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@#In recent years, increasing cases of Plasmodium vivax complications had been reported all over the world. This former benign Plasmodium species is now recognized to be one of the human malaria parasites that can produce severe disease. In this article, we report two cases of sub-microscopic P. vivax malaria confirmed by PCR. Both patients were asymptomatic before treatment. They showed unusual presentations few days after initiation of antimalarial treatment. Both patients had subsequently completed antimalarial treatment and recovered completely.
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This study aimed to observe the effects of lung-protective ventilation (LPV) on oxygenation index (OI) and postoperative pulmonary complications (PPCs) after laparoscopic radical gastrectomy in middle-aged and elderly patients. A total of 120 patients who were scheduled to undergo laparoscopic radical gastrectomy with an expected time of >3 h were randomly divided into conventional ventilation (CV group) with tidal volume (TV) of 10 mL/kg without positive end-expiratory pressure (PEEP), and lung-protective ventilation (PV group) with 7 mL/kg TV and personal level of PEEP with regular recruitment maneuver every 30 min. Measurements of OI, modified clinical pulmonary infection score (mCPIS), and PPCs were assessed during the perioperative period. Fifty-seven patients in the CV group and 58 in the PV group participated in the data analysis. Patients in the PV group showed better pulmonary dynamic compliance, OI, and peripheral capillary oxygen saturation during and after surgery. The mCPIS was significantly lower in the PV group than in the CV group after surgery. The incidence rate of PPCs was lower in the PV group than in the CV group and the difference was significant in patients whose ventilation time was longer than 6 h in both groups. LPV during laparoscopic radical gastrectomy significantly improved pulmonary oxygenation function and reduced postoperative mCPIS and the incidence of PPCs during the early period after surgery of middle-aged and elderly patients, especially patients whose mechanical ventilation time was longer than 6 h.
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Humans , Male , Female , Middle Aged , Aged , Postoperative Complications/prevention & control , Pulmonary Gas Exchange/physiology , Laparoscopy/methods , Gastrectomy/methods , Intraoperative Care/methods , Lung Diseases/prevention & control , Respiration, Artificial/methods , Double-Blind Method , Prospective Studies , Laparoscopy/adverse effects , Gastrectomy/adverse effectsABSTRACT
Objective@#To evaluate the diagnostic value of bronchoalveolar lavage (BAL) for pulmonary complications in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and its safety.@*Methods@#Patients with pulmonary complications after allo-HSCT underwent BAL. Microbiological smears, culture, PCR of CMV-DNA, EBV-DNA and TB-DNA, macro genomes new generation sequencing (mNGS) techniques were performed to detect pathogens in BAL fluid (BALF) .@*Results@#A total of 73 allo-HSCT patients with 86 times of pulmonary complications enrolled this prospective study. They underwent 132 times of BAL procedures. The clinical diagnoses of 88.4% cases were made based on BALF analysis. Of them, 67 cases (77.9%) had infectious pulmonary complications, including 29 cases (33.7%) of fungal infection, 18 cases (20.9%) of mixed infection, 11 cases (12.8%) of viral infection and 9 cases (10.5%) of bacterial infection. The other 9 cases (10.5%) of non-infectious pulmonary complications included 8 cases (9.3%) of idiopathic pneumonia syndrome (IPS) and 1 case (1.2%) of pulmonary infiltration of lymphoma. The diagnoses of the remaining 10 cases (11.6%) were not determined. The platelet counts of 33 patients were less than 50×109/L before BAL. None of them developed severe bleeding complications during or after BAL. Transient fever occurred in 10 patients after BAL. Blood cultures showed staphylococcal bacteremia in them and anti-infection therapies were effective. No life-threatening complications occurred in all of the patients during or after BAL.@*Conclusion@#BALF analysis was informative for the diagnosis of pulmonary complication and safe for patients with pulmonary complications after allo-HSCT.
