Journal articles on the topic 'Obstructive'
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1
Bashir, Ahsan, Sabina Qureshi Ahmad, Joshua Silverman, Emily Concepcion, and Haesoon Lee. "Post-obstructive pulmonary edema from aspirated nuts." SAGE Open Medical Case Reports 5 (January 1, 2017): 2050313X1771739. http://dx.doi.org/10.1177/2050313x17717391.
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Objectives: Post-obstructive pulmonary edema is thought to occur from hemodynamic changes secondary to forced inspiration against the closed airway due to acute or chronic airway obstruction. We report a case of a 13 month-old boy who developed pulmonary edema from aspirated foreign body, nuts. Methods: He underwent emergency bronchoscopy to confirm the clinical diagnosis of aspirated nuts in the trachea and nuts were removed endoscopically. His trachea was then intubated and he was mechanically ventilated with oxygen. Results: He developed florid pulmonary edema early in the course with tracheal obstruction and during endoscopic removal of nuts. After removal of obstruction he was ventilated mechanically and pulmonary edema cleared rapidly. Conclusions: Aspirated nuts obstructing trachea can induce obstructive pulmonary edema. Early recognition of foreign body obstruction based on clinical history and its removal resolved pulmonary edema.
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Phua, C. Q., W. X. Yeo, C. Su, and P. K. H. Mok. "Multi-level obstruction in obstructive sleep apnoea: prevalence, severity and predictive factors." Journal of Laryngology & Otology 131, no. 11 (September 5, 2017): 982–86. http://dx.doi.org/10.1017/s0022215117001906.
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AbstractObjectives:To characterise multi-level obstruction in terms of prevalence, obstructive sleep apnoea severity and predictive factors, and to collect epidemiological data on upper airway morphology in obstructive sleep apnoea patients.Methods:Retrospective review of 250 obstructive sleep apnoea patients.Results:On clinical examination, 171 patients (68.4 per cent) had multi-level obstruction, 49 (19.6 per cent) had single-level obstruction and 30 (12 per cent) showed no obstruction. Within each category of obstructive sleep apnoea severity, multi-level obstruction was more prevalent. Multi-level obstruction was associated with severe obstructive sleep apnoea (more than 30 events per hour) (p = 0.001). Obstructive sleep apnoea severity increased with the number of obstruction sites (correlation coefficient = 0.303, p < 0.001). Multi-level obstruction was more likely in younger (p = 0.042), male (p = 0.045) patients, with high body mass index (more than 30 kg/m2) (p < 0.001). Palatal (p = 0.004), tongue (p = 0.026) and lateral pharyngeal wall obstructions (p = 0.006) were associated with severe obstructive sleep apnoea.Conclusion:Multi-level obstruction is more prevalent in obstructive sleep apnoea and is associated with increased severity. Obstruction at certain anatomical levels contributes more towards obstructive sleep apnoea severity.
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Lau, W. Y., C. K. Leow, K. L. Leung, Thomas W. T. Leung, Michael Chan, and Simon C. H. Yu. "Cholangiographic Features in the Diagnosis and Management of Obstructive Icteric Type Hepatocellular Carcinoma." HPB Surgery 11, no. 5 (January 1, 2000): 299–306. http://dx.doi.org/10.1155/2000/79241.
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In 11 years and 3 months, 2037 patients with HCC were seen and 48 patients (2.4%) were diagnosed to have obstructive icteric type HCC. Five patients were terminally ill and were not investigated further. Forty three patients were initially investigated by endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiogram (PTC) and classified as having obstructive icteric type 1, 2, or 3 HCC based on the cholangiographic findings. The obstruction in type 1 HCC was due to intraluminal tumour casts and/or tumour fragments obstructing the hepatic ductal confluence or common bile duct, while intraluminal blood clots, from haemobilia, filling the biliary tree was the cause in type 2 HCC. The pathology in type 3 HCC was extraluminal obstruction by extensive tumour encasement of the intra–hepatic biliary ductal system and/or extrinsic compression of the hepatic and common bile ducts by tumour(s) and/or malignant lymph nodes. At the initial ERC/PTC, 10 patients (5 resected, 50%) had obstructive icteric type 1 and 23 patients (0 resected) had obstructive icteric type 3 HCC. Of the 10 patients initially classified according to cholangiography to have obstructive icteric type 2 HCC, subsequent investigations revealed that 6 patients had type 1 HCC (4 resectable, 67%) and 4 patients had type 3 HCC (0 resectable). The classification of the obstructive icteric type HCC into types 1, 2, and 3, based on the initial cholangiographic appearances has simplified and rationalized our management strategy for this condition.
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Canonne-Guibert, Morgane. "Affections respiratoires supérieures." Le Nouveau Praticien Vétérinaire canine & féline 19, no. 81 (June 2022): 17–26. http://dx.doi.org/10.1051/npvcafe/2022054.
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Parmi les affections des voies respiratoires supérieures, selon le site anatomique touché, l’exploration diagnostique nécessitera souvent a minima un examen endoscopique, celui-ci pouvant suffire dans de nombreux cas. À ce titre, pour les atteintes laryngées et trachéales ou dans l’exploration d’un syndrome obstructif respiratoire des races brachycéphales, il convient de réaliser l’endoscopie chez un animal non intubé pour parfaitement visualiser les voies respiratoires dans leur position et leur mouvement naturels. Pour les atteintes nasales et nasopharyngées, l’examen tomodensitométrique pourra s’avérer complémentaire ; pour les atteintes trachéales, la radiographie reste un très bon examen dans le cadre des affections obstructives (collapsus, sténose, tumeur) compte tenu du contraste apporté par l’air luminal. De nombreuses affections conduiront à la programmation d’une intervention chirurgicale (syndrome obstructif respiratoire des races brachycéphales, paralysie laryngée, polype nasopharyngé, rétroversion épiglottique), d’autres motiveront une prise en charge mini-invasive (sténose nasopharyngée) ou une prise en charge plus spécifique comme lors de processus tumoral. Au détour de la démarche diagnostique de confirmation, il convient également de rechercher les éventuelles complications d’une atteinte obstructive : bronchopneumonie par aspiration, hyperthermie, anomalies œsophagiennes (dilatation aérique majeure, redondance, hernie hiatale, œsophagite). Dans le contexte d’urgence, la stabilisation d’une atteinte obstructive est peu spécifique et repose sur trois piliers : une oxygénothérapie, une sédation comprenant le plus souvent du butorphanol +/- alpha-2 mimétique et le traitement des complications éventuelles (antibiotique lors d’aspiration, antiacides et pansements lors de conséquences œsophagiennes). Enfin, toute obstruction respiratoire s’accompagne d’une inflammation et d’un œdème des muqueuses respiratoires et doit conduire à l’initiation d’une corticothérapie efficace et temporaire.
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AFZAL KIANI, ASMA, RANA HASSAN JAVAID, ABDUL GHAFFAR, and Shamrez Khan. "ULTRASONOGRAPHY IN OBSTRUCTIVE JAUNDICE." Professional Medical Journal 19, no. 04 (August 7, 2012): 436–41. http://dx.doi.org/10.29309/tpmj/2012.19.04.2245.
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Objective: To evaluate the validity of ultrasonography in patients who have obstructive jaundice. Design: Descriptive study.Place and duration of study: The study was carried out from September 2006 to May 2008 in department of Radiology Combined MilitaryHospital Quetta. Patients and Methods: A total of 30 patients; 14 male and 16 female underwent operation for obstructive jaundice. All of themhad preoperative ultrasonography. The site and nature of biliary obstruction were noted and the accuracy was determined with per-operativefindings / histological diagnosis as gold standard. Results: The cause of obstructive jaundice identified by ultrasonography with reasonablesensitivity of 90% and specificity of 90% for choledocholithiasis and sensitivity of 55.5% and specificity of 95.2% for pancreatic head tumours.Conclusions: Ultrasonography should be the first and best initial imaging procedure in patients who have obstructive jaundice and showsreasonable sensitivity and specificity to identify causes of obstruction in obstructive jaundice.
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Mohson, Khaleel I., and Zaid Hadi Kadhum. "Role of Interventional Radiology in the Management of Obstructive Jaundice: Achieving Drainage and Stenting." Open Access Macedonian Journal of Medical Sciences 10, B (March 9, 2022): 529–31. http://dx.doi.org/10.3889/oamjms.2022.8438.
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BACKGROUND: Obstructive jaundice due to the central malignant cause is really challenging for gastroenterologists and usually results in failed drainage of obstructing system, the percutaneous transhepatic biliary drainage (PTBD) usually results in a dramatic pathway opening. AIM: The study aimed to evaluate the role of interventional radiology (IR) in achieving drainage of obstructing system and subsequent reduction of serum bilirubin and its role in stenting the obstructing lesion. METHODS: A prospective study included 40 patients who complained of obstructive jaundice referred to IR unit in specialties surgical hospital from gastroenterology hospital after failed endoscopic drainage and stenting during the period from September 2020 to November 2021. RESULTS: Of 40 patients in study population, 26 are male and 14 females, their median age was 65 years, cholangiocarcinoma is leading cause of biliary obstruction, the technical success of PTBD was 100% and clinical success achieved by lowering of total serum bilirubin by 60% within 2 weeks seen in 75% of the patients, no significant major complications seen after procedure, and only 5% of the patients developed leaking bile along the drain tract. CONCLUSIONS: PTBD and transhepatic biliary stenting are amazing technique in acute and chronic management of patients with obstructive jaundice, achieve dramatic lowering of serum bilirubin, fighting biliary sepsis and long-term palliation of advanced biliary, pancreatic, and ampullary malignancy.
