1/23. Lung volume reduction surgery combined with cardiac interventions.OBJECTIVE: Postoperative course and functional outcome were evaluated in patients who underwent lung volume reduction surgery (LVRS) or in combination with valve replacement (VR), percutaneous transluminal coronary angioplasty (PTCA), placement of a stent, or coronary artery bypass grafting (CABG). methods: patients with severe bronchial obstruction and hyperinflation due to pulmonary emphysema were evaluated for lung volume reduction surgery. Cardiac disorders were screened by history and physical examination and assessed by coronary angiography. Nine patients were accepted for LVRS in combination with an intervention for coronary artery disease (CAD). In addition, three patients with valve disease and severe emphysema were accepted for valve replacement (two aortic-, one mitral valve) only in combination with LVRS. Functional results over the first 6 months were analysed. RESULTS: Pulmonary function testing demonstrates a significant improvement in postoperative FEV1 in patients who underwent LVRS combined with an intervention for CAD. This was reflected in reduction of overinflation (residual volume/total lung capacity (RV/TLC)), and improvement in the 12-min walking distance and dyspnea. Median hospital stay was 15 days (10-33). One patient in the CAD group died due to pulmonary edema on day 2 postoperatively. One of the three patients who underwent valve replacement and LVRS died on day 14 postoperatively following intestinal infarction. Both survivors improved in pulmonary function, dyspnea score and exercise capacity. Complications in all 12 patients included pneumothorax (n = 2), hematothorax (n = 1) and urosepsis (n = 1). CONCLUSION: Functional improvement after LVRS in patients with CAD is equal to patients without CAD. mortality in patients who underwent LVRS after PTCA or CABG was comparable to patients without CAD. LVRS enables valve replacement in selected patients with severe emphysema otherwise inoperable.- - - - - - - - - - ranking = 1keywords = function test (Clic here for more details about this article) |
2/23. Recombinant human growth hormone for reconditioning of respiratory muscle after lung volume reduction surgery.OBJECTIVE: To investigate the effects of recombinant human growth hormone (rHGH) as a "rescue treatment" in an end-stage chronic obstructive pulmonary disease patient after prolonged weaning failure. DESIGN: Descriptive case report. SETTING: Fifteen-bed intensive care unit in a university hospital. PATIENT: A 62-year-old man with end-stage chronic obstructive pulmonary disease and pulmonary emphysema after lung reduction surgery and prolonged weaning failure after long-term mechanical ventilation. INTERVENTIONS: After 42 days of unsuccessful weaning from the respirator, rHGH (27 IU/day, 0.3 IU/kg body weight/day) was administered for 20 days through a subcutaneous injection in addition to standard intensive care. MEASUREMENTS AND MAIN RESULTS: In addition to daily routine laboratory studies, the visceral proteins prealbumin, retinol-binding protein, and transferrin, and nitrogen balance were measured twice a week, as were the thyroid hormones triiodothyronine, thyroxine, and thyroid-stimulating hormone, plasma insulin levels, and the insulin-like growth factor (IGF)-1 binding proteins IGF-BP1 and IGF-BP3. IGF-1 was measured from day 1 to day 4 of rHGH administration. nutritional support was guided by indirect calorimetry. Additionally, weaning variables such as peak expiratory flow rate and expiratory tidal volume were measured noninvasively. T-piece weaning trials were carried out daily until respiratory muscle fatigue occurred. IGF-1 increased in response to rHGH stimulation, from 103 to 230 microg/mL, within 4 days. The carrier protein IGF-BP3 increased from 126 to 283 mg/L at the end of the study period, and the inhibiting IGF-BP1 decreased initially from 19 to 14 mg/L and then increased until the end of the study to 31 mg/L. nitrogen balance increased initially from 4.6 to 13.6 g/24 hrs and thereafter decreased until the end of rHGH treatment to 8.3 g/24 hrs. Resting energy expenditure increased from 1800 to 2300 kcal/24 hrs. peak expiratory flow rate increased from 0.69 to 0.88 L/sec. The expiratory tidal volume showed a slight increase during the study period during the daily decrease of pressure support on the ventilator setting. Respiratory muscular strength increased beginning 10 days after rHGH therapy was started. From this point, T-piece weaning trials could be prolonged almost daily. The patient was extubated successfully on postoperative day 75. CONCLUSIONS: This case report shows that after a prolonged catabolic state and long-term mechanical ventilation, administration of rHGH not only enhances the response of protein metabolism but improves respiratory muscular strength. Therefore, it may reduce the duration of mechanical ventilation in selected patients.- - - - - - - - - - ranking = 0.011147000524625keywords = thyroid (Clic here for more details about this article) |