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Objective: To evaluate the diagnostic value of bronchoalveolar lavage (BAL) for pulmonary complications in patients after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and its safety. Methods: Patients with pulmonary complications after allo-HSCT underwent BAL. Microbiological smears, culture, PCR of CMV-DNA, EBV-DNA and TB-DNA, macro genomes new generation sequencing (mNGS) techniques were performed to detect pathogens in BAL fluid (BALF) . Results: A total of 73 allo-HSCT patients with 86 times of pulmonary complications enrolled this prospective study. They underwent 132 times of BAL procedures. The clinical diagnoses of 88.4% cases were made based on BALF analysis. Of them, 67 cases (77.9%) had infectious pulmonary complications, including 29 cases (33.7%) of fungal infection, 18 cases (20.9%) of mixed infection, 11 cases (12.8%) of viral infection and 9 cases (10.5%) of bacterial infection. The other 9 cases (10.5%) of non-infectious pulmonary complications included 8 cases (9.3%) of idiopathic pneumonia syndrome (IPS) and 1 case (1.2%) of pulmonary infiltration of lymphoma. The diagnoses of the remaining 10 cases (11.6%) were not determined. The platelet counts of 33 patients were less than 50×10(9)/L before BAL. None of them developed severe bleeding complications during or after BAL. Transient fever occurred in 10 patients after BAL. Blood cultures showed staphylococcal bacteremia in them and anti-infection therapies were effective. No life-threatening complications occurred in all of the patients during or after BAL. Conclusion: BALF analysis was informative for the diagnosis of pulmonary complication and safe for patients with pulmonary complications after allo-HSCT.
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Humans , Bronchoalveolar Lavage , Bronchoalveolar Lavage Fluid , Hematopoietic Stem Cell Transplantation/adverse effects , Pneumonia/etiology , Prospective StudiesABSTRACT
Esophageal cancer is one of the most prevalent cancers in China. Lymph node metastasis is one of the most important prognostic factors and severely affect the long-term survival after surgical treatment. Therefore, systemic two-field lymph node dissection including thoracic and abdominal draining nodes of the esophagus during surgery is essential in order to improve the long-term survival for the patients with thoracic esophageal cancer, and it is also the basis for precise staging and postoperative adjuvant treatment regimen- making. As reported in the literature, lymph node metastases along bilateral recurrent laryngeal nerve was the highest, therefore, the lymph node dissection along bilateral recurrent laryngeal nerve is the most important manipulation during esophagectomies, however, it is also the most technically difficult procedure during operation. It usually results in postoperative complications especially the respiratory complications due to paralysis of recurrent laryngeal nerves caused by lymph node dissection. Therefore, the gain and loss of lymph node dissection along bilateral recurrent laryngeal nerve has been a disputed and entangle topic for thoracic surgeons, and the purpose of this paper is to summarize author′s experience and the key technology to prevent the associated complications in lymph node dissection along recurrent laryngeal nerve during esophagectomies for the patients with thoracic esophageal cancer.
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ventilation mode selection , which can reduce the incidence of postoperative pulmonary complications and improve patient ’ s outcomes . This paper reviewed and summarized the application of protective lung ventilation during general anesthesia .
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Objective To observe the role of preoperative lung function test in predicting the risk of postoperation pulmonary complications in patients with chronic obstructive pulmonary disease (COPD) accepting non chest operations. Methods 80 patients accepting non-invasive chest operations during Oct 2006 to May 2013 in the third affiliated hospital of SYSU were studied retrospectively. All the patients accepted lung function test 1 week before operation. Based on the lung function records, patients were divided into 2 groups. 40 of them in COPD group, 40 in control group. The incidence rate of postoperation pulmonary complications in different group and the relationship between the severity of lung function decreasing and the rate of postoperation pulmonary complications were investigated. The differences of the American Society of Anesthesiologists (ASA) Physical Status Classification, body mass index, smoking index, length of stay, hospitalization costs between the 2 groups were also studied. Results The incidence rate of postoperation pulmonary disease in COPD group was 30% (12/40) while the rate in control group was 12.5% (5/40), the statistic difference was significant (P = 0.046). There was remarkable relationship between the severity of lung function decreasing and the rate of postoperation pulmonary complications(P=0.005), patients with mild to moderate lung function decreasing would be safer in operation, but patients with severe lung function decreasing would be in high risk(r=-0.451). Patients in COPD group were older than the control group, but there were no significant difference on body mass index, smoking index, length of stay, hospitalization costs between the 2 groups (P > 0.05). There was no relationship between ASA physical status classification and postoperation pulmonary complications. Conclusion Incidence of postoperation pulmonary complications in patients with COPD is high, which mainly manifests as pneumonia. It was important to test the lung function before non-invasive chest operations, especially in patients with COPD(P>0.05).
