1/8. lung cancer associated with pulmonary bulla. case report and review of literature.A few reports have suggested the possible association between lung cancer and bullous disease. We report a surgical case of lung adenocarcinoma located in close proximity to pulmonary bullae. A 48-year-old nonsmoker, asymptomatic male was found to have a pulmonary tumor mass and giant bulla in the right lung. thoracotomy identified a tumor arising from a firm, scarred and contracted area close to the bulla wall. Based on this report and review of other cases in the literature, we emphasize the need for physicians to be aware of the potential development of lung cancer in patients with pulmonary bulla. copyright copyright 1999 S. Karger AG, Basel- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. tobacco and public health.OBJECTIVES: An interactive program for physicians and surgeons was used to focus their attention on current issues of lung cancer in the united states. The issues examined were the risks for the development of lung cancer in smokers, spouses of smokers, recipients of second-hand or sidestream smoke, and the appropriate workup and treatment of patients with lung cancer. DESIGN: Case presentation with interactive questions and answers. patients: Six patients are presented whose cases demonstrate issues that are relevant and timely to the practice of thoracic surgery and oncology Interventions: Treatment for the five case presentations is used for interactive teaching purposes. CONCLUSIONS: lung cancer is epidemic in the united states, particularly among women at the present time. Physician awareness of the environmental and other factors contributing to the disease should stay current with the population variables that we are seeing in clinical practice.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Eight years of unexplained headaches (why did the diagnosis take so long?).The patient had chronic incapacitating headaches for a period of eight years. Neurologic tests ruling out organic causes such as tumors and analysis of diet, allergies, stress levels, and chronic infections left the patient and physicians without an explanation. The headaches did not fit the patterns of common or classic migraines. The patient's energy level had significantly decreased during this same time period, and she had frequently become short of breath. diagnosis of underlying pathology occurred when efforts were focused on explaining respiratory conditions. The patient had an oxygen saturation of 77% and a pulse of 98, following a brief walk around the building. Further testing by a pulmonary specialist confirmed diagnosis of emphysema secondary to a deficiency of Alpha-1 Antitrypsin (AAT). Background materials supporting this case history include: a model for AAT function, genetics of AAT deficiency, pathophysiology of both liver and pulmonary diseases, and a summary of treatment options and prognosis for AAT deficient patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Simultaneous bilateral spontaneous pneumothorax: case report.A 22-year-old previously healthy male was admitted to the emergency department for chest pain and dyspnea of 1-day's duration. He had a history of heavy smoking. The patient was cyanotic, agitated, and severely dyspneic. lung auscultation revealed severe diffuse bronchospasm and equally diminished breath sounds on both sides. Nasotracheal intubation and mechanical ventilation were performed shortly after admission due to acute respiratory failure. Simultaneous bilateral spontaneous pneumothorax was diagnosed from the chest x-ray, and chest tube drainage was immediately performed bilaterally. Computerized tomography of the chest 1 month later showed diffuse emphysematous bullae of the lungs. The case presented here should increase physicians' awareness of this rare form of spontaneous pneumothorax and its diverse manifestations.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. pregnancy and alpha-1 antitrypsin deficiency.A 29 year old patient with alpha-1 antitrypsin deficiency and bullous emphysema became pregnant against the advice of her physicians. Despite a mid-trimester pneumothorax requiring the insertion of a chest tube, she went on to deliver a healthy child under epidural anaesthesia using a midforceps technique. Vaginal delivery is not necessarily contra-indicated in multiparous patients with bullous emphysema.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Problematic diagnosis of bronchial foreign bodies in children.Bronchial foreign bodies by children are dangerous and require immediate therapeutic measures. Findings and significance of chest film in the diagnosis of bronchial foreign bodies in 24 children were analysed. All patients were symptomatic. 18 patients had an abnormal and 6 normal auscultation finding. In three cases the physician did not suspect aspiration, and the diagnosis was delayed, which caused the death of one child. Roentgenpositive foreign bodies were found in 8 and -negative in 16 cases. Secondary changes (obstructive emphysema, atelectasis, pneumonia) were seen in 16 cases. In emergency cases the chest films were analysed by physician and later by a radiologist, who found 88% of them to be abnormal. fluoroscopy of expiratory chest film helps to detect the unilateral emphysema more distinctly. The diagnosis must always be confirmed with bronchoscopy and extraction thereby is the adequate treatment of bronchial bodies.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
7/8. Bullous sarcoidosis: a report of three cases.Three cases of pulmonary sarcoidosis presented as bullous emphysema with severe airflow obstruction, and the diagnosis of sarcoidosis was unsuspected for at least 2 years. Potential mechanisms of bullous emphysema from sarcoidosis are discussed. The physician should suspect sarcoidosis as the cause of bullous emphysema when young patients who have smoked relatively few pack-years present with emphysema or severe airflow obstruction. Additional clues are the presence of mediastinal adenopathy on a chest radiograph or a CT scan and a history consistent with extrapulmonary sarcoidosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Nonsurgical causes of pneumoperitoneum.The radiographic manifestation of free air in the peritoneal cavity suggests serious intra-abdominal disease and the need for urgent surgical management. Yet, about 10% of all cases of pneumoperitoneum are caused by physiologic processes that do not require surgical management. We retrospectively reviewed cases of nonsurgical causes of pneumoperitoneum at the 2 teaching hospitals of a university medical center between January 1990 and December 1995. Successful management by observation and supportive care without surgical intervention was defined as the diagnostic feature of nonperforation. Failure of a laparotomy to delineate a surgical cause or to result in a reparative procedure is congruent with a nonsurgical cause of pneumoperitoneum. During this period, 8 patients (6 men and 2 women; mean age, 61 years) were identified with nonsurgical causes of pneumoperitoneum. Two patients underwent negative laparotomy, and the other 6 were successfully managed nonoperatively and discharged from the hospital. In 6 patients, a cause of the pneumoperitoneum was identified. The causes may be grouped under the following categories: postoperatively retained air, thoracic, abdominal, gynecologic, and idiopathic. In our review of the literature, 61 of 139 reported cases underwent surgical treatment without evidence of perforated viscus. To avoid unnecessary surgical procedures, both primary medicine physicians and surgeons need to recognize nonsurgical causes of pneumoperitoneum. Conservative management is warranted in the absence of symptoms and signs of peritonitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |