Respiration; international review of thoracic diseases
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Case Reports
An unusual case of bronchiolitis obliterans organizing pneumonia concomitant with bronchioloalveolar carcinoma.
Although bronchiolitis obliterans organizing pneumonia (BOOP) has been associated with a variety of underlying disorders, the majority of cases of BOOP are idiopathic. We present the case of a 61-year-old patient with fever, dry cough, bilateral patchy consolidation and high erythrocyte sedimentation rate. Open lung biopsy shows coexistence of BOOP and bronchioloalveolar carcinoma. It is interesting that both diseases are predominantly air space diseases and present similar radiologic features making the diagnosis and follow-up of treatment more difficult.
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Letter Case Reports
Chin stimulation: a trigger point for provoking acute hiccups.
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The extubation or discontinuation of mechanical ventilatory support (MVS) is only the final step in the weaning process, and an improvement in the efficiency of the weaning process is required for more successful extubation or discontinuation of MVS. ⋯ Measuring the OCOB was clinically beneficial in avoiding the induction of an excessive movement load on the respiratory muscles. In patients treated with MVS, continuous monitoring of VO2 is a useful to predict success or failure of trials attempting to reduce MVS.
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The diagnosis of pulmonary embolism (PE) presents a considerable challenge and requires a high index of clinical suspicion from the attending physician. In addition, diagnosing PE may require the use of one or more direct and indirect diagnostic methods. Here, transthoracic sonography (TS) provides an alternative and attractive bedside approach which is based on (1) detecting alterations in the lung parenchyma, (2) involvement of the pleura and (3) peripheral perfusion characteristics associated with thromboembolism. ⋯ Since localisation of PE-associated lesions may occasionally escape sonographic detection, an inconspicuous sonographic result does not fully exclude PE. As detection of PE-associated lesions using chest ultrasonography has a high specificity and sensitivity, can be rapidly performed, is widely available, non-invasive, cost-effective, and avoids transport of critically ill patients to the investigation site, the technique may prove a valuable tool in the diagnosis of PE at bedside facilitating immediate treatment decision. Further, because the method focuses on detection of peripheral lesions it complements other diagnostic techniques employed when PE is suspected.
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A 61-year-old Caucasian female presented with a 6-week history of dry persistent cough. She had no shortness of breath, chest pain, fever, chills, or weight loss. She had been diagnosed with melanoma on the left thigh 6 months earlier. ⋯ Treatment of her melanoma was limited to surgical excision with no subsequent radiation or chemotherapy. Other significant past medical history included hypertension, hypothyroidism, and bilateral breast augmentation. She had a 40 pack-year history of smoking.