scholarly journals Benign gastrobronchial fistula following oesophagectomy in a patient presenting with respiratory failure

2019 ◽  
Vol 12 (9) ◽  
pp. e228537 ◽  
Author(s):  
Kasper Favere ◽  
Klaas Vanderbiest ◽  
Jan Bresseleers ◽  
Pieter Depuydt
Keyword(s):  
Respiratory Failure ◽  
Minute Ventilation ◽  
Muscle Flap ◽  
Causative Factor ◽  
Type Ii ◽  
Ivor Lewis ◽  
Gastrobronchial Fistula ◽  
Life Threatening ◽  
Intercostal Muscle Flap

Benign gastrobronchial fistula (GBF) is a rare but potentially life-threatening complication of oesophagectomy for malignancy. We present a case of GBF post Ivor-Lewis surgery manifesting as pulmonary sepsis and type II respiratory failure. Clues to the diagnosis were persistent hypercapnia despite high minute ventilation, aspiration of gastric content through the endotracheal tube and accumulation of air in the nasogastric drainage bag. Flexible bronchoscopy confirmed the diagnosis. Surgical exploration identified necrosis of the proximal stomach as causative factor. Despite reconstruction of the oesophagogastric anastomosis and interposition of an intercostal muscle flap, the patient developed a new episode of type II respiratory failure. Bronchoscopy revealed in situ recurrence of the fistula. Patency of the fistula was proven through application of methylene blue with subsequent gastroscopy. A conservative, symptom-based, management was conducted. The patient died 6 hours later.

scholarly journals A case report of a gastrobronchial fistula and lung abscess caused by leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Tohru Nishimura ◽  
Chisakou Fuse ◽  
Masayuki Akita ◽  
Nobuhisa Takase ◽  
Eri Maeda ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Gastric Tube ◽  
Staple Line ◽  
Muscle Flap ◽  
Intercostal Muscle ◽  
Lower Lobectomy ◽  
Gastrobronchial Fistula ◽  
Regional Lymphadenectomy ◽  
Intercostal Muscle Flap ◽  
Right Lower Lobectomy

Abstract Background Gastrobronchial fistulas are rare, but life-threatening, complications of esophagectomy. They are caused by anastomotic leakage and mainly occur around anastomotic sites. In the present paper, we report a rare case of leakage from the staple line of a gastric tube after esophagectomy for esophageal cancer, which was successfully treated using an intercostal muscle flap and lung resection. Case presentation A 61-year-old male underwent subtotal esophagectomy with regional lymphadenectomy for esophageal cancer. The sutures along the staple line of the gastric tube failed 11 days after surgery, and a pulmonary abscess was also found on imaging. The abscess did not heal after conservative treatment; therefore, right lower lobectomy, gastrobronchial fistula resection, primary closure, and patching of the leaking portion of the gastric tube with an intercostal muscle flap were performed 9 months after the first operation. The patient’s postoperative course was uneventful, and he was discharged on the 354th day. Conclusions We experienced a case involving a gastrobronchial fistula caused by leakage from the staple line of a gastric tube and successfully treated it by performing right lower lobectomy and patching the leak with an intercostal muscle flap.

A case of a gastrobronchial fistula after esophageal reconstruction successfully closed with an intercostal muscle flap

Esophagus ◽  
2009 ◽  
Vol 6 (2) ◽  
pp. 133-136 ◽  
Author(s):  
Hisako Kubota ◽  
Toshihiro Hirai ◽  
Hideo Matsumoto ◽  
Haruaki Murakami ◽  
Masaharu Higashida ◽  
...  
Keyword(s):  
Muscle Flap ◽  
Esophageal Reconstruction ◽  
Intercostal Muscle ◽  
Gastrobronchial Fistula ◽  
Intercostal Muscle Flap

A Multicentric non-interventional observational study to determine treatment patterns and response of drugs in various stages of breast cancer along with epidemiology

