full Text Available Spontaneous pneumothorax, a prevalent medical challenge in most trauma cases, is a form of sudden lung collapse closely associated with risk factors such as lung cancer and emphysema. Our work seeks to explore and quantify the currently unknown pathological factors underlying lesion rupture in pneumothorax through biomechanical modeling. We hypothesized that lesion instability is closely associated with elastodynamic strain of the pleural membrane from pulsatile air flow and collagen-elastin dynamics. Based on the principles of continuum mechanics and fluid-structure interaction, our proposed model coupled isotropic tissue deformation with pressure from pulsatile air motion and the pleural fluid. Next, we derived mathematical instability criteria for our ordinary differential equation system and then translated these mathematical instabilities to physically relevant structural instabilities via the incorporation of a finite energy limiter. The introduction of novel biomechanical descriptions for collagen-elastin dynamics allowed us to demonstrate that changes in the protein structure can lead to a transition from stable to unstable domains in the material parameter space for a general lesion. This result allowed us to create a novel streamlined algorithm for detecting material instabilities in transient lung CT scan data via analyzing deformations in a local tissue boundary.

  5. On the stability of lung parenchymal lesions with applications to early pneumothorax diagnosis.

    Science.gov (United States)

    Bhandarkar, Archis R; Banerjee, Rohan; Seshaiyer, Padmanabhan

    2013-01-01

    Spontaneous pneumothorax, a prevalent medical challenge in most trauma cases, is a form of sudden lung collapse closely associated with risk factors such as lung cancer and emphysema. Our work seeks to explore and quantify the currently unknown pathological factors underlying lesion rupture in pneumothorax through biomechanical modeling. We hypothesized that lesion instability is closely associated with elastodynamic strain of the pleural membrane from pulsatile air flow and collagen-elastin dynamics. Based on the principles of continuum mechanics and fluid-structure interaction, our proposed model coupled isotropic tissue deformation with pressure from pulsatile air motion and the pleural fluid. Next, we derived mathematical instability criteria for our ordinary differential equation system and then translated these mathematical instabilities to physically relevant structural instabilities via the incorporation of a finite energy limiter. The introduction of novel biomechanical descriptions for collagen-elastin dynamics allowed us to demonstrate that changes in the protein structure can lead to a transition from stable to unstable domains in the material parameter space for a general lesion. This result allowed us to create a novel streamlined algorithm for detecting material instabilities in transient lung CT scan data via analyzing deformations in a local tissue boundary.

  6. Testing of a Complete Training Model for Chest Tube Insertion in Traumatic Pneumothorax.

    Science.gov (United States)

    Ghazali, Aiham; Breque, Cyril; Léger, Alexandre; Scépi, Michel; Oriot, Denis

    2015-08-01

    Chest tube insertion is a frequent procedure in cases of traumatic pneumothorax, but severe complications can occur if not well performed. Although simulation-based training in chest tube insertion has improved performance, an affordable and realistic model for surgical insertion of a chest tube is lacking. The objective was to design a model for surgical chest tube insertion that would be realistic, affordable, and transportable and that would reflect all extrathoracic and intrathoracic steps of the procedure. The model was a task trainer designed by 4 experts in our simulation laboratory combining plastic, electronic, and biologic material. The cost of supplies needed for construction was evaluated. The model was used and tested over 30 months on 56 participants, of whom 44 were surveyed regarding the realism of the model. The model involved a half chest wall (lamb) on a plastic box, connected to a webcam facilitating assessment of the extrathoracic and intrathoracic steps of the procedure, for a cost of €60. Chest tubes, water seal package, and sterile instruments costed €200. All anatomic structures were represented during surgical insertion of chest tube. The demonstration contributed to teaching small groups of up to 8 participants and was reproducible over 30 months of diversely located courses. Anatomic correlation, realism, and learning experience were highly rated by users. This model for surgical chest tube insertion in traumatic pneumothorax was found to be realistic, affordable, and transportable. Furthermore, it allowed comprehensive assessment of the extrathoracic and intrathoracic procedural steps.

  7. Needle aspiration versus intercostal tube drainage for pneumothorax in the newborn.

    Science.gov (United States)

    Bruschettini, Matteo; Romantsik, Olga; Ramenghi, Luca Antonio; Zappettini, Simona; O'Donnell, Colm P F; Calevo, Maria Grazia

    2016-01-11

    Pneumothorax occurs more frequently in the neonatal period than at any other time of life and is associated with increased mortality and morbidity. It may be treated with either needle aspiration or insertion of a chest tube. The former consists of aspiration of air with a syringe through a needle or an angiocatheter, usually through the second or third intercostal space in the midclavicular line. The chest tube is usually placed in the anterior pleural space passing through the sixth intercostal space into the pleural opening, turned anteriorly and directed to the location of the pneumothorax, and then connected to a Heimlich valve or an underwater seal with continuous suction. To compare the efficacy and safety of needle aspiration and intercostal tube drainage in the management of neonatal pneumothorax. We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 11), MEDLINE via PubMed (1966 to 30 November 2015), EMBASE (1980 to 30 November 2015), and CINAHL (1982 to 30 November 2015). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. Randomised controlled trials, quasi-randomised controlled trials and cluster trials comparing needle aspiration (either with the needle or angiocatheter left in situ or removed immediately after aspiration) to intercostal tube drainage in newborn infants with pneumothorax. For each of the included trial, two authors independently extracted data (e.g. number of participants, birth weight, gestational age, kind of needle and chest tube, choice of intercostal space, pressure and device for drainage) and assessed the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). The primary outcomes considered in this review are mortality during the neonatal period and during hospitalisation. One

  8. 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.

  9. Tension type headaches: a review

    African Journals Online (AJOL)

    23. Epidemiology. A wide variation in the prevalence of tension-type headaches .... intensity tending to be less in the morning, building up after noon, and reducing ... with a change in position or the start of Valsalva-like sneezing. • Associated ...

  10. Abolishing the maximum tension principle

    CERN Document Server

    Dabrowski, Mariusz P

    2015-01-01

    We find the series of example theories for which the relativistic limit of maximum tension $F_{max} = c^2/4G$ represented by the entropic force can be abolished. Among them the varying constants theories, some generalized entropy models applied both for cosmological and black hole horizons as well as some generalized uncertainty principle models.

  11. Abolishing the maximum tension principle

    Directory of Open Access Journals (Sweden)

    Mariusz P. Da̧browski

    2015-09-01

    Full Text Available We find the series of example theories for which the relativistic limit of maximum tension Fmax=c4/4G represented by the entropic force can be abolished. Among them the varying constants theories, some generalized entropy models applied both for cosmological and black hole horizons as well as some generalized uncertainty principle models.

  12. Effect of ageing and pulmonary inflammation on the incidence and number of cross-bridging structures in pneumothorax patients

    Energy Technology Data Exchange (ETDEWEB)

    Sasaki, Tomoaki; Takahashi, Koji; Aburano, Tamio (Dept. of Radiology, Asahikawa Medical Univ., Asahikawa, Hokkaido (Japan)), email: tomoaki3est@gmail.com

    2011-12-15

    Background. There is an improved prognosis for T4 non-small-cell lung cancer in patients who show particular patterns of direct mediastinal invasion. The particular patterns suggest the presence of direct pathways other than the pulmonary hilum between each of the lungs and the mediastinum/chest wall. Purpose. To determine the incidence and number of such direct pathways in pneumothorax patients as well as the factors that affect the development of these pathways. Material and Methods. Two radiologists independently analyzed multidetector computed tomographic images of 81 patients with pneumothorax to assess the incidence and distribution pattern of the cross-bridging structures in the pleural cavity. Results. Cross-bridging structures were observed in the right pneumothorax in 34/54 (63%) patients and in the left pneumothorax in 19/32 (59%) patients. The number of cross-bridging structures was found to be positively correlated with ageing and pulmonary disease. The distribution patterns of cross-bridging structures were found to be specific in formation and often in repeated locations, regardless of the presence of pulmonary disease or the age of the patient. Conclusion. Cross-bridging structures in pneumothoraces were found more frequently in older patients and in patients with pulmonary disease. However, some of the cross-bridging structures may have been congenital because of their specific formations and repeated locations

  13. Risk of spontaneous pneumothorax due to air travel and diving in patients with Birt-Hogg-Dube syndrome

    NARCIS (Netherlands)

    Johannesma, P.C.; Beek, I. van de; Wel, J.W. van der; Paul, M.A.; Houweling, A.C.; Jonker, M.A.; Waesberghe, J.H. van; Reinhard, R.; Starink, T.M.; Moorselaar, R.J. van; Menko, F.H.; Postmus, P.E.

    2016-01-01

    BACKGROUND AND OBJECTIVES: Birt-Hogg-Dube syndrome is an autosomal dominant disorder characterized by skin fibrofolliculomas, lung cysts, spontaneous pneumothorax and renal cell cancer due to germline folliculin (FLCN) mutations (Menko et al. in Lancet Oncol 10(12):1199-1206, 2009). The aim of this

  14. 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 pneumot

  15. Use of spirometry to predict risk of pneumothorax in CT-guided needle biopsy of the lung

    Energy Technology Data Exchange (ETDEWEB)

    Garcia-Rio, F.; Pino, J.M.; Diaz-Lobato, S.; Villamor, S. [Autonoma Univ., Madrid (Spain)] [and others

    1996-01-01

    Our goal was to assess the usefulness of spirometry to estimate the risk of pneumothorax in patients undergoing percutaneous needle biopsy with CT guidance for solitary pulmonary nodule (SPN). We studied the results of 51 consecutive percutaneous needle biopsies with CT guidance for SPN obtained between 1988 and 1990. Forty-five men and six women, aged 65 {+-} 11 (36-86) years, were included in the study. All biopsies were performed under CT guidance, with 90 mm 25G needles (0.5 mm thickness) fitted into luer-type syringes. The number of needle pass attempts never exceeded three. A spirometry before biopsy was performed in all patients. Pneumothorax occurred in only 10 cases (19%). The patients with pneumothorax showed lower lesion size, forced vital capacity (FVC), forced expiratory volume (FEV{sub 1}), and FEV{sub 1}/FVC ratio. The contribution of these factors to pneurnothorax was analyzed by a logistic regression model. The FEV{sub 1} was most strongly associated with the incidence of pneumothorax. We developed an equation for predicting the risk of this complication. We conclude that decreasing FEV{sub 1} is associated with a higher neurnothorax rate. 15 refs., 2 figs., 2 tabs.

  16. Prevention and treatment of iatrogenic vascular injury in inguinal herniorrhaphy%腹股沟疝手术中医源性血管损伤的防范及处理

    Institute of Scientific and Technical Information of China (English)

    赵渝; 王学虎; 刘洪

    2014-01-01

    Iatrogenic vascular injury is relatively common in clinic and it usually happens nearby blood vessels area. In the past,the occurrence of iatrogenic vascular injury in the traditional (tension) inguinal hernia repair operation is rare. But in recent,with the popularity of tension free hernia repair with the mesh repair material,especially in the preperitoneal repair,the vascular injury is more than before. To avoid vascular injury,surgeons must be familiar with vascular anatomy of the groin area and all kinds of inguinal hernia repair operation. Once the complications happen,such as vascular injury,surgeons should know the reasons and treat it in time,to reduce the iatrogenic vascular injury of inguinal hernia to a minimum.%医源性血管损伤相对比较常见,多见于邻近血管区域的各类手术,而在以往传统的(有张力)腹股沟疝修补术中,血管损伤的发生比较少见。近年来随着无张力疝修补术的普及,网片修补材料的应用,尤其是应用网片的腹膜前间隙疝修补术,时有血管损伤的发生,严重者导致死亡。避免血管损伤需要术者熟悉腹股沟区血管解剖,正确掌握各种腹股沟疝修补术式及网片应用,一旦手术导致血管损伤等并发症,及时分析原因并正确处理,均能将腹股沟疝手术中医源性血管损伤的危害降到最低。

  17. CALCULATION OF TENSION FORCE OF BELT CONVEYOR

    Directory of Open Access Journals (Sweden)

    Ismet Ibishi

    2012-12-01

    Full Text Available In this paper is done the explanation on tension fashion of the belt conveyor which is employed in Kosovo Energy Corporation – KEK, for coal transportation to provide electric power plant. The aim of the paper enables to recognize tension forces not to pass with deformation of belt so that this problem will damage the workingprocess. Work principle is based on initial tension and tension during working process. The fact is known that the tension starts from the carriage on the way to tension mechanization, so forces on the rope passing through pulley there has to dominate the friction coefficient. All this process is related to economy of transportationmechanism.

  18. Misdiagnosis and management of iatrogenic pseudoaneurysm of vertebral artery after Harms technique of C1-C2 fixation

    Institute of Scientific and Technical Information of China (English)

    MIN Li; SONG Yue-ming; XIE Xiao-dong; WANG Chao-hua; LIU Li-min

    2012-01-01

    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 atlantoaxial complex,iatrogenic VAI will result in catastrophic consequences 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 postoperative computed angiography is very helpful to diagnose the exact site of VAI and the combination of endovascular coil occlusion as well as external local compression can further prevent bleeding and abnormal vertebral artery flow in the pseudoaneurysm.However,patients treated require further follow-up to confirm that there is no recurrence of the pseudoaneurysm.

