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Pesavento, Raffaele, Lucia Filippi, Antonio Palla, Adriana Visonà, Carlo Bova, Marco Marzolo, Fernando Porro i in. "Impact of residual pulmonary obstruction on the long-term outcome of patients with pulmonary embolism". European Respiratory Journal 49, nr 5 (maj 2017): 1601980. http://dx.doi.org/10.1183/13993003.01980-2016.
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The impact of residual pulmonary obstruction on the outcome of patients with pulmonary embolism is uncertain.We recruited 647 consecutive symptomatic patients with a first episode of pulmonary embolism, with or without concomitant deep venous thrombosis. They received conventional anticoagulation, were assessed for residual pulmonary obstruction through perfusion lung scanning after 6 months and then were followed up for up to 3 years. Recurrent venous thromboembolism and chronic thromboembolic pulmonary hypertension were assessed according to widely accepted criteria.Residual pulmonary obstruction was detected in 324 patients (50.1%, 95% CI 46.2–54.0%). Patients with residual pulmonary obstruction were more likely to be older and to have an unprovoked episode. After a 3-year follow-up, recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension developed in 34 out of the 324 patients (10.5%) with residual pulmonary obstruction and in 15 out of the 323 patients (4.6%) without residual pulmonary obstruction, leading to an adjusted hazard ratio of 2.26 (95% CI 1.23–4.16).Residual pulmonary obstruction, as detected with perfusion lung scanning at 6 months after a first episode of pulmonary embolism, is an independent predictor of recurrent venous thromboembolism and/or chronic thromboembolic pulmonary hypertension.
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Kroft, Lucia J. M., Petra M. G. Erkens, Renée A. Douma, Inge C. M. Mos, Gé Jonkers, Marcel M. C. Hovens, Marc F. Durian i in. "Thromboembolic resolution assessed by CT pulmonary angiography after treatment for acute pulmonary embolism". Thrombosis and Haemostasis 114, nr 07 (2015): 26–34. http://dx.doi.org/10.1160/th14-10-0842.
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SummaryThe systematic assessment of residual thromboembolic obstruction after treatment for acute pulmonary embolism (PE) has been under-studied. This assessment is of potential clinical importance, should clinically suspected recurrent PE occur, or as tool for risk stratification of cardiopulmonary complications or recurrent venous thromboembolism (VTE). This study aimed to assess the rate of PE resolution and its implications for clinical outcome. In this prospective, multi-center cohort study, 157 patients with acute PE diagnosed by CT pulmonary angiography (CTPA) underwent follow-up CTPA-imaging after six months of anticoagulant treatment. Two expert thoracic radiologists independently assessed the presence of residual thromboembolic obstruction. The degree of obstruction at baseline and follow-up was calculated using the Qanadli obstruction index. All patients were followed-up for 2.5 years. At baseline, the median obstruction index was 27.5 %. After six months of treatment, complete PE resolution had occurred in 84.1 % of the patients (95 % confidence interval (CI): 77.4–89.4 %). The median obstruction index of the 25 patients with residual thrombotic obstruction was 5.0 %. During follow-up, 16 (10.2 %) patients experienced recurrent VTE. The presence of residual thromboembolic obstruction was not associated with recurrent VTE (adjusted hazard ratio: 0.92; 95 % CI: 0.2–4.1). This study indicates that the incidence of residual thrombotic obstruction following treatment for PE is considerably lower than currently anticipated. These findings, combined with the absence of a correlation between residual thrombotic obstruction and recurrent VTE, do not support the routine use of follow-up CTPA-imaging in patients treated for acute PE.
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Ulualp, Seckin. "Outcomes of Tongue Base Reduction and Lingual Tonsillectomy for Residual Pediatric Obstructive Sleep Apnea after Adenotonsillectomy". International Archives of Otorhinolaryngology 23, nr 04 (28.05.2019): e415-e421. http://dx.doi.org/10.1055/s-0039-1685156.
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Introduction Upper airway obstruction at multiple sites, including the velum, the oropharynx, the tongue base, the lingual tonsils, or the supraglottis, has been resulting in residual obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (TA). The role of combined lingual tonsillectomy and tongue base volume reduction for treatment of OSA has not been studied in nonsyndromic children with residual OSA after TA. Objective To evaluate the outcomes of tongue base volume reduction and lingual tonsillectomy in children with residual OSA after TA. Methods A retrospective chart review was conducted to obtain information on history and physical examination, past medical history, findings of drug-induced sleep endoscopy (DISE), of polysomnography (PSG), and surgical management. Pre- and postoperative PSGs were evaluated to assess the resolution of OSA and to determine the improvement in the obstructive apnea-hypopnea index (oAHI) before and after the surgery. Results A total of 10 children (5 male, 5 female, age range: 10–17 years old, mean age: 14.5 ± 2.6 years old) underwent tongue base reduction and lingual tonsillectomy. Drug-induced sleep endoscopy (DISE) revealed airway obstruction due to posterior displacement of the tongue and to the hypertrophy of the lingual tonsils. All of the patients reported subjective improvement in the OSA symptoms. All of the patients had improvement in the oAHI. The postoperative oAHI was lower than the preoperative oAHI (p < 0.002). The postoperative apnea-hypopnea index during rapid eye movement sleep (REM-AHI) was lower than the preoperative REM-AHI (p = 0.004). Obstructive sleep apnea was resolved in children with normal weight. Overweight and obese children had residual OSA. Nonsyndromic children had resolution of OSA or mild OSA after the surgery. Conclusions Tongue base reduction and lingual tonsillectomy resulted in subjective and objective improvement of OSA in children with airway obstruction due to posterior displacement of the tongue and to hypertrophy of the lingual tonsils.
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Awolaran, Olugbenga, Kirsty Brennan, Iain Yardley i Hemanshoo Thakkar. "Water beads ingestion presenting with repeated bowel obstruction in an infant". BMJ Case Reports 17, nr 2 (luty 2024): e257875. http://dx.doi.org/10.1136/bcr-2023-257875.
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An infant presented repeatedly with features of transient bowel obstruction 72 hours after unwitnessed ingestion of water beads. At the third presentation 5 days later, he underwent laparotomy and jejunal enterotomy for retrieval of obstructing water bead in the duodenum. Four other water beads were retrieved. Due to persistent obstructive symptoms, he had a relaparotomy on fourth postoperative day. A further obstructing bead at the duodenojejunal flexure was retrieved. Antegrade upper gastrointestinal endoscopy and retrograde endoscopy through the enterotomy were performed to ensure no further retained water beads. The patient progressed well postoperatively and was discharged home 5 days later. This case highlights the challenges involved in the diagnosis and management of water bead ingestion in children. Children under 2 years are at a higher risk of complications and most require intervention. Palpation alone can miss residual water beads at surgery. Endoscopy including intraoperative enteroscopy could be a useful adjunct.
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Afanasyev, A. V., A. V. Bogachev-Prokophiev, S. I. Zheleznev, R. M. Sharifulin, A. S. Zalesov, D. Yu Kozmin i A. M. Karaskov. "SEPTAL MYECTOMY WITH SUBVALVULAR APPARATUS INTERVENTION IN PATIENTS WITH HYPERTROPHIC OBSTRUCTIVE CARDIOMYOPATHY: IMMEDIATE RESULTS". Siberian Medical Journal 33, nr 3 (28.11.2018): 71–77. http://dx.doi.org/10.29001/2073-8552-2018-33-3-71-77.
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Aim. Surgical septal myectomy is a standard treatment option for patients with hypertrophic obstructive cardiomyopathy. Subvalvular abnormalities of the mitral valve may play an important role in residual left ventricular outflow tract obstruction. This study aimed to evaluate the surgical outcomes of septal myectomy with subvalvular interventions.Material and Methods. Between July, 2015 and December, 2016, 40 eligible patients underwent septal myectomy with subvalvular intervention. The peak gradient was 92.3±16.9 mm Hg. The mean septum thickness was 26.8±4.5 mm. Moderate or severe systolic anterior motion syndrome-mediated mitral regurgitation was observed in all patients.Results. There was no residual mitral regurgitation. Residual systolic anterior motion syndrome was observed in 5%. The postoperative gradient was 8.7±4.5 mm Hg. At 12-month follow-up, all patients were alive. According to the New York Heart Association (NYHA) classification, 87.5 and 12.5% of patients had NYHA functional classes I and II, respectively. The prevalence rate of residual mitral regurgitation was 10%.Conclusions. Concomitant subvalvular intervention during septal myectomy effectively eliminated left ventricular outflow tract obstruction and provided high freedom from residual mitral regurgitation one year after surgery.
