Cases reported "Anoxia"

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11/29. Positive airway pressure for high-altitude pulmonary oedema.

    Expiratory positive airway pressure was studied on Mount McKinley, alaska, at an altitude of 4400 m, in three climbers with high-altitude pulmonary oedema and five climbers without evidence of this disorder. In the subjects with high-altitude pulmonary oedema oxygen saturation improved from 53.3 /- 10.1% to 72.0 /- 5.7% with expiratory positive airway pressure of 10 cm water. oxygen saturation, heart rate, and respiratory rate did not change in healthy climbers. No adverse effects were noted. Improved oxygen saturation did not persist when expiratory positive airway pressure was discontinued. This procedure may be useful as a temporary first-aid measure in high-altitude pulmonary oedema.
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keywords = airway
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12/29. Treatment of alveolar hypoventilation in a six-year-old girl with intermittent positive pressure ventilation through a nose mask.

    persons with alveolar hypoventilation have abnormal daytime arterial blood gases and abnormal responses to hypercapnia and hypoxia in the absence of any identifiable lung or neuromuscular disease. The underlying defect in the control of breathing has not, however, been confirmed. We studied a 6-yr-old girl who was admitted in respiratory failure after a long history of disturbed breathing awake and asleep, which had been diagnosed as primary alveolar hypoventilation, (PaCO2 = 120). After several days of endotracheal intubation and assisted ventilation, her condition improved and she was extubated. At this time her ventilatory response to hypoxia was absent (VE/SaO2:0.1 l/min/% at a CO2 of 45) and there was a right-shifted response to hypercapnia (VE/PaCO2:2.6 l/min/mmHg). As obstructive sleep apnea was suspected, nocturnal nasal continuous positive airway pressure (CPAP) was tried; however, it was not effective in maintaining arterial oxyhemoglobin saturation. Definite central apneas were observed during sleep both with and without nasal CPAP, and there was an absence of snoring. Her condition deteriorated, and there was a progressive increase in her awake arterial CO2 levels for a period of 4 wk. The IPPV with 5 cm H2O of PEEP was administered through a nose mask during sleep and this maintained both oxygen saturation and transcutaneous CO2 levels within the normal range. After 10 days of nocturnal assisted ventilation, the hypercapnic response returned to the normal position (VE/CO2:2.1 l/min/mmHg).(ABSTRACT TRUNCATED AT 250 WORDS)
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ranking = 0.14285714285714
keywords = airway
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13/29. Differential ventilation in acute respiratory failure. Indications and outcome.

    Acute respiratory failure (ARF) is a life-threatening condition which frequently requires ventilatory support. Many patients die of hypoxaemia despite a high inspired oxygen concentration and application of general positive end-expiratory pressure (PEEP). Differential ventilation has been used in selected patients with unilateral lung disease or with large inequalities in pathology between the two lungs. An important contributor to the hypoxaemia is a vertical inequality in the ventilation-perfusion (V/Q) matching. This can be compensated for by placing the patient in the lateral position, ventilating each lung separately in proportion to its assumed blood flow, and applying PEEP selectively to the dependent lung to counteract airway closure and alveolar collapse and thus improve the gas distribution within that lung. This ventilatory regime should promote V/Q matching better than general PEEP, and will not impede cardiac output. Major improvement in gas exchange has been achieved in short-term experiments and in prolonged ventilator treatment of patients with ARF.
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ranking = 0.14285714285714
keywords = airway
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14/29. Nasal continuous positive airway pressure in the treatment of whooping cough.

    A 3-week-old baby, suffering from whooping cough with severe attacks of apnoea and hypoxia, was treated by nasal CPAP with a positive airway pressure of about 5 cm H2O. The respiration improved rapidly and the transcutaneous oxygen tension increased to a normal level. The treatment was carried on for 7 days and discontinued gradually in the course of 3 days. The child was also treated with pertussis immunoglobulin and erythromycin. The CPAP system employed is easily and rapidly applied and allows normal nursing of the child during the treatment and manual lung physiotherapy in upright position. The treatment probably proved lifesaving.
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ranking = 0.71428571428571
keywords = airway
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15/29. Wrapped to death. Unusual autoerotic death.

