Bula gigante secundaria a neumonía adquirida en la comunidad en niños / Giant Bulla Secondary to Community-Acquired Pneumonia in Children

Introducción: Los neumatoceles y las bulas pulmonares son lesiones que se observan en los niños casi siempre asociadas a neumonías infecciosas, aunque sus causas pueden ser diversas. La importancia clínica de estos procesos radica en el peligro de crecimiento progresivo, que puede comprometer las funciones respiratoria y cardiovascular. Objetivo: Describir las experiencias derivadas del proceso de diagnóstico por imágenes y del tratamiento invasivo de casos atendidos. Presentación de los casos: Desde finales de 2021 y durante un período de un año, se atendieron, en la unidad de cuidados intensivos pediátricos del Hospital Pediátrico Universitario de Cienfuegos, cinco niños con neumonías extensas, que desarrollaron bulas de gran tamaño varios días después del tratamiento antimicrobiano adecuado. Estas necesitaron drenaje y aspiración percutáneos debido a su magnitud y a la presencia de síntomas cardiovasculares. Conclusiones: Las bulas que aparecieron como complicación de la neumonía en el niño pueden presentarse con una frecuencia no despreciable, y hay que mantenerse atentos a su evolución, porque, a diferencia de los neumatoceles, pueden crecer progresivamente y comprometer las funciones respiratoria y cardiovascular. El drenaje percutáneo y aspiración continua por cinco días resultó un método seguro y eficaz para tratar estos procesos(AU)

Introduction: Pneumoatoceles and pulmonary bullae are lesions that are observed in children almost always associated with infectious pneumonia, although their causes may be diverse. The clinical importance of these processes lies in the danger of progressive growth, which can compromise respiratory and cardiovascular functions. Objective: To describe the experiences derived from the imaging process and the invasive treatment of treated cases. Presentation of the cases: Since the end of 2021 and for a period of one year, five children with extensive pneumonia were treated in the pediatric intensive care unit of the University Pediatric Hospital of Cienfuegos, who developed large bullae several days after appropriate antimicrobial treatment. The bullae required percutaneous drainage and aspiration due to their magnitude and the presence of cardiovascular symptoms. Conclusions: The bulla that appeared as a complication of pneumonia in the child can occur with a not negligible frequency, and it is necessary to be attentive to their evolution, because, unlike pneumoatoceles, can grow progressively and compromise respiratory and cardiovascular functions. Percutaneous drainage and continuous aspiration for five days was a safe and effective method to treat these processes(AU)

Dioctophymatosis as cause of dyspnea in a dog / Dioctofimatose como causa de dispnéia em cão

ABSTRACT: Dioctophyme renale is a parasite of the nematode class that can infect various species, including humans and dogs. Usually, the parasite migrates to the right kidney of the definitive host. Although, aberrant migrations have been previously reported, they mainly occur without clinical manifestations. No reports of dyspnea secondary to D. renale infestation has been found in the reported literature. The aim of this paper is to report intense respiratory distress caused by the presence of the parasite in the thoracic cavity of a dog. Radiographic images revealed multiple circular structures with a cavity with a radiopaque, thick contour in the thorax, which raised the suspicion of pulmonary bullae. Ultrasound examination revealed nematode infestation in the right kidney, scrotum, and thoracic cavity. Subsequently, right nephrectomy, orchiectomy and trans-sternal thoracotomy were performed to remove the parasites. The patient exhibited recovery after the procedures.

