-
Cureus Mar 2024Acute ischemic stroke (AIS) following pulmonary lobectomy, which is traditionally attributed to air embolism and atrial fibrillation (AF), may occur after thrombus...
Mechanical Thrombectomy Using Double Stent Retriever Technique for Acute Ischemic Stroke Following Embolism From the Pulmonary Vein Stump After Left Upper Lobectomy: A Case Report.
Acute ischemic stroke (AIS) following pulmonary lobectomy, which is traditionally attributed to air embolism and atrial fibrillation (AF), may occur after thrombus formation in the pulmonary vein stump (PVS). Herein, we document the mechanical thrombectomy (MT) of a carotid bifurcation occlusion post-left upper lobectomy (LUL) to manage AIS. A 76-year-old male with a history of diabetes, dyslipidemia, and a treated dural arteriovenous fistula at the transverse sigmoid junction, with no history of AF, successfully underwent LUL for a pulmonary tumor. The patient independently walked on postoperative day 1. He developed right hemiparesis and total aphasia on the morning of the second day after surgery, which was discovered by the nursing staff. A magnetic resonance imaging (MRI) confirmed an occlusion of the left common carotid artery (CCA). Tissue plasminogen activator (t-PA) was not administered owing to recent surgery. An urgent MT using multiple MT techniques carried out 90 minutes after the discovery of symptoms only achieved partial recanalization. Subsequently, a double stent retriever technique (DSRT) addressed the occlusion in the common and cervical internal carotid artery (ICA). Following this, a T occlusion was encountered, which was addressed with a combined approach using a single stent retriever (SR), achieving a thrombolysis in cerebral infarction (TICI) grade 2b result. However, postoperative aphasia and severe right hemiparesis remained. Postoperative imaging showed a significant left cerebral hemisphere infarction and a thrombus in the PVS. Oral edoxaban was administered, and PVS thrombosis did not recur. The patient was transferred to a rehabilitation facility 190 days post-embolization with a modified Rankin Scale score of 4. In this report, we demonstrate the challenging case of the DSRT in addressing AIS after LUL, which led to the formation of a massive thrombus and occlusion of the carotid artery, as revealed by the PVS. This case emphasizes the importance of collaborative efforts between thoracic surgeons and all staff involved in stroke care in managing such complex scenarios.
PubMed: 38516287
DOI: 10.7759/cureus.56610 -
The Journal of International Medical... Mar 2024Pneumatosis intestinalis (PI) is a rare disease, and there are many theories about its pathogenesis. Hepatic portal venous gas (HPVG), is thought to occur secondary to...
Pneumatosis intestinalis (PI) is a rare disease, and there are many theories about its pathogenesis. Hepatic portal venous gas (HPVG), is thought to occur secondary to intramural intestinal gas emboli migrating through the portal venous system via the mesenteric veins. PI accompanied by HPVG is usually a sign of bowel ischaemia and is associated with a high mortality rate. We report here, a patient with liver metastases from colorectal cancer who developed PI followed by HPVG after treatment with 5-Fluorouracil, leucovorin, and oxaliplatin (mFOLFOX6). Timely attention and management of gastrointestinal symptoms following chemotherapy are essential in the treatment of this type of patient.
Topics: Humans; Portal Vein; Embolism, Air; Antineoplastic Agents
PubMed: 38513142
DOI: 10.1177/03000605241239276 -
Acute Coronary Artery Air Embolism Complicating a CT-guided percutaneous lung biopsy: A case report.Heliyon Mar 2024Systemic air embolism is a fatal complication of computed tomography-guided percutaneous lung biopsy. Here, we report a case of acute coronary artery air embolism...
Systemic air embolism is a fatal complication of computed tomography-guided percutaneous lung biopsy. Here, we report a case of acute coronary artery air embolism following computed tomography (CT) guided percutaneous lung biopsy. The patient exhibited cardiac symptoms, and CT showed air density in left ventricle and aorta, indicating air embolism. Trendelenburg positioning and coronary angiography were performed during the treatment, and the patient was discharged without obvious complications.
PubMed: 38509877
DOI: 10.1016/j.heliyon.2024.e27914 -
Diving and Hyperbaric Medicine Mar 2024Hyperbaric oxygen treatment (HBOT) is recommended for arterial gas embolism (AGE) with severe symptoms. However, once symptoms subside, there may be a dilemma to treat...
INTRODUCTION
Hyperbaric oxygen treatment (HBOT) is recommended for arterial gas embolism (AGE) with severe symptoms. However, once symptoms subside, there may be a dilemma to treat or not.