3/23. Drug-induced rash with eosinophilia and systemic symptoms syndrome with bupropion administration.BACKGROUND: Sustained-release bupropion is commonly used for the symptomatic relief of depressive illness and as an adjuvant in smoking cessation therapy. OBJECTIVE: To report a case of bupropion-induced drug rash with eosinophilia and systemic symptoms syndrome, including acute hepatitis, obstructive lung disease, and myositis. methods: After the patient discontinued use of bupropion, serologic tests, muscle biopsies, pulmonary function tests, a chest x-ray examination, venous Doppler ultrasounds, and an electrocardiogram were performed. RESULTS: On discontinuation of bupropion and prolonged systemic corticosteroid therapy, there was complete resolution of symptoms. CONCLUSIONS: To our knowledge, this is the first reported case of drug rash with eosinophilia and systemic symptoms syndrome induced by bupropion therapy. We report this case to notify clinicians of the potential serious multisystem complications that can occur with sustained-release bupropion therapy.- - - - - - - - - - ranking = 1keywords = function test (Clic here for more details about this article) |
4/23. Obstructive airway disease associated with occupational sodium hydroxide inhalation.sodium hydroxide (NaOH) is well known for its corrosive properties and its ability to generate heat on contact with water. The respiratory effects of industrial exposure to NaOH have, however, never been reported. A 63 year old man worked daily for 20 years cleaning large industrial jam containers by boiling lye (NaOH) solution without using respiratory protective equipment. physical examination, chest x ray film, pulmonary function tests, and arterial blood gases were all compatible with severe obstructive airway disease with significant air trapping. It is probable that this massive and prolonged occupational exposure to the corrosive effect of NaOH mists induced irritation and burns to the respiratory system, eventually leading to severe obstructive airway disease.- - - - - - - - - - ranking = 1keywords = function test (Clic here for more details about this article) |
5/23. hyperthyroidism induced by iodinated glycerol.We report a case of iodide-induced thyrotoxicosis after the use of iodinated glycerol (Organidin) for the symptomatic treatment of chronic obstructive pulmonary disease. In patients with severe chronic obstructive pulmonary disease, symptoms of hyperthyroidism may be overlooked. hyperthyroidism may be induced by any iodinated expectorant, especially in patients with preexisting thyroid disease.- - - - - - - - - - ranking = 0.039014501836187keywords = thyroid (Clic here for more details about this article) |
6/23. Definitions in chronic obstructive pulmonary disease.States of airflow obstruction are common disorders which span the spectrum from asthmatic-chronic bronchitis to emphysema. Asthmatic and chronic bronchitic states are at least potentially reversible by systematic, pharmacologically oriented therapy focusing on bronchodilators and corticosteroids. Both asthmatic bronchitis, particularly when it is not adequately treated, and emphysema result in the final common pathway of COPD. These are generally progressive states, unless smoking cessation can be achieved in early or mild stages of disease. The future focuses on the great challenge of early identification, classification, and intervention. Thus, all patients with cough, dyspnea, and wheeze should be carefully evaluated by health workers who understand the history, physical examination, and simple pulmonary function tests in the context of chest radiology. These clinical methods together can help define the disease states characterized by airflow obstruction. Often, a final definition of disease cannot be made until aggressive attempts at the treatment of the airflow obstruction and its attendant symptoms complex have been vigorously pursued by experienced clinicians.- - - - - - - - - - ranking = 1keywords = function test (Clic here for more details about this article) |