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Gaparkhoeva, Z. M., O. A. Bashkina, and E. N. Seliverstova. "Comparative characteristics of bronchial obstruction formation trigger mechanisms in children with bronchial asthma and recurrent obstructive bronchitis." Kazan medical journal 97, no. 1 (February 15, 2016): 66–69. http://dx.doi.org/10.17750/kmj2016-66.
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Aim. To study the comparative characteristics of the causative significant factors involved in the bronchial obstruction development in children with bronchial asthma and recurrent obstructive bronchitis.Methods. A cross-sectional (transversal) study of 50 children with bronchial asthma, 38 children with recurrent obstructive bronchitis was conducted. The differences and similarities of etiopathogenetic factors of the bronchial obstruction occurrence were revealed. According to medical history, in all patients regardless of the severity and duration of the disease at the time of examination, the impact of the factors, acting as triggers of bronchial asthma, according to patients, such as infectious agents, infectious allergens and aeroallergens, nighttime, climatic conditions deterioration, physical and/or emotional stress, was registered.Results. The main triggers that influence the bronchial obstruction occurrence in children with asthma were infectious factors impact, allergens and aeroallergens, and in patients with recurrent obstructive bronchitis more important in the bronchial obstruction development were infectious agents and weather conditions worsening (high humidity, fog, rain). However, unlike the other factors involved in the bronchial obstruction development in asthma, nighttime, allergens and aeroallergens did not have significant impact on the bronchial obstruction occurrence in children with recurrent obstructive bronchitis. In both groups, physical stress (jogging, gymnastics) and emotional stress (loud laugh, crying) contributed to the bronchial obstruction syndrome development with the corresponding clinical picture, but in the second group of children with recurrent obstructive bronchitis duration of cough lasted 2 times less (1-1,5 h) than in children with bronchial asthma (over 3 hours).Conclusion. Conducted comparative characteristics showed that there is a clear link with the trigger mechanisms of bronchial obstruction occurrence in bronchial asthma and recurrent obstructive bronchitis, and triggers, regardless of the severity and duration of disease, have the same effect on the recurrent obstructive bronchitis outcome.
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Sheybani-Deloui, Sepideh, Lijun Chi, Marian V. Staite, Jason E. Cain, Brian J. Nieman, R. Mark Henkelman, Brandon J. Wainwright, et al. "Activated Hedgehog-GLI Signaling Causes Congenital Ureteropelvic Junction Obstruction." Journal of the American Society of Nephrology 29, no. 2 (November 6, 2017): 532–44. http://dx.doi.org/10.1681/asn.2017050482.
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Intrinsic ureteropelvic junction obstruction is the most common cause of congenital hydronephrosis, yet the underlying pathogenesis is undefined. Hedgehog proteins control morphogenesis by promoting GLI-dependent transcriptional activation and inhibiting the formation of the GLI3 transcriptional repressor. Hedgehog regulates differentiation and proliferation of ureteric smooth muscle progenitor cells during murine kidney-ureter development. Histopathologic findings of smooth muscle cell hypertrophy and stroma-like cells, consistently observed in obstructing tissue at the time of surgical correction, suggest that Hedgehog signaling is abnormally regulated during the genesis of congenital intrinsic ureteropelvic junction obstruction. Here, we demonstrate that constitutively active Hedgehog signaling in murine intermediate mesoderm–derived renal progenitors results in hydronephrosis and failure to develop a patent pelvic-ureteric junction. Tissue obstructing the ureteropelvic junction was marked as early as E13.5 by an ectopic population of cells expressing Ptch2, a Hedgehog signaling target. Constitutive expression of GLI3 repressor in Ptch1-deficient mice rescued ectopic Ptch2 expression and obstructive hydronephrosis. Whole transcriptome analysis of isolated Ptch2+ cells revealed coexpression of genes characteristic of stromal progenitor cells. Genetic lineage tracing indicated that stromal cells blocking the ureteropelvic junction were derived from intermediate mesoderm–derived renal progenitors and were distinct from the smooth muscle or epithelial lineages. Analysis of obstructive ureteric tissue resected from children with congenital intrinsic ureteropelvic junction obstruction revealed a molecular signature similar to that observed in Ptch1-deficient mice. Together, these results demonstrate a Hedgehog-dependent mechanism underlying mammalian intrinsic ureteropelvic junction obstruction.
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Sisniega, Carlos, and Umakanth Katwa. "Children with Upper Airway Dysfunction: At Risk of Obstructive Sleep Apnea." Journal of Child Science 09, no. 01 (January 2019): e59-e67. http://dx.doi.org/10.1055/s-0039-1688956.
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AbstractObstructive sleep apnea is characterized by prolonged partial upper airway obstruction or intermittent complete obstruction that disrupts normal ventilation during sleep and alters normal sleep patterns. Patients with obstructive sleep apnea tend to develop neurocognitive, cardiovascular, behavioral, attention issues, and poor academic performance. Therefore, it is essential to diagnose and treat obstructive sleep apnea early and avoid significant and long-lasting adverse outcomes. Most commonly, upper airway obstruction is caused by enlarged lymphoid tissues within the upper airway, and therefore adenotonsillectomy is considered as the first-line treatment of obstructive sleep apnea in children. Fifty to 70% of patients who have obstructive sleep apnea and treated by surgery are not entirely cured on follow-up polysomnography. In light of this, it is recommended that patients with suspected obstructive sleep apnea undergo a thorough evaluation, and all potential risk factors are identified and treated. The purpose of this review is to familiarize pediatricians with developmental, anatomical, and physiological risk factors involved in the development of obstructive sleep apnea. Additionally, we will present an array of evaluation techniques that can offer adequate assessment of the patient's upper airway anatomy and physiology.
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Rana, Surinder Singh, Ravi Sharma, Rajesh Gupta, and Sobur Uddin Ahmed. "Palliation of Obstructive Jaundice: Endoscopic Ultrasound‑guided Choledochoduodenostomy in the Presence of Bleeding Duodenal Infiltration Due to Metastatic Urinary Bladder Cancer." Journal of Digestive Endoscopy 09, no. 03 (July 2018): 118–21. http://dx.doi.org/10.4103/jde.jde_55_17.
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Obstructive jaundice is a common manifestation of malignancies involving pancreaticobiliary area of the gastrointestinal tract. The palliation of obstructive jaundice involves bypassing the obstruction by an endoprosthesis using either endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic biliary drainage route. Endoscopic ultrasound‑guided choledochoduodenostomy (ECD) is a challenging alternative for obstructive jaundice due to distal bile duct obstruction in patients who have failed ERCP. In this report, we describe a challenging case of disseminated urinary bladder cancer that presented with extensive duodenal as well as periduodenal infiltration leading on to gastrointestinal bleed and severe pruritus along with obstructive jaundice and was successfully managed with initial argon plasma coagulation of bleeding duodenal lesions followed by ECD.
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Mycroft, Katarzyna, and Katarzyna Górska. "Diagnosis and management of COPD in primary care." Medycyna Faktów 14, no. 4 (December 31, 2021): 350–55. http://dx.doi.org/10.24292/01.mf.0421.3.
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Chronic obstructive pulmonary disease is a significant health problem. However, a large proportion of cases remain undiagnosed. Early diagnosis of chronic obstructive pulmonary disease leads to earlier treatment initiation, and in consequence, to improvement of patients quality of life. The gold standard for chronic obstructive pulmonary disease diagnosis is spirometry and the presence of irreversible obstruction after a bronchodilator. One of the most important interventions in the treatment of chronic obstructive pulmonary disease is anti-smoking education. The main group of drugs used in chronic obstructive pulmonary disease treatment are the long-acting bronchodilators.
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Uryasev, O. M., S. V. Faletrova, and L. V. Korshunova. "Combination of asthma and chronic obstructive pulmonary disease: features of etiology, pathogenesis, diagnosis, pharmacotherapy." Kazan medical journal 97, no. 3 (June 15, 2016): 394–400. http://dx.doi.org/10.17750/kmj2016-394.
