Cases reported "Emphysema"

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1/39. Pneumatocele of the orbit.

    PURPOSE: To describe an uncommon sinus condition that can cause proptosis. methods: Intermittent unilateral proptosis and diplopia developed in a 29-year-old man. Computed tomography showed an enlarged frontal sinus with erosion of the floor of the sinus and air in the orbit. RESULTS: Endoscopic ethmoidectomy and frontal sinusotomy corrected an outlet check valve of the nasal frontal duct and eliminated the proptosis. CONCLUSION: Pneumatocele of the orbit is an uncommon cause of proptosis and diplopia and can be corrected with endoscopic sinus surgery.
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2/39. Gas in the bile ducts (pneumobilia) in emphysematous cholecystitis.

    Gas in the biliary ducts (pneumobilia) was demonstrated in three cases of emphysematous cholecystitis. Pneumobilia is usually secondary to a spontaneous internal biliary fistula or incompetent sphincter of oddi, and is rarely considered a manifestation of emphysematous cholecystitis. The presence of gas in the biliary ducts in these cases suggests that the cystic duct is patent, allowing gas to escape from the gallbladder lumen. The pathophysiology of emphysematous cholecystitis is discussed and an ischemic etiology considered.
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3/39. Pneumoparotid due to spirometry.

    Pneumoparotid has been described in patients who generate increased intraoral pressures when playing wind instruments, while coughing, and when undergoing dental work. Some patients have intentionally created pneumoparotid to avoid duties at school or in the military, or to gain attention. We describe a patient who developed pneumoparotid during pulmonary function testing. The diagnosis of pneumoparotid depends on a suggestive clinical situation and glandular swelling with or without crepitus. observation of aerated saliva per Stensen's duct or air in the parotid duct and/or gland by any imaging study is diagnostic if infection with a gas-forming organism can be reasonably excluded. No specific treatment is required, other than the avoidance of predisposing activities.
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4/39. Lung volume reduction surgery: new hope for emphysema patients.

    Lung volume reduction is a new surgical procedure for patients with severe emphysema. The hyperinflated portion of the lung or lungs is removed so the patient's chest wall and diaphragm can return to normal positions, easing breathing. This article describes the patient criteria, surgical procedure, and nursing problems and interventions related to the care of the lung volume reduction patient.
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5/39. ehlers-danlos syndrome type IV with a unique point mutation in COL3A1 and familial phenotype of myocardial infarction without organic coronary stenosis.

    We report on a 43-year-old male patient with ehlers-danlos syndrome (EDS) type IV with acute myocardial infarction (MI) without organic coronary stenosis. The disease was complicated with pneumothorax, subcutaneous and mediastinal emphysema, and splenic artery rupture. Three of the patient's family members suffered sudden cardiac death or MI. A diagnosis of EDS type IV was confirmed by decreased production of type III collagen by 86%. Mutation analysis revealed a point mutation in the COL3A1 gene that substituted glycine for aspartate at amino acid position 877. This mutation had not been reported as pathogenic for EDS type IV. These findings suggest close linkage between the mutation and the phenotype with familial MI.
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6/39. Emphysematous pyelonephritis.

    Emphysematous pyelonephritis is a severe form of acute pyelonephritis, characterised by fever, abdominal pain, nausea and vomiting, associated with intraparenchymal and perirenal gas production. It is often diagnosed radiologically, by plain films of abdomen, ultrasonogram and/or CT scan and often needs surgical drainage. We report a case which could be diagnosed clinically because of extensive surgical emphysema in a diabetic patient which was successfully managed by a combined medical and surgical approach.
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7/39. Gastrointestinal pneumatosis after docetaxel chemotherapy.

    breast cancer is one of the most frequent neoplasms in women. New drugs, including taxanes, have improved survival in patients with metastatic disease. quality of life and efficacy are important goals during treatment of these women. Herein, we report a 51 year-old woman with metastatic breast cancer who developed gastrointestinal pneumatosis (GIP) after the first cycle of treatment, which consisted of docetaxel and pamidronate. The symptoms disappeared after 7 days with supportive management, nasogastric intubation, parenteral fluids, and wide-spectrum antibiotics. Thereafter, weekly fractionated chemotherapy with an initial 50% dose reduction was administered. Because of adequate tolerance, the dose was increased by 25% after the second cycle, and full-dose docetaxel was administered after the third cycle. After 6 months of follow-up, the patient remained under treatment, with an Eastern Cooperative Oncology Group performance status of 1. Gastrointestinal pneumatosis has been reported in association with chemotherapy. In most patients, it is reported to be associated with neutropenia, which was not present in this patient.
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8/39. Periosteal infusion of bupivacaine/morphine post sternal fracture: a new analgesic technique.

