Congenital Lobar Emphysema: Perioperative Evaluation and Management

Background: Congenital lobar emphysema (CLE) is a lung malformation characterized by overdistension and air trapping in the affected lobe. It is one of the causes of neonatal and infantile respiratory distress. This study aimed to evaluate our experience regarding perioperative and surgical management in children with CLE. Methods: A retrospective observational study was done for all CLE patients who underwent surgery at Menoufia University Hospital. Perioperative data collected included demographic, clinical, and radiological findings, as well as operative and postoperative data. Results: We included 30 neonates and infants who suffered from CLE between January 2013 and December 2020; the mean age was 111.43 ± 65.19 days, and 21 were males. All cases presented with respiratory distress; 19 had cyanosis, and 15 had recurrent pneumonia and fever. Plain chest x-ray and computed tomography (CT) revealed emphysema in all cases. Lobectomy was done in all cases; the mean age at surgery was 147.58 ± 81.49 days. Postoperative complications occurred in 5 patients, and 2 of them needed mechanical ventilation. The follow-up duration ranged from 3 months to 1 year (except 1 case lost to follow-up after 3 months), and all patients were doing well. Conclusion: CLE is a rare bronchopulmonary malformation that requires a high index of clinical suspicion, especially in persistent and recurrent infantile respiratory distress. Chest CT is the most useful diagnostic modality. Early management of CLE improves outcome and prevents life-threatening complications. Surgical management is the treatment of choice in our center, without recorded mortality.

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Congenital lobar emphysema: 30-year case series in two university hospitals

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37132013000400004 ◽

2013 ◽

Vol 39 (4) ◽

pp. 418-426 ◽

Cited By ~ 16

Author(s):

Daniele Cristina Cataneo ◽

Olavo Ribeiro Rodrigues ◽

Erica Nishida Hasimoto ◽

Aurelino Fernandes Schmidt Jr ◽

Antonio Jose Maria Cataneo

Keyword(s):

Surgical Treatment ◽

Respiratory Distress ◽

Case Series ◽

X Rays ◽

University Hospitals ◽

Radiographic Findings ◽

Congenital Lobar Emphysema ◽

Lateral Muscle ◽

Lobar Emphysema

OBJECTIVE: To review the cases of patients with congenital lobar emphysema (CLE) submitted to surgical treatment at two university hospitals over a 30-year period. METHODS: We reviewed the medical records of children with CLE undergoing surgical treatment between 1979 and 2009 at the Botucatu School of Medicine Hospital das Clínicas or the Mogi das Cruzes University Hospital. We analyzed data regarding symptoms, physical examination, radiographic findings, diagnosis, surgical treatment, and postoperative follow-up. RESULTS: During the period studied, 20 children with CLE underwent surgery. The mean age at the time of surgery was 6.9 months (range, 9 days to 4 years). All of the cases presented with symptoms at birth or during the first months of life. In all cases, chest X-rays were useful in defining the diagnosis. In cases of moderate respiratory distress, chest CT facilitated the diagnosis. One patient with severe respiratory distress was misdiagnosed with hypertensive pneumothorax and underwent chest tube drainage. Only patients with moderate respiratory distress were submitted to bronchoscopy, which revealed no tracheobronchial abnormalities. The surgical approach was lateral muscle-sparing thoracotomy. The left upper and middle lobes were the most often affected, followed by the right upper lobe. Lobectomy was performed in 18 cases, whereas bilobectomy was performed in 2 (together with bronchogenic cyst resection in 1 of those). No postoperative complications were observed. Postoperative follow-up time was at least 24 months (mean, 60 months), and no late complications were observed. CONCLUSIONS: Although CLE is an uncommon, still neglected disease of uncertain etiology, the radiological diagnosis is easily made and surgical treatment is effective.

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Evaluation of Clinical Outcomes in Neonates Undergoing Lung Resection for Congenital Lesions

Journal of Child Science ◽

10.1055/s-0037-1603772 ◽

2017 ◽

Vol 07 (01) ◽

pp. e4-e9

Author(s):

Hemonta Dutta ◽

Madhuchanda Bora ◽

Diganta Saikia

Keyword(s):

