Cases reported "Respiratory Sounds"

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1/63. pulmonary eosinophilia associated with montelukast.

    Antileukotriene drugs are new therapeutic agents that have recently been approved for the treatment of asthma. Several cases of eosinophilic conditions including churg-strauss syndrome have been reported to be associated with zafirlukast, a cysteinyl leukotriene type 1 receptor antagonist. So far no other leukotriene modifier has been associated with the syndrome. The case history is presented of a man with allergic rhinitis and asthma who had received intermittent pulse therapy with oral corticosteroids. pulmonary eosinophilia developed while he was receiving treatment with montelukast, a chemically distinct cysteinyl leukotriene type 1 receptor antagonist. After discontinuation of montelukast therapy and administration of systemic corticosteroids the patient's symptoms reversed rapidly and there was prompt resolution of the pulmonary infiltrates. We believe that cysteinyl leukotriene type 1 receptor antagonists are safe and effective drugs for most patients with asthma but caution is needed for those with more severe disease who require systemic corticosteroids, especially if they show characteristics of the atypical allergic diathesis seen in the prodromal phase of churg-strauss syndrome.
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keywords = asthma
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2/63. Disappearance of wheezing during epidural lidocaine anesthesia in a patient with bronchial asthma.

    BACKGROUND AND OBJECTIVES: Local anesthetics in blood absorbed from the epidural space attenuate bronchial hyperreactivity to chemical stimuli. However, it is not documented whether local anesthetics at clinically relevant concentrations improve active wheezing in patients with bronchial asthma. CASE REPORT: We managed a 60-year-old man with bronchial asthma and active wheezing under continuous epidural anesthesia using plain lidocaine. The wheezing gradually diminished 20 minutes after the epidural injection of 13 mL 2% lidocaine and completely disappeared over 155 minutes during continuous epidural injection of 2% lidocaine (6 mL/h). The plasma concentrations of lidocaine in arterial blood during the epidural anesthesia ranged from 2.5 to 3.9 microg/mL. Wheezing reappeared 55 minutes after termination of the continuous epidural injection of lidocaine. The plasma concentration of lidocaine at this time was 1.9 microg/mL. CONCLUSIONS: At clinically relevant concentrations, lidocaine in the blood absorbed from the epidural space may improve bronchospasm in patients with bronchial asthma.
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ranking = 2.3333333333333
keywords = asthma
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3/63. Wheezing as the sole clinical manifestation of cor triatriatum.

    Cardiac malformations involving low-pressure chambers (i.e., either of the atria) are more often diagnosed later in life than lesions that involve high-pressure systems such as ventricular septal defects or persistent ducti arteriosi. patients with congenital heart disease involving the atria may present only symptoms suggesting lung disease. We report on a child with recurrent episodes of wheezing, which did not respond to albuterol nebulizations and intravenous corticosteroids; he was subsequently found to have cor triatriatum. When a patient suffers from recurrent episodes of lower pulmonary infection and wheezing, despite appropriate management for asthma, less common (including cardiac) causes should be considered.
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keywords = asthma
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4/63. mucus plugging as a cause of acute lobar overdistension.

    Acute lobar overdistension in children is usually indicative of foreign body aspiration, especially when a history of a choking episode is recalled. An unusual presentation of asthma as recurrent overdistension of the left lung in a toddler is described. The child had undergone two consecutive negative bronchoscopies with a presumptive diagnosis of foreign body aspiration; however, it was only the antiasthmatic treatment that resulted in an excellent outcome.
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ranking = 0.66666666666667
keywords = asthma
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5/63. 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 = 0.33333333333333
keywords = asthma
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6/63. An unusual case of congenital short trachea with very long bronchi mimicking bronchial asthma.

    case reports of a short trachea with early branching of the main bronchi are uncommon. The case is presented of a 64 year old woman with upper airway obstruction due to this anatomical abnormality which caused breathlessness and wheezing that was misdiagnosed (and treated) as bronchial asthma for many years.
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ranking = 1.6666666666667
keywords = asthma
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7/63. All that wheezes is not asthma--broncholithiasis, a forgotten disease.

    INTRODUCTION: asthma is a common condition seen by medical practitioners. However, 'all that wheezes is not asthma', is an important adage not to be forgotten. We report a case of broncholithiasis which was initially misdiagnosed as asthma. CLINICAL PICTURE: An 81-year-old female presented with cough and intermittent wheezing associated with one episode of haemoptysis. Chest radiograph and CT thorax were suggestive of broncholithiasis. This was confirmed by flexible bronchoscopy. TREATMENT: The broncholith was successfully extracted using flexible bronchoscopy. OUTCOME: The patient had complete resolution of symptoms post procedure. CONCLUSIONS: physicians should always entertain other differential diagnoses which may mimic asthma.
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ranking = 2.3333333333333
keywords = asthma
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8/63. Pulmonary function tests leading to the diagnosis of vascular ring in an infant.

    A 5-month-old baby was referred to our pulmonary clinic because of chronic cough and wheeze, unresponsive to antiasthmatic treatment. Examination in the infant Pulmonary Function Laboratory suggested an upper airway obstruction. An aberrant right subclavian artery was subsequently confirmed by a barium swallow, flexible bronchoscopy, and an angiographic reconstructed chest CT study. Due to modest symptoms a conservative medical approach was taken. At follow-up 1 year later, the patient had fewer respiratory and gastrointestinal symptoms.
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ranking = 0.33333333333333
keywords = asthma
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9/63. All that wheezes is not asthma.

    asthma is a common disease. Wheezing is not pathognomonic of asthma, however. One must be alert when appropriate asthmatic treatment does not provide adequate control. Other causes of airway obstruction must be considered, especially when stridor is heard. This report describes an elderly patient who had been managed as having asthma but had an endotracheal tumour.
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ranking = 2.3333333333333
keywords = asthma
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10/63. Unresponsive wheezing to asthma therapy in a 32-year-old female.

    Repeat failure of any patient to respond to asthma therapy, particularly corticosteroids, should alert physicians to carry out further pulmonary evaluation. This will prevent unnecessary side effects of asthma therapy and provide prompt treatment for other diseases that may require urgent attention.
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ranking = 2
keywords = asthma
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