RESUMO: Dioctophyme renale é um parasita da classe de nematoda que pode infectar diferentes espécies, incluindo humanos e cães. Normalmente, o parasita migra para o rim direito do hospedeiro definitivo. Embora migrações erráticas tenham sido relatadas anteriormente, estas geralmente ocorrem sem manifestações clínicas. Não foram encontrados relatos de dispnéia secundária à infestação de D. renale. O objetivo deste trabalho é relatar a presença do parasita na cavidade torácica de um cão, causando angústia respiratória. As imagens radiográficas revelaram a presença de múltiplas estruturas circulares com aspecto de cavidade e contorno espesso radiopaco no tórax, o que suscitou a suspeita de bullae pulmonar. O exame de ultra-som foi determinante na revelação de infestação múltipla por nematódeos, no rim direito, escroto e cavidade torácica. Posteriormente, como medida terapêutica, foram realizadas os procedimentos de nefrectomia direita, orquiectomia e toracotomia transesternal para remoçãodos parasitas. O paciente evoluiu clinicamente bem após os procedimentos.

Sjogren' s syndrome with pulmonary bullae in both lungs as lung imaging performance: A case report and literature review / 吉林大学学报(医学版)

Objective: To explore the clinical characteristics of Sjogren' s syndrome (SS) with pulmonary bullae in both lungs as lung imaging performance, to analyze the common lung imaging performance of SS, and to impove the clinicians' understanding of the common lung imaging performace of the SS patients. Methods: The clinical materials, the results of bronchoscope and pathological examination of a SS patient with pulmonary bullae in both lungs as lung imaging performance were collected, and the relative literatures were reviewed. Results: A young female patient with dyspnea and hemoptysis as the chief complaint was permitted to the hospital. The physical examination results showed rampant tooth and there were no other obvious positive signs. The chest CT results showed the pulmonary bullae in both lungs. Further rheumatism examinations, corneal staining, labial gland biopsy and other assistant examinations were performed, and the patient received the related treatment. The serum immunological results indicated anti-SSA, anti-SSB, and corneal staining (+), and the rheumatoid factors were all positive; the pathology of the lower labial gland biopsy showed the number of lymphocytes in each lesion 50; the patient was diagnosed as SS finally. The patient was treated with glucocorticoids and cyclophosphamide. After the treatment, the symptoms of the patient were improved. After discharged from the hospital, the patient was treated with glucocorticoids and cyclophosphamide continuously for 2 months. However, reviewing of chest CT showed no significant changes in the lung bullae in both lungs. Conclusion: SS is a connective tissue disease with diverse clinical manifestations. When the lungs are involved, the lung imaging performance also presents no specificity. When the patient' s chest CT indicates the presence of multiple pulmonary bullae in both lungs, and no causes are find out, the possibility of SS should be considered; so that early detection and early treatment should be performed, and misdiagnosis and delay treatment of illness can be avoided.

Application of spontaneous breathing anesthesia combined with tubeless uniportal thoracoscopy in pulmonary bullae resection: A randomized controlled trial / 中国胸心血管外科临床杂志

@#Objective    To explore the safety and feasibility of spontaneous breathing anesthesia combined with tubeless uniportal thoracoscopy in pulmonary bullae surgery. Methods    Totally 112 patients with pulmonary bullae in the Affiliated Hospital of Inner Mongolia Medical University from March 2015 to May 2017 were enrolled. According to the random number chosen by computer, the patients were randomly divided into two groups: a tubeless group (spontaneous breathing anesthesia combined with tubeless uniportal thoracoscopy) and a control group (uniportal thoracoscopy by general anesthesia with tracheal intubation) . There were 49 males and 7 females with an average age of 25.5±6.5 years in the tubeless group, and 50 males and 6 females with an average age of 23.5±4.5 years in the control group. The difference of the lowest intraoperative arterial oxygen saturation (SaO2), SaO2 at postoperative one hour, operation time, postoperative awakening time, hospital stay, hospitalization cost and postoperative pain score were analyzed. Results    There was no significant difference between the two groups in the operation time, the lowest SaO2, SaO2 at one hour after the operation and the partial pressure of carbon dioxide (PaCO2). The awakening time and duration of postoperative hospital stay in the tubeless group was shorter than those in the control group (P=0.000). The cost of hospitalization in the tubeless group was less than that in the control group (P=0.000). The discomfort caused by urinary tract and visual analogue score (VAS) in the tubeless group were better than those in the control group. Conclusion    It is safe and feasible to use spontaneous breathing anesthesia combined with tubeless uniportal thoracoscopy in pulmonary  bullae resection.