  19. Fluticasone furoate induced iatrogenic Cushing syndrome in a pediatric patient receiving anti-retroviral therapy

    Directory of Open Access Journals (Sweden)

    S A A van den Berg

    2017-04-01

    Full Text Available We present a case of iatrogenic Cushing’s syndrome, induced by treatment with fluticasone furoate (1–2 dd, 27.5 μg in each nostril in a pediatric patient treated for congenital HIV. The pediatric patient described in this case report is a young girl of African descent, treated for congenital HIV with a combination therapy of Lopinavir/Ritonavir (1 dd 320/80 mg, Lamivudine (1 dd 160 mg and Abacavir (1 dd 320 mg. Our pediatric patient presented with typical Cushingoid features (i.e. striae of the upper legs, full moon face, increased body and facial hair within weeks after starting fluticasone furoate therapy, which was exacerbated after increasing the dose to 2 dd because of complaints of unresolved rhinitis. Biochemical analysis fitted iatrogenic Cushing’s syndrome, with a repeatedly low cortisol (<0.03 μM, ref 0.14–0.60 μM and low ACTH (9 pg/mL, ref 9–52 pg/mL without signs of adrenal insufficiency. No other biochemical abnormalities that could point to adrenal or pituitary dysfunction were detected; electrolytes, thyroid and gonadal function, and IGF-1 were within the normal range. Pharmacogenetic analysis revealed that the pediatric patient carried the CYP3A4 *1B/*1G and CYP3A5 *3/*3 genotype (associated with a partial and complete loss of enzyme activity, respectively which is associated with the development of iatrogenic Cushing’s syndrome in patients treated for HIV due to the strong inhibition of CYP3 enzymes by Ritonavir. Upon discontinuation of fluticasone treatment, the pediatric patient improved both clinically and biochemically with normalisation of cortisol and ACTH within a couple of weeks.

  20. Emergency and elective implantation of covered stent systems in iatrogenic arterial injuries

    Energy Technology Data Exchange (ETDEWEB)

    Goltz, J.P.; Kickuth, R. [Universitaetsklinikum Wuerzburg (Germany). Inst. fuer Roentgendiagnostik; Bastuerk, P.; Hoppe, H.; Triller, J. [Universitaetsspital Bern (Switzerland). Inst. fuer Diagnostische, Interventionelle und Paediatrische Radiologie

    2011-07-15

    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.)

  1. Occult pneumothorax in blunt trauma: is there a need for tube thoracostomy?

    Science.gov (United States)

    Zhang, M; Teo, L T; Goh, M H; Leow, J; Go, K T S

    2016-12-01

    Occult pneumothorax (OPTX) is defined as air within the pleural cavity that is undetectable on normal chest X-rays, but identifiable on computed tomography. Currently, consensus is divided between tube thoracostomy and conservative management for OPTX. The aim of this retrospective study is to determine whether OPTX can be managed conservatively and whether any adverse events occur under conservative management. Data on all trauma patients from 1 Jan 2010 to 31 December 2012 were obtained from our hospital's trauma registry. All patients with occult pneumothorax who had chest X-ray (CXR) and any CT scan visualizing the thorax were included. The exclusion criteria included those with penetrating wounds; CXR showing pneumothorax, hemothorax, or hemopneumothorax; those with prophylactic chest tube insertion before CT; and those with no CT diagnosis of OPTX. The complications of these patients were analyzed to determine if tube thoracostomy is necessary for OPTX and whether not inserting it would alter the outcome significantly. A total of 1564 cases were reviewed and 83 patients were included. Of these 83 patients, 35 (42.2 %) had tube thoracostomy after OPTX detection and 48 (57.8 %) were observed initially. Patients who had tube thoracostomy had similar ISS compared to those without (median ISS 17 vs. 18.5, p = 0.436). Out of the 48 patients who did not have tube thoracostomy on detection of an OPTX, 4 (8.3 %) had complications. In the group of 35 patients who had tube thoracostomy on detection of an OPTX, 7 (20 %) had complications. Of the 83 patients, a total of 12 patients had IPPV, of which 7 (58.3 %) had tube thoracostomy and 5 (41.7 %) did not. Patients who had tube thoracostomy under our care have a statistically significant likelihood of experiencing any complication compared to those without tube thoracostomy (odds ratio 9.92. The median length of stay was also longer (13 days) in those who had tube thoracostomy compared to those without (5

  2. Iatrogenic central retinal artery occlusion after carotid body tumor embolization and excision

    Directory of Open Access Journals (Sweden)

    Rangel, Carlos M.

    2017-03-01

    Full Text Available Objective: To report a case of iatrogenic central retinal artery occlusion after embolization and surgical resection of carotid body paraganglioma.Methods: Case report Results: One adult female patient presented with persistent unilateral visual loss after embolization with Embosphere and Contour microparticles of carotid body tumor. Fluorescein angiography revealed intraluminal microspheres in the central retinal artery ramifications. OCT revealed intraretinal spherical, hyporeflective particles with posterior shadowing. Conclusions: Central retinal artery occlusion should be assessed as a possible complication after surgical repair of head and neck paragangliomas.

  3. Neo-liberal Governing of “Radicals”: Danish Radicalization Prevention Policies and Potential Iatrogenic Effects

    Directory of Open Access Journals (Sweden)

    Lasse Lindekilde

    2012-05-01

    Full Text Available The Danish government’s counter-radicalization Action Plan of 2009 had intended and unintended effects. Primarily targeting Danish Muslims, it employs neoliberal governmentality approaches of governance through individual support and response, information and knowledge, empowerment, surveillance and intervention, and anti-discrimination. It aims to prevent radicalization by transforming, shaping, and disciplining illiberal and violence-prone “radicals” into active, liberal citizens. Prolonged fieldwork and in-depth interviews with seventeen Muslims from a targeted milieu reveal skepticism about the effectiveness of the measures. Implementation of the action plan in practice may yield iatrogenic effects.

  4. Stent graft repair of iatrogenic femoral arteriovenous fistula: a useful therapeutic approach in a hostile groin.

    Science.gov (United States)

    De Martino, Randall R; Nolan, Brian W; Powell, Richard J; Walsh, Daniel B; Stone, David H

    2010-01-01

    The incidence of iatrogenic femoral arteriovenous fistulas (IFAVF) has increased in contemporary practice. We herein report the case of a 55-year-old obese woman with significant surgical comorbidities who sustained an IFAVF between the superficial femoral artery (SFA) and the femoral vein. Given her substantial risk factors, she was treated with a SFA stent-graft (iCast 6 x 22 mm) using a contralateral endovascular approach. She remains asymptomatic at 15 months with ongoing resolution of the AVF. This report highlights the utility of stent-graft repair of an IFAVF in high surgical risk patients or in those with ''hostile'' anatomy.

  5. Combined endovascular intervention and percutaneous thrombin injection in the treatment of iatrogenic pseudoaneurysm. Case report.

    Science.gov (United States)

    Gabriel, M; Juszkat, R; Pukacki, F; Waliszewski, K

    2007-06-01

    One of the basic techniques of treatment of iatrogenic pseudoaneurysms is percutaneous thrombin injection. Unfortunately, success rate of this treatment can be limited in cases associated with extensive damage to arterial wall. Our paper presents one case of combined treatment involving endovascular occlusion of the entry to the false aneurysm and percutaneous thrombin injection into the pseudoaneurysm chamber. In our opinion this technique can be successfully applied in patients with contraindications for compression therapy, surgical intervention or failure of traditional injection due to large entry, multiple arterial wall damage or accompanying arteriovenous fistula.

  6. Pneumothorax Complicating Coaxial and Non-coaxial CT-Guided Lung Biopsy: Comparative Analysis of Determining Risk Factors and Management of Pneumothorax in a Retrospective Review of 650 Patients

    Energy Technology Data Exchange (ETDEWEB)

    Nour-Eldin, Nour-Eldin A., E-mail: nour410@hotmail.com; Alsubhi, Mohammed, E-mail: mohammedal-subhi@yahoo.com; Emam, Ahmed, E-mail: morgan101002@hotmail.com; Lehnert, Thomas, E-mail: thomas.lehnert@kgu.de; Beeres, Martin, E-mail: beeres@gmx.net; Jacobi, Volkmar, E-mail: volkmar.jacobi@kgu.de; Gruber-Rouh, Tatjana, E-mail: tatjanagruber2004@yahoo.com; Scholtz, Jan-Erik, E-mail: janerikscholtz@gmail.com; Vogl, Thomas J., E-mail: t.vogl@em.uni-frankfurt.de; Naguib, Nagy N., E-mail: nagynnn@yahoo.com [Johan Wolfgang Goethe – University Hospital, Institute for Diagnostic and Interventional Radiology (Germany)

    2016-02-15

    PurposeTo assess the scope and determining risk factors related to the development of pneumothorax throughout CT-guided biopsy of pulmonary lesions in coaxial and non-coaxial techniques and the outcome of its management.Materials and MethodsThe study included CT-guided percutaneous lung biopsies in 650 consecutive patients (407 males, 243 females; mean age 54.6 years, SD 5.2) from November 2008 to June 2013 in a retrospective design. Patients were classified according to lung biopsy technique into coaxial group (318 lesions) and non-coaxial group (332 lesions). Exclusion criteria for biopsy were lesions <5 mm in diameter, uncorrectable coagulopathy, positive-pressure ventilation, severe respiratory compromise, pulmonary arterial hypertension, or refusal of the procedure. Risk factors related to the occurrence of pneumothorax were classified into: (a) Technical risk factors, (b) patient-related risk factors, and (c) lesion-associated risk factors. Radiological assessments were performed by two radiologists in consensus. Mann–Whitney U test and Fisher’s exact tests were used for statistical analysis. p values <0.05 were considered statistically significant.ResultsThe incidence of pneumothorax complicating CT-guided lung biopsy was less in the non-coaxial group (23.2 %, 77 out of 332) than the coaxial group (27 %, 86 out of 318). However, the difference in incidence between both groups was statistically insignificant (p = 0.14). Significant risk factors for the development of pneumothorax in both groups were emphysema (p < 0.001 in both groups), traversing a fissure with the biopsy needle (p value 0.005 in non-coaxial group and 0.001 in coaxial group), small lesion, less than 2 cm in diameter (p value of 0.02 in both groups), location of the lesion in the basal or mid sections of the lung (p = 0.003 and <0.001 in non-coaxial and coaxial groups, respectively), and increased needle track path within the lung tissue of more than 2.5 cm (p = 0.01 in both

  7. Tensions of Corporate Social Responsibility

    DEFF Research Database (Denmark)

    Strand, Robert

    I engaged with the top management team (TMT) and employees of American Cafes Corporation as an action/intervention researcher in the 20 months immediately following the TMT’s decision to formalize the company’s corporate social responsibility (CSR) activities. This led to the establishment...... CSR agenda is considered, which brings with it a multiplicity of substantively rational ends for which the corporation could pursue. I show the CSR bureaucracy can create a space for reflection in which the multiplicity of substantively rational ends can be considered, negotiated, and selected...... for reflection within the corporation. But I also show tensions can arise from the establishment of the CSR bureaucracy itself. This suggests the CSR bureaucracy itself resides in a tension....

  8. Introducing surface tension to spacetime

    Science.gov (United States)

    Perko, H. A.

    2017-05-01

    Concepts from physical chemistry of surfaces and surface tension are applied to spacetime. More specifically, spacetime is modeled as a spatial fluid continuum bound together by a multi-dimensional membrane of time. A metric tensor that relates empty flat spacetime to energetic curved spacetime is found. Equations of motion for an infinitesimal unit of spacetime are derived. The equation of motion in a time-like direction is a Klein-Gordon type equation. The equations of motion in space-like directions take the form of Schrodinger’s equation where Plank’s constant is related to membrane elastic modulus. Although much work remains, it is suggested that the spacetime surface tension may serve as a mechanical model for many phenomena in quantum mechanics and atomic particle physics.

  9. A prospective multicentre observational study of adverse iatrogenic events and substandard care preceding intensive care unit admission (PREVENT).

    Science.gov (United States)

    Garry, D A; McKechnie, S R; Culliford, D J; Ezra, M; Garry, P S; Loveland, R C; Sharma, V V; Walden, A P; Keating, L M

    2014-02-01

    We examined the current incidence, type, severity and preventability of iatrogenic events associated with intensive care unit admission in five hospitals in England. All unplanned adult admissions to intensive care units were prospectively reviewed over a continuous six-week period. In the week before admission, 76/280 patients (27%) experienced 104 iatrogenic events. The majority of iatrogenic events were categorised as medical (37%), drug (17%) or nursing events (17%). Seventy-seven per cent of the events were considered preventable and 80% caused or contributed to admission. Eleven events were thought to have contributed to a patient's death. The mean (SD) age of patients who had an event was greater (63 (21) years) than those who had not (57 (19) years, p = 0.023), and they had a longer median (IQR [range]) intensive care stay, 4 (1-8 [0-29]) days vs 3 (1-5 [0-20]) days, respectively, p = 0.043.

  10. Novel paravertebral block during single-incision thoracoscopic surgery for primary spontaneous pneumothorax.

    Science.gov (United States)

    Tsuboshima, Kenji; Nagata, Machiko; Wakahara, Teppei; Matoba, Yasumi; Nishio, Wataru; Maniwa, Yoshimasa

    2016-01-01

    Recently, the use of paravertebral block (PVB) during thoracic surgery has been re-evaluated, as it is not inferior to epidural anaesthesia for postoperative pain control, and has been associated with fewer complications (e.g., hematoma of epidural, hypotension, urinary retention, postoperative nausea and vomiting). No reports have described intraoperative catheterization for PVB during single-incision thoracoscopic surgery (SITS) as distinct from thoracotomy or multi-ports video-assisted thoracoscopic surgery. We describe a case of SITS bullectomy using a chest wall pulley for lung excision to treat primary spontaneous pneumothorax and 25 catheterizations for PVB during SITS that have been performed since June 2013. Our novel technique is both easy and safe. It is ideal to combine PVB with SITS because both methods are less invasive.

  11. Conservative management of pneumothorax and pneumoperitoneum in two Florida manatees (Trichechus manatus latirostris).

    Science.gov (United States)

    Gerlach, Trevor J; Sadler, Valerie M; Ball, Ray L

    2013-12-01

    Two distressed Florida manatees (Trichechus manatus latirostris) were reported to the Florida Fish and Wildlife Conservation Commission. The first animal was determined to be an abandoned, emaciated calf. The second animal was a nursing calf that had sustained watercraft-related trauma. Both animals were captured and transported to Tampa's Lowry Park Zoo, where diagnostic evaluations, including physical examinations, blood work, computed tomography (CT), and radiographs were performed. Radiograph and CT scans identified the presence of free air within the pleural and abdominal cavities of both animals. Based on the lack of substantial findings in the first animal and a rapid resolution of clinical signs in the second animal, both animals were managed conservatively. This report documents simultaneous pneumothorax and pneumoperitoneum, the associated clinical and diagnostic findings, and conservative medical management of these conditions in the Florida manatee.

