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Abu Suleiman A, James D, Wilkins A, Bladel AV, Lo T. Achalasia-associated megaoesophagus presenting with dyspnoea and cough. BMJ Case Rep 2024; 17:e258950. [PMID: 38367990 PMCID: PMC10875499 DOI: 10.1136/bcr-2023-258950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2024] Open
Abstract
We present an unusual case of achalasia presenting with dyspnoea and persistent cough. These symptoms persisted for months, leading to the patient undergoing a chest X-ray by her general practitioner which showed right basal consolidation and a density extending along the right mediastinum. CT scan was done which revealed megaoesophagus with a diameter of 7 cm causing tracheal compression, as well as right basal consolidation, consistent with aspiration. Further history revealed 6-month history of progressive swallowing difficulty, retrosternal chest pain and shortness of breath which worsened when eating solid foods. After thorough workup, a diagnosis of idiopathic achalasia (type II) was made. She was treated with laparoscopic Heller cardiomyotomy and Dor fundoplication with significant improvement at follow-up. Dyspnoea and respiratory symptoms are unusual presenting symptoms, suggesting a need to consider achalasia in a wider range of presentations. Successful treatment of achalasia depends on timely diagnosis and intervention prior to oesophageal failure.
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Affiliation(s)
- Amro Abu Suleiman
- Department of Upper Gastrointestinal Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Daniel James
- Department of Upper Gastrointestinal Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Alexander Wilkins
- Department of Upper Gastrointestinal Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - Adrian Van Bladel
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Terence Lo
- Department of Upper Gastrointestinal Surgery, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
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Bao T, Chen P, Yu J, Cai DH, He XD, Wang YJ, Xie XF, Li KK, Zhao XY, Guo W. Learning curve in relation to health-related quality of life in long-term, disease free survivors after McKeown minimally invasive esophagectomy. Surg Endosc 2024; 38:671-678. [PMID: 38012442 DOI: 10.1007/s00464-023-10553-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/20/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND The potential impact of learning curve on long-term health-related quality of life (QoL) after esophagectomy for cancer has not been investigated. The aim of this article is to investigate the relationship between learning curve for McKeown minimally invasive esophagectomy (MIE) and health-related quality of life (QoL) in long-term, disease free survivors up to 10 years after esophageal cancer resection. METHODS Esophageal cancer patients who underwent McKeown MIE between 2009 and 2019 were identified in which 280 who were free of disease at the time of survey and completed health-related QoL and symptom questionnaires, including EORTC QLQ-C30, EORTC QLQ-OES18, and Digestive Symptom Questionnaire. Patients were assessed in 3 cohorts according to the learning phases of expertise reported by our previous study: initial phase; plateau phase, and; experienced phase. RESULTS Median time from operation to survey was 5.8 years (interquartile range 4.6-8.2). The QLQ-C30 mean scores of functional scales, and symptom scales of respiratory and digestive systems including dyspnea (P = 0.006), shortness of breath (P = 0.003), and dysphagia (P = 0.031) were significantly better in experienced phase group. Furthermore, in the subgroup analyses for patients without postoperative major complications, patients in the initial learning phase remained suffering from more symptoms of dyspnea (P = 0.040) and shortness of breath (P = 0.001). CONCLUSION Esophageal cancer patients undergoing McKeown MIE in initial learning phase tend to suffer from a deterioration in long-term health-related QoL and higher symptomatic burden as compared to experienced learning phase, which did not improved over time and warranted more attention.
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Affiliation(s)
- Tao Bao
- Army Medical University, Gaotanyan Route 30#, Chongqing, 400038, People's Republic of China
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Ping Chen
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Jun Yu
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Dao-Hong Cai
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Xian-Dong He
- Army Medical University, Gaotanyan Route 30#, Chongqing, 400038, People's Republic of China
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Ying-Jian Wang
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Xian-Feng Xie
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Kun-Kun Li
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Xiao-Ying Zhao
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Wei Guo
- Army Medical University, Gaotanyan Route 30#, Chongqing, 400038, People's Republic of China.
- Department of Thoracic Surgery, Daping Hospital, Army Medical University, Chongqing, People's Republic of China.
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Ibrahim AA, Hamdan AM, Elnaggar AA. Endoscopic assisted microscopic posterior cordotomy for bilateral abductor vocal fold paralysis using radiofrequency versus coblation. Eur Arch Otorhinolaryngol 2024; 281:835-841. [PMID: 38040937 PMCID: PMC10796539 DOI: 10.1007/s00405-023-08331-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 11/01/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE To assess the outcomes of endoscopic assisted microscopic posterior cordotomy for bilateral abductor vocal fold paralysis (BAVFP) using radiofrequency versus coblation. METHODS This was a randomized prospective cohort study that carried out on 40 patients with BAVFP who were subjected to endoscopic/assisted microscopic posterior cordotomy. The patients were randomly allocated into two groups: group (A) patients were operated with radiofrequency, and group (B) patients were operated with coblation. Glottic chink, grade of dyspnea, voice handicap index 10 (VHI10), and aspiration were evaluated pre-operatively and 2 weeks and 3 months post-operatively. RESULTS There was a significant improvement in the glottic chink and VHI10 scores postoperatively with a non-significant difference between both groups regarding the degree of improvement. In addition, there was a significant improvement of the grade of dyspnea with a non-significant impact on the degree of aspiration in both groups post operatively. There was a lower incidence of oedema and granulation formation in the coblation group but without a statistical significance. CONCLUSION Both techniques are effective alternatives for performing posterior transverse cordotomy in cases of BAVFP.
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Affiliation(s)
- Anwar Abdelatty Ibrahim
- Faculty of Medicine, Otorhinolaryngology Department, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Ahmad Mahmoud Hamdan
- Faculty of Medicine, Otorhinolaryngology Department, Menoufia University, Shebin El-Kom, Menoufia, Egypt.
| | - Ahmed Ali Elnaggar
- Faculty of Medicine, Otorhinolaryngology Department, Tanta University, Tanta, Egypt
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Shafiq M, Qadeer T, Tentzeris V, Kastelik J. Rare presentation of pneumothorax in a young woman with underlying congenital pulmonary airway malformation. BMJ Case Rep 2023; 16:e254294. [PMID: 38050398 PMCID: PMC10693894 DOI: 10.1136/bcr-2022-254294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2023] [Indexed: 12/06/2023] Open
Abstract
Congenital pulmonary airway malformation (CPAM) is the most common among a rare group of congenital anomalies of the lower respiratory tract. It has variable presentation depending on its subtype and the patient's age. It may lead to respiratory distress in neonates. It can be a particularly challenging diagnosis in children born asymptomatic but present with complications later in life such as haemoptysis, recurrent chest infections, breathlessness and pneumothorax. Prenatal ultrasound, chest X-ray, CT scan and MRI are helpful in making a radiological diagnosis.A woman in her late teens presented with shortness of breath and right pleuritic chest pain. CT's chest showed a number of bullae of varying sizes on the right, including one huge bulla compressing all three lobes. She underwent lung volume reduction surgery via video-assisted thoracoscopy, and the histology specimen confirmed the diagnosis of CPAM type 1.
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Affiliation(s)
- Muhammad Shafiq
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, UK
- Department of Respiratory Medicine, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Tariq Qadeer
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, UK
| | - Vasileios Tentzeris
- Thoracic Surgery, Castle Hill Hospital, Cottingham, East Riding of Yorkshire, UK
| | - Jack Kastelik
- Department of Respiratory Medicine, Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, UK
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Stevanović S, Knežević M, Obraz M, Košec A. Successful emergency Lichtenberger lateralisation for immediate bilateral laryngeal immobility after total thyroidectomy: a CARE case report. J Laryngol Otol 2023; 137:1413-1415. [PMID: 37039448 DOI: 10.1017/s0022215123000646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE This case report discusses a successful emergency Lichtenberger lateralisation procedure after immediate bilateral laryngeal immobility, occurring after total thyroidectomy. METHODS A 63-year-old female with right-sided vocal fold paralysis due to compression by a multinodular thyroid goitre underwent total thyroidectomy, which resulted in immediate post-operative bilateral vocal fold immobility. The patient had acute-onset post-operative dyspnoea, was promptly re-intubated, and an emergency lateralisation Lichtenberger suture was placed over the right vocal fold and fixated on the outer surface of the neck. RESULTS After two weeks, her right vocal fold recovered first, with the suture still in place. At four weeks, both vocal folds regained function and the suture was extracted. CONCLUSION The take-away message is that an emergency lateralisation suture may be a viable option in maintaining airway patency, while allowing for normal deglutition, in patients who would otherwise be candidates for prolonged intubation, posterior cordotomy, medial arytenoidectomy or tracheostomy.
