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At least 595 records · Page 33Linked to original sources
PubMed1993

Chest radiograph--a poor method for determining the size of a pneumothorax.

The ability of chest radiographs to determine the size of a pneumothorax was tested in 16 patients using computed tomographic (CT) scan as a reference method. To determine if CT with a slice thickness of 12 mm could be used, its accuracy was assessed in a lung model experiment. The lung model consisted of a water-filled plastic bag (lung) fitted into a plastic chamber (hemithorax), both of approximately the same size and shape as in man. Water was drawn off in incremental steps and a CT was done after each step. The area of the pneumothorax was calculated by computer and when multiplied by slice thickness and number of slices, the total volume of the pneumothorax could be compared with the extracted amount of water. A good correlation (r = 0.99), with the line of regression close to the line of identity, was found between the CT investigation and the artificial pneumothorax. In the patients, the size of the pneumothorax, judged by radiograph using two different methods of calculation, was correlated to the size obtained by CT. The correlation was poor (r = 0.71) irrespective of method of calculation. The size of the pneumothorax estimated by CT showed a good correlation (r = 0.99) to the initial aspirated air volumes in 12 of the 16 patients treated with drainage. A cautious attitude toward the use of chest radiographs for calculations of the degree of lung collapse in patients with pneumothorax is recommended.

Adult↗
PubMed2001

Thoracoscopy in the pediatric patient.

The pediatric applications of minimally invasive surgical procedures such as thoracoscopy continue to increase. Specific alterations in anesthetic management may be required during the perioperative care of these patients. This article reviews the anesthetic care of infants and children during thoracoscopy with emphasis on cardiopulmonary disturbances of the patient, techniques to isolate the operative and nonoperative lungs and provide one-lung ventilation to improve surgical visualization, cardiopulmonary alterations induced by the creation of the artificial pneumothorax or the absorption of CO2 by the plural surface, intraoperative management of one-lung ventilation, and the potential for and treatment of inadvertent CO2 embolism.

Anesthesia↗
PubMed1992

[The importance and urgency of pneumothorax].

In a group of 110 subject with pneumothorax some factors are evaluated which may influence its impact and urgency. Attention is devoted to the length of the disease before surgical treatment, to the most frequent basic and accessory diseases, methods and complications of therapy, its effect and to economic aspects. Treatment on account of thoracotomy was indicated in 8.2% subjects. A total of six patients died. The authors recorded an increase of artificial pneumothorax. They draw attention to the disproportionately severe sequelae which may be due to apparently insignificant causes. Cure within one week was achieved in two-thirds of the group, the mortality increased steeply with the increasing number of relapses of the disease.

Adult↗
PubMedDate not supplied

[Thoracoscopic bilateral sympathectomy in Raynaud's syndrome. Anesthesiology problems].

The objective of this paper was to examine the major anaesthetic problems during transthoracic endoscopic sympathectomy without artificial pneumothorax and to present our experience of 16 cases suffering from Raynaud's disease. For the perioperative management we used a double lumen endo-bronchial tube and balanced anaesthesia (intravenous agents plus isoflurane). Arterial pressure, heart rate, ECG, end-tidal carbon dioxide concentration, SatO2, blood gases and peak inspiratory pressures were monitored. The results showed that no significant changes in these parameters occurred during surgery. Since hypoxaemia is the main problem of the thoracoscopic sympathectomy the A.A. emphasize the necessity to ensure a correct ventilation as well as a haemodynamic stability throughout the procedure. The combination of balanced anaesthesia and double lumen endobronchial intubation seems an advisable method when no artificial pnx is instituted. A close monitoring of the circulatory and respiratory systems is imperative.

Adolescent↗
PubMed1996

Near-sitting position and two-lung ventilation for endoscopic transthoracic sympathectomy.

