Cases reported "Respiratory Insufficiency"

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1/26. phentolamine improves clinical outcome after balloon valvoplasty in neonates with severe pulmonary stenosis.

    Two neonates with severe pulmonary stenosis deteriorated immediately after successful balloon valvoplasty as a result of increased infundibular obstruction. They were treated with beta-adrenoceptor blockers and intravascular expansion with limited success. phentolamine was then given, resulting in dramatic improvement. The children could be weaned from the ventilator within hours of starting this new therapeutic modality.
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ranking = 1
keywords = stenosis
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2/26. Surfactant treatment in a pediatric burn patient with respiratory failure.

    This report describes surfactant treatment in a burned infant with severe respiratory failure. In this patient the instillation of surfactant rapidly improved compliance, oxygen index (OI), and alveolar-capillary oxygen gradient (AaDO2), while the need for oxygen supplementation and peak positive pressure drastically decreased. The treatment was repeated after 12 hours. Although the baby had severe clinical course complications as a Gram-negative sepsis and a subglottic stenosis, she was weaned from oxygen therapy and mechanical ventilation in few weeks. Surfactant dysfunctions seem to play a central role in the respiratory insufficiency of burned patients, and its exogenous replacements could improve their outcome.
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ranking = 0.2
keywords = stenosis
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3/26. Malignant laryngotracheal obstruction: a way to treat serial stenoses of the upper airways.

    BACKGROUND: Six patients known to have inoperable esophageal carcinoma presented with stridor due to both malignant tracheal stenosis (n = 6) and bilateral vocal cord paralysis. Two patients also had respiratory-digestive fistula. methods: Patency was restored by endotracheal stenting plus unilateral cordectomy. Four patients had immediate relief. Two patients required enlargement of the cord incision. One of them declined reoperation and underwent tracheotomy. RESULTS: Stent function was uneventful. There was no dislodgement or mucous impaction. fistula seal was complete. There was no aspiration through the new-shaped glottic orifice. Peak expiratory flow increased from 24.4% /- 9.7% predicted normal before to 40.5% /- 13.7% after the procedure, whereas the dyspnea score decreased from 74.2 /- 12.7 to 24.2 /- 14.0. CONCLUSIONS: Restoration of airway continuity in serial laryngotracheal stenoses using a combined approach is a feasible technique in end-stage cancer patients. It effectively relieves respiratory distress and ensures voice preservation. In addition, it may avoid the risks of tracheotomy.
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ranking = 111.51637774216
keywords = tracheal stenosis, stenosis
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4/26. Avoiding intubation in the injured subglottis: the role of heliox therapy.

    intubation in the child presenting with severe viral tracheobronchitis or prior subglottic injury can be detrimental to the child and the subglottis. intubation may lead to further mucosal ischemia, scar, subglottic stenosis, or failed extubation requiring a tracheotomy. Heliox is a combination of helium and oxygen that produces less-dense gas exchange. Its use leads to a decrease in turbulent airflow, which may obviate the need for intubation. Here we report our experience using heliox as initial therapy in 14 consecutive children presenting with severe airway distress and the need for intubation. (Five had viral tracheobronchitis, 5 had inflammatory exacerbation of subglottic stenosis, and 4 had acute iatrogenic subglottic injury.) In 10 of the 14 children, intubation, which can lead to mucosal injury and scarring, was avoided by the use of heliox therapy. Of the 4 children in whom heliox therapy failed, 3 had a prior history of subglottic stenosis. Heliox is a relatively safe and reliable alternative to intubation of children with severe subglottic edema or injury. Heliox should be considered before intubation for selected children with subglottic inflammation and severe airway distress.
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ranking = 0.6
keywords = stenosis
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5/26. Respiratory arrest after successful neodymium:yttrium-aluminum-garnet laser treatment of subglottic tracheal stenosis.

