PS02.163: A CASE OF SEPARATION SURGERY WITH DRAINAGE TUBE-LESS (DRESS) ESOPHAGOSTOMY FOR ADVANCED CANCER WITH A RESPIRATORY FISTULA

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 168-168
Author(s):  
Yukinori Tanoue ◽  
Shinsuke Takeno ◽  
Fumiaki Kawano ◽  
Kousei Tashiro ◽  
Rouko Hamada ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Esophageal Cancer ◽  
Aspiration Pneumonia ◽  
Lower Lobe ◽  
Lung Abscess ◽  
Drainage Tube ◽  
Lung Field ◽  
Definitive Chemoradiotherapy ◽  
The Right

Abstract Background Esophagorespiratory fistulas including esophagopulmonary fistulas occur in 5–10% patients with esophageal cancer with invasion to adjacent organs. With an esophagorespiratory fistula, saliva and food flow into the respiratory tract through the fistula and severe pneumonia or lung abscess can develop. Alternatively, whether chemoradiotherapy can be performed for patients with esophagorespiratory fistulas affects the further outcomes of treatment in these patients. An esophageal cancer patient with an esophagopulmonary fistula who underwent separation surgery with drainage tube-less (DRESS) esophagostomy and whose inflammation from the esophagorespiratory fistula could be effectively controlled, which facilitated the prompt administration of definitive chemoradiotherapy, is reported. Methods Case report: A 79-year-old man visited a clinic with a month-long history of dysphagia. Esophageal cancer at the middle thoracic esophagus was detected, and invasion of the left main bronchus and lower lobe of the right lung was seen on contrast-enhanced computed tomography (CT). Three weeks later, urgent CT showed a lung abscess in the lower lobe of the right lung that continued into the adjacent esophageal cancer, infiltrative shadows in the peripheral lung field, and a pleural effusion. Due to the esophagopulmonary fistula, the patient underwent emergency surgery that consisted of esophageal separation surgery and double bilateral esophagostomy on the right and left supraclavicular region and enterostomy (drainage tube-less esophageal separation surgery). Results Antibiotic drug therapy for pneumonia and lung abscess achieved a favorable outcome. Definitive chemoradiotherapy for the esophageal cancer was started from postoperative day 25. Radiotherapy could not be completed because of sepsis due to aspiration pneumonia, though the aspiration pneumonia improved with intensive treatment. At six-month follow-up, the patient had achieved relapse-free survival and is currently symptom-free. Conclusion Separation surgery with a drainage tube-less (DRESS) esophagostomy is the less invasive operative procedure, which allows prompt initiation of chemoradiotherapy. In many cases of esophageal surgeries, an external esophagostomy is made with a drainage tube, and drainage tubes sometimes cause trouble and affect the quality of life of patients after surgery. However, our drainage tube-less (DRESS) esophagostomy might improve patient's quality of life. In addition, evaluation of esophageal cancer by endoscopic examination through the esophagocutaneostomy can be easily performed. Disclosure All authors have declared no conflicts of interest.

THE ROLE OF PULMONARY REHABILITATION IN ACUTE EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

2020 ◽  
pp. 39-40
Author(s):  
RAHMAD ◽  
SHABRINA NARASATI ◽  
EKO NUGROHO ◽  
DJOKO WITJAKSONO ◽  
DWI INDRIANI LESTARI ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pulmonary Rehabilitation ◽  
Lower Lobe ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Chest Expansion ◽  
Postural Drainage ◽  
The Right ◽  
Incentive Spirometry

