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PubMed1984

Orbital emphysema as an ophthalmologic emergency.

Orbital emphysema is generally a benign, self-limited condition. However, if a fracture produces a ball-valve effect allowing air to enter but not to leave the orbit, and if the orbital septum remains intact, then extremely high intraorbital pressure and visual loss is possible. Two cases are described of visual loss from orbital emphysema, in a 33-year-old man and a 28-year-old man, which were successfully treated by a lateral canthotomy and cantholysis.

Adult↗
PubMed2006

[Post-traumatic orbital emphysema: a case report].

Orbital emphysema is often associated with orbital fracture or communication with paranasal sinuses. It is usually moderate but could be the cause of optic neuropathy or central retinal artery occlusion. We report a case of massive orbital emphysema with ocular hypertony and prethrombosis of the central retinal artery. Emergency surgical decompression performed by an ophthalmologist and an otorhinolaryngologist provided complete and prompt relief. The authors emphasize the importance of preventing nose blowing after orbital trauma or surgery.

Adult↗
PubMed1983

Perforated cecal carcinoma presenting as thigh emphysema.

Gastrointestinal perforation into the retroperitoneum may present as thigh emphysema. In the elderly, abdominal symptoms may be minimal. We report a patient with a perforated cecal carcinoma presenting as right hip pain with thigh emphysema. A diagnosis of perforated intra-abdominal viscus was suspected from the radiographs. The patient initially did well after surgery, which included a hemicolectomy and debridement of necrotic muscle down to the knee. He later succumbed from cardiac arrest following a dyspneic episode.

Adenocarcinoma↗
PubMed1988

Orbital emphysema: a potentially blinding complication following orbital fractures.

A case of visual loss due to orbital emphysema secondary to a blow-out fracture of the orbit is presented. Because vision returned to 20/20 following an optic nerve decompression procedure, we hypothesize that our patient developed a compressive optic neuropathy with ischemia due to the emphysema. Essential instructions concerning the injury that the emergency physician should give the patient suffering an orbital blow-out are also presented.

Adolescent↗
PubMed1997

Surgical options for patients with advanced emphysema.

Since the early 1900s, a variety of operations have been suggested for emphysema but, with the exception of giant bullectomy, an option in only a small fraction of patients, none has proven effective. Data collected by a number of academic medical centers indicate that LVRS may ameliorate symptoms and improve pulmonary physiology, function, and quality of life in appropriately selected patients with emphysema. Accordingly, LVRS may provide an opportunity to intervene in a rapid, effective, and, possibly, cost-effective manner in a debilitating, chronic disease. That is an extraordinarily attractive proposition for both patients and physicians alike. But a number of questions remain: (1) What is the effect of LVRS compared with maximal medical therapy? (2) What is the duration of any beneficial effect of LVRS? (3) What is the best operative approach? (4) What patient characteristics predict good and bad outcomes? (5) What is the role of pre- and, possibly, postoperative pulmonary rehabilitation? (6) Does LVRS adversely affect the rate of loss of lung function over time, as some have suggested? (7) What is the cost of LVRS compared with standard medical therapy? (8) Can the procedure be performed safely in nontransplant centers? (9) What is the effect on disease-specific quality of life? (10) Does it affect mortality? A prospective, randomized controlled trial involving 18 selected centers will begin in the fall of 1997 under the sponsorship of the Health Care Financing Corporation (the administrators of Medicare) and the National Institutes of Health. We strongly support the creative, collaborative approach that has been taken by those two government agencies to stimulate this study. The need for controlled trials of new therapies cannot be overstated; only with such trials can the questions enumerated above be answered with certainty.

Humans↗
PubMed1989

Pneumomediastinum and cervical emphysema subsequent to mandibular injury associated with a flare pistol shot.

Pneumomediastinum in patients with war injuries to the maxillofacial region can be a life-threatening condition. A case is presented of a flare-pistol-shot wound to the mandible which subsequently resulted in cervical emphysema, mediastinal emphysema, and pneumomediastinum, causing a critical condition. Maxillofacial surgeons should be alert to this problem when treating blast or multiple-shell injuries to the maxillofacial region.

Adult↗
PubMed2000

[Bilateral lung reduction by video-assisted thoracoscopy in a patient with non-bullous pulmonary emphysema and laryngeal neoplasia].

Lung reduction has been show to be a promising treatment for the final phases of non-bullous pulmonary emphysema. The role of video-assisted thoracoscopy (VAT) in this disease has not yet been established. We report a case of bilateral non-bullous pulmonary emphysema in which transplantation was ruled out because of laryngeal neoplasm treated three months earlier. Using VAT, we performed bilateral lung reduction in the apical zones with good therapeutic results. We find that in patients reduction by VAT, although not a curative treatment, leads to immediate postoperative improvement in lung function and dyspnea, and does not exclude the possibility of later performing lung transplantation.

Carcinoma, Squamous Cell↗
PubMed2000

[Hyoid fracture and traumatic subcutaneous cervical emphysema from an attempted hanging. Apropos a case].