    IMPLICATIONS: We describe a patient who developed respiratory arrest 4 h after successful laser treatment of tracheal stenosis. Respiratory arrest was caused, presumably, by airway narrowing due to delayed tissue edema secondary to thermal injury by deep penetration of the laser beam.
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ranking = 557.5818887108
keywords = tracheal stenosis, stenosis
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6/26. Long distance road transport of a patient with Wegener's Granulomatosis and respiratory failure using extracorporeal membrane oxygenation.

    Wegener's Granulomatosis is a necrotizing vasculitis that in its most severe form can cause respiratory failure, renal failure and subglottic stenosis requiring surgical airway access. We describe the use of portable extracorporeal membrane oxygenation and the long distance road transport of a patient with Wegener's Granulomatosis who developed respiratory failure that was refractory to conventional mechanical ventilation. We have demonstrated the effective use of portable extracorporeal membrane oxygenation for stabilization and safe acute interhospital transfer over a long distance by road ambulance to a tertiary centre for further management.
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ranking = 0.2
keywords = stenosis
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7/26. Double respiratory sequelae of head injury: subglottic stenosis and bilateral pneumothoraces.

    An 18-yr-old man with insulin-dependent diabetes developed severe subglottic stenosis after a very brief period of intubation. Emergency tracheostomy was complicated by the development of bilateral pneumothoraces. This case highlights the importance of making an early diagnosis to minimize the risk of complications and examines postintubation subglottic stenosis in the context of poorly controlled insulin-dependent diabetes mellitus.
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ranking = 1.2
keywords = stenosis
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8/26. Bilateral congenital dacryocystocele as a cause of respiratory distress in a newborn.

    Newborns with respiratory distress and nasal obstruction must be examined for congenital dacryocystocele. This disease is caused by a stenosis in the proximal and distal area of the nasolacrimal duct and leads to a cystic dilatation of this duct. A case of a newborn with bilateral dacryocystocele and dyspnoea is presented. The otorhinolaryngologic as well as the paediatric examination could only reveal in the rhinoscopic examination a tumor of the left nasal cavity that partly obstructed the endonasal space. No other pathologic findings were detected. To clarify the origin and the localization of the tumor as well as to exclude an intracranial relation, a magnetic resonance imaging of the middle face and the frontal skull base was performed. After probe and rinsing of the lacrimal ducts the symptoms improved rapidly. In newborns with nasal obstruction a bilateral rhinoscopy of the lower nasal meatus is required to exclude the existence of a dacryocystocele.
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ranking = 0.2
keywords = stenosis
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9/26. Surgical emphysema: a rare presentation of foreign body inhalation.

    An 11-year-old girl with an almond lodging in the tracheobronchial tree is described. She presented with an uncommon symptom of subcutaneous emphysema The x-ray revealed left-sided pneumothorax and pneumomediastinum. Intercostal drain was inserted, but she developed respiratory failure and was ventilated. After initial stabilization for 60 hours, she deteriorated again and her x-ray revealed right-sided collapse. After removal of the foreign body, she was discharged but presented again with stridor necessitating tracheostomy. tracheal stenosis was found and required end-to-end anastomosis. The authors feel that, while foreign bodies are uncommon in this age group with emphysema as a rarer manifestation, this cause should be kept in mind, even in the absence of forthcoming history. A high index of suspicion for tracheobronchial foreign body is required in atypical presentations of acute pediatric respiratory distress.
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ranking = 0.2
keywords = stenosis
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10/26. Slide tracheoplasty for congenital tracheal stenosis with glottic stenosis.

    A 7-month-old child with respiratory distress was diagnosed to have full-length tracheal stenosis with glottic stenosis. Slide tracheoplasty and anterior cricoid split with stenting for glottic stenosis were successfully performed, and the child has completed 5 years of asymptomatic follow-up. This case widens the scope for slide tracheoplasty, and cricoid split with stenting is a feasible procedure for associated glottic stenosis.
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ranking = 558.9818887108
keywords = tracheal stenosis, stenosis
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