Objective: Chronic obstructive pulmonary disease (COPD) reduces lung function and generates systemic effects that decrease the quality of life. COPD is a major cause of chronic morbidity and mortality worldwide. Pulmonary rehabilitation can reduce symptoms of dyspnea and improve exercise capacity and quality of life in COPD patients. Methods: We report a case of a 60 y old male with an acute exacerbation (AE) of COPD and pneumonia. The inpatient pulmonary rehabilitation program was 5 consecutive days of 3 repetitions of cough control, 2 sets of 6 repetitions of pursed-lip breathing, 2 sets of 6 repetitions of deep breathing exercises, postural drainage, and manual clapping twice daily. Postural drainage in the lateral basal segment and manual clapping in the right lower lobe was chosen according to the chest x-ray (CXR). Results: At the initial visit, the following information was noted: inspiration capacity with incentive spirometry, 600 cc/s; chest expansion, 1.5 cm; and single-breath counting (SBC), 11. The activities of daily living (ADL) score according to the Barthel Index was 70, and CXR results showed COPD and pneumonia in the right lower lobe. After 5 d of pulmonary rehabilitation, there was a clear airway and improvement in shortness of breath (SOB), and the following was noted: incentive spirometry, 900 cc/s; chest expansion, 2 cm; SBC, 20; and Barthel Index score, 100. Conclusion: Early inpatient pulmonary rehabilitation in COPD AEs is clinically effective and safe, controls breathing and coughing, strengthens the respiratory muscles, and improves the clearing of the airway, which improves the patient’s pulmonary function capacity and quality of life.

Advantages of a mini right axillary thoracotomy for congenital heart defect repair in children

2021 ◽  
pp. 1-6
Author(s):  
Jannika Dodge-Khatami ◽  
Ali Dodge-Khatami
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Global Health ◽  
Congenital Heart ◽  
Surgical Repair ◽  
Median Sternotomy ◽  
Axillary Approach ◽  
Post Operative Pain ◽  
The Right

Abstract Objectives: The mini right axillary thoracotomy is an alternative surgical approach to repair certain congenital heart defects. Quality-of-life metrics and clinical outcomes in children undergoing either the right axillary approach or median sternotomy were compared. Methods: Patients undergoing either approach for the same defects between 2018 and 2020 were included. Demographic details, operative data, and outcomes were compared between both groups. An abbreviated quality of life questionnaire based on the Infant/Toddler/Child Health Questionnaires focused on the patient’s global health, physical activity, and pain/discomfort was administered to all parents/guardians within two post-operative years. Results: Eighty-seven infants and children underwent surgical repair (right axillary thoracotomy, n = 54; sternotomy, n = 33) during the study period. There were no mortalities in either group. The right axillary thoracotomy group experienced significantly decreased red blood cell transfusion, intubation, intensive care, and hospital durations, and earlier chest tube removal. Up to 1 month, parents’ perception of their child’s degree and frequency of post-operative pain was significantly less after the right axillary thoracotomy approach. No difference was found in the patient’s global health or physical activity limitations beyond a month between the two groups. Conclusions: With the mini right axillary approach, surrogates of faster clinical recovery and hospital discharge were noted, with a significantly less perceived degree and frequency of post-operative pain initially, but without the quality of life differences at last follow-up. While providing obvious cosmetic advantages, the minimally invasive right axillary thoracotomy approach for the surgical repair of certain congenital heart lesions is a safe alternative to median sternotomy.

Nordic retirement contracts and the economic situation of widows

2006 ◽  
Vol 21 (3) ◽  
pp. 383-418 ◽  
Author(s):  
BEATRICE MORING
Keyword(s):  
Quality Of Life ◽  
Eighteenth Century ◽  
Economic Status ◽  
Economic Situation ◽  
Standard Of Living ◽  
The Family ◽  
Early Eighteenth Century ◽  
The Right

The aim of this article is to explore the economic status and the quality of life of widows in the Nordic past, based on the evidence contained in retirement contracts. Analysis of these contracts also shows the ways in which, and when, land and the authority invested in the headship of the household were transferred between generations in the Nordic countryside. After the early eighteenth century, retirement contracts became more detailed but these should be viewed not as a sign of tension between the retirees and their successors but as a family insurance strategy designed to protect the interests of younger siblings of the heir and his or her old parents, particularly if there was a danger of the property being acquired by a non-relative. Both the retirement contracts made by couples and those made by a widow alone generally guaranteed them an adequate standard of living in retirement. Widows were assured of an adequately heated room of their own, more generous provision of food than was available to many families, clothing and the right to continue to work, for example at spinning and milking, but to be excused heavy labour. However, when the land was to be retained by the family, in many cases there was no intention of establishing a separate household.

