Introduction:
Persistent pulmonary air leaks present a challenging clinical problem, often requiring surgical intervention that not all patients can withstand.
Patient concerns:
An elderly female with severe emphysematous Chronic Obstructive Pulmonary Disease and dependent on continuous home oxygen supplementation developed recurrent pneumothoraces. On evaluation, the patient was considered a poor surgical candidate for Video assisted thoracoscopic surgery, and therefore a less invasive approach to treat the recurrent pneumothoraces was required.
Diagnosis:
A diagnosis of recurrent right pneumothorax due to Pulmonary-parenchymal fistula (either alveolo-pleural fistula or broncho-pleural fistula) was made
Interventions:
Due to the fragile overall condition of the patient, the peri-procedure risk of video assisted thoracoscopic surgery was not acceptable. Hence bronchoscopic evaluation with an endobronchial blood patch with thrombin injection was performed using a swan-ganz catheter.
Outcomes:
The patient had significant reduction in air leak post procedure and achieved complete resolution on day 3. She was successfully discharged home later.
Conclusion:
In patients with significant comorbidities that preclude standard interventions for persistent pulmonary-pleural fistulas, endobronchial blood patch repair with thrombin injection can be safely performed utilizing a swan-ganz catheter.
The early neonatal neurobehavioral scale ‘was administered to three groups of newborns at 2, 4, and 24 hours of age. Group 1 consisted of 28 babies whose mothers had received no narcotics during labor, group 2 of 33 babies whose mothers had received meperidine hydrochloride alone during labor, and group 3 of 40 babies whose mothers had received meperidine followed by 0.4 mg of naloxone hydrochloride intravenously approximately 15 minutes before delivery. Babies who were not exposed to meperidine showed a statistically significantly greater percentage of high scores than those exposed to meperidine alone for all items on the neurobehavioral scale at 2 and 4 hours and for all items except tone and Moro response at 24 hours. Similarly, babies whose mothers had received meperidine and naloxone showed a significantly greater percentage of high scores than those whose mothers had received meperidine alone at 2 hours of age. At 4 hours a difference was found for tone and rooting and at 24 hours for overall score, placing, and total decrement score. It is concluded that naloxone given intravenously to the mother reverses the effect of meperidine on neonatal neurobehavior for approximately two hours after birth. At 4 and 24 hours, however, the neurobehavior of neonates exposed to meperidine and naloxone is depressed almost as much as that of babies exposed to meperidine alone.
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