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Bang, Ole. "SIGNIFICANCE OF RESIDUAL URINE IN PROSTATIC OBSTRUCTION". Acta Medica Scandinavica 142, S266 (24.04.2009): 199–202. http://dx.doi.org/10.1111/j.0954-6820.1952.tb13367.x.
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Delestre, M., J. Barbieux i A. Paisant. "Small bowel obstruction due to residual appendix". Journal of Visceral Surgery 156, nr 6 (grudzień 2019): 527–28. http://dx.doi.org/10.1016/j.jviscsurg.2019.07.008.
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Bahl, Ajay, Bhupesh Kumar, Shyam KS Thingam i Sunder Lal Negi. "Midventricular Hypertrophic Obstructive Cardiomyopathy with Left Ventricular Aneurysm and Clot: The Role of Transesophageal Echocardiogram in Assessment and Management of Myomectomy". Journal of Perioperative Echocardiography 2, nr 2 (2014): 58–60. http://dx.doi.org/10.5005/jp-journals-10034-1022.
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ABSTRACT Hypertrophic obstructive cardiomyopathy (HOCM) with mid ventricular obstruction leading to apical aneurysm and clot is very rare. Intraoperative transesophageal echocardiogram (TEE) can be used to know the maximum thickness of the septum, its distance from the aortic annulus and the apical extent of septal bulge. Postresection TEE can provide information about residual obstruction or any complications. We present a case of 65-year-old male patient who underwent CABG, septal myectomy, Dor's procedure for aneurysm and clot removal. Septal resection was done under TEE guidance. How to cite this article Dutta V, Raj R, Kumar B, Bahl A, Thingam SKS, Negi SL, Puri GD. Midventricular Hypertrophic Obstructive Cardiomyopathy with Left Ventricular Aneurysm and Clot: The Role of Transesophageal Echocardiogram in Assessment and Management of Myomectomy. J Perioper Echocardiogr 2014;2(2):58-60.
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Mylavarapu, Goutham, Dhananjay Subramaniam, Raghuvir Jonnagiri, Ephraim J. Gutmark, Robert J. Fleck, Raouf S. Amin, Mohamed Mahmoud, Stacey L. Ishman i Sally R. Shott. "Computational Modeling of Airway Obstruction in Sleep Apnea in Down Syndrome". Otolaryngology–Head and Neck Surgery 155, nr 1 (5.04.2016): 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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Gumbiene, Lina, Lina Kapleriene, Dovile Jancauskaite, Monika Laukyte-Sleniene, Elena Jureviciene, Virginija Rudiene, Egle Paleviciute, Mindaugas Mataciunas i Virginija Sileikiene. "Insights to correlations and discrepancies between impaired lung function and heart failure in Eisenmenger patients". Pulmonary Circulation 10, nr 1 (styczeń 2020): 135065012090972. http://dx.doi.org/10.1177/2045894019899239.
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Impaired lung function and spirometric signs of airway obstruction without common risk factors for chronic obstructive pulmonary disease could be found in patients with Eisenmenger syndrome. This study aimed to analyse the association between lung function parameters and disease severity (including heart failure markers, associated congenital heart defect) as well as the possible reasons for airflow obstruction in Eisenmenger syndrome. The data of 25 patients with Eisenmenger syndrome were retrospectively evaluated. The patients were divided into groups according to airflow obstruction and a type of congenital heart defect. Airflow obstruction was found in nearly third (32%) of our cases and was associated with older age and worse survival. No relation was found between airway obstruction, B-type natriuretic peptide level, complexity of congenital heart defect and bronchial compression. Most of the patients (88%) had gas diffusion abnormalities. A weak negative correlation was noticed between gas diffusion (diffusing capacity of the lung for carbon monoxide) and B-type natriuretic peptide level (r = −0.437, p = 0.033). Increased residual volume was associated with higher mortality (p = 0.047 and p = 0.021, respectively). A link between B-type natriuretic peptide and lung diffusion, but not airway obstruction, was found. Further research and larger multicentre studies are needed to evaluate the importance of pulmonary function parameters and mechanisms of airflow obstruction in Eisenmenger syndrome.
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Roberts, CM, KD MacRae i WA Seed. "Multi-breath and single breath helium dilution lung volumes as a test of airway obstruction". European Respiratory Journal 3, nr 5 (1.05.1990): 515–20. http://dx.doi.org/10.1183/09031936.93.03050515.
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Total lung capacity (TLC) and residual volume (RV) measurements derived from multi-breath and single breath helium dilution methods were combined to produce four indices of gas mixing: single breath volume/multi-breath volume ratio (TLCr, RVr) or multi-breath volume minus single breath volume difference (TLCd, RVd). The reproducibility of these indices and their sensitivity and specificity in discriminating between normal subjects and those with mild asthma and severe chronic obstructive pulmonary disease (COPD) was assessed. The total lung capacity ratio (TLCr) was the superior variable overall, providing a single range for both sexes with a specificity and sensitivity similar to that of the forced expiratory volume in one second (FEV1) in the diagnosis of airflow obstruction. Despite the similar sensitivity, correlation between TLCr and FEV1 was only moderate (r = 0.56). This may reflect greater influence of peripheral rather than central airflow obstruction on TLCr. Combining both tests improved sensitivity in the detection of airways obstruction in the asthmatic and COPD groups studied.
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Shamsuddin, AK, MIS Al Manzo i M. Kabiruzzaman. "Isolated Fixed Discrete Subaortic Membrane- A Case Report". Bangladesh Heart Journal 30, nr 1 (13.06.2016): 43–45. http://dx.doi.org/10.3329/bhj.v30i1.28137.
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Discrete subaortic membrane, which is an obstructing lesion of the left ventricular outflow tract, remains a surgical challenge. A 7 year old boy came with a discrete fixed sub-aortic membrane (SAM) causing severe Left ventricular outflow tract (LVOT) obstruction. The membrane was excised totally and the patient had a satisfactory recovery. Discharge echocardiogram found no residual SAM, no gradient across LVOT, mild aortic regurgitation(AR) which was present preoperatively.Bangladesh Heart Journal 2015; 30(1) : 43-45
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Raj, Leela, Philippe Robin, Raphael Le Mao, Emilie Presles, Cécile Tromeur, Olivier Sanchez, Gilles Pernod i in. "Predictors for Residual Pulmonary Vascular Obstruction after Unprovoked Pulmonary Embolism: Implications for Clinical Practice—The PADIS-PE Trial". Thrombosis and Haemostasis 119, nr 09 (23.06.2019): 1489–97. http://dx.doi.org/10.1055/s-0039-1692424.
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Background We aimed to identify risk factors for residual pulmonary vascular obstruction after a first unprovoked pulmonary embolism (PE). Methods Analyses were based on data from the double-blind randomized “PADIS-PE” trial that included 371 patients with a first unprovoked PE initially treated during 6 uninterrupted months; all patients underwent baseline ventilation–perfusion lung scanning at inclusion (i.e., after 6 months of anticoagulation). Each patient's pulmonary vascular obstruction indexes (PVOIs) at PE diagnosis and at inclusion were centrally assessed. Results Among the 371 included patients, residual PVOI was available in 356 patients, and 150 (42.1%) patients had PVOI ≥ 5%. At multivariable analysis, age > 65 years (odds ratio [OR], 2.81, 95% confidence interval [CI], 1.58–5.00), PVOI ≥ 25% at PE diagnosis (OR, 3.53, 95% CI, 1.94–6.41), elevated factor VIII (OR, 3.89, 95% CI, 1.41–10.8), and chronic respiratory disease (OR, 2.18, 95% CI, 1.11–4.26) were independent predictors for residual PVOI ≥ 5%. Patients with ≥ 1 of these factors represented 94.5% (123 patients) of all patients with residual PVOI ≥ 5%. Conclusion Six months after a first unprovoked PE, age > 65 years, PVOI ≥ 25% at PE diagnosis, elevated factor VIII, or chronic respiratory disease were found to be independent predictors for residual pulmonary vascular obstruction. Clinical Trials Registration URL: http://www.controlled-trials.com. Unique identifier: NCT00740883.
