1/11. Possible levofloxacin-induced acute hepatocellular injury in a patient with chronic obstructive lung disease.levofloxacin is one of the most commonly prescribed antibiotics for both inpatient and outpatient care of respiratory tract infection. It is generally well tolerated, and it has an excellent safety profile. We report a case of severe acute liver toxicity that apparently complicated intravenous administration of levofloxacin, which resolved after discontinuation of the drug.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
2/11. Varicosities of the valleculae: an unusual cause of hemoptysis?hemoptysis is a common respiratory symptom causing a great deal of anxiety. The cause is often apparent following a clinical history, upper-airway examination, bronchoscopy, and CT scanning of the thorax. We present a case of massive hemoptysis, the etiology of which was not readily apparent despite this conventional approach. Vallecular hemorrhage has been previously reported but is usually minor unless associated with surgical trauma, and can be readily missed if not aware of the possibility. We speculate about the etiology and mechanism for recurrent hemorrhage.- - - - - - - - - - ranking = 3.3703970265692E-5keywords = upper (Clic here for more details about this article) |
3/11. Congenital high airway obstruction syndrome and airway reconstruction: an evolving paradigm.OBJECTIVES: To refine the classic definition of, and provide a working definition for, congenital high airway obstruction syndrome (CHAOS) and to discuss the various aspects of long-term airway reconstruction, including the range of laryngeal anomalies and the various techniques for reconstruction. DESIGN: Retrospective chart review. PATIENTS: Four children (age range, 2-8 years) with CHAOS who presented to a single tertiary care children's hospital for pediatric airway reconstruction between 1995 and 2000. CONCLUSIONS: To date, CHAOS remains poorly described in the otolaryngologic literature. We propose the following working definition for pediatric cases of CHAOS: any neonate who needs a surgical airway within 1 hour of birth owing to high upper airway (ie, glottic, subglottic, or upper tracheal) obstruction and who cannot be tracheally intubated other than through a persistent tracheoesophageal fistula. Therefore, CHAOS has 3 possible presentations: (1) complete laryngeal atresia without an esophageal fistula, (2) complete laryngeal atresia with a tracheoesophageal fistula, and (3) near-complete high upper airway obstruction. Management of the airway, particularly in regard to long-term reconstruction, in children with CHAOS is complex and challenging.- - - - - - - - - - ranking = 0.00010111191079708keywords = upper (Clic here for more details about this article) |
4/11. A patient with a severe chronic airway obstruction and preserved exercise capacity (a case report).We report a patient with chronic obstructive pulmonary disease (COPD) in whom severe lung function disorders are combined with completely preserved exercise capacity. We assessed the exercise capacity of a 44-year-old man (height 155 cm, BMI 19.6 kg.m-2, FEV1%pred. = 30.9%, FRC%pred. = 158%, KCO%pred. = 46.2%, PaO2 = 64.0 mmHg, Medical research Council dyspnea scale = 1, Baseline dyspnea Index = 10) by the 6-minute walking distance test (6MWD) and the symptom-limited cardiopulmonary exercise test (CPET) on a treadmill using the Bruce protocol. The patient was able to walk 667 meters in the test and achieved peak relative oxygen consumption (VO2/kg) of 21.9 mL.min-1.kg-1. We attribute the preserved exercise capacity of the patient to the combined beneficial effect of the following factors: 1. Efficient extraction of the hemoglobin-transported oxygen from the alveoli (P50 = 3.10 kPa). 2. Optimal right ventricle remodelling with mild hypertrophy, without dilatation and congestion. 3. Hypoxic normoxemia without polyglobulia, resulting in good rheologic properties of blood. 4. A preserved locomotory activity of the patient. Such a combination of severe lung function disorders with mildly pronounced dyspnea and preserved exercise capacity supports the concept that the function profile of COPD patients is multidimensional and therefore such patients should have a complete assessment of their disability condition.- - - - - - - - - - ranking = 0.00025107529556315keywords = tract (Clic here for more details about this article) |
5/11. Quinolone-associated tendonitis: a potential problem in COPD?BACKGROUND: Quinolones have traditionally had limited application in the area of community-acquired respiratory tract infections due to poor cover against streptococcus pneumoniae. This trend is changing with the broader spectrum of newer fluoroquinolones. A rare serious side effect of fluoroquinolones is tendinopathy. AIMS: This study describes two cases of levofloxacin-associated tendinopathy in patients with severe chronic obstructive pulmonary disease (COPD) and the implications and mechanisms involved are discussed. CONCLUSIONS: The finding of two cases of levofloxacin-induced tendinopathy in our patients suggests that the problem may be more frequent than previously considered. Patients with COPD treated with fluoroquinolones may have other risk factors for tendinopathy such as advanced age, corticosteroid use and renal impairment and merit vigilance for signs of tendonitis.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
6/11. Primary pulmonary leiomyosarcoma. Report of a case diagnosed by fine needle aspiration cytology.BACKGROUND: Primary pulmonary leiomyosarcoma is a rare but important entity. We report a case diagnosed by fine needle aspiration cytology. CASE: A 73-year-old male presented with an asymptomatic, right, pulmonary, subpleural nodule detected by computed tomography during follow-up for chronic obstructive pulmonary disease. Fine needle aspiration cytology showed cellular smears with numerous single or loosely cohesive groups of spindle-shaped to round cells. The tumor cell nuclei were blunt ended (cigar shaped), with fine to fine-granular chromatin, prominent nucleoli and an irregular nuclear rim. The tumor cells were positive for desmin and negative for cytokeratin and S-100 protein by immunocytochemistry. Right upper lobectomy with lymph node dissection was performed. Pathologic diagnosis after microscopic, immunohistochemical and electron microscopic studies was leiomyosarcoma. CONCLUSION: To our knowledge, this is the first reported case of primary pulmonary leiomyosarcoma arising in the subpleural region diagnosed by fine needle aspiration cytology. Immunocytochemistry was useful in establishing the diagnosis in this case.- - - - - - - - - - ranking = 3.3703970265692E-5keywords = upper (Clic here for more details about this article) |
