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Journal of Critical Care Medicine... Oct 2021Endotracheal tube obstruction by a mucus plug causing a ball-valve effect is a rare but significant complication. The inability to pass a suction catheter through the...
Endotracheal tube obstruction by a mucus plug causing a ball-valve effect is a rare but significant complication. The inability to pass a suction catheter through the endotracheal tube with high peak and plateau pressure differences are classical features of an endotracheal tube obstruction. A case is described of endotracheal tube obstruction from a mucus plug that compounded severe respiratory acidosis and hypotension in a patient who simultaneously had abdominal compartment syndrome. The mucus plug was not identified until a bronchoscopic assessment of the airway was performed. Due to the absence of classical signs, the delayed identification of the obstructing mucus plug exacerbated diagnostic confusion. It resulted in various treatments being trialed whilst the patient continued to deteriorate from the evasive offending culprit. We suggest that earlier and more routine use of bronchoscopy should be employed in an intensive care unit, especially as a definitive way to rule out endotracheal obstruction.
PubMed: 34934822
DOI: 10.2478/jccm-2021-0027 -
BMJ Case Reports Aug 2017A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following... (Review)
Review
A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following acute gastroenteritis and occasional use of diclofenac. Abdominal ultrasound revealed mild left hydronephrosis due to staghorn stone and normal right kidney. Soon after, complete anuria necessitating haemodialysis developed without pain or evidence of infection. CT imaging revealed stones obstructing the right ureter. Following urological surgery, postobstructive diuresis developed and the serum creatinine came down to near normal. The stones were identified as uric acid stones.Anuria has a relatively narrow differential and painless (partially non-dilated) bilateral ureteral obstruction is a distinctly unusual cause. A review of the literature to cover all reported causes of bilateral ureteral obstruction is presented. Only a minority of cases were not associated with an underlying malignant disease or its treatment. The multifactorial aetiology of the patient's acute kidney injury (volume depletion, diclofenac and obstructive uropathy) is presented and discussed.
Topics: Acute Kidney Injury; Adult; Anuria; Creatinine; Humans; Hydronephrosis; Male; Staghorn Calculi; Ureter; Ureteral Calculi; Ureteral Obstruction
PubMed: 28784872
DOI: 10.1136/bcr-2016-218173 -
Acta Radiologica (Stockholm, Sweden :... Oct 2023The appearance of renal swelling during an acute obstruction of the urinary tract could be caused by hydronephrosis or an increase of the parenchymal volume. To the best...
BACKGROUND
The appearance of renal swelling during an acute obstruction of the urinary tract could be caused by hydronephrosis or an increase of the parenchymal volume. To the best of our knowledge no studies have been performed regarding renal parenchymal volume change during an acute urinary tract obstruction.
PURPOSE
To investigate the change in renal parenchymal volume during an acute urinary tract obstruction and to correlate any such volume change to the degree of secondary signs of obstruction.
MATERIAL AND METHODS
In total, 20 patients with obstructive ureterolithiasis were retrospectively and randomly included. Two observers measured the parenchymal volume of the obstructed and the contralateral kidney in CT examinations before, during, and after obstruction. Hydronephrosis, hydroureter, perirenal stranding, and thickening of the renal fascia were graded and correlated to volume change.
RESULTS
A decreased volume was noted after obstruction in the obstructed kidneys (-24%) ( < 0.0001) and in the contralateral kidneys (-5%) ( = 0.0110) with a positive correlation of change in volume ( = 0.011). The volume of the obstructed kidneys was larger than the contralateral kidneys during obstruction ( < 0.0001) but not after obstruction ( = 0.559). No significant difference in volume was found before compared to after obstruction. Secondary signs of obstruction did not correlate to volume change.
CONCLUSION
The parenchymal volume increases in the obstructed kidneys as well as in the contralateral kidneys during obstruction. The increase in volume was larger in the obstructed kidneys compared to the contralateral kidneys. After obstruction the kidneys regained their original volume. Secondary signs did not correlate to volume change.
Topics: Humans; Ureteral Obstruction; Retrospective Studies; Kidney; Hydronephrosis
PubMed: 37606531
DOI: 10.1177/02841851231190618 -
HNO Feb 2017Drug-induced sedation endoscopy (DISE) is a diagnostic procedure which allows evaluation of the collapsibility of the upper airway. According to expert opinion, it is... (Review)
Review
BACKGROUND
Drug-induced sedation endoscopy (DISE) is a diagnostic procedure which allows evaluation of the collapsibility of the upper airway. According to expert opinion, it is possible to imitate nocturnal collapsibility and perform a realistic investigation of the site of obstruction and vibration. This should enable sufficient and precise therapeutic advice to be given solely on the basis of clinical assessment.
