scholarly journals The use of transdermal therapeutic systems for chemical pleurodesis in a patient with prolonged air leakage after lung resection for cancer

2021 ◽  
Vol 2 (4) ◽  
pp. 18-25
Author(s):  
D. A. Rozenko ◽  
N. D. Ushakova ◽  
S. N. Tikhonova ◽  
Yu. N. Lazutin ◽  
N. N. Popova ◽  
...  
Keyword(s):  
Pain Relief ◽  
Pleural Cavity ◽  
Lung Resection ◽  
The Body ◽  
Parietal Pleura ◽  
External Respiration ◽  
Air Leakage ◽  
Narcotic Drug ◽  
Chemical Pleurodesis ◽  
Sharp Drop

This clinical observation demonstrates a method of a motivated use of a transdermal therapeutic system (TTS) based on fentanyl for chemical pleurodesis in a patient with prolonged air leakage after lung resection for cancer. The most common complication after elective lung resections is an alveolar-pleural fistula or prolonged air leakage. This clinical phenomenon occurs as a result of communication between the alveoli of the lung parenchyma distal to the segmental bronchus and the pleural cavity. In most cases, air leakage through the drains is eliminated spontaneously, but the frequency of prolonged pneumostasis absence in the postoperative period can reach 25 %, which has a negative effect on the outcomes of surgical interventions due to the development of pneumonia and empyema. Long-term drainage of the pleural cavity does not always end with aerostasis and requires repeated invasive interventions. One of the ways to achieve the tightness of the lung tissue involves various methods of chemical pleurodesis, which is a surgical manipulation – the introduction of a sclerosing chemical substance into the pleural cavity by spraying medical talc through a trocar or a injecting tetracycline solution into the pleural drains. The chemical causes aseptic inflammation and adhesions between the visceral and parietal pleura, followed by obliteration of the pleural cavity. The sclerosant introduction is accompanied by severe pain that can provoke respiratory and/or hemodynamic deficits, up to apnea and life-threatening heart rhythm disturbances. Pain relief during chemical pleurodesis is obviously an important factor in the prevention of a number of complications in patients undergoing surgery for lung cancer. Bolus intravenous injections of narcotic analgesics lead to an analgesic effect, but a short-term one due to the absence of a depot in the body and a sharp drop in the drug concentration in the blood serum. Unfortunately, this method of introducing narcotic drugs can cause various complications in weakened and elderly cancer patients, such as respiratory depression and cardiac arrest. The TTS action is characterized with continuous dosing and the creation of a constant concentration of the narcotic drug over a certain period of time. This method provides a multilevel and systematic approach to pain relief, reduces toxicity and minimizes the inhibition of the central mechanisms of external respiration regulation without causing respiratory and cardiac disorders in patients who underwent lung resection.

scholarly journals VIDEO-ASSISTED RESECTIONS FOR PULMONARY TUBERCULOSIS WITH THE PRESENCE OF PLEURAL CAVITY OBLITERATION

2021 ◽  
Vol 29 (2) ◽  
pp. 53-57
Author(s):  
M. S. Opanasenko ◽  
◽  
V. I. Lysenko ◽  
O. V. Tereshkovych ◽  
B. N. Konik ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Pulmonary Tuberculosis ◽  
Pleural Cavity ◽  
Intraoperative Complications ◽  
Lung Resection ◽  
Parietal Pleura ◽  
Tuberculosis Patients ◽  
Video Assisted ◽  
Regular Open ◽  
Cavity Obliteration

Pulmonary tuberculosis surgery is characterized by a number of aspects associated with adhesions in the pleural cavity, fibrosis of the lung root, destruction of the parenchyma, which contribute to the development of intra- and postoperative complications such as residual pleural cavity and reactivation of tuberculosis in operated lung due to compensatory tissue distortion. Aim: to improve video-assisted lung resection (VATS) in tuberculosis patients with the presence of pleural cavity obliteration. Materials and methods. The developed method of VATS for tuberculosis patients with pleural cavity obliteration is based on separate intubation of right and left main bronchi for mechanical ventilation of one lung, placement of thoracic port, performing revision of pleural cavity using video-assisted thoracoscopy, performing mini-thoracotomy and resection of lung with separate treatment of anatomical structures in required volume by means of disposable stapler or regular open thoracotomy instruments, pleural cavity draining and layered wound closure. Computed tomography of chest is performed during the operation in order to assess the extent and severity of pleural adhesions and to locate safe position of thoracic ports. Hydraulic needle preparation of parietal pleura is performed in severe adhesions area. Hemorrhage is treated using hemostatic plate Surgicel Fibrillar made of restored cellulose. Phrenicotripsy, pleural cavity drainage and, finally, artificial pneumoperitoneum are performed. The proposed method of video-assisted lung resection was used in 41 patients, 25 patients underwent video-assisted resection according to the prototype method. Results. The proposed method reduced duration of the surgical intervention by 52.7 minutes; the frequency of intraoperative complications by 14.4%; the incidence of postoperative complications by 14.2; the duration of patient�s stay at the hospital by 5.8 days and increased of overall treatment efficiency by 14.5%. The proposed method of VATS for patients with pulmonary tuberculosis and pleural cavity obliteration is safe, effective, simple to implement and can be performed at thoracic surgery departments of various pulmonary hospitals of city and regional level. Key words: pulmo

