PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “PNEUMOTHORAX, ARTIFICIAL”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,603 records · Page 89Linked to original sources
PubMed1997

[Protective pneumothorax in CT-guided mediastinal puncture].

PURPOSE: To achieve an extrapulmonary pathway for biopsy of mediastinal masses. METHODS: In 6 patients a protective, temporary pneumothorax was established before performing large-bore needle biopsies of mediastinal masses using a Verres-needle. RESULTS: Transpleural, extrapulmonary access was easy to achieve. One patient developed a tension pneumothorax after biopsy which was drained by percutaneous small chest tube. Another patient showed mediastinal tumor bleeding through the biopsy needle. As a prophylactic measure the bleeding was stopped by injection of tissue glue through the biopsy needle. CONCLUSION: The use of protective pneumothorax allows cutting needle biopsies of mediastinal masses where aspiration cytology yields no secure specific diagnosis.

Adult↗
PubMed1989

Mortality from breast cancer after irradiation during fluoroscopic examinations in patients being treated for tuberculosis.

The increasing use of mammography to screen asymptomatic women makes it important to know the risk of breast cancer associated with exposure to low levels of ionizing radiation. We examined the mortality from breast cancer in a cohort of 31,710 women who had been treated for tuberculosis at Canadian sanatoriums between 1930 and 1952. A substantial proportion (26.4 percent) had received radiation doses to the breast of 10 cGy or more from repeated fluoroscopic examinations during therapeutic pneumothoraxes. Women exposed to greater than or equal to 10 cGy of radiation had a relative risk of death from breast cancer of 1.36, as compared with those exposed to less than 10 cGy (95 percent confidence interval, 1.11 to 1.67; P = 0.001). The data were most consistent with a linear dose-response relation. The risk was greatest among women who had been exposed to radiation when they were between 10 and 14 years of age; they had a relative risk of 4.5 per gray, and an additive risk of 6.1 per 10(4) person-years per gray. With increasing age at first exposure, there was substantially less excess risk, and the radiation effect appeared to peak approximately 25 to 34 years after the first exposure. Our additive model for lifetime risk predicts that exposure to 1 cGy at the age of 40 increases the number of deaths from breast cancer by 42 per million women. We conclude that the risk of breast cancer associated with radiation decreases sharply with increasing age at exposure and that even a small benefit to women of screening mammography would outweigh any possible risk of radiation-induced breast cancer.

Adolescent↗
PubMed2005

Tuberculosis, bronchiectasis, and infertility: what ailed George Orwell?

In the last and most productive years of his life, George Orwell struggled with pulmonary tuberculosis, dying at the dawn of the era of chemotherapy. His case history illustrates clinical aspects of tuberculosis with contemporary relevance: the role of poverty in its spread, the limited efficacy of monotherapy, the potential toxicity of treatment, and the prominence of cachexia as a terminal symptom. Orwell's ordeals with collapse therapy may have influenced the portrayal of the tortures of Winston Smith in the novel 1984. I discuss unifying diagnoses for Orwell's respiratory problems and apparent infertility, including tuberculous epididymitis, Young syndrome, immotile cilia syndrome, and cystic fibrosis.

Antitubercular Agents↗
PubMed2002

Impact of temperature and humidity of carbon dioxide pneumoperitoneum on body temperature and peritoneal morphology.

BACKGROUND: The insufflation of cold gas during laparoscopic surgery exposes patients to the risk for hypothermia. The objectives of this study were to investigate whether heating or humidification of insufflation gas could prevent peroperative hypothermia in a rat model, and to assess whether the peritoneum was affected by heating or humidification of the insufflation gas. METHODS: Rats were exposed to insufflation with either cold, dry carbon dioxide CO2 (group I); cold, humidified CO2 (group II); warm, dry CO2 (group III); or warm, humidified CO2 (group IV); another group underwent gasless laparoscopy (group V). Core temperature and intraperitoneal temperature were registered in all animals during 120 minutes. Specimens of the parietal peritoneum were taken directly after desufflation and 2 and 24 hours after the procedure. All specimens were analyzed with scanning electron microscopy (SEM). RESULTS: During the 120-minute study period, core temperature and intraperitoneal temperature were significantly reduced in groups I, II, and III. In the animals that underwent warm, humidified insufflation (group IV) and the gasless controls (group V), intraoperative hypothermia did not develop. At SEM, retraction and bulging of mesothelial cells and exposure of the basal lamina were seen in the four insufflation groups (groups I-IV) and also in the gasless controls (group V). CONCLUSION: Insufflation with cold, dry CO2 may lower the body temperature during laparoscopic surgery. Hypothermia can be prevented by both heating and humidifying the insufflation gas. Changes of the peritoneal surface occur after CO2 insufflation, despite heating or humidifying, and also after gasless surgery.

