Search

A 74-year-old man presented to the Emergency Department after a fall from a ladder. Plain radiographic screening of the lumbar spine revealed an unanticipated curvilinear, oval-shaped air configuration in the pelvis. Computed tomography of the lumbar spine showed air within the bladder wall and lumen. Urine cultures were positive for Escherichia coli. The patient was discharged after bladder drainage and empiric antibiotic treatment.

A 34 year old male was admitted to our hospital with a severe pancreatitis. On a CT scan we diagnosed a developing emphysematous pancreatitis. This is a rare form of pancreatitis usually caused by an infection with an Escherichia coli.

A 72-year-old woman had reduced vision due to orbital emphysema after a blow-out fracture.

A 91-year-old woman with type 2 diabetes presented at the emergency ward subconscious with lower abdominal swelling. Evaluation revealed dehydration and hyperglycaemia, and abdominal x-ray showed an air space surrounding a severely swollen bladder. After excluding enterovesical fistulae, the patient was diagnosed with emphysematous cystitis. Treatment for urinary retention, antibiotic treatment and control of the diabetes mellitus resulted in a rapid recovery. A second patient, a 65-year-old woman with a history of recurrent urinary tract infections and urolithiasis, presented with irritative urinary symptoms and pain in the lower abdomen. Explicit inquiry revealed that she also had intermittent pneumaturia. Urethrocystoscopy revealed submucosal bullae, which are a hallmark of emphysematous cystitis. The patient was given intravenous antibiotic therapy. Diabetes mellitus is a risk factor for emphysematous cystitis. The disorder is treated by draining the bladder with an indwelling catheter and intravenous antibiotic therapy, selected according to the urine culture results. In general, orally administered antibiotics are insufficient.

Certain surgical techniques may improve pulmonary function, exercise capacity and quality of life in selected patients suffering from severe end-stage emphysema, who remain symptomatic despite maximal pharmacological and non-pharmacological treatment. Bullectomy can be offered to patients with a giant bulla; lung volume reduction surgery can be proposed to patients with severe but not catastrophic, heterogeneous emphysema; and lung transplantation may constitute an option in relatively young patients with end-stage, homogeneous emphysema associated with hypoxemia, hypercapnia and pulmonary hypertension. As lung volume reduction surgery is associated with significant morbidity and mortality, less invasive alternative treatments are currently being investigated. Recently, various bronchoscopic techniques have been developed. Intrabronchial placement of one-way valves in patients with heterogeneous emphysema, as well as the creation of extra-anatomical airways by means of bronchial perforation followed by placement of drug-eluting stents seem the most promising.

The literature on the possible complications of laparoscopic sterilization is reviewed. The reliability of this method and the correlation between its reliability and the surgeon's experience are discussed. In addition, a report is presented of the experience gained with the first 1000 laparoscopic sterilizations in a general hospital.