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Bronchial asthma and chronic obstructive pulmonary disease are the most common obstructive diseases of the respiratory system. 230 million people suffer from chronic obstructive pulmonary disease, from bronchial asthma - 300 million people worldwide. Annually 200-300 people in Europe and 2.74 million of world population die from chronic obstructive pulmonary disease, from asthma - 250 thousand people a year. The social and economic significance of these diseases determine the need for in-depth study of their combination in the same patient. Each disease has its own phenotypes, but in 10-20% of patients, there are symptoms of both chronic obstructive pulmonary disease and asthma. In spite of clear diagnostic criteria, in some cases it is difficult to distinguish these diseases. Morphological basis of these diseases is a chronic inflammation in the bronchial tree that causes damage to the epithelial continuity that initiates bronchoconstrictive reaction and leads to irreversible airway obstruction attributable for both severe bronchial obstruction and chronic obstructive pulmonary disease. However, the treatment strategy of bronchial asthma and chronic obstructive pulmonary disease has significant differences, it is important to have a clear diagnostic criteria to distinguish different phenotypes, including those of combined phenotype of asthma and chronic obstructive pulmonary disease. Rational starting therapy of asthma and chronic obstructive pulmonary disease overlap syndrome includes drugs acting on the pathogenic mechanisms of both diseases, and is a combination of inhaled corticosteroids with combined bronchodilator therapy - long-acting β2-agonists and long-acting anticholinergics.
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Kaushal, Lovely, Swati Goyal, and Vetrivel K. S. "Comparison of USG KUB Findings with MR Urography (fluid static) in Patients with Obstructive Uropathy- A Cross Sectional Study." International Journal of Medical and Allied Health Sciences 2, no. 02 (July 22, 2022): 29–37. http://dx.doi.org/10.54618/ijmahs.2022223.
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Introduction– Obstructive uropathy is one of the most urgent clinical entities that has to be diagnosed and treated on time. Ultrasonography [USG] is cheap and easily accessible for determining the cause of obstructive uropathy. Magnetic Resonance Urography [MRU] has the potential to provide an excellent noninvasive examination of a wide range of urinary tract disorders, congenital anomalies and neoplasms without contrast administration. Aims- To assess the role of USG in obstructive uropathy patients and compare its finding with MRU static fluid. Design- Cross sectional study Materials and methods- This study was conducted on all patients referred to the Radio-Diagnosis department with any clinically suspicious obstructive uropathy symptoms. They underwent USG KUB and those with confirmed obstructive uropathy, underwent static fluid MR urography. Results- The study was conducted in 74 patients; 59.4% patients were males. Hydroureteronephrosis was the most common finding. MRU was superior to USG for diagnosis of stricture ureter and calculus in patients with obstructive uropathy. USG and MRI for diagnosis of VUJ, vesical, renal and pelvis calculus showed perfect agreement (κ=1; p=0.01); moderate for ureteric calculus (0.60-0.79; p less than 0.05) and minimal for ureteric stricture (0.21-0.39; p less than 0.05). MRU was superior in detailing PUJ obstruction as partial and complete. Conclusions- Ultrasound as an initial investigation helped in finding the level and severity of urinary obstruction. However, MRU performed better, in whom ultrasound showed inadequate results. In case of malignant obstruction, it gave precise soft tissue details. MRU appears as a better tool in diagnosing both extrinsic and intrinsic causes of obstructive uropathy.
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Schlegel, P. N. "Causes of azoospermia and their management." Reproduction, Fertility and Development 16, no. 5 (2004): 561. http://dx.doi.org/10.1071/rd03087.
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Azoospermia may occur because of reproductive tract obstruction (obstructive azoospermia) or inadequate production of spermatozoa, such that spermatozoa do not appear in the ejaculate (non-obstructive azoospermia). Azoospermia is diagnosed based on the absence of spermatozoa after centrifugation of complete semen specimens using microscopic analysis. History and physical examination and hormonal analysis (FSH, testosterone) are undertaken to define the cause of azoospermia. Together, these factors provide a >90% prediction of the type of azoospermia (obstructive v. non-obstructive). Full definition of the type of azoospermia is provided based on diagnostic testicular biopsy. Obstructive azoospermia may be congenital (congenital absence of the vas deferens, idiopathic epididymal obstruction) or acquired (from infections, vasectomy, or other iatrogenic injuries to the male reproductive tract). Couples in whom the man has congenital reproductive tract obstruction should have cystic fibrosis (CF) gene mutation analysis for the female partner because of the high risk of the male being a CF carrier. Patients with acquired obstruction of the male reproductive tract may be treated using microsurgical reconstruction or transurethral resection of the ejaculatory ducts, depending on the level of obstruction. Alternatively, sperm retrieval with assisted reproduction may be used to effect pregnancies, with success rates of 25–65% reported by different centres. Non-obstructive azoospermia may be treated by defining the cause of low sperm production and initiating treatment. Genetic evaluation with Y-chromosome microdeletion analysis and karyotype testing provides prognostic information in these men. For men who have had any factors potentially affecting sperm production treated and remain azoospermic, sperm retrieval from the testis may be effective in 30–70% of cases. Once sperm are found, pregnancy rates of 20–50% may be obtained at different centres with in vitro fertilisation and intracytoplasmic sperm injection.
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Roy, Ranjit Ranjan, Md Firoz Anjum, and Shahana Ferdous. "Obstructive Uropathy in Children – An Update." Bangladesh Journal of Child Health 41, no. 2 (March 25, 2018): 117–24. http://dx.doi.org/10.3329/bjch.v41i2.36108.
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Obstructive nephropathy is a structural or functional hindrance of normal urine flow, sometimes leading to renal dysfunction. Urinary tract obstruction can result from congenital (anatomic) lesion or can be caused by trauma, neoplasia, calculi, inflammation or surgical procedures, although most childhood obstructive lesions are congenital.The clinical features in most of the patients are due to consequences of the obstruction2. Obstruction of the urinary tract generally causeshydronephrosis, which is typically asymptomatic in its early phase. Renal USG gives information about urinary tract dilatation, renal cortical thickness, calyx size, diameter of pelvis, ureter, bladder thickness, tumor & calculi and doppler USG for evaluation of aberrentvessles. Once obstructive nephropathy has been identified therapy focuses on the rapid restoration of normal urine flow either by medical or surgical intervention.Bangladesh J Child Health 2017; VOL 41 (2) :117-124
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Kim, Sung Deuk. "Obstructive Jaundice." Soonchunhyang Medical Science 28, no. 2 (December 30, 2022): 85–89. http://dx.doi.org/10.15746/sms.22.018.
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Jaundice is a medical condition in which the skin or sclera of the eyes becomes yellow, and elevation of bilirubin production or obstruction of bile excretion can cause jaundice while disrupting the balance between bilirubin production and bile excretion. Jaundice is a very visual clinical sign that both patients and physicians can easily recognize. It warrants further investigation regarding the cause of jaundice because jaundice is always a pathological sign regardless of its seriousness. Clinical manifestations of obstructive jaundice can be understood in terms of bile formation and secretion, and the anatomy of the biliary tree. Obstruction of a critical part of the biliary tree such as the common bile duct can cause jaundice, and investigating the etiology of jaundice is the first step of managing this condition. Choledocholithiasis, pancreatic ductal adenocarcinoma, cholangiocarcinoma, and biliary atresia are some of the common medical conditions that cause obstructive jaundice. Whenever jaundice is observed by a physician, early diagnosis and prompt treatment should be performed as early as possible for better outcomes.
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Khan, Fouzia Hussain, Hajra Ameer Shaikh, and Aribah Ahmed. "EFFECTS OF DIFFERENT EXERCISE THERAPIES ON OBSTRUCTION, DYSPNEA, AND QUALITY OF LIFE IN COPD PATIENTS: A SYSTEMATIC REVIEW." Journal of Medical Sciences 30, no. 01 (March 31, 2022): 92–98. http://dx.doi.org/10.52764/jms.22.30.1.19.
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Abstract
Objective: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and it causes pulmonary and extrapulmonary symptoms, also impacts the quality of life. Rigorous evidence on manual and mechanical chest physiotherapy is still scarce. Therefore, this review aims to evaluate the effects of different exercise therapies on obstruction, dyspnea and quality of life in obstructive patients.
Materials and Methods: Databases such as Medline, BioMed Central, CINHAL and Cochrane were reviewed. We performed a systematic review of randomized controlled trials published from 2011 to 2020, to evaluate the effects of exercise therapies on obstruction, dyspnea and quality of life in obstructive patients. Methodological quality and risk of bias were assessed using the Cochrane tool.
Results: Most of the trials supported the effectiveness of mechanical chest physiotherapy in improving obstruction, dyspnea and quality of life.
Conclusion: High-to-moderate evidence shows that mechanical chest physiotherapy is useful in the improvement of obstruction, dyspnea and quality of life in obstructive patients.
Keywords: Borg dyspnea scale, COPD, High-frequency chest wall oscillation, mMRC dyspnea scale, St. George Respiratory Questionnaire, Spirometry
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Ilnytskyi, R. I., D. V. Dobrianskyi, G. L. Gumeniuk, N. M. Kuzmenko, and L. B. Petelytska. "CDIAGNOSTICS OF BRONCHIAL OBSTRUCTION IN PRIMARY CARE PHYSICIAN PRACTICE." Asthma and allergy 2021, no. 2 (2021): 43–48. http://dx.doi.org/10.31655/2307-3373-2021-2-43-48.
