Cases reported "Airway Obstruction"

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1/101. Upper airway obstruction--a report on sixteen patients.

    In sixteen patients with upper airway obstruction, breathlessness was a symptom in all with maximum mid vital capacity flow rates in inspiration or expiration of 1-7 litres per second or less. With one exception, all these patients had stridor. The stridor was inspiratory in nine, expiratory in one and both inspiratory and expiratory in two. There was no diagnostic difficulty in the twelve patients with extrathoracic airway obstruction and in this group tests of inspiratory flow (forced inspired volume in one second, peak inspiratory flow or maximum mid inspiratory flow) were of most value in following the progression of the disease and the response to treatment. Flow volume loops were particularly useful where extrathoracic obstruction and diffuse intrapulmonary airway obstruction co-existed. The two patients with intrathoracic upper airway obstruction caused considerable difficulty with diagnosis and both were initially thought to have, and treated unsuccessfully for, asthma. In each patient flow volume loops showed a low flow expiratory plateau, diagnostic of severe intrathoracic airway obstruction but recorded in the absence of any clinical or radiographic features of emphysema. An obstructing lesion of the intrathoracic trachea was therefore suspected and this was confirmed by tracheal tomography. In one patient serial expiratory flow volume curves demonstrated the combination of intrathoracic upper and lower airway obstruction. Two patients had tracheal stenosis in the region of the suprasternal notch. Each showed a characteristic twin humped expiratory flow volume curve and in one patient the stenosis was demonstrated both physiologically and radiologically to move in and out of the thorax. The importance of a standard posture during serial measurements is emphasized. The ratio of forced expired volume in one second measured in millilitres, to the peak expiratory flow measured in litres per minute, was of limited value if differentiating upper from lower airway obstruction in these patients. It is concluded that upper airway obstruction is likely to become more common and that respiratory function tests, in particular the flow volume loop, play an essential part in the recognition and management of this problem.
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keywords = vital capacity, capacity, volume
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2/101. The answer is blowing in the wind: a pedunculated tumour with saw tooth flow-volume loop.

    Obstructing tumours of the upper airways have been demonstrated to alter the flow volume loop of pulmonary function testing. These alterations could be clues to the nature and location of the obstruction. This report describes a case of a pedunculated squamous cell carcinoma arising in the pharynx whose flow volume loop showed a saw tooth pattern which reflected the location and structure of the tumour.
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ranking = 0.002158974336913
keywords = volume
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3/101. Pulmonary lymphangioleiomyomatosis. A study of 69 patients. Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P).

    Pulmonary lymphangioleiomyomatosis (LAM) is a rare disorder of unknown cause characterized by peribronchial, perivascular, and perilymphatic proliferation of abnormal smooth muscle cells leading to cystic lesions. The hypothesis of hormonal dependence and the effectiveness of hormonal therapy have not yet been demonstrated conclusively, and the prevalence of extrathoracic manifestations and the survival of patients with LAM are somewhat contradictory. A multicentric retrospective study was conducted in an attempt to describe better the initial features, the diagnostic procedures, the associated lesions, and, above all, the management and course of LAM in a large homogeneous series of 69 stringently selected patients, with a majority of cases diagnosed since 1990. The aim of the study, based on a review of the literature, also was to provide a comprehensive view of this uncommon disease. The clinical features were in keeping with previous studies, but we found that exertional dyspnea and pneumothorax were the most common features, and chylous involvement was less frequent. LAM was diagnosed after menopause in about 10% of cases. The onset of LAM occurred during pregnancy in 20% of cases, and a clear exacerbation of LAM was observed in 14% of cases during pregnancy. Pulmonary LAM was diagnosed on lung histopathology in 83% of cases, but renal angiomyolipoma, observed in 32% of our patients, may be a useful diagnostic criterion when associated with typical multiple cysts on chest CT scan or with chylous effusion. Chest CT scan was more informative than chest X-ray (normal in 9% of cases), and may be indicated in spontaneous pneumothorax or renal angiomyolipoma in women of childbearing age. About 40% of the patients had a normal initial spirometry, while an obstructive ventilatory defect (44%), a restrictive ventilatory defect (23%), was observed in other patients. Initial diffusing capacity for carbon monoxide was frequently decreased (82%). Hormonal therapy was administered in 57 patients, but a clear > or = 15% improvement of FEV1 was observed in only 4 evaluable patients, treated with tamoxifen and progestogens (n = 2), progestogen (n = 1), and oophorectomy (n = 1). Probably 1 of the most urgent needs for clinical research in LAM is to test the currently available hormonal treatments in the context of international multicenter prospective controlled studies. pleurodesis was performed in 40 patients. lung transplantation was performed in 13 patients, 7.8 /- 5.2 years after onset of LAM, in whom the mean FEV1 was 0.57 /- 0.15 L. After a follow-up of 2.3 /- 2.2 years, 9 patients were alive. Mean follow-up from onset of disease to either death or closing date was 8.2 /- 6.3 years. overall survival was better than usually reported in LAM, and Kaplan-Meier plot showed survival probabilities of 91% after 5 years, 79% after 10 years, and 71% after 15 years of disease duration.
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ranking = 0.0058258274992238
keywords = capacity
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4/101. prenatal diagnosis of tracheal obstruction: possible association with maternal pertussis infection.