OBJECTIVE
The current publication critically evaluates the present state of development of DISE and its potential indications.
MATERIALS AND METHODS
A PubMed literature research was performed using "sleep" and "endoscopy" or "DISE" as keywords. Relevant publications were evaluated.
RESULTS
The present publication provides a historical summary of the available publications and relates these to other methods for examining obstructive sleep apnea. The present state of DISE in terms of drugs applied, grading systems, and validity is evaluated. Indications for DISE are described and critically discussed on the basis of literature data.
CONCLUSION
DISE provides deep insights into the genesis of obstructions of the upper airway and snoring. Although its value for diagnosis and treatment of sleep-disordered breathing could not yet be demonstrated for all non-CPAP (continuous positive airway pressure) therapies, DISE could identify predictive parameters some methods. Further potential indications for DISE might be predictive examinations for mandibular advancement devices and respiration-synchronous neurostimulation of the hypoglossal nerve. DISE will thus remain a valuable diagnostic tool for obstructive sleep apnea and rhonchopathy.
Topics: Conscious Sedation; Diagnosis, Differential; Endoscopy; Forecasting; Humans; Hypnotics and Sedatives; Image Enhancement; Lung Diseases, Obstructive; Prognosis; Reproducibility of Results; Sensitivity and Specificity; Sleep Apnea, Obstructive
PubMed: 28116457
DOI: 10.1007/s00106-016-0329-1 -
Sleep & Breathing = Schlaf & Atmung Mar 2022Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue...
PURPOSE
Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue protrusion and consecutive alleviation of obstructions at the tongue base level (lower obstructions). Furthermore, obstructions at the soft palate level (upper obstructions) may be prevented through palatoglossal coupling as seen on sleep endoscopy. However, it has not been studied if the distribution of obstruction level during a whole night measurement is a relevant factor for the treatment outcome.
METHODS
Obstruction levels were measured with a manometry system during a whole night of sleep in 26 patients with OSA (f = 1, m = 25; age 59.4 ± 11.3; BMI = 29.6 ± 3.6) either before (n = 9) or after sHNS implantation (n = 12). Five patients received a measurement before and after implantation. Obstructions were categorized into velar (soft palate and above), infravelar (below soft palate), and multilevel obstructions. An association between obstruction level and treatment outcome was calculated.
RESULTS
The mean distribution of preoperative obstruction level could be divided into the following: 38% velar, 46% multilevel, and 16% infravelar obstructions. Patients with a good treatment response (defined as AHI < 15/h and AHI reduction of 50%) had fewer preoperative velar obstructions compared to non-responder (17% vs. 54%, p-value = 0.006). In patients measured after sHNS implantation, a significantly higher rate of multilevel obstructions per hour was measured in non-responders (p-value = 0.012).
CONCLUSIONS
Selective hypoglossal nerve stimulation was more effective in patients with fewer obstructions at the soft palate level. Manometry may be a complementary diagnostic procedure for the selection of patients for HNS.
Topics: Adult; Aged; Electric Stimulation Therapy; Female; Humans; Hypoglossal Nerve; Male; Middle Aged; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 34091793
DOI: 10.1007/s11325-021-02396-y -
Neurosurgical Focus Mar 2023Management of Chiari malformation type I (CM-I) requires the functional restoration of an obstructed cisterna magna. In posterior fossa decompression with duraplasty...
OBJECTIVE
Management of Chiari malformation type I (CM-I) requires the functional restoration of an obstructed cisterna magna. In posterior fossa decompression with duraplasty (PFDD), various intradural pathologies are suggested to alter CSF flow at the craniocervical junction and require surgical correction. However, reports of the spectrum of intraoperative intradural findings and their nuances are scarce, especially those characterizing rarer findings pertaining to the vascular structures and vascular compression.
METHODS
The authors conducted a retrospective cohort analysis of adults and children who underwent first-time PFDD for CM-I (2011-2021), with and without syringomyelia. The surgical reports and intraoperative videos were reviewed, and the frequency and nature of the intradural observations in regard to the tonsils, arachnoid, and vasculature were analyzed along with the clinical findings and surgical outcomes.