7/11. Horizontal transfer of the gene encoding outer membrane protein P2 of nontypeable haemophilus influenzae, in a patient with chronic obstructive pulmonary disease.An adult with chronic obstructive pulmonary disease was monitored prospectively for 2 years. Nontypeable haemophilus influenzae was isolated from sputum cultures at 22 of 23 monthly clinic visits. Analysis of the isolates, by pulsed-field gel electrophoresis (PFGE), revealed that the patient was colonized by 3 different strains during the 2-year period. The gene encoding outer-membrane protein (OMP) P2, ompP2, was amplified from sputum samples and selected strains obtained from this patient. Analysis of the ompP2 sequences, in combination with the PFGE patterns, indicated that ompP2 horizontal transfer between 2 strains occurred in the respiratory tract, between clinic visits 13 and 14. observation of ompP2 horizontal transfer in the human respiratory tract has important implications for both the understanding of ompP2 diversity among strains and the future design of OMP P2-based vaccines.- - - - - - - - - - ranking = 0.14614047197346keywords = respiratory tract, tract (Clic here for more details about this article) |
8/11. tracheomalacia associated with Mounier-Kuhn syndrome in the intensive care Unit: treatment with Freitag stent. A case report.tracheomalacia is a process characterized by softness of the supporting tracheal cartilages, by the extension of the posterior membranous wall and by reduction of the tracheal antero-posterior diameter. Exceptionally, tracheomalacia can be associated with tracheobronchomegaly or Mounier-Kuhn syndrome. Fibro-bronchoscopy represents the ''gold standard'' for diagnosis. The case of a 79-year-old male observed after hospitalization in a medical ward for chronic pulmonary obstructive disease (COPD) decompensation, and with basal left bronchopulmonary focus, is described. During this period, a progressive worsening of clinical conditions occurred, despite cortisone and antibiotic therapy, and the patient was transferred to the ICU for dyspnea, hypoxia, hypocapnia and with a diagnosis of pulmonary fibrosis. bronchoscopy, performed during spontaneous breathing, revealed tracheomalacia which was responsible for tracheal dynamic complete stenosis during expiration and dynamic subtotal stenosis of the left primary bronchus in the first tract, together with sputum retention. Moreover, this investigation confirmed the diagnosis of tracheobronchomegaly already seen on CT. It was suggested to place a Freitag stent, since the insertion of another model would not have had enough chance of stability, due to the enormous extension of the tracheal lumen and could not have guaranteed good clearance of the secretions. Seven days after this intervention, performed in an outpatients' setting, the patient was dismissed from the ICU, without the help of O2, with good ventilation, saturation in line with his age and good expectoration.- - - - - - - - - - ranking = 0.00025107529556315keywords = tract (Clic here for more details about this article) |
9/11. ciprofloxacin treatment failure in a patient with resistant streptococcus pneumoniae infection following prior ciprofloxacin therapy.Reported here is the case of a patient with underlying chronic obstructive pulmonary disease (COPD) in whom ciprofloxacin treatment of a lower respiratory tract infection failed subsequent to ciprofloxacin treatment of an exacerbation of COPD several weeks earlier. During the second course of ciprofloxacin therapy, the patient's condition continued to deteriorate, and she was admitted to the intensive care unit. Bilateral pneumonia was diagnosed. streptococcus pneumoniae, serotype 11A, resistant to ciprofloxacin was isolated from the sputum. Sequencing revealed a S79F mutation in parC and there was evidence of an efflux pump. The patient improved rapidly after administration of azithromycin and ampicillin/sulbactam. This report of treatment failure due to ciprofloxacin-resistant streptococcus pneumoniae shows that fluoroquinolones should be avoided when treating patients who have recently received this class of antibiotics.- - - - - - - - - - ranking = 1keywords = respiratory tract infection, respiratory tract, tract infection, tract (Clic here for more details about this article) |
10/11. Failure of NIV in acute asthma: case report and a word of caution.noninvasive ventilation (NIV) is the provision of ventilatory support without the need for an invasive airway, and has revolutionized the management of patients with diverse forms of respiratory failure. The advantages of NIV include improved patient comfort and reduced need for sedation, while avoiding the complications of endotracheal intubation, including upper airway trauma, sinusitis, otitis, and nosocomial pneumonia. In selected patients, NIV has also been shown to improve survival. The role of NIV in acute severe asthma is at best controversial. In this case report, we describe a patient with acute severe asthma who was initially managed and failed with NIV, and was successfully managed with invasive ventilation. We also review the pathophysiological mechanisms of benefit of NIV in acute severe asthma, and the current literature on the use of NIV in acute asthma. In conclusion, a trial of NIV in acute asthma may be justified in carefully selected and monitored patients who do not respond to initial medical therapy. However, as its role is not clear and as the condition of an asthmatic patient may deteriorate abruptly, extreme caution is advisable to recognize failure of NIV as in the case presented here. Facilities for immediate endotracheal intubation and next level of treatment should be readily available.- - - - - - - - - - ranking = 3.3703970265692E-5keywords = upper (Clic here for more details about this article) |
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