    A fetus with the sonographic appearance of echogenic and enlarged lungs and dilated trachea and bronchi, indicating laryngotracheal obstruction, is reported. Additionally, the fetus had ascites and subcutaneous edema and the amniotic fluid volume was reduced. Doppler flow investigation of the systemic venous circulation revealed signs of heart failure, and color Doppler visualized possible increased pulmonary flow. Following termination of pregnancy, autopsy confirmed the sonographic observations and revealed a hypoplastic thymus. During the present pregnancy the mother suffered from sustained cough, and serological tests revealed acute pertussis infection. polymerase chain reaction investigation for bordetella pertussis in the amniotic fluid was negative. The possibilities of pertussis toxins as noxious factors and of an atypical presentation of DiGeorge anomaly are discussed.
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ranking = 0.00035982905615217
keywords = volume
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5/101. Obstructive airway disease associated with heterozygous alpha-1-antitrypsin deficiency.

    Twenty-eight members of one family were investigated for the presence of pulmonary disease concurrent with variable (ZZ, MZ, or MS) degrees of alpha-1 antitrypsin deficiency. Three symptomatic siblings (2, ZZ; 1, MZ) had abnormal pulmonary scans and abnormal routine pulmonary function studies. Five asymptomatic heterozygotes, three of whom had never smoked and were the youngest studied, had distinctly abnormal closing volumes. Three of the five patients also had abnormal perfusion dynamics when scanning was done in the upright position. Pulmonary dysfunction occurs in asymptomatic heterozygotes but requires the use of sensitive techniques for its appreciation.
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keywords = volume
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6/101. Relief of central airways obstruction following spinal release in a patient with idiopathic scoliosis.

    SUMMARY. patients with idiopathic scoliosis are reported to have a restrictive pattern on pulmonary function tests. A case is presented of a teenage girl with juvenile idiopathic scoliosis who had evidence of airways obstruction in addition to restriction on pulmonary function tests (PFT). Examination of flow-volume loops suggested central airways obstruction. At the time of induction of anesthesia for the initial spinal release surgery, a double-lumen endotracheal tube could not be passed, despite fiberoptic visualization, because of extreme deviation of the left main-stem bronchus. Postoperatively, PFT demonstrated improved flows at high lung volumes and normalization of the shape of the flow volume loop. We suggest that preoperative PFT may be used to predict which patients have central airways obstruction. This may lessen unanticipated problems with intubation at the time of surgery and may identify patients who may expect immediate improvement in lung function after scoliosis repair.
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ranking = 0.0010794871684565
keywords = volume
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7/101. Atypical expiratory flow volume curve in an asthmatic patient with vocal cord dysfunction.