Animals↗
PubMed2004

Cardiovascular changes during drainage of pericardial effusion by thoracoscopy.

BACKGROUND: Cardiovascular changes during drainage of pericardial effusion are not well understood, and most studies are of systemic effects and not of right ventricular performance. Thoracoscopy is not widely used to drain pericardial effusions because of haemodynamic changes in relation to the use of single lung ventilation. PATIENTS AND METHODS: We studied 16 patients undergoing partial pericardiectomy for pericardial effusion, using videothoracoscopy with a low-pressure pneumothorax (6 mm Hg). Cardiac output was measured by thermodilution with the patient anaesthetized in the supine position before the procedure; in the right lateral position after a low-pressure pneumothorax had been established; and after drainage of the pericardial effusion. RESULTS: Before the procedure, cardiac output was low and central venous pressure and pulmonary artery occlusion pressure were increased. Systemic vascular resistance and arterial blood pressure were within normal limits. Cardiac filling pressure and pulmonary arterial pressure increased during the pneumothorax. After the drainage cardiac index increased and systemic and pulmonary vascular resistances were reduced. CONCLUSIONS: Pericardial effusion reduces right ventricular distensibility, right and left systolic ventricular function, and cardiac output. Anaesthesia with mechanical ventilation and a low-pressure pneumothorax do not affect the circulation greatly. Drainage of the pericardial effusion allows cardiac distensibility to increase and cardiac performance changes to allow increased ejection.

Adolescent↗
PubMed1997

Effects of oxygenation during selective lobar versus total lung collapse with or without continuous positive airway pressure.

UNLABELLED: Hypoxemia is common during anesthesia with one-lung ventilation (OLV). This study tested the hypothesis that selective lobar blockade would result in higher PaO2 values compared with those found with total lung collapse independent of continuous positive airway pressure (CPAP) application. Thirty patients undergoing lobectomy were randomly assigned to one of four groups with the following maneuvers during OLV: Group 1 (n = 8) total lung collapse (TLC) plus 5 cm H2O of CPAP to the nonventilated operative lung for 15 mins, followed by selective lobe collapse plus 5 cm H2O of CPAP (during selective collapse only the surgical lobe was collapsed and the rest of that lung was ventilated); Group 2 (n = 6) selective lobar collapse plus 5 cm H2O of CPAP to the operative lung, followed by TLC plus 5 cm H2O of CPAP; Group 3 (n = 8) total lung collapse without CPAP, followed by selective lobe collapse and no CPAP; Group 4 (n = 8) selective lobe collapse without CPAP, followed by TLC and no CPAP. To obtain selective lobe collapse, the bronchial blocker of the Univent (Vitaid, Lewiston, NY) endotracheal tube was guided into the operative bronchus with the aid of a fiberoptic bronchoscope. Blood pressure, heart rate, and arterial blood gas measurements were obtained during the following times: Time 1--while the patient was awake; Time 2--two-lung ventilation (2LV) in the supine position; Time 3--after 30 min of OLV in the lateral decubitus position (no CPAP or selective blockade); Time 4 and Time 5--during maneuvers described above (see group description); Time 6--2LV resumed; Time 7--30 min after extubation. Twenty-eight patients completed the study. There were no differences among groups with regard to arterial blood pressure, heart rate, or arterial oxygen saturation during the experimental maneuvers. All four groups showed a decrease in PaO2 from 2LV to OLV (P < 0.05). Both with and without CPAP application, oxygenation was improved with selective lobe collapse compared with TLC. When selective lobe collapse with 5 cm H2O of CPAP followed TLC (group 1), PaO2 values increased to values similar to those found for 2LV (PaO2 449 +/- 122 vs 394 +/- 105 mm Hg). This study indicates that by using a bronchial blocker, changing from total lung collapse to selective lobar blockade improves PaO2 during lung surgery. IMPLICATIONS: This study examines how oxygen tension in arterial blood can be higher during one-lung ventilation. The use of a bronchial blocker, which changes a total lung collapse to selective lobar blockade, improves oxygenation during lung surgery.

Adult↗
PubMed2002

Segmental wall motion abnormalities during telerobotic totally endoscopic coronary artery bypass grafting.