OBJECTIVE: To control for hypoxemia during endoscopic transthoracic sympathectomy, usually by using double-lumen tube and one-lung ventilation, a different anesthetic technique was adopted. DESIGN: A prospective clinical study. SETTING: A university-affiliated medical center. PARTICIPANTS: Twenty-one adult patients (10 male and 11 female) between 15 and 44 years of age (mean, 22 years), ASA (American Society of Anesthesiologists) physical status I and II, participated in the study. INTERVENTIONS: Under general anesthesia, a single-lumen endotracheal tube was inserted. The radial artery was cannulated for blood pressure monitoring and blood gas sampling. Patients were gradually raised from a supine position to 60 to 70 degrees from the horizontal plane. Mean fractional inspiratory O2 ratio was 0.4 +/- 0.02 (mixture of O2 and air) throughout the operation. Blood gas samples were taken during two-lung ventilation before surgery, at each one-chest operation, and when switching between the operated chest sides. An artificial pneumothorax was established by insufflation of CO2, the sympathetic chain coagulated, the pneumothorax released, and the lung reinflated. MEASUREMENTS AND MAIN RESULTS: Comparisons were performed using one-way analysis of variance and the Bonferroni post-test. Arterial O2 partial pressure at right- and left-chest operation were 209 +/- 83 and 189 +/- 63 mmHg, respectively, compared with 227 +/- 43 and 241 +/- 69 mmHg on two-lung ventilation before and during surgery, respectively. O2 saturation, arterial CO2 partial pressure, bicarbonate, base excess, peak inspiratory pressure, and hemodynamic parameters (in most patients) did not change throughout the operation. CONCLUSIONS: The near-sitting position, a single-lumen tube, and a continuous two-lung ventilation technique is simple and may prevent hypoxemia during endoscopic transthoracic sympathectomy.

Adolescent↗
PubMed1987

Non-Hodgkin's lymphoma of the pleural cavity developing from long-standing pyothorax.

Malignant lymphomas developing in tissue affected by a long-standing severe inflammatory process of nonautoimmune nature are presented. Two men and a woman aged 50, 58, and 73 years, were admitted after 22 to 30 year histories of pyothorax resulting from artificial pneumothorax for the treatment of pulmonary tuberculosis or tuberculous pleuritis. The diagnoses at admission were chronic pyothorax associated with a lung mass. Microscopically, tumors diffusely or locally proliferated with thickened pleura were present. A histologic examination showed that all the tumors were diffuse non-Hodgkin's lymphomas (NHL) of immunoblastic type with (one case) or without (two cases) plasmacytoid differentiation. Immunohistochemistry on paraffin sections revealed restricted expression of immunoglobulin light chains in one case showing plasmacytoid differentiation. A review of the literature showed that malignant lymphomas of this type have been reported exclusively from Japan but never from Western countries.

Aged↗
PubMed2005

Pyothorax-associated lymphoma: an unusual case with both T- and B-cell genotypes.

Pyothorax-associated lymphoma (PAL) is a B-cell lymphoma which develops in the pleural cavity of patients with an over-20-year history of pyothorax. Aberrant expression of surface antigens is occasional in PAL, although genotype is not fully investigated. We report here a PAL with dual genotype, i.e., simultaneous immunoglobin (Ig) and T-cell receptor (TcR) gene rearrangement. An 82-year-old woman with pain on the left side of the chest was admitted. She had been suffering from pyothorax after artificial pneumothorax for treatment of tuberculosis of the pulmonary when she was 18 years old. The mass that was confined to the left pleural cavity affected by pyothorax was biopsied and histologically diagnosed as diffuse large cell lymphoma. The tumor cells were positive for CD20, CD16, and TIA-1 but negative for CD79a, CD45RO, CD43, CD3, and CD56. Surface antigen expression was further investigated in cultured cells, showing that the cultured cells did not express representative B-cell markers, except for CD20, as well as T-cell markers, but were positive for CD16, CD30, and CD103. Southern blotting revealed the monoclonally rearranged bands of both Ig heavy chain and TcR gene. The patients died of tumors 14 months after admission. Aberrant genotype and immunophenotype of PAL cells is discussed in reviewing the pertinent literature.

Aged, 80 and over↗
PubMed1981

Empyema presenting over thirty years after pulmonary tuberculosis.

Four patients are described who presented with empyema between 32 and 53 years after pulmonary tuberculosis had been treated by artificial pneumothorax (A.P.) without chemotherapy. Diagnostic problems included non-specific radiographic features and failure to find a causative organism. Empyema should be considered when patients with old pulmonary tuberculosis deteriorate and there are non-specific radiographic changes. Antituberculosis chemotherapy, or even decortication, may be indicated if a pyogenic organism cannot be found.

Aged↗
PubMed2002

Percutaneous radiofrequency ablation therapy after intrathoracic saline solution infusion for liver tumor in the hepatic dome.

Two liver tumors undetected by ultrasonography (US) because they were located in the hepatic dome were treated with radiofrequency (RF) ablation therapy after intrathoracic saline solution infusion. After administration of local anesthesia, artificial pneumothorax was produced by needle thoracentesis and a drainage catheter was inserted into the right thoracic cavity. After saline solution (450-500 mL) was injected into the thoracic cavity via the catheter, US-guided RF ablation was performed. No severe complications occurred and complete therapeutic effects were obtained. Percutaneous RF ablation therapy with intrathoracic saline solution injection seems to be a feasible alternative to other ablation therapies.

