Survival analyses of patients with thoracic complications secondary to bronchial carcinoma at the time of diagnosis.
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BACKGROUND: The impact on survival of thoracic complications secondary to bronchial carcinoma has not been clearly analyzed. OBJECTIVES: The purpose of this study was to assess the significance of these complications for the survival of lung cancer patients. METHODS: All patients diagnosed at our center from March 2000 to January 2004 were analyzed to estimate survival among patients with or without thoracic complication. Any intrathoracic change or abnormality secondary to bronchial carcinoma such as atelectasis or pleural effusion was defined a thoracic complication. Survival was calculated using the Kaplan-Meier method, and the complications predicting survival were evaluated using Cox's regression analysis. RESULTS: Of the 182 eligible patients, 61.5% had at least one thoracic complication. The complications were atelectasis, pulmonary metastases, pleural effusion, laryngeal nerve involvement, vena cava superior syndrome and others. Specific survival times for each complication were not different, except in the case of atelectasis. Median survival was significantly longer in patients with atelectasis, as opposed to nonatelectatic patients. Survival times in patients with at least one complication were not different than those of patients without complication. However, median survival of patients with one of the complications, excluding atelectasis (since this was associated with improved survival), was 3 months shorter (p = 0.029). Cox's regression analysis also predicted atelectasis for improved survival. CONCLUSION: Atelectasis, which was determined to be the most frequent thoracic complication, was identified as a favorable prognostic factor in patients with advanced stage lung cancer. (+info)
Right upper lobe consolidation: an unusual complication of an uneventful endotracheal intubation.
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A 28 year old fit and healthy Caucasian man had a Bankart's repair of the left shoulder under general anaesthetic for a recurrent dislocation of the shoulder. The operative procedure was uneventful. Following extubation he was tachycardic and saturation dropped in the recovery room. The chest radiograph revealed shadowing in the right lung and he was diagnosed to have right middle lobe collapse. Subsequently the radiograph was reported as right upper lobe consolidation by the radiologist. We wish to report this unusual complication and the difficulty in diagnosis of such a complication occurring following an uneventful anaesthetic. (+info)
Oxygen attenuates atelectasis-induced injury in the in vivo rat lung.
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BACKGROUND: Atelectasis results in impaired compliance and gas exchange and, in extreme cases, increased microvascular permeability, pulmonary hypertension, and right ventricular dysfunction. It is not known whether such atelectasis-induced lung injury is due to the direct mechanical effects of lung volume reduction and alveolar collapse or due to the associated regional lung hypoxia. The authors hypothesized that addition of supplemental oxygen to an atelectasis-prone ventilation strategy would attenuate the pulmonary vascular effects and reduce the local levels of vasoconstrictor eicosanoids. METHODS: In series 1, anesthetized, atelectasis-prone mechanically ventilated rats were randomly assigned to one of six groups based on the inspired oxygen concentration and ventilated without recruitment. Series 2 was performed to determine the cardiac and pulmonary vascular effects of 21% versus 100% inspired oxygen. In series 3, computed tomography scans were performed after ventilation with a recruitment strategy (21% O2) or no recruitment strategy (21% O2 or 100% O2). In series 4, functional residual capacity was measured in animals where the gas was 21% or 100% O2. RESULTS: The partial pressure of arterial oxygen increased with increasing inspired oxygen, but the alveolar-arterial oxygenation gradient was also greater with higher inspired oxygen. Ventilation with 21% O2 (but not with 100% O2) was associated with progressive pulmonary vascular impedance and increased pulmonary vascular permeability. Prostaglandin F2alpha was increased by mechanical ventilation, especially without supplemental oxygen. Computed tomography scans demonstrated no atelectasis in recruited lungs, and atelectasis in nonrecruited lungs that was greater with supplemental oxygen. Increased atelectasis with 100% O2 (vs. 21% O2) was demonstrated by measurement of functional residual capacity. CONCLUSIONS: Although supplemental oxygen worsened atelectasis in this model, it prevented the pathologic effects of atelectasis, including microvascular leak and pulmonary hypertension. Atelectasis-induced lung injury seems to be mediated by hypoxia rather than by the direct mechanical effects of atelectasis. (+info)
DNase and atelectasis in non-cystic fibrosis pediatric patients.