    Despite the large population of new orleans, including many homosexual and transsexuals, there have been relatively few cases of autoerotic deaths. The case reported here is an interesting one as it includes a bizarre form of autoerotic behavior from the standpoint of the method used. There have been no deaths reported in the literature in which the victim died as a result of jeopardizing himself by enclosing his body into plastic with an airway out of his "cocoon" in the form of a snorkel tube. He was engaged in masturbation when he apparently lost his mouth piece or airway. He attempted to use a knife to cut himself out.
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ranking = 0.28571428571429
keywords = airway
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16/29. Principles for safety in application of neodymium-YAG laser in bronchology.

    The YAG laser is being used more often in cases of nonresectable bronchogenic cancer and in some cases is called on in lieu of surgery for tracheal stenosis. patient safety hinges first on the endoscopist's technical skill and second on his understanding of the dangers involved in laser therapy. This report is based on experience gleaned from a 1,503 case series of endoscopic YAG laser treatments on 839 patients. These treatments were carried out by seven endoscopists in four teams using exactly the same equipment and techniques. In spite of the use of this high-risk technique in a high-risk patient population comprising a majority of major airways malignancy, the mortality rate was only 0.4 percent (six deaths: all in the postoperative period). We attribute this success to careful screening prior to resection, whenever possible, and above all to our methodology which not only emphasizes prevention but also enables rapid response.
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ranking = 0.14285714285714
keywords = airway
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17/29. multiple organ failure after near-hanging. A case report.

    Near-hanging and strangulation injuries can result in multiorgan failure. A 13-year-old male sustained an ischemic anoxic cerebral injury that was followed by an encephalopathy lasting approximately 30 hours and pulmonary edema lasting more than 48 hours. The patient was treated with continuous positive pressure ventilation followed by spontaneous breathing with continuous positive airway pressure by a mask; shock was reversed. The loss of cardiovascular competency and pulmonary insufficiency are problems frequently encountered in the patient who has sustained an hypoxic insult. Cerebral injury can result from hypoxemia related to tracheal compression, aspiration, and pulmonary edema; cerebral vascular engorgement secondary to venous compression; and ischemic anoxia related to arterial compression. Cerebral changes continue after circulatory and pulmonary competence has been restored. Multiorgan monitoring and control including intracranial pressure monitoring may be required to guide therapy. Respiratory distress syndrome may develop secondary to multiple factors including autonomic reflexes triggered by cerebral hypoxia and edema.
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ranking = 0.14285714285714
keywords = airway
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18/29. Bronchial adenoma resection with relief of hypoxic pulmonary vasoconstriction.

    Experimental airway obstruction is known to cause reflex pulmonary artery constriction, but clinical documentation of reversible bronchial obstruction and vasoconstriction is rare. A soft bronchial adenoma obstructed the left main bronchus, and scans showed minimal ventilation and perfusion on the left. Gas aspirated from beyond the tumor was hypoxic. The adenoma was removed and the lung left intact by means of a skin graft in the bronchial wall. Four months later, pulmonary function was normal, and both ventilation and perfusion of the left lung were normal. reflex pulmonary vasoconstriction resulting from alveolar hypoxia minimizes systemic hypoxemia and also minimizes alveolar tissue hypoxia in the lung itself. The reflex is seen most frequently in perfusion scans in patients with chronic airways disease. This case in important in that it documents reversal of vasoconstriction after ventilation was restored.
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ranking = 1.0012971177754
keywords = airway obstruction, airway, obstruction
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19/29. phrenic nerve injury following scalenectomy in a patient with thoracic outlet obstruction.

    We present a case in which a patient with normal pulmonary reserve experienced orthopnea and hypoxia secondary to unilateral diaphragmatic paralysis following right scalenectomy. This operation was performed in an attempt to relieve neurovascular compromise at the thoracic outlet. To our knowledge, this association has not been previously described in the literature.
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ranking = 0.12050085606392
keywords = obstruction
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20/29. Scintigraphic appearance of albuterol-induced inhibition of hypoxic pulmonary vasoconstriction.

    Alveolar hypoxia is known to result in localized pulmonary arterial vasoconstriction. As a consequence, blood is diverted from poorly ventilated alveoli, maintaining ventilation-perfusion (V/Q) matching and thereby reducing the deleterious effects on gas exchange. An incomplete alveolar hypoxic vasoconstrictive response can be easily demonstrated by radionuclide V/Q lung scanning. A case of albuterol-induced inhibition of hypoxic pulmonary vasoconstriction is described in a patient with steroid-dependent asthma. The utility of V/Q lung scanning as a simple, noninvasive test to detect this phenomenon in patients with primary airway disorders who deteriorate despite appropriate therapy is also briefly discussed.
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ranking = 0.14285714285714
keywords = airway
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