We describe a patient with a history of psychiatric disorder who was brought to our hospital after attempted suicide by hanging. Severe subcutaneous facial, palpebral and cervical emphysema was present, with dysphonia, dysphagia and slight respiratory difficulty. Fiberoptic bronchoscopy revealed upper airway obstruction due to edema in an intact airway. Successive CAT scans gave evidence of hyoid fracture and laryngocele, in addition to the corresponding emphysema of the subcutaneous area and pneumomediastinum. Given the persistence of dysphagia, we ordered esophageal tests, which showed functional alteration of the upper esophageal sphincter. Suprasternal cervicotomy to drain the pneumomediastinum and laryngeal microsurgery to treat the laryngocele resolved the problem.

Alcoholism↗
PubMed1999

The role of persisting infections in the pathogenesis of pulmonary emphysema. Electron microscopy reveals a probable bacterial colonization of the alveolar space and the bronchioles.

Lung volume reduction surgery (LVRS) yields resection specimens from patients with advanced pulmonary emphysema. Regarding the development of lung function parameters, recent results obtained by light microscopy revealed an unfavorable prognosis in patients with remarkable inflammation, particularly in the bronchioli. Tissue from ten patients (alpha1-antitrypsin level in the normal range) was furthermore investigated by electron microscopy. Scanning electron microscopy shows 0.4-0.6 micron spherical bodies variably densely arranged in the whole alveolar space and in the bronchioles of all patients. These bodies are mostly seen on the microvilli of type II pneumocytes. An immunological reaction with activation of macrophages and granulocytes occurs simultaneously. Macrophages show cytoplasmic extensions to the spherical bodies, which exhibit a cellular membrane but no cellular wall. This favors the diagnosis of bacterial colonization of the alveolar space and the bronchioles by mycoplasmas or L-forms of other bacteria. As patients undergoing lung volume reduction surgery are under optimal medical treatment and without any infection clinically, these findings appear to be relevant for the pathogenesis and/or progression of pulmonary emphysema.

Acute Disease↗
PubMed2003

A case of orbital emphysema associated with internal laryngocele.

Orbital emphysema (OE) is usually the result of a fracture of lamina papyrecea or maxillary roof allowing air to pass from the sinuses into the orbit. OE without evidence of any significant trauma is a rare occurrence. Thorough literature search revealed that no case of OE due to the rupture of internal laryngocele has been reported. A case is reported here of bilateral orbitopalpebral emphysema associated with internal laryngocele, in the absence of facial skeleton trauma, in a healthy young adult male. It should be kept in mind that laryngocele rupture would be one of the underlying causes of OE or OE would be the presenting symptom of laryngocele rupture.

Adult↗
PubMed2004

[Surgical management of emphysema].

Surgery is an important therapeutic option for emphysema patients with invalidating dyspnea and poor quality-of-life. Preoperative tests must determine the degree of functional impairment (dyspnea score, walking test, quality-of-life) and evaluate lesion reversibility (imaging, function tests, TLCO, blood gases, scintigraphy, right microcatheterism) and assess the patient's general health status. Besides lung transplantation, the only surgical alternative is resection which, depending on the type of parenchymal damage, can involve excision of bullae or volume reduction. Several modalities can be proposed: atypical resection of the apexes via sternotomy, multiple unilateral atypical resection, simple lobectomy. The choice depends on the distribution of the parenchymal destruction and also on the severity of the emphysema and the patient's age. Operative mortality is now well below 10%. Volume reduction provides significant functional improvement in 80% of patients but with a temporary effect (4-5 years). Bullae excision is particularly important since functional recovery is achieved early and persists.

Dyspnea↗
PubMed2004

[Surgery for emphysema: recent advances].

INTRODUCTION: The treatment of chronic obstructive pulmonary disease has progressed considerably over the past 40 Years but, for most patients with advanced disease, medical management does not often produce more than limited benefits, particularly in terms of quality of life. STATE OF ART: Over the last decade the surgical treatment of emphysema, which was previously limited to bullectomy, has seen important developments: for carefully selected patients lung Volume reduction surgery and lung transplantation now offer the possibility of real symptomatic improvement and even prolonged survival. Thanks to the thousands of patients who have received these treatments our understanding of the pathophysiological mechanisms, surgical techniques, risks and benefits, medium and long-term results, and selection criteria has improved considerably. PERSPECTIVES AND CONCLUSIONS: This review summarises the most important aspects of these developments and discusses the role of Volume reduction and lung transplantation in the treatment of advanced emphysema.

Cost-Benefit Analysis↗
PubMed2004

[VENT: International study of bronchoscopic lung volume reduction as a palliative treatment for emphysema].