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Aganovic, Damir, i Alden Prcic. "Detrusor contraction duration and strength in the patients with benign prostatic enlargement". Bosnian Journal of Basic Medical Sciences 4, nr 1 (20.02.2004): 29–33. http://dx.doi.org/10.17305/bjbms.2004.3457.
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OBJECTIVE: examine detrusor contraction duration (DCD) in relation with obstruction grade and strength of detrusor contractility; analyze individual correlations of this parameter with urodynamic, physiological and symptoms variables in patients with benign prostatic enlargement (BPE).SAMPLE AND METHODOLOGY: 102 patients with proved BPE, underwent complete urodynamic measurements (UDM), namely uroflowmetry, cystometry and pressure/flow studies. Postvoid residual urine (PVR) was measured and the International Prostate Symptom Score (I-PSS) was fulfilled by each patient. Methodology of measurement and definitions of UDM are based on definitions and terminology defined by the International Continence Society.RESULTS: After grouping the patients (average age 64,7+8,5) related to obstruction grades according to the Schafer nomogram, ANOVA has shown a group extension of the detrusor contraction duration related to higher levels of obstruction (LinPURR 0-VI; p<0,01), which is also followed by stronger detrusor contractility (Pdetmax; p<0,001). Dichotomizing of the patients with DCD cut off point 90 sec. has shown that 67% patients with underactive detrusor have DCD>90 sec, while extension of DCD and increase of the obstruction level are directly related to preserved detrusor contractility only in 20,5% cases. There is neither statistically significant difference of DCD in the patients that are not in obstruction allocated in two groups depending on detrusor contraction strength, (t=1.2, p>0.05); nor in the patients who are in obstruction range, divided on the same way (t=0.568, p>0.05). There is also no difference of the same patients groups regarding PVR (t=1.38 and t=1.17, p>0.05). Individual correlation of DCD with I-PSS has not been shown (r=0.16, p>0.05), although there is a statistically significant correlation with its obstructive subset (r=0.20, p<0.05), as well as, with LinPUR and URA nomograms (r=0.33, r=0.29; respectively, p<0.005) and with Pdetmax (r=0.26, p<0.01), PdetQmax (r=0.24, p<0.05), Qmax and Qaver (r=0.31, p<0.005). DCD does not have individual correlations with patients’ age, prostate volume and with cystometric capacity.CONCLUSION: DCD is rather independent urodynamical variable, which does not correlate with I-PSS. Generally, DCD is prolonged during obstruction, while extension of DCD only partially depends on detrusor contraction strength. Practically, individual correlations of DCD with the urodynamic factors, which characterize obstructions, are modest.
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Christopoulos, P., S. Ross-Thriepland, H. McCarthy, C. S. Day i W. Sasi. "A Rare Case of an Early Postoperative Obstructive Ileus in a Young Female Patient due to a Residual Trichobezoar Mass". Case Reports in Surgery 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/4121969.
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Trichobezoar is a rare cause of small bowel obstruction, whereby a mass forms most commonly in the stomach and duodenum of young females, from ingestion of hair, a condition known as trichophagia. We present a case of recurrent small bowel obstruction due to a residual hair mass that was removed surgically in a young female patient who had a laparotomy and gastrotomy for removal of a large gastric trichobezoar just two weeks prior to the current admission. This case illustrates the importance of a thorough inspection of the whole bowel to ensure that no residual bezoars remain after surgery.
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Mothersole, Kelsey, Seckin Omer Ulualp, Peter Szmuk i Christopher Liu. "The Effect of Tonsillectomy and Adenoidectomy on Upper Airway Obstruction Patterns in Children with Obstructive Sleep Apnea". International Archives of Otorhinolaryngology 27, nr 02 (kwiecień 2023): e211-e217. http://dx.doi.org/10.1055/s-0043-1768207.
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Abstract Introduction Alterations in upper airway flow dynamics and sites of airway obstruction immediately after tonsillectomy and adenoidectomy (TA) have not been assessed. Identification of the changes in airway obstruction patterns after TA potentially improves the surgical management of children with obstructive sleep apnea (OSA). Objective To evaluate the effect of TA on upper airway obstruction patterns detected with drug-induced sleep endoscopy (DISE). Methods The medical records of patients who underwent pre-TA DISE during the induction of anesthesia and post-TA DISE at the end of TA were reviewed. Data pertaining to polysomnography and DISE findings were analyzed. Results Twenty-seven patients (15 male and 12 females aged between 2 and 18 years old) were identified. All patients had obstruction at multiple sites of the upper airway. Prior to TA, airway obstruction was at the level of the velum in 27 patients, of the oropharynx/lateral walls in 27, of the tongue in 7, and of the epiglottis in 4. After TA, airway obstruction was at the level of the velum in 24 patients, of the oropharynx/lateral walls in 16, of the tongue in 6, and of the epiglottis in 4. The degree of obstruction at the levels of the velum and oropharynx/lateral walls after TA was significantly decreased. Conclusions Drug-induced sleep endoscopy performed prior to TA revealed that most of the sites of airway obstruction persisted after TA in OSA children with multiple sites of airway obstruction. Further studies in larger group of children with OSA are needed to establish the value of DISE findings in predicting residual OSA after TA, surgical planning, determining the need for post TA sleep study, and counseling caregivers.
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Upadhyay, Vinay, Praveen Nayak, Ruchit Patel i Sandipbhai Lukhi. "Study of right ventricular outflow tract gradient in immediate postoperative period following intracardiac repair for tetralogy of Fallot". Heart India 11, nr 2 (2023): 57–62. http://dx.doi.org/10.4103/heartindia.heartindia_11_23.
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Background: Surgical repair of tetralogy of Fallot (TOF) consists of adequate ventricular septal defect closure and relief of right ventricular outflow tract (RVOT) obstruction to the greatest extent possible. The residual RVOT gradient can be due to dynamic and fixed obstruction, and high gradient is sometimes seen even after a satisfactory RVOT resection often confirmed with intraoperative TransEsophageal Echocardiogram (TEE). Aim: The present study was conducted to study the changes in RVOT residual gradient in the early postoperative period. We analyzed the change in residual gradient by invasive monitoring intraoperatively after separating from cardiopulmonary bypass (CPB) in a case of intracardiac repair (ICR) for TOF and compared the readings 24 h after extubating the patients in intensive care unit (ICU). Materials and Methods: This was an observation study done in the Department of CTVS, Advanced Cardiac Centre, PGIMER, and Chandigarh from February 2018 to March 2019. A total of thirty patients with preoperative diagnosis of TOF were included in the study. After ICR for TOF, postseparation from CPB, RVOT gradient was measured using 23G needle connected to pressure transducer and compared with RVOT gradient measured 24 h postextubating using invasive line kept intraoperatively in pulmonary artery and RVOT. Results: There was a significant decrease in residual RVOT gradient postoperatively in ICU after 24 h of extubating, in comparison to intraoperative postbypass residual RVOT gradient. Postbypass residual RVOT gradient was 11.33 ± 1.39 that decreased to 7.81 ± 1.29 24 h after extubating (P < 0.05). Patients in whom pulmonary valve was preserved had greater postbypass residual RVOT gradient (12.44 ± 1.13) than patients with transannular patch (10.5 ± 0.90). However, both decreased after 24 h of extubating (9 ± 0.7 and 6.9 ± 0.8, respectively). Conclusion: Once satisfactory RVOT resection for fixed obstruction is done and is confirmed using TEE, the residual gradient, if marginally high, can be ignored as residual gradient significantly decreases after extubation and hemodynamic improvement is seen in postoperative period.
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Woodson, Gayle, i Todd Weiss. "Arytenoid Abduction for Dynamic Rehabilitation of Bilateral Laryngeal Paralysis". Annals of Otology, Rhinology & Laryngology 116, nr 7 (lipiec 2007): 483–90. http://dx.doi.org/10.1177/000348940711600702.