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The practical recommendations describe the clinical symptoms and signs of bronchial obstructive syndrome, which is common in primary care physician practice. The main causes of bronchial obstruction are analyzed. Differential diagnosis of bronchial obstruction and upper airway obstruction are performed. Detailed attention is paid to the differential diagnosis of bronchial asthma (BA) and chronic obstructive pulmonary disease (COPD). Differences in clinical symptoms of these diseases are described. The main diagnostic criteria for BA and COPD are analyzed, which are determined by peak flowmetry and spirometry. It is emphasized that the diagnostic significance of the functional indicators of pulmonary ventilation are only in combination with typical clinical symptoms and risk factors. Clinical features of bronchial obstruction in patients with Churg-Strauss syndrome are described. Methods of diagnosis and two clinical cases of this syndrome are described. Key words: syndrome of bronchial obstruction, bronchial asthma, chronic obstructive pulmonary disease, peak flowmetry, spirometry, Churg-Strauss syndrome.
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Kadam, Dipali, Saurabh Patil, Avinash Dhok, and Meenal Jain. "MR urography in evaluating obstructive uropathy: one stop shop." International Surgery Journal 6, no. 3 (February 25, 2019): 944. http://dx.doi.org/10.18203/2349-2902.isj20190829.
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Background: Any anatomical or physiological obstruction to flow of urine in urinary tract results in obstructive uropathy which is one of the leading etiologies of renal failure. So, physicians require accurate and early diagnosis of obstructive uropathy to initiate appropriate treatment of these entities for better prognosis of patient. The purpose of the present study aims to determine the feasibility, accuracy and diagnostic potential of combined static and excretory MR Urography in patients of clinical features of obstructive uropathy with sonographically detected hydronephrosis.Methods: A cross sectional study of 100 patients were carried in the Department of Radio-diagnosis. The results of MR Urography were compared with the results of post-operative findings and clinical follow-up.Results: In our study of 100 patients of obstructive uropathy, MRU better depicted mild to severe PCS dilatation, renal and ureteric calculi, impaired renal function, extrinsic ureteric and PUJ obstruction. Static-fluid and excretory MR urography provided a comprehensive evaluation of the kidneys, ureters, bladder, vasculature, and soft tissues in patients with symptoms of obstructive uropathy.Conclusions: MR urography provided a superior imaging of urinary system dilatation, the site and the etiology of obstruction. In conclusions, static and excretory MRU give both morphological and functional information in a single examination without exposure to ionizing radiation and iodinated contrast agent.
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Preveden, Andrej, Mirko Todic, Vanja Drljevic-Todic, Mihaela Preveden, Ranko Zdravkovic, and Biljana Zvezdin. "Use of beta blockers in patients with asthma and chronic obstructive pulmonary disease." Medical review 74, no. 3-4 (2021): 127–33. http://dx.doi.org/10.2298/mpns2104129p.
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Introduction. Beta blockers play an essential role in the treatment of cardiovascular diseases, but also various other endocrinological, gastroenterological, ophthalmological and neurological disorders. The most important effects of beta blockers are a reduction in myocardial oxygen consumption and inhibition of renin secretion. Beta blockers are divided into three generations according to their selectivity - non-selective, cardioselective and vasodilating beta blockers. Beta blockers and obstructive pulmonary diseases. Patients with obstructive pulmonary diseases are significantly more likely to develop cardiovascular diseases compared to general population, largely due to common risk factors such as smoking, systemic inflammation, age, and genetic predisposition. The use of nonselective beta blockers carries a great risk for patients with obstructive pulmonary diseases, while cardioselective beta blockers can be used more extensively. Reversible airway obstruction is predominantly present in asthma, so that the adverse effects of beta blockers on the airways are significantly more pronounced in asthma compared to chronic obstructive pulmonary disease. Conclusion. In both asthma and chronic obstructive pulmonary disease, the use of highly cardioselective beta blockers such as bisoprolol and nebivolol is preferred. The use of beta blockers in patients with asthma requires great caution due to the possibility of bronchial obstruction, while in patients with chronic obstructive pulmonary disease they are somewhat safer. Patients must be closely monitored by a physician, with special attention focused on clinical signs of airway obstruction such as wheezing, shortness of breath, and prolonged expiration.
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Tahasildar, Kunal K., and Jagannath S. Shete. "The clinical profile of obstructive lung diseases patients attending tertiary care hospital in Nanded, Maharashtra: an observational study." International Journal of Research in Medical Sciences 6, no. 12 (November 26, 2018): 3970. http://dx.doi.org/10.18203/2320-6012.ijrms20184892.
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Background: Obstructive lung diseases as asthma and Chronic Obstructive Pulmonary Disease (COPD) have considerable morbidity and mortality globally. Chronic obstructive pulmonary disease (COPD) remains a major public health problem. It is projected to rank fifth in 2020 in burden of disease worldwide, according to the WHO study. Aim and objectives was to evaluate clinical profiles of obstructive lung diseases patients attending tertiary care hospital.Methods: The data was collected from 112 obstructive lung diseases patients presenting to OPD of pulmonary medicine department from January 2009 to August 2010. Research tool comprised of questions about demographic characteristics, past or presenting symptoms, general and systemic examinations. For statistical analysis MS Excel and SPSS 16 were used.Results: Overall 72 (64.28%) were smokers. 63 (56.25%) were suffering from COPD and 49 (43.75%) were asthmatic. Breathlessness was found as most common symptom in 53 (84.12%) COPD and in 45 (91.83%) asthma patients. Among COPD patients, 26 (41.26%) were of moderate obstruction whereas in asthma patients, 17 (34.69%) were of moderate obstruction and 16 (32.65%) were of severe obstruction as per Pulmonary Function Tests (PFT).Conclusions: Males were most commonly affected in obstructive lung diseases. COPD was common after 35 years of age where as asthma occurs mostly before 35 years of age. Smoking was most common etiological factor. Breathlessness was the most common presenting symptom. Family history of asthma was most common risk factor for asthma patients. Most of the patients with both COPD as well as asthma had moderate type of obstructions.
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Chaudhari, Dhara, Sarah Khan, Atif Saleem, Tamarro Taylor, Chakradhar Reddy, Thomas Borthwick, and Mark Young. "Obstructive Jaundice as an Initial Manifestation of Non-Hodgkin Lymphoma: Treatment Dilemma and High Mortality." Case Reports in Medicine 2013 (2013): 1–5. http://dx.doi.org/10.1155/2013/259642.
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Introduction. Non Hodgkin lymphoma (NHL) presenting with obstructive jaundice is a rare occurrence. Because of rarity of combination, it is seldom considered in differential diagnosis of patients presenting with obstructive jaundice. It is considered treatable due to the chemosensitive nature of the disease and the recent advances in chemotherapy.Case Series. We present a case series of 2 patients with NHL presenting with obstructive jaundice as an initial manifestation. Both patients presented with obstructive jaundice and were diagnosed by CT guided liver biopsy. One patient died of sepsis and multiorgan failure before initiating chemotherapy and the second patient did not choose to undergo chemotherapy.Conclusion. Biliary obstruction is a sign of poor prognosis. The diagnosis of NHL needs to be considered in patients presenting with biliary obstruction. It can be associated with high mortality and poses treatment dilemma.
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Hudgel, D. W. "Variable site of airway narrowing among obstructive sleep apnea patients." Journal of Applied Physiology 61, no. 4 (October 1, 1986): 1403–9. http://dx.doi.org/10.1152/jappl.1986.61.4.1403.
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The purpose of this was to determine whether the site of physiological narrowing within the upper airway was uniform or differed among patients with obstructive sleep apnea. Inspiratory pressures were measured with an esophageal balloon catheter and three catheters located at different sites along the upper airway: supralaryngeal airway, oropharynx, and nasopharynx. Peak inspiratory pressure differences between catheters allowed assessment of pressure gradients across three airway segments: lungs-larynx-retroepiglottal airway (esophageal-supralaryngeal pressure), hypopharynx (supralaryngeal-oropharynx pressure), and transpalatal airway (oropharynx-nasopharynx pressure). In five patients, hypopharyngeal obstruction was present, and in four patients no hypopharyngeal obstruction existed. In these four patients the site of obstruction was located at the level of the palate. In a given subject, the site of obstruction was the same during repeated measurements. The presence or absence of hypopharyngeal narrowing during sleep was not predictable from gradients measured across different segments of the upper airway during wakefulness. We conclude that the site of physiological upper airway obstruction varies among patients with obstructive sleep apnea and is not predictable from pressure measured during wakefulness. We speculate that uvulopalatopharyngoplasty may not relieve obstructive apneas in patients with hypopharyngeal obstruction.
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McGinley, Brian M., Alan R. Schwartz, Hartmut Schneider, Jason P. Kirkness, Philip L. Smith, and Susheel P. Patil. "Upper airway neuromuscular compensation during sleep is defective in obstructive sleep apnea." Journal of Applied Physiology 105, no. 1 (July 2008): 197–205. http://dx.doi.org/10.1152/japplphysiol.01214.2007.