BACKGROUND: Therapeutic options for patients with severe emphysema remain limited. In selected patients, lung volume reduction surgery has been shown to improve pulmonary function, exercise capacity, quality of life and also survival. The technique of inserting one-way valves endoscopically into the airways supplying the most affected areas of lung provides the possibility of achieving similar results to surgery (i.e. volume reduction) in a less invasive way, which is also reversible, since the valves can be removed at any time. This technique has been shown to be safe. The aim of this study is to evaluate the efficacy of this technique compared to optimal medical therapy in patients with heterogeneous emphysema defined according to radiological criteria. METHODS: A prospective, international, multicentre (20 centres) randomised trial is underway to establish the efficacy and safety of endobronchial valve placement in this patient group. This study will enrol 270 patients and be analysed on an intention to treat basis. Patients are randomised either to valve insertion or optimal medical treatment alone in a ratio of 2 to 1. Follow up will be ensured for at least one year. EXPECTED RESULTS: The two principal outcome measures will be improvement at six months in FEV1 and in six minute walk distance. The safety of the technique will be evaluated over the same period. Details of the study are available online for patients and their physicians at www.euroemphysema.com.

Bronchoscopy↗
PubMedDate not supplied

[Emphysema and lung volume reduction surgery--a case report].

Lung volume reduction surgery (LVRS) has been proposed as a palliative therapy in severe emphysema, with good results in lung function improvement, exercise capacity and quality of life. The authors present a case report of a 34 years old man with severe, heterogeneous lung emphysema submit to bilateral LVRS in 2000 January. Pre-surgical conditions, clinical and radiological evolution after surgery and for a 30 months follow up were analysed. Based on a literature revision, some technical aspects of LVRS, selection criteria and comparative study of medical and surgical therapy were discussed.

Adult↗
PubMed2000

Subcutaneous emphysema in advanced cancer.

Spontaneous subcutaneous emphysema is a rare and usually benign entity that may occasionally be symptomatic. We report a case of a patient with advanced cancer who developed extensive but asymptomatic subcutaneous emphysema shortly before death. Perforation of the lower gastrointestinal tract, perhaps as a result of straining due to severe unrelieved constipation or due to fistula formation, is suspected to have been the mechanism. The causes, treatment, and implications for management of this condition are discussed.

Adenocarcinoma↗
PubMedDate not supplied

Assessment of lung volumes in pulmonary emphysema using multidetector helical CT: comparison with pulmonary function tests.

The purpose of this study is to evaluate the usefulness of multidetector helical CT (MDCT) with three-dimensional (3D) postprocessing for assessing the lung volume at inspiration and expiration of the pulmonary emphysema and for comparing it with pulmonary function tests. Percentage lung volume at the threshold of -930, -900, -810, -790, and -770 at expiration showed good correlation with FEV1, FEV1/FVC, and DLCO/Va. Excellent correlation was observed between percentage lung volume at the threshold of -900 and FEV1/FVC. CT densitometry at expiration showed better correlation than that at inspiration with pulmonary function tests. MDCT with 3D technique is useful for assessing the severity of pulmonary emphysema.

Adult↗
PubMed1990

Combined cryptogenic fibrosing alveolitis and emphysema: the value of high resolution computed tomography in assessment.

Simple tests of lung function may be misleading in the assessment of patients with interstitial lung disease. Eight patients are described with cryptogenic fibrosing alveolitis (histologically proven in four) with severe breathlessness and low gas transfer (median DLCO 32.4%, range 9.2 to 35.3%, % predicted) in whom lung volumes were preserved [median VC 98.7, range 67.5-131.1%; median TLC 92.5, range 88.1 to 121.2, (% predicted)], and in whom there was no evidence of airflow obstruction [median FEV1/FVC 84.6, range 68-116 (% predicted)]. All were current or ex-heavy smokers. Thoracic high resolution computed tomography revealed upper zone emphysema, the extent of which was not appreciated using conventional chest radiography. The atypical physiological and radiological features can be explained by coincidental cryptogenic fibrosing alveolitis and emphysema and high resolution computed tomography was valuable in the assessment of these patients.

Aged↗
PubMed1997

The effect of inhaled glucocorticosteroids in emphysema due to alpha1-antitrypsin deficiency.

Despite the success of inhaled steroids in controlling asthma, the benefit in patients with chronic obstructive pulmonary disease (COPD) remains controversial. Five subjects with moderate to severe emphysema due to alpha 1-antitrypsin deficiency (phenotype PiZ) were followed with daily home spirometry in a 2 x 8 weeks, randomized double-blind, placebo-controlled, crossover study of inhaled budesonide 0.8 mg b.i.d. In three of the five patients, there was a statistically significant increase in the mean forced expiratory volume in 1 s (FEV1), and in two of these patients, there was also a statistically significant increase in the mean forced vital capacity (FVC) during budesonide treatment. A significant diurnal variation in FEV1 and FVC was found in three and two patients, respectively, but did not change significantly during treatment. These findings emphasize the need for renewed evaluation of inhaled steroids in the treatment of patients with emphysema, and indicate that individual patients may have significant clinical improvement.

Administration, Inhalation↗