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At least 1,261 records · Page 70Linked to original sources
PubMed1999

Subcutaneous access ports with fenestrated catheters for improved management of recurrent pleural effusions.

Repeated percutaneous thoracentesis can involve serious complications, such as pneumothorax or infection. Alternatives such as placement of chest tubes or pleurodesis have their own potential complications. Creative options such as pleuroperitoneal shunting and video thoracoscopy have previously been used to avoid the disadvantages of repeated percutaneous thoracentesis. This paper describes an easy and effective method for managing these patients without repeated percutaneous thoracentesis. A port is inserted that can be accessed percutaneously and immediately for needed aspirations. We have successfully performed this procedure on 6 patients. Our hope is that the easy access using a short needle into the port aperture will allow the thoracentesis to be performed by appropriately instructed and supervised paramedical personnel. Also, with fewer postprocedure chest radiographs or hemothoraceses, future benefits from this procedure could include cost effectiveness.

Catheterization↗
PubMed2003

Bronchial fenestration improves expiratory flow in emphysematous human lungs.

BACKGROUND: The crippling effects of emphysema are due in part to dynamic hyperinflation, resulting in altered respiratory mechanics, an increased work of breathing, and a pervasive sense of dyspnea. Because of the extensive collateral ventilation present in emphysematous lungs, we hypothesize that placement of stents between pulmonary parenchyma and large airways could effectively improve expiratory flow, thus reducing dynamic hyperinflation. METHODS: Twelve human emphysematous lungs, removed at the time of lung transplantation, were placed in an airtight ventilation chamber with the bronchus attached to a tube traversing the chamber wall, and attached to a pneumotachometer. The chamber was evacuated to -10 cm H2O pressure for lung inflation. A forced expiratory maneuver was simulated by rapidly pressurizing the chamber to 20 cm H2O, while the expiratory volume was continuously recorded. A flexible bronchoscope was then inserted into the airway and a radiofrequency catheter (Broncus Technologies) was used to create a passage through the wall of three separate segmental bronchi into the adjacent lung parenchyma. An expandable stent, 1.5 cm in length and 3 mm in diameter, was then inserted through each passage. Expiratory volumes were then remeasured as above. In six experiments, two additional stents were then inserted and forced expiratory volumes again determined. RESULTS: The forced expiratory volume in 1 second (FEV1) increased from 245 +/- 107 mL at baseline to 447 +/- 199 mL after placement of three bronchopulmonary stents (p < 0.001). With two additional stents, the FEV1 increased to 666 +/- 284 mL (p < 0.001). CONCLUSIONS: Creation of extra-anatomic bronchopulmonary passages is a potential therapeutic option for emphysematous patients with marked hyperinflation and severe homogeneous pulmonary destruction.

Feasibility Studies↗
PubMed1991

Surgical fenestration of large periapical lesions.

The decompression technique utilizing tubing for the treatment of large periapical lesions has been widely used with success. However, unobtainable biopsies and patient noncompliance are among the disadvantages that are of concern. An alternative approach is presented, whereby a surgical procedure is performed involving only partial removal of tissue from the lesion. The advantages of this procedure are discussed.

Adult↗