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Objectives: Bilateral laryngeal paralysis results in airway obstruction, but the voice is often nearly normal. Tracheotomy provides an airway and preserves voice. Surgical procedures to statically enlarge the glottis can permit decannulation, but do so at the expense of the voice. Motion analysis in cadaver larynges has demonstrated that adductor and abductor muscles rotate the arytenoid cartilage around different axes. We sought to determine whether external rotation of the arytenoid cartilage could enlarge the airway without abolishing residual phonatory adduction. Methods: We performed arytenoid abduction in 6 patients with obstructing laryngeal paralysis. A suture was placed in the muscular process and posterior-inferior traction was applied, anchoring the suture to the inferior cornu of the thyroid cartilage. Outcomes were evaluated by assessing airway symptoms, by assessing the voice, and by documentation of laryngeal motion via videolaryngoscopy. Results: Three patients with severe stridor had marked relief of symptoms, and 2 of the 3 tracheotomy-dependent patients were decannulated. Three patients had good voices, 2 had mild breathiness, and 1 was very breathy. Conclusions: Arytenoid abduction is a promising treatment for relieving airway obstruction in patients with laryngeal paralysis. It has the potential to preserve voice in patients with residual phonatory adduction.
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Bhattarai, B., i S. Shrestha. "Negative Pressure Pulmonary Edema- Case Series and Review of Literature". Kathmandu University Medical Journal 9, nr 4 (18.06.2012): 310–14. http://dx.doi.org/10.3126/kumj.v9i4.6352.
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Post obstructive pulmonary edema (POPE) also known as Negative pressure pulmonary edema (NPPE)is potentially life threatening complication. It occurs in about 0.1% of anesthetics and is related to upper airway obstruction. Two types have been described in literature. Different etiology has been attributed to development of Negative pressure pulmonary edema. Early identification and treatment of predisposing factor along with proper monitoring of this complication early treatment should be instituted because resolution is also fast and in most cases without residual effects. DOI: http://dx.doi.org/10.3126/kumj.v9i4.6352 Kathmandu Univ Med J 2011;9(4):310-4
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Saleem, Kamal, Iftikhar Ahmed, Mehboob Sultan, Intisar ul Haq, Umair Younus i William M. Novick. "Bidirectional Glenn for residual outflow obstruction in Tetralogy of Fallot". Cardiology in the Young 29, nr 5 (maj 2019): 684–88. http://dx.doi.org/10.1017/s1047951119000866.
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AbstractBackground:Residual right ventricular outflow obstruction during Tetralogy of Fallot repair necessitates peri-operative revision often requiring trans-annular patch with its negative sequels. Bidirectional Glenn shunt in this setting reduces trans-pulmonary gradient to avoid revision.Methods:Bidirectional Glenn shunt was added during Tetralogy repair in patients with significant residual obstruction. A total of 53 patients between January, 2011 and June, 2018 were included. Final follow-up was conducted in July, 2018.Results:Mean age at operation was 5.63±3.1 years. Right to left ventricular pressure ratio reduced significantly (0.91±0.09 versus 0.68±0.05; p<0.001) after bidirectional Glenn, avoiding revision in all cases. Glenn pressures at ICU admission decreased significantly by the time of ICU discharge (16.7±3.02 versus 13.5±2.19; p<0.001). Pleural drainage ≥ 7 days was seen in 14 (26.4%) patients. No side effects related to bidirectional Glenn-like facial swelling or veno-venous collaterals were noted. Mortality was 3.7%. Discharge echocardiography showed a mean trans-pulmonary gradient of 32.11±5.62 mmHg that decreased significantly to 25.64±5 (p<0.001) at the time of follow-up. Pulmonary insufficiency was none to mild in 45 (88.2%) and moderate in 6 (11.8%). Mean follow-up was 36.12±25.15 months (range 0.5–90). There was no interim intervention or death. At follow-up, all the patients were in NYHA functional class 1 with no increase in severity of pulmonary insufficiency.Conclusion:Supplementary bidirectional Glenn shunt significantly reduced residual right ventricular outflow obstruction during Tetralogy of Fallot repair avoiding revision with satisfactory early and mid-term results.
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Pontikides, Nickolaos, Spyridon Karras, Antonios Papagiannis, Athina Kaprara, Panagiotis Anagnostis, George Noussios, Argyrios Doumas i in. "Recombinant Human Thyrotropin-Aided Radioiodine Therapy in Tracheal Obstruction by an Invading Well-Differentiated Thyroid Carcinoma". Case Reports in Otolaryngology 2013 (2013): 1–4. http://dx.doi.org/10.1155/2013/579527.
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Papillary thyroid carcinomas (PTCs) usually extend to lymph nodes in the neck and mediastinum. Rarely, they invade the neighboring upper airway anatomical structures. We report a 56-year-old woman who presented with symptoms of upper airway obstruction. Imaging studies revealed a lesion derived from the thyroid which invaded and obstructed the trachea, which appeared to be a highly differentiated PTC. Total thyroidectomy was performed, with removal of the endotracheal part of the mass along with the corresponding anterior tracheal rings. Two months later, a whole body I131scan after recombinant human thyroid-stimulating hormone (rh-TSH) administration was performed and revealed a residual mass in upper left thyroid lobe. Subsequently, 150 mCi I131were given following rh-TSH administration. Nine months later, there was no sign of residual tumor. This case is the first one reported in the literature regarding rh-TSH administration prior to RAI ablation in a PTC obstructing the trachea.
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Pillai, Manjusha N., Shrinivas Gadhinglajkar, Sabarinath Menon i Rupa Sreedhar. "Residual Obstruction After Repair of Total Anomalous Pulmonary Venous Connection". A & A Practice 12, nr 6 (marzec 2019): 215–17. http://dx.doi.org/10.1213/xaa.0000000000000916.
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Hady, Kelly K., i Caroline U. A. Okorie. "Positive Airway Pressure Therapy for Pediatric Obstructive Sleep Apnea". Children 8, nr 11 (29.10.2021): 979. http://dx.doi.org/10.3390/children8110979.
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Pediatric obstructive sleep apnea syndrome (OSAS) is a disorder of breathing during sleep, characterized by intermittent or prolonged upper airway obstruction that can disrupt normal ventilation and/or sleep patterns. It can affect an estimated 2–4% of children worldwide. Untreated OSAS can have far reaching consequences on a child’s health, including low mood and concentration as well as metabolic derangements and pulmonary vascular disease. Most children are treated with surgical intervention (e.g., first-line therapy, adenotonsillectomy); however, for those for whom surgery is not indicated or desired, or for those with postoperative residual OSAS, positive airway pressure (PAP) therapy is often employed. PAP therapy can be used to relieve upper airway obstruction as well as aid in ventilation. PAP therapy is effective in treatment of OSAS in children and adults, although with pediatric patients, additional considerations and limitations exist. Active management and care for various considerations important to pediatric patients with OSAS can allow PAP to be an effective and safe therapy in this population.
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Castellani, Daniele, Redi Claudini, Luca Gasparri, Alessandro Branchi, Maria Pia Pavia i Marco Dellabella. "Is complete anatomical endoscopic laser enucleation of the prostate always necessary? Yes, it is!" Urologia Journal 86, nr 2 (20.11.2018): 93–95. http://dx.doi.org/10.1177/0391560318812302.
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Introduction: Thulium laser enucleation of the prostate is gaining popularity due to its short learning curve and low postoperative morbidity. The aim of Thulium laser enucleation of the prostate is the complete endoscopic enucleation of the adenoma. We report an unusual case of bladder outlet obstruction developed 6 weeks after Thulium laser enucleation of the prostate. Case description: A 74-year-old man complained of severe voiding phase symptoms lasting 2 weeks, starting 6 weeks after Thulium laser enucleation of the prostate. He underwent a transrectal ultrasound, which showed a wide prostatic fossa. A cystoscopy revealed that the prostatic fossa was filled with whitish tissue arising from two tiny residual adenomas. The obstructing tissue was resected with the aid of Thulium laser and the histopathology report showed necrotic prostatic glands. Conclusion: Partially enucleated and left inside adenoma may become necrotic and cause bladder outlet obstruction several weeks after Thulium laser enucleation of the prostate. Transrectal ultrasound control at the end of enucleation may help reduce this complication.
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Caffè, Andrea, Francesco Maria Animati, Giulia Iannaccone, Riccardo Rinaldi i Rocco Antonio Montone. "Precision Medicine in Acute Coronary Syndromes". Journal of Clinical Medicine 13, nr 15 (5.08.2024): 4569. http://dx.doi.org/10.3390/jcm13154569.