scholarly journals EVALUATION OF THE IMPACT OF ENVIRONMENTAL CONDITIONS ON THE STATUS OF THE BODY OF YOUNG PEOPLE OF 17-19 YEARS OF DIFFERENT ETHNIC GROUPS OF THE NORTH-EAST RUSSIA

2019 ◽  
Vol 96 (8) ◽  
pp. 766-769 ◽  
Author(s):  
Inessa V. Averyanova ◽  
S. I. Vdovenko ◽  
A. L. Maksimov
Keyword(s):  
Gas Exchange ◽  
Climatic Conditions ◽  
The Body ◽  
External Respiration ◽  
Adaptive Responses ◽  
Northeast Russia ◽  
North East ◽  
The North ◽  
Magadan Region ◽  
The Impact

Natural and climatic conditions of the environment of Northeast Russia and particularly Magadan region are the very factor mostly influencing adaptive responses by individuals inhabiting the region. Compensatory and adaptive responses in indigenes and newcomers of the region can be assumed to have their specific features. In 2009 there was executed the examination of the cardiovascular and respiratory systems and gas exchange in 392 cases aged of 17-19 years, including Europeans (Caucasians) born in the North in the 1st-2nd generation and indigenes. The methodologically similar study was carried out in 2014 in 265 persons, referred to the same cohorts of North-born Caucasians and Indigenes from the Magadan region. The results of the study executed in 2009 testified to a small number of physiological parameters that were reliably different in Caucasians vs. Indigene subjects. In 2014 no difference was found between the two examined cohorts throughout the observed parameters. The revealed changes in gas exchange, external respiration and cardiovascular systems demonstrated by modern young Indigenes of Northeast Russia testified to the fall in the effectiveness of their breathing. All that makes them farther from the classic “polar metabolic type” and their morphofunctional status becomes closer to European male subjects of Northeast Russia. Thus, we can observe a clear tendency towards “convergence in programs” of the adaptive changes between populations of the North residents undergoing similar natural, environmental and social factors.

The use of stereotaxic chemical hypophysectomy in the treatment of thalamic pain syndrome

1983 ◽  
Vol 59 (6) ◽  
pp. 1002-1006 ◽  
Author(s):  
Allan B. Levin ◽  
Lincoln F. Ramirez ◽  
Jordan Katz
Keyword(s):  
Pain Relief ◽  
Diabetes Insipidus ◽  
Pain Syndrome ◽  
Pituitary Hormones ◽  
The Body ◽  
Cerebral Stroke ◽  
Preoperative Pain ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Thalamic Pain Syndrome

✓ Three patients with neurological injuries consistent with cerebral stroke subsequently developed pain over portions of the body contralateral to the injured hemisphere. Stereotaxic chemical hypophysectomy was used in the management of this pain after other surgical procedures and medical management had failed to provide relief. Postoperatively, all patients were treated for hypopituitarism. All developed transient diabetes insipidus, and one patient developed transient right third nerve palsy. No other complications were encountered. All three patients experienced significant pain relief within 48 hours of the procedure. By the date of discharge, two of the three patients reported complete, and the third greater than 80% pain relief. At the initial follow-up visit all patients were essentially pain-free. These patients have now been followed for 58, 39 and 19 months, and remain free of their original pain. During this time the intravenous administration of naloxone has failed to reproduce the preoperative pain. Pituitary function testing 1 year or more following operation demonstrated that none of the patients had an endocrinologically complete hypophysectomy. Recovery from transient diabetes insipidus was not associated with return of the original pain. The mechanism of action of stereotaxic chemical hypophysectomy in the relief of pain related to thalamic lesions remains unknown. The observation that naloxone failed to reproduce the preoperative pain casts doubt on the theory that augmentation of endogenous opiate release is the primary mechanism. Additional observations suggest that pain relief after hypophysectomy may be more directly the result of stimulation of a hypothalamic pain-suppressing mechanism than due to the elimination of pituitary hormones.