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Obstructive sleep apnea is the result of repeated episodes of upper airway obstruction during sleep. Recent evidence indicates that alterations in upper airway anatomy and disturbances in neuromuscular control both play a role in the pathogenesis of obstructive sleep apnea. We hypothesized that subjects without sleep apnea are more capable of mounting vigorous neuromuscular responses to upper airway obstruction than subjects with sleep apnea. To address this hypothesis we lowered nasal pressure to induce upper airway obstruction to the verge of periodic obstructive hypopneas (cycling threshold). Ten patients with obstructive sleep apnea and nine weight-, age-, and sex-matched controls were studied during sleep. Responses in genioglossal electromyography (EMGGG) activity (tonic, peak phasic, and phasic EMGGG), maximal inspiratory airflow (VImax), and pharyngeal transmural pressure (PTM) were assessed during similar degrees of sustained conditions of upper airway obstruction and compared with those obtained at a similar nasal pressure under transient conditions. Control compared with sleep apnea subjects demonstrated greater EMGGG, VImax, and PTM responses at comparable levels of mechanical and ventilatory stimuli at the cycling threshold, during sustained compared with transient periods of upper airway obstruction. Furthermore, the increases in EMGGG activity in control compared with sleep apnea subjects were observed in the tonic but not the phasic component of the EMG response. We conclude that sustained periods of upper airway obstruction induce greater increases in tonic EMGGG, VImax, and PTM in control subjects. Our findings suggest that neuromuscular responses protect individuals without sleep apnea from developing upper airway obstruction during sleep.
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Lee, Eung Hyun, Su-Hyun Kim, Jung-ho Shin, Sung Bin Park, Byung Hoon Chi, and Jin Ho Hwang. "Effects on renal outcome of concomitant acute pyelonephritis, acute kidney injury and obstruction duration in obstructive uropathy by urolithiasis: a retrospective cohort study." BMJ Open 9, no. 11 (November 2019): e030438. http://dx.doi.org/10.1136/bmjopen-2019-030438.
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ObjectiveObstruction release from urolithiasis can be delayed with a lack of suggested time for preventing the deterioration of renal function. The objective of this study was to investigate the effect of obstruction duration, concomitant acute kidney injury (AKI) or acute pyelonephritis (APN) during the obstruction on the prognosis of renal function.DesignRetrospective cohort study.Setting and participants1607 patients from a urolithiasis-related obstructive uropathy cohort, between January 2005 and December 2015.Outcome measuresEstimated glomerular filtration rate (eGFR) decrease ≥30% and/or end-stage renal disease (ESRD), and eGFR decrease ≥50% and/or ESRD, according to obstruction duration, AKI and APN accompanied by obstructive uropathy.ResultsWhen the prognosis was divided by obstruction duration quartile, the longer the obstruction duration the higher the probability of eGFR reduction >50% (p=0.02). In patients with concomitant APN or severe AKI during hospitalisation with obstructive uropathy, an eGFR decrease of >30% and >50% occurred more frequently, compared with others (p<0.001). When we adjusted for sex, age, hypertension, diabetes mellitus, APN, AKI grades and obstruction release >7 days for multivariate analysis, we found that concomitant APN (HR 3.495, 95% CI 1.942 to 6.289, p<0.001), concomitant AKI (HR 3.284, 95% CI 1.354 to 7.965, p=0.009 for AKI stage II; HR 6.425, 95% CI 2.599 to 15.881, p<0.001 for AKI stage III) and an obstruction duration >7 days (HR 1.854, 95% CI 1.095 to 3.140, p=0.001) were independently associated with an eGFR decrease >50%. Tree analysis also showed that AKI grade 3, APN and an obstruction duration >7 days were the most important factors affecting renal outcome.ConclusionsIn patients with urolithiasis-related obstructive uropathy, concomitant APN was strongly associated with deterioration of renal function after obstruction release. The elapsed time to release the obstruction also affected renal function.
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Bitar, M. A., J. Nassar, and R. Dana. "Is the effect of topical intranasal steroids on obstructive adenoids transient or long-lasting? Case series and systematic review of literature." Journal of Laryngology & Otology 130, no. 4 (February 5, 2016): 357–62. http://dx.doi.org/10.1017/s0022215116000256.
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AbstractObjectives:To study and review the short- and long-term effects of intranasal steroids on obstructive adenoids.Methods:In this prospective cohort study, 19 children previously treated with mometasone furoate for 3 months were contacted at 3, 6 and 12 months after cessation of treatment. Main outcome measures included: change in severity of nasal obstruction, allergic rhinitis and obstructive symptoms. A systematic review of literature was also performed.Results:By one year, 25 per cent of patients required adenoidectomy; the remaining children had no significant change in clinical score (p = 0.464), obstruction severity (p = 0.191) or allergic symptoms (p = 0.284). Fourteen pertinent studies were identified; all but one study showed improvement in the patients’ symptoms and/or degree of obstruction. Two studies with follow up reaching 25 months showed positive effects.Conclusion:The short-term positive effect of some intranasal steroids on obstructive adenoids seems to persist in a significant number of patients after the cessation of treatment.
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Willett, C., J. E. Tepper, A. Cohen, E. Orlow, and C. Welch. "Obstructive and perforative colonic carcinoma: patterns of failure." Journal of Clinical Oncology 3, no. 3 (March 1985): 379–84. http://dx.doi.org/10.1200/jco.1985.3.3.379.
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Carcinoma of the colon complicated by obstruction or perforation has been recognized as having a poorer prognosis than tumors without obstruction or perforation. To clarify the natural history, failure patterns, and implications for adjuvant treatment after resection with curative intent, a review of the recent Massachusetts General Hospital (MGH) experience was undertaken. From 1970 to 1977, 77 patients with obstructive colonic carcinoma and 34 patients with localized perforation at the tumor site were identified and compared with a control group of 400 patients without obstruction or perforation undergoing curative resection. All patients were observed for a minimum of five years or until the patient's death. The actuarial five-year survival and disease-free survival rates in patients with obstruction was 31% and 44%, respectively, in contrast to 59% and 75% in control patients. For patients with localized perforation, the five-year actuarial survival and disease-free survival rates were 44% and 35%, respectively. Of the 77 patients with obstructing tumors, 32 patients (42%) developed local failure--nine with local failure only and 23 patients with local failure and distant metastases. Thirty-four patients (44%) developed distant metastases. Fifteen (44%) patients of 34 with perforative colonic carcinoma had local failure. Distant metastases occurred in 15 patients (44%). The incidence of local failure and distant metastases in the control group was 14% and 21%, respectively. The rate of local failure and distant metastases increased with stage and was generally higher stage for stage than in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)
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TOADER, Corneliu, Mioriţa TOADER, Andreea ŞERBĂNICĂ, Mircea DRĂGHICI, Alina OPREA, and Iolanda Cristina VIVISENCO. "Pediatric obstructive sleep apneea – surgical treatment." Romanian Journal of Medical Practice 10, no. 2 (June 30, 2015): 182–86. http://dx.doi.org/10.37897/rjmp.2015.2.16.
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Obstructive sleep apnea is characterized by recurrent episodes of partial or complete obstruction of upper respiratory airways which appear during sleep and lead to the decrease of oxygen saturation and numerous awakenings. The symptomatology in pediatric obstructive sleep apnea is very different from the adult type in many aspects. The gold standard examination for diagnosis and evaluation of severity is polysomnography. The authors present their experience in the surgical tratament of children with obstructive sleep apnea. It is outlined a group of patient enrolled during a period of 5 years (2010-2014) who had their tonsils reduced through coblation and radiofrequency techniques.
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Radovic, Milan, Lidija Ristic, Milan Rancic, Slavica Golubovic, Snezana Djordjevic, and Tatjana Radjenovic-Petkovic. "Bronchial obstruction in the active tuberculosis with reference to our experiences." Medical review 66, suppl. 1 (2013): 42–46. http://dx.doi.org/10.2298/mpns13s1042r.
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The association of active pulmonary tuberculosis and bronchial obstruction prolongs further parnechymal destruction, while its detection and treatment on time prevent irreversible changes in the airways and consecutive significant functional limitations of the respiratory system, which are very similar to those in chronic obstructive pulmonary disease; however, despite some analogies in the pathogenesis, clinical and functional manifestations, these two entities can not be equated, but should be differentiated in time. Risk factors for development of bronchial obstruction in active pulmonary tuberculosis are of the multifactor nature, and the matrix metalloproteinase-system could be a key to the future solutions of etiopathogenic and therapeutic models. Bronchial obstruction in active pulmonary tuberculosis is often the initial manifestation of an unrecognized chronic obstructive pulmonary disease, and a consequent, significant, functional impairment of the respiratory system that has developed on the site of extensive parenchymal destruction and intense systemic inflammatory response during reparative processes, which, in the absence of risk factors for chronic obstructive pulmonary disease, change the normal architecture of respiratory system and its proper function. The administration of bronchodilators by the Global Initiative for Chronic Obstructive Lung Disease strategy represents a good way in systemic and objective therapeutic approach to these patients, while the results in the application of current questionnaires on life quality of patients with chronic obstructive pulmonary disease and asthma indicate positive experience, as well as conventional indicator of treatment outcomes. Therefore, the existing strategies for control and treatment of tuberculosis should consider the fact that only microbiological cure of patients with concomitant airway obstruction is not a sufficient and effective approach to the prevention of further potential, chronic disruption of their health.
