1/8. The UPAO test in preoperative evaluation for major pulmonary resection: an operative case with markedly improved ventilatory function after radical pulmonary resection for lung cancer associated with pulmonary emphysema.A 65-year-old man was admitted to our hospital for treatment of a squamous cell carcinoma in his right lung. Respiratory function testing showed an extremely reduced forced expiratory volume in 1 second (FEV1) of 1.0 l (29.9% of predicted), and a reduced FEV1/FVC ratio of 24.1%. Arterial blood gases on room air showed a pH of 7.41, a PaCO(2) of 36.7 mmHg, and a PaO(2) of 79.3 mmHg. To assess the predictive postoperative cardiopulmonary function, unilateral pulmonary artery occlusion (UPAO) testing was performed. In the condition of right main PA occlusion, the mean pulmonary artery pressure (mPAP), cardiac index (CI) and total pulmonary vessel resistance index (TPVRI) was 18 mmHg, 3.2 l/min/m(2) and 443.37 dyne.sec.cm(-5)/m(2), respectively. He underwent a middle lobectomy with combined partial resection of both the upper and lower lobes. He also underwent simultaneous resection of a giant bulla arising from the right upper lobe as lung volume reduction surgery. At 80 days after the operation, his FEV1 rose to 1.88 l, and the PaO(2) on room air was improved to 88.9 mmHg. UPAO testing was suggested to be more useful than routine pulmonary function test to determine the accurate predictive postoperative cardiopulmonary function and to decide indication for a radical operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/8. A rare case of dilatation of pulmonary veins and pulmonary emphysema in both lower lobes.A 34-year-old man was admitted to hospital because of persistent shortness of breath and diffuse vascular dilation at both lower fields of his CXR. bronchiectasis had been suspected during childhood because of abnormal chest shadows. However, a chest CT scan obtained on admission failed to show bronchiectasis, but rather there was a dilation of blood vessels and low attenuation areas in both lower lobes. A pulmonary angiogram showed normal pulmonary arteries in the arterial phase and diffuse dilated veins in the venous phase. Although the patient also had liver cirrhosis type B with portal hypertension, no association could be found between his liver cirrhosis and the lung lesions. This is a rare case of possible congenital or idiopathic diffuse dilatation of the pulmonary veins.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/8. air embolism and pulmonary interstitial emphysema in a preterm infant with hyaline membrane disease.A preterm infant with severe hyaline membrane disease requiring extreme mechanical ventilation developed pulmonary air leaks with consecutive shock. The chest roentgenogram showed bilateral pulmonary interstitial emphysema and gas within the heart silhouette as well as in the hepatic veins, inferior v. cava, portal vein, and many abdominal vessels. The respiratory and circulatory failure by massive systemic gas embolism resulted in death.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/8. Clinical spectrum of infantile lobar emphysema.Infantile lobar emphysema in an uncommon disease affecting newborns and infants with varying degrees of respiratory distress, evidence of lobar overaeration, mediastinal shift, and herniation. Congenital malformations of the bronchi and alveoli and extrinsic compression by vessels and cysts account for less than 50% of these cases. All segments of the upper and middle lobe may be involved, but the major overexpansion occurs in the anterior segment. Respiratory distress may be absent, mild, or severe, and the condition may be acutely progressive, acutely reverisble, chronic, or recurrent. This symptom complex is the result of multiple factors requiring investigation prior to definitive operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/8. Systemic air embolism in the respiratory distress syndrome of the newborn.Details of 25 cases of neonatal systemic air embolism, including three of our patients, are reviewed. This rare complication of respiratory distress syndrome (RDS) was observed in 21 premature infants and 4 fullterm newborns, of whom 23 required intermittent positive pressure ventilation (IPPV). In 21 of these patients air embolism was preceded by pulmonary interstitial emphysema, pneumomediastinum, pneumothorax and/or pneumopericardium. air embolism occurred between 3 and 288 hours after delivery. The outcome was lethal in 24 cases, only one patient survived. Two main pathogenic mechanisms are discussed; entrance of air from ruptured alveoli into the lung capillaries and introduction of air via catheters in umbilical vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/8. Computed tomography of bronchiectasis.Computed tomography (CT) was performed on six patients with bronchiectasis. In two cases of advanced cystic bronchiectasis, the diagnosis was apparent on plain chest roentgenograms. In four cases, bronciectasis was initially diagnosed by CT and later confirmed by bronchography. The CT signs of bronchiectasis include air--fluid levels in distended bronchi, a linear array or cluster of cysts, dilated bronchi in the periphery of the lung, and bronchial wall thickening due to peribronchial fibrosis. Distended bronchi must be distinguished from emphysematous blebs, which generally have no definable wall thickness and no accompanying vessels. It is concluded that CT should have a role in establishing the presence and anatomic extent of bronchiectasis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/8. Use of staplers in congenital lobar emphysema.The authors report on a technique for the treatment of congenital lobar emphysema in a patient of 6.5 kg body weight. After left thoracotomy and vessel isolation, a section of the lobar bronchus and interlobar fissure was performed, because of incompleteness of 3/4 of its length. Metal clips were used with the stapler ENDO-GIA 30v Autosuture after tissue calibration. The authors underline the importance of the staplers, which have been widely used in adult surgery, because they reduce the risk of bacterial contamination and air leakage through the suture rims, especially in lung resective surgery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/8. hemoptysis from an emphysematous bulla developing after open-heart surgery: report of a case.We present herein the case of a 62-year-old woman with an emphysematous bulla who developed intractable hemoptysis 16 days after undergoing mitral and aortic valve replacement with tricuspid annuloplasty. A bronchoscopic examination with balloon occlusion of the bronchial lumen revealed that the blood source was the right middle lobe bronchus. A computed tomographic (CT) scan of the chest subsequently demonstrated a blood-filled emphysematous bulla in the right middle lobe. A right middle lobectomy was performed and the bulla was observed to be swollen with clotted blood. The respiratory tract bleeding stopped immediately after the lobectomy. Pathohistological examinations suggested that disruption of the pulmonary vessels in the wall of the bulla had caused the respiratory tract bleeding.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |