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Cavitation, Thin-walled Cysts and Bullae, their Association with Tumours. Emphysema. Fat and Calcification. Spurious Tumours. Intravascular, Pulmonary Interstitial & Mediastinal Gas, and Pneumoperitoneum.
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Text books often quote as an asymptomatic cause pneumatosis intestinalis, but this appears to be very unusual, as none of the cysts (if they should rupture) contain sufficient gas - Illus. PNEUMATOSIS. However some cases have been reported, and some have both small bowel diverticula and pneumatosis. Pneumatosis intestinalis appears not to be related to asthma per se, but to nitrogen accumulation as a result of decreased pressure in the abdominal cavity (like gas pulled out of solution in 'vacuum discs' or stressed joints - see Illus. GAS IN JOINTS/DISCS) and can be 'cured' by breathing a greater concentration of oxygen or the use of a hyperbaric oxygen chamber (the treatment lasting long enough for the residual nitrogen in the cysts to be adsorbed). Peritoneal gas can occur in females following vaginal douches with a bulb syringe or effervescent fluid; it may occur when a mobile uterus can pump air through the Fallopian tubes - such has been reported in charladies who scrubbed floors on their hands and knees, and in a post-partum woman carrying out knee-chest position exercises, The presence of gas below the diaphragm has also been used to confirm the patency of Fallopian tubes after gas insufflation into them.
Surgery for Necrotizing Enterocolitis
Published in David J. Hackam, Necrotizing Enterocolitis, 2021
The second scenario is the child who has persistent pneumatosis yet fails to clinically improve despite maximal medical treatment. Under this scenario, the patient presents just as in Scenario 1 (i.e., a child around 27 to 30 weeks' gestation, several weeks old, and around 1 kg in weight) and develops sudden abdominal distension, feeding intolerance, and vomiting. This child has a slow drift in both platelets and hemoglobin. X-rays show persistent pneumatosis. In view of the low and slow drift in platelets and hemoglobin, the child may receive transfusions of blood and platelets. Here's an important point: A child who is described as having a “stable hemoglobin” and “a stable platelet count” after requiring and therefore receiving multiple transfusions of either blood or platelets has neither a stable hemoglobin nor a stable platelet count. Rather, the child has “artificially stabilized” hemoglobin and/or platelets. In my view, this is the child in which there is the most potential for danger and also the highest risk of death due to missing the opportunity to intervene. Without the comforting and clear push to operate that an x-ray with free air provides, this scenario requires close and careful management and thoughtful intervention in order to optimize the chance for survival.
Test Paper 2
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
Pneumatosis is the presence of gas bubbles within the wall of the involved segment of bowel. It is seen in a wide variety of conditions. It is widely divided into two groups: primary (idiopathic) and secondary. Conditions associated with secondary pneumatosis include obstruction, pulmonary disease such as COPD and asthma, vascular conditions such as ischaemia and infarction, inflammatory conditions such as Crohn’s and UC, necrotising enterocolitis, drugs such as steroids and chemotherapy, collagen vascular diseases such as scleroderma, SLE and dermatomyositis.
Association of Placental Pathologic Findings with the Severity of Necrotizing Enterocolitis in Preterm infants – A Matched Case-Control Study
Published in Fetal and Pediatric Pathology, 2023
Parvesh Mohan Garg, Jaslyn L. Paschal, Md Abu Yusuf Ansari, Lauren Billington, Jennifer Ware, Kristin Adams, Youssef Al Hamda, Adebamike Oshunbade, Charles R. Rosenfeld, Imran N. Mir
We recorded demographic characteristics, including birth weight, GA, sex, race, and mode of delivery (cesarean delivery vs. vaginal delivery), APGAR scores at 5 min, outborn status, and neonatal growth assessment at birth. We also collected information regarding maternal factors, including pregnancy-induced hypertension, chorioamnionitis, and antenatal steroids. Infants who did not show obvious pneumatosis on radiology were classified as ≥ stage II NEC only if they displayed highly suggestive clinical signs with loss of bowel sounds, generalized abdominal tenderness, abdominal distension, systemic instability with increased needs for respiratory and hemodynamic support, and radiological evidence of intestinal dilatation, fixed bowel loops and/or portal venous gas on abdominal X-ray. We also gathered information on the length of stay defined as the total duration of hospitalization from the day of admission until discharge or death and mortality defined as death due to any cause before hospital discharge.
Not all nebulizers are created equal: Considerations in choosing a nebulizer for aerosol delivery during mechanical ventilation
Published in Expert Review of Respiratory Medicine, 2023
Ronan MacLoughlin, Ignacio Martin-Loeches
Similar concentration observations were made where increases in osmolality were noted during JN operation indicating solvent evaporation, and again, these changes were not seen with VMN [51]. Maintenance of the pharmaceutical formulation’s intended osmolality is critical in maintaining the stability and potential for proper action post deposition, however critically, an increase in osmolality is associated with increased cough in patients [52]. For reasons of potential thoracic pneumatosis for example, cough should be avoided during mechanical ventilation [53]. Another consideration of dynamic changes in drug concentration over time, is the lack of accurate control of dosing. Concentrations at the start of the dose, will be as prescribed, however, as the dose continues, and concentration increases, there may be instability in the formulation, potential toxicity concerns, or at a very basic level, no understanding of what the cumulative amount of drug the patient may have received was over time.
Idiopathic spontaneous pneumoperitoneum
Published in Baylor University Medical Center Proceedings, 2022
Anasua Deb, Binita Ghosh, Annia Cavazos, Busara Songtanin, Natnicha Leelaviwat, Kenneth Nugent
Recurrence of SP is rarely reported.8–10 Recurrent cases are associated with underlying comorbidities that predispose to pneumoperitoneum formation, such as diverticulosis,11–13 pneumatosis intestinalis,14,15 chronic cough,10 constipation,16 and rarely systemic sclerosis.17–19 Recently, a few cases of SP have been reported in patients infected with SARS-CoV-2.20–24 SP has sometimes been reported in patients on mechanical ventilation4; such cases are thought to originate from air leaks from the lungs, which then spread to contiguous anatomical spaces by the Macklin effect.25 Although few diverticuli were seen on coloscopy in our patient, there was no evidence of perforation, thus making these a less likely source of origin of the pneumoperitoneum. Our patient also had inclusion body myositis, which has never been reported to be associated with pneumoperitoneum. Rare cases of smooth muscle involvement of the GI tract have been reported in inflammatory myopathies such as polymyositis, eosinophilic myositis, and dermatomyositis.26 The mechanism of GI tract involvement in myopathies is poorly understood; a possible hypothesis is a non-inflammatory acute endarteropathy with ischemia, ulceration, and perforation of the GI tract resulting from vascular intimal hyperplasia and thrombi, as seen in juvenile dermatomyositis.27