CASE PRESENTATION
A 71-year-old man was noted to have a mass shadow in his left lung, and a transbronchial biopsy was performed with sedation. Flumazenil was intravenously administered at the end of the procedure. However, the patient remained comatose and developed bradycardia, hypotension, and ST-segment elevation in lead II. Although the ST changes spontaneously resolved, the patient had prolonged disorientation. Whole- body computed tomography revealed several black rounded lucencies in the left ventricle and brain, confirming AGE. The patient received oxygen and remained supine. His neurological symptoms gradually improved but worsened again, necessitating HBOT. HBOT was performed seven times, after which neurological symptoms resolved almost completely.
CONCLUSIONS
AGE can secondarily deteriorate after symptoms have subsided. We recommend that HBOT be performed promptly once severe symptoms appear, even if they resolve spontaneously.
Topics: Humans; Aged; Embolism, Air; Lung; Hyperbaric Oxygenation; Brain
PubMed: 38507911
DOI: 10.28920/dhm54.1.61-64 -
Diving and Hyperbaric Medicine Mar 2024Diving injuries are influenced by a multitude of factors. Literature analysing the full chain of events in diving accidents influencing the occurrence of diving injuries...
INTRODUCTION
Diving injuries are influenced by a multitude of factors. Literature analysing the full chain of events in diving accidents influencing the occurrence of diving injuries is limited. A previously published 'chain of events analysis' (CEA) framework consists of five steps that may sequentially lead to a diving fatality. This study applied four of these steps to predominately non-lethal diving injuries and aims to determine the causes of diving injuries sustained by divers treated by the Diving Medical Centre of the Royal Netherlands Navy.
METHODS
This retrospective cohort study was performed on diving injuries treated by the Diving Medical Centre between 1966 and 2023. Baseline characteristics and information pertinent to all four steps of the reduced CEA model were extracted and recorded in a database.
RESULTS
A total of 288 cases met the inclusion criteria. In 111 cases, all four steps of the CEA model could be applied. Predisposing factors were identified in 261 (90%) cases, triggers in 142 (49%), disabling agents in 195 (68%), and 228 (79%) contained a (possible-) disabling condition. The sustained diving injury led to a fatality in seven cases (2%). The most frequent predisposing factor was health conditions (58%). Exertion (19%), primary diver errors (18%), and faulty equipment (17%) were the most frequently identified triggers. The ascent was the most frequent disabling agent (52%).
CONCLUSIONS
The CEA framework was found to be a valuable tool in this analysis. Health factors present before diving were identified as the most frequent predisposing factors. Arterial gas emboli were the most lethal injury mechanism.
Topics: Humans; Diving; Netherlands; Retrospective Studies; Accidents; Embolism, Air; Decompression Sickness
PubMed: 38507908
DOI: 10.28920/dhm54.1.39-46 -
Journal of Surgical Case Reports Mar 2024Trauma management forms a significant component of any health system. It can affect any body system, and as such knowledge of the wide possible presentations and...
Trauma management forms a significant component of any health system. It can affect any body system, and as such knowledge of the wide possible presentations and sequalae are critical. Systemic air embolism (SAE) is a rare presentation in trauma, though it can be associated with significant morbidity and mortality. We present the case of a 23-year-old gentleman with isolated penetrating trauma to the chest who developed widespread neurological insult as a result of SAE, and review historical and proposed contemporary management of SAE.
PubMed: 38505339
DOI: 10.1093/jscr/rjae167 -
International Wound Journal Mar 2024Neoadjuvant chemoimmunotherapy is becoming an increasingly important part of the management of lung cancer to facilitate surgical resection. This study aimed to...
Neoadjuvant chemoimmunotherapy is becoming an increasingly important part of the management of lung cancer to facilitate surgical resection. This study aimed to summarize the treatment-related adverse events (TRAEs) and wound complications of neoadjuvant chemoimmunotherapy in non-small cell lung cancer (NSCLC). Eligible studies of neoadjuvant chemoimmunotherapy for NSCLC were identified from PubMed, Embase and Web of Science. The endpoints mainly included TRAEs and wound complications. Stata18 software was used for statistical analysis with p < 0.05 considered statistically significant. Twenty studies including a total of 1072 patients were eligible for this study. Among the patients who received neoadjuvant chemoimmunotherapy, the pooled prevalence of any grade TRAEs was 77% (95% confidence interval [CI] [0.64-0.86]), grade 1-2 TRAEs was 77% (95% CI [0.58-0.89]) and grade ≥3 TRAEs was 26% (95% CI [0.16-0.38]). Surgery-related complications rate was 22% (95% CI [0.14-0.33]). Among the wound complications, the pooled rate of air leakage was 10% (95% CI [0.04-0.23]), pulmonary/wound infection was 8% (95% CI [0.05-0.13]), bronchopleural fistula was 8% (95% CI [0.02-0.27]), bronchopulmonary haemorrhage was 3% (95% CI [0.01-0.05]), pneumonia was 5% (95% CI [0.02-0.10]), pulmonary embolism was 1% (95% CI [0.01-0.03]), pleural effusion was 7% (95% CI [0.03-0.14]) and chylothorax was 4% (95% CI [0.02-0.09]). Overall, neoadjuvant chemoimmunotherapy in NSCLC results a high incidence of grade 1-2 TRAEs but a low risk of increasing the incidence of ≥3 grade TRAEs and wound complications. These results need to be confirmed by more large-scale prospective randomized controlled trials and studies.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Neoadjuvant Therapy; Prospective Studies; Lung Neoplasms; Immunotherapy
PubMed: 38484730
DOI: 10.1111/iwj.14831 -
Mediterranean Journal of Hematology and... 2024
Pneumatosis Cystoides Intestinalis with Fatal Air Embolism after Minor Blunt Abdominal Trauma in a 6-Year-Old Girl Undergoing Hematopoietic Stem Cell Trasplant: Case Report and Review of Literature.
