Cases reported "Pneumothorax"

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1/112. Use of postoperative chest x-ray after elective adult tracheotomy.

    Surgeons have been creating tracheotomies since at least 124 AD, when first reported by Asclepiades (Price HC, Postma DS. Ear nose Throat J 1983;62:44-59). Intraoperative and postoperative complications specifically associated with this procedure have been well established. The incidence of pneumothorax ranges from 0% to 17%, depending on the age group studied. To evaluate this complication, it is generally accepted that a postoperative chest film should routinely be obtained after a tracheotomy in adult patients. In adult nonemergent tracheotomies, the routine use of a postoperative chest film has a low yield for detecting a pneumothorax in patients without clinical findings of pneumothorax. To evaluate the use of postoperative chest x-ray in adult tracheotomy patients, a retrospective review of tracheotomies performed at the boston Medical Center from January 1994 to June 1996 was undertaken. Data examined consisted of age, sex, surgical indication, urgency, operating service, intraoperative and postoperative complications, difficulty of procedure, anesthetic technique, findings on postoperative chest film, signs and symptoms of pneumothorax, and specific treatment of pneumothorax if present. In total, 250 patients were identified. The main indication for tracheostomy in this study was ventilator dependence, accounting for 77% of the procedures. A complication rate of 11.6% was encountered, with no deaths. postoperative hemorrhage was the most common complication (3.6%). pneumothorax was documented by chest x-ray in 3 (1.2%) patients, 1 of whom had bilateral pneumothoraces. The most common symptom of a pneumothorax was tachycardia, with 8.8% of the patients exhibiting at least 1 episode. Of the 3 cases of pneumothorax in this study, only 1 was clinically relevant and required treatment. Furthermore, the clinical signs and symptoms in this patient clearly supported the diagnosis of pneumothorax before a postoperative chest film was obtained. Thus postoperative chest radiographs did not change the treatment or outcome of any of the patients undergoing a tracheotomy. This suggests that postoperative chest x-ray after adult tracheotomy is not required in routine cases. Chest radiographs should be obtained after emergent procedures, after difficult procedures, or in patients exhibiting signs or symptoms of pneumothorax.
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2/112. Late pleuropulmonary aspergillosis after the treatment of pneumothorax: report of three cases.

    A bullectomy for spontaneous pneumothorax is often combined with pleurodesis to prevent recurrence. A recurrent or progressive residual bullous lung beneath adhesive pleura neovascularized from the chest wall may be affected by aspergillosis. Of the 12 patients with pulmonary aspergillosis secondary to bullous lung disease treated surgically at our hospital since 1974, 3 underwent a bullectomy with pleurodesis for spontaneous pneumothorax. The presenting symptoms in all cases were hemosputum. aspergillus lesions affected the patients in the right upper lobe, the left apical segment, and both apical segments at 16, 9, and 13 years, respectively, after a bullectomy. Angiograms demonstrated hypervascularization in the intercostal and internal thoracic arteries, as well as in the bronchial branches. Catheter embolization for airway bleeding was not effective in 1 patient. Four operations, including an emergency procedure for massive intrapulmonary bleeding, were performed. These included a right upper lobectomy followed by a left upper segmentectomy at second-look operation in 1 patient who required bilateral chest wall resections. All patients survived the operations. Intraoperative bleeding ranged between 700 and 3 500 ml (1 543 ml on average), and bleeding foci were mainly from the chest wall, with hypervascularization stemming from the ipsilateral chest wall. postoperative complications included pleural space hemorrhaging and a bronchopleural fistula, both of which required additional chest wall resections. patients with bullous lung disease late after a bullectomy with pleurodesis may thus be associated with complex pleuropulmonary aspergillosis, which requires surgical therapy concomitant with a chest wall resection.
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3/112. life-threatening nail gun injuries.

    The use of pneumatic and explosive cartridge-activated nail guns is common in the construction industry. The ease and speed of nailing these tools afford enhance productivity at the cost of increased potential for traumatic injury. Although extremity injuries are most common, life-threatening injuries to the head, neck, chest, or abdomen and pelvis may occur. During a 20-month period, eight potentially life-threatening nail gun injuries were admitted to a Level I trauma center, including injuries to the brain, eye, neck, heart, lung, and femoral artery. Mechanism of injury included nail ricochet, nail gun misuse due to inadequate training, and successful suicide. Nail guns have significant potential for causing severe debilitating injury and death. These findings indicate a need for improved safety features and user education. The various types of nail guns, their ballistic potential, and techniques for operative management are discussed.
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4/112. Successful management of spontaneous pneumothorax during general anaesthesia in a patient with eosinophilia.