2020 ◽  
Vol 8 (2) ◽  
pp. 71-81
Author(s):  
Mukkamala Durga Niharika ◽  
Shaik Kulsumbi ◽  
Devagiri Anupama ◽  
Tadigiri Vineela Supriya ◽  
Kotari Navya ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Study ◽  
Receptor Expression ◽  
Breast Cancer Patients ◽  
Female Patients ◽  
Life Threatening ◽  
Guntur District ◽  
Study Population ◽  
Hormone Receptor Expression

Cancer is a life-threatening disease which causes to lose cohesiveness and orderliness of normal tissue. These malignant cells can spread to any other organ through blood flow or lymphatic flow and develop malignancy over there; this phenomenon is called metastasis. The aim is to focus on treatment pattern and response of drugs in various stages of breast cancer along with epidemiology. It is a non- interventional multicentric observational study. Female patients confirmed with Breast cancer are included in the study. All the relevant data were collected on a patient demographic form after obtaining informed consent from individual patients. In our study, the mean age of presentation in breast cancer patients was 41.35 years. Further it was found that 40.5% (n = 81) majority-female patients with Breast cancer are from Guntur District and 21.5% (n= 43). The majority of women with Breast cancer have hormone receptor expression of ER+/PR+HER2- was found to be 33% (n= 50). In the study on analyzing comorbidities of the study population, it was noted that 28.5% of women were affected with Diabetes mellitus. In our study, it was found that most of the patients with Breast cancer have been most often prescribed with Adriamycin 27.86%. From these observations, we conclude that late menarche may be one of the etiological causes of breast cancer in women, Invasive carcinoma in situ is the most commonly reported breast cancer in the study. Patients have been diagnosed with breast cancer at their stage 3 of progression, which may be the reason for making it mandatory for more than 50% of patients to undergo 6 to 8 cycles of chemotherapy. Coming to the patterns of drug use, ADRIAMYCIN, CYCLOPHOSPHAMIDE and DOCETAXEL are the three most commonly used single drug and combinational drug therapies among the study population.

scholarly journals Asymptomatic mediastinal extra-adrenal paraganglioma as a cause of sudden death: a case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 564-567
Author(s):  
Qiancheng Xu ◽  
Yingya Cao ◽  
Hongzhen Yin ◽  
Rongrong Wu ◽  
Tao Yu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Respiratory Failure ◽  
Pressure Drop ◽  
Thoracic Cavity ◽  
Severe Hypotension ◽  
Life Threatening ◽  
History Of ◽  
Posterior Mediastinal ◽  
Extra Adrenal Paraganglioma

AbstractA 23-year-old female patient was referred for treatment of a posterior mediastinal tumour. There was no history of hypertension or headache and no other complaints. The patient’s blood pressure increased to 210/125 mmHg after surgically manipulating the tumour, subsequently reversing to severe hypotension (25/15 mmHg) immediately after the tumour was removed. The life-threatening and irreversible blood pressure drop was difficult to treat with fluid and vasopressors, and the patient ultimately died of cardio-respiratory failure. Asymptomatic paraganglioma can be non-functional but can also be fatal. For any lump in the thoracic cavity, paraganglioma should be ruled out.

scholarly journals Respiratory Failure Due to Differentiation Arrest and Expansion of Alveolar Cells following Lung-Specific Loss of the Transcription Factor C/EBPα in Mice

2006 ◽  
Vol 26 (3) ◽  
pp. 1109-1123 ◽  
Author(s):  
Daniela S. Bassères ◽  
Elena Levantini ◽  
Hongbin Ji ◽  
Stefano Monti ◽  
Shannon Elf ◽  
...  
Keyword(s):  
Transcription Factor ◽  
Cell Differentiation ◽  
Respiratory Failure ◽  
Leucine Zipper ◽  
Type I ◽  
Type Ii ◽  
Alveolar Cells ◽  
Proliferating Cells ◽  
Therapeutic Benefits ◽  
Factor C

