RESUMO
Decompression illness (DCI) is an uncommon problem but can be significant in terms of morbidity and, very rarely, mortality. The mechanisms of DCI are pulmonary barotrauma and decompression sickness due to inert gas supersaturation. After the initial management phase, identification of predisposing factors is important to help advise divers regarding future risk and avoidance. Here we present four cases of DCI where pulmonary barotrauma was the likely causative mechanism. We highlight the important features in assessment for pulmonary barotrauma and advising divers on the risk of a recurrence.
Assuntos
Barotrauma/complicações , Doença da Descompressão/etiologia , Mergulho/efeitos adversos , Forame Oval Patente/diagnóstico por imagem , Lesão Pulmonar/complicações , Adulto , Braço , Vesícula/diagnóstico por imagem , Feminino , Forame Oval Patente/complicações , Hemiplegia/diagnóstico , Humanos , Pneumopatias/complicações , Pneumopatias/diagnóstico por imagem , Masculino , Mucocele/complicações , Mucocele/diagnóstico por imagem , Paralisia , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Volta ao Esporte , Adulto JovemRESUMO
We experienced 25 cases of spontaneous hemopneumothorax, in which 9 were defined as occult cases on chest X-ray at the time of visit. All 9 cases visited our hospital within 12 hours after the onset. Of these, 5 were done chest computed tomography (CT) and 3 could be diagnosed as hemopneumothorax. Emergency surgery were necessary in 4 of 9. Chest CT and careful observation is thought to be essential in case of suspiciously combined hemothorax in pneumothorax cases.
Assuntos
Hemopneumotórax/diagnóstico por imagem , Tratamento de Emergência , Hemopneumotórax/cirurgia , Hemotórax/complicações , Hemotórax/diagnóstico por imagem , Humanos , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Tórax/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
RATIONALE: The definition of primary spontaneous pneumothorax excludes patients with known lung disease; however, the assumption that the underlying lung is normal in these patients is increasingly contentious. OBJECTIVES: The purpose of this study was to assess lung structure and compare the extent of emphysema in patients with primary versus secondary spontaneous pneumothorax and to patients with no pneumothorax in an otherwise comparable control group. METHODS: We identified patients treated for pneumothorax by screening inpatient and outpatient medical records at one medical center in the United Kingdom. From this group, 20 patients had no clinically apparent underlying lung disease and were classified as having a primary spontaneous pneumothorax, and 20 patients were classified as having a secondary spontaneous pneumothorax. We assembled a control group composed of 40 subjects matched for age and smoking history who had a unilateral pleural effusion or were suspected to have a thoracic malignancy and had a chest computed tomography scan suitable for quantitative analysis. Demographics and smoking histories were collected. Quantitative evaluation of low-attenuation areas of the lung on computed tomography imaging was performed using semiautomated software, and the extent of emphysema-like destruction was assessed visually. MEASUREMENTS AND MAIN RESULTS: The extent of emphysema and percentage of low-attenuation areas was greater for patients with primary spontaneous pneumothorax than for control subjects matched for age and smoking history (median, 0.25 vs. 0.00%; P = 0.019) and was also higher for patients with secondary pneumothorax than those with primary spontaneous pneumothorax (16.15 vs. 0.25%, P < 0.001). Patients with primary pneumothorax who smoked had significantly greater low-attenuation area than patients with primary pneumothorax who were nonsmokers (0.7 vs. 0.1%, P = 0.034). CONCLUSIONS: The majority of patients with primary spontaneous pneumothorax had quantifiable evidence of parenchymal destruction and emphysema. The exclusion of patients with underlying lung disease from the definition of primary spontaneous pneumothorax should be reappraised.