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Toxic epidermal necrolysis (TEN) is the most severe form of skin reactions caused by drugs or infection. Acute pulmonary complications in TEN are often observed. The mortality is especially high in those who suffer chronic pulmonary complications of TEN such as bronchiolitis obliterance, which occur as a consequence of bronchial epithelial injury. We report a case of a 16-year-old male who had required mechanical ventilation due to acute respiratory distress syndrome caused by TEN at 8 years of age. Although the patient initially recovered from acute respiratory distress syndrome, he required mechanical ventilation again due to severe chronic pulmonary complications of bronchiolitis obliterance and bronchiectasis caused by respiratory epithelial detachment. Thereafter, chronic bronchitis and chronic sinusitis has persisted due to mucosal ciliary dysfunction and several episodes of spontaneous pneumothorax has occurred. However, despite these persisting and serious sequelae of TEN, the patient has survived for 8 years. We report a rare case of a patient with long-term chronic pulmonary complications who had previously suffered TEN 8 years ago.
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Adolescent , Humans , Male , Bronchiectasis , Bronchiolitis , Bronchitis, Chronic , Stevens-Johnson Syndrome , Mortality , Pneumothorax , Respiration, Artificial , Respiratory Distress Syndrome , Sinusitis , SkinABSTRACT
ObjectiveTo investigate the clinical significance of admission hemoglobin (Hb) value for posttransplantation early respiratory complications in cirrhotic hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT).MethodsBetween April 2001 and February 2010,the medical record of 100 consecutive liver recipients at First Affiliated Hospital of Guangxi Medial University were retrospectively reviewed. Pulmonary complications developed in 45 patients after LT. Using bivariate correlation analysis between the admission Hb value and pulmonary complications screened for the threshold value of admission Hb value affecting early-phase pulmonary complications.According to the threshold value of admission Hb,LT recipients could be divided into two groups. Twenty-seven peri-operative clinical parameters were analyzed in the two groups.ResultsAdmission Hb ≤ 100 g/L was the threshold value affecting postoperative pulmonary complications.The duration of time to initial passage of flatus and the ICU length of stay were significantly prolonged in patients with admission Hb values ≤ 100 g/L,in which poorer arterial blood gas analyses were common. ConclusionsThe admission Hb value of patients with cirrhosisassociated hepatocellular carcinoma affects the early-phase prognosis after LT.