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Nowadays, current guidelines on acute coronary syndrome (ACS) provide recommendations mainly based on the clinical presentation. However, greater attention is being directed to the specific pathophysiology underlying ACS, considering that plaque destabilization and rupture leading to luminal thrombotic obstruction is not the only pathway involved, albeit the most recognized. In this review, we discuss how intracoronary imaging and biomarkers allow the identification of specific ACS endotypes, leading to the recognition of different prognostic implications, tailored management strategies, and new potential therapeutic targets. Furthermore, different strategies can be applied on a personalized basis regarding antithrombotic therapy, non-culprit lesion revascularization, and microvascular obstruction (MVO). With respect to myocardial infarction with non-obstructive coronary arteries (MINOCA), we will present a precision medicine approach, suggested by current guidelines as the mainstay of the diagnostic process and with relevant therapeutic implications. Moreover, we aim at illustrating the clinical implications of targeted strategies for ACS secondary prevention, which may lower residual risk in selected patients.
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Qiabi, Mehdi, Karine Chagnon, Alain Beaupré, Julian Hercun i George Rakovich. "Scoliosis and Bronchial Obstruction". Canadian Respiratory Journal 22, nr 4 (2015): 206–8. http://dx.doi.org/10.1155/2015/640573.
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Severe scoliosis may have a significant effect on respiratory function. The effect is most often restrictive due to severe anatomical distortion of the chest, leading to reduced lung volumes, limited diaphragmatic excursion and chest wall muscle inefficiency. Bronchial compression by the deformed spine may also occur but is more unusual. Management options include a conservative approach using bracing and physiotherapy in mild cases, as well as surgical correction of the scoliosis in more severe cases. Bronchial stenting has also been used successfully as an alternative to surgical correction, and in cases in which spinal surgery was either unsuccessful or not feasible. The authors present a case involving a 52-year-old woman who exhibited symptomatic compression of the bronchus intermedius by severe residual scoliosis despite previous corrective surgery. She was treated with an indwelling bronchial stent.
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Wilson, Jason, Angela S. Collins i Brea O. Rowan. "Residual Neuromuscular Blockade in Critical Care". Critical Care Nurse 32, nr 3 (1.06.2012): e1-e10. http://dx.doi.org/10.4037/ccn2012107.
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Neuromuscular blockade is a pharmacological adjunct for anesthesia and for surgical interventions. Neuromuscular blockers can facilitate ease of instrumentation and reduce complications associated with intubation. An undesirable sequela of these agents is residual neuromuscular blockade. Residual neuromuscular blockade is linked to aspiration, diminished response to hypoxia, and obstruction of the upper airway that may occur soon after extubation. If an operation is particularly complex or requires a long anesthesia time, residual neuromuscular blockade can contribute to longer stays in the intensive care unit and more hours of mechanical ventilation. Given the risks of this medication class, it is essential to have an understanding of the mechanism of action of, assessment of, and factors affecting blockade and to be able to identify factors that affect pharmacokinetics.
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Park, Jintae, Sora Baek, Gowun Kim, Seung-Joo Nam i Ji Hyun Kim. "Esophageal Motility Disorders in Patients With Esophageal Barium Residue After Videofluoroscopic Swallowing Study". Annals of Rehabilitation Medicine 46, nr 5 (31.10.2022): 237–47. http://dx.doi.org/10.5535/arm.22039.
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Objective To investigate esophageal motility disorders in patients with esophageal residual barium on chest x-rays after videofluoroscopic swallowing studies (VFSS) through high-resolution esophageal manometry (HREM).Methods We reviewed the records of 432 patients who underwent VFSS from September 2019 to May 2021, and 85 patients (19.7%) with large residual barium (diameter ≥1 cm) were included. As a result of HREM, motility disorders were classified as major or minor motility disorders according. Esophagogastroduodenoscopy and chest computed tomography results available were also reviewed.Results Among 85 patients with large residual barium in the esophagus, 16 patients (18.8%) underwent HREM. Abnormal esophageal motilities were identified in 68.8% patient: three patients (18.8%) had major motility disorders—achalasia (n=1), esophagogastric junction (EGJ) outflow obstruction (n=2)—and eight patients (50%) had minor motility disorders—ineffective esophageal motility (n=7), fragmented peristalsis (n=1). In those with normal esophageal motility, three patients of esophageal structure disorders (18.8%)—esophageal cancer (n=1), cardiogenic dysphagia (n=1), slight narrowing without obstruction of EGJ (n=1)—and two patients (12.5%) with chronic atrophic gastritis (n=2) were confirmed.Conclusion Esophageal motility disorders were identified in 68.8% of 16 patients with large esophageal residual barium with three patients in the major and eight patients in the minor categories. Residual barium in the esophagus was not rare and can be a sign of significant esophageal motility disorders.
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Varma, Praveen Kerala, Neethu Krishna, Hisham Ahamed i Sujatha Madassery. "Posterior mitral leaflet plication for hypertrophic obstructive cardiomyopathy". Asian Cardiovascular and Thoracic Annals 26, nr 5 (18.04.2018): 400–403. http://dx.doi.org/10.1177/0218492318773590.
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Anomalies of the mitral valve apparatus in hypertrophic cardiomyopathy are an important cause of systolic anterior motion. Patients with significant residual obstruction due to systolic anterior motion after myectomy and anterior mitral leaflet plication may end up having mitral valve replacement. We describe the case of a 52-year-old man who underwent posterior mitral leaflet plication to correct residual systolic anterior motion after anterior mitral leaflet plication.
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Aboulela, Waseem Nabil, Mahmoud Shoukry Eladawy i Ahmed Abdel Latif. "The effect of use of alpha-blockers in posterior urethral valve pediatric patients postvalve ablation in the absence of further outlet obstruction". Urology Annals 16, nr 3 (lipiec 2024): 218–20. http://dx.doi.org/10.4103/ua.ua_105_23.
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Objectives: The objectives of this study were to detect whether the use of alpha-blockers in posterior urethral valve (PUV) pediatric patients after valve ablation will improve the persistent obstructive symptoms despite the absence of obstruction and if there are associated side effects of its use. Patients and Methods: A prospective, single-blinded randomized study was conducted at the urology department of two hospitals on 50 male children between September 2019 and June 2021 with PUV. All children were treated by endoscopic ablation of PUV using the cold knife and were followed clinically for voiding symptoms and with ultrasonography and laboratory tests. All patients underwent second-look cystoscopy 1 month after primary valve ablation to see residual valves as a routine procedure confirming no remnant of the valve and still complaining of obstructive symptoms. They were divided into two equal groups 25 patients each. Group A was given alpha-blockers and Group B placebo for 1 month. Results: Marked improvement of obstructive symptoms in Group A reaching about 90% (21 patients), whereas no mentioned improvement in Group B was noticed with no side effects of both medication the alpha-blocker and the placebo during its use. Conclusion: The use of alpha-blockers improves the obstructive symptoms in pediatric patients with PUV after valve ablation and in the absence of any further urethral obstruction with no side effects noticed during the period of its use.
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Magarey, M. J. R., S. M. Jayaraj, H. A. Saleh i A. Sandison. "Ball valve nasal obstruction following incomplete inferior turbinectomy". Journal of Laryngology & Otology 118, nr 2 (luty 2004): 146–47. http://dx.doi.org/10.1258/002221504772784621.
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An interesting case is presented of a 53-year-old male who was seen with a 10-year history of intermittent, unilateral nasal obstruction following a bilateral total inferior turbinectomy. A pedunculated mass was seen in the right posterior nasal space acting as a ball valve. This was removed and found to be residual turbinate tissue.
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Grommes, J., KT von Trotha, MA de Wolf, H. Jalaie i CHA Wittens. "Catheter-directed thrombolysis in deep vein thrombosis: Which procedural measurement predicts outcome?" Phlebology: The Journal of Venous Disease 29, nr 1_suppl (maj 2014): 135–39. http://dx.doi.org/10.1177/0268355514529394.