Assuntos
Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumotórax/complicações , Pneumotórax/diagnóstico por imagem , Enfisema Pulmonar/diagnóstico por imagem , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar , Tomografia Computadorizada por Raios X , Reino Unido , Adulto JovemRESUMO
BACKGROUND: Severe hypoxic respiratory failure is a leading cause of neonatal mortality in Chile. Extracorporeal membrane oxygenation improves survival in neonates with hypoxic respiratory failure. OBJECTIVE: To determine the impact of the establishment of a Neonatal Extracorporeal Membrane Oxygenation Program on the outcome of newborns with severe hypoxic respiratory failure in a developing country. DESIGN/PATIENTS: Data of newborns (birthweight > 2,000 g and gestational age ≥ 35 wk) with hypoxic respiratory failure and oxygenation index greater than 25 were compared before and after extracorporeal membrane oxygenation was available. Extracorporeal membrane oxygenation was initiated in infants with refractory hypoxic respiratory failure who failed to respond to inhaled nitric oxide/high-frequency oscillatory ventilation. MAIN RESULTS: Data from 259 infants were analyzed; 100 born in the pre-extracorporeal membrane oxygenation period and 159 born after the extracorporeal membrane oxygenation program was established. Patients were similar in terms of risk factors for death for both periods except for a higher oxygenation index and a greater proportion of outborn infants during the extracorporeal membrane oxygenation period. Survival significantly increased from 72% before extracorporeal membrane oxygenation to 89% during the extracorporeal membrane oxygenation period (p < 0.01). During the extracorporeal membrane oxygenation period, 98 of 159 patients (62%) with hypoxic respiratory failure were rescued using inhaled nitric oxide/high-frequency oscillatory ventilation, whereas 61 (38%) did not improve; 52 of these 61 neonates were placed on extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation survival rate to discharge was 85%. After adjusting for potential confounders, the severity of the pretreatment oxygenation index, a late arrival to the referral center, the presence of a pneumothorax, and the diagnosis of a diaphragmatic hernia were significantly associated with the need for extracorporeal membrane oxygenation or death. CONCLUSIONS: The establishment of an extracorporeal membrane oxygenation program was associated with a significant increase in the survival of newborns more than or equal to 35 weeks old with severe hypoxic respiratory failure.
Assuntos
Oxigenação por Membrana Extracorpórea , Hipóxia/mortalidade , Hipóxia/terapia , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/terapia , Broncodilatadores/uso terapêutico , Chile/epidemiologia , Análise Custo-Benefício , Oxigenação por Membrana Extracorpórea/economia , Feminino , Hérnia Diafragmática/complicações , Hérnias Diafragmáticas Congênitas , Ventilação de Alta Frequência , Humanos , Hipóxia/etiologia , Recém-Nascido , Masculino , Síndrome de Aspiração de Mecônio/complicações , Óxido Nítrico/uso terapêutico , Oxigênio/sangue , Síndrome da Persistência do Padrão de Circulação Fetal/complicações , Pneumotórax/complicações , Síndrome do Desconforto Respiratório do Recém-Nascido/complicações , Insuficiência Respiratória/etiologia , Índice de Gravidade de Doença , Taxa de Sobrevida , Fatores de Tempo , Tempo para o TratamentoRESUMO
RATIONALE: Women with pulmonary lymphangioleiomyomatosis (LAM) who present with a sentinel spontaneous pneumothorax (SPTX) will experience an average of 2.5 additional pneumothoraces. The diagnosis of LAM is typically delayed until after the second pneumothorax. OBJECTIVES: We hypothesized that targeted screening of an LAM-enriched population of nonsmoking women between the ages of 25 and 54 years, who present with a sentinel pneumothorax indicated by high-resolution computed tomography (HRCT), will facilitate early identification, definitive therapy, and improved quality of life for patients with LAM. METHODS: We constructed a Markov state-transition model to assess the cost-effectiveness of screening. Rates of SPTX and prevalence of LAM in populations stratified by age, sex, and smoking status were derived from the literature. Costs of testing and treatment were extracted from 2007 Medicare data. We compared a strategy based on HRCT screening followed by pleurodesis for patients with LAM, versus no HRCT screening. MEASUREMENTS AND MAIN RESULTS: The prevalence of LAM in nonsmoking women, between the ages of 25 and 54 years, with SPTX is estimated at 5% on the basis of the available literature. In our base case analysis, screening for LAM by HRCT is the most cost-effective strategy, with a marginal cost-effectiveness ratio of $32,980 per quality-adjusted life-year gained. Sensitivity analysis showed that HRCT screening remains cost-effective for groups in which the prevalence of LAM in the population subset screened is greater than 2.5%. CONCLUSIONS: Screening for LAM by HRCT in nonsmoking women age 25-54 that present with SPTX is cost-effective. Physicians are advised to screen for LAM by HRCT in this population.