Successful Treatment of a Giant Emphysematous Bulla with an Endobronchial Valve in a Patient with Contralateral Lung Cancer

Patients with severe emphysema have a higher risk of developing lung cancer, and their surgical risk increases when emphysema is accompanied by a giant bulla. Here, we describe a patient who had an emphysematous giant bulla in the right upper lobe that was treated with an endobronchial valve placement. Subsequently, a cancerous lesion on the contralateral lung was successfully removed by lobectomy.

Comparison of the efficacy of video assisted thoracic surgery using two ports and three ports for pulmonary bullae / 中国基层医药

Objective To compare the clinical efficacy of video assisted thoracic surgery using two ports and three ports for pulmonary bullae.Methods Clinical data of 120 patients used video assisted thoracic surgery in the treatment of pulmonary bullae were retrospectively analyzed.62 patients with three ports conventional surgery were selected as three ports group,58 patients with two ports method were selected as two ports group.The two groups were followed up after operation,and the operation time,intraoperative bleeding,extubation time,postoperative drainage volume and hospital stay,the pain scores at postoperative 6h,1 day,3 days,1 week and postoperative complications were compared between the two groups.Results There were no significant differences in operative time and blood loss between the two groups(t=-0.845,-1.164,all P>0.05).After operation,the extubation time[(3.2±1.6)d],postoperative thoracic drainage[(270.8±192.4)mL]and hospitalization time[(5.9±2.1)d] of the two ports group were significantly less than those of the three ports group(t=-4.972,-2.637,-4.601,all P<0.05).The two groups had no postoperative complications,all patients recovered and discharged,followed up,there was no recurrence and other complications.6h,1 day,3 days and 1 week after surgery,the VAS scores of the two ports group were significantly lower than those of the three ports group(t=-5.888,-6.682,-4.190,-5.710,all P<0.01).Conclusion The clinical curative effect of video assisted thoracic surgery using two ports is obvious,the safety is high,and it has high popularization and application value.

Analysis of 120 cases of froracoscopic resection for pulmonary bullae / 中国基层医药

Objective To discuss the clinical efficacy of video-assisted thoracoscopic surgery(VATS)for bilateral bullous lung disease operation.Methods VATS procedures were performed on 120 patients with bilateral ballous lung disease.56 patients were operated in one-stage with traditional incision surgery.Results 120 patients were cured.The mean duration of chest drainage after surgery was 4.7 days.Postoperative complications occurred in 14 cases,including pulmonary edema,pneumothorax again respiratory failure and so on.The mean postoperative hospital stay was 14.5 days.The patients were followed up 1 to 60 months.Conclusion VATS is an effective and preferred method for bilateral bullous lung disease.compared with conventional open techniques for bilateral bullous lung disease,the advantages of VATS include shorter hospital stays,less postoperative pain and earlier return to work.

Clinical efficacy of NEOVEIL in postoperative pulmonary air leakage of pulmonary bullae resection by video-assisted thoracic surgery / 中国综合临床

