1/129. The use of REE determination in a clinical setting applied to respiratory disease. The determination of a patient's nutritional condition is an important moment of clinical evaluation in everyday experience. Quite often, it is important to identify symptoms, signs and objective parameters that may reveal a malnourished condition. To satisfy this request, clinicians recur to clinical examination and biochemical tests. It is also possible to use indirect calorimetry. Through the evaluation of oxygen consumption (VO2) and carbon dioxide production (VCO2), indirect calorimetry permits the respiratory quotient (RQ) to be calculated and the exact energy consumption during resting conditions to be determined. This technology, currently used in research departments and in hospital units, is more accurate for the estimation of resting energy expenditure (REE) than the Harris-Benedict equation, especially in the case of patients affected by respiratory diseases or other systemic conditions. The evaluation of REE through indirect calorimetry is a useful monitoring and prognostic index in acutely and chronically ill patients. ( info) |
2/129. Emergence of rifampin-resistant streptococcus pneumoniae as a result of antimicrobial therapy for penicillin-resistant strains. A multidrug-resistant strain of streptococcus pneumoniae was isolated in The netherlands during a nosocomial outbreak among 36 patients who mainly had chronic obstructive pulmonary disease. After the commencement of barrier nursing and short-term ceftriaxone-rifampin eradication therapy, the epidemic ceased. However, eradication therapy failed in 3 patients, and follow-up investigation of these patients showed the emergence of rifampin-resistant isolates. ( info) |
| Pseudomembranous colitis usually presents with diarrhea in a clinical setting of recent antibiotic use. It is uncommon to see it as a cause of obstipation and colonic pseudo-obstruction. We report an unusual case of an elderly woman with hypertension, congestive heart failure, chronic obstructive pulmonary disease, chronic renal insufficiency, and diabetes mellitus, who was admitted with fever, abdominal pain, and distension without diarrhea. She presented with decreased stool frequency and obstipation. She did not respond to conservative management. colonoscopy revealed a picture of pseudomembranous colitis, and clostridium difficile toxin was positive. She responded well to metronidazole therapy. ( info) |
4/129. cardiac tamponade secondary to chest tube placement. A 69-year-old woman was hospitalized because of a left-sided pneumothorax due to chronic obstructive pulmonary disease. During chest tube placement she developed hypotension and a decrease in peripheral oxygen saturation. A diagnosis of heart tamponade was made and the patient was treated successfully with pericardiocentesis and placement of a pericardial drain. cardiac tamponade following chest tube placement is a rare and serious complication. When the clinical condition deteriorates following chest tube insertion, cardiac tamponade should be considered. ( info) |
5/129. 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. ( info) |
6/129. Autocycling and increase in intrinsic positive end-expiratory pressure during mechanical ventilation. Modern ventilators are complicated electronic instruments with microprocessors and software, with the possibility of technical errors and problems such as autocycling. Despite autocycling being recognized as a problem in textbooks and reviews, there are few reports about autocycling in the literature. We report a case where a sudden increase in respiratory frequency due to autocycling resulted in a dangerous increase in intrinsic positive end-expiratory pressure (intrinsic PEEP, PEEPi). We think our case illustrates that autocycling does occur, but that the exact underlying mechanism may be hard to document and understand for clinicians. To remedy this situation, we suggest that manufacture-independent technical expertise should be established to evaluate incidents and suggest improvements. ( info) |
7/129. Translaryngeal open ventilation to treat acute respiratory failure in acute exacerbation of chronic obstructive pulmonary disease. A preliminary report. PURPOSE: To describe a minimally invasive alternative to conventional mechanical ventilation, using a small size uncuffed nasotracheal tube (translaryngeal open ventilation) paired with pressure control ventilation, in acute respiratory failure complicating chronic obstructive pulmonary disease (COPD). Clinical features: Two cooperative COPD patients, who failed noninvasive mechanical ventilation, were intubated nasotracheally. Mechanical ventilation was initiated in pressure control mode via an uncuffed 6 mm tube. RESULTS: respiratory rate improved after 1 hour (from 44 to 28 breaths*min(-1) in case 1 and from 32 to 25 breaths*min(-1) in case 2); PaC0(2) decreased (from 120 to 62 mmHg in case 1 and from 69 to 51 mmHg in case 2); with pressure control mode levels of 45 cm H(2)O and 55 cm H(2)O respectively. PaO(2) increased from 40 mmHg (with FIO(2) 0.3) to 55 mmHg (with FIO(2) 0.3) in the first patient and from 55 mmHg (with FIO(2) 0.4) to 60 mmHg (with FIO(2) 0.4 ) in the second patient; pH improved from 7.18 to 7.31 in case 1 and from 7.22 to 7.39 in case 2. patients were able to trigger the ventilator, speak, swallow and to clear secretions spontaneously. Both patients were ventilated for three days in this manner without any adverse effects. Both survived and were discharged home after 20 and 18 days in hospital respectively. CONCLUSION: This very preliminary report suggests that, in carefully selected patients who fail mask ventilation, mechanical support with translaryngeal open ventilation can improve gas exchange, breathing pattern and tachypnea, without hindering glottic function. ( info) |
8/129. Endoscopic repair of bronchial dehiscence after lung transplantation. We report a case of bronchial dehiscence after right single lung transplantation and describe a novel means of management: bronchoscopic closure of the defect with alpha-cyanoacrylate glue. ( info) |
9/129. 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. ( info) |
10/129. rifabutin-induced cystoid macular oedema. rifabutin is a semi-synthetic antimycobacterial agent mainly used in the treatment of mycobacterium avium-complex (MAC) in AIDS patients. rifabutin-induced anterior uveitis has been reported previously. We report the case of a rifabutin-induced cystoid macular oedema (CMO) in an immunocompetent patient with pulmonary MAC infection. As far as we know, CMO secondary to rifabutin therapy has not been described previously. ( info) |