Emphysematous cystitis successfully treated with hyperbaric oxygen therapy: case report.

Emphysematous cystitis is an uncommon acute infection of the underlying bladder musculature and mucosa, caused by gas-producing organisms. Here we describe an 87-year-old woman with diabetes mellitus and emphysematous cystitis who was successfully treated with hyperbaric oxygen (HBO2) therapy. Her predisposition of diabetes and infection with gas-producing bacteria was considered to precede the development of emphysematous cystitis. Computed tomography revealed gas accumulation in the bladder wall and lumen. Antibiotics and HBO2 therapy were administered. HBO2 therapy may be beneficial due to the improvement in oxygenation of the tissues affected by the disease. HBO2 is a useful adjunct therapy for the management of severe emphysematous cystitis.

Intrabronchial Infusion of Autologous Blood Plus Thrombin for Intractable Pneumothorax After Bronchial Occlusion Using Silicon Spigots: A Case Series of 9 Patients With Emphysema.

BACKGROUND: Bronchial occlusion therapy using silicon spigots is effective for intractable pneumothorax. However, sometimes the pneumothorax is refractory to bronchial occlusion because of collateral ventilation. For such difficult pneumothoraces, we attempted an intrabronchial infusion of autologous blood plus thrombin to control collateral ventilation and stop air leaks. METHODS: We performed bronchial occlusions using silicon spigots in patients with spontaneous pneumothorax secondary to emphysema and refractory to chest drainage, but which was inoperable owing to each patient's poor surgical candidacy and poor overall health condition. When bronchial occlusion proved ineffective, we undertook intrabronchial infusion of autologous blood plus thrombin, 2 to 4 days after bronchial occlusion. A catheter was inserted into the subpleural area, through a gap between the silicon spigot and the bronchial wall, using a flexible bronchoscope under fluoroscopic guidance. Autologous blood, followed by a thrombin solution, was infused using the catheter. We repeated the same infusion a total of 4 to 6 times while changing the target bronchi. All interventions were performed under local anesthesia. RESULTS: The subjects were 9 men, aged from 61 to 88 years, with smoking histories. Three patients also had interstitial pneumonia, and 6 patients had undergone pleurodesis in vain before bronchial occlusion. For 4of the 9 patients, autologous blood plus thrombin infusions successfully stopped air leaks, and in 3 patients, intrabronchial infusions and pleurodesis halted leaks altogether. CONCLUSION: Intrabronchial infusion of autologous blood plus thrombin was effective for intractable pneumothoraces that could not be clinically managed, even by bronchial occlusion using silicon spigots.

Enfisema subcutáneo durante tratamiento restaurador: caso clínico / Subcutaneous emphysema secondary to dental treatment: case report

El enfisema subcutáneo es una complicación poco frecuente en la práctica odontológica, que ha ido en aumento debido al uso de instrumentos con aire a presión. Muchos de los casos no son reconocidos o presentan un diagnóstico errado. La mayor parte de los pacientes con esta complicación presentan resolución espontánea, sin embargo algunos pueden evolucionar con complicaciones que ponen en peligro la vida. Aquí presentamos un caso de enfisema subcutáneo ocurrido durante un procedimiento restaurador de rutina. El diagnóstico diferencial y el manejo de esta condición son discutidos (AU)

Subcutaneous emphysema is a relatively rare complication of dental treatment, although increasingly due to he use of high pressure air instruments. Many cases go unrecognized or are misdiagnosed. Majority of patients with this complication resolve spontaneously, however some can advance to potentially life-threatening complications. A case of subcutaneous emphysema during restorative procedure is presented. The differential diagnosis and management of this condition is discussed (AU)

Outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis.

OBJECTIVE: Emphysematous pyelonephritis (EPN) is an acute necrotizing infection of the kidney characterized by gas formation. In order to compare the outcome of nephrectomy and kidney-preserving procedures for the treatment of EPN we reviewed our experiences of EPN over the past 18 years. MATERIAL AND METHODS: The medical records of 17 patients with EPN treated between October 1986 and September 2004 were retrospectively reviewed. Abdominal X-ray and/or CT were used as diagnostic methods. RESULTS: Women outnumbered men (12 vs five), and all patients had diabetes. Obstruction of the corresponding reno-ureteral unit was found in one patient. Thirteen of the 17 patients (76%) had poorly controlled diabetes (hemoglobin A1c>7%). The diagnosis of EPN was confirmed by gas in the parenchymal or perinephric space as detected by abdominal X-ray or CT. Escherichia coli was the commonest organism present in urine cultures (52%), followed by Klebsiella pneumoniae (24%). Prompt efforts were made to control diabetes, and i.v. antibiotics were given. Nephrectomy was performed in 10 patients and nine patients survived (90% success rate). The success rate among those who received medical therapy only was 50% (2/4 patients). Percutaneous drainage was performed in three patients, two of whom survived (67% success rate). The overall mortality rate was 17.6% (3/17 patients). CONCLUSIONS: Immediate nephrectomy with glycemic control measures and antibiotic administration is crucial for the successful treatment of EPN. However, in inoperable cases, percutaneous drainage can be an effective treatment option.

Emphysematous cystitis: rapid resolution of symptoms with hyperbaric treatment: a case report.

INTRODUCTION: Emphysematous cystitis is a rare disease that occurs most often in elderly diabetic patients characterized by gas formation in the bladder wall due to infection. The infecting organism is usually an aerobic bacterium, most commonly E. coli although anaerobic species have also been reported. We report the use of hyperbaric oxygen in a patient with emphysematous cystitis and air in the femoral vein in which the treatment rapidly resolved the symptoms and radiological abnormalities. METHODS: A 65-year-old female presented to the Emergency Department with altered mental status, weakness, dark urine, dysuria and fever. She was febrile and lethargic. Abdominal exam showed suprapubic tenderness. Urinalysis was positive for white blood cells and bacteria. A CT scan of the abdomen demonstrated extensive air in the bladder wall with an air bubble in the femoral vein. Presumptive diagnosis was urinary tract infection, emphysematous cystitis, and sepsis. A question of air embolism was raised due to the intravascular gas. The patient was treated with hyperbaric oxygen (2.85 atm abs, 90 minutes) on two separate occasions in the first 12 hours. Within 24 hours, the patient's condition rapidly improved. Repeat CT scan 48 hours after admission showed near complete resolution of the emphysematous cystitis. The patient grew Klebsiella pneumonia from her urine. CONCLUSIONS: Emphysematous cystitis is a rare condition caused by either aerobic or anaerobic bacteria and may be associated with both bladder wall and intravascular gas formation. Hyperbaric oxygen therapy has not been previously reported as a treatment modality. The rapid improvement in our patient may indicate a role for hyperbaric oxygen in addition to IV hydration and antibiotics in this disease.

Pneumomediastinum and retropneumoperitoneum: an unusual complication of syrup-of-ipecac-induced emesis.

A young woman returned to the emergency department two hours after discharge because of persistent vomiting and chest pain. Six hours earlier she had received syrup of ipecac to induce emesis following a drug overdose. Radiologic examination in the emergency department revealed pneumomediastinum and retropneumoperitoneum. A nasogastric tube was inserted in the emergency department. The patient was admitted to the ICU and placed on prophylactic antibiotics. Barium and gastrograffin esophagrams revealed no evidence of extravasation. Gastrointestinal endoscopy showed distal esophagitis. Gastroscopy and duodenoscopy were unremarkable. The patient did well following discharge.