The clinical respiratory journal
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Case Reports
Spontaneous cervicothoracolumbar pneumorrhachis, pneumomediastinum and pneumoperitoneum.
Pneumorrhachis, or epidural pneumatosis, is a rare entity that is usually traumatic or iatrogenic. Usually, the epidural emphysema is limited to a few vertebral spaces. Less commonly, it is secondary to mediastinal air that tracks into the epidural space. Mediastinal air is usually associated with subcutaneous emphysema, but rarely is it associated with pneumopericardium or pneumoperitoneum. The cause of pneumomediastinum is usually identifiable on history or radiology. ⋯ Extensive pneumorrhachis and pneumoperitoneum may simultaneously accompany pneumomediastinum and subcutaneous emphysema in the absence of an identifiable cause and still follow a benign clinical course.
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Readiness to speak is a major problem for many tracheostomized patients. Evaluation for tracheostomy tube capping or speaking valve is often subjective. ⋯ Tracheostomy tube manometry is very helpful in objectively guiding recommendations for speaking valve use, capping, and changing tracheostomy tubes. Speech is an early recommendation for most patients.
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The global initiative for COPD (GOLD) adopted the degree of airway obstruction as a measure of the severity of the disease. The objective of this study was to apply CT to assess the extent of emphysema in patients with chronic obstructive pulmonary disease (COPD) and relate this extent to the GOLD stage of airway obstruction. ⋯ The extent of emphysema increases with increasing severity of COPD and most patients with COPD have emphysema. Tissue destruction by emphysema is therefore an important determinant of disease severity in COPD.