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The post-thrombotic syndrome (PTS) as a long-term consequence of deep vein thrombosis (DVT) is caused by a venous obstruction and/or chronic insufficiency of the deep venous system. New endovascular therapies enable early recanalization of the deep veins aiming reduced incidence and severity of PTS. Extended CDT is associated with an increased risk of bleeding and stenting of residual venous obstruction is indispensable to avoid early rethrombosis. Therefore, this article focuses on measurements during or after thrombolysis indicating post procedural outcome.
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de Vries, Kristin Anne, Aukje van der Wolk, Jantine Venker i Jasper Koolwijk. "Vocal cord dysfunction causing hypoxaemia in the postanaesthesia care unit". BMJ Case Reports 17, nr 1 (styczeń 2024): e257685. http://dx.doi.org/10.1136/bcr-2023-257685.
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Hypoxaemia in the postanaesthesia care unit is common and the majority is caused by hypoventilation or upper airway obstruction due to the (residual) effects of anaesthetic and analgesic agents. We present a case of upper airway obstruction caused by vocal cord dysfunction, a less frequently occurring aetiology. The patient’s case suggests a notable relationship between procedural laryngeal stimulus and the onset of symptoms. Approach to the diagnosis and flexible laryngoscopy to either rule-in or rule-out several relevant differentials are discussed.
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Postma, DS, I. Peters, EJ Steenhuis i HJ Sluiter. "Moderately severe chronic airflow obstruction. Can corticosteroids slow down obstruction?" European Respiratory Journal 1, nr 1 (1.01.1988): 22–26. http://dx.doi.org/10.1183/09031936.93.01010022.
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In a former study in patients with severe chronic airflow obstruction (CAO), (forced expiratory volume in one second (FEV1) ranging from 350-910 ml), we concluded that daily oral corticosteroids might slow down the progression of disease. The results of the present long-term (14-20 yr) study on 139 non-allergic patients with less severe CAO (FEV1 greater than or equal to 1200 ml, FEV1 as a percentage of vital capacity (FEV1%VC) 40-55%) confirm and extend our former observations. Four patterns of the course of FEV1 and inspiratory vital capacity (VC) in time were recognized: 1) linear decrease; 2) no change; 3) initial increase, followed by decrease; 4) initial decrease, followed by increase. Groups 1 and 3 had a higher functional residual capacity as a percentage of total lung capacity (FRC%TLC) as compared to group 2 and 4; the work of breathing was lower in group 2 than in the other three groups. Otherwise the initial 82 parameters, including the degree of reversibility of airflow obstruction and smoking habits were comparable in the four groups. The four patterns of FEV1 showed a strong association with the long-term use of prednisolone. When oral prednisolone was instituted or increased to a dose of at least 10 mg/day continuously, FEV1 either remained constant, decreased more slowly or even increased over many years of follow-up. When the oral dose was diminished to below 10 mg/day, FEV1 decreased.(ABSTRACT TRUNCATED AT 250 WORDS)
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Zabczyk, Michal, Joanna Natorska i Anetta Undas. "Erythrocyte compression index is impaired in patients with residual vein obstruction". Journal of Thrombosis and Thrombolysis 46, nr 1 (27.03.2018): 31–38. http://dx.doi.org/10.1007/s11239-018-1650-1.
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D'Honneur, Gilles, Frederic Lofaso, Gordon B. Drummond, Jean-Marc Rimaniol, Jean V. Aubineau, Alain Harf i Philippe Duvaldestin. "Susceptibility to Upper Airway Obstruction during Partial Neuromuscular Block". Anesthesiology 88, nr 2 (1.02.1998): 371–78. http://dx.doi.org/10.1097/00000542-199802000-00016.
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Background Airway obstruction after anesthesia may be caused or exaggerated by residual neuromuscular block, with loss of muscle support for collapsible upper airway structures. Methods Six male volunteers were studied before treatment, during stable partial neuromuscular block with vecuronium at a mean train-of-four (TOF) ratio of 50% (95% CI, 36-61%), and after reversal by neostigmine. Catheter-mounted transducers were placed in the pharynx and esophagus to estimate, respectively, the upper airway resistance, and the work of breathing (calculated as the time integral of the inspiratory pressure developed by the respiratory muscles, esophageal pressure time product) during quiet breathing, during breathing 5% carbon dioxide, and while breathing with an inspiratory resistor. Breathing with pressure at the airway opening held at pressures from -5 to 40 cm H2O were also tested to assess airway collapsibility. Results Although breathing through a resistor increased upper airway resistance from 1.2 (0.67, 1.72) cm H2O x l(-1) x s to 2.5 (1.32, 3.38) cm H2O x l(-1) x s, and carbon dioxide stimulation reduced resistance to 0.8 (0.46, 1.33) cm H2O x l(-1) x s, no effect of partial neuromuscular block (mean TOF ratio, 52%) on upper airway properties could be shown. Conclusions Neuromuscular block with a TOF ratio of 50% can be present yet clinically difficult to detect in patients recovering from anesthesia. This degree of block has no effect on airway patency in volunteers, even during challenge. Airway obstruction during recovery from anesthesia thus is more likely to be caused by residual effects of general anesthetic agents or centrally acting analgesics, either alone or perhaps in concert with residual neuromuscular block.
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Isaiah, Amal, Edgar Kiss, Patrick Olomu, Korgun Koral i Ron B. Mitchell. "Characterization of upper airway obstruction using cine MRI in children with residual obstructive sleep apnea after adenotonsillectomy". Sleep Medicine 50 (październik 2018): 79–86. http://dx.doi.org/10.1016/j.sleep.2017.10.006.
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., Yasrab, Muhammad Nauman Iqbal, Qurat-Ul-Ain Khan, Hafiz Muhammad Asim Mushtaq, Syeda Samina Asad i Aftab Ahmed. "Analysis of use of Percutaneous Nephrostomy and Ureteral Stenting in Management of Ureteral Obstruction". Pakistan Journal of Medical and Health Sciences 16, nr 5 (29.05.2022): 479–81. http://dx.doi.org/10.53350/pjmhs22165479.
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Introduction: Urinary diversion is one of the ways to manage ureteral obstructions and is commonly performed in our daily practice when the underlying condition of ureteral obstruction cannot be eliminated in a short period. Ureteral obstructions can be a consequence of malignancies or benign diseases. Aims and objectives: The basic aim of the study is to analyze the use of percutaneous nephrostomy and ureteral stenting in management of ureteral obstruction. Methodology of the study: This cross sectional study was conducted at Department of Urology, Shaikh Zayid Hospital Lahore during October 2020 to Dec 2021. This study was done with the permission of ethical committee of hospital. There were 110 patients who selected for this study analysis. Enrollment criteria consisted of the need for unilateral or bilateral upper urinary tract diversion for at least 6 months. Either a PCN tube or an internal ureteral stent (e.g., double-J stent) was used for ureteral obstructions of various etiologies. Results: There were 110 patients with mean age 60 years in this study. There were 66 patients with ureteral stents and 44 (40%) with PCN tubes. A smaller elevation in serum creatinine was noted in the PCN group (0.21 vs. 0.78 mg/dL, p = 0.03). Nine of 86 (10.4%) double-J stents were converted to PCN tubes during the study period. Residual hydronephrosis after decompression was more common in the stent group than in the PCN group (65.2% vs. 27.2%, p = 0.01). Conclusion: It is concluded that Urinary diversion or decompression using PCN produced better preservation of renal function and lower incidences of complications in our study. Keywords: PCN, Hydronephrosis, Urinary, Renal, Function
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Núñez-Fernández, David, i Jan Vokurka. "Surgical Treatment of Anterior Septal Deviations". Acta Medica (Hradec Kralove, Czech Republic) 41, nr 3 (1998): 141–44. http://dx.doi.org/10.14712/18059694.2019.179.
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Anterior septal deviations are very difficult to handle because their location causes valvular obstruction, and any small residual deviation can cause a high degree of obstruction. The commonly performed submucous resection is not a suitable technique to handle this deformity. The maxilla-premaxilla technique offers a better approach. The surgical technique for anterior septal deviation differs from the standard septoplasty in several steps. A modified technique to treat this particular pathology is described in detail. This technique is highly reliable, and simplifies the access to a difficult-to-handle deformity.
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Nitayavardhanam, Prompak, i Teerapong Tocharoenchok. "Predictive Value of Right Ventricular Pressure Measurement for Residual Pulmonary Stenosis in Tetralogy Repair". Siriraj Medical Journal 74, nr 4 (1.04.2022): 225–32. http://dx.doi.org/10.33192/smj.2022.28.