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Don, Garrick W., Turkka Kirjavainen, Catherine Broome, Chris Seton, and Karen A. Waters. "Site and mechanics of spontaneous, sleep-associated obstructive apnea in infants." Journal of Applied Physiology 89, no. 6 (December 1, 2000): 2453–62. http://dx.doi.org/10.1152/jappl.2000.89.6.2453.
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To examine the mechanics of infantile obstructive sleep apnea (OSA), airway pressures were measured using a triple-lumen catheter in 19 infants (age 1–36 wk), with concurrent overnight polysomnography. Catheter placement was guided by correlations between measurements of magnetic resonance images and body weight of 70 infants. The level of spontaneous obstruction was palatal in 52% and retroglossal in 48% of all events. Palatal obstruction predominated in infants treated for OSA (80% of events), compared with 38.6% from infants with infrequent events ( P = 0.02). During obstructive events, successive respiratory efforts increased in amplitude (mean intrathoracic pressures −11.4, −15.0, and −20.4 cmH2O; ANOVA, P < 0.05), with arousal after only 29% of the obstructive and mixed apneas. The soft palate is commonly involved in the upper airway obstruction of infants suffering OSA. Postterm, infant responses to upper airway obstruction are intermediate between those of preterm infants and older children, with infrequent termination by arousal but no persisting “upper airway resistance” and respiratory efforts exceeding baseline during the event.
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Careddu, Lucio, Francesco Dimitri Petridis, Emanuela Angeli, Giorgio Romano, Valentina Agostini, Antonietta Fucà, Andrea Donti, and Gaetano Gargiulo. "Excision of Congenital Rhabdomyoma of the Left Outflow Tract through the Left Atrium and Mitral Valve." Journal of Neonatal Surgery 7, no. 3 (July 24, 2018): 35. http://dx.doi.org/10.21699/jns.v7i3.749.
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Primary rhabdomyomas obstructing the right or left outflow tract are uncommon findings in the perinatal period. The presenting symptom may be arrhythmia, cardiac murmur, complete or variable atrioventricular block, pericardial effusion, cardiomegaly, cardiac failure, or sudden death. The variety of symptoms can be explained on the basis of obstruction of blood flow, myocardial involvement, and disturbance of the cardiac rhythm. Commonly, rhabdomyoma spontaneously regresses in the majority of cases, and neonatal surgery is advocated only in case of severe left ventricular outflow tract (LVOT) obstruction or the development of arrhythmias. Herein, we describe the pathologic and clinical characteristics of neonatal presentation of a cardiac rhabdomyoma with a nearly obstructive mass in the LVOT, discovered during pregnancy and operated 4 months after delivery.
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Meredith, George. "Nasal Obstruction, Snoring, and Obstructive Sleep Apnea." Seminars in Plastic Surgery 9, no. 01 (1995): 74–78. http://dx.doi.org/10.1055/s-2008-1080291.
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Schwartz, Alan R., David W. Eisele, and Philip L. Smith. "PHARYNGEAL AIRWAY OBSTRUCTION IN OBSTRUCTIVE SLEEP APNEA." Otolaryngologic Clinics of North America 31, no. 6 (December 1998): 911–18. http://dx.doi.org/10.1016/s0030-6665(05)70098-0.
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Rama, Anil N., Shivan H. Tekwani, and Clete A. Kushida. "Sites of Obstruction in Obstructive Sleep Apnea." Chest 122, no. 4 (October 2002): 1139–47. http://dx.doi.org/10.1378/chest.122.4.1139.
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Anonsen, Cynthia. "Laryngeal Obstruction and Obstructive Sleep Apnea Syndrome." Laryngoscope 100, no. 7 (July 1990): 775???778. http://dx.doi.org/10.1288/00005537-199007000-00015.
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Hueler, G. W. "Laryngeal obstruction and obstructive sleep apnea syndrome." Journal of Oral and Maxillofacial Surgery 49, no. 3 (March 1991): 323. http://dx.doi.org/10.1016/0278-2391(91)90246-i.
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Zarubin, V. V., A. P. Kurazhov, V. D. Zavadovskaja, O. V. Rodionova, O. S. Tonkikh, I. Yu Klinovitskiy, M. A. Zorkaltsev, and V. I. Haritonkin. "CONTRAST-ENHANCED COMPUTED TOMOGRAPHIC CHOLANGIOGRAPHY IN DIFFERENTIAL DIAGNOSIS OF THE MALIGNANT AND BENIGN CAUSES OF BILIARY OBSTRUCTION." Siberian journal of oncology 20, no. 4 (August 30, 2021): 39–48. http://dx.doi.org/10.21294/1814-4861-2021-20-4-39-48.
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Introduction. Determination of the cause of cholestasis and treatment of patients with obstructive jaundice syndrome remains challenging owing to the steady rise in diseases of the hepatopancreatoduodenal zone and the high frequency of diagnostic errors. In the differential diagnosis of the causes of obstructive jaundice, diagnostic imaging techniques are of the greatest importance. In the world literature, there are few reports on the assessment of the diagnostic potential of multispiral computed tomography under conditions of direct contrasting of the biliary tree using endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, or through pre-installed palliative drainage in the bile ducts. There is no generally accepted algorithm for determining the causes of biliary obstruction. It leads to ineffective use of various diagnostic imaging techniques, complicating the diagnostic process.The purpose of the study was to evaluate the diagnostic efficacy of contrast-enhanced ct cholangiography (ct-cg) in the differential diagnosis of causes of malignant and benign biliary obstruction in cases with obstructive jaundice syndrome.Material and methods. The study included 55 patients with obstructive jaundice, who were treated in a surgical hospital from july 2016 to july 2019.Results. It was found that contrast ct-cg in diagnosing the causes of biliary obstruction of both malignant and benign genesis is more informative than x-ray endoscopic retrograde cholangiopancreatography. The diagnostic efficacy of ct-cg in detecting causes of malignant biliary obstruction was: 93.3% sensitivity, 92.9% specificity, and 93.1% accuracy. The diagnostic efficacy of ct-cg in detecting causes of benign biliary obstruction was: 92.9%, 93.3% and 93.1%, respectively.Conclusion. Based on the high accuracy, contrast-enhanced ct-cg is a promising imaging technique in cases with bile duct obstruction.
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Kaur, Harshindar, Sukhmani Kaur, Sanjana Saholi, and Pehal Goyal. "Assessment of Cases of Congenital Obstructive Uropathy in Children." Annals of International Medical and Dental Research 8, no. 3 (May 15, 2022): 139–44. http://dx.doi.org/10.53339/aimdr.2022.8.3.18.
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Background: The aim is to assess cases of congenital obstructive uropathy in children.Material & Methods:Sixty- five children in age ranged 5-12 years of either gender with congenital obstructive uropathy were recruited for the study. In all cases, ultrasonography was done in all cases. Growth of the child was monitored and height standard deviation score (Ht-SDS) was calculated annually. Glomerular filtration rate (ml/min/1.73 m2) was calculated.Results:Out of 65 patients, males were 40 and females were 25. Etiology found to be ureteropelvic junction obstruction (PUJO) in 12, posterior urethral valve (PUV) in 14, PUJO + PUV in 30 and obstructive megaureter in 9 cases. Symptoms were fever in 34, pain abdomen in 20, burning micturition in 45, poor urinary stream in 21 and flank pain in 15 cases. Treatment given was pyeloplasty in 14, nephrectomy in 20, PUV fulguration in 11, ureterocele decompression in 12 and ureteric reimplantation in 8 cases.Conclusions:Most common etiologies for congenital obstructive uropathy in children were congenital uretero-pelvic junction obstruction and posterior urethral valve. Male preponderance was seen with burning micturition.
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Mylavarapu, Goutham, Dhananjay Subramaniam, Raghuvir Jonnagiri, Ephraim J. Gutmark, Robert J. Fleck, Raouf S. Amin, Mohamed Mahmoud, Stacey L. Ishman, and Sally R. Shott. "Computational Modeling of Airway Obstruction in Sleep Apnea in Down Syndrome." Otolaryngology–Head and Neck Surgery 155, no. 1 (April 5, 2016): 184–87. http://dx.doi.org/10.1177/0194599816639544.
