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Chest Infections (chest + infections)

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Medical Sciences	100%

Selected Abstracts

Gastrostomy placement in paediatric patients with neuromuscular disorders: indications and outcome

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 5 2007
Gian Paolo Ramelli MD
Studies of children with neurodevelopmental disorders have shown that receiving nutrition through a gastrostomy can improve clinical outcomes and quality of life. However, there is little information on gastrostomy and its effect in patients with neuromuscular disorders. A retrospective casenote review of all patients with a gastrostomy, followed-up at the Hammersmith Hospital, London, was undertaken to assess the indications for, and outcomes of, gastrostomy placement. Notes for 32 patients (17 males, 15 females) were reviewed (age range 32mo,31y; median age 12y 5mo). We found three main groups of diagnoses: congenital muscular dystrophy (n=15), structural congenital myopathies (n=11), and other neuromuscular disorders (n=6). Two main patterns of feeding problems were identified before gastrostomy: swallowing difficulties, and nutrition and growth problems. The follow-up period after gastrostomy was from 12 months to 19 years (mean 5y). Weight faltering was reversed in 17 out of 22 patients, and height faltering in 9 out of 14, where data were available. Twenty-six patients had a reduced frequency of chest infections. No significant complication of gastrostomy placement was documented. Twenty-eight patients or their families were happy with the results of the gastrostomy. Gastrostomy seems to have a substantial positive impact in patients with neuromuscular disease and feeding difficulties. [source]

A study of the effect of a resistive heat moisture exchanger (trachinaze) on pulmonary function and blood gas tensions in patients who have undergone a laryngectomy: A randomized control trial of 50 patients studied over a 6-month period

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 5 2003
Andrew Simpson Jones MD
Abstract Background. Previous work from this department has shown that resistive tracheostomy filters increase the partial pressure of oxygen in capillary blood and also provide a significant amount of heat/moisture exchange. Until now it has not been shown whether there is any long-term beneficial effect and in particular whether raised tissue oxygenation is maintained using a practical filter device. Methods. We carried out a 6-month randomized control trial including 50 laryngectomees. Twenty-five patients were treated with the Liverpool Heat Moisture Exchange device incorporating an airway resistor (Trachinaze). Another 25 patients were treated with a placebo device. Relevant subjective and objective data were collected before and at the end of the study. The objective measurements were capillary oxygen tension (which parallels blood arterial tension), carbon dioxide tension, FEV1, FVC, and PIF. Patients were reviewed at intervals throughout the study. Data were analyzed using the Mann,Whitney U test and the paired t test to test the difference between the active device and placebo at 6 months. Results. Subjective lower airway parameters, including cough, number of chest infections, mucus production, and shortness of breath at rest, were significantly improved in the active group compared with the placebo group. The objective parameters FEV1, FVC, and PIF were not significantly different. Capillary oxygen tension, however, was highly significantly raised in the active group at 6 months. Conclusions. Trachinaze is highly superior to placebo at improving subjective pulmonary parameters, including shortness of breath. It is also superior in its ability to maintain an increased peripheral tissue oxygen tension over a 6-month period. © 2003 Wiley Periodicals, Inc. Head Neck 25: 000,000, 2003 [source]

Laparoscopic cholecystectomy in the grossly obese: 4 years experience and review of literature

HPB, Issue 4 2002
M Hussien
Background Conventional abdominal surgery in grossly obese patients is associated with an increased rate of postoperative complications; thus, laparoscopic surgery may be preferred in these patients. Patients and methods A prospective analysis was performed of 20 grossly obese patients who underwent laparoscopic cholecystectomy between April 1996 and April 2000 for symptomatic non-complicated gallstone disease. Results Technical problems at operation included difficulty with induction of pneumoperitoneum and introduction of the most lateral subcostal port, retraction of the gallbladder fundus, the need for longer instruments and the closure of the fascia. Laparoscopic cholecystectomy was successfully completed in 19 patients, but one patient required conversion to open operation. There were no anaesthetic difficulties. Two patients developed minor chest infections. The mean hospital stay was 2.9 days. Conclusion Laparoscopic cholecystectomy is feasible and can be recommended for symptomatic gallstone disease in grossly obese patients. [source]

Long-term non-invasive positive airway pressure ventilation in infants

ACTA PAEDIATRICA, Issue 12 2008
Agneta Markström
Abstract Aim: To evaluate the clinical application of long-term non-invasive ventilation (NIV) in infants with life-threatening ventilatory failure with regard to: diagnosis, age at initiation, indication for and duration of treatment, clinical outcome and mortality and adverse effects. Patients and methods: The medical records of 18 infants treated in a home setting during a 7-year period were reviewed. The criteria for ventilatory support were: (a) transcutaneous partial pressures of carbon dioxide (TcPCO2) >6.5 kPa and oxygen (TcPO2) < 8.5 kPa and (b) decreased cough ability and/or recurrent chest infections. Results: The median age at initiation was 4 months (range 1,12). NIV was initiated because of hypoventilation in 12 infants and because of reduced cough ability and/or recurrent infections in six infants. Tracheotomy was eventually needed in two infants. The median duration of treatment was 24 months (range 1,84). NIV produced significant improvements, with median TcPCO2 falling from 9.9 to 6.1 kPa, and median TcPO2 rising from 9.8 to 11.1 kPa. Conclusion: NIV can be successfully and safely used in infants with prolonged life-threatening ventilatory failure, potentially avoiding intubation and tracheotomy. [source]