RESULTS
All 180 patients (age range 1-72 years; median [interquartile range] 24 (14-38) years; 37% of patients were children < 21 years of age) exhibited multiple intradural findings, with a median of 7 distinct concurrent observations in each patient. Novel findings not previously reported included posterior inferior communicating artery (PICA) branches compressing the neural elements at the cervicomedullary junction (26.7%). Other common findings included arachnoid adhesions (92.8%), thickening (90.6%), webs at the obex (52.2%), tonsillar gliosis (57.2%), tonsillar hypertrophy (18.3%), adhesions obstructing the foramen of Magendie (FoM) (62.2%), PICA obstruction of the FoM (17.2%), and dural scarring (87.8%). Tonsillar gliosis and intertonsillar adhesions obstructing the FoM were more common in children than adults. Tonsillar gliosis and arachnoid webs were more common among syringomyelia patients. After multivariable adjustment, none of the observed findings were independently associated with syringomyelia, preoperative symptoms, or postoperative improvement. The vast majority of patients improved postoperatively. The complication rate was low: 1.2% of patients required revision PFDD at > 3 years postoperatively, 3.6% experienced other operative complications, and 0% had CSF leaks.
CONCLUSIONS
The diversity of intradural findings and observations revealed in this study suggests that obstructive and compressive structural anomalies may be more common than previously reported among CM-I patients, both those patients with and those without syringomyelia and especially those with obstructive and compressive PICA branches. Although the authors cannot conclude that all these findings are necessarily pathological, further study may determine how they contribute to CM-I pathology and symptomatology in the setting of a compromised cisterna magna.
Topics: Adult; Child; Humans; Infant; Child, Preschool; Adolescent; Young Adult; Middle Aged; Aged; Arnold-Chiari Malformation; Gliosis; Retrospective Studies; Syringomyelia; Plastic Surgery Procedures
PubMed: 36857788
DOI: 10.3171/2022.12.FOCUS22628 -
Dento Maxillo Facial Radiology Jul 2023The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well...
OBJECTIVES
The proportionality between anatomical characteristics and disease severity in children and adolescents with obstructive sleep apnea (OSA) has not been well characterized. The present study investigated the relationship between the dentoskeletal and oropharyngeal features of young patients with OSA and either the apnea-hypopnea index (AHI) or the amount of upper airway obstruction.
METHODS
MRI of 25 patients (8- to 18-year-old) with OSA (mean AHI = 4.3 events/h) was retrospectively analyzed. Sleep kinetic MRI (kMRI) was used to assess airway obstruction, and static MRI (sMRI) was used to assess dentoskeletal, soft tissue, and airway parameters. Factors related to AHI and obstruction severity were identified with multiple linear regression (significance level = 0.05).
RESULTS
As evidenced by kMRI, circumferential obstruction was present in 44% of patients, while laterolateral and anteroposterior was present in 28%; as evidenced by kMRI, obstructions were retropalatal in 64% of cases and retroglossal in 36% (no nasopharyngeal obstructions); kMRI showed a higher prevalence of retroglossal obstructions compared to sMRI( = 0.037); the main obstruction airway area was not related to AHI; the maxillary skeletal width was related to AHI ( = -0.512, = 0.007) and obstruction severity ( = 0.625, = 0.002); and the retropalatal width was related to AHI ( = -0.384, = 0.024) and obstruction severity ( = 0.519, = 0.006).
CONCLUSIONS
In children and adolescents, the severity of OSA and obstruction were inversely proportional to the maxillary basal width and retropalatal airway width. Further studies are needed to assess the benefits of targeted clinical treatments widening the transverse dimension of these structures.
Topics: Adolescent; Humans; Child; Retrospective Studies; Sleep Apnea, Obstructive; Airway Obstruction; Oropharynx; Magnetic Resonance Imaging
PubMed: 37192022
DOI: 10.1259/dmfr.20220422 -
Topics in Companion Animal Medicine Dec 2016This study evaluates the clinical findings obtained in routine screening examinations in cats with obstructive feline lower urinary tract disease at the time of service.... (Review)
Review
This study evaluates the clinical findings obtained in routine screening examinations in cats with obstructive feline lower urinary tract disease at the time of service. Twenty-six cats with urethral obstruction were assessed by physical examination, blood pressure, electrocardiogram, and laboratory tests. Cats with signs of obstruction less than 36 hours before the service were in a state of alert, with body temperature and heart rate higher compared with cats in lethargy and stupor, obstructed up to 36 hours. The results revealed that 30.76% of the cats were hypertensive (>140mmHg). Arrhythmias were found in 15.38% of the cats with potassium >8.5mEqL. Creatinine, phosphorus, magnesium, potassium, and lactate concentrations were higher in cats obstructed more than 36 hours. All these data claim that a protocol of examinations should be established for obstructed cats, principally to stabilize the cat before the anesthesia for unobstruction.
