1/3. Effect of azithromycin on bronchiectasis and pulmonary function in a heart-lung transplant patient with severe chronic allograft dysfunction: a case report.azithromycin has been shown to be beneficial in several diseases with chronic neutrophilic inflammation of the airways, such as cystic fibrosis and bronchiolitis obliterans syndrome (BOS) after lung transplantation. Up to now, however, its healing effect on bronchiectasis has never been demonstrated. We report a heart-lung transplant patient who developed chronic rejection (BOS stage 3) with the appearance of gross bronchiectasis on a spiral computed tomography (CT) chest scan. Within 2 weeks after starting azithromycin, the patient's forced expiratory volume in 1 second increased significantly and a repeat spiral CT chest scan 5 months later, showed a major improvement of the bronchiectasis. This case report illustrates that bronchiectasis may greatly improve after treatment with azithromycin and no longer needs to be considered an endstage finding in patients with severe BOS.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
2/3. Gas exchange detection of right-to-left shunt in dyspneic patients: report of three cases.We evaluated three patients with undiagnosed complaints of progressive dyspnea. Based on gas-exchange findings as the initial diagnostic tool, the high ventilatory equivalents for CO2, low sustained end-tidal PCO2, hypoxemia, and central cardiovascular dysfunction during cardiopulmonary exercise testing (CPET) suggested that each had significant pulmonary vasculopathy with right-to-left shunting. The diagnoses of Osler-Rendu-Weber syndrome, ventricular septal defect with Eisenmenger's complex, and hepatopulmonary syndrome were later confirmed by pulmonary angiography, cardiac catheterization, and contrast enhanced echocardiography respectively. We suggest that CPET is an appropriate noninvasive tool to begin and guide the evaluation of undiagnosed dyspnea.- - - - - - - - - - ranking = 0.25keywords = dysfunction (Clic here for more details about this article) |
3/3. Congenital intracardiac shunting in the adult: outline for nursing care.Adults with an untreated intracardiac shunt present a unique challenge to the critical care nurse. The disease process necessitates an understanding of cardiac anatomy and physiology in order to determine the etiology of the cardiac defect and resulting shunt. An understanding of fluid and pressure dynamics is also of importance since anatomic shunting alters usual adult hemodynamics. Arterial and mixed venous oximetry monitoring is most helpful in determining the response to therapies. One must rethink some of the hemodynamic goals that are traditionally used in caring for adults with primary left ventricular dysfunction. Therapeutic response is usually limited to a narrow hemodynamic range. Many of these patients have superimposed health problems such as atherosclerosis, hypertension, and cigarette smoking. Therefore, the critical care nurse is confronted with caring for a patient with unique problems that test creativity and assessment skills.- - - - - - - - - - ranking = 0.25keywords = dysfunction (Clic here for more details about this article) |