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Objective: The long-term outcome of tetralogy of Fallot repair depends on an adequate relief of right ventricular outflow tract obstruction and preservation of the pulmonary valve function. Since intraoperative transesophageal echocardiography is not routinely performed in small patients, we postulated that the post-bypass right ventricular pressure measured intraoperatively could predict residual pulmonary stenosis when evaluated by transthoracic echocardiography.Materials and Methods: Of the 187 patients who underwent tetralogy repair between 2012 and 2019 at Siriraj Hospital, Thailand, 95 with right ventricular pressure measurements and pre-discharge echocardiography were included in the study. Their intraoperative parameters, and postoperative outcomes were analyzed. The tolerable pressure cutoff was determined.Results: The median patient age was 3.9 years old (interquartile range 2.75–6). Fifty-three patients (54.6%) required the use of the transannular patch. Ten patients (10.3%) had significant residual pulmonary stenosis with a mean right ventricular systolic pressure of 64.0±10.6 mmHg compared with 48.7±14.4 mmHg for the other patients. There was an association between the pressure figure and the degree of residual pulmonary stenosis (rho=0.391, p=0.01). A systolic pressure above 49 mmHg predicted pulmonary stenosis with a likelihood ratio of 2.18 (1.94-2.80, 95%CI). The likelihood rose to 2.93 (2.44-4.01, 95%CI) if the pressure resulted in a right to left ventricular pressure ratio above 0.62. The patients whose figures did not exceed 49 mmHg experienced no significant residual obstruction, regardless of the pressure ratio.Conclusion: Intraoperative measurement of the right ventricular pressure can predict residual pulmonary stenosis after tetralogy repair with a reassuring cutoff of 49 mmHg
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Biselli, Paolo, Peter R. Grossman, Jason P. Kirkness, Susheel P. Patil, Philip L. Smith, Alan R. Schwartz i Hartmut Schneider. "The effect of increased lung volume in chronic obstructive pulmonary disease on upper airway obstruction during sleep". Journal of Applied Physiology 119, nr 3 (1.08.2015): 266–71. http://dx.doi.org/10.1152/japplphysiol.00455.2014.
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Patients with chronic obstructive pulmonary disease (COPD) exhibit increases in lung volume due to expiratory airflow limitation. Increases in lung volumes may affect upper airway patency and compensatory responses to inspiratory flow limitation (IFL) during sleep. We hypothesized that COPD patients have less collapsible airways inversely proportional to their lung volumes, and that the presence of expiratory airflow limitation limits duty cycle responses to defend ventilation in the presence of IFL. We enrolled 18 COPD patients and 18 controls, matched by age, body mass index, sex, and obstructive sleep apnea disease severity. Sleep studies, including quantitative assessment of airflow at various nasal pressure levels, were conducted to determine upper airway mechanical properties [passive critical closing pressure (Pcrit)] and for quantifying respiratory timing responses to experimentally induced IFL. COPD patients had lower passive Pcrit than their matched controls (COPD: −2.8 ± 0.9 cmH2O; controls: −0.5 ± 0.5 cmH2O, P = 0.03), and there was an inverse relationship of subject's functional residual capacity and passive Pcrit (−1.7 cmH2O/l increase in functional residual capacity, r2 = 0.27, P = 0.002). In response to IFL, inspiratory duty cycle increased more ( P = 0.03) in COPD patients (0.40 to 0.54) than in controls (0.41 to 0.51) and led to a marked reduction in expiratory time from 2.5 to 1.5 s ( P < 0.01). COPD patients have a less collapsible airway and a greater, not reduced, compensatory timing response during upper airway obstruction. While these timing responses may reduce hypoventilation, it may also increase the risk for developing dynamic hyperinflation due to a marked reduction in expiratory time.
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Kadiyani, Lamk, Saurabh Kumar Gupta i Sivasubramaniam Ramakrishnan. "Interventional management of an unusual cause of cyanosis in repaired tetralogy of Fallot". Annals of Pediatric Cardiology 17, nr 3 (maj 2024): 217–20. http://dx.doi.org/10.4103/apc.apc_80_24.
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ABSTRACT Arterial desaturation following surgical repair of tetralogy of Fallot (TOF) is rare. In most instances, it results from residual right ventricular outflow tract obstruction, causing right-to-left shunt across residual interatrial or interventricular communication. In this report, we present an unusual scenario of arterial desaturation due to a recanalized left cardinal vein in a child with repaired TOF. We also discuss stepwise evaluation that led to successful identification and occlusion of the abnormal venous channel by percutaneous device closure.
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Lopata, M., E. Onal i G. Cromydas. "Respiratory load compensation in chronic airway obstruction". Journal of Applied Physiology 59, nr 6 (1.12.1985): 1947–54. http://dx.doi.org/10.1152/jappl.1985.59.6.1947.
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To assess respiratory neuromuscular function and load compensating ability in patients with chronic airway obstruction (CAO), we studied eight stable patients with irreversible airway obstruction during hyperoxic CO2 rebreathing with and without a 17 cmH2O X l-1 X s flow-resistive inspiratory load (IRL). Minute ventilation (VE), transdiaphragmatic pressure (Pdi), and diaphragmatic electromyogram (EMGdi) were monitored. Pdi and EMGdi were obtained via a single gastroesophageal catheter with EMGdi being quantitated as the average rate of rise of inspiratory (moving average) activity. Based on the effects of IRL on the Pdi response to CO2 [delta Pdi/delta arterial CO2 tension (PaCO2)] and the change in Pdi for a given change in EMGdi (delta Pdi/delta EMGdi) during rebreathing, two groups could be clearly identified. Four patients (group A) were able to increase delta Pdi/delta PaCO2 and delta Pdi/delta EMGdi, whereas in the other four (group B) the IRL responses decreased. All group B patients were hyperinflated having significantly greater functional residual capacity (FRC) and residual volume than group A. In addition the IRL induced percent change in delta Pdi/delta PaCO2, and delta VE/delta PaCO2 was negatively correlated with lung volume so that in the hyperinflated group B the higher the FRC the greater was the decrease in Pdi response due to IRL. In both groups the greater the FRC the greater was the decrease in the ventilatory response to loading. Patients with CAO, even with severe airways obstruction, can effect load compensation by increasing diaphragmatic force output, but the presence of increased lung volume with the associated shortened diaphragm prevents such load compensation.
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Ammirati, Enrico, Alberto Manassero, Alessandro Giammò, Francesco Marson, Alberto Gurioli i Roberto Carone. "Female Primary Bladder Neck Obstruction: Role of Videourodynamics and Treatment Options in a Rare Clinical Entity". Urologia Journal 84, nr 2 (14.11.2016): 109–12. http://dx.doi.org/10.5301/uro.5000203.
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Introduction Primary female bladder neck obstruction is a rare clinical condition characterized by the absence/incomplete bladder neck opening during the voiding phase of micturition. Methods We present the cases of two women complaining dysuria, abdominal straining and sensation of incomplete bladder emptying. Videourodynamic evaluation was fundamental for a correct diagnosis. Results Videourodynamic evaluation showed a high detrusor pressure during emptying phase, partial use of abdominal strain, very low urine flow rate and significant postvoid residual; imaging showed a defect in the physiological funneling of the bladder neck, absent or incomplete. The first step therapy is represented by oral alpha-blockers and clean intermittent self-catheterization in case of high postvoid residual. Surgical operations, such as bladder neck incision and resection, represent the last option. Conclusions In our experience, bladder neck obstruction is a rare condition in women and only a complete clinical evaluation associated with videourodynamic study can lead to an appropriate diagnosis and treatment.
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Planquette, Benjamin, Olivier Sanchez, James J. Marsh, Peter G. Chiles, Joseph Emmerich, Grégoire Le Gal, Guy Meyer i in. "Fibrinogen and the prediction of residual obstruction manifested after pulmonary embolism treatment". European Respiratory Journal 52, nr 5 (18.10.2018): 1801467. http://dx.doi.org/10.1183/13993003.01467-2018.