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Objective To examine the kinetics of plasma S100A12 and soluble receptor for advanced glycation end products (sRAGE) in infants and young children undergoing cardiopulmonary bypass ( CPB),and to investigate whether they could protective the occurrence of noninfectious pulmonary complication (NPC) after cardiac surgery.Methods This was a case-control study.The subjects included all children aged ＜3 years old who underwent cardiac surgery with CPB during the period from June 1st to July 31st 2011.The patient who showed pulmonary inflammation or had abnormal liver or renal function before surgery was excluded.The remain patients were divided into 2 groups according to whether they had developed NPC postoperatively.Twenty patients were grouped into NPC because they developed the complications of pleural effusion,chylothorax,partial lung collapse,pulmonary hypertensive crisis,airway disorders,pneumothorax,pneumomediastinum,or phrenic nerve palsy.Forty patients were categorized into the no-NPC group.Plasma concentrations of S100A12 and sRAGE were measured using ELISA at baseline,before CPB,immediately after CPB,1 h,12 h and 24 h after operation.Differences concentrations between two groups were analyzed with t test.A stepwise logistic regression analysis was used to indentify the independent risk factor for NPC.A P value ＜0.05 was considered statistically significant.Results Plasma levels of S100A12 and sRAGE dramatically increased immediately after CPB ( P ＜ 0.01 ).The levels of sRAGE dropped to lower than baseline level (P ＜0.05),while S100A12 was still at high level 24h after operation (P ＜0.01 ).Levels of S100A12 and sRAGE immediately after CPB in NPC group were significantly higher than the no-NPC group (P ＜ 0.05).Twenty-four hours after operation,levels of S100A12 were still higher in NPC group than no-NPC (P ＜ 0.01 ),while levels of sRAGE were similar in the two groups ( P ＞ 0.05 ).In the stepwise logistic regression analysis,plasma S100A12 level immediately after CPB remained as a independently predictor for postoperative NPC (OR =1.042,95％ CI:1.010 ～ 1.076,P =0.011 ).Levels of S100A12 immediately after CPB were positively associated with mechanical ventilation time ( r =0.47,P ＜ 0.01 ),duration of surgical Intensive Care Unit ( r =0.407,P =0.002) and hospital stay ( r =0.421,P =0.01 ).Conclusions Plasma levels of S100A12 and sRAGE were significantly increased immediately after CPB and the elevated plasma S100A12 immediately after CPB served as an early reliable biomarker of the occurrence and the prognosis of NPC after CPB in infants and young children.
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Objective: To compare the incidence of pulmonary complications in coronary artery bypass graft surgery patients who underwent a pre-operative pulmonary training program to those who did not. Methods: The patients with coronary artery disease who underwent elective coronary artery bypass graft (CABG) surgery at Siriraj Hospital from January to December 2007 were included in this study and were divided into two groups depending on whether they received a pre-operative pulmonary training program. The primary clinical variable was the presence or absence of pulmonary complications. The comparison of the pre-operative pulmonary training and non- pre-operative pulmonary training group was performed by the Chi-square test for the qualitative data and the Independent sample t-test for the quantitative data. Results: A total of 627 patients were divided into two groups, the pre-operative pulmonary training group (G1) and non-pre-operative pulmonary training group (G2). Comparison between the two groups showed, pulmonary complications were significantly more frequent in G2 than in G1 (7.4% and 3.1%). The difference in incidence of pneumonia was also statistically significant (6.6% and 0.8% in G2 and G1), respectively. The odds ratio for total pneumonia of G2 was 9.3, 95% CI [2.1, 57.3] and for total pulmonary complication of G2 was 2.6, 95% CI [1.1, 6.3]. G2 also had a longer length of stay than G1 (11.0 ± 10.3 and 15.3 ± 12.2 days), respectively. Conclusion: A pre-operative pulmonary training program can prevent post-operative pulmonary complications and reduce the length of hospital stay in patients who underwent coronary artery bypass surgery.
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Toxic epidermal necrolysis (TEN) is an unpredictable, acute inflammatory systemic condition that involves injury to the skin, mucous membranes, and bowel and respiratory epithelium. Pulmonary complications are often observed and usually show an acute form. However, chronic pulmonary complications are rare and little is known about the clinical manifestations. We herein report a 51-year-old woman who presented with chronic pulmonary complications after recovery from TEN. A diagnosis of chronic bronchiolitis obliterans was made with upper respiratory tract obstruction and bronchiectasis.
