1/61. subcutaneous tissue emphysema of the hand secondary to noninfectious etiology: a report of two cases.subcutaneous emphysema of the hand can be benign and noninfectious in origin. Emphysema from gas-forming organisms is associated with systemic symptoms, whereas benign subcutaneous emphysema is not. High-pressure pneumatic tool injuries are a well-known cause of subcutaneous emphysema. Minor wounds in the web space skin may result in a transport of air across the defect, acting like a ball valve mechanism to trap and then force the air into the subcutaneous tissue, as illustrated by 1 of our patients. In the second patient, use of a high-vibration tool without apparent breach of skin was associated with extensive subcutaneous emphysema. The benign nature of the emphysema was revealed by a lack of local pain and inflammation in the presence of extensive crepitus and a lack of systemic symptoms. A noninfectious cause should always be considered. This may prevent unnecessary surgical intervention, which occurred in 1 of the 2 cases presented here.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/61. 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 = pressure (Clic here for more details about this article) |
3/61. subcutaneous emphysema of a digit through a pre-existing puncture wound.A case of injection of compressed air into a digit is reported. The air was injected at 50 PSI through a trivial puncture wound sustained some hours previously. The case had a benign course, in comparison to high pressure injection injuries with foreign material.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/61. Bilateral subcutaneous emphysema of the orbits following nose blowing.Orbital emphysema without evidence of any significant trauma is a rare occurrence. A case is reported here of bilateral subcutaneous emphysema of the orbital, in the absence of facial skeleton trauma, in a healthy adult male following nose blowing. It assumes importance because of potential complications such as loss of vision due to pressure effects and infection. Lamina papyracea is the most common site of bony defect and point of air entry into the orbit. Spontaneous resolution in around two weeks is usual.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/61. Cervical emphysema, pneumomediastinum, and pneumothorax following self-induced oral injury: report of four cases and review of the literature.Spontaneous rupture of the pulmonary alveoli after a sudden increase in intra-alveolar pressure is a common cause of pneumomediastinum, which is usually seen in healthy young men. Other common causes are traumatic and iatrogenic rupture of the airway and esophagus; however, pneumomediastinum following cervicofacial emphysema is much rarer and is occasionally found after dental surgical procedures, head and neck surgery, or accidental trauma. We present four cases of subcutaneous emphysema and pneumomediastinum with two secondary pneumothoraces after self-induced punctures in the oral cavity. They constitute an uncommon clinical entity that, to our knowledge, has not been reported in the literature. Its radiologic appearance, clinical presentation, and diagnosis are described.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/61. Pneumorachis and pneumomediastinum caused by repeated Muller's maneuvers: complications of marijuana smoking.Pneumomediastinum may occur during marijuana inhalation but only rarely has pneumorachis (epidural pneumatosis or aerorachia) been reported. The usual mechanisms that produce pneumomediastinum include severe acute asthma, toxic-induced bronchial hyperreactivity, and barotrauma caused by Valsalva's maneuver (expiration through resistance). We report a case in which barotrauma resulted from repeated deep inspiration through a device with airflow resistance equivalent to Muller's maneuver. Inspiration occurred through a homemade apparatus resembling a narrow outlet bong with 2 piled compartments. Pneumomediastinum combined with subcutaneous emphysema and pneumorachis occurred, without identified pneumothorax. There were no neurologic complications. Because of the absence of bronchospasm, expiration either through the apparatus or actively against a closed glottis, or apnea, this phenomenon is likely a result of repeated Muller's maneuvers. Successive inhalation through resistance could have resulted in extreme negative intrathoracic pressure, which would have caused a transmural pressure gradient inducing barotrauma and release of extrarespiratory air. High-concentration oxygen therapy to achieve nitrogen washout was used.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/61. High-pressure water injection injury: emergency presentation and management.Presentations of high-pressure water blaster injuries to the emergency department are varied. Though these injuries are sometimes described as a 'benign variant' of high-pressure injection injuries, external appearances can be deceptive. These injuries can produce an unexpected pattern of severe internal injury and infectious complications. Such injuries are surgical emergencies and must be evaluated quickly and thoroughly in the emergency department. We review the current literature of these injuries and present the first reported case involving a forearm injury.- - - - - - - - - - ranking = 6keywords = pressure (Clic here for more details about this article) |
8/61. Tracheal rupture from incorrect positioning of endotracheal tube.Significant ischaemic tracheal damage from endotracheal intubation is uncommon when the lateral wall pressure exerted by the cuff does not exceed the mean capillary perfusion pressure of the mucosa. This is facilitated by the modern endotracheal tubes with high-volume-low-pressure cuffs. We report a case of tracheal rupture due to an incorrectly positioned softcuffed tube. The need to review tube position radiologically and to make immediate adjustment cannot be overemphasised.- - - - - - - - - - ranking = 3keywords = pressure (Clic here for more details about this article) |
9/61. Hypercarbia during carbon dioxide gas insufflation for therapeutic laparoscopy: a note of caution.During the past decade, the number of laparoscopic procedures performed in the united states, primarily with cholecystectomy, has increased phenomenally. We recently had a patient who developed hypercarbia and cardiovascular compromise during laparoscopic cholecystectomy. The cardiovascular compromise was caused by mechanical factors directly related to increasing intra-abdominal pressures affecting ventilation and venous return as well as the absorption of carbon dioxide (CO2) into the circulation, leading to acidosis and further depression of the cardiopulmonary system. Cardiovascular compromise can be avoided with early recognition of increased end-tidal CO2 concentrations and by preventing intra-abdominal pressures from exceeding 16 mm Hg.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
10/61. Management of an unusual presentation of foreign body aspiration.Foreign body aspiration is a very common problem in children and toddlers and still a serious and sometimes fatal condition. We are reporting on a 2-year-old white asthmatic male who choked on a chick pea and presented with subcutaneous emphysema, and on chest X-ray with an isolated pneumomediastinum but not pneumothorax. On review of the literature an isolated pneumomediastinum without pneumothorax was rarely reported. This presented a challenge in management mainly because of the technique that we had to use in order to undergo bronchoscopy and removal of the foreign body. Apnoeic diffusion oxygenation was used initially while the foreign body was removed piecemeal, and afterwards intermittent positive pressure ventilation was used. The child did very well, and his subcutaneous emphysema and pneumomediastinum remarkably improved immediately post surgery.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
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