Support for People with Dementia

2009 ◽  
Vol 2 (4) ◽  
pp. 245-249
Author(s):  
Neil Hunt
Keyword(s):  
Quality Of Life ◽  
Early Intervention ◽  
Support Services ◽  
Daily Life ◽  
Terminal Condition ◽  
People With Dementia ◽  
The Right

Dementia is a progressive and eventually terminal condition, but with early intervention and the right support, people with dementia can continue to enjoy a good quality of life for many years. Living with dementia can be challenging both for those affected and their families as it can affect all aspects of daily life. It is vital that people with dementia and their carers are signposted to the support services that can help them take control of their condition and help them remain active and independent.

scholarly journals Pulmonary abscess as a complication of COVID-19 associated pneumonia: a clinical case

2022 ◽  
Vol 99 (12) ◽  
pp. 7-12
Author(s):  
T. I. Kalenchits ◽  
S. L. Kabak ◽  
S. V. Primak ◽  
N. M. Shirinaliev
Keyword(s):  
Clinical Laboratory ◽  
Lower Lobe ◽  
Pleural Empyema ◽  
Lung Abscess ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Pulmonary Abscess ◽  
Causative Factors ◽  
The Right ◽  
Test Result

The article describes a case of polysegmental destructive viral-bacterial pneumonia complicated with acute pulmonary abscess, pleural empyema, and pneumopleurofibrosis in a 50-year-old female patient infected with the SARS-CoV-2 virus. The first clinical, laboratory and radiological signs of purulent-necrotic inflammation appeared only 20 days after receiving a positive RT-PCR test result with a nasopharyngeal swab. A month later, an emerging abscess in the lower lobe of the right lung was diagnosed. Subsequently, it spontaneously drained into the pleural cavity.Coagulopathy with the formation of microthrombi in small pulmonary vessels is one of the causative factors of lung abscess in patients infected with the SARS-CoV-2 virus.

scholarly journals Euthanasia and suicide: a medical and social discourse

2021 ◽  
Vol 25 (1) ◽  
pp. 107-112
Author(s):  
V. N. Ostapenko ◽  
I. V. Lantukh ◽  
A. P. Lantukh
Keyword(s):  
Quality Of Life ◽  
Assisted Suicide ◽  
Human Life ◽  
Modern Science ◽  
Physician Assisted Suicide ◽  
Adequate Quality ◽  
The Subject ◽  
Strong Explosion ◽  
The Right

Annotation. The problem of suicide and euthanasia has been particularly updated with the spread of the COVID-19 pandemic, which caused a strong explosion of suicide, because medicine was not ready for it, and the man was too weak in front of its pressure. The article considers the issue of euthanasia and suicide based on philosophical messages from the position of a doctor, which today goes beyond medicine and medical ethics and becomes one of the important aspects of society. Medicine has achieved success in the continuation of human life, but it is unable to ensure the quality of life of those who are forced to continue it. In these circumstances, the admission of suicide or euthanasia pursues the refusal of the subject to achieve an adequate quality of life; an end to suffering for those who find their lives unacceptable. The reasoning that banned suicide: no one should harm or destroy the basic virtues of human nature; deliberate suicide is an attempt to harm a person or destroy human life; no one should kill himself. The criterion may be that suicide should not take place when it is committed at the request of the subject when he devalues his own life. According to supporters of euthanasia, in the conditions of the progress of modern science, many come to the erroneous opinion that medicine can have total control over human life and death. But people have the right to determine the end of their lives while using the achievements of medicine, as well as the right to demand an extension of life with the help of the same medicine. They believe that in the era of a civilized state, the right to die with medical help should be as natural as the right to receive medical care. At the same time, the patient cannot demand death as a solution to the problem, even if all means of relieving him from suffering have been exhausted. In defense of his claims, he turns to the principle of beneficence. The task of medicine is to alleviate the suffering of the patient. But if physician-assisted suicide and active euthanasia become part of health care, theoretical and practical medicine will be deprived of advances in palliative and supportive therapies. Lack of adequate palliative care is a medical, ethical, psychological, and social problem that needs to be addressed before resorting to such radical methods as legalizing euthanasia.

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