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Female , Humans , Middle Aged , Bronchiectasis , Bronchiolitis Obliterans , Stevens-Johnson Syndrome , Mucous Membrane , Respiratory Mucosa , Respiratory System , SkinABSTRACT
PURPOSE: Postoperative care usually required 24-48 hours at intensive care unit (ICU) in children with congenital heart disease. More longer ICU stay may give more chances to produce the postoperative complications. Postoperative pulmonary complication is produced to a much higher incidence after longer immobilized state with keeping catheters and arterial and venous lines. So, we evaluated the predisposing factors those are oriented to ICU stay factors and age, hematologic abnormalities, hepatic dysfunction, infections during ICU care in children with congenital heart disease. METHODS: A retrospective review was performed of postoperative factors for children undergoing open heart surgery in intensive cardiac unit, Wonkwang medical cardiac center. A total of 193 pediatric patients who had cardiac surgery with cardiopulmonary bypass in a 10 year period from Jan. 1995 until Dec. 2004 were reviewed. After logistic regression test, predisposing factors were deemed significant if associated with a pulmonary complication with P<0.05. RESULTS: Children who fell postoperative pulmonary complication in our institution occupied 15% of 193 patients with congenital heart disease. Of all clinical factors considered, those significantly associated with postoperative pulmonary complication were as follows: high ALT level, longer duration of mechanical ventilation and arterial line maintenance. CONCLUSION: Prompt weaning of mechanical ventilation and removal of arterial line during ICU stay in children underwent open heart surgery may be necessary to decrease the risks of postoperative pulmonary complication.
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Child , Humans , Cardiopulmonary Bypass , Catheters , Causality , Heart Defects, Congenital , Incidence , Intensive Care Units , Logistic Models , Postoperative Care , Postoperative Complications , Respiration, Artificial , Retrospective Studies , Thoracic Surgery , Vascular Access Devices , WeaningABSTRACT
Objective: To explore the preventive measures for early stage pulmonary complications in old patients following thoracic surgery.Methods: We conducted psychotherapy,pulmonary infection control,training in breathing and instructions in expectorating phlegm in 127 old patients(over 70 years) undergoing thoracic surgery.Results: The patients experienced difficult expectoration on the first postoperative day because of increased sputum viscoelasticity,which was gradually improved later.Analgestic and mucokinetic measures produced intended results on the first three postoperative days,with significant improvement of sputum fluidity.And the concept of fast track surgery promoted the recovery of the patients.Conclusion: The preventive measures proved essential for the prevention of early stage pulmonary complications in old patients following thoracic surgery.
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BACKGROUND: Postoperative pulmonary complications (PPCs) following upper abdominal surgery are common, and are associated with prolonged hospital stay even for cardiopulmonary healthy patients. The development of atelectasis and the unequal distribution of perfusion-ventilation during anesthesia and surgery, and perhaps the reappearance of these disturbances after surgery, are the main hypotheses used to explain postoperative hypoxemia and pulmonary complications. Atelectasis may be increased by using a Kent retractor, which retracts the abdominal wall and compresses the lung. This study evaluated the effect of preventive intraoperative positive end-expiratory pressure (PEEP) on perioperative oxygenation and complications in patients who receive gastrectomy with a Kent retractor. METHODS: Thirty eight cardiopulmonary healthy patients were randomly allocated to receive 0 (control), 5 or 10 cmH2O of PEEP during surgery. Arterial blood was obtained to evaluate arterial oxygenation and the unequal distribution of perfusion-ventilation by analyzing arterial oxygen tension and alveolar-arterial oxygen tension differences ((A-a)Do2) during the perioperative period. Pulmonary function and complications were also evaluated. RESULTS: Intraoperative arterial oxygenation improved for all patients receiving 5 or 10 cm H2O PEEP. In the control group, there was statistically significant decrease in PaO2 and increase in (A-a)Do2 after Kent retractor was applied, but the others did not show this effect (P<0.05). No differences in postoperative oxygenation, the incidence of pulmonary complications or pulmonary function were observed between the three groups. CONCLUSIONS: The application of PEEP was effective at improving oxygenation, and at preventing atelectasis and an unequal distribution of perfusion-ventilation during gastrectomy with a Kent retractor. However, the effects of PEEP did not extend beyond surgery.