  12. A Shocking Complication of a Pneumothorax: Chest Tube-Induced Arrhythmias and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Shaun Cardozo

    2014-01-01

    Full Text Available We describe a patient with a recent chest tube insertion leading to atrial fibrillation with rapid ventricular rate that led to multiple inappropriate internal cardiac defibrillator (ICD shocks. This is the first reported case of this occurring in a patient with an ICD leading to inappropriate shocks. Our elderly patient with emphysema presented with a spontaneous pneumothorax and developed rapid atrial fibrillation following emergency tube thoracostomy. The patient had a single lead ICD and received multiple inappropriate shocks for the rapid ventricular rate in the therapy zone. Although medical treatment helped stabilize the patient, resolution of the atrial fibrillation occurred only after the chest tube was removed. In a patient with a chest tube or other intrathoracic catheters, maintaining a high index of suspicion that chest tube insertions can cause secondary life threatening cardiovascular complications needs to be considered. In such patients, removal of the device proves to be the most prudent treatment action.

  13. Erlotinib treatment for persistent spontaneous pneumothorax in non-small cell lung cancer: a case report

    Institute of Scientific and Technical Information of China (English)

    REN Sheng-xiang; ZHOU Song-wen; ZHANG Ling; ZHOU Cai-cun

    2010-01-01

    @@ Spontaneous pneumothorax (SP) develops secondary to primary lung cancer. It has a very low incidence and accounts for less than 1% of all cases.1 Once SP develops, the prognosis is usually very poor, and majority of patients live no longer than 3 months.1,2Most patients with advanced stage can not undergo resection due to the poor general condition. Thus, chest tube drainage remains among the treatments of choice although it is not always completely effective in preventing recurrence. In refractory SP, patients would bear the chest tube for their whole life.3 Here we report a case of SP following chemotherapy in adenocarcinoma of the lung with multiple organs metastases. In this case, chest tube drainage was not effective in preventing recurrence of SP.However, the treatment was successful with oral erlotinib,an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI).

  14. Spontaneous Pneumothorax With Subcutaneous Emphysema: A Rare Complication of Respiratory Syncytial Virus Infection.

    Science.gov (United States)

    Silva, Carmen; Almeida, Ana Filipe; Ferraz, Catarina; Nunes, Teresa; Guedes Vaz, Luisa

    2016-03-01

    Viral bronchiolitis is the most common lower respiratory tract infection in infants and children under the age of 2. Respiratory syncytial virus (RSV) is the infecting agent in more than 50% of the cases. Usually the clinical course is uneventful and complications are uncommon. Secondary air leaks are a recognized rare complication of bronchiolitis, although the real incidence remains unknown. We report a case of a 21-month-old female that developed a spontaneous pneumothorax (PNO) with subcutaneous emphysema (SE) late in the course of RSV acute bronchiolitis. Additional investigation ruled out any underlying disease predisposing to spontaneous PNO. Physicians, especially those who work with small children, must be aware of this uncommon complication of bronchiolitis that may appear late in the course of the disease despite an initial clinical improvement.

  15. Bronchiolitis obliterans complicating a pneumothorax after Stevens-Johnson syndrome induced by lamotrigine

    Directory of Open Access Journals (Sweden)

    Wu-ping Wang

    2015-03-01

    Full Text Available Bronchiolitis obliterans (BO was defined as a nonreversible obstructive lung disease in which the bronchioles are always compressed and narrowed by fibrosis or inflammation. In the severe event of lung collapse after BO, surgical intervention is often recommended, and conservative therapy is thought to be ineffective. Here, we report the case of a 9-year old girl clinically diagnosed as having bronchiolitis obliterans with abrupt occlusion of the right B4b bronchus. After a lamotrigine-induced Stevens-Johnson syndrome (SJS occurred, she presented with total collapse of the right lung on admission, which was subsequently complicated by a pneumothorax during conservative treatment, but with the re-expansion of the right upper lobe after intervention. The case indicates the possibility of reversing pulmonary atelectasis in BO. Thus, surgery may not be necessary.

  16. 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

    Directory of Open Access Journals (Sweden)

    Zeeshan Ahmed

    2016-01-01

    Conclusion: 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.

  17. 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.

  18. Quality of life after iatrogenic bile duct injury: a case control study.

    LENUS (Irish Health Repository)

    Hogan, Aisling M

    2012-02-01

    OBJECTIVE: To compare quality of life (QOL) of patients following iatrogenic bile duct injuries (BDI) to matched controls. SUMMARY BACKGROUND DATA: BDI complicate approximately 0.3% of all cholecystectomy procedures. The literature regarding impact on quality of life is conflicted as assessment using clinical determinants alone is insufficient. METHODS: The medical outcomes study short form 36 (SF-36), a sensitive tool for quantification of life quality outcome, was used. The study group of iatrogenic BDI was compared with an age- and sex-matched group who underwent uncomplicated cholecystectomy. Telephone questionnaire using the SF-36 quality of life tool was administered to both groups at a median postoperative time of 12 years 8 months (range, 2 months -20 years). RESULTS: Seventy-eight patients were referred with BDI but due to mortality (n = 10) and unavailability (n = 6) 62 participated. The age- and sex-matched control cohort had undergone uncomplicated cholecystectomy (n = 62). Comparison between groups revealed that 7 of 8 variables examined were statistically similar to those of the control group (physical functioning, role physical, bodily pain, general health perceptions, vitality and social functioning, and mental health index). Mean role emotional scores were slightly worse in the BDI group (46 vs. 50) but the significance was borderline (P = 0.045). Subgroup analysis by method of intervention for BDI did not demonstrate significant differences. CONCLUSION: Quality of life of surviving patients following BDI compares favorably to that after uncomplicated laparoscopic cholecystectomy.

  19. Managing iatrogenic trigeminal nerve injury: a case series and review of the literature.

    Science.gov (United States)

    Renton, T; Yilmaz, Z

    2012-05-01

    This study describes the management of 216 patients with post-traumatic iatrogenic lingual nerve injuries (LNIs; n=93) and inferior alveolar nerve injuries (IANI; n=123). At initial consultation, 6% IANI and 2% LNI patients had undergone significant resolution requiring no further reviews. Reassurance and counselling was adequate management for 51% IANI and 55% LNI patients. Systemic or topical medication was offered as pain relief to 5% of patients. Additional cognitive behaviour therapy (CBT) was offered to 8% of patients. Topical 5% lidocaine patches reduced pain and allodynia in 7% of IANI patients, most often used without any other form of management. A small percentage of IANI patients (4%) received a combination of therapies involving CBT, surgery, medication and 5% lidocaine patches. Exploratory surgery improved symptoms and reduced neuropathic area in 18 LNI and 15 IANI patients resulting in improved quality of life. In conclusion, the authors suggest a more diverse and perhaps holistic strategy for management of patients with iatrogenic trigeminal nerve injuries and recommend pragmatic assessment criteria for measurement of treatment success in these patients.

  20. Iatrogenic Ulnar Nerve Injury post Laceration Suturing – An Unusual Presentation

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    Murali Mothilal

    2013-07-01

    Full Text Available Introduction: Nerve entrapment while suturing a lacerated wound is a complication that is easily avoidable. We report a case low ulnar nerve palsy due to nerve entrapment while suturing a lacerated wound. Case Report: A 48 year old lady came with complaints of pain and a lacerated wound over the dorsomedial aspect of lower third of the left forearm. The lacerated wound was sutured elsewhere one week back. She had fracture of lower third of the ulna which was stabilised with plates and screws using a separate dorsal incision. She developed ulnar claw hand on the third postoperative day. Strength duration curve revealed neurotmesis of ulnar nerve. Ulnar nerve exploration was done and the nerve was found to be ligated at the site of original laceration. The ligature was released and nerve was found to be thinned out at the site. There was no neurological recovery at 5 months follow up and reconstruction procedures in form of tendon tranfer are planned for the patient. Conclusion: This is a case of iatrogenic ulnar nerve palsy which is very rare in our literature. This can be easily avoided if proper care is taken while suturing the primary laceration. A nerve can be mistakenly sutured for a bleeding vein and proper exposure while suturing will be necessary especially at areas where nerves are superficial. Keywords: Iatrogenic, ulnar nerve palsy

  1. Conventional mesh repair of a giant iatrogenic bilateral diaphragmatic hernia with an enterothorax

    Directory of Open Access Journals (Sweden)

    Lingohr P

    2014-02-01

    Full Text Available Philipp Lingohr,1 Thomas Galetin,2 Boris Vestweber,2 Hanno Matthaei,1 Jörg C Kalff,1 Karl-Heinz Vestweber2 1Department of Surgery, University of Bonn, Bonn, Germany; 2Department of Surgery, Klinikum Leverkusen, Leverkusen, Germany Purpose: Diaphragmatic hernias (DHs are divided into congenital and acquired hernias, most of which are congenital. Among acquired DHs, up to 80% are left-sided, only a few iatrogenic DHs have been reported, and bilateral hernias are extremely rare. For diagnostic reasons, many DHs are overlooked by ultrasonography or X-ray and are only recognized at a later stage when complications occur. Methods: In 2009, we performed three partial diaphragm replacements in our clinic for repairing DHs using a PERMACOL™ implant. Results: As all patients had uneventful postoperative courses and the clinical outcomes were very good, we present one special case of a 65-year-old male with a giant iatrogenic bilateral DH with an enterothorax. Conclusion: We see a good indication for diaphragm replacements by using a PERMACOL™ implant for fixing especially DHs with huge hernial gaps and in cases with fragile tissue. Keywords: bilateral diaphragmatic hernia, enterothorax, conventional hernia repair, PERMACOL™, biological implant, diaphragm replacement, mesh repair

  2. Metachronous adrenal metastasis from operated contralateral renal cell carcinoma with adrenalectomy and iatrogenic Addison's disease.

    Science.gov (United States)

    Ozturk, Hakan; Karaaslan, Serap

    2014-09-01

    Metachronous adrenal metastasis from contralateral renal cell carcinoma (RCC) surgery is an extremely rare condition. Iatrogenic Addison's disease occurring after metastasectomy (adrenalectomy) is an even rarer clinical entity. We present a case of a 68-year-old male with hematuria and left flank pain 9 years prior. The patient underwent left transperitoneal radical nephrectomy involving the ipsilateral adrenal glands due to a centrally-located, 75-mm in diameter solid mass lesion in the upper pole of the left kidney. The tumour lesion was confined within the renal capsule, and the histo-pathological examination revealed a Fuhrman nuclear grade II clear cell carcinoma. The patient underwent transperitoneal right adrenalectomy. The histopathological examination revealed metastasis of clear cell carcinoma. The patient was diagnosed with iatrogenic Addison's disease based on the measurement of serum cortisol levels and the adrenocorticotropic hormone (ACTH) stimulation test, after which glucocorticoid and mineralocorticoid replacement was initiated. The patient did not have local recurrence or new metastasis in the first year of the follow-up. The decision to perform ipsilateral adrenalectomy during radical nephrectomy constitutes a challenge, and the operating surgeon must consider all these rare factors.

  3. Iatrogenic facial nerve injuries during chronic otitis media surgery: a multicentre retrospective study.

    Science.gov (United States)

    Linder, T; Mulazimoglu, S; El Hadi, T; Darrouzet, V; Ayache, D; Somers, T; Schmerber, S; Vincent, C; Mondain, M; Lescanne, E; Bonnard, D

    2017-06-01

    To give an insight into why, when and where iatrogenic facial nerve (FN) injuries may occur and to explain how to deal with them in an emergency setting. Multicentre retrospective study in eight tertiary referral hospitals over 17 years. Twenty patients with partial or total FN injury during surgery for chronic otitis media (COM) were revised. Indication and type of surgery, experience of the surgeon, intra- and postoperative findings, value of CT scanning, patient management and final FN outcome were recorded. In 12 cases, the nerve was completely transected, but the surgeon was unaware in 11 cases. A minority of cases occurred in academic teaching hospitals. Tympanic segment, second genu and proximal mastoid segments were the sites involved during injury. The FN was not deliberately identified in 18 patients at the time of injury, and nerve monitoring was only applied in one patient. Before revision surgery, CT scanning correctly identified the lesion site in 11 of 12 cases and depicted additional lesions such as damage to the lateral semicircular canal. A greater auricular nerve graft was interposed in 10 cases of total transection and in one partially lesioned nerve: seven of them resulted in an HB III functional outcome. In two of the transected nerves, rerouting and direct end-to-end anastomosis was applied. A simple FN decompression was used in four cases of superficially traumatised nerves. We suggest checklists for preoperative, intraoperative and postoperative management to prevent and treat iatrogenic FN injury during COM surgery. © 2016 John Wiley & Sons Ltd.

  4. Clinical Application of Six Current Classification Systems for Iatrogenic Bile Duct Injuries after Cholecystectomy.

    Science.gov (United States)

    Velidedeoglu, Mehmet; Arikan, Akif Enes; Uludag, Sezgin Server; Olgun, Deniz Cebi; Kilic, Fahrettin; Kapan, Metin

    2015-05-01

    Due to being a severe complication, iatrogenic bile duct injury is still a challenging issue for surgeons in gallbladder surgery. However, a commonly accepted classification describing the type of injury has not been available yet. This study aims to evaluate ability of six current classification systems to discriminate bile duct injury patterns. Twelve patients, who were referred to our clinic because of iatrogenic bile duct injury after laparoscopic cholecystectomy were reviewed retrospectively. We described type of injury for each patient according to current six different classifications. 9 patients underwent definitive biliary reconstruction. Bismuth, Strasberg-Bismuth, Stewart-Way and Neuhaus classifications do not consider vascular involvement, Siewert system does, but only for the tangential lesions without structural loss of duct and lesion with a structural defect of hepatic or common bile duct. Siewert, Neuhaus and Stewart-Way systems do not discriminate between lesions at or above bifurcation of the hepatic duct. The Hannover classification may resolve the missing aspects of other systems by describing additional vascular involvement and location of the lesion at or above bifurcation.

