1/32. Cardiovascular collapse associated with extreme iatrogenic PEEPi in patients with obstructive airways disease.Chronic obstructive pulmonary disease (COPD) is commonly associated with positive alveolar pressure at end-expiration (intrinsic PEEP or PEEPi) caused by a prolonged expiratory time constant. Positive pressure ventilation (PPV) with large tidal volumes and high ventilatory frequencies may cause pulmonary hyperinflation, with increases in intrathoracic pressure and cardiopulmonary effects. We report two cases, one of fatal pulseless electrical activity, the other of life-threatening hypotension, both during vigorous manual PPV, in patients with severe COPD. This phenomenon has been well-recognized by intensivists but is reported poorly more widely.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
2/32. Bronchopulmonary levage to remove pulmonary casts and plugs.Therapy for such obstructive pulmonary lung diseases as alveolar proteinosis, pneumonia, asthma, bronchiectasis, and cystic fibrosis, ranges from medical therapy to inhalation therapy to direct bronchoscopy and irrigation. The basic pathophysiologic feature is the retention of mucous secretions and foreign material within the lungs and therapy directed to removal of these secretions. Bronchopulmonary lavage recently has been suggested as an effective tool toward resolution of these illnesses. The otolaryngologist, who is adept in endoscopy, is asked to perform bronchoscopic procedures with washings to aid in the alleviation of these obstructive pulmonary diseases. This paper deals with the effectiveness of massive bronchopulmonary lavage in the elimination of severe chronic obstructive pulmonary lung diseases.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
3/32. Pulmonary capillaritis and its relationship to development of emphysema in hypocomplementaemic urticarial vasculitis syndrome.Hypocomplementaemic urticarial vasculitis syndrome (HUVS) is a rare disorder characterised by complement activation and the presence of C1q precipitins together with a syndrome of urticarial vasculitis, angioedema, arthralgia, ocular inflammation, glomerulonephritis and obstructive lung disease. The pathophysiology of the obstructive airways disease is poorly understood. We report a 46 year-old woman with HUVS who developed progressive obstructive airways disease. Lung biopsy early in the course of her disease revealed pulmonary capillaritis. The disease progressed despite treatment with steroids and cyclosporin and the patient eventually underwent successful double lung transplantation. The explanted lung showed the coexistence of a patchy active vasculitis with severe panacinar emphysema. This is the first description of the histopathological process of HUVS in an explanted lung. Through analysis of serial histopathological specimens and clinical data we show the evolution of pulmonary capillaritis to emphysema, and demonstrate that active vasculitis can coexist with emphysema in patients with HUVS and obstructive airways disease. We suggest that there is a role for ongoing immunosuppressive therapy in these patients.- - - - - - - - - - ranking = 0.0039820263745213keywords = process (Clic here for more details about this article) |
4/32. Contaminated commercial charcoal as a source of fungi in the respiratory tract.OBJECTIVE: To investigate the possibility that contaminated commercial activated charcoal may serve as a source for fungal colonization or infection of the lower respiratory tract. DESIGN: The clinical course of a patient who aspirated commercial activated charcoal was reviewed. Fungal cultures were performed for 2 samples of an activated charcoal in sorbitol product from separate lots produced by a single manufacturer. Details of the manufacturing process were obtained from a representative of the manufacturer. SETTING: An intensive care unit in a large community teaching hospital. patients: A single patient with steroid-treated lung disease who developed a fatal pulmonary illness after aspirating a commercial activated charcoal product. RESULTS: After aspirating the charcoal product, the patient developed respiratory tract colonization and possible infection with aspergillus niger, paecilomyces variotii, and penicillium species. Similar fungal species were isolated from cultures of samples obtained from two separate lots of the same commercial activated charcoal product. Several opportunities for contamination during the manufacturing process were identified. CONCLUSIONS: physicians caring for immunocompromised patients should be aware that commercial activated charcoal products can be a source of fungal respiratory tract colonization that may mimic or cause pneumonia.- - - - - - - - - - ranking = 0.0079640527490427keywords = process (Clic here for more details about this article) |
5/32. Micronodular hyperplasia of type II pneumocytes--a new lung lesion associated with tuberous sclerosis.Open lung biopsy in a 38-year-old female with Pringle-Bourneville syndrome and recurrent pneumothorax revealed a micronodular pneumocyte II hyperplasia, a new entity probably associated with the tuberous sclerosis syndrome. The lesion caused an obstruction of the alveolar lymphatic vessels and alveolar ducts, resulting in an emphysema-like picture. This cystic dilation of alveoli and draining lymphatics followed by rupture caused the recurrent pneumothorax. The epithelial pneumocytic nature of the lesion was confirmed by immunohistochemistry and electronmicroscopy.- - - - - - - - - - ranking = 2keywords = alveolar (Clic here for more details about this article) |