    BACKGROUND: vocal cord dysfunction can coexist with or masquerade as asthma. vocal cord dysfunction, when coexistent with asthma, contributes substantially to the refractory nature of the respiratory problem. OBJECTIVE: To report a case of an asthmatic patient with vocal cord dysfunction and a previously unreported unique expiratory flow volume curve. RESULTS: A 16-year-old female, known to have asthma, developed increased frequency of her asthma exacerbations. spirometry, during symptoms, showed an extrathoracic airway obstruction with a reproducible unique abrupt drop and rise in the expiratory flow volume loop. laryngoscopy showed adduction of the vocal cords during inspiration and expiration. CONCLUSIONS: We report a unique expiratory flow volume curve in an asthmatic with vocal cord dysfunction that resolved with panting maneuvers. speech and psychological counseling helped prevent future attacks.
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ranking = 0.0025188033930652
keywords = volume
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8/101. Upper airway obstruction due to rhinoscleroma: case report.

    rhinoscleroma is a very rare cause of upper airway obstruction with only isolated reports in the literature of rhinoscleroma with isolated tracheal obstruction. The course is usually chronic with the presentation most often being non-specific. We report a 54-year-old woman with progressive shortness of breath and wheezing over 7 years' duration. She was diagnosed and treated as bronchial asthma without improvement in her symptoms. At the time of referral to our institution, her flow-volume loop revealed fixed upper airway obstruction. Her chest radiography and other laboratory tests were normal. bronchoscopy revealed a 70-80% irregular concentric stenosis of the trachea beginning immediately below the vocal cords and extending 4 cm distally. biopsy showed characteristic Mikulicz histiocytes containing numerous gram-negative intracellular coccobacilli consistent with a diagnosis of rhinoscleroma. The patient was treated with laser resection of the stenosis followed by a course of ciprofloxcin and trimethoprim-sulfamethoxazole. She has remained asymptomatic over a year follow-up period and repeated biopsies have shown no evidence of recurrence.
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ranking = 0.00035982905615217
keywords = volume
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9/101. A clinical report about an unusual occurrence of post-anesthetic tongue swelling.

    dentures are routinely removed from the oral cavity before general anesthetic procedures. They are only reinserted much later when the patient returns to the room. This clinical report describes an edentulous patient who developed acute tongue swelling from venous congestion as a result of tongue recovery from general anesthesia. Her complete dentures were used to separate the residual ridges during the recovery period and relieved the congestion. Denture insertion increased the height and volume of the oral cavity, which reduced pressure on the tongue, preventing a cycle of tongue compression, congestion, and swelling. This unusual complication suggests that it may be prudent for the edentulous patient to be accompanied by their dentures in the perioperative period.
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ranking = 0.00035982905615217
keywords = volume
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10/101. Bag-mask ventilation as a temporizing measure in acute infectious upper-airway obstruction: does it really work?

    jaw-thrust and bag-mask ventilation usually provide adequate oxygenation in patients with acute infectious upper-airway obstruction (AIUAO). It is the treatment of choice for patients on the way to hospital or in an emergency department until definitive stabilization is achieved with available resources. We report three fatal case studies showing ineffective bag-mask ventilation in AIUAO that raise concerns over this treatment. Case 1 is a 4-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 2 is a 3-year-old patient with epiglottitis who suffered complete obstruction during transport to the hospital. Case 3 is a 3-year-old child with viral laryngotracheitis and respiratory arrest just after the admission. Should the approach of bag-mask ventilation in AIUAO change to ventilate patients in the prone position? This approach offers two advantages. First, gravity helps the epiglottis fall forward, reducing the airway obstructions. Second, if the patient vomits during ventilation, the vomit will fall to the floor. During bag-mask ventilation in patients with severe partial airway obstruction, ventilation pressure is high. Gastric inflation may occur and rapidly distend the stomach. This gastric distension interferes with ventilation by elevating the diaphragm, resulting in a decreased lung volume. Cricoid pressure could prevent gastric distension in these instances and should be recommended.
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ranking = 0.00035982905615217
keywords = volume
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