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Affiliation(s)
- S Stevanović
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - M Knežević
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - M Obraz
- Department of Anesthesiology and Intensive Care, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - A Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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廖 桥, 林 宗, 沈 翎, 杨 中, 高 信. [Analysis of cases of laryngeal airway diseases in infants]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:953-957. [PMID: 38114310 PMCID: PMC10985684 DOI: 10.13201/j.issn.2096-7993.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/25/2023] [Indexed: 12/21/2023]
Abstract
Objective:To analyze the clinical data of laryngeal airway diseases in infants and provide reference for the standardized diagnosis and treatment of the disease. Methods:From June 2022 to August 2023, analyze the clinical data of 4 cases of children with laryngeal airway diseases recently admitted to Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, and summarize the experience and lessons of diagnosis and treatment by consulting relevant literature. Results:Three cases had symptoms such as laryngeal wheezing, dyspnea, backward growth and development, etc. After electronic laryngoscopy, the first case was diagnosed with laryngeal softening (severe, type Ⅱ), and the angular incision was performed. While cases 2, 3 diagnosed with case 2 and 3 were diagnosed with laryngeal cyst and underwent laryngeal cyst resection. All three cases underwent low-temperature plasma surgery under visual laryngoscope, and the symptoms were relieved after operation. Case 4 was laryngeal wheezing and dyspnea after extubation under general anesthesia. The electronic laryngoscopy showeded early stage of globetic stenosis, and endoscopic pseudomembrane clamping was performed, and the postoperative symptoms were relieved. Conclusion:Infants and young children with laryngeal airway diseases should pay attention to the early symptoms and be diagnosed by electronic laryngoscopy as soon as possible. With good curative effect and few complications, low-temperature plasma surgery under visual laryngoscope is recommended. The formation of pseudomembrane under the gluteal caused by tracheal intubation causes rapid onset and rapid development. The pseudomembrane extraction by clamping is convenient and fast, with good curative effect.
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Affiliation(s)
- 桥淯 廖
- 福建省福州儿童医院耳鼻咽喉科(福州,350005)Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou, 350005, China
| | - 宗通 林
- 福建省福州儿童医院耳鼻咽喉科(福州,350005)Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou, 350005, China
| | - 翎 沈
- 福建省福州儿童医院耳鼻咽喉科(福州,350005)Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou, 350005, China
| | - 中婕 杨
- 福建省福州儿童医院耳鼻咽喉科(福州,350005)Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou, 350005, China
| | - 信忠 高
- 福建省福州儿童医院耳鼻咽喉科(福州,350005)Department of Otolaryngology, Fuzhou Children's Hospital of Fujian Province, Fuzhou, 350005, China
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7
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马 玉, 胡 艳, 刘 海, 彭 中, 袁 洛. [Retrospective review of airway obstruction in 19 infants with pharyngeal cysts]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2023; 37:958-959. [PMID: 38114311 PMCID: PMC10985697 DOI: 10.13201/j.issn.2096-7993.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Indexed: 12/21/2023]
Abstract
Objective:To discuss the clinical characteristic and treatment of laryngeal cysts in infants. Methods:The clinical data of 19 patients diagnosed with laryngeal cysts in Department of Otolaryngology, Sichuan Provincial Maternity and Child Health Care Hospital from November 2017 to April 2023 were retrospectively analyzed. Results:All of the 19 patients were diagnosed as laryngeal cysts, with clinical manifestations included respiratory distress, inspiratory dyspnea, difficulty in feeding and low and weak crying, etc. All of them were cured after surgical treatment. Conclusion:Misdiagnosis and missed diagnosis of laryngeal cysts are prone to occur in infants and young children. After diagnosis, patients should undergo early surgical treatment to remove airway obstruction and improve ventilation.
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Affiliation(s)
- 玉玲 马
- 四川省妇幼保健院耳鼻咽喉科(成都,610045)Department of Otolaryngology, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610045, China
| | - 艳 胡
- 四川省妇幼保健院耳鼻咽喉科(成都,610045)Department of Otolaryngology, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610045, China
| | - 海兵 刘
- 四川省妇幼保健院耳鼻咽喉科(成都,610045)Department of Otolaryngology, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610045, China
| | - 中华 彭
- 四川省妇幼保健院耳鼻咽喉科(成都,610045)Department of Otolaryngology, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610045, China
| | - 洛花 袁
- 四川省妇幼保健院耳鼻咽喉科(成都,610045)Department of Otolaryngology, Sichuan Provincial Maternity and Child Health Care Hospital, Chengdu, 610045, China
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8
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Hunt AR, Stuart CM, Gergen AK, Bang TJ, Reihman AE, Helmkamp LJ, Lin Y, Mitchell JD, Meguid RA, Scott CD, Wojcik BM. Long-Term Patient-Reported Symptom Improvement and Quality of Life after Transthoracic Diaphragm Plication in Adults. J Am Coll Surg 2023; 237:533-544. [PMID: 37194947 DOI: 10.1097/xcs.0000000000000762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Open and robotic-assisted transthoracic approaches for diaphragm plication are accepted surgical interventions for diaphragm paralysis and eventration. However, long-term patient-reported symptom improvement and quality of life (QOL) remains unclear. STUDY DESIGN A telephone-based survey was developed focusing on postoperative symptom improvement and QOL. Patients who underwent open or robotic-assisted transthoracic diaphragm plication (2008-2020) across three institutions were invited to participate. Patients who responded and provided consent were surveyed. Likert responses on symptom severity were dichotomized and rates before and after surgery were compared using McNemar's test. RESULTS Forty-one percent of patients participated (43 of 105 responded, mean age 61.0 years, 67.4% male, 37.2% robotic-assisted surgery), with an average time between surgery and survey of 4.1 ± 3.2 years. Patients reported significant improvement in dyspnea while lying flat (67.4% pre- vs 27.9% postoperative, p < 0.001), dyspnea at rest (55.8% pre- vs 11.6% postoperative, p < 0.001), dyspnea with activity (90.7% pre- vs 55.8% postoperative, p < 0.001), dyspnea while bending over (79.1% pre- vs 34.9% postoperative, p < 0.001), and fatigue (67.4% pre- vs 41.9% postoperative, p = 0.008). There was no statistical improvement in chronic cough. 86% of patients reported improved overall QOL, 79% had increased exercise capacity, and 86% would recommend surgery to a friend with a similar problem. Analysis comparing open and robotic-assisted approaches found no statistically significant differences in symptom improvement or QOL responses between the groups. CONCLUSIONS Patients report significantly improved dyspneic and fatigue symptoms after transthoracic diaphragm plication, regardless of open or robotic-assisted approach. The majority of patients report improved QOL and exercise capacity.
