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At least 1,549 records · Page 86Linked to original sources
PubMed1975

Mediastinal esophageal duplication cyst associated with a partial pericardial defect.

A two-year-old girl with a mediastinal esophageal duplication cyst is the twelfth example of a thoracic cyst of foregut origin or pulmonary "sequestration" (bronchopulmonary foregut malformation according to the expanded definition of Gerle et al.) that has been associated with a partial pericardial defect on the same side, suggesting that anomalous thoracic masses of several morphologic types have a similar pathogenesis.

Bronchopulmonary Sequestration↗
PubMed2003

[Life-threatening displacement of a tracheostomy tube in a patient with severe angiotensin-converting enzyme inhibitor-induced angioedema].

Angioedema of the lips and the tongue with pharyngeal and laryngeal involvement caused by angiotensin-converting enzyme inhibitors (ACEI) is rare but can cause severe airway compromise and even death due to suffocation. We present the case of a 83-year-old woman with a life-threatening displacement of a tracheostomy tube followed by tension pneumothorax after initial successful treatment of such an airway obstruction by emergency tracheostomy. This case highlights the hazards of tracheostomy tube displacement and is a reminder that where concern of tube dislodgement exists and especially when the possibility of orotracheal intubation is lacking due to upper airway obstruction or difficult airway, permanent epithelized tracheostomy should be performed early to ensure safe and fast tube replacement at any time.

Aged↗
PubMed1997

[Delayed complications after extrapleural pneumonolysis for lung tuberculosis].

The epidemic spread of tuberculosis after World War II and the deficiency of appropriate antituberculotic drugs led to a renaissance of surgical procedure such as plombage thoracoplasty, initiated in 1891 by Tuffier. Especially in Germany the insertion of paraffin and polyethylene was used in order to achieve an extrapleural pneumothorax in order to collapse the tuberculous cavities in the upper lobes. Due to a high rate of early complications and the assumed cancerogenicity, in a considerable number of cases the material was removed soon after its deployment. In some cases with the filling remaining in place, 30-40 years later infections and/or neoplasms occurred. From 1985 to 1996 in two centers of thoracic surgery 13 patients underwent procedures for removal of filling material. The patients suffered from infections (n = 11), malignant lymphoma associated with infection of the plombage (n = 1) and bronchial carcinoma (n = 1). Technically, we performed the thoracoplasty described by Schede (n = 9). Schede's thoracoplasty in combination with a muscle flap repair (n = 1) or partial resection of the thoracic wall (n = 1), an empyemectomy (n = 1), and an en-bloc pleuropneumonectomy (n = 1). All patients suffered from multiple underlying diseases (COPD, coronary heart disease, diabetes mellitus). However, apart from beside two procedure related deaths (pulmonary embolism n = 1, pneumonia complicated by multi-organ failure n = 1) no other major complications were observed. The plombage material in the case of malignant lymphoma is probably carcinogenic in relation to the time of exposure and should be removed in all cases.

Adult↗
PubMed2005

Thoracoscopic repair of congenital diaphragmatic hernia by inflation-assisted bowel reduction, in a resuscitated neonate: a better access?

Elective endoscopic diaphragmatic hernia repairs have been reported. But endoscopic surgery was regarded unsuitable for emergency repair of diaphragmatic hernia in ventilated newborn children in bad general condition. We report a new method for inflation-assisted reduction and thoracoscopic repair of congenital diaphragmatic hernia diaphragmatic in a vitally endangered neonate. From three 2.7 mm to 5 mm accesses warmed low-pressure, low-volume CO2 was inflated into the thorax at 100 ml/min and 2 mm mercury. This allowed spontaneous reduction of the thoracic viscera into the abdomen and diaphragmatic suture with minimal handling. The 65-min procedure was tolerated well without perioperative deterioration. The baby was weaned off the respirator and breast-fed within 2 days, mediastinal shift normalized in 6 days. In suitable infants thoracoscopic repair and inflation-assisted reduction of thoracic contents is a more physiological access to congenital diaphragmatic hernia than laparoscopy or laparotomy.

Hernia, Diaphragmatic↗
PubMed2001

Optimal positive end-expiratory pressure (PEEP) settings in differential lung ventilation during simultaneous unilateral pneumothorax and laparoscopy: an experimental study in pigs.

BACKGROUND: A combined thoraco-laparoscopic technique for esophageal resection is technically possible, but it requires special attention to ventilation. The positive insufflation pressure normally used in laparoscopy will, when communication between thorax and abdomen is established, create a pneumothorax. METHODS: We performed an experimental study of differential lung ventilation with different levels of positive end-expiratory pressure (PEEP) settings during thoraco-laparoscopy in anesthetized pigs. RESULTS: Positive pressure insufflation of carbon dioxide (CO2) resulted in elevated pulmonary capillary wedge pressure, hypercarbia, and respiratory acidosis. Hypoxemia, however, developed only at lower settings of PEEP. Heart rate, mean arterial pressure, and cardiac output remained relatively stable. CONCLUSION: Pneumopleuroperitoneum under positive CO2 insufflation pressure had adverse effects on blood gases. Hypercarbia, respiratory acidosis, and hypoxemia were early manifestations that occurred even in the presence of hemodynamic stability. The application of PEEP equal to or above CO2 insufflation pressure improved blood gases; in particular, the hypoxia could be avoided. No beneficial effects of differential lung ventilation were documented.