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Residual pulmonary vascular obstruction (RPVO) and chronic thromboembolic pulmonary hypertension (CTEPH) are both long-term complications of acute pulmonary embolism, but it is unknown whether RPVO can be predicted by variants of fibrinogen associated with CTEPH.We used the Akaike information criterion to select the best predictive models for RPVO in two prospectively followed cohorts of acute pulmonary embolism patients, using as candidate variables the extent of the initial obstruction, clinical characteristics and fibrinogen-related data. We measured the selected models’ goodness of fit by analysis of deviance and compared models using the Chi-squared test.RPVO occurred in 29 (28.4%) out of 102 subjects in the first cohort and 46 (25.3%) out of 182 subjects in the second. The best-fit predictive model derived in the first cohort (p=0.0002) and validated in the second cohort (p=0.0005) implicated fibrinogen Bβ-chain monosialylation in the development of RPVO. When the derivation procedure excluded clinical characteristics, fibrinogen Bβ-chain monosialylation remained a predictor of RPVO in the best-fit predictive model (p=0.00003). Excluding fibrinogen characteristics worsened the predictive model (p=0.03).Fibrinogen Bβ-chain monosialylation, a common structural attribute of fibrin, helped predict RPVO after acute pulmonary embolism. Fibrin structure may contribute to the risk of developing RPVO.
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AFŞAR, Hamit, i M. Metin BAYRAM. "Ultrasonic Assessment of Residual Urine Volume". European Journal of Therapeutics 2, nr 2 (1.06.1991): 131–35. http://dx.doi.org/10.58600/eurjther.19910202-525.
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The assessment of residual urine forms an essential part of the investigation of many urological patients, particularly those with suspected urinary outflow obstruction; the presence of residual urine may influence their management. Generally, it is necessary to measure the volume of residual urine to assess bladder function. The advantages of establishing a simple non-invasive method to measure bladder volume have long been recognized. Various methods of assessing residual urinary volumes exist, including abdominal palpation, the use of postvoiding films from excretory urography and excretion tests using phenolsulphaphtalein or radiolabeled compounds. The most commonly used and accurate technique, catheterisation of the bladder, has the risk of introducing infection and traumatizing the urethra. A method to assess residual urine that is simple, safe, easily repeatable, non-invasive and accurate would be considerable value in clinical practice. in our study we compared the ultrasonically measured residual volumes measured by catheterisation. We describe an ultrasound method for the measurement of residual urine that is quick, easy to perform, accurate and causes no discomfort to the patient.
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Munsif, Tahsin, Syed Shabeeh Haider, Vineeta Tewari, Mariyam Fatima i Pradeep Kumar Sharma. "Ultrasonographic study of comparison of prostate volume and post void residual urine with age in north Indian population". Asian Journal of Medical Sciences 12, nr 10 (1.10.2021): 124–28. http://dx.doi.org/10.3126/ajms.v12i10.37933.
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Background: As men’s life expectancy increases, benign prostatic hyperplasia (BPH) is the significant cause of morbidity. BPH generally involves the central region of the prostate which gradually enlarges. Due to the central hypertrophic change of prostate the urethra is compressed and urinary outflow obstruction develops. Predictive risk factors associated with chance of developing urinary retention includes age, symptoms, urinary flow rate and prostate size. Estimation of accurate intravesical, residual urine has significant importance and serves as an index of adequacy of bladder emptying. Aims and Objectives: The study aimed to measure the post void residual urine volume with age in Prostate outflow obstruction and compare the prostate volume and post void residual urine with age by ultrasonography. Materials and Methods: The present study was performed in 100 patients. Transrectal ultrasonography was performed using 7.5 MHZ transrectal probe. Prostate volume was calculated with the help of inbuilt software, by measuring 3 dimensions of prostate in transverse and longitudinal sections. Transabdominal suprapubic ultrasound was done to measure post void residual urine. Results: It was seen that in the lower age groups, the prostate size was smaller, while in the higher age group it was higher (p>0.001). Minimum post void residual urine was seen in age group of 40-49 years (3.42 -+2.23ml). while maximum mean value was seen in the 70-79 years of age. Statistically a significant difference in mean was seen among different age groups (p<0.001). Conclusion: There is a significant correlation between age and post void residual urine volume and prostatic volume. The present study showed that PVRUV is a novel accurate non-invasive test for predicting prostate biopsyoutcome that can easily be used by clinicians, alone or in combination with Prostate Volume in the decision-making for treatment.
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Kim, Jungghi, Jong-Gyun Ha i Hyung-Ju Cho. "Development of Central Sleep Apnea After Sleep Surgery". Journal of Rhinology 29, nr 1 (31.03.2022): 56–58. http://dx.doi.org/10.18787/jr.2021.00386.
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Central sleep apnea (CSA) is defined as an absence of breathing without respiratory drive during sleep. It can occur after treatment of obstructive sleep apnea (OSA), a phenomenon known as treatment-emergent central sleep apnea (TECSA). We present a case of a 23-year-old male who developed CSA after pharyngeal and nasal surgery for severe OSA. High loop gain and increased ventilations from frequent arousal are likely explanations for our patient’s central apnea, which resolved with positive airway pressure therapy that possibly alleviated residual airway obstruction and ventilatory instability. This case suggests that effectiveness of treatment for OSA should be based on careful long-term observation with multiple follow-up polysomnography tests, especially in patients at high risk of TECSA.
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Palaniswamy, Nithiyanandhan, Mamatha Munaf, Saravana Babu i Shrinivas V. Gadhinglajkar. "Three-Dimensional Transesophageal Echocardiographic Detection of Left Ventricular Outflow Tract Obstruction by Residual Native Mitral Leaflet following Mitral Valve Replacement in a Hypertrophic Obstructive Cardiomyopathy Patient". Annals of Cardiac Anaesthesia 26, nr 3 (2023): 349–52. http://dx.doi.org/10.4103/aca.aca_180_22.
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Hypertrophic obstructive cardiomyopathy (HOCM), although a worldwide prevalent cardiac disease, it imposes a greater task in the patient management. The association of coronary artery disease with HOCM poses an immense perioperative challenge and it demands an expert transesophageal echocardiography (TEE) examination for guiding the surgery and detailed assessment after surgical correction. We report a case of HOCM with coronary artery disease where the post-cardiopulmonary bypass three-dimensional TEE played a crucial role in exact identification of the mechanism of fixed left ventricular outflow tract obstruction, when the two-dimensional TEE failed to provide adequate information.
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Schranz, Dietmar, Christian Jux, Melanie Vogel, Jürgen Bauer, Hakan Akintürk i Klaus Valeske. "Large-diameter graft-stent (Advanta V12) implantation in various locations: early results". Cardiology in the Young 21, nr 1 (27.10.2010): 66–73. http://dx.doi.org/10.1017/s1047951110001459.
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AbstractObjectivesTranscatheter stent placement carries the risk of cardiovascular aneurysm or rupture. Covered stent implantation reduces these risks. The recently marketed Advanta V12 large-diameter-covered stent is pre-mounted and requires 9 (8)-11 Fr delivery systems. The aim was to report on the early results of the treatment of various cardiovascular obstructions by the implantation of a new polytetrafluoroethylene-covered stent (V12).MethodsGraft stents on balloons with a diameter (12, 14, 16 millimetres) sufficient to anchor the stent in various obstructions (congenital aortic coarctation, n = 5; obstruction after ascending aorta repair, n = 2; pulmonary arteries, n = 5; inferior caval vein, n = 1; atretic superior caval vein, n = 1; pulmonary vein obstruction, n = 1; and right ventricular outflow tract, n = 1) were implanted using the smallest available delivery system. Secondary dilation with larger-diameter balloons was performed when the residual pressure was gradient, the stent-vessel wall relationship or stent re-coiling due to different reasons needed a re-intervention by pure ballooning or second stent placement.ResultsAll 16 patients aged 5–46 years underwent V12 implantation. The variability of the treated lesions and the need for additional interventions were responsible for large ranges in fluoroscopy time between 7.3 to 48.2 minutes (median 17.3). Considering the additional procedures, the V12 stent achieved the desired result in all cases. There were no major complications. At short-term median follow-up of 2 months, all patients are alive and well with no evidence of stent failing.ConclusionThese initial results show that the covered Advanta V12 large-diameter stent is safe and effective in the immediate treatment of various cardiovascular obstructions. Long-term follow-up is required.