  5. Iatrogenic facial nerve palsy "Prevention is better than cure": Analysis of four cases

    Directory of Open Access Journals (Sweden)

    Rakesh Kumar

    2011-01-01

    Full Text Available Iatrogenic facial nerve palsy in mastoid surgery is considered a crime or a taboo in the present scenario of medical science. But one has to accept the fact that every otologist encounters this entity at some point in his/her career. Hence it is of prime importance to be equipped to detect and to manage these cases. The obvious and disfiguring facial deformity it causes makes this a dreaded complication. Our article here discusses our experience in managing four cases of iatrogenic facial palsy. The etiology in all the cases was mastoidectomy for cholesteatoma. The detection of the site and repair was performed by the same surgeon in all cases. The facial nerve was transected completely in three cases, and in one case there was partial loss (>50% of fibers. Cable nerve grafting was utilized in three patients. There was grade 4 improvement in three patients who underwent cable nerve grafting, and one patient had grade 2 recovery after end-to-end anastomosis. A good anatomical knowledge and experience with temporal bone dissection is of great importance in preventing facial nerve injury. If facial nerve injury is detected, it should be managed as early as possible. An end-to-end anastomosis provides better results in final recovery as opposed to cable nerve grafting for facial nerve repair.

  6. Iatrogenic bleb formation and hypotony maculopathy following pterygium surgery with Mitomycin-C

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    Saeed Shokouhi-Rad

    2015-01-01

    Full Text Available Purpose: To report a case of late iatrogenic bleb formation and hypotony maculopathy after pterygium surgery applying Mitomycin C (MMC. Case Report: A 66-year-old man presented with an elevated, bleb-like, fluid-filled, cystic lesion on the nasal sclera of the right eye. The patient had undergone pterygium surgery with a combination of conjunctival autograft and adjuvant intraoperative MMC 0.02% four years before. The sclera seemed fistulized at the site of surgery and a thin layer of conjunctiva completely covered the lesion. A scleral patch graft was secured over the fistula with sutures, followed by excision of the thinned, avascular conjunctiva and advancement of the healthy adjacent conjunctiva to cover the patch graft. One month later, a small bleb re-appeared adjacent to the scleral patch graft and IOP was 2 mmHg. Argon-laser treatment of the bleb was tried to induce scarring and reduction of bleb size, and was highly effective. After one week, IOP was increased to 8 mmHg. The clinical features remained stable four months after initial presentation. Conclusion: Pterygium surgery using adjuvant MMC may result in late iatrogenic bleb formation and hypotony maculopathy. This complication can be successfully corrected surgically using a scleral patch graft combined with argon laser treatment over the inadvertent bleb.

  7. Management of a Small Paracentral Corneal Perforation Using Iatrogenic Iris Incarceration and Tissue Adhesive

    Directory of Open Access Journals (Sweden)

    Akira Kobayashi

    2012-07-01

    Full Text Available Background: Surgical intervention for corneal perforation is indicated when the anterior chamber does not reform within a short period of time. Herein, we report the successful management of a small paracentral corneal perforation using autologous iris incarceration and tissue adhesive. Case: A 41-year-old man developed a small paracentral corneal perforation (0.5 mm in size in the right eye, while the treating physician attempted to remove the residual rust ring after removal of a piece of metallic foreign body. Observations: The eye was initially managed with a bandage soft contact lens to ameliorate the aqueous leakage; however, without success. Iatrogenic iris incarceration of the wound was first induced, followed by application of cyanoacrylate tissue adhesive to the perforated site. As a result, the anterior chamber was immediately reformed and maintained. Complete corneal epithelialization of the perforation was achieved in 2 months without visual compromises. Conclusions: Cyanoacrylate tissue adhesive with iatrogenic incarceration of the autologous iris was effective in treating this type of small corneal perforation. This technique is simple and potentially useful for small paracentral corneal perforations outside the visual axis and without good apposition.

  8. Iatrogenic anemia in intensive care unit%ICU医源性贫血

    Institute of Scientific and Technical Information of China (English)

    许峰; 党红星

    2012-01-01

    ICU患者中不同程度的存在急慢性贫血,除自身原发病外,可因各种检查、治疗引起.针对医源性贫血的发生原因进行预防,加强管理,制定合理的输血方案,在保证患者必要检查治疗的基础上,最大限度地减少医源性贫血的发生,有助于改善预后.%Acute and chronic anemias are frequently seen in patients of ICU.Besides the underlying diseases,anemia can also be induced by the examination and treatment.In this paper,the reasons of iatrogenic anemia were analyzed.On the base of the essential diagnosis and treatment,it is helpful to improve the prognosis of ICU patients by strengthening the administration of blood collection.The risk of iatrogenic anemia could be minimized by making a reasonable project of blood transfusion.

  9. ‘Growing mushroom on the back’ following minimally invasive spine fixation: The theory of iatrogenic compartment syndrome revisited

    Directory of Open Access Journals (Sweden)

    M.J. Asha, MSc, MRCS

    2015-12-01

    Full Text Available The authors report a case of lumbar para-spinal muscle herniation following percutaneous thoraco-lumbar pedicle screw fixation. This is suggested to be due to subclinical iatrogenic increase in the intra-compartmental pressure. The possibility of ‘Iatrogenic paraspinal compartment syndrome’ following minimally invasive spine techniques has been discussed previously by other authors. Nevertheless, no such case has been reported so far in the literature. The awareness of this potential complication might be helpful for spinal surgeons for early detection and management.

  10. Lesão iatrogênica de vias biliares Iatrogenic bile duct injuries

    Directory of Open Access Journals (Sweden)

    Guilherme Brasileiro de Aguiar

    2005-04-01

    Full Text Available OBJETIVO: O objetivo do presente estudo foi avaliar os casos de lesões iatrogênicas de vias biliares tratados na clínica cirúrgica do Hospital Getúlio Vargas - HGV nos últimos oito anos. MÉTODO: Foi realizada análise retrospectiva dos prontuários dos pacientes internados no HGV, com hipótese diagnóstica de lesão iatrogênica de vias biliares. Foram incluídos pacientes com lesões provenientes do próprio serviço e de outras instituições. Os prontuários foram revisados e obtidas as seguintes variáveis: procedência do paciente, idade, sexo, data da cirurgia inicial, sintomas, tempo de evolução, valores da bilirrubina, fosfatase alcalina, AST e ALT, TAP, creatinina, além da cirurgia realizada para correção da lesão, complicações, permanência hospitalar e condições do paciente na alta hospitalar. RESULTADOS: Foram confirmados 10 casos de lesão iatrogênica de vias biliares. Todos os paciente eram do sexo feminino, com idades variando entre 18 e 49 anos. Os sinais ou sintomas mais freqüentes foram icterícia, colúria e dor abdominal. Em relação à terapêutica cirúrgica, a hepático-jejunostomia em "Y" de Roux foi o procedimento mais empregado. CONCLUSÕES: As lesões iatrogênicas das vias biliares ainda representam um desafio para os cirurgiões e sua ocorrência está mais relacionada a procedimentos realizados em hospitais não especializados, por cirurgiões sem treinamento adequado. A principal medida a ser adotada é a prevenção da lesão. Após sua ocorrência, esta deve ser corrigida em hospitais com equipe médica treinada.BACKGROUND: The objective of this study was to evaluate the cases of iatrogenic lesions of the biliary tract treated in the surgical clinic at Getulio Vargas Hospital - GVH during the last eight years. METHODS: A retrospective analysis of the patients' charts admitted with the diagnosis of iatrogenic lesions of the biliary tract was performed. Patients with iatrogenic lesions

  11. 43例女性自发性气胸临床分析%Clinical analysis of 43 female patients with spontaneous pneumothorax

    Institute of Scientific and Technical Information of China (English)

    俞龙; 谢利军; 金琳羚; 张化良; 陈亮; 解卫平

    2013-01-01

    Objective To investigate the rliniral features and the prognosis alter treatment oi 43 female patients with spontaneous pneumothorax. Methods The rliniral features, process, and prognosis oi 43 female patients with spontaneous pneumothorax were retrospectively analyzed. Results 39 patients were surressfully ruied by expert ant treatment, air exhaust, rhest tube drainage, and surgical interventions. 4 ratamenial pneumothorax patients were cured successiully by the combined treatment oi internal medicine, surgery and obstetrics and gynecology. Conclusion The female spontaneous pneumothorax mainly is primary pneumothorax, and the secondary pneumothorax mostly happens in patients with basic diseases. The typical spontaneous pneumothorax is easy to be cured. The possibility oi cata-menial should be considered when spontaneous pneumothorax occurs repeatedly in women.%目的 探讨43例女性自发性气胸临床特点.方法 分析43例女性自发性气胸患者临床特点、处理及预后.结果 39例经保守治疗、抽气、胸腔闭式引流术、外科手术等综合治疗,效果满意;4例月经性气胸经内外科及妇产科联合治疗,未见复发.结论 女性自发性气胸以原发性气胸为主,继发性气胸多见于基础疾病患者,典型自发性气胸容易诊断治疗,对于反复发作的女性自发性气胸患者应考虑月经性气胸可能.

  12. Tratamiento del neumotórax espontáneo en nuestro medio Treatment of spontaneous pneumothorax in our setting

    Directory of Open Access Journals (Sweden)

    Juan C Barrera Ortega

    2005-03-01

    Full Text Available Con el objetivo de determinar la conducta ante el neumotórax espontáneo, se realizó un estudio descriptivo, prospectivo, de corte transversal, en 125 pacientes con diagnóstico de neumotórax espontáneo, que fueron atendidos en el Hospital Docente “Comandante Manuel Fajardo” en el período comprendido entre enero de 1988 y julio de 2003. El 62,4 % de los casos estudiados correspondió a neumotórax primario y los restantes a neumotórax secundario. Predominaron las edades tempranas de la vida y el sexo masculino, este último en una relación de 14 a 1. Los síntomas más reportados fueron dolor, disnea y tos, y el 88,8 % de los pacientes eran fumadores. La pleurotomía fue el tratamiento definitivo en el 65,8 % de los pacientes y eficaz en el 85,6 %. Fue necesaria la toracotomía en 29,4 % de los casos, por la presencia de neumotórax persistente, recidivante y bullas. No tuvimos mortalidad quirúrgica. Concluimos que la conducta ante el neumotórax depende de la magnitud, repercusión clínica, etiología, necesidad de evitar la recidiva y la evaluación del riesgo quirúrgicoIn order to determine the conduct to be followed with the spontaneous pneumothorax, a descriptive, prospective, cross-sectional study was undertaken among 125 patients with diagnosis of spontaneous pneumothorax that received attention at “Comandante Manuel Fajardo” Teaching Hospital from January 1998 to July 2003. 62.4 % of the cases studied corresponded to primary pneumothorax and the rest to secondary pneumothorax. There was predominance of early ages and of males. The latter at a ratio of 14:1. The most reported symptoms were pain, dyspnea, and cough. 88,8 % of the patients were smokers. Pleurotomy was the definitive treatment in 65.8 % of the patients and it was efficient in 85.6 %. Thoracotomy was necessary in 29.4 % of the cases due to the presence of persistent, recidivant pneumothorax and bullae. There was no surgical mortality. We concluded that the

  13. Efficacy of high-frequency oscillatory ventilation on neonatal pneumothorax%高频振荡通气治疗新生儿气胸的疗效观察

    Institute of Scientific and Technical Information of China (English)

    王洪宇; 唐昌奎

    2015-01-01

    目的:探讨临床有效治疗新生儿气胸的可靠方法,为新生儿气胸的临床研究和治疗实践提供参考和借鉴依据。方法本研究选取2010年12月至2013年12月绵阳市人民医院收治的新生儿气胸患儿92例,随机分成常规呼吸机组和高频呼吸机组,每组46例,分别实施传统常频通气治疗和高频振荡通气治疗。观察并比较两组治疗前后的氧合指数值和动脉/肺泡氧分压比值。结果高频呼吸机组治疗后24 h和48 h氧全指数水平均显著优于常规呼吸机组,差异有统计学意义( t=3.8544,5.7208,P均<0.05);高频呼吸机组治疗后24 h和48 h的动脉/肺泡氧分压比值均显著优于常规呼吸机组,差异有统计学意义( t=6.3553,6.3803,P均<0.05)。结论在临床针对新生儿气胸患儿实施治疗的实践过程中,与传统常频通气治疗方法比较,采用高频振荡通气治疗新生儿气胸的临床治疗效果显著,是临床针对新生儿气胸患儿实施治疗的理想选择之一。%Objective To further investigate a reliable method for the treatment of neonatal pneumothorax,and thus to pro-vide reference for clinical reference and treatment practices for neonatal pneumothorax. Methods The clinical data of 92 pa-tients with neonatal pneumothorax from December 2010 to December 2013 in Mianyang People’s Hospital were chosen and ran-domly divided into the conventional breathing machine group and high-frequency breathing group,with 46 cases in each group. They were taken with traditional normal frequency ventilation therapy and high-frequency oscillatory ventilation therapy separate-ly. The oxygenation index value and arterial/alveolar oxygen tension rates for the two groups before and after conventional ventila-tor therapy and high-frequency ventilator therapy were observed and compared. Results The oxygenation index values for the two groups of 24 h and 48 h after treatment were compared. The

  14. Etiology of spontaneous pneumothorax%自发性气胸的病因学研究进展

    Institute of Scientific and Technical Information of China (English)

    韩瑞超; 周敏; 郭雪君

    2012-01-01

    自发性气胸是临床常见病,某些情况下可危及生命.尽管其治疗已经取得了不小进步,但发病机制复杂,病因尚未完全阐明,且复发率高.对其病因学近年研究进展加以概括,可能有助于加深对该病的理解.%Spontaneous pneumothorax is a common disease with high recurrence rate,in some cases it is life-threatening.Although considerable progress in the treatment has been made,the pathogenensis and etiology have not been fully elucidated.In this paper,new research progress has been reviewed in order for a better understandig of spontaneous pneumothorax.