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Affiliation(s)
- Amanda R Hunt
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Christina M Stuart
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Anna K Gergen
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Tami J Bang
- Division of Cardiopulmonary Imaging, Department of Radiology (Bang), University of Colorado, Aurora, CO
| | - Anne E Reihman
- Critical Care and Pulmonary Sleep Associates, Aurora, CO (Reihman)
| | - Laura J Helmkamp
- Adult and Child Consortium for Health Outcomes Research, University of Colorado School of Medicine, Aurora, CO (Helmkamp)
| | - Yihan Lin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, CA (Lin)
| | - John D Mitchell
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Robert A Meguid
- From the Division of Cardiothoracic Surgery, Department of Surgery (Hunt, Stuart, Gergen, Mitchell, Meguid), University of Colorado, Aurora, CO
| | - Christopher D Scott
- Division of Cardiothoracic Surgery, Department of Surgery, University of Virginia, Charlottesville, VA (Scott)
| | - Brandon M Wojcik
- the Division of Cardiothoracic Surgery, Department of Surgery, Munson Medical Center, Traverse City, MI (Wojcik)
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Bouriez D, Belaroussi Y, Boubaddi M, Martre P, Najah H, Berger P, Gronnier C, Collet D. Laparoscopic fundoplication for para-oesophageal hernia repair improves respiratory function in patients with dyspnoea: a prospective cohort study. Surg Endosc 2022; 36:7266-7278. [PMID: 35732837 PMCID: PMC9216289 DOI: 10.1007/s00464-022-09127-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 02/07/2022] [Indexed: 01/20/2023]
Abstract
Background Dyspnoea in patients with a para-oesophageal hernia (PEH) occurs in 7% to 32% of cases and is very disabling, especially in elderly patients, and its origin is not well defined. The present study aims to assess the impact of PEH repair on dyspnoea and respiratory function. Methods From January 2019 to May 2021, all consecutive patients scheduled for PEH repair presenting with a modified Medical Research Council (mMRC) score ≥ 2 for dyspnoea were included. Before and 2 months after surgery, dyspnoea was assessed by both the dyspnoea visual analogue scale (DVAS) and the mMRC scale, as well as pulmonary function tests (PFTs) by plethysmography. Results All 43 patients that were included had pre- and postoperative dyspnoea assessments and PFTs. Median age was 70 years (range 63–73.5 years), 37 (86%) participants were women, median percentage of the intrathoracic stomach was 59.9% (range 44.2–83.0%), and median length of hospital stay was 3 days (range 3–4 days). After surgery, the DVAS decreased statistically significant (5.6 [4.7–6.7] vs. 3.0 [2.3–4.4], p < 0.001), and 37 (86%) patients had a clinically significant decrease in mMRC score. Absolute forced expiratory volume in one second (FEV1), total lung capacity, and forced vital capacity also statistically significantly increased after surgery by an average of 11.2% (SD 17.9), 5.0% (SD 13.9), and 10.7% (SD 14.6), respectively. Furthermore, from the subgroup analysis, it was identified that patients with a lower preoperative FEV1 were more likely to have improvement in it after surgery. No correlation was found between improvement in dyspnoea and FEV1. There was no correlation between the percentage of intrathoracic stomach and dyspnoea or improvement in PFT parameters. Conclusion PEH repair improves dyspnoea and FEV1 in a statistically significant manner in a population of patients presenting with dyspnoea. Patients with a low preoperative FEV1 are more likely to have improvement in it after surgery.
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Affiliation(s)
- Damien Bouriez
- Esophagogastric Surgery Unit, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France
| | - Yaniss Belaroussi
- Thoracic Surgery Unit, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, 33076, Bordeaux, France
| | - Mehdi Boubaddi
- Esophagogastric Surgery Unit, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France
| | - Paul Martre
- Esophagogastric Surgery Unit, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France
| | - Haythem Najah
- Esophagogastric Surgery Unit, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France
| | - Patrick Berger
- Pulmonary Function Tests Department, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
| | - Caroline Gronnier
- Esophagogastric Surgery Unit, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France.
- University of Bordeaux, Bordeaux, France.
- INSERM, U1053, Bordeaux, France.
| | - Denis Collet
- Esophagogastric Surgery Unit, Haut Lévêque Hospital, CHU Bordeaux, Bordeaux, France
- University of Bordeaux, Bordeaux, France
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Said A, Konimba C, Ilias T, Loubna T, Amal H, Mustapha S, Salwa O, Ali J, Mohammed Z, Fouad B. Gestion en urgence d'un énorme goitre compressif: à propos d'un cas. Pan Afr Med J 2022; 41:265. [PMID: 35734334 PMCID: PMC9187980 DOI: 10.11604/pamj.2022.41.265.30516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022] Open
Abstract
Le goitre plongeant compressif est une urgence au traitement du fait du risque d´asphyxie par compression de l´arbre respiratoire. Nous rapportons le cas d´une patiente de 48 ans qui s´est présentée aux urgences avec une dyspnée laryngée sur un goitre plongeant et compressif, à travers notre observation et une revue de la littérature nous allons mettre le point sur les caractéristiques cliniques, l'aspect radiologique, et les différentes options du traitement. La gestion d´un patient qui présente un goitre compressif est difficile et doit être rapide car le risque d´asphyxie est majeur, la prise en charge est multidisciplinaire par une équipe opératoire expérimentée incluant les réanimateurs l´Otho-rhino-laringologie (ORL) et les chirurgiens thoraciques.
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Affiliation(s)
- Anajar Said
- Ear, Neck, Throat Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
- Corresponding author: Anajar Said, Ear, Neck, Throat Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences Casablanca, Morocco.
| | - Coulibaly Konimba
- Ear, Neck, Throat Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Tahiri Ilias
- Ear, Neck, Throat Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Taali Loubna
- Ear, Neck, Throat Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Hajjij Amal
- Ear, Neck, Throat Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Saadi Mustapha
- Ear, Neck, Throat Department, Face and Neck Surgery, Hospital Cheikh Khalifa, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Ouraini Salwa
- Ear, Neck, Throat Department, Face and Neck Surgery, Military Hospital Mohammed V, Rabat, Morocco
| | - Jahidi Ali
- Ear, Neck, Throat Department, Face and Neck Surgery, Military Hospital Mohammed V, Rabat, Morocco
| | - Zalakh Mohammed
- Ear, Neck, Throat Department, Face and Neck Surgery, Military Hospital Mohammed V, Rabat, Morocco
| | - Benariba Fouad
- Ear, Neck, Throat Department, Face and Neck Surgery, Military Hospital Mohammed V, Rabat, Morocco
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Goel AN, Filimonov A, Teruya-Feldstein J, Salib C, Rousso JJ, Hackett AM, Rothschild MA, Wanna GB. Burkitt lymphoma of the nasopharynx causing life-threatening airway obstruction: A case report. Am J Otolaryngol 2021; 42:102977. [PMID: 33636684 DOI: 10.1016/j.amjoto.2021.102977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To describe a case of Burkitt lymphoma (BL) in a child manifesting with acute airway obstruction. To review available literature on the clinical features and characteristic presentation of this disease. METHODS Case report with literature review. RESULTS We present the case of an 8-year-old boy with nasopharyngeal BL manifesting initially as sore throat, nasal congestion, and snoring that progressed to dyspnea and, ultimately, acute airway obstruction requiring emergent tracheostomy. The child was treated with intensive chemotherapy and achieved complete response. CONCLUSION This case highlights the importance of maintaining high clinical suspicion when evaluating common otolaryngologic symptoms and emphasizes the potential for Burkitt lymphoma to cause rapid patient deterioration.
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Affiliation(s)
- Alexander N Goel
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, NY, New York, USA.
| | - Andrey Filimonov
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, NY, New York, USA
| | | | - Christian Salib
- Department of Pathology, Icahn School of Medicine at Mount Sinai, NY, New York, USA
| | - Joseph J Rousso
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, NY, New York, USA
| | - Alyssa M Hackett
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, NY, New York, USA
| | - Michael A Rothschild
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, NY, New York, USA
| | - George B Wanna
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, NY, New York, USA; Department of Otolaryngology-Head and Neck Surgery, New York Eye and Ear Infirmary of Mount Sinai, NY, New York, USA
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12
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Genç S, Eneyli MG, Polat O, Oğuz AB, Enön S. Hemopneumothorax After Trigger Point Injection for Fibromyalgia. Altern Ther Health Med 2020; 26:62-64. [PMID: 31221937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
CONTEXT Trigger point injections (TPIs) and acupuncture are common procedures in management of chronic back pain and usually are considered safe. Needling into cervical and thoracic regions can be associated with life-threatening complications. OBJECTIVE The team intended to make practitioners aware of the potential for hemopneumothorax after TPI. DESIGN The research team describes a case of hemopneumothorax after TPI. SETTING The case study took place in the Department of Emergency Medicine at the Ankara University School of Medicine (Ankara, Turkey). PARTICIPANT The participant was a 45-y-old woman, who had been admitted to the emergency department at the School of Medicine with dyspnea and dizziness after TPI for fibromyalgia. RESULTS Computerized tomography of the thorax showed a significant hemopneumothorax at the right hemithorax and a collapsed right lung, markedly in the right, lower lobe. The hemopneumothorax was successfully treated with chest-tube and video-assisted thoracoscopic surgery. CONCLUSIONS Health care professionals need to be aware of hemopneumothorax when performing TPI on the chest wall.