Topics: Animals; Blood Chemical Analysis; Cat Diseases; Cats; Clinical Protocols; Diagnostic Tests, Routine; Electrocardiography; Male; Urethral Obstruction; Urinalysis; Urinary Tract Infections
PubMed: 28317615
DOI: 10.1053/j.tcam.2016.10.006 -
Animals : An Open Access Journal From... May 2017Horses engaged in strenuous exercise display physiological responses that approach the upper functional limits of key organ systems, in particular their... (Review)
Review
Horses engaged in strenuous exercise display physiological responses that approach the upper functional limits of key organ systems, in particular their cardiorespiratory systems. Maximum athletic performance is therefore vulnerable to factors that diminish these functional capacities, and such impairment might also lead to horses experiencing unpleasant respiratory sensations, i.e., breathlessness. The aim of this review is to use existing literature on equine cardiorespiratory physiology and athletic performance to evaluate the potential for various types of breathlessness to occur in exercising horses. In addition, we investigate the influence of management factors such as rein and bit use and of respiratory pathology on the likelihood and intensity of equine breathlessness occurring during exercise. In ridden horses, rein use that reduces the jowl angle, sometimes markedly, and conditions that partially obstruct the nasopharynx and/or larynx, impair airflow in the upper respiratory tract and lead to increased flow resistance. The associated upper airway pressure changes, transmitted to the lower airways, may have pathophysiological sequelae in the alveolae, which, in their turn, may increase airflow resistance in the lower airways and impede respiratory gas exchange. Other sequelae include decreases in respiratory minute volume and worsening of the hypoxaemia, hypercapnia and acidaemia commonly observed in healthy horses during strenuous exercise. These and other factors are implicated in the potential for ridden horses to experience three forms of breathlessness-"unpleasant respiratory effort", "air hunger" and "chest tightness"-which arise when there is a mismatch between a heightened ventilatory drive and the adequacy of the respiratory response. It is not known to what extent, if at all, such mismatches would occur in strenuously exercising horses unhampered by low jowl angles or by pathophysiological changes at any level of the respiratory tract. However, different combinations of the three types of breathlessness seem much more likely to occur when pathophysiological conditions significantly reduce maximal athletic performance. Finally, most horses exhibit clear behavioural evidence of aversion to a bit in their mouths, varying from the bit being a mild irritant to very painful. This in itself is a significant animal welfare issue that should be addressed. A further major point is the potential for bits to disrupt the maintenance of negative pressure in the oropharynx, which apparently acts to prevent the soft palate from rising and obstructing the nasopharynx. The untoward respiratory outcomes and poor athletic performance due to this and other obstructions are well established, and suggest the potential for affected animals to experience significant intensities of breathlessness. Bitless bridle use may reduce or eliminate such effects. However, direct comparisons of the cardiorespiratory dynamics and the extent of any respiratory pathophysiology in horses wearing bitted and bitless bridles have not been conducted. Such studies would be helpful in confirming, or otherwise, the claimed potential benefits of bitless bridle use.
PubMed: 28587125
DOI: 10.3390/ani7060041 -
Giornale Italiano Di Nefrologia :... Feb 2020The term "obstructive uropathy" refers to the complex structural and functional changes following the interruption of normal urinary runoff, which can occur at every...
The term "obstructive uropathy" refers to the complex structural and functional changes following the interruption of normal urinary runoff, which can occur at every level of the urinary tract. Depending on its origin, duration and severity, urinary tract obstructions can be acute or chronic, mono or bilateral, partial or complete. The obstruction can be localized or extended to the entire pielo-caliceal system and/or homolateral urethra. The term "hydronephrosis" indicates the dilation of the pelvis detected through imaging techniques. Among these, ultrasound is considered the gold standard in the diagnosis of obstructive uropathy: it allows to distinguish three degrees of urinary tract dilation, depending on the extent of the dilation itself and the thickness of the parenchyma. Nephrologists are confronted daily with patients who experience kidney failure and must be able to quickly distinguish between chronic and acute and, in the latter case, to discern between issues of nephrological or urological competence. This short review aims at helping them deal with this very common scenario, through the use of ultrasound.
Topics: Acute Kidney Injury; Diagnosis, Differential; Dilatation, Pathologic; Echocardiography, Doppler, Color; Humans; Hydronephrosis; Kidney Calices; Kidney Pelvis; Renal Insufficiency, Chronic; Ultrasonography; Ureteral Obstruction; Urethral Obstruction; Vascular Resistance
PubMed: 32068358
DOI: No ID Found