PubMed: 38468831
DOI: 10.4084/MJHID.2024.028 -
Nihon Shokakibyo Gakkai Zasshi = the... 2024A 40-year-old woman was admitted to our hospital by ambulance due to accidental ingestion of 100ml of 35% hydrogen peroxide. Although the patient suffered from frequent...
A 40-year-old woman was admitted to our hospital by ambulance due to accidental ingestion of 100ml of 35% hydrogen peroxide. Although the patient suffered from frequent vomiting, abdominal distension, and abdominal pain, signs of peritonitis were not observed. An abdominal computed tomography examination demonstrated obvious gas images in the gastric wall and intrahepatic portal veins. Upper gastrointestinal endoscopy revealed mucosal redness, swelling, and erosion from the lower part of the esophagus to the duodenum. Portal venous gas and upper gastrointestinal mucosal injury due to accidental hydrogen peroxide ingestion were suspected. As the vital signs were stable and there were no signs peritoneal irritation or neurological symptoms, she was treated medically with vonoprazan, rebamipide, and sodium alginate. The next day, abdominal symptoms immediately improved and 3 days later, hepatic portal venous gas had disappeared on ultrasonography. She was discharged on the 5th day after admission. Two months later, upper gastrointestinal endoscopy showed improvement in inflammatory findings. We report a remarkable case of hepatic portal venous gas and upper gastrointestinal mucosal injury and elucidate the endoscopic findings associated with hydrogen peroxide ingestion.
Topics: Adult; Female; Humans; Eating; Embolism, Air; Hydrogen Peroxide; Inflammation; Liver; Portal Vein
PubMed: 38462471
DOI: 10.11405/nisshoshi.121.230 -
Annals of Surgery Apr 2024To compare the effect of low and standard pneumoperitoneal pressure (PP) on the occurrence of gas embolism during laparoscopic liver resection (LLR). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To compare the effect of low and standard pneumoperitoneal pressure (PP) on the occurrence of gas embolism during laparoscopic liver resection (LLR).
BACKGROUND
LLR has an increased risk of gas embolism. Although animal studies have shown that low PP reduces the occurrence of gas embolism, clinical evidence is lacking.
METHODS
This parallel, dual-arm, double-blind, randomized controlled trial included 141 patients undergoing elective LLR. Patients were randomized into standard ("S," 15 mm Hg; n = 70) or low ("L," 10 mm Hg; n = 71) PP groups. Severe gas embolism (≥ grade 3, based on the Schmandra microbubble method) was detected using transesophageal echocardiography and recorded as the primary outcome. Intraoperative vital signs and postoperative recovery profiles were also evaluated.
RESULTS
Fewer severe gas embolism cases (n = 29, 40.8% vs n = 47, 67.1%, P = 0.003), fewer abrupt decreases in end-tidal carbon dioxide partial pressure, shorter severe gas embolism duration, less peripheral oxygen saturation reduction, and fewer increases in heart rate and lactate during gas embolization episodes was found in group L than in group S. Moreover, a higher arterial partial pressure of oxygen and peripheral oxygen saturation were observed, and fewer fluids and vasoactive drugs were administered in group L than in group S. In both groups, the distensibility index of the inferior vena cava negatively correlated with central venous pressure throughout LLR, and a comparable quality of recovery was observed.
CONCLUSIONS
Low PP reduced the incidence and duration of severe gas embolism and achieved steadier hemodynamics and vital signs during LLR. Therefore, a low PP strategy can be considered a valuable choice for the future LLR.
Topics: Animals; Humans; Carbon Dioxide; Embolism, Air; Laparoscopy; Liver; Pneumoperitoneum, Artificial
PubMed: 38456278
DOI: 10.1097/SLA.0000000000006130