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Li Z, Xiang D, Gao L, Tan J, Zeng X. Resection of a Giant Bronchogenic Cyst in the Left Atrium. Can J Cardiol 2020; 36:967.e13-967.e15. [PMID: 32413338 DOI: 10.1016/j.cjca.2020.02.078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 11/19/2022] Open
Abstract
A bronchogenic cyst in the left atrium is rare. We report the case of a 17-year-old male patient who was admitted to the emergency department because of severe chest pain and dyspnea. He was diagnosed using echocardiography and computed tomography, which revealed a huge cardiac tumour in the dome of the left atrium. He was surgically treated with tumour enucleation. The resultant atrial dome defect was reconstructed with a bovine pericardial patch. Pathologic investigation revealed that the tumour was a bronchogenic benign cyst.
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Affiliation(s)
- Zhongkui Li
- Department of Cardiac Surgery, The People's Hospital of Guizhou Province, Guiyang, P.R. China
| | - Daokang Xiang
- Department of Cardiac Surgery, The People's Hospital of Guizhou Province, Guiyang, P.R. China
| | - Lufang Gao
- Department of Cardiac Surgery, The People's Hospital of Guizhou Province, Guiyang, P.R. China
| | - Jing Tan
- Department of Cardiac Surgery, The People's Hospital of Guizhou Province, Guiyang, P.R. China
| | - Xiangjun Zeng
- Department of Cardiac Surgery, The People's Hospital of Guizhou Province, Guiyang, P.R. China.
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Abstract
INTRODUCTION Various phenotypes have been identified for MYH7 gene mutation-related myopathy. Here, we describe a patient with severe muscular weakness and skeletal deformity with de novo heterozygous MYH7 gene mutation. PATIENT CONCERNS A 33-year-old woman presented with early onset of muscular weakness, with delayed motor development during infancy. At age 8 years, she was unable to walk, with signs of skeletal deformity, including the progression of kyphoscoliosis. At age 31 years, she developed dyspnea. DIAGNOSIS She diagnosed with esophageal hiatal hernia with abdominal CT. In electromyography, short duration, small amplitude motor unit action potential (MUAP), and early recruitment patterns were observed in the involved proximal muscles, suggesting myopathy. Muscle histopathology showed fiber-type disproportion. INTERVENTIONS Next-generation sequencing study revealed a heterozygous in-frame deletion variation in the exon 14 of the MYH7 gene (c.1498_1500del/p.Glu500del), which is a novel variation confirmed by conventional Sanger sequencing. Compared with the parental test, this variant was concluded as de novo. OUTCOMES She received laparoscopic hiatal hernia repair and Nissen fundoplication for esophageal hiatal hernia. After surgery, her postural dyspnea improved. As there is no fundamental treatment for MYH7-related myopathies, she continued conservative treatment for her symptoms. CONCLUSION Here, we presented a rare case of de novo mutation of the myosin head domain in the MYH7 gene. This report broadens both the phenotypic and genotypic spectra of MYH7-related myopathies.
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Affiliation(s)
- Jin Young Ko
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
| | - Minyong Lee
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | | | - Dae-Hyun Jang
- Department of Rehabilitation Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Ju Seok Ryu
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam
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Abstract
RATIONALE Primary clear cell carcinoma of the lung is a rare condition, and presentation as an endotracheal lesion is even more unusual. In this report, we present a patient with clear cell carcinoma occurring in the trachea, which obstructed the tracheal lumen and lead to the respiratory distress. PATIENT CONCERNS A 60-year old female patient was admitted due to a 6-month history of dyspnea with worsening symptoms for 1 month. Chest CT scan revealed a smooth nodular shadow with homogeneous density on the wall of upper trachea. DIAGNOSIS Bronchoscopy therapy and surgical removal of the tumor were performed. The histopathological diagnosis revealed clear cell carcinoma. INTERVENTION Surgical removal of the clear cell carcinoma was performed. OUTCOMES The patient recovered well after the surgery and is now being followed-up after hospital discharge. LESSONS Bronchoscopy is an essential tool for diagnosis of tracheal clear cell carcinoma. Surgical removal should be performed if possible.
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Affiliation(s)
- Min Li
- Department of Respiratory Medicine
| | - Wenye Zhu
- Department of Pharmacy, First Affiliated Hospital of Kunming Medical University
| | | | - Ummair Saeed
- Postgraduate School of Kunming Medical University, Kunming, Yunnan, P.R. China
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Kahan J, Banner R, Lutchman-Singh K. Breathlessness and abdominal swelling: a classic eponymous syndrome. BMJ 2017; 356:j382. [PMID: 28183705 DOI: 10.1136/bmj.j382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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17
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Koda Y, Murakami H, Matsuda H, Mukohara N. Release of tracheal compression by innominate artery aneurysm. J Vasc Surg 2016; 64:499. [PMID: 27763270 DOI: 10.1016/j.jvs.2015.12.058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/28/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Yojiro Koda
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Hirohisa Murakami
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan.
| | - Nobuhiko Mukohara
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
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Heffernan AE, Biskup JJ, Kramek BA, Anderson GM. Simultaneous staphylectomy and unilateral arytenoid lateralization in dogs presenting for dyspnea: 23 cases (2010-2013). Can Vet J 2016; 57:1087-1093. [PMID: 27708449 PMCID: PMC5026151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This retrospective study assesses postoperative complications with simultaneous staphylectomy and unilateral arytenoid lateralization (SP + UAL) in dogs with laryngeal paralysis and concurrent elongation of the soft palate compared to dogs having a UAL alone. Medical records of dogs having a UAL performed from 2010 to 2013 were reviewed. Twenty-three dogs were diagnosed with a concurrent elongated soft palate and had a SP + UAL performed and 89 dogs were diagnosed with an appropriate soft palate and had only a UAL performed. A telephone questionnaire for long-term postoperative outcomes was completed. Survival probability was not statistically different between the 2 groups. Dogs in the SP + UAL group were more likely to be seen for respiratory distress after surgery (P = 0.05). There was no significant difference between the 2 groups in the number of dogs which developed postoperative aspiration pneumonia. The overall complication rate for both groups was high, with postoperative pneumonia being the most common complication.
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Abstract
Platypnea-orthodeoxia syndrome is a rare disease defined by dyspnea and deoxygenation, induced by an upright position, and relieved by recumbency. Causes include shunting through a patent foramen ovale and pulmonary arteriovenous malformations. A 79-year-old woman experienced 2 syncopal episodes at rest and presented at another hospital. In the emergency department, she was hypoxic, needing 6 L/min of oxygen. Her chest radiograph showed nothing unusual. Transthoracic echocardiograms with saline microcavitation evaluation were mildly positive early after agitated-saline administration, suggesting intracardiac shunting. She was then transferred to our center. Right-sided heart catheterization revealed no oximetric evidence of intracardiac shunting while the patient was supine and had a low right atrial pressure. However, her oxygen saturation dropped to 78% when she sat up. Repeat transthoracic echocardiography while sitting revealed a dramatically positive early saline microcavitation-uptake into the left side of the heart. Transesophageal echocardiograms showed a patent foramen ovale, with right-to-left shunting highly dependent upon body position. The patient underwent successful percutaneous patent foramen ovale closure, and her oxygen supplementation was suspended. In patients with unexplained or transient hypoxemia in which a cardiac cause is suspected, it is important to evaluate shunting in both the recumbent and upright positions. In this syndrome, elevated right atrial pressure is not necessary for significant right-to-left shunting. Percutaneous closure, if feasible, is first-line therapy in these patients.
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20
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Lee ML, Chiu IS. Platypnea-Orthodeoxia Syndrome Two Decades after Definitive Surgical Repair of Pulmonary Atresia with Intact Ventricular Septum. Yonsei Med J 2016; 57:799-802. [PMID: 26996585 PMCID: PMC4800375 DOI: 10.3349/ymj.2016.57.3.799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/29/2015] [Accepted: 06/16/2015] [Indexed: 11/27/2022] Open
Abstract
A 20-year-old female had undergone definitive surgical repair for pulmonary atresia with intact ventricular septum soon after birth. She was referred to our institution with the chief complaint of clubbing fingers. A thorough examination revealed platypnea-orthodeoxia syndrome due to an interatrial right-to-left shunt through a secundum atrial septal defect. Percutaneous closure with an Amplatzer Septal Occluder resulted in resolution of the syndrome.