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Current treatment options are successful in 40% to 60% of children with persistent obstructive sleep apnea after adenotonsillectomy. Residual obstruction assessments are largely subjective and do not clearly define multilevel obstruction. We endeavor to use computational fluid dynamics to perform virtual surgery and assess airflow changes in patients with Down syndrome and persistent obstructive sleep apnea. Three-dimensional airway models were reconstructed from respiratory-gated computed tomography and magnetic resonance imaging. Virtual surgeries were performed on 10 patients, mirroring actual surgeries. They demonstrated how surgical changes affect airflow resistance. Airflow and upper airway resistance was calculated from computational fluid dynamics. Virtual and actual surgery outcomes were compared with obstructive apnea-hypopnea index values. Actual surgery successfully treated 6 of 10 patients (postoperative obstructive apnea-hypopnea index <5). In 8 of 10 subjects, both apnea-hypopnea index and the calculated upper airway resistance after virtual surgery decreased as compared with baseline values. This is a feasibility and proof-of-concept study. Further studies are needed before using these techniques in surgical planning.
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Sarkar, Anirban, Anirban Das, Sibes Kumar Das, Soumya Das, and Sabyasachi Choudhury. "A Case of Bilateral Endobronchial Squamous Cell Carcinoma Mimicking Asthma." Journal of Medicine 15, no. 1 (August 6, 2014): 61–63. http://dx.doi.org/10.3329/jom.v15i1.19875.
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Partial or complete obstruction of bronchial tree by endobronchial tumours results in obstructive hyperinflation, non resolving pneumonia, or atelectasis. Partial endobronchial obstruction may be associated with wheezes, which mimic asthmatic attack, non responding to inhaled medications. Here, we report a rare case of bilateral endobronchial squamous cell carcinoma, presenting with obstructive hyperinflation and wheezes, which was wrongly diagnosed as difficult asthma in a forty year old male. Histopathology of endobronchial biopsy tissue ultimately revealed the truth.DOI: http://dx.doi.org/10.3329/jom.v15i1.19875 J Medicine 2014; 15: 61-63
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Soldatova, Liuba, Hansel J. Otero, David A. Saul, Christian A. Barrera, and Lisa Elden. "Lateral Neck Radiography in Preoperative Evaluation of Adenoid Hypertrophy." Annals of Otology, Rhinology & Laryngology 129, no. 5 (December 21, 2019): 482–88. http://dx.doi.org/10.1177/0003489419895035.
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Objective: To assess the value of lateral neck radiographs in quantifying adenoid hypertrophy to help guide treatment decisions in patients with symptoms of nasal obstruction. Study Design: Retrospective review. Methods: Quantitative radiologic grading of adenoids was correlated with the intraoperative grading to select cases in agreement between the two methods. The percent airway obstruction was calculated as a ratio of adenoid size to the size of the nasopharyngeal airway near the level of the choanae on the lateral neck radiographs for adenoidectomy cases in which radiographic and intraoperative grading of adenoid size were in agreement. Results: A total of 426 adenoidectomy cases with preoperative lateral neck radiographs were reviewed (M:F = 254:172 for age range 9 months to 16 years), and only cases in agreement between radiographic and intraoperative adenoid grading were included in radiographic analysis (N = 234). The percent airway obstruction values were significantly different between “severely obstructive” (N = 137, mean = 94.71, SD = 6.55, range [72.00; 100.00]) and “moderately obstructive” adenoid categories (N = 97, mean = 78.53, SD = 6.91, range [63.67; 98.08]), not only within clinically relevant age groups (1-3 years, 4-7 years, 8-15 years), but also for the entire data set (95% CI [14.41; 17.95], P < .0001). “Mildly obstructive” category was omitted due to small sample size (N = 4). Conclusion: Lateral neck radiographs can provide useful supplemental information on the degree of nasopharyngeal airway obstruction when other clinical findings do not clearly point toward adenoid hypertrophy as a primary cause of nasal obstruction. In our data set, a 65% nasopharyngeal airway obstruction represents a value two standard deviations below the mean for “moderately” obstructive adenoid category, and can be viewed as a simplified cut-off to indicate that the degree of adenoid enlargement is clinically relevant. This cut-off value can assist in evaluation of patients with symptoms of nasal obstruction. Level of Evidence: 4
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Baetz-Greenwalt, Barbara, B. Debaz, and Mary L. Kumar. "Bladder Fungus Ball: A Reversible Cause of Neonatal Obstructive Uropathy." Pediatrics 81, no. 6 (June 1, 1988): 826–29. http://dx.doi.org/10.1542/peds.81.6.826.
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Very low birth weight infants often have multiple predisposing conditions for the development of invasive candidiasis. In patients with systemic candidiasis, the kidney is vulnerable to the formation of cortical abscesses or obstructive intrarenal masses ("fungus balls"), usually at the ureteropelvic junction. Ureteropelvic junction obstructive fungal uropathy necessitates invasive debridement to restore renal function. A very low birth weight infant, infected with Candida, was first seen with hypertension, renal insufficiency, and urine cultues positive for fungus; obstructive bladder fungus ball was diagnosed by ultrasography. Mechanical disruption with amphotericin B bladder irrigation was accomplished via ultrasographic guidance, relieving renal obstruction and insufficiency. Systemic antifungal therapy was completed with amphotericin B and flucytosine. The first reported case of bladder obstructive fungal uropathy in a neonate is added to a review of 16 cases of neonatal renal obstructive uropathy.
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Gutierrez, T., A. C. Leong, L. Pang, E. Chevretton, J.-P. Jeannon, and R. Simo. "Multinodular thyroid goitre causing obstructive sleep apnoea syndrome." Journal of Laryngology & Otology 126, no. 2 (October 12, 2011): 190–95. http://dx.doi.org/10.1017/s0022215111002714.
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AbstractBackground:Obstructive sleep apnoea syndrome has been linked to obesity, nasal obstruction and adenotonsillar hypertrophy, but rarely to large thyroid goitres.Objective:To study the possible association between multinodular retrolaryngo-pharyngeal or retrosternal goitres and obstructive sleep apnoea syndrome.Subjects and methods:Retrospective case series at a tertiary referral centre (2000–2010). Study parameters included body mass index, Epworth sleep score and polysomnographic index.Results:Five patients were diagnosed with obstructive sleep apnoea syndrome and managed with nasal continuous positive airway pressure ventilation. Computed tomography showed a retrolaryngo-pharyngeal or retrosternal goitre with significant tracheal compression, displacement and laryngeal oedema. After total thyroidectomy, obstructive sleep apnoea resolved in all patients.Conclusion:Large, multinodular goitres with retrolaryngo-pharyngeal extension can cause obstructive sleep apnoea syndrome due to laryngeal compression and oedema. In such cases, total thyroidectomy enables resolution of symptoms. Patients with obstructive sleep apnoea syndrome should be screened for thyroid goitre.
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Sun, Ying, Yue Zhang, Yangyang Zhu, Aihua Zhang, Songming Huang, Xiaoxin Yin, Guixia Ding, Mi Liu, and Zhanjun Jia. "Inhibition of mitochondrial complex-1 restores the downregulation of aquaporins in obstructive nephropathy." American Journal of Physiology-Renal Physiology 311, no. 4 (October 1, 2016): F777—F786. http://dx.doi.org/10.1152/ajprenal.00215.2015.
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Obstructive kidney disease is a common complication in the clinic. Downregulation of aquaporins (AQPs) in obstructed kidneys has been thought as a key factor leading to the polyuria and impairment of urine-concentrating capability after the release of kidney obstruction. The present study was to investigate the role of mitochondrial complex-1 in modulating AQPs in obstructive nephropathy. Following 7-day unilateral ureteral obstruction (UUO), AQP1, AQP2, AQP3, and vasopressin 2 (V2) receptor were remarkably reduced as determined by qRT-PCR and/or Western blotting. Notably, inhibition of mitochondrial complex-1 by rotenone markedly reversed the downregulation of AQP1, AQP2, AQP3, and V2. In contrast, AQP4 was not affected by kidney obstruction or rotenone treatment. In a separate study, rotenone also attenuated AQPs' downregulation after 48-h UUO. To study the potential mechanisms in mediating the rotenone effects on AQPs, we examined the regulation of the COX-2/microsomal prostaglandin E synthase (mPGES)-1/PGE2/EP pathway and found that COX-2, mPGES-1, and renal PGE2 content were all significantly elevated in obstructive kidneys, which was not affected by rotenone treatment. For EP receptors, EP2 and EP4 but not EP1 and EP3 were upregulated in obstructive kidneys. Importantly, rotenone strikingly suppressed EP1 and EP4 but not EP2 and EP3 receptors. However, treatment of EP1 antagonist SC-51322 could not affect AQPs' reduction in obstructed kidneys. Collectively, these findings suggested an important role of mitochondrial dysfunction in modulating AQPs and V2 receptor in obstructive nephropathy possibly via prostaglandin-independent mechanisms.
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Nisa, Syeila Ainun, Yohni Wahyu Finansah, Uning Marlina, and Syaiful Rochman. "Differences Characteristics of Partial Bowel Obstruction and Total Bowel Obstruction in Ileus Patients at Dr. Soegiri Lamongan Hospital." MAGNA MEDICA Berkala Ilmiah Kedokteran dan Kesehatan 8, no. 1 (February 1, 2021): 29. http://dx.doi.org/10.26714/magnamed.8.1.2021.29-34.
