Respiration; international review of thoracic diseases
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Bronchial artery (BA) embolization (BAE) is recommended as a minimally invasive therapy for hemoptysis, though some patients recover after only conservative treatment. ⋯ Evaluation of BAs on MDCT could be useful for identifying the anatomical characteristics of bleeding-related BAs and determining whether BAE is indicated or whether conservative treatment is sufficient.
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Mechanical ventilation with a high tidal volume (VT) increases lung and systemic plasminogen activator inhibitor (PAI)-1 levels and alveolar fibrin deposition. Activated protein C (APC) may decrease PAI activity in endothelial cell-conditioned medium and thus enhance fibrinolysis. ⋯ These results suggest that APC administered at a higher dosage might improve lung function by reducing alveolar protein leakage and systemic coagulation.
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Chronic obstructive pulmonary disease (COPD) is one of the leading causes of death in the US. Numerous studies have demonstrated that sleep disturbances are common in COPD patients, with more prominent complaints in patients with more severe disease and with increasing age. Sleep disturbances may occur due to the effects of breathing abnormalities on sleep and sleep disruption. ⋯ Treatment includes use of nocturnal oxygen therapy, noninvasive positive pressure ventilation, and long-acting medications. There has been little study on improving sleep quality beyond treating the respiratory disease, despite the fact that numerous studies show poor sleep quality, a high prevalence of insomnia, and tolerability of newer hypnotic agents in the setting of COPD. This article defines the scope of sleep problems in the setting of COPD, reviews the impact of sleep on ventilation, explores the role of obstructive sleep apnea in the setting of COPD, and reviews therapeutic options.
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Since its introduction over 9 years ago, capsule video endoscopy has become increasingly popular within the gastroenterology community, leading to its use in a growing number of patients including the elderly. With the widespread adoption of this diagnostic modality within the elderly population comes the added risk of capsule aspiration. ⋯ In the article, we discuss the novel use of a Roth Net expandable foreign body extractor to remove the capsule using a flexible bronchoscope with minimal need for sedation. As video capsule endoscopy is used more routinely in elderly patients and clinical pulmonologists will be more frequently called up to assist in foreign body removal, our experience highlights that it is possible to remove these large capsules with a flexible bronchoscope and avoid the need for rigid bronchoscopy in this high-risk patient group.