1/17. pneumothorax due to electrical burn.A 25-year-old male developed early as well as delayed (15 days post burn) pneumothorax of right side following high voltage, 1100 KV, electrical burn of the right side of the chest wall. diagnosis was established by clinical examination and chest x-ray. Intercostal tube drainage with underwater seal relieved the patient of pneumothorax.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
2/17. Pneumomediastinum, pneumothorax and subcutaneous emphysema complicating MIS herniorrhaphy.PURPOSE: Videoscopic herniorrhaphy is being performed more frequently with advantages claimed over the conventional open approach. This clinical report describes a pneumothorax, pneumomediastinum and subcutaneous emphysema occurring at the end of an extraperitoneal videoscopic herniorrhaphy. CLINICAL FEATURES: A 25 yr old ASA I man presented for elective extraperitoneal videoscopic hernia repair. Following intravenous induction with fentanyl, midazolam and propofol a balanced anesthetic technique using enflurane in N2O and O2 was used. Apart from a prolonged operating time (195 min), the procedure and anesthetic was uneventful. At the conclusion of the operation, prior to reversal of neuromuscular blockade extensive subcutaneous emphysema was noted on removal of the surgical drapes. Chest radiography revealed a pneumomediastinum and pneumothorax. A 25 FG intercostal tube was inserted and connected to an underwater seal drain. Sedation and positive pressure ventilation was maintained overnight to permit resolution and avoid airway compromise. The clinical and radiological features had resolved by the next morning and the patient's trachea was extubated. His subsequent recovery was uneventful. CONCLUSION: pneumothorax and pneumomediastinum are well recognised complications of laparoscopic techniques but have not been described following extraperitoneal herniorrhaphy. In this report we postulate possible mechanisms which may have contributed to their development, including inadvertent breach of the peritoneum and leakage of gas around the diaphragmatic herniae or tracking of gas retroperitoneally. The case alerts us to the possibility of this complication occurring in patients undergoing videoscopic herniorrhaphy.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
3/17. Management of subcutaneous emphysema, pneumomediastinum, and pneumothorax during respirator therapy.Pulmonary barotrauma developed in 18/430 patients receiving respirator support for longer than 12 hours. pneumothorax occurred in 15 of these patients and was treated with tube thoracostomy and 15-20 cm H2O pleural suction. Full reexpansion of the lungs were achieved in all but three patients, two of whom had bronchopleural fistulae. Major complications occurred in 8/15 patients developing pneumothorax. We recommend extreme conservatism in clamping or removing tube thoracostomy. There should be no air leak and full lung expansion for 48 hours, followed by a trial of underwater seal drainage without recurrence of pneumothorax. Removal should be preceded by an additional trial of tube clamping.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
4/17. Neonatal pneumothorax. A Simple drainage device.A simple method of providing under-water-seal drainage using readily available equipment is described. It enables adequate treatment of pneumothorax to be instituted with the minimum delay.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
5/17. A giant retrosternal goiter with severe tracheal compression and superior vena cava syndrome: an operative experience.The peculiarities in the operation of a giant retrosternal goiter with severe tracheal compression and superior vena cava syndrome are highlighted in this report of a 53 year-old female with a large anterior neck swelling interfering with normal breathing and swallowing. From the initiation of the neck incision, mobilization of the gland and performing the subtotal excisions there was troublesome bleeding. pneumothorax resulting after delivery of the massive retrosternal portion was managed with an underwater-seal drainage tube.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
6/17. Bilateral pneumothorax complicating miliary tuberculosis in children: case report and review of the literature.An 11-year-old boy presented with a 4-week history of fever and 2 weeks later developed a cough with breathlessness. His chest X-ray showed bilateral miliary shadows with pneumothorax on the left side. While on antituberculous therapy which was started on admission, he developed right-sided pneumothorax with significant collapse of the left lung. He was managed by tube thoracotomy with underwater seal but died 4 hours after the procedure was completed.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
7/17. Improvised chest tube drain for decompression of an acute tension pneumothorax.A case of a woman presenting with an acute tension pneumothorax during a Navy humanitarian mission in east timor is presented. The patient was treated at a local rural clinic run by our medical team. Prompt insertion of a chest tube saved the woman's life; however, there were no chest tube drains available. A field chest tube drain constructed out of an IV bag, a sterile water bottle, and tubing provided an adequate underwater seal and drain. Because of the remote location and limited resources, standard prehospital chest tube management had to be modified. A brief review of simple and tension pneumothoraces and management along with a description of the field chest tube drain is presented.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
8/17. Outpatient treatment of spontaneous pneumothorax using an improved pocket sized Heimlich valve.We report two patients, who have used Pneumostat to replace the conventional underwater seal drainage system for recurrent pneumothorax. Both patients had required repeated chest tube insertion for recurrent pneumothorax and needed a longer hospital stay. Both patients were able to be discharged with the Pneumostat device and were reviewed in outpatient clinic. Both patients had optimal clinical improvement and chest X-ray showed no residual pneumothorax.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
9/17. Stent-graft treatment of complete acute aortic transection complicated by intussusception and pseudo-coartaction.Aim of the study was to validate the use of endoluminal stent-graft treatment as an alternative to conventional surgery in patients affected by blunt chest trauma and aortic disruption with multiple associated lesions. We report the case of a young female admitted with diagnosis of descending thoracic aortic transection and multiple traumas following a car accident. Spiral computed tomography revealed circular disruption of thoracic aorta immediately after isthmus region with intussusception of leaflets and pseudo-coartation. Doppler analysis showed a 70 mmHg transaortic gradient. The hemodynamic evaluation confirmed the existence of severe transaortic gradient. A Gore-TAG endoprosthesis (26 x 100 mm) was selected. Intraoper-ative transesophageal echocardiography assessment was performed to monitoring the entire procedure. The final arteriogram showed an optimal sealing at proximal and distal site without endoleak with complete readjustment of intimal leaflets to the aortic wall and disappearance of transaortic gradient related to the pseudo-coartation. No complication was observed in the early postoperative and patient was discharged one month later once complete rehabilitation of associated lesion was obtained. Computed tomography scan performed before discharge revealed persistency of patent lumen of aorta with fibrosis of readjusted circumferential intimal flap. In conclusion endovascular repair of complete aortic transection may result safe and effective particularly in patients with extensive associated injuries. Indeed the severity of coexisting non-aortic lesions could be adversely affected by conventional surgery in consideration of high surgical morbidity due to open thoracotomy. Stent-graft repair allows the patient to timely undergo medical or surgical management of associated lesions and a prompt rehabilitation with shorter hospital stay.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
10/17. radiotherapy: a novel treatment for pneumothorax.pneumothorax is a relatively common condition that is usually managed either conservatively, by chest tube drainage or, if a refractory air leak persists, then with cardiothoracic intervention. However, there is a small group of patients with a persistent air leak in whom surgical intervention is felt to be inappropriate. This study looks at a novel management strategy in a patient presenting with this scenario. A male with underlying bullous lung disease presented with a right pneumothorax. Complete re-expansion was not achieved, despite chest tube drainage and suction. Cardiothoracic intervention was felt to be inappropriate and the air leak persisted despite prolonged conservative management. ventilation scintigraphy was therefore used to localise the air leak prior to targeted radiotherapy in an attempt to seal the leak via radiation-induced fibrosis. Three weeks after the first fraction of radiotherapy, the air leak ceased. In complex cases of pneumothorax with persistent air leak where cardiothoracic intervention is deemed inappropriate, identification of the air leak site and localised radiotherapy could be considered.- - - - - - - - - - ranking = 1keywords = seal (Clic here for more details about this article) |
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