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Affiliation(s)
- Meng-Luen Lee
- Department of Pediatrics, Division of Pediatric Cardiology, Changhua Christian Children's Hospital, Changhua, Taiwan.
| | - Ing-Sh Chiu
- Department of Surgery, Division of Cardiovascular Surgery, Changhua Christian Children's Hospital, Changhua, Taiwan
- Department of Surgery, Division of Cardiovascular Surgery, College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
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21
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Sano N, Yamamoto M, Nagai K, Yamada K, Ohkohchi N. Nasogastric tube syndrome induced by an indwelling long intestinal tube. World J Gastroenterol 2016; 22:4057-4061. [PMID: 27099450 PMCID: PMC4823257 DOI: 10.3748/wjg.v22.i15.4057] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/14/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
The nasogastric tube (NGT) has become a frequently used device to alleviate gastrointestinal symptoms. Nasogastric tube syndrome (NTS) is an uncommon but potentially life-threatening complication of an indwelling NGT. NTS is characterized by acute upper airway obstruction due to bilateral vocal cord paralysis. We report a case of a 76-year-old man with NTS, induced by an indwelling long intestinal tube. He was admitted to our hospital for treatment of sigmoid colon cancer. He underwent sigmoidectomy to release a bowel obstruction, and had a long intestinal tube inserted to decompress the intestinal tract. He presented acute dyspnea following prolonged intestinal intubation, and bronchoscopy showed bilateral vocal cord paralysis. The NGT was removed immediately, and tracheotomy was performed. The patient was finally discharged in a fully recovered state. NTS be considered in patients complaining of acute upper airway obstruction, not only with a NGT inserted but also with a long intestinal tube.
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22
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Mishra EK, Corcoran JP, Hallifax RJ, Stradling J, Maskell NA, Rahman NM. Defining the minimal important difference for the visual analogue scale assessing dyspnea in patients with malignant pleural effusions. PLoS One 2015; 10:e0123798. [PMID: 25874452 PMCID: PMC4398419 DOI: 10.1371/journal.pone.0123798] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/06/2015] [Indexed: 11/18/2022] Open
Abstract
Background The minimal important difference (MID) is essential for interpreting the results of randomised controlled trials (RCTs). Despite a number of RCTs in patients with malignant pleural effusions (MPEs) which use the visual analogue scale for dyspnea (VASD) as an outcome measure, the MID has not been established. Methods Patients with suspected MPE undergoing a pleural procedure recorded their baseline VASD and their post-procedure VASD (24 hours after the pleural drainage), and in parallel assessed their breathlessness on a 7 point Likert scale. Findings The mean decrease in VASD in patients with a MPE reporting a ‘small but just worthwhile decrease’ in their dyspnea (i.e. equivalent to the MID) was 19mm (95% CI 14-24mm). The mean drainage volume required to produce a change in VASD of 19mm was 760ml. Interpretation The mean MID for the VASD in patients with a MPE undergoing a pleural procedure is 19mm (95% CI 14-24mm). Thus choosing an improvement of 19mm in the VASD would be justifiable in the design and analysis of future MPE studies.
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Affiliation(s)
- Eleanor K. Mishra
- Oxford Centre for Respiratory Medicine and Oxford Respiratory Trials Unit, Oxford Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
- * E-mail:
| | - John P. Corcoran
- Oxford Centre for Respiratory Medicine and Oxford Respiratory Trials Unit, Oxford Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | - Robert J. Hallifax
- Oxford Centre for Respiratory Medicine and Oxford Respiratory Trials Unit, Oxford Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | - John Stradling
- Oxford Centre for Respiratory Medicine and Oxford Respiratory Trials Unit, Oxford Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
| | | | - Najib M. Rahman
- Oxford Centre for Respiratory Medicine and Oxford Respiratory Trials Unit, Oxford Biomedical Research Centre, Churchill Hospital, Oxford, United Kingdom
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Gueldich M, Hentati A, Chakroun A, Abid H, Kammoun S, M'saad S, Frikha I. Giant cystic schwannoma of the middle mediastinum with cervical extension. Libyan J Med 2015; 10:27409. [PMID: 25854982 PMCID: PMC4390562 DOI: 10.3402/ljm.v10.27409] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 02/02/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022] Open
Abstract
Schwannomas (neurilemmomas) are benign tumors arising from the Schwann cells of the neural sheath. They are typically, well-encapsulated lesions which rarely adhere to the adjacent structures. In the chest, schwannomas are often seen within the posterior mediastinum and commonly originating along intercostal nerves. Several operative approaches have previously been described for the resection of these tumors, including thoracoscopic techniques and posterolateral thoracotomy. We report in this case a giant cystic mediastinal schwannoma of the left recurrent laryngeal nerve with cervical extension, unresectable by the usual described approaches, which was completely removed through a cervical approach.
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Affiliation(s)
- Majdi Gueldich
- Department of Cardiothoracic Surgery, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Abdesslem Hentati
- Department of Cardiothoracic Surgery, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Amine Chakroun
- Department of ENT Surgery, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Hanen Abid
- Department of Radiology, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Samy Kammoun
- Department of Pulmonology, Hédi Chaker Hospital, University of Sfax, Sfax, Tunisia
| | - Sameh M'saad
- Department of Pulmonology, Hédi Chaker Hospital, University of Sfax, Sfax, Tunisia;
| | - Imed Frikha
- Department of Cardiothoracic Surgery, Habib Bourguiba Hospital, Sfax, Tunisia
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Wu J, Liu Y, Chen W. [Surgical management of dysphagia and dyspnea secondary to esophagus type cervical spondylosis]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2015; 50:160-161. [PMID: 25916540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Abstract
Platypnea-orthodeoxia syndrome (POS) is a rare syndrome of severe hypoxemia upon assuming an upright position. It is classically described as shunting from the right atrium to the left atrium usually via a patent foramen ovale (PFO). Alterations in the intrathoracic anatomy after liver resection and regeneration may trigger this condition in patients with clinically silent PFO -a previously unreported cause of POS.
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Maeda S, Sado T, Sakurada A, Okada Y, Kondo T. [Two types of diaphragmatic plication; therapeutic plication and prophylactic plication]. Kyobu Geka 2014; 67:971-975. [PMID: 25292373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Plication of the hemidiaphragm is effective to relieve respiratory symptoms such as exertional dyspnea and orthopnea of the patients with unilateral diaphragmatic paralysis. We have experiences of 2 types of diaphragmatic plication;one for the symptomatic patients with unilateral diaphragmatic paralysis, and the other for the patients who underwent phrenicotomy during extended surgery for a recurrent thymoma. The former plication was performed for a therapeutic purpose to alleviate the patient's symptoms. The latter was performed for a prophylactic purpose to keep the patient free from possible symptoms or postoperative morbidity after phrenicotomy. Case 1:A 65-year-old female with an eventration of the right diaphragm underwent a sternal resection and reconstruction for a large desmoid tumor. After continuous mechanical ventilation for 3 months, she was still under noninvasive positive pressure ventilation( NPPV) for 24 hours a day. Plication of the right hemidiaphragm was performed and the patient was successfully weaned from NPPV. Case 2:A 41-year-old female with myasthenia gravis underwent a surgery for a recurrent thymoma. Left phrenicotomy was necessary to achieve a complete resection of the tumor. Plication of the left diaphragm was performed during the tumor resection to prevent possible respiratory complications. Postoperative course was uneventful, and her vital capacity was well maintained.
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Affiliation(s)
- Sumiko Maeda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai Japan
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27
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Affiliation(s)
- Tsung O Cheng
- Department of Medicine, The George Washington University, Washington, DC, United States.