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INTRODUCTION: No evidence based treatment is available for atelectasis. We aimed to evaluate the clinical and radiologic changes in pediatric patients who received DNase for persistent atelectasis that could not be attributed to cardiovascular causes, and who were unresponsive to treatment with inhaled bronchodilators and physiotherapy. METHODS: All non-cystic fibrosis pediatric patients who received nebulised or endotracheally instilled DNase for atelectasis between 1998 and 2002, with and without mechanical ventilation, were analysed in a retrospective descriptive study. The endpoints were the blood pCO2, the heart rate, the respiratory rate, the FiO2 and the chest X-ray scores before and after treatment. RESULTS: In 25 of 30 patients (median [range] age, 1.6 [0.1-11] years) who met inclusion criteria, paired data of at least three endpoints were available. All clinical parameters improved significantly within 2 hours (P < 0.01), except for the heart rate (P = 0.06). Chest X-ray scores improved significantly within 24 hours after DNase treatment (P < 0.001). Individual improvement was observed in 17 patients and no clinical change was observed in five patients. Temporary deterioration (n = 3) was associated with increased airway obstruction and desaturations. No other complications were observed. CONCLUSION: After treatment with DNase for atelectasis of presumably infectious origin in non-cystic fibrosis pediatric patients, rapid clinical improvement was observed within 2 hours and radiologic improvement was documented within 24 hours in the large majority of children, and increased airway obstruction and ventilation-perfusion mismatch occurred in three children, possibly due to rapid mobilisation of mucus. DNase may be an effective treatment for infectious atelectasis in non-cystic fibrosis pediatric patients. (+info)
Treatment of atelectasis: where is the evidence?
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Lobar atelectasis is a common problem caused by a variety of mechanisms including resorption atelectasis due to airway obstruction, passive atelectasis from hypoventilation, compressive atelectsis from abdominal distension and adhesive atelectasis due to increased surface tension. However, evidence-based studies on the management of lobar atelectasis are lacking. Examination of air-bronchograms on a chest radiograph may be helpful to determine whether proximal or distal airway obstruction is involved. Chest physiotherapy, nebulised DNase and possibly fibreoptic bronchoscopy might be helpful in patients with mucous plugging of the airways. In passive and adhesive atelectasis, positive end-expiratory pressure might be a useful adjunct to treatment. (+info)
Primary pulmonary AIDS-related lymphoma.
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Extranodal involvement is common in lymphomas associated with human immunodeficiency virus infection (HIV) and acquired immunodeficiency syndrome (AIDS). However, primary pulmonary AIDS-related non-Hodgkin's lymphoma is very rare and only few reports were published in the medical literature. Clinical presentation is nonspecific, with "B" and respiratory symptoms. Also, patients were with advanced immunodeficiency at the time of diagnosis. Generally, chest radiography showed peripheral nodules or cavitary masses. Primary pulmonary lymphoma associated with AIDS is generally a high-grade B-cell non-Hodgkin lymphoma and Epstein-Barr virus is strongly associated with the pathogenesis of these tumors. We report a patient with AIDS and primary pulmonary lymphoma which clinical presentation was a total atelectasis of the left lung. (+info)
Aspiration of an extracted molar: case report.
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A case of aspiration of an extracted molar is presented. The main objective of this paper is to provide dental colleagues with an educational framework on foreign-body aspiration to help prevent delayed diagnosis of such events in the future. (+info)
Bronchoscopic surfactant administration in pediatric patients with persistent lobar atelectasis.
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Persistent lobar atelectasis in pediatric patients on mechanical ventilation results in impaired gas exchange and lung mechanics and contributes to a further need for mechanical ventilation. The most common types of atelectasis in children are resorption atelectasis following airway obstruction, and atelectasis due to surfactant deficiency or dysfunction. We aimed to determine whether bronchoscopic suctioning and surfactant application to atelectatic lung segments would result in improved oxygenation, ventilation, chest X-ray scoring, and early extubation. Five children with heterogeneous lung diseases (aged between 7 months and 15 years) were treated with a diluted surfactant preparation (Curosurf) in a concentration of 5-10 mg/ml (total dose 120-240 mg) which was instilled into the affected segments. Outcome parameters were gas exchange, radiographic resolution of atelectasis and extubation. All mechanically ventilated patients could be extubated within 24 h following the intervention. Bronchoscopic surfactant application could be carried out without adverse effects and brought improvements in oxygenation, respiratory rate, and partial or complete resolution of atelectases without recurrence. (+info)