UNLABELLED: In addition to single-lung ventilation (SLV), intrathoracic CO2 insufflation is mandatory for adequate exposure during totally endoscopic coronary artery bypass grafting. With transesophageal echocardiography, we investigated biventricular myocardial wall motion in 25 patients with isolated disease of the left anterior descending coronary artery who underwent totally endoscopic coronary artery bypass grafting with the "Da Vinci" robotic surgical system. At distinct time points during the operation, a cine loop of both ventricles was registered from a transgastric mid-short-axis view. Myocardial wall motion analysis was performed according to an established segmentation model of the left ventricle and to an established five-point scale for wall motion (1, normal; 5, dyskinesia). Significant alterations from preoperative baseline wall motion were visible in the septal, inferior, and anterior segments of the left ventricle at some time during the prebypass period, combined with a markedly decreased PaO2 under SLV and increased intrathoracic pressure. The same findings applied to the right ventricle; however, wall motion abnormalities were more pronounced here. After myocardial revascularization, weaning from cardiopulmonary bypass, CO2 deflation, and return to double-lung ventilation, myocardial wall motion recovered to baseline values. Clinically significant hemodynamic instability did not occur. The data suggest that robot-assisted coronary artery bypass grafting leads to significant prebypass alterations of biventricular segmental wall motion. On the basis of our data, it cannot be definitively stated whether the observed results were due to reduced oxygenation during SLV and thus "real" myocardial ischemia, intrathoracic CO2 insufflation with positive pressure leading to mechanical compromise of the heart, absolute or relative hypovolemia, or a combination of these factors. However, in this cohort, which consisted of patients with single-vessel disease and good ventricular function, these changes were of limited clinical relevance. IMPLICATIONS: Segmental myocardial wall motion was evaluated with transesophageal echocardiography during robot-assisted totally endoscopic coronary artery bypass grafting. Significant biventricular segmental wall motion abnormalities occurred before cardiopulmonary bypass under single-lung ventilation and carbon dioxide insufflation. The changes in myocardial wall motion were of limited clinical relevance.

Carbon Dioxide↗
PubMed1976

Congenital absence of the left pericardium: an unusual palpation finding and echocardiographic demonstration of the defect.

A patient with classical clinical and roentgenographic features of congenital absence of the left pericardium is described. On physical examination in the supine position, the precordial apical impluse was markedly displaced laterally. In the left lateral decubitus position, however, the apical impulse was felt in a mor medial location. This apparently paradoxical movement of the apical impulse was not found in persons with normal hearts or with left ventricular enlargement of hypertrophy, and may be characteristic of the pericardial defect. Further, with echocardiography we were able to demonstrate the absence of a pericardial echo on the lateral surface of the heart. Thus, echocardiography may be a useful noninvasive tool in the diagnosis of this defect.

Adult↗
PubMed2005

Minimally invasive pediatric nephrectomy.

PURPOSE OF REVIEW: Since the first laparoscopic pediatric nephrectomy was performed in 1992, many articles have reported the feasibility of minimally invasive nephrectomy, heminephrectomy, and nephroureterectomy in children. This article reviews the literature related to minimally invasive nephrectomy, including robot-assisted surgery, and its complications published between November 2002 and November 2004. RECENT FINDINGS: The retroperitoneoscopic approach to nephrectomy and nephroureterectomy continues to prove successful in the pediatric population, although the transperitoneal approach is beneficial in combined upper and lower tract procedures. Initial reports on bilateral transperitoneal nephrectomy for nephrotic syndrome and laparoscopic nephrectomy for Wilms tumor are presented. Comparison studies between laparoscopic nephrectomy and open procedures are reviewed. Robot-assisted procedures are possible in children but little information is available on their pediatric use at the present time. Laparoscopy in children appears to have a similar complication rate to that in adults. SUMMARY: More studies are needed to compare the outcomes of minimally invasive procedures with those of open procedures. Robot-assisted surgery offers promise but expense currently limits its use.

Child↗
PubMed2005

Protective pneumothorax for needle biopsy of mediastinum and pulmonary hilum.

The risk of performing CT-guided transthoracic needle biopsy of some mediastinal and pulmonary hilar masses is increased by the presence of intervening lung. A series of patients is presented in whom a protective pneumothorax provided access for biopsy of masses in the mediastinum and pulmonary hilum. Review of Interventional Radiology records revealed 24 patients who had biopsies of mediastinum or pulmonary hilum, in whom protective pneumothorax was used, or attempted, to provide percutaneous access for biopsy. Characteristics of these patients and their procedures were reviewed. Percutaneous access to the pleural space was gained in 21/24 (88%) of patients. A protective pneumothorax was established in 19 (79%); 2 patients had pleural adhesions that prevented the lung from being displaced. The process of creating the protective pneumothorax added a mean time of 17 minutes to the procedure (range 6-30 minutes). All patients had biopsy using coaxial technique, with either a 20-gauge or 18-gauge core biopsy instrument, in addition to needle aspiration. Air leak requiring tube drainage occurred in 1/19 (5%) of patients who had a protective pneumothorax, and in 2/5 (40%) of patients in whom protective pneumothorax was not established. Percutaneous creation of a protective pneumothorax is a safe method that provides access for needle biopsy of deep lesions in the chest without traversing aerated lung.

Biopsy, Needle↗