7/23. Laryngeal dysfunction and pulmonary disorder.The normal respiratory function of the larynx has been described in detailed reports in both the otolaryngology and the respiratory physiology literature. The role of the posterior cricoarytenoid muscle in vocal cord abduction has been shown to be paramount in laryngeal respiratory function. However, only in recent reports has attention been directed toward disordered laryngeal function as evidenced in pulmonary disorders, such as asthma, or in association with underlying pulmonary disorders, such as asthma (ROAD) or emphysema (COPD). In this article, cases will be presented to demonstrate the role of disordered laryngeal function appearing as pulmonary disease and associated with various degrees of underlying pulmonary disease. The effect on pulmonary function tests and the role of treatment will be discussed.- - - - - - - - - - ranking = 1keywords = function test (Clic here for more details about this article) |
8/23. Pulmonary function testing in children with cardiac disease.These cases illustrate the clinical importance of pulmonary function testing in children. The first case demonstrated a significant restrictive defect in a child with pulmonic stenosis and scoliosis. Although this child had no respiratory symptoms, it was important to document the degree of functional impairment to plan for her postoperative course. The second case demonstrated the way in which pulmonary function tests can lead to a specific diagnosis and provide important information about response to therapy. This patient had distressing symptoms which limited her ability to participate in sports. Her chest x-ray revealed no significant abnormality and she had no auscultatory finding. Pulmonary function tests defined both the nature and severity of her problems and provided objective information about her response to therapy. In the third case, one might have anticipated decreases in flow rates and lung volumes because of neuromuscular weakness. That was not evident on testing and the patient had an uneventful postoperative recovery. Pulmonary function testing provides invaluable information about the nature and severity of functional impairment in children with known or suspected pulmonary disease. New equipment and individuals specifically trained to work with children now permit the evaluation of even young children. Pulmonary function testing can expand our knowledge of disease processes and improve our therapeutic strategies.- - - - - - - - - - ranking = 9keywords = function test (Clic here for more details about this article) |
9/23. high-frequency jet ventilation: applications for endoscopy and surgery of the airway.Twenty-four patients underwent endoscopic procedures under general anesthesia and mechanical ventilation by high-frequency jet ventilation, provided by a catheter inserted through the cricothyroid membrane and connected to an IDC-VS600 ventilator. The arterial blood gas values, arterial blood pressures, and heart rates observed were within acceptable clinical levels. In some patients, blockage of the airway by the surgeon required shutting off the ventilator to prevent a pneumothorax. With the rapid rate jet ventilation, we found that laryngeal bleeding after biopsy passed outward from the larynx into the hypopharynx. It was necessary for the surgeon to wear protective eye and face shielding when performing endoscopies to avoid getting blood and secretions on his face. The unobstructed surgical field is an advantage of the jet ventilation, which can be continued in the postoperative period until the patient is fully recovered.- - - - - - - - - - ranking = 0.0055735002623124keywords = thyroid (Clic here for more details about this article) |
10/23. mitomycin C and vindesine associated pulmonary toxicity with variable clinical expression.A patient receiving mitomycin and vindesine chemotherapy for lung cancer developed abrupt onset of shortness of breath following vindesine administration. Pulmonary function tests both before and after rechallenging him with vindesine showed an acute obstructive pattern, which resolved with bronchodilator therapy; persisting lung damage was evident by arterial blood gas analysis. A record review of the 126 patients placed on the same chemotherapy regimen uncovered an additional 6 patients with possible lung toxicity. These seven patients (5.5%) had a variable clinical picture, from acute, reversible shortness of breath temporally related to vindesine administration to a progressive, fatal interstitial infiltrate. physicians administering the combination of mitomycin and a vinca alkaloid should be aware of potential lung toxicity with variable clinical expression and be prepared to take appropriate action should they encounter it.- - - - - - - - - - ranking = 1keywords = function test (Clic here for more details about this article) |
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