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28
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Issing PR, Wenger M. [Lump in the throat - problems breathing]. MMW Fortschr Med 2014; 156:5. [PMID: 24851423 DOI: 10.1007/s15006-014-2943-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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29
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Gaio E, Maggiore G, Canesso A, Artico R. Conservative cricoid surgery for chondrosarcoma: a case report. Ear Nose Throat J 2014; 93:E6-E9. [PMID: 24526490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
We present the case of a 39-year-old man who presented with hoarseness and progressively worsening dyspnea. Findings on laryngoscopy and computed tomography strongly suggested the presence of a chondrosarcoma. The patient underwent open surgery for removal of the lesion with wide margins. Reconstruction was carried out with two segments of costal cartilage. Laryngeal chondrosarcomas are rare, malignant, usually well-differentiated neoplasms that should be treated with conservative surgery. Recurrences should be treated more aggressively.
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Affiliation(s)
- Elena Gaio
- ENT Department, Civil Hospital, via Casa di Ricovero, 35012 Cittadella(Padova), Italy.
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30
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Lococo F, Charpentier MC, Guinet C, Brandolini J, Alifano M, Regnard JF. Mediastinal recurrence from ovarian cystadenocarcinoma presenting as pleuro-pericardial cyst. Eur Rev Med Pharmacol Sci 2014; 18:2094-2096. [PMID: 25070811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A 56 year-old woman (treated for ovarian cystadenocarcinoma 9-yrs before) presented a slowly increasing dyspnea. CT-scan revealed a mediastinal cyst with typical radiological pattern compatible with benign pleuro-pericardial cyst. The cyst was removed via right thoracoscopy. Surprisingly, the pathology were indicative of cystic mediastinal recurrence from ovarian adenocarcinoma.
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Affiliation(s)
- F Lococo
- Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
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31
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Wu HT, Zhao CP, Li Z, Yan JC, Hao JD, Li ZY. [Value of preventive tracheotomy in patients with acute cervical spinal cord injury]. Zhonghua Yi Xue Za Zhi 2013; 93:3762-3765. [PMID: 24548393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To evaluate the value of preventive tracheotomy in patients with acute cervical spinal cord injury. METHODS A retrospective analysis was performed on 54 cases of severe C4-C8 cervical spinal cord injury patients undergoing anterior fixation. They were classified as A and B according to the criteria of American Spinal Injury Association. And no tracheotomy was performed preoperatively. The patients with a high risk of dyspnea and with an indication for preventive tracheotomy received a preventive tracheotomy right after anterior fixation. 11 cases were classified into tracheotomy group and 43 cases were in non-tracheotomy group. The preoperative and hospital stays, incidence of hypoxemia and pulmonary infection, incidence of surgical incision site infection and mortality were analyzed between two groups. RESULTS The preoperative and hospital stays of tracheotomy group were shorter than those of non-tracheotomy group (2.9 ± 1.2 vs 5.7 ± 4.4 days, 10.3 ± 4.0 vs 16.5 ± 9.2 days). The incidence of hypoxemia was lower in tracheotomy group (9.1% vs 44.2%). There was difference existed between two groups. 44.2% patients in the non-tracheotomy group underwent tracheotomy or endotracheal intubation for dyspnea and hypoxemia. There was no significant difference between two groups in the incidence of pulmonary infection (9.1% vs 7.0%) or surgical incision site infection (0 vs 2.3%). The mortality of non-tracheotomy group was 3.07 folds of that of tracheotomy group (9.1% vs 27.9%). But there was no significant statistical difference. CONCLUSION The preventive tracheotomy is an effective solution for the patients with respiratory compromises, a high risk of dyspnea and with an indication for preventive tracheotomy. The preventive tracheotomy for severe cervical spinal cord can improve respiratory function effectively and fixation may be performed earlier. And there are lower rates of mortality and infection.
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Affiliation(s)
- Hao-tian Wu
- Department of Orthopedic Surgery, Third Hospital, Hebei Medical University, Shijiazhuang 050051, China.
| | - Chang-ping Zhao
- Department of Orthopedic Surgery, Third Hospital, Hebei Medical University, Shijiazhuang 050051, China
| | - Zhi Li
- Department of Orthopedic Surgery, Third Hospital, Hebei Medical University, Shijiazhuang 050051, China
| | - Jin-cheng Yan
- Department of Orthopedic Surgery, Third Hospital, Hebei Medical University, Shijiazhuang 050051, China
| | - Jian-dong Hao
- Department of Orthopedic Surgery, Third Hospital, Hebei Medical University, Shijiazhuang 050051, China
| | - Zeng-yan Li
- Department of Orthopedic Surgery, Third Hospital, Hebei Medical University, Shijiazhuang 050051, China
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Blanche C, Noble S, Roffi M, Testuz A, Müller H, Meyer P, Bonvini JM, Bonvini RF. Platypnea-orthodeoxia syndrome in the elderly treated by percutaneous patent foramen ovale closure: a case series and literature review. Eur J Intern Med 2013; 24:813-7. [PMID: 24007641 DOI: 10.1016/j.ejim.2013.08.698] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 07/24/2013] [Accepted: 08/12/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND Platypnea-orthodeoxia syndrome (POS) is a rare clinical phenomenon, associating normal oxygen saturation in a supine position and arterial hypoxemia in an upright position. This pathology can be secondary to an intracardiac shunt, a pulmonary vascular shunt or a ventilation-perfusion mismatch. Cardiac POS occurs in the presence of a right-to-left cardiac shunt, most commonly through a patent foramen ovale (PFO). METHODS AND RESULTS From our single-center prospective database of percutaneous PFO closure we identified five patients (4 females, mean age: 77 ± 11 years) out of 224 (2.2%) patients with a PFO who presented with a POS of cardiac origin. Transthoracic and transoesophageal echocardiographic examinations revealed the underlying mechanisms of POS and the diagnosis was confirmed by right-and-left cardiac catheterization (RLC) and by measuring serial blood oxygen saturation in the pulmonary veins and left atrium in supine and upright positions. PFO was associated with atrial septal aneurysm and a persistent prominent Eustachian valve in 3 patients. All patients underwent a successful percutaneous PFO closure without any immediate or subsequent complications (mean follow-up of 24 ± 18 months). Immediately after the procedure, mean arterial oxygen saturation improved from 83% ± 3 to 93% ± 2 in an upright position and symptoms disappeared. CONCLUSION POS is a rare and under-diagnosed pathology that must be actively investigated in the presence of position-dependent hypoxemia. The diagnostic work-up must exclude other causes of hypoxemia and confirm the intracardiac shunt using either contrast echocardiography or RLC. For cardiac POS, percutaneous PFO closure is a safe and effective technique that immediately relieves orthodeoxia and patient symptoms.
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Affiliation(s)
- Coralie Blanche
- Cardiology Division, University Hospital, Geneva, Switzerland
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Declerck S, Testelmans D, Nafteux P, Coosemans W, Belge C, Decramer M, Buyse B, Buyse B. Diaphragm plication for unilateral diaphragm paralysis: a case report and review of the literature. Acta Clin Belg 2013; 68:311-5. [PMID: 24455805 DOI: 10.2143/acb.3307] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Unilateral diaphragm paralysis is an often not recognised cause of dyspnoea. We present a patient with a unilateral phrenic nerve paralysis treated with diaphragmatic plication. Patient presented with life-style limiting dyspnoea and pulmonary function showed a decrease in FVC when lying down. Since there was no improvement after respiratory muscle training, plication of the hemidiaphragm was performed by a small thoracotomy. The patient improved with regard to respiratory complaints and lung function. Furthermore, we also demonstrate for the first time a significant improvement in exercise capacity with accompanying striking amelioration of quality of life. The patient is now in follow up up for more than 2 years and the impressive improvement in exercise capacity remains present. Surgical treatment of unilateral diaphragm paralysis has been described in case reports and in small series since 1985. Although comparison of the available data is difficult a diaphragm plication seems an effective and safe procedure for patients with symptomatic, acquired unilateral diaphragm paralysis. Improvement of dyspnoea is present in the majority of patients and we even observed an impressive amelioration in exercise capacity. Consequently, it seems appropriate to propose plication to patients with clear symptoms from the moment spontaneous recovery seems unlikely; yet, prospective randomised controlled studies are needed to prove this.