  15. Effective Management of Persistent Pneumothorax Using a Thopaz® Digital Drainage System Combined with an Endobronchial Watanabe Spigot.

    Science.gov (United States)

    Shiroyama, Takayuki; Okamoto, Norio; Tamiya, Motohiro; Hamaguchi, Masanari; Tanaka, Ayako; Nishida, Takuji; Hayama, Manabu; Nishihara, Takashi; Morishita, Naoko; Suzuki, Hidekazu; Hirashima, Tomonori

    2016-01-01

    A 72-year-old man with salivary gland cancer and multiple pulmonary metastases suffering from intractable pneumothorax was transferred to our institution; he was inoperable because of a low pulmonary function. A chest tube had been placed more than a month prior to this admission. A digital drainage system was used for 24-h monitoring of air leaks (Thopaz®). Using the Thopaz® system, we performed endoscopic bronchial occlusion using an endobronchial Watanabe spigot (EWS) to reduce air leaks. Finally, the air leaks ceased, and the chest tube was removed five days after EWS placement. We herein report a case of persistent pneumothorax that was successfully treated by endoscopic bronchial EWS placement with the aid of a Thopaz® system.

  16. Axelrod's Model with Surface Tension

    CERN Document Server

    Pace, Bruno

    2012-01-01

    In this work we propose a subtle change in Axelrod's model for the dissemination of culture. The mechanism consists of excluding non-interacting neighbours from the set of neighbours out of which an agent is drawn for potential cultural interactions. Although the alteration proposed does not alter topologically the configuration space, it yields significant qualitative changes, specifically the emergence of surface tension, driving the system in some cases to metastable states. The transient behaviour is considerably richer, and cultural regions have become stable leading to the formation of different spatio-temporal structures. A new metastable "glassy" phase emerges between the globalised phase and the polarised, multicultural phase.

  17. MDCT quantification is the dominant parameter in decision–making regarding chest tube drainage for stable patients with traumatic pneumothorax

    OpenAIRE

    Cai, Wenli; Lee, June-Goo; Fikry, Karim; Yoshida, Hiroyuki; Novelline, Robert; De Moya, Marc

    2012-01-01

    It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision, in particular regarding whether chest tube drainage (CTD) is required. However, the volumetric quantification of pneumothoraces has not routinely been performed in clinics. In this paper, we introduced an automated computer-aided volumetry (CAV) scheme for quantification of volume of pneumothoraces in chest multi-detect CT (MDCT) images. Moreover, we investigated the impact of accurate v...

  18. Bullectomy for “bong lung” in an 18 year-old male presenting with spontaneous pneumothorax

    Directory of Open Access Journals (Sweden)

    Roger K.A. Allen

    2010-01-01

    Full Text Available SUMMARY. An 18 year-old male who had smoked cannabis for four years presented with a spontaneous pneumothorax and was treated by apical bullectomy. The surgical and histopathological findings were characteristic of “bong lung”. This patient is the youngest reported in the literature and the case highlights the fact that the disease can occur even in adolescents after a few years of smoking cannabis. Pneumon 2010, 23(3:301-303.

  19. Histiocytose langerhansienne pulmonaire révélée par un pneumothorax: à propos d’un cas

    Science.gov (United States)

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

    2016-01-01

    L’histiocytose langerhansienne est une affection rare d’étiologie inconnue caractérisée par une infiltration d’un ou plusieurs organes, par des cellules de type Langerhans. Elle a une présentation clinique polymorphe. Nous rapportons le cas de Mr R.Y, âgé de 22 ans, tabagique à 8 PA, admis pour pneumothorax total spontané droit. Un drainage thoracique a été réalisé avec bonne évolution. La TDM thoracique de contrôle a objectivé de multiples formations kystiques diffuses prédominant aux lobes supérieurs. Un bilan a été réalisé à la recherche d’une histiocytose systémique mais s’est révélé négatif. L’évolution était marquée par la récidive du pneumothorax, le recours à une pleurodèse et la réalisation d’une biopsie pulmonaire qui a confirmé le diagnostic. Le diagnostic de l’HistiocytoseLangerhansienne doit être évoqué devant un pneumothorax sur poumon kystique. Le diagnostic est aisé devant un tableau clinique et radiologique évocateur. Néanmoins, les possibilités thérapeutiques restent limitées et la récidive du pneumothorax est fréquente. PMID:28154724

  20. The frequency of reexpansion pulmonary edema after trocar and hemostat assisted thoracostomy in patients with spontaneous pneumothorax.

    Science.gov (United States)

    Cha, Kyoung Chul; Kim, Hyun; Ji, Ho Jin; Kwon, Woo Cheol; Shin, Hyung Jin; Cha, Yong Sung; Lee, Kang Hyun; Hwang, Sung Oh; Lee, Christopher C; Singer, Adam J

    2013-01-01

    Several risk factors for development of reexpansion pulmonary edema (REPE) after drainage of pneumothoraces have been reported, but the association between the method of thoracostomy and the development of REPE is unknown. The aim of this study was to compare the frequency of REPE after treatment of spontaneous pneumothorax with trocar or hemostat assisted closed thoracostomy. We performed a prospective, observational study including 173 patients with spontaneous pneumothorax who visited the emergency department from January 2007 to December 2008. In 2007, patients were treated with hemostat-assisted drainage, whereas patients in 2008 were treated with trocar-assisted drainage. The main outcome was the development of REPE, determined by computed tomography of the chest 8 hours after closed thoracostomy. Outcomes in both groups were compared using univariate and multivariate analyses. Ninety-two patients were included, 48 (42 males) of which underwent hemostat-assisted drainage and 44 (41 males) underwent trocar-assisted drainage. The groups were similar in mean age (24 ± 10 vs. 26 ± 14 respectively). The frequencies of REPE after hemostat- and trocar-assisted drainage were 63% (30 patients) and 86% (38 patients) respectively (p=0.009). In multivariate analysis, trocar-assisted drainage was the major contributing factor for developing REPE (odds ratio=5.7, 95% confidence interval, 1.5-21). Age, gender, size of pneumothorax, symptom duration and laboratory results were similar between the groups. Closed thoracostomy using a trocar is associated with an increased risk of REPE compared with hemostat- assisted drainage in patients with spontaneous pneumothorax.

  1. Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers

    Directory of Open Access Journals (Sweden)

    Marx Jean-Sebastian

    2009-01-01

    Full Text Available Abstract Background While ultrasound (US has continued to expedite diagnosis and therapy for critical care physicians inside the hospital system, the technology has been slow to diffuse into the pre-hospital system. Given the diagnostic benefits of thoracic ultrasound (TUS, we sought to evaluate image recognition skills for two important TUS applications; the identification of B-lines (used in the US diagnosis of pulmonary edema and the identification of lung sliding and comet tails (used in the US diagnosis of pneumothorax. In particular we evaluated the impact of a focused training module in a pre-hospital system that utilizes physicians as pre-hospital providers. Methods 27 Paris Service D'Aide Médicale Urgente (SAMU physicians at the Hôpital Necker with varying levels of US experience were given two twenty-five image recognition pre-tests; the first test had examples of both normal and pneumothorax lung US and the second had examples of both normal and pulmonary edema lung US. All 27 physicians then underwent the same didactic training modules. A post-test was administered upon completing the training module and results were recorded. Results Pre and post-test scores were compared for both the pneumothorax and the pulmonary edema modules. For the pneumothorax module, mean test scores increased from 10.3 +/- 4.1 before the training to 20.1 +/- 3.5 after (p Conclusion This brief training module resulted in significant improvement of image recognition skills for physicians both with and without previous ultrasound experience. Given that rapid diagnosis of these conditions in the pre-hospital system can change therapy, especially in systems where physicians can integrate this information into treatment decisions, the further diffusion of this technology would seem to be beneficial and deserves further study.

  2. Avoidable iatrogenic complications of urethral catheterization and inadequate intern training in a tertiary-care teaching hospital.

    LENUS (Irish Health Repository)

    Thomas, Arun Z

    2009-10-01

    To examine the magnitude of potentially avoidable iatrogenic complications of male urethral catheterization (UC) within a tertiary-care supra-regional teaching hospital, and to evaluate risk factors and subjective feeling of interns in our institution on the adequacy of training on UC.

  3. 新生儿气胸的临床与X线分析%Clinical and X-ray Analysis of Pneumothorax in Newborn

    Institute of Scientific and Technical Information of China (English)

    裘华兴; 夏瑞明

    2011-01-01

    Objective To analyse the clinical and X-ray characteristics of pneumothorax in newborn, so that to improve the knowledge of pneumothorax in newborn. Methods 52 cases of pneumothorax in newborn underwent chest anterioposterior radiography at supine position and horizontal supine lateral position in some cases. All cases followed-up with X-ray. Results According to X-ray manifestations of pneumothorax, pneumothorax in newborn included four types : adult type in 5 cases , medial margin type in 29 cases ,superior diaphragm type in 12 cases and anterior chest wall type in 6 cases,which appeared as lateral pneumothorax,medial mediastinum side pneumothorax, diaphragmatic surface nearby pneumothorax and prethoracic pneumothorax on X-ray images , respectively. 13 infants simultaneously suffered from pneumomediastinum. Conclusion X-ray manifestations of pneumothorax in newborn are of certain characteristics.%目的 分析新生儿气胸的临床与X线特点,提高对新生儿气胸的认识与X线诊断水平.方法 52例新生儿气胸,摄取仰卧前后位胸片,部分患者加摄仰卧水平侧位片,所有病例均经X线片随访复查.结果 根据气胸X线表现,新生儿气胸可分为4种类型:成人型,内侧缘型,膈上型和前胸壁型.X线分别表现为外侧气胸、内侧纵隔旁气胸、膈面附近气胸及胸前部气胸.52例气胸患儿中,成人型5例,内侧缘型29例,膈上型12例,前胸壁型6例.另外,同时伴有纵隔积气13例.结论 新生儿气胸有一定X线特征.

  4. Pneumomediastinum, pneumothorax and pneumoretroperitoneum following endoscopic retrieval of a tracheal foreign body from a cat : clinical communication

    Directory of Open Access Journals (Sweden)

    A.B. Zambelli

    2006-06-01

    Full Text Available 6-year-old entire male cat was presented with a 1-week history of severe dyspnoea without coughing. Upon auscultation, an inspiratory and particularly pronounced expiratory wheeze was noted, with severe dyspnoea. The minimum database was normal. Plain thoracic radiographs showed signs of a mural or intraluminal intrathoracic (1-T4 tracheal narrowing. A dynamic collapsing trachea was ruled out using fluoroscopy. Bronchoscopy was performed and a dark green and brown spiculated foreign object was found just cranial to the carina. Following removal, the cat rapidly developed extensive truncal subcutaneous emphysema and oxygen-responsive dyspnoea and cyanosis. Follow-up radiographs demonstrated unilateral pneumothorax and lung collapse, marked pneumomediastinum and dissection of air through the tracheal wall. A thoracic drain was placed and the pneumothorax resolved rapidly. Follow-up radiographs demonstrated resolution of pneumothorax and development of extensive retroperitoneal air. The cat made an uneventful recovery. The foreign object was the calyx and stem of a flower. This article emphasises the importance of diagnostic imaging in the dyspnoeic patient, both for confirming initial suspicions of respiratory tract disease, and in managing and charting post-therapy resolution or complications.

  5. Diagnosis and Treatment of Spontaneous Pneumothorax%自发性气胸的临床诊治分析

    Institute of Scientific and Technical Information of China (English)

    王慧星

    2015-01-01

    目的:对自发性气胸的临床诊断与方法进行讨论。方法选取2012年收治的29例自发性气胸患者的临床资料,对其进行分析与探讨。结果29例患者中,23例患者伴有各种慢性肺部疾病,主要临床表现有突发或突然加重的呼吸困难和胸痛。结论自发性气胸为常见急症,误诊率较高,应做到及时诊断和及早治疗,对患者的不同情况采取不同的治疗方法。%Objective The clinical diagnosis of spontaneous pneumothorax and methods will be discussed.Methods The clinical data of 29 patients with spontaneous pneumothorax in our hospital in 2012 were analyzed and discussed. ResultsAl 29 cases of patients, 23 patients had chronic lung diseases, there were unexpected or sudden worsening dyspnea and chest pain.ConclusionSpontaneous pneumothorax was a common emergency, and has a higher rate of misdiagnosis. Timely diagnosis and early treatment should be done, and with different conditions to take different approaches.