    BACKGROUND AND OBJECTIVES: Sternal fracture pain is severe and is difficult to alleviate due to the forces acting on the chest wall during respiration. We describe a continuous infusion regional analgesic technique for pain due to sternal fracture. CASE REPORT: A 47-year-old woman presented with a spontaneous sternal fracture, precluding effective coughing. diclofenac and increasing doses of opioids did not give adequate pain relief and led to opioid toxicity. Two brief periods of analgesia were achieved with deep subcutaneous infiltration of bupivacaine. An epidural catheter was positioned periosteally, and an infusion of bupivacaine was commenced at 5 mL/h, achieving long-lasting analgesia. The bupivacaine concentration was reduced in a stepwise fashion from 0.5% to 0.25% and was changed to levobupivacaine after 3 days. Adding morphine (5 mg/60 mL levobupivicaine) permitted a reduction in infusion rate. The catheter was removed after 14 days because a local infection developed that resolved uneventfully with antibiotic therapy. CONCLUSIONS: Continuous infusion of local anesthetic and opioid to a sternal fracture site using a periosteally positioned catheter led to successful analgesia and hence improved respiratory function. Clinicians should consider placing a periosteal catheter when pain associated with sternal fracture cannot be adequately controlled with conventional methods.
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9/39. Microangiopathic haemolytic anaemia and thrombocytopenia following lung volume reduction surgery in a single lung transplant recipient on maintenance tacrolimus (FK506) therapy.

    Microangiopathic haemolytic anaemia (MAHA) describes intravascular haemolysis due to mechanical destruction of red cells as a result of pathological changes in small blood vessels. It is well recognized as a complication of cyclosporin A therapy in solid organ transplantation but has been uncommonly reported in association with tacrolimus therapy and never before in the setting of lung transplantation. Discussed is a 54-year-old female recipient of a left single lung transplant who developed anaemia, thrombocytopenia and red blood cell fragmentation consistent with MAHA following lung volume reduction surgery (VRS) of the native right lung in the setting of high serum tacrolimus levels. Treatment with fresh frozen plasma and plasmapharesis plus supportive therapy with blood and platelet transfusions resulted in successful resolution of the haemolytic process. Cyclosporin A was substituted for tacrolimus and 18 months later there has been no evidence of recurrence. tacrolimus therapy is a rare cause of MAHA in solid organ transplants but the diagnosis should be considered if there is an unexplained fall in haemoglobin and/or platelet count in the context of high serum tacrolimus levels.
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10/39. Recurrent pneumoparotid: cause and treatment.

    OBJECTIVE: To document the etiology and successful treatment of severe recurrent pneumoparotid. STUDY DESIGN: Computed tomography, ductal measurement by probe size, surgical treatment. RESULTS: We performed a superficial parotidectomy for a 13-year-old with a history of recurrent parotitis. He subsequently developed recurrent pneumoparotid in the contralateral gland with subcutaneous dissection of air into the face, neck, and mediastinum. At surgery, Stensen's ducts were measured and found to be abnormally patent bilaterally compared to standardized norms. Parotid duct ligation, commonly used for sialorrhea, was employed as a novel treatment and was curative. CONCLUSION: insufflation of air into the parotid duct system can trouble woodwind instrument players, can complicate dental procedures, or can be self-induced. It is generally a benign condition requiring no therapy. Occasionally, pneumoparotid can be recurrent and lead to inflammation and infection of the parotid or subcutaneous emphysema. SIGNIFICANCE: In selected cases of recurrent pneumoparotid, ductal ligation may be curative.
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ranking = 5
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