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Affiliation(s)
- S Declerck
- Respiratory Division, University of Leuven, Leuven, Belgium.
| | - D Testelmans
- Respiratory Division, University of Leuven, Leuven, Belgium
| | - Ph Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - W Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - C Belge
- Respiratory Division, University of Leuven, Leuven, Belgium
| | - M Decramer
- Respiratory Division, University of Leuven, Leuven, Belgium
| | - B Buyse
- Respiratory Division, University of Leuven, Leuven, Belgium
| | - B Buyse
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Abstract
A 79-year-old woman presented with unexplained hypoxia that became exacerbated by an upright posture (platypnea-orthodeoxia syndrome). A (99m)Tc-macroaggregated albumin pulmonary perfusion scan revealed a right to left shunt of 25.5% in the supine position and 32.3% in the sitting position. A dynamic CT scan and a transoesophageal echocardiogram confirmed the presence of a shunt across an atrial septal defect (ASD). A percutaneous transcatheter closure of the defect significantly improved the patient's blood oxygenation levels when she was in the upright position. An ASD should therefore be included in the differential diagnosis of platypnea-orthodeoxia syndrome, regardless of the patient's age.
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Affiliation(s)
- Hiroto Takiguchi
- Department of Pulmonary Medicine, Tokai University School of Medicine, Japan
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35
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Seder CW, Suri RM, Rehfeldt K, Pislaru S, Burkhart HM. Robot-assisted repair of tricuspid leaflet prolapse using standard valvuloplasty techniques. J Heart Valve Dis 2012; 21:749-752. [PMID: 23409356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
While minimally invasive approaches are used routinely to correct severe mitral regurgitation due to leaflet prolapse, isolated tricuspid valve prolapse is less frequent and usually addressed via sternotomy. A 34-year-old female presented with exertional dyspnea and severe tricuspid regurgitation due to an unsupported anterior leaflet causing prolapse, a tethered septal leaflet, and dilated annulus. Herein, the technique is described of a robot-assisted tricuspid valve repair using established open valvuloplasty principles. The robotic repair was performed by the placement of Gore-Tex neochordae from the anterior papillary muscle to the anterior tricuspid leaflet, plication of the anteroseptal and anteroposterior commissures, closure of an anterior leaflet cleft, and the insertion of an annuloplasty band. The patient had an uncomplicated hospital course and was dismissed home on the third postoperative day.
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36
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Nazir T, Polydorou D, Irwin RB, Cooper A, Woolfson P, Thomson A. Platypnoea-orthodeoxia in an elderly man with patent foramen ovale and dilated ascending aorta. Age Ageing 2012; 41:132-4. [PMID: 22089080 DOI: 10.1093/ageing/afr131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We report the case of an 85-year-old male with platypnoea-orthodeoxia associated with patent foramen ovale (PFO) and ectatic ascending aorta, in the absence of any significant pulmonary pathology.
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Affiliation(s)
- Tahir Nazir
- Department of Medicine/Care of the Elderly, Salford Royal Hospital, Stott Lane, Manchester M6 8HD, UK.
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37
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Boumans D, Veneman TF. [A marine with acute dyspnea]. Ned Tijdschr Geneeskd 2012; 155:A3690. [PMID: 22929745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
A 29-year-old male marine presented with acute dyspnea and abdominal discomfort. The complaints were caused by a diaphragmatic rupture with an intrathoracic stomach and spleen probably due to an explosion during a military mission a year earlier. Subsequent operative intervention was initiated.
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Affiliation(s)
- Dennis Boumans
- Ziekenhuisgroep Twente, afd. Interne Geneeskunde, Almelo, the Netherlands.
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38
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Meyer P, Götze O, Hochuli M. [Chest pain, dyspnea, discomfort with swallowing]. Praxis (Bern 1994) 2011; 100:308-310. [PMID: 21365563 DOI: 10.1024/1661-8157/a00453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Achalasia is a rare neuromuscular disease of the gastrointestinal tract, often characterized by unspecific chest pain, dysphagia and regurgitation. Our case shows the slowly progression of the disease and its frequent relapse. All possible treatment options are only for palliation, but depending on the method with good (long-term) results. In end-stage disease resection of the oesophagus is a possible treatment.
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Affiliation(s)
- P Meyer
- Klinik und Poliklinik für Innere Medizin, Universitätsspital Zürich
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39
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Herkert E, de Ru JA, Speleman L, Schilder AGM. [Paediatric breathlessness caused by aspiration of a foreign body in food]. Ned Tijdschr Geneeskd 2011; 155:A2824. [PMID: 21382208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Two one-year-old boys were seen by a paediatrician with symptoms of increasing breathlessness and inspiratory stridor. Upon the probable diagnosis subglottic laryngitis and toddler's asthma, respectively, they were admitted to hospital for medical treatment. Because they failed to recover sufficiently with this treatment, an ENT specialist subsequently performed a laryngotracheobronchoscopy under general anaesthesia. A fish-bone and chicken-bone, respectively, were found and removed from the larynx. In retrospect, the parents of both children realized that onset of symptoms followed a choking incident. These case histories illustrate the importance of active questioning concerning the onset of symptoms in order to differentiate between possibly causes. Endoscopy of the airways is required when parents mention a triggering moment or if the course of respiratory complaints is atypical.
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Affiliation(s)
- Ellen Herkert
- Universitair Medisch Centrum, locatie Wilhelmina Kinderziekenhuis, Afd. KNO-heelkunde, Utrecht, the Netherlands.
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40
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Yamazaki Y, Saito A, Takahashi H. [Ventricular tachycardia on arrival at the operating room in a patient with bilateral recurrent nerve paralysis]. Masui 2010; 59:1518-1521. [PMID: 21229695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 66-year-old man developed dyspnea at rest due to bilateral recurrent nerve paralysis. He was rushed into the operating room for emergency tracheostomy. He developed ventricular tachycardia (VT) due to hypoxemia before induction of general anesthesia. After tracheal intubation, VT returned to regular sinus rhythm. Although the similar case is rare, reliable airway controls such as tracheostomy and intubation are necessary for patients with dyspnea at rest due to bilateral recurrent nerve paralysis.
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Affiliation(s)
- Yutaka Yamazaki
- Department of Anesthesia, Yuri Kumiai General Hospital, Yurihonjo 015-8511
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41
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Kocatürk S, Beriat GK, Doğan C. Spontaneous displacement of silastic prosthesis 10 years after type 1 thyroplasty: a case report. Kulak Burun Bogaz Ihtis Derg 2009; 19:268-271. [PMID: 19961407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Implant dislocation following type 1 tyroplasty mostly results from the effects of triggering factors in the early postoperative period. A 42-year-old female patient who had had tyroplasty type 1 surgery with silastic implant, applied to our clinic with cough episodes, dyspnea and hoarseness following an upper airway infection 10 years after the surgery. In laryngeal endoscopic examination of the patient, white colored irregularity on anterior left vocal cord and left band ventricule fullness was seen. Regarding the patient's medical history, it was thought that the silastic prosthesis which had been implanted in the type 1 thyroplasty surgery might have displaced. The silastic prosthesis was removed by means of microsurgery technique through endolaryngeal way under general anesthesia. During the first month follow-up of the patient, dyspnea and hoarseness complaints were improved right away and she had no other problems. The causes and consequences of displacement of the prothesis which rarely occurs, after tyroplasty type 1 have been discussed along with the latest data in the literature.
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Affiliation(s)
- Sinan Kocatürk
- Department of Otolaryngology, Medicine Faculty of Ufuk University, Ankara, Turkey
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42
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Vielva del Campo B, Moráis Pérez D, Saldaña Garrido D. Nasogastric tube syndrome: a case report. Acta Otorrinolaringol Esp 2009; 61:85-6. [PMID: 20061208 DOI: 10.1016/j.otorri.2009.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2007] [Accepted: 11/26/2008] [Indexed: 02/05/2023]
Abstract
Nasogastric tube syndrome (NTS) is an uncommon complication of an indwelling nasogastric tube. Ulceration and infection in the posterior cricoid region causes dysfunction in the abduction of the vocal cords and may seriously compromise patients' airway. This pathology should be considered in patients with prolonged nasogastric intubation who start with moderate pharyngeal pain. We report a case of a 70 year-old woman, admitted to the Neurology department of our centre due to an ischaemic cerebral accident who presented acute dyspnoea requiring emergency tracheotomy following prolonged nasogastric intubation.