  6. MDCT quantification is the dominant parameter in decision–making regarding chest tube drainage for stable patients with traumatic pneumothorax

    Science.gov (United States)

    Cai, Wenli; Lee, June-Goo; Fikry, Karim; Yoshida, Hiroyuki; Novelline, Robert; de Moya, Marc

    2013-01-01

    It is commonly believed that the size of a pneumothorax is an important determinant of treatment decision, in particular regarding whether chest tube drainage (CTD) is required. However, the volumetric quantification of pneumothoraces has not routinely been performed in clinics. In this paper, we introduced an automated computer-aided volumetry (CAV) scheme for quantification of volume of pneumothoraces in chest multi-detect CT (MDCT) images. Moreover, we investigated the impact of accurate volume of pneumothoraces in the improvement of the performance in decision-making regarding CTD in the management of traumatic pneumothoraces. For this purpose, an occurrence frequency map was calculated for quantitative analysis of the importance of each clinical parameter in the decision-making regarding CTD by a computer simulation of decision-making using a genetic algorithm (GA) and a support vector machine (SVM). A total of 14 clinical parameters, including volume of pneumothorax calculated by our CAV scheme, was collected as parameters available for decision-making. The results showed that volume was the dominant parameter in decision-making regarding CTD, with an occurrence frequency value of 1.00. The results also indicated that the inclusion of volume provided the best performance that was statistically significant compared to the other tests in which volume was excluded from the clinical parameters. This study provides the scientific evidence for the application of CAV scheme in MDCT volumetric quantification of pneumothoraces in the management of clinically stable chest trauma patients with traumatic pneumothorax. PMID:22560899

  7. Assessment of a Human Cadaver Model for Training Emergency Medicine Residents in the Ultrasound Diagnosis of Pneumothorax

    Directory of Open Access Journals (Sweden)

    Srikar Adhikari

    2014-01-01

    Full Text Available Objectives. To assess a human cadaver model for training emergency medicine residents in the ultrasound diagnosis of pneumothorax. Methods. Single-blinded observational study using a human cadaveric model at an academic medical center. Three lightly embalmed cadavers were used to create three “normal lungs” and three lungs modeling a “pneumothorax.” The residents were blinded to the side and number of pneumothoraces, as well as to each other’s findings. Each resident performed an ultrasound examination on all six lung models during ventilation of cadavers. They were evaluated on their ability to identify the presence or absence of the sliding-lung sign and seashore sign. Results. A total of 84 ultrasound examinations (42-“normal lung,” 42-“pneumothorax” were performed. A sliding-lung sign was accurately identified in 39 scans, and the seashore sign was accurately identified in 34 scans. The sensitivity and specificity for the sliding-lung sign were 93% (95% CI, 85–100% and 90% (95% CI, 81–99%, respectively. The sensitivity and specificity for the seashore sign were 80% (95% CI, 68–92% and 83% (95% CI, 72–94%, respectively. Conclusions. Lightly embalmed human cadavers may provide an excellent model for mimicking the sonographic appearance of pneumothorax.

  8. Highly sensitive monitoring of chest wall dynamics and acoustics provides diverse valuable information for evaluating ventilation and diagnosing pneumothorax.

    Science.gov (United States)

    Pesin, Jimy; Faingersh, Anna; Waisman, Dan; Landesberg, Amir

    2014-06-15

    Current practice of monitoring lung ventilation in neonatal intensive care units, utilizing endotracheal tube pressure and flow, end-tidal CO2, arterial O2 saturation from pulse oximetry, and hemodynamic indexes, fails to account for asymmetric pathologies and to allow for early detection of deteriorating ventilation. This study investigated the utility of bilateral measurements of chest wall dynamics and sounds, in providing early detection of changes in the mechanics and distribution of lung ventilation. Nine healthy New Zealand rabbits were ventilated at a constant pressure, while miniature accelerometers were attached to each side of the chest. Slowly progressing pneumothorax was induced by injecting 1 ml/min air into the pleural space on either side of the chest. The end of the experiment (tPTX) was defined when arterial O2 saturation from pulse oximetry dropped ventilation was attained for all animals. Side identification of the pneumothorax was achieved at 50% tPTX, within a 95% confidence interval. Diagnosis was, on average, 34.1 ± 18.8 min before tPTX. In conclusion, bilateral monitoring of the chest dynamics and acoustics provide novel information that is sensitive to asymmetric changes in ventilation, enabling early detection and localization of pneumothorax.

  9. Surgical management of pneumothorax: significance of effective admission or communication strategies between the district general hospitals and specialized unit.

    Science.gov (United States)

    Aslam, Muhammad I; Martin-Ucar, Antonio E; Nakas, Apostolos; Waller, David A

    2011-11-01

    A preoperative delay in emergency surgery for spontaneous pneumothorax is associated with a poor outcome after surgery and a prolonged hospital stay. To reduce preoperative delays, all tertiary referrals from district general hospitals to our thoracic surgery unit were processed through a 'clinical decisions unit' (CDU). Prior to the establishment of the CDU, these patients were added to a waiting list for a surgical bed. This study has reviewed the effect of this change in admission policy on the efficiency of treatment for non-elective spontaneous pneumothorax. An intergroup comparison (pre-CDU group vs. post-CDU group) was made of the following parameters: referral to transfer time, transfer to surgery time and length of inpatient stay in the referring and tertiary hospitals. There were no significant differences in gender, diagnosis, treatment in the referring hospitals, postoperative clinical outcome, or indications for or type of surgery. The total length of inpatient stay in the referring and tertiary hospitals was significantly reduced for the post-CDU group (12 vs. 15 days; P<0.001), which was attributed to the earlier transfer of patients (18 vs. 78 hours; P<0.001) hours. Allowing surgical access to a traditional medical admission unit is therefore, cost-effective and significantly improves the efficiency of non-elective pneumothorax surgery.

  10. Update on normal tension glaucoma

    Directory of Open Access Journals (Sweden)

    Jyotiranjan Mallick

    2016-01-01

    Full Text Available Normal tension glaucoma (NTG is labelled when typical glaucomatous disc changes, visual field defects and open anterior chamber angles are associated with intraocular pressure (IOP constantly below 21 mmHg. Chronic low vascular perfusion, Raynaud's phenomenon, migraine, nocturnal systemic hypotension and over-treated systemic hypertension are the main causes of normal tension glaucoma. Goldmann applanation tonometry, gonioscopy, slit lamp biomicroscopy, optical coherence tomography and visual field analysis are the main tools of investigation for the diagnosis of NTG. Management follows the same principles of treatment for other chronic glaucomas: To reduce IOP by a substantial amount, sufficient to prevent disabling visual loss. Treatment is generally aimed to lower IOP by 30% from pre-existing levels to 12-14 mmHg. Betaxolol, brimonidine, prostaglandin analogues, trabeculectomy (in refractory cases, systemic calcium channel blockers (such as nifedipine and 24-hour monitoring of blood pressure are considered in the management of NTG. The present review summarises risk factors, causes, pathogenesis, diagnosis and management of NTG.

  11. Iatrogenic stigma in outpatient treatment for Hansen's disease (leprosy) in Brazil.

    Science.gov (United States)

    White, Cassandra

    2008-02-01

    This paper explores how iatrogenic stigma, or stigma that is produced through a patient's encounter with physicians or with biomedicine in general, might emerge in outpatient treatment for Hansen's disease, or leprosy. Based on in-depth interviews with people affected by Hansen's disease and observations conducted at several public health clinics in Rio de Janeiro, Brazil, this research identified several aspects of the biomedical encounter that generated or contributed to stigma, either felt or enacted. Also noted in the research were positive examples of techniques used by physicians and health care workers for minimizing or circumventing stigma. The paper touches upon several topics, such as culturally mediated responses to medication side effects and communication between health care workers and patients, that might be salient or useful for health educators and others who are attempting to reduce health-related stigma.

  12. Orthopaedic surgeon's nightmare: iatrogenic fractures of talus and medial malleolus following tibial nailing

    Institute of Scientific and Technical Information of China (English)

    Sanjay Meena; Vivek Trikha; Pramod Saini; Rakesh Kumar; Buddhadev Chowdhary

    2013-01-01

    Intramedullary interlocking nailing is the gold standard for treatment of tibial shaft fractures.The growing use of intramedullary nailing has resulted in an increased number of tibial nailing in daily clinical practice.Despite adequate surgeon experience,tibial nailing is not without complications if proper techniques are not followed.A case of iatrogenic talar neck and medial malleolus fractures during intramedullary nailing of tibia in a 24-year-old male is reported.It is believed to be caused by forceful hammering of insertion zig with foot dorsiflexed.To the best of our knowledge,no such case has been reported in the literature.It is possible to reduce the risk of this complication by adoption of preventive measures.

  13. Deep anterior lamellar keratoplasty for the management of iatrogenic keratectasia occurring after hexagonal keratotomy

    Directory of Open Access Journals (Sweden)

    Paras Mehta

    2012-01-01

    Full Text Available Iatrogenic keratectasia has been reported subsequent to refractive surgery or trauma. Hexagonal keratotomy (HK is a surgical incisional technique to correct hyperopia. A number of complications have been reported following this procedure, including irregular astigmatism, wound healing abnormalities and corneal ectasia. When visual acuity is poor because of ectasia or irregular astigmatism and contact lens fitting is not possible, penetrating or lamellar keratoplasty can be performed. Since incisions in refractive keratotomy are set at 90-95% depth of cornea, intraoperative microperforations are known to occur and lamellar keratoplasty may become difficult. We describe deep anterior lamellar keratoplasty (DALK used to successfully manage keratectasia after HK. Pre DALK vision was 20/400 and post DALK vision was 20/30 two months after surgery. This report aims to show improved visual outcome in corneal ectasia secondary to HK. DALK can be a procedure of choice with proper case selection.

  14. How Should Physicians Help Gender-Transitioning Adolescents Consider Potential Iatrogenic Harms of Hormone Therapy?

    Science.gov (United States)

    Steensma, Thomas D; Wensing-Kruger, S Annelijn; Klink, Daniel T

    2017-08-01

    Counseling and treatment of transgender youth can be challenging for mental health practitioners, as increased availability of gender-affirming treatments in recent years raises ethical and clinical questions. Is a gender identity diagnosis helpful? What is the right time to treat, and should the adolescent's age matter in decision making? In this article, we discuss these questions in light of a case in which an adolescent wishes to pursue hormone therapy. Our analysis focuses on the importance of balanced decision making when counseling and treating adolescents with nonconforming gender identities. We argue that clinicians' communicating appropriate expectations about the effectiveness and limitations of hormone therapy and the risks of psychological and physical iatrogenic effects is critical. © 2017 American Medical Association. All Rights Reserved.

  15. [CRITERIA OF ESTIMATION AND RESULTS OF TREATMENT OF IATROGENIC INJURIES OF URETERS IN ONCOLOGICAL PATIENTS].

    Science.gov (United States)

    Kononenko, O A; Stakhovskiy, E O; Vukalovych, P S; Voylenko, O A; Stakhovskiy, O E; Vitruk, Yu V; Chepurnatiy, M V

    2015-11-01

    Clinical analysis was conducted in 74 oncological patients, in whom 103 iatrogenic injuries of ureter (IIU) were revealed and for which they were treated in Scientific-nvestigative Department of Plastic and Reconstructive Oncourology. Restoration of renal and ureteric function were noted in terms up to 6 mo, in these terms were revealed all complications, caused by recurrence of obstruction. Late follow-up results of III were positive in 95.2% patients, unsatisfactory result was revealed in 3 (4.8%) patients, what have demanded conduction of surgical secondary correction of urodynamics. Quality of life after restoration operative treatment have improved in 31.70%patients in comparison of such before the operation.

  16. [TACTICS OF TREATMENT OF PATIENTS FOR ONCOLOGICAL DISEASES IN IATROGENIC INJURY OF UPPER URINARY WAYS].

    Science.gov (United States)

    Stakhovskyi, E O; Vukalovych, P S; Voylenko, O A; Stakhovskyi, O E; Vitruk, Yu V; Kononenko, O A

    2015-10-01

    Results of examination and treatment of 119 patients for oncological diseases were analyzed, in whom iatrogenic injury of ureter (IIU) have occurred. Remission of oncological diseases plastic operations were performed in 48 (40.3%) patients, reconstructive - in 23 (19.3%), restoration - in 3 (2.5%); while a progress - palliative nephrostomy in 41 (34.5%) patients. In 4 (3.4%) patients dynamical observation was conducted. The method of operative treatment was selected, taking into account efficacy of treatment of oncological diseases; mechanism of IIU; level of obstruction and irreversibility of changes in wall of ureter; character of injury (one-sided, bilateral, injury of ureter of a single kidney); anatomo-functional changes of upper and lower urinary ways; the patient state severity.

  17. CRITERIA FOR THE EVALUATION AND ESTIMATION OF IATROGENIC PROSTHETIC FACTORS – SEMIOLOGY AND SYMPTOMATOLOGY

    Directory of Open Access Journals (Sweden)

    G. LUCA

    2013-12-01

    Full Text Available Introduction: The principles lying at the basis of a balanced dental occlusion cannot be analyzed separately, but only if considering the teeth (and, implicitly, dental occlusion as integrated into the masticatory system, which includes the masticatory muscles, the temporo-mandibu‑ lary joint and the maxillary bones. Scope: The scope of the present study was to correlate and establish the interde‑ pendence between the morpholgically-incorrect prosthetic works and the tissular and functional damages suffered by the neighbouring structures, as a result of some incor‑ rectly-made prosthetic works. Also, the study aims at iden‑ tifying the factors and limits responsible for a prolongued maintenance of such irreversible pathological modificati‑ ons within an asymptomatic zone for the patient. Materials and method: The working hypothesis of the present inves‑ tigation started from the analysis of the various objective signs, versus the morphology of the incorrectly performed prosthetic works. The study, initiated as early as 2009, in a private stomatological clinics (DentEstet, Bucuresti, includes a number of 500 patients (250 women and 250 men, selected among the patients having addressed the stomatological office from various reasons (not always related to the prosthetic pathology of the cases here under investigation. Included in the study have been only the patients with fixed prosthetic works associated with one or several of the previously described objective signs, potentially induced by the iatrogeneicity of the prosthetic works. Results: The pathological effects of the iatrogenic works here under analysis, upon both the antagonistic and prosthetic support teeth, may be clinically identified during a minute examination performed prior to produ‑ cing irreversible final effects (abrasions, fractures, dental mobility, etc.. Such noxious effects of the iatrogenic pros‑ thetic works appear as a false masticatory comfort and as a

  18. Iatrogenic effects of photoprotection recommendations on skin cancer development, vitamin D levels, and general health.