ABSTRACT The leucine zipper family transcription factor CCAAT enhancer binding protein alpha (C/EBPα) inhibits proliferation and promotes differentiation in various cell types. In this study, we show, using a lung-specific conditional mouse model of C/EBPα deletion, that loss of C/EBPα in the respiratory epithelium leads to respiratory failure at birth due to an arrest in the type II alveolar cell differentiation program. This differentiation arrest results in the lack of type I alveolar cells and differentiated surfactant-secreting type II alveolar cells. In addition to showing a block in type II cell differentiation, the neonatal lungs display increased numbers of proliferating cells and decreased numbers of apoptotic cells, leading to epithelial expansion and loss of airspace. Consistent with the phenotype observed, genes associated with alveolar maturation, survival, and proliferation were differentially expressed. Taken together, these results identify C/EBPα as a master regulator of airway epithelial maturation and suggest that the loss of C/EBPα could also be an important event in the multistep process of lung tumorigenesis. Furthermore, this study indicates that exploring the C/EBPα pathway might have therapeutic benefits for patients with respiratory distress syndromes.

Mediastinal teratoma presenting with respiratory distress and cardiogenic shock in a neonate

2020 ◽  
Vol 30 (5) ◽  
pp. 788-789
Author(s):  
Mila Stajevic ◽  
Ivan Dizdarevic ◽  
Igor Krunic ◽  
Vesna Topic
Keyword(s):  
Respiratory Failure ◽  
Cardiogenic Shock ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Emergency Operation ◽  
Fast Growing ◽  
Mediastinal Teratoma ◽  
Venous Compression ◽  
Life Threatening

Abstract Mediastinal teratomas are uncommon, fast-growing thoracic tumours, which are usually diagnosed in childhood or adolescence. Neonatal forms are the rarest and often present with life-threatening respiratory distress syndrome. In our case, respiratory failure in a neonate was aggravated by severe cardiogenic shock due to aortic and systemic venous compression, extreme heart displacement and rotation, necessitating an emergency operation on the first day of life.

Gas exchange in nonperfused dog lungs

1981 ◽  
Vol 51 (5) ◽  
pp. 1261-1267 ◽  
Author(s):  
J. W. Shepard ◽  
V. D. Minh ◽  
G. F. Dolan
Keyword(s):  
Gas Exchange ◽  
Minute Ventilation ◽  
Left Lung ◽  
Co2 Concentration ◽  
Gas Transfer ◽  
O2 Uptake ◽  
Tissue Metabolism ◽  
End Tidal

Gas exchange was studied under conditions of zero perfusion both in situ and in vitro. Six dogs, anesthetized with pentobarbital sodium, underwent surgical interruption of both pulmonary and bronchial circulations to the left lung. Despite the absence of perfusion, O2 uptake for the left lung ranged from 0.76 to 0.98 ml/min, whereas CO2 elimination greatly exceeded O2 uptake ranging from 1.68 to 4.34 ml/min. In addition, CO2 output was observed to vary directly with the level of minute ventilation (VE) and inversely with end-tidal CO2 concentration. To investigate the mechanisms responsible for these findings we studied 20 excised, ventilated, but nonperfused dog lungs to evaluate the relative roles of tissue metabolism and transpleural diffusion to gas exchange. The results obtained with these excised lungs under conditions of varying VE and extrapleural gas concentrations indicate that the high respiratory exchange ratios observed in situ can be explained by the greater rate with which CO2 diffuses through the pleura, and that reduced ventilation decreases total gas transfer by decreasing the transpleural partial pressure driving gradient. Our data further document that the concentration of CO2 in alveolar gas may differ significantly from that present in inspired gas under conditions of ventilation-perfusion ratio equal to infinity, and that tissue metabolism as well as transpleural diffusion contribute to gas exchange in nonperfused lung.

scholarly journals Progress on Coronal, Interplanetary, Foreshock, and Outer Heliospheric Radio Emissions