Assuntos
Pneumopatias/diagnóstico por imagem , Linfangioleiomiomatose/diagnóstico por imagem , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Pneumotórax/complicações , Tomografia Computadorizada por Raios X/métodos , Adulto , Análise Custo-Benefício/métodos , Análise Custo-Benefício/estatística & dados numéricos , Técnicas de Apoio para a Decisão , Feminino , Humanos , Pneumopatias/economia , Linfangioleiomiomatose/complicações , Linfangioleiomiomatose/economia , Cadeias de Markov , Pessoa de Meia-Idade , Qualidade de Vida , Tomografia Computadorizada por Raios X/economiaRESUMO
Chest pain is one of the main reasons for emergency admission to hospital in the UK. Jackie Tough examines the causes and treatment of chest pain and offers a structured system for taking the patient's history.
Assuntos
Dor no Peito , Enfermagem em Emergência/métodos , Avaliação em Enfermagem/métodos , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico , Dissecção Aórtica/terapia , Angioplastia Coronária com Balão , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico , Aneurisma Aórtico/terapia , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Contraindicações , Doença das Coronárias/complicações , Doença das Coronárias/diagnóstico , Doença das Coronárias/terapia , Eletrocardiografia , Tratamento de Emergência/métodos , Tratamento de Emergência/enfermagem , Humanos , Anamnese/métodos , Pneumotórax/complicações , Pneumotórax/diagnóstico , Pneumotórax/terapia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Medição de Risco/métodos , Fatores de Risco , Terapia Trombolítica/métodos , Terapia Trombolítica/enfermagem , Triagem/métodosRESUMO
Se presentaron los datos correspondientes a 109 casos de Neumopatías Supuradas, recogidos en el Servicio de Pediatría del Hospital General Base Goyeneche, entre el 01 de junio de 1974 y 01 de junio de 1983. De 114 historias clínicas revisados minuciosamente se relacionaron 109 que reunían los criterios 2 mayores y como mínimo 1 criterio mayor y otro menor de Highman y Camphell. De estos fueron aceptados 86 historias con un criterio mayor y otro menor; 22 historias tuvieron 2 criterios mayores y una presentó 3 criterios mayores. Se valoran los síntomas, signos, hallazgos de laboratorio, bacteriológico y datos radiológicos referentes al momento del ingreso y evolución posterior, así como algunos datos anatomopatológicos. Finalmente, se analizó el tratamiento administrativo, la respuesta conseguida y las complicaciones más frecuentes y se compararon los resultados obtenidos con otros similares mostrados en la literatura
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Adolescente , Pediatria , Pneumonia Estafilocócica/diagnóstico , Pneumonia/complicações , Pneumopatias/etiologia , Peru , Toracotomia , Toracotomia , Empiema/etiologia , Abscesso Pulmonar/diagnóstico , Abscesso Pulmonar/terapia , Pneumotórax/complicaçõesRESUMO
Nine patients with bullous emphysema for which surgery was being considered have been investigated with computed tomography (CT). In six out of nine patients (67%) CT showed more extensive disease or bilateral disease where only unilateral was suspected from postero-anterior and lateral chest radiographs. Only one patient proceeded to surgery and post-operative CT showed satisfactory re-expansion of the compressed lung. Surgery was abandoned in one patient as a result of the CT findings. Computed tomography is of value in patients with bullous emphysema in assessing the extent of disease and may assist the surgeon in operative planning.