    A 10-year-old male patient posted for left elbow arthrolysis developed pneumothorax during general anaesthesia. He had history of upper respiratory tract infection and high eosinophil count, which remained high in spite of treatment. In such patients, it is advisable to use steroid pre-operatively & intraoperatively to produce transient eosinopenia so that complications of eosinophilia are avoided.
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5/112. Video-assisted thoracoscopic surgical pleurodesis for persistent spontaneous pneumothorax in late pregnancy.

    A case of persistent spontaneous pneumothorax in the third trimester of pregnancy managed by video-assisted thoracoscopic surgical pleurodesis is presented. Anaesthetic and perioperative considerations are discussed.
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6/112. Oesophageal rupture in a patient with postoperative nausea and vomiting.

    rupture of the oesophagus (Boerhaave's syndrome) is a rare complication of forceful or suppressed vomiting. postoperative nausea and vomiting is common but does not usually lead to life-threatening complications. A case of oesophageal rupture in a man who experienced postoperative nausea and vomiting after an uncomplicated procedure is described in this report. delayed diagnosis mandated conservative treatment. The clinical presentation, diagnosis and management of oesophageal rupture is discussed.
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ranking = 0.375
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7/112. Unsuspected lung cancer accompanied by catamenial pneumothorax.

    A 45-year-old nonsmoking woman with repeated coughing and dyspnea on effort was admitted to our hospital diagnosed with right-sided pneumothorax on chest X-ray. Chest computed tomography showed neither bullae nor nodules. Chest drainage failed to completely reexpand the lung, necessitating video-assisted thoracic surgery. thoracoscopy showed pleural thickening in the apical segment without bullae or air leakage, dark-brown pigmentation of the diaphragm, and an unsuspected small nodule about 5 mm in diameter on the diaphragmatic surface of the right lower lobe. pneumothorax was treated by mechanical abrasion of parietal pleura and upper lobe wedge resection. The lower lobe and nodule were wedge-resected using staplers. The nodule was bronchioloalveolar carcinoma of Noguchi's type B. To improve curability and check for diaphragmatic lesions, right posterolateral thoracotomy was conducted on post-video-assisted thoracic surgery day 28. Aggressive intraoperative lymph node exploration yielded no remarkable histological findings. Nonanatomical lower lobe wedge resection was done and the diaphragm with pinhole-like perforations was partially resected. The resected lung showed no cancerous tissue. Endometrial tissue was histologically confirmed in the resected diaphragm. The patient has remained asymptomatic in 14-month follow-up. This is, to our knowledge, the first lung cancer accompanied by catamenial pneumothorax.
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8/112. Recurrent spontaneous pneumothoraces associated with juvenile polymyositis.

    A 17-year-old man, who had received a diagnosis of juvenile polymyositis (PM) at the age of 1 year, developed recurrent spontaneous pneumothoraces and underwent surgical treatment by means of video-assisted thoracic surgery. Intraoperative observation and microscopic studies demonstrated numerous bleb-like lesions below the visceral pleura. To our knowledge, this is the first article that describes a case of spontaneous pneumothorax associated with PM. Our observation should lead to broadening of the spectrum of pleuropulmonary manifestations of PM.
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9/112. Bilateral tension pneumothorax during jet ventilation: a case report.

    Jet ventilation (JV) involves high-pressure ventilation for upper laryngeal laser procedures. Anesthetic management for the patient undergoing JV can be challenging, as complications of JV can include subcutaneous emphysema and tension pneumothorax. A 52-year-old woman with a diagnosis of vocal cord polyps presented for direct microlaryngoscopy and laser laryngoplasty with JV. Intraoperatively, the patient developed lack of bilateral chest movement and an audible change in jet-ventilatory sounds. The patient was reintubated with a standard endotracheal tube. Subsequent attempts to ventilate the patient failed. A diagnosis of bilateral tension pneumothorax was made. Immediate pleural decompression resulted in improved ventilatory and hemodynamic status. The purpose of this case report is to discuss the pathophysiology related to tension pneumothorax and anesthetic implications for management of cases involving JV.
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10/112. pneumonia presenting as acute abdomen in children: a report of three cases.

    From 10th September 1998 till 5th June 1999, the Paediatric and Cardiothoracic Surgery Units of Sultanah Aminah Hospital Johor Bahru managed three children with lung collapse secondary to pneumonia. The dominant initial clinical presentation in all three cases was acute abdominal pain. Basal pneumonia was diagnosed in two cases post-operatively after surgical contributory causes were excluded intra-operatively. thoracotomy, evacuation of infected debris and decortication of the collapsed lung was done in all three cases. In children presenting with acute abdominal pain, basal pneumonia should be considered as a possible contributory cause.
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