Respiratory gymnastics as a means of strengthening the health of student youth

2021 ◽  
pp. 135-137
Author(s):  
N. Shashlov
Keyword(s):  
Healthy Lifestyle ◽  
Human Life ◽  
Effective Means ◽  
Specific Effect ◽  
The Body ◽  
External Respiration ◽  
State Of Health ◽  
Critical Systems ◽  
Breathing Exercises ◽  
Current State

The article analyzes the current state of health of students of higher education institutions. The importance of breathing exercises for student youth in a pandemic is determined. The necessity of using respiratory techniques to harden the body, improve the work of the respiratory and cardiovascular systems is substantiated. It is established that breathing exercises are a system of breathing exercises and an effective means of strengthening human health. During respiratory gymnastics our body is saturated with oxygen, blood circulation improves, metabolic processes are accelerated, emotional state is stabilized, immunity is strengthened. Breathing exercises improve and activate the function of external respiration, promote its faster recovery after exercise and have a specific effect on some respiratory diseases. Health is the main value of human life, to which man himself does not pay due attention. An important preventive factor in strengthening it is a healthy lifestyle. There are basic requirements for maintaining a healthy lifestyle - physical activity, nutrition, comfortable conditions and a rational mode of work and rest, optimal exercise, abandonment of bad habits, the use of traditional and non-traditional means of health. The problem of health, especially of students, is receiving more and more attention. The state of health of students can be classified as high risk. The transition from one learning environment to another, more intensive, requires the body of the future student to pay more attention to the work of critical systems, including respiratory. There are many issues related to the formation of new approaches to health promotion.

Frostbite and Hypothermia

2015 ◽  
Author(s):  
Jeffrey I. Schneider
Keyword(s):  
Body Temperature ◽  
Heat Loss ◽  
Pleural Cavity ◽  
The Body ◽  
Ice Crystals ◽  
Homeless Population ◽  
Outdoor Sports ◽  
Increased Risk ◽  
Long Term Consequences

Frostbite and hypothermia are becoming increasingly common as the popularity of extreme and outdoor sports rises and the homeless population increases. Advanced age is also associated with an increased risk of frostbite and hypothermia; thus, their incidence will likely continue to increase as the population ages. Frostbite occurs when there is sufficient heat loss to produce ice crystals within either superficial or deep flesh. Hypothermia is defined as an involuntary drop in body temperature to below 35°C, but a useful functional definition is a decrease in temperature that results in an inability of the body to maintain its natural functions. This review details the assessment and stabilization, diagnosis, and treatment and disposition for frostbite and hypothermia. Figures show factors that may predispose individuals to developing frostbite, long-term consequences of severe frostbite, and an approach for pleural cavity lavage. Tables list factors that increase the risk of frostbite, degrees of frostbite, three phases of frostbite, and staging of hypothermia. This review contains 3 highly rendered figures, 4 tables, and 71 references.

scholarly journals Outcome of Internal Fixation of Metacarpal Fractures of Hand at a Tertiary Care Hospital, Kathmandu

2019 ◽  
Vol 21 (1) ◽  
pp. 35-39
Author(s):  
Praphulla Shrestha ◽  
SR Paudel ◽  
P Chalise
Keyword(s):  
Pain Relief ◽  
Internal Fixation ◽  
Tertiary Care ◽  
Kirschner Wire ◽  
The Body ◽  
Care Hospital ◽  
Metacarpal Fractures ◽  
Active Flexion ◽  
Hand Fractures

