Chest
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We conducted a population-based case-control study to determine the magnitude of the excess risk of tuberculosis in those infected with the human immunodeficiency virus (HIV) in Seattle-King County, Washington. Patients were 39 of the 54 cases of tuberculosis in white and in black (including Hispanic) men aged 20 through 49 reported to the Seattle-King County Department of Public Health between January 1986 and June 1988. ⋯ Eleven (28 percent) of the 39 patients with tuberculosis and 2 (6 percent) of the 34 controls tested positive for antibody to HIV (odds ratio adjusted for age and race = 6.2; 95 percent confidence interval 1.2 to 31.9). Calculation of the etiologic fashion indicated that 24 percent of the tuberculosis cases in this population of young black and white men were attributable to concurrent HIV infection.
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Review Case Reports
Relapsing fever associated with ARDS in a parturient woman. A case report and review of the literature.
We report a patient who survived acute respiratory failure associated with tick-borne relapsing fever in the third trimester of pregnancy. The fetus was delivered by cesarian section and did not have spirochetemia. The severity of the patient's illness may be related to the immunosuppressive effects of pregnancy.
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The incidence of mediastinal emphysema (ME) and pneumothorax (PTX) was analyzed to determine the roentgenographic patterns and risk factors for the development of barotrauma in a population of mechanically ventilated patients. The roentgenograms of 139 intubated patients admitted to our medical intensive care unit over a ten-month period were evaluated for the presence of ME and PTX. Barotrauma was diagnosed in 34 of these patients, and ME was the initial manifestation in 24 patients. ⋯ The adult respiratory distress syndrome (ARDS) patient population was at highest risk for barotrauma, with an intermediate risk seen in those admitted with COPD or pneumonia. Values of peak inspiratory pressure, positive end-expiratory pressure level, respiratory rate, tidal volume, and minute ventilation were significantly elevated in patients who developed barotrauma as compared with patients who did not develop barotrauma. However, these elevations in part reflect the high incidence of barotrauma in the ARDS population, a patient group in which all of the above parameters were elevated.
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To examine the relationship among clinical dyspnea ratings, physiologic pulmonary function, and general health status in symptomatic patients with chronic obstructive pulmonary disease (COPD). ⋯ Dyspnea ratings influence and predict general health status to a greater extent than do physiologic measurements in symptomatic patients with COPD. A shift in focus from the pathophysiology of disease to assessment and relief of symptoms may provide more meaningful benefits for the individual patient in terms of quality of life. This consideration requires that health-care providers use available measuring tools in clinical practice to quantify symptoms, as well as overall health status.