Chest
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We report an uncommon and potentially dangerous complication of continuous positive airway pressure (CPAP) applied during spontaneous respiration. A patient with multiple fractures and recurrernt atelectasis developed pneumocephalus on the seventh day of respiratory therapy with CPAP via a face mask. A fracture of the base of the skull, not recognized despite neurologic and radiologic evaluation at admission, was at the origin of this complication.
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A 68-year-old patient developed increasingly frequent episodes of ventricular and supraventricular arrhythmias over the past five years. During the last 12 months, he was admitted to the hospital on several occasions with complex arrhythmias including multifocal PVCs, bigeminy, trigeminy, ventricular tachycardia, and atrial flutter and fibrillation. Large and frequent doses of quinidine, procainamide, disopyramide, propranolol, and digoxin failed to suppress his arrhythmias. ⋯ A new antiarrhythmic drug, lorcainide, was given intravenously and it suppressed all PVCs, including bigeminy and ventricular tachycardia. All his arrhythmias have been completely suppressed by oral regimens of lorcainide, 100 mg four times daily, for the past four months. This is the first case of oral treatment of ventricular arrhythmias with lorcainide in this country.