Postoperative Complications ◽

Respiratory Distress ◽

Epidural Anesthesia ◽

Lung Resection ◽

Lung Lesions ◽

Congenital Lobar Emphysema ◽

Presenting Symptoms ◽

Lobar Emphysema ◽

Neonates And Infants

Objective The purpose of this study is to review our experience with neonates and infants with congenital lung lesions emphasizing natural history, management, and outcomes. Methods A total of 29 neonates and infants presented with congenital lung lesions between 2000 and 2015. Two patients died before surgery due to complications, and one patient refused surgery. Overall, 26 of them were subjected to surgical treatment and were included in the study. Demographic data, indications for surgery, operative procedure, complications, hospital stay, and follow-up were assessed. Results A total of 26 children aged 5 to 122 days (mean: 35.5 days, 14 males) presented with various congenital lung malformations: congenital lobar emphysema in 10, congenital cystic adenomatous malformation in 8, bronchogenic cyst in 5, and pulmonary sequestration in 3 patients. Respiratory distress and respiratory tract infection were the most common presenting symptoms noted in 22 patients. In three patients the lesion was detected incidentally on chest X-ray. Lobectomy was the most common operation (19/26). Postoperative complications were noted in 12 patients. One patient died due to postoperative sepsis. Postoperative ventilation was required in 24 patients. Patients in the asymptomatic group recovered without any complications. The follow-up period ranged from 3 months to 15 years (median: 76.3 months). Only 12 patients received epidural anesthesia and had a better recovery than the other patients. Conclusion Congenital lobar emphysema was the most common congenital lung lesion in our series. Respiratory distress and respiratory infection were the most common symptoms. Neonates and infants tolerated lung resection well. Use of epidural anesthesia led to less postoperative complications.

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Congenital lobar emphysema presenting as recurrent pneumonia in an infant

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20170726 ◽

2017 ◽

Vol 4 (2) ◽

pp. 655

Author(s):

Balaji M. D. ◽

Sowmya S. ◽

Naveen K. S.

Keyword(s):

Respiratory Tract ◽

Respiratory Distress ◽

Lower Respiratory Tract ◽

Developmental Anomaly ◽

Recurrent Pneumonia ◽

Congenital Lobar Emphysema ◽

Life Threatening ◽

Lobar Emphysema

Congenital lobar emphysema (CLE) is a developmental anomaly of the lower respiratory tract, which is characterised by hyperinflation of one or more lobes of lung. CLE is potentially reversible, though possible life threatening cause of respiratory distress in neonate. Here we present a 4 months baby who presented with respiratory distress related to CLE.

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EVALUATION OF LONGO’S HEMORRHOIDECTOMY AT HUE UNIVERSITY HOSPITAL

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2012.6.10 ◽

2012 ◽

pp. 79-85

Author(s):

Van Lieu Nguyen ◽

Doan Van Phu Nguyen ◽

Thanh Phuc Nguyen

Keyword(s):

Hospital Stay ◽

Perioperative Complications ◽

University Hospital ◽

Anal Pain ◽

Stapled Hemorrhoidectomy ◽

Fourth Degree ◽

Duration Of Hospital Stay ◽

The Mean ◽

Good For

Introduction: Since Longo First described it in 1998, Stapled Hemorrhoidectomy has been emerging as the procedure of choice for symtomatic hemorrhoid. Several studies have shown it to be a safe, effective and relative complication free procedure. The aim of this study was to determine the suitability of (SH) as a day cas procedure at Hue University Hospital. Methods: From Decembre 2009 to April 2012, 384 patients with third- degree and fourth-degree hemorrhoids who underwent Stapled Hemorrhoidectomy were included in this study. Parameters recorded included postoperative complications, analegic requirements, duration of hospital stay and patient satisfaction. Follow-up was performed at 1 month and 3 months post-operative. Results: Of the 384 patients that underwent a Stapled Hemorrhoidectomy 252 (65,7%) were male and 132 (34,3%) were female. The mean age was 47,5 years (range 17-76 years. Duration of hospital stay: The mean day was 2,82 ± 1,15 days (range 1-6 days). There were no perioperative complications. There was one case postoperative complication: hemorrhage; Follow-up after surgery: 286 (74,4%) patients had less anal pain, 78 (20,3%) patients had moderate anal pain, 3 (0,8%) patients had urinary retention; Follow-up after one month: good for 325 (84,6%) patients, average for 59 (15,4%) patients; Follow-up after three months: good for 362 (94,3%) patients, average for 22 (5,7%) patients. Conclusion: Our present study shows that Stapled Hemorrhoidectomy is a safe, reduced postoperative pain, shorter hospital stay and a faster return to unrestricted daily activity

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Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121994550 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199455

Author(s):

Nicola Maffulli ◽

Francesco Oliva ◽

Gayle D. Maffulli ◽

Filippo Migliorini

Keyword(s):

