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Biomedical subjects

M Helsted

Publications and source records attributed to M Helsted.

8 recordsLinked to original sources

[Traumatic rupture of a main bronchus. Clinical and peroperative presentation, physiopathological mechanisms, treatment and late sequelae].

On the basis of a case report, the clinical and peroperative features of bronchial rupture caused by blunt thoracic trauma, theories concerning the pathophysiological mechanisms, the treatment and outcome are reviewed. Two distinct clinical presentations may occur: (a) with free communication between the bronchus and the pleura (as in the present case) and (b) with little or no communication. The suspected diagnosis is confirmed by bronchoscopy. Peroperatively, bronchial rupture is seen at places of reduced resistance (the junction between the cartilaginous and the membranous trachea or bronchus and the annular ligaments) and typically within 2.5 cm from the carina. The pathophysiological basis includes three mechanisms: decrease in the anteroposterior diameter of the thorax, sudden increase in intrabronchial pressure with a closed glottis and rapid deceleration. These mechanisms may occur independently or together. The initial treatment aims at maintaining the airway, reversing shock and relieving pneumothorax. Surgical repair should follow as soon as the condition of the patient permits. The optimal surgical technique is identical with that employed for vascular anastomoses. Surgical repair of bronchial rupture should only be omitted if extensive parenchymal pulmonary damage and/or suppuration are present. Even after years of delay, reconstruction will lead to partial recovery of pulmonary function.

Adult↗

Popliteal venous aneurysms with or without pulmonary embolism.

Popliteal venous aneurysms are rare and are most often found in patients with pulmonary embolism suggesting that such aneurysms are thrombogenic. Only 16 cases have been found in the past and only a few of these patients were without thrombus or pulmonary embolism. In this paper three patients are presented of whom two showed signs of thrombus. Surgical resection was performed to prevent thrombosis with a successful result. The literature is reviewed and according to this and our own experience surgical resection under cover of anti-coagulation is recommended. Our surgical technique is presented.

Aged↗

Efficacy of enprofylline in acute airway obstruction.

The efficacy and safety of different regimens of intravenously administered enprofylline, an anti-asthma xanthine, were evaluated in a randomized open study, including 155 patients with acute exacerbation of obstructive lung disease. The regimen 2.5 mg/kg i.v. over 10 min was canceled after seven patients had been included, due to two cases of hypotensive/vasovagal reactions. The regimens 2.0 mg/kg/20 min and 2.5 mg/kg/20 min were significantly more effective with regard to bronchodilation than 2.0 mg/kg/10 min (PEF increase +35%, +30% and +17% respectively). Nausea and headache were the most common side effects (16-33% and 23-33% of the patients respectively on different regimens) with the lowest frequency on 2.0 mg/kg/20 min. Four additional hypotensive reactions occurred; one on each 2.0 mg/kg regimen and two on 2.5 mg/kg/20 min. The regimen 2.0 mg/kg20 min was found to be the most favourable with regard to efficacy and side effects. Enprofylline i.v. was found to be an effective bronchodilating treatment of acute airway obstruction but the frequency of side effects has to be considered.

Acute Disease↗

Popliteal venous aneurysm.

A case of popliteal venous aneurysm in a 69-year-old male is presented. Although rare these aneurysms are potential sources of thromboembolism indicated by the fact that they are most often discovered in patients with a history of recurrent pulmonary embolism. The aneurysm was successfully treated by simple surgical resection and a short course of oral anticoagulants.

Aneurysm↗

Primary paraganglioma of the lung. Report of two cases and review of the literature.

Two cases of primary paragangliomas of the lung are presented. The first occurred in a 69-year-old woman and was a grossly and histologically benign tumour. The other case occurred in a 33-year-old woman who had metastases to the peribronchial lymph nodes. This seems to be the second malignant case reported. No evidence of recurrence nor metastatic disease was found at follow-up, 8 months for the first case and 7 years for the second, respectively. The morphological and immunohistochemical findings are discussed and the literature comprising 20 cases is reviewed.

Aged↗