ABSTRACT
STUDY OBJECTIVES: Advances in bronchoscopic electrosurgery have allowed its application in the outpatient setting in patients who otherwise would have required Nd-YAG laser photoresection (LPR) in the operating room. We intended to evaluate the impact of endobronchial electrosurgery (EBES) on the need for Nd-YAG LPR on patients with symptomatic airway lesions. DESIGN: Prospective observational case series. PARTICIPANTS: One hundred eighteen evaluations for LPR were performed. Forty-seven evaluations (40%) were considered to be amendable to EBES and were treated during the initial bronchoscopy. The remaining patients underwent LPR. SETTING: Outpatient bronchoscopy suite at the Cleveland Clinic Foundation, Cleveland, OH. RESULTS: Of the 47 procedures, 42 (89%) were successful in alleviating the obstruction, thus eliminating the need for LPR. No major complications were encountered. CONCLUSION: EBES can be performed safely in the outpatient setting and is an effective procedure in treating select endobronchial lesions. EBES eliminated the need for LPR in 36% of such procedures with a potential for significant time and cost savings.
Subject(s)
Airway Obstruction/surgery , Ambulatory Surgical Procedures/methods , Bronchoscopy , Electrosurgery/instrumentation , Laser Coagulation/methods , Adult , Aged , Aged, 80 and over , Airway Obstruction/etiology , Airway Obstruction/pathology , Equipment Design , Female , Humans , Male , Middle Aged , Observation , Prospective Studies , Treatment OutcomeSubject(s)
Embolism, Air/therapy , Head-Down Tilt , Animals , Dogs , Embolism, Air/physiopathology , Hemodynamics , HumansSubject(s)
Anti-Glomerular Basement Membrane Disease/physiopathology , Pulmonary Diffusing Capacity , Anti-Glomerular Basement Membrane Disease/diagnosis , Anti-Glomerular Basement Membrane Disease/metabolism , Breath Tests , Carbon Monoxide/analysis , Diagnosis, Differential , Disease Progression , Forced Expiratory Volume , Humans , Male , Middle Aged , Prognosis , Pulmonary Diffusing Capacity/physiology , Reproducibility of Results , Vital CapacityABSTRACT
Despite advances in medical and surgical therapy, heart failure (HF) remains a common and serious problem. An association between HF and sleep-related breathing disorders has been recognized since Cheyne's observations in 1818, but only recently have treatment options targeting sleep-related breathing disorders become available. This overview will consider the clinical features, pathophysiology, and treatment options of sleep-related breathing disorders in patients with HF.
Subject(s)
Heart Failure/complications , Sleep Apnea Syndromes/complications , Cheyne-Stokes Respiration , Heart Failure/physiopathology , Humans , Polysomnography , Sleep Apnea Syndromes/physiopathology , Sleep Apnea Syndromes/therapy , Sleep Apnea, Central/complications , Sleep Apnea, Central/physiopathology , Sleep Apnea, Obstructive/complications , Sleep Apnea, Obstructive/physiopathologyABSTRACT
The uses of the pulmonary artery catheter have been expanded from its original use, helping to assess the cardiac output and left ventricular filling pressure of patients with cardiac disease, to include the management of patients with trauma, septic shock, respiratory failure, and those undergoing high-risk surgeries. Although more than 1 million pulmonary artery catheters are inserted each year in the United States, clear evidence establishing that they improve outcome remains hard to find. This article discusses the complications of invasive hemodynamic monitoring.
Subject(s)
Cardiovascular Diseases/etiology , Catheterization/adverse effects , Embolism/etiology , Infections/etiology , Wounds and Injuries/etiology , Catheterization/methods , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Catheters, Indwelling/adverse effects , Equipment Failure , Female , Hemodynamics/physiology , Humans , Male , Monitoring, Physiologic/adverse effects , Monitoring, Physiologic/methods , Prognosis , Risk Assessment , Risk Factors , RuptureABSTRACT
Posttraumatic arteriovenous fistulas can form between vessels of the thorax that have sustained loss of integrity to the vessel wall. Although most are caused by injuries as a consequence of missile penetration or stab wounds, iatrogenic damage is a potential cause. Herein we present a case of a systemic arteriovenous fistula involving an intercostal artery and subcutaneous vein after chest tube placement.