2000 ◽  
Vol 17 (1) ◽  
pp. 22-34 ◽  
Author(s):  
Iver H. Cairns ◽  
P. A. Robinson ◽  
G. P. Zank
Keyword(s):  
Solar Wind ◽  
Plasma Waves ◽  
Recent Theory ◽  
Type Ii ◽  
Solar Radio Bursts ◽  
Radio Emissions ◽  
Source Regions ◽  
Earth’S Bow Shock ◽  
Made In

AbstractType II and III solar radio bursts are associated with shock waves and streams of energetic electrons, respectively, which drive plasma waves and radio emission at multiples of the electron plasma frequency as they move out from the corona into the interplanetary medium. Analogous plasma waves and radiation are observed from the foreshock region upstream of Earth's bow shock. In situ spacecraft observations in the solar wind have enabled major progress to be made in developing quantitative theories for these phenomena that are consistent with available data. Similar processes are believed responsible for radio emissions at 2–3 kHz that originate in the distant heliosphere, from where the solar wind interacts with the local interstellar medium. The primary goal of this paper is to review the observations and theories for these four classes of emissions, focusing on recent progress in developing detailed theories for the plasma waves and radiation in the source regions. The secondary goal is to introduce and review stochastic growth theory, a recent theory which appears quantitatively able to explain the wave observations in type III bursts and Earth's foreshock and is a natural theory to apply to type II bursts, the outer heliospheric emissions, and perhaps astrophysicalemissions.

scholarly journals There is no correlation between a delayed gastric conduit emptying and the occurrence of an anastomotic leakage after Ivor-Lewis esophagectomy

2022 ◽  
Author(s):  
Benjamin Babic ◽  
Lars Mortimer Schiffmann ◽  
Hans Friedrich Fuchs ◽  
Dolores Thea Mueller ◽  
Thomas Schmidt ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
High Volume ◽  
Gastric Conduit ◽  
Common Finding ◽  
Type Ii ◽  
Ivor Lewis ◽  
Stapling Device ◽  
Ivor Lewis Esophagectomy ◽  
Cervical Reconstruction ◽  
Prolonged Hospital

Abstract Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

scholarly journals Role of SatO2, PaO2/FiO2 Ratio and PaO2 to Predict Adverse Outcome in COVID-19: A Retrospective, Cohort Study

2021 ◽  
Vol 18 (21) ◽  
pp. 11534
Author(s):  
Stefano Sartini ◽  
Laura Massobrio ◽  
Ombretta Cutuli ◽  
Paola Campodonico ◽  
Cristina Bernini ◽  
...  
Keyword(s):  
Respiratory Failure ◽  
Adverse Outcome ◽  
University Hospital ◽  
Rt Pcr ◽  
Threatening Condition ◽  
Life Threatening ◽  
Group A ◽  
Group B ◽  
The University

COVID-19 respiratory failure is a life-threatening condition. Oxygenation targets were evaluated in a non-ICU setting. In this retrospective, observational study, we enrolled all patients admitted to the University Hospital of Genoa, Italy, between 1 February and 31 May 2020 with an RT-PCR positive for SARS-CoV-2. PaO2, PaO2/FiO2 and SatO2% were collected and analyzed at time 0 and in case of admission, patients who required or not C-PAP (groups A and B) were categorized. Each measurement was correlated to adverse outcome. A total of 483 patients were enrolled, and 369 were admitted to hospital. Of these, 153 required C-PAP and 266 had an adverse outcome. Patients with PaO2 <60 and >100 had a higher rate of adverse outcome at time 0, in groups A and B (OR 2.52, 3.45, 2.01, respectively). About the PaO2/FiO2 ratio, the OR for < 300 was 3.10 at time 0, 4.01 in group A and 4.79 in group B. Similar odds were found for < 200 in any groups and < 100 except for group B (OR 11.57). SatO2 < 94% showed OR 1.34, 3.52 and 19.12 at time 0, in groups A and B, respectively. PaO2 < 60 and >100, SatO2 < 94% and PaO2/FiO2 ratio < 300 showed at least two- to three-fold correlation to adverse outcome. This may provide simple but clear targets for clinicians facing COVID-19 respiratory failure in a non ICU-setting.

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