Surgical Management ◽

Revision Surgery ◽

Case Series ◽

Sports Participation ◽

Patellar Tendinopathy ◽

Symptom Duration ◽

Level Of Evidence ◽

Training Time ◽

The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

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Intraoperative cone beam computed tomography for detecting residual stones in percutaneous nephrolithotomy: a feasibility study

Urolithiasis ◽

10.1007/s00240-021-01259-1 ◽

2021 ◽

Author(s):

R. A. Kingma ◽

M. J. H. Voskamp ◽

B. H. J. Doornweerd ◽

I. J. de Jong ◽

S. Roemeling

Keyword(s):

Computed Tomography ◽

Percutaneous Nephrolithotomy ◽

Cone Beam Computed Tomography ◽

University Hospital ◽

Cone Beam ◽

Cross Sectional ◽

The Mean ◽

Residual Stones ◽

Residual Fragments

AbstractCone beam computed tomography (CBCT) provides multiplanar cross-sectional imaging and three-dimensional reconstructions and can be used intraoperatively in a hybrid operating room. In this study, we investigated the feasibility of using a CBCT-scanner for detecting residual stones during percutaneous nephrolithotomy (PCNL). Intraoperative CBCT-scans were made during PCNL procedures from November 2018 until March 2019 in a university hospital. At the point where the urologist would have otherwise ended the procedure, a CBCT-scan was made to image any residual fragments that could not be detected by either nephroscopy or conventional C-arm fluoroscopy. Residual fragments that were visualized on the CBCT-scan were attempted to be extracted additionally. To evaluate the effect of this additional extraction, each CBCT-scan was compared with a regular follow-up CT-scan that was made 4 weeks postoperatively. A total of 19 procedures were analyzed in this study. The mean duration of performing the CBCT-scan, including preparation and interpretation, was 8 min. Additional stone extraction, if applicable, had a mean duration of 11 min. The mean effective dose per CBCT-scan was 7.25 mSv. Additional extraction of residual fragments as imaged on the CBCT-scan occurred in nine procedures (47%). Of the follow-up CT-scans, 63% showed a stone-free status as compared to 47% of the intraoperative CBCT-scans. We conclude that the use of CBCT for the detection of residual stones in PCNL is meaningful, safe, and feasible.

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Follow-Up Care Barriers for Patients with Orofacial Clefts

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211042162 ◽

2021 ◽

pp. 105566562110421

Author(s):

Joshua Van Swol ◽

Bethany J. Wolf ◽

Julia Toumey ◽

Phayvanh Pecha ◽

Krishna G. Patel

Keyword(s):

Outcome Measure ◽

Tertiary Care ◽

University Hospital ◽

Exclusion Criteria ◽

Actual Patient ◽

The Mean ◽

Return Visits ◽

Significant Factors ◽

Patient Attendance

Objective The aim of this study was to evaluate whether a patient with a cleft's age, associated syndrome, cleft phenotype or travel distance affects their follow-up rate. Design This study is a retrospective review of patients with CL/P treated by a craniofacial clinic. Setting The setting was a craniofacial clinic at a tertiary care university hospital. Patients, Participants Candidates were patients seen by the craniofacial clinic between January 2007 and December 2019. An initial pool of 589 patients was then reduced to 440 due to exclusion criteria. Interventions None Main Outcome Measure(s) The outcome measure was actual patient attendance to the craniofacial team compared to the team goal expectation of annual return visits. Results The mean age of participants at the end of the study was 9.0 ± 5.4 years with a mean follow-up period (total possible follow-up period length based on patient age at presentation and study window) of 5.5 ± 3.6 years. There was no association between cleft phenotype, type of syndrome, or distance to the clinic with attendance. Children with syndromes had an 11% decrease in the odds of attending follow-up visits with each 1-year increase in age compared to a 4% decrease in children without syndromes. Conclusions The only significant factors determining patient attendance were the presence of a syndrome and increasing age.