Carcinoma, Hepatocellular↗
PubMed1985

Diagnostic thoracoscopy in pleuro-pulmonary infiltrates without pleural effusion.

In seven patients with pleuro-pulmonary infiltrates without pleural effusion, an artificial pneumothorax was induced, followed by diagnostic thoracoscopy, as the first and only invasive investigation; in all cases the diagnosis was confirmed by this simple procedure. The method has a low mortality correlated to other alternative diagnostic methods.

Aged↗
PubMed2003

B-cell marker negative (CD7+, CD19-) Epstein-Barr virus-related pyothorax-associated lymphoma with rearrangement in the JH gene.

Pyothorax-associated lymphoma (PAL) develops decades after receiving artificial pneumothorax for pulmonary tuberculosis. The lymphomas, develop in tissue affected by long-standing severe inflammatory process. Most cases demonstrate diffuse large B-cell lymphoma. We present a patient with T-cell phenotype-positive and B-cell phenotype-negative (CD7+, CD43+, CD19-, and CD20-) PAL. Southern blot hybridization using immunglobulin heavy chain J region (IgH) gene probe revealed a monoclonal rearrangement, and hybridization using T-cell receptor beta chain (TCR) gene probe revealed a germline configuration. This indicates that the tumor origin was of B-lymphocytes. Chromosomal abnormality of the lymphoma was complicated. It suggested that many transformations occurred. In the transformation process, probably B-cell antigens were lost, and T-cell antigens were aberrantly expressed.

Aged↗
PubMed1980

Two forgotten pioneers. James Carson and George Bodington.

James Carson, a Scot, graduated from Edinburgh in 1799. He settled in Liverpool where he became a successful and respected physician and where he also found time to pursue a longstanding interest in physiology and to conduct certain important experiments. He read a series of papers on these experiments and their import before the Literary and Philosophical Society of Liverpool of which the two most important were On the elasticity of the lungs and On lesions of the lungs. In the first he clarified the mechanics of respiration while in the second he suggested that this knowledge might be employed to produce temporary collapse of the lung as a therapeutic measure. Two attempts at a clinical trial were defeated by widespread pleural adhesions but the first recorded attempts at artificial pneumothorax had been made. George Bodington, a Warwickshire man, after serving a surgical apprenticeship studied at St Bartholomew's Hospital and obtained the licence of the Society of Apothecaries in 1825. He later practised near Sutton Coldfield where he was known as an acute observer and a thoughtful and fluent speaker. In 1840 he published an essay on the treatment and cure of pulmonary consumption in which he roundly condemned the current therapy and advocated instead fresh air in abundance, gentle exercise in the open, an adequate and varied diet, and a minimum of medicaments. Violently attacked by the reviewers he became discouraged about tuberculosis and devoted the remainder of his professional life to the care of the mentally ill.

Collapse Therapy↗
PubMed1987

Late sequelae of pulmonary tuberculosis treated by thoracoplasty.

With the help of information provided by the Office of Population, Censuses and Surveys the survival up to 1 July 1985 of the 171 patients treated for pulmonary tuberculosis by thoracoplasty at Papworth from 1951 to 1953 was determined. Thirteen (8%) could not be traced, 65 (38%) had died, and 93 (54%) were alive. For those who were traced the survival at 10, 20, and 30 years from the date of operation was 93%, 79%, and 65%. This represents a significantly greater mortality rate than that predicted from the Registrar General's review of deaths in England and Wales (1841-1984). Nineteen patients died from cardiorespiratory failure. Eight of the survivors are known to have developed respiratory failure, five having enjoyed apparently good health before this was precipitated by intercurrent illness or drugs. A stepwise logistic regression analysis using information from the 124 patients for whom full details were available showed significant associations between the development of cardiorespiratory or respiratory failure and a preoperative contralateral artificial pneumothorax, older age at operation, the presence of cavities before operation, and male sex. In a questionnaire 50 of the survivors (57% of those who replied) reported cough, 45 (51%) breathlessness, 41 (47%) wheeze, and 24 (27%) ankle swelling. Nineteen (22%) smoke and the same number now attend a chest clinic. Many patients treated for tuberculosis by thoracoplasty have respiratory symptoms and some are at risk of respiratory failure. There are grounds for considering that they should be reviewed periodically by a chest physician.

Adolescent↗