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43
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Carrillo G, Estrada A, Pedroza J, Aragón B, Mejía M, Navarro C, Selman M. Preoperative Risk Factors Associated With Mortality in Lung Biopsy Patients With Interstitial Lung Disease. J INVEST SURG 2009; 18:39-45. [PMID: 15804951 DOI: 10.1080/08941930590905206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The objective of this study was to evaluate the risk factors associated with mortality in interstitial lung disease patients. We performed a retrospective study of 722 consecutive patients submitted for lung biopsy during the 1986-1990 period. Twenty-two (3%) died within the 30 days following surgery. Forty-four patients who survived after the surgery for the same time span were randomly chosen as control group. Dyspnea at rest was present in 18/44 of surviving group (SG) and in 18/22 of the nonsurviving group (NSG) (OR 6.5, 95% CI 1.8-22.4,p = .001). Systemic diseases (i.e., diabetes, systemic arterial hypertension)were mainly present in the NSG (OR 7.2, 95% CI 2.3-22.8, p < .001). The SG displayed significantly less respiratory insufficiency with a PaO2 of 52.2 + 8.4 versus 38.5 i 9.4 mm Hg, and PaCO2 of 28.8 i 4.5 versus 38.5 +/- 9.2 mm Hg, respectively (p < .001). Likewise, the SG exhibited a PaCO2/PaO2 ratio of 0.5 - 0.1, while in the NSG it was of 1 +/- 0.4 (p < .001), showing a sensitivity of 84% and specificity of 93% for mortality. Multiple logistic regression analysis for these variables showed that log likelihood was still significant for PaCO2 > 34 mm Hg, PaO2 <48 mm Hg, and comorbid diseases. Logistic regression analysis of these three variables showed the greatest sensitivity and specificity (84 and 750/0,respectively) for prediction of mortality. However, the strongest association was found when PaCO2/PaO2 ratio was analyzed alone (OR 21,073,CI 95% 28-15,946,357, p < .005). These data suggest that PaCO2/PaO2 ratio appears to be a predictor of mortality in this subset of patients. Its prospective use has reduced early mortality after surgery less than 1% in the last decade.
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Affiliation(s)
- G Carrillo
- Instituto Nacional de Enfermedades Respiratorias, México DF.
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44
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Terada Y, Nakayama E, Sakaguchi Y, Kono T, Noda H. Airway compression by the ascending aorta due to a thin thoracic cage. Gen Thorac Cardiovasc Surg 2009; 57:108-10. [PMID: 19214453 DOI: 10.1007/s11748-008-0324-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 08/18/2008] [Indexed: 11/30/2022]
Abstract
An 89-year-old woman with dyspnea and disturbed consciousness due to hypoventilation was admitted to our hospital. Chest radiography showed no abnormal shadow, but she was intubated for deteriorated hypoventilation. Bronchoscopy demonstrated obstruction of the left main bronchus at the carina. Computed tomography (CT) showed neither a mass lesion in the mediastinum nor an aortic aneurysm, but compression of the airway by the ascending aorta was observed. It was thought that the patient's thin thoracic cage was unable to support the weight of the ascending aorta, which consequently compressed the left main bronchus. After inserting stents into both main bronchi, the patient's consciousness improved, and respirator support was withdrawn. In aged, bedridden, thin patients with hypopnea or recurrent airway infection, CT and bronchoscopy should be performed to investigate airway patency.
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Affiliation(s)
- Yasuji Terada
- Department of Thoracic Surgery, Nagahama City Hospital, 313 Oinui-cho, Nagahama 526-8580, Japan.
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45
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Zuurmond-Tromp KA, Klinkenberg TJ, Dikkers FG, Koppelman GH, de Weerd W. [Severe dyspnoea in children following a fall]. Ned Tijdschr Geneeskd 2009; 153:A394. [PMID: 19900339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
A 12-year-old boy fell off his bicycle, hitting his neck on the handle-bars. He sustained a tracheal rupture, which required surgical treatment. Two other patients, a 4-year-old and a 2-year-old boy, also suffered laryngeal injuries following a fall. Both were treated conservatively, the 2-year-old boy needed endotracheal intubation and mechanical ventilation. Blunt neck trauma can cause life-threatening complications, which are difficult to diagnose.
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46
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Chowdhury UK, Seth S, Sheil A, Mittal CM, Jagia P, Malhotra P, Reddy SM. Successful aneurysmectomy of a congenital apical left ventricular aneurysm. Tex Heart Inst J 2009; 36:331-333. [PMID: 19693309 PMCID: PMC2720295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Congenital apical left ventricular aneurysm is a rare clinical entity that is different from congenital left ventricular diverticulum. This aneurysm usually occurs as an isolated anomaly. Its clinical presentation varies, and it is usually diagnosed by exclusion. Herein, we report the case of a 54-year-old man who experienced progressively increasing symptoms of congestive cardiac failure. Through the use of contrast echocardiography and angiocardiography, and upon histopathologic examination, he was diagnosed to have a congenital apical left ventricular aneurysm. He was successfully treated by means of left ventricular aneurysmectomy. We discuss the process of diagnosis and surgical correction of the aneurysm, and we briefly review the pertinent medical literature.
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Affiliation(s)
- Ujjwal K Chowdhury
- Department of Cardiothoracic Surgery, All India Institute of Medical Sciences, New Delhi 110029, India.
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47
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Ramar K, Daniels CA. Constrictive pericarditis presenting as unexplained dyspnea with recurrent pleural effusion. Respir Care 2008; 53:912-915. [PMID: 18593494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Kannan Ramar
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester MN 55905, USA.
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48
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Brill AK, Woelke K, Schädlich R, Weinz C, Laier-Groeneveld G. Tracheobronchial amyloidosis--bronchoscopic diagnosis and therapy of an uncommon disease: a case report. J Physiol Pharmacol 2007; 58 Suppl 5:51-55. [PMID: 18204115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report on a 65-year-old female who complained of recurrent bronchopulmonary infections since 1999. She suffered from permanent cough and progressive dyspnea. The diagnosis of amyloidosis was made by bronchoscopic tissue biopsies, during which severe bleeding occurred. Argon-plasma-laser treatment stopped the bleeding and resulted in a successful recanalization of the left main bronchus. The patient noticed a decrease in dyspnea shortly after the intervention. Further diagnostic procedures did not show any signs of systemic or malignant disease. This led us to the diagnosis of a rare form of isolated tracheobronchial amyloidosis.
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Affiliation(s)
- A K Brill
- Evangelisches und Johanniter Klinikum Niederrhein GmbH, Bronchial und Lungenheilkunde, Oberhausen, Germany
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49
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Kopp R, Wizgall I, Kreuzer E, Meimarakis G, Weidenhagen R, Kühnl A, Conrad C, Jauch KW, Lauterjung L. Surgical and endovascular treatment of symptomatic aberrant right subclavian artery (arteria lusoria). Vascular 2007; 15:84-91. [PMID: 17481369 DOI: 10.2310/6670.2007.00018] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Right aberrant subclavian artery, also called arteria lusoria, is one of the most common intrathoracic arterial anomalies. Although mostly asymptomatic, the retroesophageal and retrotracheal course of the lusorian artery might result in unspecific thoracic pain, dysphagia, dyspnea, arterioesophageal or arteriotracheal fistulae with hematemesis or hemoptysis, and aneurysmal formation with relevant risk of rupture. The purpose was to present our experience with six patients with a symptomatic aberrant right subclavian artery, two patients with dysphagia or dyspnea caused by a nonaneurysmal lusorian artery, and four patients with arteria lusoria aneurysms. The operative procedures performed are described and discussed in view of the data reported in the literature. According to the classification of the lusorian artery pathology, a combined intervention with right subclavian artery transposition, distal or proximal lusorian artery ligation or proximal endovascular occlusion for nonaneurysmal disease, or endovascular thoracic aortic stent graft implantation for lusorian artery aneurysms seems to be an additional and minimally invasive approach with promising midterm results.
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Affiliation(s)
- Reinhard Kopp
- Department of Vascular Surgery, Klinikum Grosshadern University of Munich, Munich, Germany.
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50
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Affiliation(s)
- Juan C Collado Otero
- Department of Thoracic Surgery of the National Institute of Oncology and Radiobiology, Havana City, Cuba.
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