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Comparison of Snodgross and para-meatal based flap technique for hypospadiasis

Annals of King Edward Medical University ◽

10.21649/akemu.v12i2.900 ◽

2016 ◽

Vol 12 (2) ◽

Author(s):

Jaffry S A H ◽

Naveed Iqbal ◽

Muhammad Nazir ◽

Khuda Dad Tarrar

Keyword(s):

Clinical Intervention ◽

Wound Dehiscence ◽

University Hospital ◽

Flap Technique ◽

External Meatus ◽

Good Cosmetic ◽

Watertight Closure ◽

The Mean ◽

Complications Rate

Objective: To compare the two surgical procedures Snod gross & parameatal based flap technique for mid & distal penile hypospadias including cosmosis. Study design: Randomized Clinical interventional trail. Place of study: This study was conducted in the Urology Department of Assir Central University Hospital ABHA, KSA and Department of Urology & Renal transplantation, Jinnah Hospital, Lahore from June 2002 to Dec 2004. Material & Methods: Thirty-two patients were selected for this randomized clinical intervention study with mid shaft & distal hypospadias fulfilling the inclusion criteria. Snod Gross and parameatal based flap technique was assigned randomly to patients comprising of two groups of sixteen each. Watertight closure was made with 6/0 vicryl. Tourniquet or 1:10000 epinephrine were used. Follow up at 2 weeks, three months; 6 months post catheter or stent removal and the patient were assessed on criteria of cosmosis, time for surgery and complications associated with the procedure. Results: Th irty-two patients who underwent procedure of Snodgross & parameatal-based flap in the management of mid shaft & distal penile Hypospadias. Age ranged from 2-12 years. The mean age was 5.23+4 years. The presentation of patients was dystocia of external meatus with misdirected stream in sixteen (50%) patients, spraying of urine in six (25%) and narrow stream in 4(13%) patients. Eighteen patients were having distal penile and fourteen were having mid shaft hypospadias. Following Snod grass technique all patients had good cosmetic results without any complication. Following parameatal based flap, one patients (6.3%) develop wound dehiscence, three patients (18.8%) develop urethral fistula, two patients (12.5%) showed metal retrieval and twenty patients showed good cosmosis. In our study, comparison between Snodgross & parameatal-based flap, the success rate was 100% and 62.4% respectively. Conclusions: Success with Snod gross procedure is better with no complications and good cosmosis. Complications rate was 37.6 % in-patient with para-meatal technique.

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Congenital lobar emphysema: a rare cause of respiratory distress in a neonate

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20185214 ◽

2018 ◽

Vol 6 (1) ◽

pp. 218

Author(s):

Nishant Mittal ◽

Ankit Parakh ◽

Prashant Jain ◽

N. K. Mittal

Keyword(s):

Early Intervention ◽

Respiratory Distress ◽

Treatment Options ◽

Term Outcome ◽

Long Term Outcome ◽

Congenital Lobar Emphysema ◽

Congenital Condition ◽

Lobar Emphysema ◽

Intervention Message ◽

The Right

Congenital lobar emphysema (CLE) is a congenital condition characterized by distension and air trapping of the affected lobe of the lung. It is one of the causes of infantile respiratory distress, which may require surgical resection of affected lobe. Case characteristics: 3-day-old neonate with ventilation refractory respiratory distress. Imaging was suggestive of decreased lung tissue on the right side with ipsilateral mediastinal shift. Intervention/ outcome: Early surgical lobectomy was done to improve lung functions and the child improved dur to early intervention. Message: An early diagnosis with high index of suspicion helps patients with this rare congenital anomaly. Early intervention is the key to good long-term outcome. More awareness about the entity and treatment options available would greatly help improving the outcome and disease burden.

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Acute Worsening of Congenital Lobar Emphysema with Subsequent Spontaneous Improvement

PEDIATRICS ◽

10.1542/peds.71.5.844 ◽

1983 ◽

Vol 71 (5) ◽

pp. 844-848

Author(s):

WAYNE J. MORGAN ◽

RICHARD J. LEMEN ◽

RODRIGO ROJAS

Keyword(s):

Respiratory Distress ◽

Clinical Status ◽

Respiratory Illness ◽

Acute Respiratory Tract Infection ◽

Base Line ◽

Sudden Increase ◽

Respiratory Dysfunction ◽

Congenital Lobar Emphysema ◽

Spontaneous Improvement ◽

Lobar Emphysema

The degree of respiratory dysfunction and subsequent morbidity of patients with congenital lobar emphysema (CLE) are related to the degree of hyperinflation of the involved lobe.1 Whereas neonates with severe CLE may have marked respiratory distress requiring surgical resection of the hyperinflated lobe, children with mild forms of CLE seldom have a sudden increase in size of the involved lobe leading to respiratory failure.2,3 We report two infants with mild CLE who were clinically stable and developed respiratory distress with increased hyperinflation of the involved lobe associated with an acute respiratory tract infection. Both infants returned to their base line clinical status with conservative therapy alone following resolution of their respiratory illness.

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