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Humans , Abdominal Wall , Anesthesia , Hypoxia , Gastrectomy , Incidence , Length of Stay , Lung , Oxygen , Perioperative Period , Positive-Pressure Respiration , Pulmonary AtelectasisABSTRACT
PURPOSE: In the course of treatment, patients with hematological or oncological disorders often develop pulmonary complication. The patients who develop a severe pulmonary complication have a poor outlook. The causes of pulmonary complication are either infectious or non-infectious in origin. We have analyzed the etiology and outcome of these patients admitted to the pediatric intensive care unit of Asan Medical Center. METHODS: Medical records of 95 patients on Pediatric oncology service who were admitted to pediatric intensive care unit(PICU) of Asan Medical Center from Jan 1997 to May 2000 were retrospectively reviewed. RESULTS: The mean age of the patients was 8.5 years(2 months-18 years). The underlying malignancies of these 95 patients were as following; acute lymphoblastic leukemia(31 cases), lymphoma (11 cases), acute myeloid leukemia(nine cases), brain tumor(eight cases) and other solid tumors(25 cases). Pulmonary complications included pneumonia, acute respiratory failure, pneumothorax and pleural effusion. The most common cause of pulmonary complication was infection(88%) in etiology. The overall mortality rate was 56.8%. Pulmonary complications in these patients carried high rates of mortality regardless of whether they were immune compromised(76%) or not(69%). Even without pulmonary complications, the hematological or oncological patients admitted to PICU had high mortality rates of 43%. CONCLUSION: Pulmonary complications are frequent finding in the hematological or oncological patients admitted to Intensive Care Unit. The main etiology of these pulmonary complications was infection, which carried a high mortality rate regardless of their immune status at the time when they were admitted to PICU
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Child , Humans , Brain , Intensive Care Units , Critical Care , Lymphoma , Medical Records , Mortality , Pleural Effusion , Pneumonia , Pneumothorax , Prognosis , Respiratory Insufficiency , Retrospective StudiesABSTRACT
Foreign body aspiration (especially peanut) is the leading cause of accidental death in children under 1 year of age and most cases of serious aspiration occur between the age of 1 and 3. We report a case of severe pulmonary complication and adult respiratory distress syndrome (ARDS) secondary to peanut aspiration in 15 month old male in spite of all removal (9 pieces) by ventilating bronchoscope. Chest X-ray showed pulmonary interstitial emphysema, marked subcutaneous emphysema, pneumothorax and autopsy findings showed interstitial inflammatory cell infiltration with destruction of acinar septal architecture and formation of hyaline membranes. Chest X-ray and pathologic findings are compatible with the late ARDS. A brief review of related literature was made.
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Child , Humans , Infant , Male , Autopsy , Bronchoscopes , Emphysema , Foreign Bodies , Hyalin , Membranes , Pneumothorax , Respiratory Distress Syndrome , Subcutaneous Emphysema , ThoraxABSTRACT
Esophagea1 achalasia is a disease of unkown etiology characterized by abscenee of peristalsis in the body of the esophagus and failure of the lower esaphageal sphincter to relax in response to swallow. The cause has been suggested by the lack or abscence of ganglion cell in Auerbach's plexus. About 10% of patients with achalasis develop pulmonary complication such as aspiration pnuemonia, pulmonary fibrosis, pulmonary tuberculosis, culosis, bronchiectasis, lung abscess and bronchial asthma. Although aspiration pneumonia is the most common pulmonary complication in patients with achalasia, lung abscess is the extremely rare complication. A 48 years old female, who has experienced dysphagia and regurgitation for several years, is hospitalized because of high fever, cough and sputurn for 2 weeks. Lung abscess in apicoposterior segment of left upper lobe is observed in X-ray and chest CT. The findings of esophagogram, esophagogastroscopy and esophageal manometry are consistent with achalasia. We report a case of lung abscess associated with achalasia.