Objective To explore the clinical efficacy of NEOVEIL in postoperative pulmonary air leakage of pulmonary bullae resection by video-assisted thoracic surgery. Methods We retrospectively analyzed clinical data of 37 cases received NEOVEIL combined with ATB45 in video-assisted thoracic surgery (the NEOVEIL group), and clinical data of 40 cases by ATB45 alone(the control group) . We compared postoperative hospitalization time, keeping time of pleural cavity tubes, the pulmonary leakage time and the incidence of pulmonary infection in the two groups. Results There was no postoperative mechanical ventilation,hemothorax and death. In the NEOVEIL group, the postoperative hospitalization time was 5 to 9 days, the postoperative keeping time of pleural cavity tubes 2 to 4 days, the postoperative pulmonary leakage time 0 to 2 days with 4 patients un-leakage, and 1 patients with pulmonary infection; whereas the postoperative hospitalization time was 6 to 10 days,the postoperative keeping time of pleural cavity tubes 3 to 6 days,the postoperative pulmonary leakage time 2 to 5 days and 8 patients with pulmonary infection in the control group. There was statistical significance in the postoperative hospitalization time, keeping time of pleural cavity tubes, the pulmonary leakage time and the incidence of pulmonary inflammation in two groups(P ＜ 0. 05). The incidence of pulmonary inflammation of the NEOVEIL group (2. 7%) was significantly lower than that of the control group(20. 0%)(x2 = 4. 02, P ＜ 0. 05). Conclusion The operative effectiveness of the NEOVEIL group is better than that of the control group. The NEOVEIL can prevent the postoperative pulmonary leakage.

Video-assisted Thoracoscopic Surgery for Spontaneous Pneumothorax:Report of 61 Cases / 中国微创外科杂志

Objective To evaluate the efficacy of video-assisted thoracoscopic surgery(VATS)for spontaneous pneumothorax.Methods From January 2003 to June 2006,VATS was carried out in 61 cases of spontaneous pneumothorax in our hospital.Resection or ligatation of pulmonary bullae,and pleurodesis were performed by using Endo-GIA.Results Among the cases,unilateral VATS was performed on 58 patients(an axillary small incision was made in one case),and bilateral VATS was done in 3.No conversion to open surgery or severe postoperative complications occurred in this series.Pulmonary bullae was detected in 56 of all the patients.The operation time was 35-55 min(mean,46 min)for unilateral VATS,and was 85,175,and 190 min respectively for the 3 cases of bilateral VATS.The mean blood loss for unilateral operation was 40 ml(range,30-45 ml),and the blood loss in the 3 cases of bilateral VATS was 55,60,and 200 ml.The thoracic-drainage volume was 230-500 ml(mean,390 ml)in the unilateral cases,and was 350,1030,and 1200 respectively in the 3 bilateral cases.The drainage tube was withdrawn 3-6 d(mean 4 d)later in the unilateral cases,and 3,4,and 5 d later in the 3 bilateral cases.The 61 patients were followed up for 4-24 mon(mean,8 mon),during which one patient experienced recurrent pneumothorax in 2 months and was cured by closed thoracic drainage.Conclusions VATS is safe and effective for patients with spontaneous pneumothorax.

Chronic Pulmonary Complications Associated with Toxic Epidermal Necrolysis Caused by Carbamazepine / 实用儿科临床杂志

Objective To explore the clinical manifestations of toxic epidermal necrolysis(TEN) and its rare pulmonary complications.Methods Clinical symptoms,treatment and prognosis of 1 child with TEN caused by carbamazepine were analyzed.Radiological images were reviewed to evaluate the manifestations and the outcome of chronic pulmonary complications associated with TEN.Results The patient had high fever shortly after a dosage increment of carbamazepine.A confluent erythematous exanthema developed rapidly into painful blistering with skin erosion,denudation and involvement of conjunctive and oropharyngeal mucosa.The diagnosis of TEN was made.The mucocutaneous damage was gradually recovered with steroid plus intravenous immunoglobulin for 3 weeks.However,the patient presented with respiratory failure in the recovery phase of TEN.The computer tomography revealed pulmonary bullae and pneumothorax in the right lung.Lung parenchyma was squeezed and pulmonary bullae ruptured with pneumothorax and atelectasis,which were absorbed gradually through thoracic drainages.The patient′s lung function and pulmonary bullae were partly improved during a 7-month follow-up.Conclusions TEN is a severe form of blistering skin di-sease which is characterized by an extensive loss of epidermis and mucous membrane.Chronic pulmonary complications may occur in recovery phase of TEN.Pulmonary bullae,which might be caused by mucous damage and respiratory obstruction,is a rare complication of TEN.