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Background: Across all age ranges, one in a thousand people is diagnosed with ileus annually. Ileus is categorized into two types, obstructive ileus, and paralytic ileus. Obstructive ileus is a condition where intestinal passage disorder occurs as a result of a mechanical blockage. There are 7,024 obstructive ileus without hernia in Indonesia and 7,059 paralytic ileus cases in 2004.Purpose: To understand the comparison of characteristics of obstructive ileus patients.Method: This analytic descriptive research use the cross-sectional method. Samples are diagnosed with ileus based on the laparotomy result from RSUD Dr. Soegiri, Lamongan. The sampling method is total sampling based on 2015-2019 data. The samples were also using secondary data from medical records, from December 2019 to January 2020.Result: Respondents are mostly male with ages 65 years and over, less than ten days treatment duration, 39 minutes in the average length of partial bowel obstruction surgery duration, 42 minutes in the average length of total bowel obstruction surgery duration, less than two days treatment duration before surgery, percentage of ICU admission as high as 51.5 %, and blood transfusion percentage on 6.1%. There are significant differences in the characteristics of ileus patient’s age (p-value 0,021).Conclusion: Based on this study, it can be concluded that there are differences based on age in the characteristics of partial bowel obstruction and total bowel obstruction on ileus patients, whereas gender, treatment duration, treatment duration before surgery, and surgery duration did not deliver any differences.
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Bolog, Mihaela, Mihaela Dumitrescu, Florentina Romanoschi, Elena Pacuraru, and Alina Rapa. "Role of global longitudinal strain diastolic index in assessment of patients with suspected obstructive coronary artery disease and normal or mildly reduced ejection fraction." Romanian Journal of Cardiology 30, no. 2 (June 30, 2020): 222–29. http://dx.doi.org/10.47803/rjc.2020.30.2.222.
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Objective – To examine the utility of global longitudinal strain imaging diastolic index (SI-DI) in the assessment of patients with suspected obstructive coronary artery disease (CAD). Methods – We performed rest 2D standard echocardiography and strain imaging in 30 healthy subjects and in 148 patients with normal or mildly reduced ejection fraction and indication for coronarography for suspected obstructive CAD. Standard echocardiographic and strain parameters were analysed. Results – Global SI-DI was signifi cantly lower in the selected vs control group (p <0.001). After coronarography patients were divided in three subgroups: 74 patients with more than 50% obstruction in any major artery, 26 patients with previous revascularisation but no significant obstructive lesions at present and 48 patients without obstructive artery disease. Average global SI-DI was significantly lower in the subgroup with obstructive CAD vs the other two subgroups (p<0.05). Global SI-DI lower than 0.5 had a good sensitivity (84%) and a reasonable positive predictive value (52%) for detection of obstructive CAD. Conclusions – Global SI-DI is significantly lower in patients with obstructive CAD and normal or mildly reduced ejection fraction compared with normal subjects. A cut off value lower than 0.5 selects patients with a higher probability of obstructive CAD.
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Leal, Mariana C., Danielle Seabra Ramos, Thiago Pinto Bezerra, Ana Elizabeth S. C. Vilela, Rebeka Jacques de F. Maciel, Mirella Rodrigues, Mariana Lira, et al. "The Prevalence of Adenoid Hypertrophy among Children with Zika Related Microcephaly." Viruses 13, no. 1 (January 5, 2021): 62. http://dx.doi.org/10.3390/v13010062.
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Upper respiratory obstruction is a common sequela in children with Zika-related microcephaly (ZRM). As a cross-sectional analysis nested in a cohort study, this study aims to investigate the prevalence of adenoid hypertrophy (AH) in children with ZRM and symptoms of respiratory obstruction. The data were collected in the first three years of life from children with ZRM who were followed in two reference centers for otorhinolaryngological care of patients with congenital Zika syndrome. Out of 92 children with confirmed ZRM, 57 were evaluated by nasopharyngoscopy after presenting with upper respiratory obstruction symptoms. In this study, 31 of the 57 (54%) children with ZRM who were evaluated had obstructive AH. Thirteen children with obstructive AH were submitted to surgery, which resulted in the complete resolution of symptoms for 11, partial resolution in 1, and no improvement in 1. No evidence of direct involvement by Zika virus (ZIKV) infection in the adenoid tissues was demonstrated by histology or immunohistochemistry. Our results suggest that there is a high prevalence and early presentation of AH in children with ZRM, with consequent upper airway obstruction causing upper airway obstructive disorder, secretory otitis media, and dysphagia.
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Gharibeh, Lara, Nicholas G. Smedira, and Juan B. Grau. "Comprehensive left ventricular outflow tract management beyond septal reduction to relieve obstruction." Asian Cardiovascular and Thoracic Annals 30, no. 1 (October 4, 2021): 43–52. http://dx.doi.org/10.1177/02184923211034689.
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The surgical management of patients with hypertrophic obstructive cardiomyopathy can be extremely challenging. Relieving the left ventricular outflow tract obstruction in these patients is often achieved by performing a septal myectomy. However, in many instances, septal reduction alone is not enough to relieve the obstruction. Interventions on the sub-valvular apparatus, including the anomalous chordae tendineae and the abnormal papillary muscles, are often required. In this review, we summarize the embryology and the pathophysiology of the different elements that may contribute to the left ventricular outflow tract obstruction in the setting of hypertrophic obstructive cardiomyopathy. In addition, we highlight the different surgical procedures that a surgeon may adopt to relieve the left ventricular outflow tract obstruction, beyond the septal myectomy.
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Amaral, André F. S., Sonia Coton, Bernet Kato, Wan C. Tan, Michael Studnicka, Christer Janson, Thorarinn Gislason, et al. "Tuberculosis associates with both airflow obstruction and low lung function: BOLD results." European Respiratory Journal 46, no. 4 (June 25, 2015): 1104–12. http://dx.doi.org/10.1183/13993003.02325-2014.
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In small studies and cases series, a history of tuberculosis has been associated with both airflow obstruction, which is characteristic of chronic obstructive pulmonary disease, and restrictive patterns on spirometry. The objective of the present study was to assess the association between a history of tuberculosis and airflow obstruction and spirometric abnormalities in adults.The study was performed in adults, aged 40 years and above, who took part in the multicentre, cross-sectional, general population-based Burden of Obstructive Lung Disease study, and had provided acceptable post-bronchodilator spirometry measurements and information on a history of tuberculosis. The associations between a history of tuberculosis and airflow obstruction and spirometric restriction were assessed within each participating centre, and estimates combined using meta-analysis. These estimates were stratified by high- and low/middle-income countries, according to gross national income.A self-reported history of tuberculosis was associated with airflow obstruction (adjusted odds ratio 2.51, 95% CI 1.83–3.42) and spirometric restriction (adjusted odds ratio 2.13, 95% CI 1.42–3.19).A history of tuberculosis was associated with both airflow obstruction and spirometric restriction, and should be considered as a potentially important cause of obstructive disease and low lung function, particularly where tuberculosis is common.
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Formiga, Magno F., Isabel Vital, Gisel Urdaneta, Kira Balestrini, Lawrence P. Cahalin, and Michael A. Campos. "The BODE index and inspiratory muscle performance in COPD: Clinical findings and implications." SAGE Open Medicine 6 (January 2018): 205031211881901. http://dx.doi.org/10.1177/2050312118819015.
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Objectives: The Test of Incremental Respiratory Endurance is a novel testing method that provides a unique examination of one’s inspiratory muscle strength, work and endurance. Little is known about the relationship between inspiratory muscle performance and mortality risk in obstructive lung disease. We examined the relationship between the Test of Incremental Respiratory Endurance measures and the Body-mass index, airflow Obstruction, Dyspnea and Exercise index in chronic obstructive pulmonary disease. Methods: In all, 70 males with mild-to-very severe chronic obstructive pulmonary disease (mean ± standard deviation of 70.2 ± 5.9 years) underwent measurements of body-mass index, spirometry, dyspnea and a 6-min walk test from which the Body-mass index, airflow Obstruction, Dyspnea and Exercise score was calculated. The Test of Incremental Respiratory Endurance provided measures of maximal inspiratory pressure, sustained maximal inspiratory pressure and inspiratory duration. Results: All Test of Incremental Respiratory Endurance parameters inversely correlated with the Body-mass index, airflow Obstruction, Dyspnea and Exercise score: maximal inspiratory pressure (r = −0.355, p = 0.00), sustained maximal inspiratory pressure (r = −0.426, p = 0.00) and ID (r = −0.278, p = 0.02), with sustained maximal inspiratory pressure displaying the highest correlation. Independent significant correlations were also observed between the sustained maximal inspiratory pressure and all Body-mass index, airflow Obstruction, Dyspnea and Exercise score components, except for body-mass index. Finally, sustained maximal inspiratory pressure was significantly different among the Body-mass index, airflow Obstruction, Dyspnea and Exercise index quartiles. Discussion: The significant association between the Body-mass index, airflow Obstruction, Dyspnea and Exercise score and inspiratory muscle performance, in particular sustained maximal inspiratory pressure, suggests that these measures may have a potential prognostic value in the evaluation of chronic obstructive pulmonary disease.