    Science.gov (United States)

    Reddy, Kavitha K; Gilchrest, Barbara A

    2011-01-01

    Ultraviolet (UV) radiation is an established carcinogen that causes skin cancers and other cutaneous photodamage. Vitamin D is produced in the skin after UV exposure and may also be obtained from dietary and supplemental sources. The effect of recommendations for UV protection, as well as for very large vitamin D supplements, and possible adverse effects of both are explored. Current evidence supports the conclusion that protection from UV radiation reduces the incidence of skin cancers and photodamage, but generally does not compromise vitamin D status or lead to iatrogenic disease. Conversely, risks of maintaining very high vitamin D levels have not been adequately studied. Vitamin D obtained from diet and supplements is functionally identical to that produced after UV exposure, and is a more reliable and quantifiable source of the vitamin.

  19. Iatrogenic fracture of the superomedial orbital rim during frontal trephine irrigation.

    Science.gov (United States)

    Angel, Douglas; Zener, Rebecca; Rotenberg, Brian W

    2014-12-01

    Frontal sinus trephination (FST) has numerous applications in the treatment of acute and chronic sinus disease. This procedure involves making an incision at the medial aspect of the supraorbital rim and then drilling the sinus's anterior table. Placement of a frontal trephine allows for irrigation of the frontal recess in order to evacuate the frontal sinus in a minimally invasive manner. Orbital injury is a rare complication of FST. We present a case of previously unreported orbital compartment syndrome secondary to iatrogenic fracture of the superomedial orbital rim as a complication of frontal trephine irrigation. We also review the literature on the applications of FST and its associated complications, and we discuss orbital compartment syndrome as a complication of sinus surgery.

  20. Antegrade deligation of iatrogenic distal ureteric obstruction utilising a high pressure balloon dilatation technique.

    LENUS (Irish Health Repository)

    Rajendran, Simon

    2012-02-01

    BACKGROUND: Iatrogenic trauma is the leading cause of ureteric injury with an incidence in abdominal and pelvic surgery varying between 0.4 and 2.5%. CASE: We report a case of ureteric obstruction caused by a haemostatic clip. There was associated rupture of the ureter proximal to the clip with intra-peritoneal leakage of urine. The patient was unfit for surgery and was managed by a novel procedure of endoluminal balloon deligation. CONCLUSION: Ureteric injuries are rare but potentially serious complications. They require prompt diagnosis and management depends on the patients\\' clinical condition, extent of injury and interval from injury to diagnosis. We have successfully demonstrated a new technique to treat ureteric obstruction caused by a haemostatic clip with associated ureteral rupture in a patient unfit for surgery.

  1. Preventing Cushing: Iatrogenic Cushing Syndrome due to Ritonavir-Fluticasone Interaction.

    Science.gov (United States)

    Tiruneh, Fasil; Awan, Ahmad; Didana, Abiot; Doshi, Saumil

    2017-07-17

    Ritonavir is commonly used in low doses to boost plasma levels of protease inhibitors in patients with human immunodeficiency virus (HIV) infections. It is also a potent inhibitor of cytochrome P450. We present a 50-year-old African American male with past medical history of HIV on highly active antiretroviral therapy (HAART), which also included ritonavir and long standing asthma that has been treated with inhaled fluticasone, who presented with back pain. He had central obesity, prominent abdominal striae and wasted extremities on physical examination. Laboratory tests showed low morning serum cortisol and suboptimal cosyntropin test consistent with adrenal insufficiency. Computed tomography (CT) of the spine showed a fracture of inferior endplate of the lumbar (L3) vertebra. The cause of osteoporosis is believed to be iatrogenic Cushing syndrome caused by enhanced levels of inhaled fluticasone effects secondary to inhibition of cytochrome P450. The patient was managed surgically and fluticasone was discontinued.

  2. Iatrogenic injury to the inferior alveolar nerve: etiology, signs and symptoms, and observations on recovery.

    Science.gov (United States)

    Hillerup, S

    2008-08-01

    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 assessing tactile, thermal, and positional perception as well as two-point discrimination and pain. In 48 patients with IAN injuries of differing etiologies who did not undergo surgery, 32 patients with injury associated with third molar surgery exhibited significant spontaneous improvement of sensory function. Recovery improvement of sensory function was insignificant in the patients with other etiologies. In most patients the level of sensory perception was such that microsurgical repair was only occasionally indicated. Four patients had microsurgical repair; the outcome was favourable in three. IAN injuries associated with third molar surgery, other dento-alveolar surgery or implant surgery occur sufficiently often to render prevention a key issue.

  3. Iatrogenic aspergillus infection of the central nervous system in a pregnant woman

    Directory of Open Access Journals (Sweden)

    Lokuhetty Menaka

    2009-07-01

    Full Text Available A healthy postnatal woman succumbed to fulminant iatrogenic Aspergillus infection of the central nervous system, following accidental inoculation into the subarachnoid space at spinal anesthesia, during an outbreak of Aspergillus meningitis in Sri Lanka. Autopsy revealed extensive Aspergillus meningitis and culture confirmed Aspergillus fumigatus. The thalamic parenchyma in the brain was invaded by fungal hyphae producing necrotizing angitis with thrombosis, thalamic infarcts and fungal abscesses. The directional growth of fungal hyphae from the extra-luminal side of blood vessels towards the lumen favored extension from the brain parenchyma over hematogenous spread. The spinal parenchyma was resistant to fungal invasion in spite of the heavy growth within the spinal meninges and initial inoculation at spinal level. Modulation of the immune response in pregnancy with depression of selective aspects of cell-mediated immunity probably contributed to rapid spread within the subarachnoid space, to involve the brain parenchyma leading to clinical deterioration and death.

  4. Iatrogenic oesophageal perforation during placement of an endoscopic vacuum therapy device.

    Science.gov (United States)

    Halliday, Edwin; Patel, Anant; Hindmarsh, Andrew; Sujendran, Vijay

    2016-07-28

    Endoscopic vacuum-assisted closure (VAC) is increasingly being used as a means of managing perforations or anastomotic leaks of the upper gastrointestinal (GI) tract. Published outcomes are favourable, with few mentions of complications or morbidity. We present a case in which the management of a gastric perforation with endoscopic vacuum therapy was complicated by cervical oesophageal perforation. The case highlights the risks of such endoscopic therapeutic procedures and is the first report in the literature to describe significant visceral injury during placement of a VAC device for upper GI perforation. Iatrogenic oesophageal perforation is an inherent risk to upper GI endoscopy and the risk increases in therapeutic endoscopic procedures. Complications may be reduced by management under a multidisciplinary team in a centre with specialist upper GI services. There is no doubt that the endoscopic VAC approach is becoming established practice, and training in its use must reflect its increasingly widespread adoption.

  5. Interdisciplinary Approach for Management of Iatrogenic Internal Root Resorption: A Case Report.

    Science.gov (United States)

    Ramazani, Mohsen; Asgary, Saeed; Zarenejad, Nafiseh; Mehrani, Javad

    2016-01-01

    For management of a symptomatic maxillary lateral incisor with dull pain on chewing, suppurative sinus tract, defective metal-ceramic crown and iatrogenic internal root resorption, an interdisciplinary approach was taken. Two-visit nonsurgical treatment with calcium-enriched mixture (CEM) cement, replacement of metal-ceramic crown with all-ceramic crown and corrective periodontal plastic surgery were included in the treatment plan. Six-month and one-year follow-ups revealed complete resolution of signs and symptoms and radiographic healing. This case report highlights the importance of adequate cooling during crown preparation to preserve the pulp vitality and prevent internal resorptive lesions and also the profound sealing ability and biocompatibility of CEM cement.

  6. Laparoscopic reconstruction of iatrogenic-induced lower ureteric strictures: Does timing of repair influence the outcome?

    Directory of Open Access Journals (Sweden)

    George P Abraham

    2011-01-01

    Full Text Available Context: Influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures Aims: To assess the influence of timing of repair on outcome following laparoscopic reconstruction of lower ureteric strictures in our adult patient population. Settings and Design: Single surgeon operative experience in two institutes. Retrospective analysis. Materials and Methods: All patients were worked up in detail. All patients underwent cystoscopy and retrograde pyelography prior to laparoscopic approach. Patients were categorised into two groups: early repair (within seven days of inciting event and delayed repair (after two weeks. Operative parameters and postoperative events were recorded. Postprocedure all patients were evaluated three monthly. Follow-up imaging was ordered at six months postoperatively. Improvement in renal function, resolution of hydronephrosis and unhindered drainage of contrast through the reconstructed unit on follow-up imaging was interpreted as a satisfactory outcome. Statistical Analysis Used: Mean, standard deviation, equal variance t test, Mann Whitney Z test, Aspin-Welch unequal variance t test. Results: Thirty-six patients (37 units, 36 unilateral and 1 simultaneous bilateral underwent laparoscopic ureteral reconstruction of lower ureteric stricture following iatrogenic injury - 21 early repair (Group I and 15 delayed repair (Group II. All patients were hemodynamically stable at presentation. Early repair was more technically demanding with increased operation duration. There was no difference in blood loss, operative complications, postoperative parameters, or longterm outcome. Conclusions: In hemodynamically stable patients, laparoscopic repair of iatrogenically induced lower ureteric strictures can be conveniently undertaken without undue delay from the inciting event. Compared to delayed repairs, the procedure is technically more demanding but morbidity incurred and outcome is at par.

  7. Surface tension profiles in vertical soap films

    CERN Document Server

    Adami, N

    2013-01-01

    Surface tension profiles in vertical soap films are experimentally investigated. Measurements are performed introducing deformable elastic objets in the films. The shape adopted by those objects set in the film can be related to the surface tension value at a given vertical position by numerical solving of adapted elasticity equations. We show that the observed dependency of the surface tension versus the vertical position in the soap film can be reproduced by simple modeling taking into account film thickness measurements.

  8. On Surface Tension for Compact Stars

    Indian Academy of Sciences (India)

    R. Sharma; S. D. Maharaj

    2007-06-01

    In an earlier analysis it was demonstrated that general relativity gives higher values of surface tension in strange stars with quark matter than neutron stars. We generate the modified Tolman–Oppenheimer–Volkoff equation to incorporate anisotropic matter and use this to show that pressure anisotropy provides for a wide range of behaviour in the surface tension than is the case with isotropic pressures. In particular, it is possible that anisotropy drastically decreases the value of the surface tension.

  9. PROSPECTIVE RANDOMIZED TRIAL OF EFFICACY AND SAFETY OF IODOPOVIDONE VS OXYTETRACYCLINE FOR PLEURODESIS IN SPONTANEOUS PNEUMOTHORAX AND RECURRENT PLEURAL EFFUSIONS

    Directory of Open Access Journals (Sweden)

    Uday C

    2016-02-01

    Full Text Available BACKGROUND Recurrent malignant pleural effusion and spontaneous pneumothorax can be treated by a procedure called pleurodesis by which the pleural space is obliterated. This can be done by surgical means using mechanical force or by introducing any one of the recommended agents into the pleural space via tube thoracostomy or during thoracoscopy. Examples of agents used are talc as powder or as slurry, tetracycline derivatives, antineoplastic agents (Bleomycin, mitoxantrone, quinacrine, silver nitrate, Corynebacterium parvum and iodopovidone. The aim of the present study was to evaluate the safety and efficacy of iodopovidone as a sclerosing agent in the treatment of recurrent pleural effusion and spontaneous pneumothorax. This was a randomized prospective interventional study comparing iodopovidone with oxytetracycline as the latter is now sparingly available for clinical use. MATERIAL AND METHODS Study was conducted in 44 patients above 12 years of age, admitted in the Dept. of Pulmonary Medicine, Goa Medical College. Patients with a diagnosis of spontaneous pneumothorax or recurrent malignant pleural effusion were randomly allocated to either iodopovidone or oxytetracycline group and pleurodesis was done as per British Thoracic Society Guidelines (BTS. 1 RESULTS Among 44 patients 23 were secondary spontaneous pneumothorax, 9 were primary spontaneous pneumothorax and 12 were malignant pleural effusion; 2 patients did not report for follow-up visits and the remaining 42 patients were followed up for 6 months. The success rate of oxytetracycline and iodopovidone pleurodesis is 81% and 95.2% respectively. All the patients had chest pain of varying severity during the procedure in either groups; 8 patients in oxytetracycline group and 6 patients in iodopovidone group had fever after the procedure; 2 patients in iodopovidone group developed hypotension after the procedure and there was no mortality in either group attributable to the procedure

  10. HILBERTIAN APPROACH FOR UNIVARIATE SPLINE WITH TENSION

    Institute of Scientific and Technical Information of China (English)

    A.Bouhamidi

    2001-01-01

    In this work,a new approach is proposed for constructing splines with tension.The basic idea is in the use of distributions theory,which allows us to define suitable Hilbert spaces in which the tension spline minimizes some energy functional.Classical orthogonal conditions and characterizations of the spline in terms of a fundamental solution of a differential operator are provided.An explicit representation of the tension spline is given.The tension spline can be computed by solving a linear system.Some numerical examples are given to illustrate this approach.

  11. Surface Tension Calculation of Undercooled Alloys

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Based on the Butler equation and extrapolated thermodynamic data of undercooled alloys from those of liquid stable alloys, a method for surface tension calculation of undercooled alloys is proposed. The surface tensions of liquid stable and undercooled Ni-Cu (xNi=0.42) and Ni-Fe (xNi=0.3 and 0.7) alloys are calculated using STCBE (Surface Tension Calculation based on Butler Equation) program. The agreement between calculated values and experimental data is good enough, and the temperature dependence of the surface tension can be reasonable down to 150-200 K under the liquid temperature of the alloys.

  12. The Plastic Tension Field Method

    DEFF Research Database (Denmark)

    Hansen, Thomas

    2005-01-01

    . The emphasis is attached to the presentation of a design method based on the diagonal tension field theory. Also, how to determine the load-carrying capacity of a given steel plate girder with transverse web stiffeners, is briefly presented. The load-carrying capacity may be predicted by applying both...... method. The method is based on the theory of plasticity and is analogous to the so-called diagonal compression field method developed for reinforced concrete beams with transverse stirrups, which is adopted in the common European concrete code (Eurocode 2). Many other theories have been developed......, but the method presented differs from these theories by incorporating the strength of the transverse stiffeners and by the assumption that the tensile bands may pass the transverse stiffeners, which often is observed in tests. Other methods have only dealt with a single web field between two stiffeners...

