Cases reported "Pneumothorax"

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11/36. Management of advanced ARDS complicated by bilateral pneumothoraces with high-frequency oscillatory ventilation in an adult.

    We report the case of a 33-yr-old patient with adult respiratory distress syndrome (ARDS) complicated by bilateral pneumothoraces, who was successfully treated with high-frequency oscillatory ventilation following failure to respond to conventional ventilation. The role of high-frequency ventilation in the management of ARDS and air leaks is discussed.
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12/36. music: a new cause of primary spontaneous pneumothorax.

    Most cases of primary spontaneous pneumothorax are thought to be caused by air leaks at so-called "emphysema-like changes" or in areas of pleural porosity at the surface of the lung. Environmental pressure swings may cause air leaks as a result of transpulmonary pressure changes across areas of trapped gas in the distal lung. This is the first report of music as a specific form of air pressure change causing pneumothorax (five episodes in four patients). While rupture of the interface between the alveolar space and pleural cavity in these patients may be linked to the mechanical effects of acute transpulmonary pressure differences caused by exposure to sound energy in association with some form of distal air trapping, we speculate that repetitive pressure changes in the high energy-low frequency range of the sound exposures is more likely to be responsible. Exposure to loud music should be included as a precipitating factor in the history of patients with spontaneous pneumothorax.
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13/36. Lobar bronchial blockade in bronchopleural fistula.

    A 59-yr-old man with bullous lung disease developed a refractory bronchopleural fistula involving the right upper lobe. Despite independent lung and high-frequency jet ventilation, a large air leak persisted. Following the introduction of a bronchial blocker into the right upper lobe bronchus via the tracheal lumen of a left-sided endobronchial tube, oxygenation and ventilation improved, and the airleak was reduced by 90%. The presence of pneumonia led to an inexorably downhill course with death from overwhelming sepsis.
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14/36. fibrin glue for persistent pneumothorax in an extremely low birth weight infant.

    pleurodesis with fibrin glue has been used to treat bronchopleural fistulas and persistent air leaks in adults and neonates. We report successful use of fibrin glue in an extremely premature infant to seal a pneumothorax that had persisted for more than one week despite high-frequency ventilation.
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15/36. Pneumothorax complicating small-bore feeding tube placement.

    Small-bore Silastic feeding tubes are being used with increasing frequency for short- and long-term enteral hyperalimentation. We present three cases where these flexible tubes were passed into the tracheobronchial tree and then out into the pleural space. The result in each case was a pneumothorax or hydropneumothorax. These cases were collected at one community hospital over a 6-month period. A review of the current literature reveals reports of 10 similar cases. We conclude that, although the exact incidence of pleural complications of small-bore feeding tubes is unknown, it is not insignificant. The traditional methods of assessing proper nasogastric tube placement are inadequate when applied to these small tubes. Only a chest roentgenogram can assure placement in the stomach. education of hospital staff on methods to avoid malposition of feeding tubes has resulted in an absence of pulmonary complications over a subsequent 1-year period.
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16/36. Intrapleural tetracycline for spontaneous pneumothorax in acquired immunodeficiency syndrome.

    Spontaneous pneumothorax is occurring in patients with the acquired immunodeficiency syndrome and pneumocystis carinii infection with increasing frequency. These patients are typically poor surgical candidates. Conservative management using tetracycline sclerosis was performed with good results in a patient with acquired immunodeficiency syndrome and recurrent pneumothorax.
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17/36. Recurrent pneumothorax in AIDS patients with Pneumocystis pneumonia. A clinicopathologic report of three cases and review of the literature.

    Spontaneous pneumothorax associated with pneumocystis carinii pneumonia (PCP) in AIDS patients has been reported with increasing frequency; however, little is known about the causative histopathology. In the past year, we treated three patients with documented PCP subsequently complicated by multiple spontaneous pneumothoraces. All patients underwent open surgical repair. In contrast to traditional pathologic findings of PCP in AIDS, histologic sections of lung from each patient consistently demonstrated an extensive interstitial inflammatory process with destruction of lung tissue primarily involving the periphery of the lung. Subpleural necrosis with bleb formation as well as bullous changes persisted even in the absence of an alveolar filling process. We conclude that the mechanism for pneumothorax in PCP is spontaneous rupture of necrotic lung tissue occurring in a subgroup of AIDS patients in which the interstitial inflammatory response to Pneumocystis has been accelerated.
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18/36. Two cases of barotrauma associated with transtracheal jet ventilation.

    Two patients suffered barotrauma whilst undergoing transtracheal jet ventilation (TTJV). In the first, TTJV was provided by a Sanders injector and in the second it was given by a high frequency jet ventilator. barotrauma was a consequence of the expiratory pathway becoming blocked. The mechanism of barotrauma and a method of airway pressure monitoring during TTJV are discussed. It is recommended that meticulous care is taken to ensure an adequate path for expiration when jet ventilation is used.
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19/36. Iatrogenic perforation of the bronchus intermedius in a 1,100-g neonate.

    A 1,100-g infant was found to have a right tension pneumothorax following multiple attempts at endotracheal intubation. Despite the use of high-frequency ventilation, adequate oxygenation was not possible. bronchoscopy was hazardous, and bronchography of the right lung using propyliodone oil suspension confirmed perforation of the bronchus intermedius. At thoracotomy, while on high-frequency ventilation, the size of the perforation precluded suture repair, and right middle and lower lobectomies were performed. Follow-up at 1 year showed a small, though healthy infant. review of the surgical literature has not documented successful operative management of bronchial perforation in a neonate. Selective bronchography was precise in identifying the site of perforation and was well tolerated.
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20/36. Median sternotomy with bilateral bullous resection for unilateral spontaneous pneumothorax, with special reference to operative indications.

    Simultaneous bilateral pulmonary operations were done through median sternotomy in 29 patients with unilateral spontaneous pneumothorax, because bullae and blebs of the lung are frequently bilateral. Bullous lesions on the contralateral lung were encountered in eight of 10 patients (80%) in whom no roentgenographic evidence of the additional lesions had been detected preoperatively. Postoperative examination of percent vital capacity was satisfactory (more than 80%) in 21 of 23 patients followed up over a month after operation, and this suggested that simultaneous bilateral thoracotomy through median sternotomy does not lead to a much greater decrease in postoperative pulmonary function than does unilateral operation. To determine the indications for this method of treatment, we investigated the frequency of subsequent development of contralateral pneumothorax in 178 patients who initially had unilateral spontaneous pneumothorax. The occurrence rate of contralateral pneumothorax with visible bullae on chest roentgenograms was as high as 60% and 33.3% in patients in their teens and in those in their 20s, respectively. In conclusion, therefore, the bilateral operative approach should be considered, especially in teenaged patients with contralateral bullae, in whom the highest contralateral occurrence rate of 60% was found.
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