6/32. Exacerbation of chronic obstructive pulmonary disease due to hyperinfection with strongyloides stercoralis.Pulmonary infection due to the filariform larvae of Strongloides stercoralis may occur in immunocompromised patients residing in endemic areas of the united states. Such infection usually presents as dyspnea with a cough that sometimes results in bloody sputum. Although the chest roentgenogram often reveals a patchy bilateral alveolar infiltrate, acute respiratory distress is unusual. We report a patient who experienced severe exacerbation of his underlying obstructive lung disease that was associated with chest infiltrates and recovery of S stercoralis from his sputum. Although initial improvement was accomplished with Thiobendazole treatment, a re-exacerbation occurred when antiparasitic therapy was completed. The persistence of his infection is correlated to factors that are commonly employed in the treatment of COPD but may be overlooked as predisposing causes of hyperinfection with S stercoralis.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
7/32. Biofeedback and progressive relaxation in weaning the anxious patient from the ventilator: a brief report.weaning patients with chronic obstructive pulmonary disease from mechanical ventilators is occasionally a long and difficult process complicated by the patient's fear of losing his or her breath during the weaning procedure. A case is presented of an anxious 58-year-old man who was taught to relax using biofeedback and progressive relaxation during aerosol "T-piece" weaning trials. The relaxation effect was elicited by having the patient contract and relax specific muscle groups in a progressive manner, to experience the difference between the states. Ear oximetry served as physiologic feedback as well as a safety feature in the event of oxygen desaturation during exercise. During and after the exercises he felt secure breathing without the ventilator as measured by the physiologic parameters: heart rate, respiratory rate, and oxygen saturation determined by oximetry.- - - - - - - - - - ranking = 0.0039820263745213keywords = process (Clic here for more details about this article) |
8/32. Athletic training in chronic obstructive pulmonary disease.Chronic obstructive pulmonary disease (COPD) is a common and very debilitating disease in the united states. COPD is characterized by plugging of airways with secretions, impaired airway integrity with airway collapse with effort, bronchospasm, frequent infections, destruction of alveolar tissue, and ventilation-to-perfusion inequality. This results in abnormalities in pulmonary mechanics and respiratory gas exchange, all of which make hyperventilation much less effective. However, research has shown that the pulmonary patient can improve work capacity in an exercise training program. Training also alleviates the severe emotional problems of anxiety, depression, and social isolation frequently present in COPD sufferers. Even the lowest level patient can frequently improve in a training program, and guidelines for the implementation of such a therapeutic regimen are provided.- - - - - - - - - - ranking = 1keywords = alveolar (Clic here for more details about this article) |
9/32. Digital signal processing of stridor and snoring in children.Stridor and snoring are common signs of upper airway obstruction. The nature and characteristics of the stridor and snoring depend upon the site of obstruction. Sophisticated analysis of these sounds may provide important information concerning the source of the sound helping to assess the patient more objectively. The preliminary results of computerized digital analysis of stridor and snoring sounds are presented in 5 children. Two main programs were applied to analyse the signal: the Power Spectral Density (PSD) function and the Estimated Cross-sectional Area (ECSA). A consistent pattern according to the site of the produced sound was seen. Further acoustical analyses are needed to standardize this method and to program the computer to indicate the various sites of lesions.- - - - - - - - - - ranking = 0.015928105498085keywords = process (Clic here for more details about this article) |
10/32. Severe spirometric defects in systemic lupus erythematosus. A possible role for bronchoalveolar lavage and gallium scanning.Two patients with systemic lupus erythematosus (SLE) developed progressive chronic pulmonary disease. Pulmonary bronchoalveolar lavage (BAL) and gallium-67 scanning were performed and were consistent with alveolitis. In one patient, an open lung biopsy was performed and showed the presence of several immunoreactants as well as interstitial pneumonitis. Although mild pulmonary function abnormalities are common in SLE, some patients such as the two described in this report develop progressive and incapacitating pulmonary impairment. The need for developing standardized indices of pulmonary inflammation such as BAL and gallium scanning for the purposes of diagnosis, prognostication, and monitoring treatment responses in systemic lupus erythematosus is stressed.- - - - - - - - - - ranking = 5keywords = alveolar (Clic here for more details about this article) |
| | Next -> |