  13. ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax.

    Science.gov (United States)

    Tschopp, Jean-Marie; Bintcliffe, Oliver; Astoul, Philippe; Canalis, Emilio; Driesen, Peter; Janssen, Julius; Krasnik, Marc; Maskell, Nicholas; Van Schil, Paul; Tonia, Thomy; Waller, David A; Marquette, Charles-Hugo; Cardillo, Giuseppe

    2015-08-01

    Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.The European Respiratory Society's Scientific Committee established a multidisciplinary team of pulmonologists and surgeons to produce a comprehensive review of available scientific evidence.Smoking remains the main risk factor of PSP. Routine smoking cessation is advised. More prospective data are required to better define the PSP population and incidence of recurrence. In first episodes of PSP, treatment approach is driven by symptoms rather than PSP size. The role of bullae rupture as the cause of air leakage remains unclear, implying that any treatment of PSP recurrence includes pleurodesis. Talc poudrage pleurodesis by thoracoscopy is safe, provided calibrated talc is available. Video-assisted thoracic surgery is preferred to thoracotomy as a surgical approach.In first episodes of PSP, aspiration is required only in symptomatic patients. After a persistent or recurrent PSP, definitive treatment including pleurodesis is undertaken. Future randomised controlled trials comparing different strategies are required.

  14. Risk of Stroke in Patients With Spontaneous Pneumothorax: A Nationwide, Population-Based Study.

    Science.gov (United States)

    Cheng, Ching-Yuan; Yeh, Diana Yu-Wung; Lin, Cheng-Li; Kao, Chia-Hung

    2016-04-01

    The association between spontaneous pneumothorax (SP) and stroke has not been reported, and this study aimed to explore this association. We used the National Health Insurance Research Database for conducting a nationwide, population-based, retrospective cohort study of patients newly hospitalized for SP from 2000 to 2010. A total of 2541 patients with newly diagnosed SP were included and compared with patients without SP. We observed that patients with SP were at higher risk for developing stroke, with an adjusted hazard ratio (HR) of 1.56. In addition, these patients had a significantly higher risk of hemorrhagic stroke (adjusted HR = 2.22) than of ischemic stroke (adjusted HR = 1.48). The risk of stroke was the highest in the initial 4 months after hospitalization for SP (adjusted HR = 3.41, 95% confidence interval = 1.98-5.87). In conclusion, our study revealed a correlation between stroke and a history of SP, and the risk of stroke after SP was time sensitive.

  15. Etiology of spontaneous pneumothorax in 105 HIV-infected patients without highly active antiretroviral therapy

    Energy Technology Data Exchange (ETDEWEB)

    Rivero, Antonio [Reina Sofia University Hospital, Cordoba (Spain)], E-mail: ariveror@saludalia.com; Perez-Camacho, Ines [Reina Sofia University Hospital, Cordoba (Spain); Lozano, Fernando [Virgen de Valme University Hospital, Sevilla (Spain); Santos, Jesus [Virgen de la Victoria University Hospital, Malaga (Spain); Camacho, Angela [Reina Sofia University Hospital, Cordoba (Spain); Serrano, Ascencion [Puerta del Mar University Hospital, Cadiz (Spain); Cordero, Elisa [Virgen del Rocio University Hospital, Sevilla (Spain); Jimenez, Francisco [Carlos Haya Hospital, Malaga (Spain); Torres-Tortosa, Manuel [Punta de Europa Hospital, Cadiz (Spain); Torre-Cisneros, Julian [Reina Sofia University Hospital, Cordoba (Spain)

    2009-08-15

    Introduction: Spontaneous pneumothorax (SP) is a frequent complication in non-treated HIV-infected patients as a complication of opportunistic infections and tumours. Objective: To analyse the aetiology of SP in non-treated HIV patients. Patients and methods: Observational study of SP cases observed in a cohort of 9831 of non-treated HIV-infected patients attended in seven Spanish hospitals. Results: 105 patients (1.06%) developed SP. The aetiological cause was identified in 89 patients. The major causes identified were: bacterial pneumonia (36 subjects, 34.3%); Pneumocystis jiroveci pneumonia (PJP) (31 patients, 29.5%); and pulmonary tuberculosis (17 cases, 15.2%). The most common cause of SP in drugs users was bacterial pneumonia (40%), whereas PJP was more common (65%) in sexual transmitted HIV-patients. The most common cause of bilateral SP was PJP (62.5%) whereas unilateral SP was most commonly associated with bacterial pneumonia (40.2%). The most common cause of SP in patients with a CD4+ lymphocyte count >200 cells/ml and in patients without AIDS criteria was bacterial pneumonia. PJP was the more common cause in patients with a CD4+ lymphocyte count <200 cells/ml or with AIDS. Conclusion: The incidence of SP in non-treated HIV-infected patients was 1.06%. The aetiology was related to the patients risk practices and to their degree of immunosuppression. Bacterial pneumonia was the most common cause of SP.

  16. Differential outcome of fissure-positioned tube in closed thoracostomy for primary spontaneous pneumothorax.

    Science.gov (United States)

    Kim, Yong Won; Byun, Chun Sung; Cha, Yong Sung; Kim, Oh Hyun; Lee, Kang Hyun; Park, Il Hwan

    2015-05-01

    Closed tube thoracostomy is often used to evacuate a primary spontaneous pneumothorax (PSP). Occasionally, this procedure is complicated by placement of the chest tube location in the fissural area instead of pleural space. There is a paucity of studies on outcomes according to chest tube placement. As such, we investigated outcomes of chest tube placement in fissural versus pleural area in closed thoracostomy for PSP. Patients between 14 and 65 years of age who had been treated with chest tube insertion to evacuate PSP were selected based on retrospective review of medical records. Patients selected for this study received chest tube placement at either the fissural or pleural spaces. Those with pre-existing lung disease or those transferred into our hospital after closed thoracostomy were excluded. Of the 255 patients with PSP treated with chest tube insertion, 172 patients were enrolled in this study. Twenty-nine (16.9%) had fissural tube placement and 143 (83.1%) had pleural tube placement. A higher proportion of patients in the fissural versus pleural group required additional chest tube insertion (20.7% vs 4.9%, P = 0.010, respectively). There was no significant difference in body mass index, smoker status, symptom duration, number of episodes, post-thoracostomy complications, need for subsequent management, and duration of hospitalization in either group. In closed thoracostomy for PSP, there is a higher chance of tube dysfunction when the chest tube is positioned at fissural area as compared with the pleural space.

  17. Primary spontaneous pneumothorax in children: the role of CT in guiding management

    Energy Technology Data Exchange (ETDEWEB)

    Choudhary, A.K. [Department of Radiology, Great Ormond Street Hospital for Children, London (United Kingdom)]. E-mail: arvradio@yahoo.com; Sellars, M.E.K. [Department of Radiology, Great Ormond Street Hospital for Children, London (United Kingdom); Wallis, C. [Department of Respiratory Medicine, Great Ormond Street Hospital for Children, London (United Kingdom); Cohen, G. [Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London (United Kingdom); McHugh, K. [Department of Radiology, Great Ormond Street Hospital for Children, London (United Kingdom)

    2005-04-01

    AIM: Primary spontaneous pneumothorax (PSP) is rare in older children and most likely to be associated with apical subpleural blebs; there is a significant risk of recurrence. Our aim was to assess the radiological findings and final treatment of PSP in children presenting at our institution. METHODS: The study included 3 children presenting over a 15-month period at our institution with PSP; the clinical features at presentation and examination findings were recorded. The chest radiographic and CT appearances and findings at surgery were reviewed. RESULTS: In all cases, chest pain and breathlessness were presenting features and initial treatment included intercostal chest drainage. Chest radiographs on admission raised the suspicion of unilateral apical blebs in 2 children and bilateral apical blebs in the 3rd. Chest CT demonstrated apical blebs/cysts in all 3 children. The cysts ranged in size from 0.5 to 3.0 cm and were bilateral in 2 children. Surgery confirmed the radiological findings in all cases. CONCLUSION: CT is of value in the detection of apical pleural blebs in children with PSP. On CT, particular attention should be paid to the lung apices, where majority of blebs in otherwise healthy young patients are located. Prompt diagnosis of a morphological abnormality in these children is likely to expedite definitive surgical treatment.

  18. Outcome of Concurrent Occult Hemothorax and Pneumothorax in Trauma Patients Who Required Assisted Ventilation

    Science.gov (United States)

    Mahmood, Ismail; Tawfeek, Zainab; El-Menyar, Ayman; Zarour, Ahmad; Afifi, Ibrahim; Kumar, Suresh; Latifi, Rifat; Al-Thani, Hassan

    2015-01-01

    Background. The management and outcomes of occult hemopneumothorax in blunt trauma patients who required mechanical ventilation are not well studied. We aimed to study patients with occult hemopneumothorax on mechanical ventilation who could be carefully managed without tube thoracostomy. Methods. Chest trauma patients with occult hemopneumothorax who were on mechanical ventilation were prospectively evaluated. The presence of hemopneumothorax was confirmed by CT scanning. Hospital length of stay, complications, and outcome were recorded. Results. A total of 56 chest trauma patients with occult hemopneumothorax who were on ventilatory support were included with a mean age of 36 ± 13 years. Hemopneumothorax was managed conservatively in 72% cases and 28% underwent tube thoracostomy as indicated. 29% of patients developed pneumonia, 16% had Acute Respiratory Distress Syndrome (ARDS), and 7% died. Thickness of hemothorax, duration of mechanical ventilation, and development of ARDS were significantly associated with tube thoracostomy in comparison to no-chest tube group. Conclusions. The majority of occult hemopneumothorax can be carefully managed without tube thoracostomy in patients who required positive pressure ventilation. Tube thoracotomy could be restricted to those who had evidence of increase in the size of the hemothorax or pneumothorax on follow-up chest radiographs or developed respiratory compromise. PMID:25785199

  19. 自发性气胸241例临床分析%Clinical analysis of 241 cases with spontaneous pneumothorax

    Institute of Scientific and Technical Information of China (English)

    李红娟; 陈维亚

    2001-01-01

    目的探讨自发性气胸的临床特点、处理及预后。方法收集1995年1月~2001年3月杭州市第一人民医院胸外科收治的自发性气胸病例共241例,对其临床资料进行回顾性调查分析。结果原发性自发性气胸发生率为69%,继发性自发性气胸发生率31%;在原发性自发性气胸中,16~45岁占85%,46~81岁占15%;在继发性自发性气胸中,16~45岁占13.5%,46~81岁占86.5%自发性气胸的发生中,男性较女性多见,男性占89%,女性占11%,男女比例为8.2∶1。结论自发性气胸中以原发性自发性气胸为多见,且多发于青壮年,继发性自发性气胸相对较少,多发于中老年;自发性气胸中,男性较女性多见。%Objective To investigate clinical characters,treatment and prognosis of spontaneous pneumothorax.Method 241 patients with spontaneous pneumothorax who were treated in Hangzhou First Hospital during Jan.1995-Mar.2001 were collected and their clinical materials were retrospectively analyzed.Result The incidence of the primary spontaneous pneumothorax was 69% and the incidence of the secondary spontaneous pneumothorax was 31%.Among the cases with primary spontaneous pneumothorax,85% of all cases were from 16 to 45 years old and 15% were from 46 to 81 years old;Among the cases with secondary spontaneous pneumothorax,13.5% were from 14 to 45 years old and 86.5% were from 46 to 81 years old.The male patients with spontaneous pneumothorax(89%) were more than the female patients (11%) and the ratio of the male to female patients was 8.2∶1.Conclusion The incidence of primary spontaneous pneumothorax was higher than that of the secondary spontaneous pneumothorax.

  20. Breath-hold after forced expiration before removal of the biopsy needle decreased the rate of pneumothorax in CT-guided transthoracic lung biopsy

    Energy Technology Data Exchange (ETDEWEB)

    Min, Lingfeng; Xu, Xingxiang [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Song, Yong [Jinling Hospital, Nanjing University School of Medical, Nanjing 210002, Jiangsu (China); Issahar, Ben-Dov [Pulmonary Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv (Israel); Wu, Jingtao; Zhang, Le; Huang, Qian [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China); Chen, Mingxiang, E-mail: chenmx1129@126.com [Subei People' s Hospital of Jiangsu Province, Clinical Medical School of Yangzhou University, Yangzhou 225001, Jiangsu (China)

    2013-01-15

    Purpose: To assess the effect of a breath-hold after forced expiration on the rate of pneumothorax after computed tomography (CT)-guided transthoracic needle biopsy of pulmonary lesions. Materials and methods: Between January 2008 and December 2011, percutaneous CT-guided lung biopsy was performed in 440 patients. Two hundred and twenty-one biopsies were performed without (control group) and two hundred and nineteen biopsies were performed with (study group) the study maneuver – a breath-hold after forced expiratory approach. Multivariate analysis was performed between groups for risk factors for pneumothorax, including patient demographics, lesion characteristics, and biopsy technique. Results: A reduced number of pneumothoraces (18 [8.2%] vs 35 [15.8%]; P = 0.014) but no significant difference in rate of drainage catheter insertions (2 [0.9%] vs (4 [1.8%]; P = 0.418) were noted in the study group as compared with the control group. By logistic regression analysis, three factors significantly and independently affected the risk for pneumothorax including lesion size (transverse and longitudinal diameter), distance from pleura and utilizing or avoiding the breath-hold after deep expiration maneuver. Conclusion: Breath-holding after forced expiration before removal of the biopsy needle during the percutaneous CT-guided transthoracic lung biopsy almost halved the rate of overall pneumothorax. Small lesion size (longitudinal diameter) and the distance from pleura were also predictors of pneumothorax in our study.