Hand fractures are different from other fractures elsewhere in the body. Functional impairment of hand leads to a prominent issue to the patient. We have a common practice of treatment of hand fractures by using kirschner wire(s). The internal fixation using plates and screws for metacarpal fractures of the hand is technically demanding but it is beneficial to the patients as it permits early mobilization and better pain relief. We studied the outcome of this type of internal fixation of the metacarpal fractures at Nepal Medical College. We included 26 patients above 18years with isolated extraarticular, closed and open Swanson I metacarpal fractures of the hand. Fractures with rotation of the digit and unacceptable angulation, shortening and unstable fractures were included. Pain was evaluated by visual analogue scale and function using American Society for Surgery of hand Total Active Flexion (ASSHTAF) score. The mean pain score (VAS) was 0.27 at 12 weeks. The ASSHTAF score showed excellent results in 92.3% patients at 12 weeks. At the final follow up 92.3% patients had excellent results, 3.8% had good and 3.8% had poor results. Fracture union was seen in all patients at final follow up. The study shows that internal fixation of unstable metacarpal fractures gives significant pain relief to the patient and an excellent functional outcome.

scholarly journals AMPHOTERIC COLLOIDS

1918 ◽  
Vol 1 (2) ◽  
pp. 237-254 ◽  
Author(s):  
Jacques Loeb
Keyword(s):  
Isoelectric Point ◽  
Water Solubility ◽  
Biological Significance ◽  
Volumetric Analysis ◽  
The Body ◽  
Hydrogen Ion ◽  
Ion Concentration ◽  
Sharp Drop ◽  
Hydrogen Ion Concentration ◽  
Alkaline Side

1. It is shown by volumetric analysis that on the alkaline side from its isoelectric point gelatin combines with cations only, but not with anions; that on the more acid side from its isoelectric point it combines only with anions but not with cations; and that at the isoelectric point, pH = 4.7, it combines with neither anion nor cation. This confirms our statement made in a previous paper that gelatin can exist only as an anion on the alkaline side from its isoelectric point and only as a cation on the more acid side of its isoelectric point, and practically as neither anion nor cation at the isoelectric point. 2. Since at the isoelectric point gelatin (and probably amphoteric colloids generally) must give off any ion with which it was combined, the simplest method of obtaining amphoteric colloids approximately free from ionogenic impurities would seem to consist in bringing them to the hydrogen ion concentration characteristic of their isoelectric point (i.e., at which they migrate neither to the cathode nor anode of an electric field). 3. It is shown by volumetric analysis that when gelatin is in combination with a monovalent ion (Ag, Br, CNS), the curve representing the amount of ion-gelatin formed is approximately parallel to the curve for swelling, osmotic pressure, and viscosity. This fact proves that the influence of ions upon these properties is determined by the chemical or stoichiometrical and not by the "colloidal" condition of gelatin. 4. The sharp drop of these curves at the isoelectric point finds its explanation in an equal drop of the water solubility of pure gelatin, which is proved by the formation of a precipitate. It is not yet possible to state whether this drop of the solubility is merely due to lack of ionization of the gelatin or also to the formation of an insoluble tautomeric or polymeric compound of gelatin at the isoelectric point. 5. On account of this sudden drop slight changes in the hydrogen ion concentration have a considerably greater chemical and physical effect in the region of the isoelectric point than at some distance from this point. This fact may be of biological significance since a number of amphoteric colloids in the body seem to have their isoelectric point inside the range of the normal variation of the hydrogen ion concentration of blood, lymph, or cell sap. 6. Our experiments show that while a slight change in the hydrogen ion concentration increases the water solubility of gelatin near the isoelectric point, no increase in the solubility can be produced by treating gelatin at the isoelectric point with any other kind of monovalent or polyvalent ion; a fact apparently not in harmony with the adsorption theory of colloids, but in harmony with a chemical conception of proteins.

scholarly journals Unusual Life-Threatening Pneumothorax Complicating a Ruptured Complex Aspergilloma in an Immunocompetent Patient in Cameroon

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Bernadette Ngo Nonga ◽  
Bonaventure Jemea ◽  
Angele O. Pondy ◽  
Daniel Handy Eone ◽  
Marie Claire Bitchong ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Lung Resection ◽  
Tension Pneumothorax ◽  
Immunocompetent Patient ◽  
Air Leakage ◽  
Quick Recovery ◽  
Life Threatening ◽  
History Of ◽  
Main Complication

An aspergilloma is a well-recognized lesion of the lung caused most of the time by the fungus Aspergillus fumigatus. Its main complication is hemoptysis and has been very rarely associated with tension pneumothorax. We present the case of a 47-year-old man with a history of treated and healed tuberculosis, which was successfully managed in our service for a ruptured right upper lobe complexed aspergilloma, complicated by a massive and tension pneumothorax. The patient underwent thoracotomy and lung resection with quick recovery. Conclusively, although rare, an aspergilloma may rupture and cause a life-threatening air leakage.

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