Chest
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A 49-year-old man presented with a two-day history of severe recurrent dyspnea and inspiratory stridor. A chest roentgenogram, computed tomographic scan of the neck, direct laryngoscopy, and bronchoscopy excluded organic upper airway obstruction. Laryngospasm occurred during the bronchoscopy. ⋯ The marked discrepancy between severe flow limitation (as detected by flow volume loops) and normal airway resistance (measured plethysmographically) may be a diagnostic test for functional laryngeal obstruction, and panting may be an effective emergency measure for its relief. Relief by panting may also suggest the diagnosis. A second patient with an almost identical symptom complex is described, in whom the panting maneuver was also dramatically successful in promptly aborting recurrent severe attacks of airway obstruction and stridor.
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To assess the effects of acute cardioselective beta blockade on ventilatory function in patients with COPD and active cardiac disorders, 50 patients were studied during intravenous infusion of esmolol. All patients had an obstructive ventilatory component on baseline pulmonary function testing, and 58 percent had a significant bronchodilator response to inhaled albuterol. ⋯ No patient experienced dyspnea or wheezing with acute esmolol infusion; however, three patients (6 percent) developed asymptomatic decreases of FEV1. It is concluded that acute beta blockade with esmolol can be achieved in patients with COPD and cardiac disorders with little risk of bronchospasm.
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To describe a sepsis-like syndrome associated with chronic salicylate intoxication. ⋯ Occult salicylate intoxication should be considered when apparent sepsis syndrome occurs without a readily easily identifiable source of infection.
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We report the cases of four patients seen with ventricular septal defects (VSDs) resulting from penetrating chest trauma; initial surgical management was via left thoracotomy and comprised relief of tamponade and suture of the surface cardiac wound. A VSD was suspected in all four patients postoperatively on the basis of a holosystolic murmur as confirmed with two-dimensional echo and angiography. ⋯ Three defects were closed directly and one was closed with a pericardial patch. The surgical correction of posttraumatic VSD from a penetrating injury can be safely and effectively achieved via a right atrial approach.