Animals↗
PubMed2002

Carbon dioxide pneumothorax during laparoscopic surgery.

BACKGROUND: Anesthetic considerations for laparoscopic cholecystectomy are similar to those for other laparoscopic procedures and result from the creation of a pneumoperitoneum by insufflation of carbon dioxide (CO 2) into the abdominal cavity. The resultant problems such as decreased functional residual capacity, increased airway pressure, hypercarbia, and circulatory impairment are well known [1]. The reported case is that of a healthy 45-yr-old man who underwent elective laparoscopic cholecystectomy under general anesthesia. As surgery proceeded he developed hypercapnia (arterial blood partial pressure of CO 2 [pCO] 2], 97.1 mmHg; extrapolated end-tidal CO 2 tension [P ETCO 2], 90 mmHg) and hypoxemia (partial pressure of oxygen [pO 2], 53.1 mmHg). The cause was attributed to absorption of CO 2 directly related to the surgical pneumoperitoneum. This report illustrates the diagnosis and management of an unusual case of CO 2 absorption, resulting in hypercapnia and hypoxemia, and a spontaneous recovery within 30 to 60 min without need of thoracentesis.

Carbon Dioxide↗
PubMed2001

Helium and other alternative insufflation gases for laparoscopy.

BACKGROUND: Carbon dioxide (CO(2)) is currently the insufflation gas of choice for laparoscopy. It fulfills most of the requirements for an ideal insufflation gas, being colorless, noninflammable, and rapidly excreted from the circulation. However, its use is associated with adverse cardiorespiratory effects, especially in patients with preexisting cardiorespiratory compromise. METHODS: The descriptive review of relevant literature, moreover, has been proposed that it increases the incidence of port site (wound) metastases from abdominal cancers when used during oncological surgery. In addition, it may cause postoperative pain due to peritoneal irritation, and its use is associated with physiological and immunological impairment. Hence, there is scope for the investigation of alternative insufflation gases. Other possibilities include gasless laparoscopy, helium, nitrous oxide, (N(2)O), and argon. Helium insufflation has been used extensively in animal models but only to a limited extent in humans. In experimental studies, it has been shown to produce fewer changes in cardiorespiratory and intraperitoneal immunological status than CO(2) insufflation, and its use is associated with less spread of tumors to port sites in a variety of small animal tumor models. However, helium also has the potential for some adverse effects. Helium pneumothorax probably resolves more slowly than CO(2) pneumothorax, and helium gas embolism is tolerated poorly in animal models. The clinical significance of these potential problems has yet to be determined. CONCLUSIONS: Although the use of alternative gases appears to be promising, further evaluation is needed within both clinical and laboratory settings before their routine clinical use can be supported.

Abdominal Neoplasms↗
PubMed1999

A randomized controlled trial assessing the benefit of humidified insufflation gas during laparoscopic surgery.

BACKGROUND: We conducted a randomized controlled trial during laparoscopic cholecystectomy to determine the extent of heat preservation and postoperative pain reduction using humidified carbon dioxide (CO2) gas insufflation instead of standard dry insufflation gas. METHODS: Forty consecutive patients were randomized. Twenty patients received humidified CO2, and 20 control patients received standard CO2 insufflation. A sample of 16 patients from each group was evaluated for postoperative pain levels. RESULTS: No adverse effects from the humidification of insufflated gas were observed. There was no significant difference in core body temperature between the two groups for this brief operation. Pain, as assessed by the Analogue Pain Score (APS) was significantly less for the group with humidified gas insufflation than for the control group at 6 h postoperatively as well as on the 1st, 2nd, and 3rd postoperative day and at follow-up 10 days after the operation. In the humidified group, the mean time to return to normal activities was significantly less-5.9 days, as compared to 10.9 days in the control group. CONCLUSIONS: The use of humidified insufflation gas reduces postoperative pain following laparoscopic cholecystectomy, but except for these relatively brief procedures, the heat-preserving effect of humidified gas insufflation is not significant.

Adult↗
PubMed1999

A randomized controlled trial to determine the effects of humidified carbon dioxide insufflation during thoracoscopy.

BACKGROUND: The humidification of gas insufflated during laparoscopy can reduce the degree of postoperative hypothermia and may result in less peritoneal reaction and less postoperative pain. The present study was designed to determine whether the beneficial effects of humidified gas insufflation also applied to thoracoscopy. METHODS: Six pigs were each studied on three separate occasions with insufflation into the right thoracic cavity of either humidified gas, standard dry gas, or with no insufflation (control procedure). Core body temperature was recorded every 15 min, and biopsies of the parietal pleura were taken at the end of each study for electron microscopy. RESULTS: Humidification of insufflated gas significantly minimized the fall in core temperature during the procedure. Electron microscopy showed that dry gas insufflation resulted in greater structural injury to the pleura than humidified gas insufflation. CONCLUSIONS: The potential benefits of humidifying insufflation gas during thoracoscopy warrant its evaluation in the clinical setting.

Analysis of Variance↗